National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Community-Based Practice (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (2)
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- Health Information Technology (HIT) (1)
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- Practice Improvement (1)
- (-) Primary Care (11)
- Provider: Nurse (1)
- Quality Improvement (3)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Risk (1)
- Rural/Inner-City Residents (1)
- Rural Health (4)
- Screening (2)
- Social Determinants of Health (4)
- Teams (1)
- Telehealth (1)
- (-) Urban Health (11)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedHatch BA, Kenzie E, Ramalingam N
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
The purpose of this cross-sectional study was to determine how vaccine mandates affect the healthcare workforce. Between October 28, 2021- November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel, the researchers conducted a survey of Oregon primary care clinic staff. The survey included 19 questions that assessed the clinic-level effects of the vaccination mandate. Study outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. The study found that clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) used medical and/or religious vaccination waivers (71% vs 33%) and reported significant impact on clinic staffing (45% vs 21%). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%). Qualitative analysis revealed a decrease in clinic morale and mixed opinions of the vaccination mandate.
AHRQ-funded; HS027080.
Citation: Hatch BA, Kenzie E, Ramalingam N .
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
PLoS One 2023 Jun 27; 18(6):e0287553. doi: 10.1371/journal.pone.0287553..
Keywords: COVID-19, Vaccination, Primary Care, Policy, Rural Health, Urban Health, Rural/Inner-City Residents
Barton AJ, Amura CR, Willems EL
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
The aim of this study was to describe the patient and provider encounter in the unexpected telehealth application that took place with the onset of the COVID-19 pandemic. Patients and providers from 3 nurse-led models of care (federally qualified health centers, nurse midwifery practices, and the Nurse-Family partnership program) in Colorado were surveyed. Data from the Patient Attitude toward Telehealth survey and Provider Perceptions about Telehealth were collected. Patients who resided in urban areas utilized telehealth with greater frequency than in rural or frontier areas. Across each of the 5 domains assessed, rural/frontier patients had significantly lower attitude scores than urban patients. The mode of Telehealth employed differed across location, with video calls utilized more frequently by urban providers, and phone calls utilized by rural/frontier providers.
AHRQ-funded; HS028085.
Citation: Barton AJ, Amura CR, Willems EL .
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
J Patient Exp 2023 Jan 25; 10:23743735231151546. doi: 10.1177/23743735231151546..
Keywords: COVID-19, Telehealth, Primary Care, Patient Experience, Rural Health, Urban Health, Vulnerable Populations, Provider: Nurse
Fraze TK, Lewis VA, Wood A
Configuration and delivery of primary care in rural and urban settings.
This study examined configuration and delivery of rural primary care of Medicare beneficiaries compared to more urban settings. The study included over 27 million participants with qualifying visits who were assigned to practices. The authors characterized practices’ structures, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Rural practices were smaller, more primary care dominant and system owned with more beneficiaries per practice. Rural area beneficiaries were more likely to be from high-poverty areas and disabled. There was less engagement in quality-focused payment programs than in metropolitan practices. There was less preventive care, such as fewer beneficiaries with diabetes receiving an eye exam, fewer mammograms, and higher overall and condition-specific readmissions. While most isolated beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Wood A .
Configuration and delivery of primary care in rural and urban settings.
J Gen Intern Med 2022 Sep;37(12):3045-53. doi: 10.1007/s11606-022-07472-x..
Keywords: Primary Care, Healthcare Delivery, Rural Health, Urban Health, Medicare
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Fiori KP, Heller CG, Rehm CD
Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019.
This study used results from a 10-item social needs screener conducted across 19 primary care practices in Bronx County, New York to determine reasons for no-show appointments between April 2018 and July 2019. They examined the association between unmet needs and a 2-year history of missed appointments from 41,637 patients. Overall, the no-show appointment rate was 26.6%. Patients with 1 or more unmet social needs had a significantly higher no-show proportion (31.5%) than those without (26.3%). The strongest association with no-shows was with transportation problems.
AHRQ-funded; HS026396.
Citation: Fiori KP, Heller CG, Rehm CD .
Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019.
Am J Public Health 2020 Jul;110(S2):S242-s50. doi: 10.2105/ajph.2020.305717..
Keywords: Urban Health, Primary Care, Access to Care, Social Determinants of Health
Heller CG, Parsons AS, Chambers EC
Social risks among primary care patients in a large urban health system.
The objective of this study was to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. Participants across nineteen ambulatory sites in the Bronx, New York, completed a 10-item screener. Findings showed that there were important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.
AHRQ-funded; HS026396.
Citation: Heller CG, Parsons AS, Chambers EC .
Social risks among primary care patients in a large urban health system.
Am J Prev Med 2020 Apr;58(4):514-25. doi: 10.1016/j.amepre.2019.11.011..
Keywords: Social Determinants of Health, Primary Care, Urban Health, Risk, Vulnerable Populations
Kirby JB, Yabroff KR
AHRQ Author: Kirby JB
Rural-urban differences in access to primary care: beyond the usual source of care provider.
This study used 2014-2016 MEPS data to analyze differences between rural and urban areas to primary care access beyond the usual source of care provider. While rural residents were more likely to have a usual source of care, they were less likely to have a provider with office hours on nights and weekends.
AHRQ-authored.
Citation: Kirby JB, Yabroff KR .
Rural-urban differences in access to primary care: beyond the usual source of care provider.
Am J Prev Med 2020 Jan;58(1):89-96. doi: 10.1016/j.amepre.2019.08.026..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Primary Care, Rural Health, Urban Health, Health Services Research (HSR)
Tieu L, Hobbs A, Sarkar U
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
This study compared the acceptability of low-literacy tablet-based and traditional paper-based patient experience surveys in English and Spanish. The Consumer Assessment of Healthcare Providers & Systems Clinician & Group Survey (CG-CAHPS) was adapted for a pilot survey using low-literacy questions in Spanish and English. The majority of interview participants preferred the tablet version over the traditional paper-based survey. This was especially true for the younger and Latino respondents.
AHRQ-funded; HS022408.
Citation: Tieu L, Hobbs A, Sarkar U .
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S140-s48. doi: 10.1097/mlr.0000000000001030..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Health Literacy, Patient Experience, Primary Care, Quality of Care, Quality Improvement, Racial and Ethnic Minorities, Urban Health
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AHRQ-funded; HS026396.
Citation: Fiori K, Patel M, Sanderson D .
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
Shelley D, Blechter B, Siman N
Quality of cardiovascular disease care in small urban practices.
This study described small, independent primary care practices' performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling). It concluded that achieving targets for ABCS measures varied considerably across practices; however, small practices were meeting or exceeding Million Hearts goals (i.e., 70 percent or greater).
AHRQ-funded; HS023922.
Citation: Shelley D, Blechter B, Siman N .
Quality of cardiovascular disease care in small urban practices.
Ann Fam Med 2018 Apr;16(Suppl 1):S21-s28. doi: 10.1370/afm.2174.
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Keywords: Cardiovascular Conditions, Quality of Care, Primary Care, Quality Improvement, Urban Health
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams