National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
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Topics
- Access to Care (1)
- Ambulatory Care and Surgery (2)
- Cancer (2)
- Cancer: Colorectal Cancer (2)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Clinician-Patient Communication (1)
- Community-Based Practice (1)
- COVID-19 (1)
- Cultural Competence (1)
- Diabetes (1)
- Disparities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (2)
- Healthcare Delivery (3)
- Healthcare Utilization (1)
- Health Information Exchange (HIE) (1)
- Health Insurance (1)
- Health Literacy (1)
- Implementation (1)
- Low-Income (1)
- Medicaid (1)
- Organizational Change (1)
- Patient-Centered Healthcare (6)
- Patient-Centered Outcomes Research (1)
- Patient Experience (3)
- Practice Improvement (1)
- Prevention (1)
- (-) Primary Care (14)
- Primary Care: Models of Care (2)
- Provider: Nurse (1)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
- Risk (1)
- Rural Health (1)
- Screening (2)
- Social Determinants of Health (2)
- Teams (1)
- Telehealth (1)
- Uninsured (2)
- Urban Health (3)
- (-) Vulnerable Populations (14)
- Workflow (1)
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 14 of 14 Research Studies DisplayedBarton 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
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation: Mojica CM, Gunn R, Pham R .
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Lewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
AHRQ-funded; HS024075.
Citation: Lewis VA, Spivack S, Murray GF .
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords: Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Chambers EC, McAuliff KE, Heller CG
Toward understanding social needs among primary care patients with uncontrolled diabetes.
This study examined the relationship between unmet social needs and diabetes among a predominantly Black and Hispanic patient population in a large urban hospital system in Bronx, New York. A total of 5846 patients with diabetes seen at a primary care visit between April 2018 and December 2019 were included and completed a social needs screener. Twenty-two percent of the patient sample had at least 1 unmet social need, with the most prevalent unmet needs being housing issues, food insecurity, and lack of healthcare transportation. Patients with more unmet needs had a greater likelihood of uncontrolled diabetes, with lack of healthcare transportation and food insecurity having the greatest likelihood.
AHRQ-funded; HS026396.
Citation: Chambers EC, McAuliff KE, Heller CG .
Toward understanding social needs among primary care patients with uncontrolled diabetes.
J Prim Care Community Health 2021 Jan-Dec;12:2150132720985044. doi: 10.1177/2150132720985044..
Keywords: Diabetes, Chronic Conditions, Primary Care, Vulnerable Populations, Social Determinants of Health
Luk JW, Parker EO, Richardson LP
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
This study examines whether sexual minority adolescents report lower satisfaction with primary care providers and lower health self-efficacy compared to heterosexual males and females. Data from 535 adolescents who participated in one of two randomized clinical trials were analyzed. Both sets of adolescents reported high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching health goals. Sexual minority females reported lower confidence in positively impacting their own health and lower self-efficacy in setting health goals compared to heterosexual females.
AHRQ-funded; HS023383.
Citation: Luk JW, Parker EO, Richardson LP .
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
J Adolesc 2020 Jun;81:96-100. doi: 10.1016/j.adolescence.2020.04.009..
Keywords: Children/Adolescents, Patient Experience, Primary Care, Clinician-Patient Communication, Vulnerable Populations, Disparities
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
Chan B, Hulen E, Edwards S
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
AHRQ-funded; HS022981.
Citation: Chan B, Hulen E, Edwards S .
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
Ann Fam Med 2019 Nov;17(6):495-501. doi: 10.1370/afm.2464..
Keywords: Primary Care, Primary Care: Models of Care, Ambulatory Care and Surgery, Vulnerable Populations, Patient-Centered Healthcare, Healthcare Delivery
Howard SD, Lee KL, Nathan AG
Healthcare experiences of transgender people of color.
Researchers investigated how transgender people of color (TPOC) healthcare experiences are shaped by both race/ethnicity and gender identity. Using interviews and focus groups with participants in the Chicago area, they found that all participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender-friendly in an effort to avoid discrimination, but feared experiencing racism there. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. The researchers concluded that TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities and recommended that providers improve understanding of intersectional experiences of TPOC to improve quality of care.
AHRQ-funded; HS023050.
Citation: Howard SD, Lee KL, Nathan AG .
Healthcare experiences of transgender people of color.
J Gen Intern Med 2019 Oct;34(10):2068-74. doi: 10.1007/s11606-019-05179-0..
Keywords: Patient Experience, Vulnerable Populations, Cultural Competence, Racial and Ethnic Minorities, Primary Care, Ambulatory Care and Surgery
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Lyles CR, Tieu L, Sarkar U
A randomized trial to train vulnerable primary care patients to use a patient portal.
This study examined the use of patient care portals in primary care practices with vulnerable patients such as those with lower socioeconomic status or limited health literacy (LHL). A randomized control trial was created with 93 English-speaking patients with 1+ chronic diseases. The patients were provided with either an 1) in-person tutorial with a research assistant, or 2) a link to view the videos on their own. A third arm of the trial were control patients with just normal access to get to the portal. There was a higher rate of access (21%) after the trial was over with the two intervention groups as compared with 9% for the usual care patients.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Lyles CR, Tieu L, Sarkar U .
A randomized trial to train vulnerable primary care patients to use a patient portal.
J Am Board Fam Med 2019 Mar-Apr;32(2):248-58. doi: 10.3122/jabfm.2019.02.180263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Literacy, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Vulnerable Populations
Chan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation: Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords: Primary Care, Healthcare Delivery, Patient-Centered Healthcare, Vulnerable Populations, Chronic Conditions
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
AHRQ-funded; HS022534.
Citation: Bradley CJ, Neumark D, Walker LS .
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Vulnerable Populations
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
Gao Y, Nocon RS, Gunter KE
AHRQ Author: Ngo-Metzger Q
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. The researchers identified characteristics associated with HCs' PCMH capability. EHR adoption likely played a role in HCs' improvement in PCMH capability. Other factors include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
AHRQ-authored; AHRQ-funded; HS000084.
Citation: Gao Y, Nocon RS, Gunter KE .
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
J Gen Intern Med 2016 Sep;31(9):1041-51. doi: 10.1007/s11606-016-3729-8.
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Keywords: Patient-Centered Healthcare, Electronic Health Records (EHRs), Primary Care, Community-Based Practice, Vulnerable Populations