National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (6)
- Adverse Drug Events (ADE) (2)
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- Children/Adolescents (1)
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- Opioids (9)
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- (-) Policy (25)
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- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Social Determinants of Health (1)
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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 25 of 25 Research Studies DisplayedHughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
Ali MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
AHRQ-authored.
Citation: Ali MM, McClellan C, Mutter R .
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Blanco C, Kato EU, Aklin WM
AHRQ Author: Kato EU, Tong ST, Bierman A, Meyers D
Research to move policy - using evidence to advance health equity for substance use disorders.
This paper discusses ways that evidence-based research can advance health equity for substance use disorder (SUD) treatment. Racial and ethnic disparities in treatment access and outcomes have widened, despite substantial efforts to address the epidemic of overdose-related deaths in the US. Overdose rates are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in White populations. Possible opportunities to address these disparities include addressing social determinants of health, implementing prevention measures, and supporting data science. The steps to ensure that research reduces disparities are to: 1) include members of underrepresented groups in the development of preventive interventions and treatments, 2) adequately recruit members of historically represented groups and ensure that studies are large enough to measure differences in outcomes according to race and ethnic group, 3) establish equitable partnerships with people who currently have or have had SUDS and their families and engage these groups in evidence production, 4) diversify the scientific workforce, and 4) have investigators measure the effects of policies and interventions on equity.
AHRQ-authored.
Citation: Blanco C, Kato EU, Aklin WM .
Research to move policy - using evidence to advance health equity for substance use disorders.
N Engl J Med 2022 Jun 16;386(24):2253-55. doi: 10.1056/NEJMp2202740..
Keywords: Substance Abuse, Behavioral Health, Policy, Racial and Ethnic Minorities, Disparities, Social Determinants of Health
Ali MM, McClellan C, West KD
AHRQ Author: McClellan C
Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States.
This study examined whether state medical marijuana laws (MMLs) was associated with lower levels of opioid-related outcomes. Data was drawn from the 2002-2014 National Survey on Drug Use and Health to compare opioid misuse in states with and without MMLs among all women, pregnant women, and parenting women. It also invested the impact of MMLs on marijuana use and marijuana use disorder. There was found to be no association of MMLs with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women and parenting women. However there was a positive correlation with marijuana use and marijuana use disorder among all women and women with children. MMLs were also associated with an increase in the frequency of opioid misuse in pregnant women and a decrease in the frequency of opioid misuse for parenting women.
AHRQ-authored.
Citation: Ali MM, McClellan C, West KD .
Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States.
Womens Health Issues 2021 Jan-Feb;31(1):24-30. doi: 10.1016/j.whi.2020.09.003..
Keywords: Women, Opioids, Substance Abuse, Medication, Policy, Practice Patterns
Green TC, Davis C, Xuan Z
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Researchers sought to examine early impacts of laws that require naloxone to be prescribed to patients at increased overdose risk. Data from CVS Pharmacy 90 days before and after the naloxone-prescribing mandates took effect in Arizona, Florida, Rhode Island, Vermont, and Virginia were examined. The researchers concluded that mandating the prescribing of naloxone quickly expands access to this life-saving medication for more people in more places. They recommended that other states consider mandating the co-prescription of naloxone to individuals at increased risk of overdose.
AHRQ-funded; HS024021.
Citation: Green TC, Davis C, Xuan Z .
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Am J Public Health 2020 Jun;110(6):881-87. doi: 10.2105/ajph.2020.305620..
Keywords: Policy, Medication, Substance Abuse, Opioids
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Heins SE, Frey KP, Alexander GC
Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017.
This paper looked at current state-level policies in the United States from January 2007-May 2017 limiting high morphine equivalent daily dose (MEDD) prescribing. State-level threshold policies were reviewed using LexisNexis and Westlaw Next for legislative acts and Google for nonlegislative state-level policies. State websites were also reviewed to identify additional policies. Policies were then independently double-coded on the categories: state, agency/organization, policy type, effective date, threshold level, and policy exceptions. Currently 22 states have at least 1 MEDD policy, most commonly guidelines (14 states). Other states have prior authorizations (4 states), rules/regulations (4 states), legislative acts (3 states), claim denials (2 states), and alert systems/automatic patient reports (2 states). Thresholds vary widely (30-300 mg MEDD), with higher thresholds corresponding to more restrictive policies (claim denial), and lower thresholds corresponding to less restrictive policies (guidelines). The majority of policies exclude patients with terminal illnesses or acute pain.
AHRQ-funded; HS025557.
Citation: Heins SE, Frey KP, Alexander GC .
Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017.
Pain Med 2020 Feb;21(2):308-16. doi: 10.1093/pm/pnz038..
Keywords: Opioids, Medication, Policy, Practice Patterns, Substance Abuse
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M,, Bailey SR .
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Wisk LE, Levy S, Weitzman ER
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Given a rapidly changing policy landscape, the investigators sought to characterize the effects of state marijuana laws on parents' views of marijuana use by their teenage children. The investigators found that among parents of medically vulnerable children, perceiving state marijuana policies as more permissive was strongly associated with lower perceived riskiness of marijuana use for their children.
AHRQ-funded; HS022986.
Citation: Wisk LE, Levy S, Weitzman ER .
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Drug Alcohol Depend 2019 Jun 1;199:59-67. doi: 10.1016/j.drugalcdep.2018.12.027..
Keywords: Children/Adolescents, Policy, Vulnerable Populations, Chronic Conditions, Substance Abuse
Delling FN, Vittinghoff E, Dewland TA
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
Researchers studied whether the legalization of cannabis in Colorado has affected healthcare utilization compared to two states where it is still illegal (New York and Oklahoma). ICD-9 was used to determine changes in healthcare utilization relative to various medical diagnoses. According to the National Academy of Science (NAS), legal cannabis use creates an increase in cannabis abuse hospitalizations and also linked to motor vehicle accidents, alcohol abuse, and overdose injury and that was true in CO. There was not a change in hospital stays and costs in CO compared to NY and OK.
AHRQ-funded.
Citation: Delling FN, Vittinghoff E, Dewland TA .
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
BMJ Open 2019 May 15;9(5):e027432. doi: 10.1136/bmjopen-2018-027432..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Policy, Substance Abuse
Peterson E, Busch S
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
This article reviews the history and measures benefits from the 2008 passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). It led to significant improvements in mental health care coverage. Directions for future research are also discussed.
AHRQ-funded; HS017589.
Citation: Peterson E, Busch S .
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
Annu Rev Public Health 2018 Apr 1;39:421-35. doi: 10.1146/annurev-publhealth-040617-013603..
Keywords: Access to Care, Behavioral Health, Disparities, Health Insurance, Policy, Substance Abuse
Davis CS, Green TC, Hernandez-Delgado H
Status of US state laws mandating timely reporting of nonfatal overdose.
Timely, actionable, nonfatal overdose data are urgently needed to improve public health response to the overdose crisis. The purpose of this paper was to provide background and catalyze discussion regarding this important issue. The authors briefly report the results of a systematic analysis of state laws mandating reporting of nonfatal overdose, and provide suggestions for improving the collection and use of nonfatal overdose data to improve the public health response to this ongoing epidemic.
AHRQ-funded; HS024021.
Citation: Davis CS, Green TC, Hernandez-Delgado H .
Status of US state laws mandating timely reporting of nonfatal overdose.
Am J Public Health 2018 Sep;108(9):1159-61. doi: 10.2105/ajph.2018.304589..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Opioids, Policy, Public Health, Substance Abuse
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Friedman SA, Azocar F, Xu H
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
The purpose of the stud was to assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.
AHRQ-funded; HS024866.
Citation: Friedman SA, Azocar F, Xu H .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
Drug Alcohol Depend 2018 Sep 1;190:151-58. doi: 10.1016/j.drugalcdep.2018.06.008..
Keywords: Behavioral Health, Health Insurance, Policy, Substance Abuse
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Tran Smith B, Seaton K, Andrews C
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
This study assessed the extent to which state insurance departments regulate the types of substance use disorder (SUD) treatment that services and medications plans must provide, and also their use of utilization controls. Data were obtained from state insurance departments via an internet-based survey, as part of the National Drug Abuse Treatment System Survey. The results indicate that states vary widely in regulations on qualified health plans’ (QHPs) administration of SUD treatment benefits; some required plans to cover all the SUD treatment services and medications assessed in this study, while others did not require plans to cover any at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance on their usage. The authors conclude that by not requiring coverage for the entire SUD continuum of care, some states hinder client access to the appropriate types of care needed for recovery.
AHRQ-funded; HS000084.
Citation: Tran Smith B, Seaton K, Andrews C .
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
Am J Drug Alcohol Abuse 2018;44(4):426-30. doi: 10.1080/00952990.2017.111934..
Keywords: Access to Care, Health Insurance, Medication, Policy, Substance Abuse
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Kennedy-Hendricks A, Barry CL, Gollust SE
Social stigma toward persons with prescription opioid use disorder: associations with public support for punitive and public health-oriented policies.
This study examined social stigma toward individuals with prescription opioid use disorder and tested whether stigma was associated with support for various policy interventions. Respondents expressed high levels of stigma toward individuals with prescription opioid use disorder. Higher levels of stigma were associated with greater support for punitive policies and lower support for public health-oriented policies.
AHRQ-funded; HS000029.
Citation: Kennedy-Hendricks A, Barry CL, Gollust SE .
Social stigma toward persons with prescription opioid use disorder: associations with public support for punitive and public health-oriented policies.
Psychiatr Serv 2017 May;68(5):462-69. doi: 10.1176/appi.ps.201600056.
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Keywords: Medication, Opioids, Policy, Social Stigma, Substance Abuse
Kim HS, Monte AA
Colorado cannabis legalization and its effect on emergency care.
The authors noted that increased marijuana use after legalization has been accompanied by increases in emergency department visits and hospitalizations due to marijuana intoxication. They recommended that providers in states with impending legalization measures should become familiar with the symptoms and management of acute marijuana intoxication, as well as understand the effects on chronic diseases frequently observed in the emergency department. Further, they suggested that residency program directors should make an effort to integrate this topic into their residency curricula.
AHRQ-funded; HS000078.
Citation: Kim HS, Monte AA .
Colorado cannabis legalization and its effect on emergency care.
Ann Emerg Med 2016 Jul;68(1):71-5. doi: 10.1016/j.annemergmed.2016.01.004.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitalization, Policy, Substance Abuse
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Montz E, Layton T, Busch AB
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
The authors examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. They documented how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders.
AHRQ-funded; HS000055.
Citation: Montz E, Layton T, Busch AB .
Risk-adjustment simulation: plans may have incentives to distort mental health and substance use coverage.
Health Aff 2016 Jun;35(6):1022-8. doi: 10.1377/hlthaff.2015.1668.
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Keywords: Health Insurance, Policy, Behavioral Health, Substance Abuse
Williams AR, Olfson M, Kim JH
Older, less regulated medical marijuana programs have much greater enrollment rates than newer 'Medicalized' programs.
The researchers analyzed marijuana programs according to seven components of traditional medical care and pharmaceutical regulation. They then examined enrollment rates, while controlling for potentially confounding state characteristics. They found that fourteen of the twenty-four programs were nonmedical and collectively enrolled 99.4 percent of participants nationwide, with enrollment rates twenty times greater than programs deemed to be "medicalized."
AHRQ-funded; HS021112.
Citation: Williams AR, Olfson M, Kim JH .
Older, less regulated medical marijuana programs have much greater enrollment rates than newer 'Medicalized' programs.
Health Aff 2016 Mar;35(3):480-8. doi: 10.1377/hlthaff.2015.0528.
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Keywords: Policy, Medication, Substance Abuse
Bachhuber MA, McGinty EE, Kennedy-Hendricks A
Messaging to increase public support for naloxone distribution policies in the United States: results from a randomized survey experiment.
The investigators conducted a web-based survey (GfK Knowledge Panel) about barriers to public support for naloxone distribution. They concluded that public support for naloxone distribution can be improved through education and sympathetic portrayals of the population who stands to benefit from these policies.
AHRQ-funded; HS000029.
Citation: Bachhuber MA, McGinty EE, Kennedy-Hendricks A .
Messaging to increase public support for naloxone distribution policies in the United States: results from a randomized survey experiment.
PLoS One 2015 Jul;10(7):e0130050. doi: 10.1371/journal.pone.0130050.
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Keywords: Medication, Opioids, Policy, Substance Abuse
Kim HS, Anderson JD, Saghafi O
Cyclic vomiting presentations following marijuana liberalization in Colorado.
This paper's primary objective was to determine the prevalence of patients presenting with cyclic vomiting before and after the liberalization of medical marijuana in Colorado in 2009. Its secondary objective was to describe the odds of marijuana use among cyclic vomiting visits in these same time periods. The researchers found that the prevalence of cyclic vomiting presentations nearly doubled after the liberalization of medical marijuana, with said patients more likely to endorse marijuana use.
AHRQ-funded; HS000078.
Citation: Kim HS, Anderson JD, Saghafi O .
Cyclic vomiting presentations following marijuana liberalization in Colorado.
Acad Emerg Med 2015 Jun;22(6):694-9. doi: 10.1111/acem.12655.
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Keywords: Adverse Drug Events (ADE), Complementary and Alternative Medicine, Emergency Medical Services (EMS), Policy, Substance Abuse
Holdsworth La E, Zhu R, Hassmiller Lich K
The effects of state psychiatric hospital waitlist policies on length of stay and time to readmission.
This study examined the effects of a waitlist policy for state psychiatric hospitals on length of stay and time to readmission. The authors found that waitlists were associated with increased length of stay and time to readmission.
AHRQ-funded; HS000032.
Citation: Holdsworth La E, Zhu R, Hassmiller Lich K .
The effects of state psychiatric hospital waitlist policies on length of stay and time to readmission.
Adm Policy Ment Health 2015 May;42(3):332-42. doi: 10.1007/s10488-014-0573-1.
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Keywords: Hospitals, Behavioral Health, Policy, Substance Abuse, Hospital Readmissions