National Healthcare Quality and Disparities Report
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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 21 of 21 Research Studies DisplayedDykes PC, Curtin-Bowen M, Lipsitz S
Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program.
The financial implications of patient falls within healthcare settings, a primary cause of nonreimbursable negative incidents, have not been thoroughly investigated. The aim of this study was to determine the expenses related to inpatient falls and the potential cost savings achieved through the adoption of a proven fall prevention program. This economic assessment employed a matched case-control approach, utilizing results from an interrupted time series analysis that evaluated the alterations in fall rates after the introduction of an evidence-based fall prevention program to estimate inpatient fall expenses. Subsequently, an economic analysis was conducted to evaluate the cost advantages of implementing the program across two American healthcare systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adult patients admitted to the participating units were included in the analysis. Data analysis took place between October 2021 and November 2022. The fall prevention program, based on evidence, was introduced in 33 medical and surgical departments across eight hospitals. The primary outcome was the expense related to inpatient falls. Secondary outcomes included costs and savings linked to the evidence-based fall prevention program. The study found that the case-control study and economic analysis included 10,176 patients who experienced a fall event (with or without injury) and 29,161 matched controls without a fall event (51.9% aged 65-74 years, 67.1% White, and 53.6% male). Prior to the intervention, there were 2,503 falls and 900 injuries; following the intervention, there were 2,078 falls and 758 injuries. Based on a 19% decrease in falls and a 20% decrease in injury-causing falls from the beginning to the end of the post-intervention period, the economic analysis revealed that noninjurious and injurious falls led to cost increases of $35,365 and $36,776, respectively. The introduction of the evidence-based fall prevention program resulted in $14,600 in net avoided expenses for every 1000 patient-days.
AHRQ-funded; HS027557; HS025128
Citation: Dykes PC, Curtin-Bowen M, Lipsitz S .
Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program.
JAMA Health Forum 2023 Jan 6;4(1):e225125. doi: 10.1001/jamahealthforum.2022.5125.
Keywords: Falls, Healthcare Delivery, Evidence-Based Practice, Prevention
Huffstetler AN, Epling J, Krist AH
The need for electronic health records to support delivery of behavioral health preventive services.
In this article the authors discuss adaptations to electronic health records to improve behavioral health preventive services. They recommend a refocus in digital health away from best business practices that help EHR vendors and toward best health-related practice in order to improve patient care and make work easier for clinicians.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Epling J, Krist AH .
The need for electronic health records to support delivery of behavioral health preventive services.
JAMA 2022 Aug 23;328(8):707-08. doi: 10.1001/jama.2022.13391..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Prevention, Healthcare Delivery
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation: Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords: Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Quality Improvement, Practice Improvement, Quality of Care
Kranz AM, Ryan J, Mahmud A, AM, Ryan J, Mahmud A
Association of primary and specialty care integration on physician communication and cancer screening in safety-net clinics.
Lack of cancer screenings are more common in community health centers (CHCs) which provide primary care to disadvantaged populations due to difficulty accessing specialty care for their patients. This study’s objective was to describe CHCs use to integrate care with specialists and examine whether strongly integrated CHCs have higher rates of screening colorectal and cervical cancers. A 2017 survey of CHCs in 12 states and the District of Columbia was used to estimate the association between a composite measure of CHC/specialist integration and cancer screening rates and 4 measures of CHC/specialist communication using multivariate regression models. More integrated CHCs had higher screening rates of colorectal and cervical cancer and had significantly higher rates of knowing that specialist visits happened, knowing visit outcomes, receiving information after visits, and timely receipt of information.
AHRQ-funded; HS024067.
Citation: Kranz AM, Ryan J, Mahmud A, AM, Ryan J, Mahmud A .
Association of primary and specialty care integration on physician communication and cancer screening in safety-net clinics.
Prev Chronic Dis 2020 Oct 29;17:E134. doi: 10.5888/pcd17.200025..
Keywords: Cancer, Screening, Communication, Prevention, Patient-Centered Healthcare, Healthcare Delivery
Knerr S, West KM, Angelo FA
Organizational readiness to implement population-based screening and genetic service delivery for hereditary cancer prevention and control.
Programs conducting population-based screening and genetic service delivery for hereditary cancer prevention and control are rare in practice. The authors interviewed individuals instrumental in implementing seven unique clinical programs conducting either universal tumor screening for Lynch Syndrome or routine family history screening and provision of genetic services for hereditary breast and ovarian cancer in the United States. Their findings suggest that developing interventions targeting change efficacy and cultivating practice change champions may be two promising ways to increase uptake of population-based hereditary cancer screening and genetic service delivery in clinical practice.
AHRQ-funded; HS022982.
Citation: Knerr S, West KM, Angelo FA .
Organizational readiness to implement population-based screening and genetic service delivery for hereditary cancer prevention and control.
J Genet Couns 2020 Oct;29(5):867-76. doi: 10.1002/jgc4.1216.
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Keywords: Cancer, Screening, Genetics, Prevention, Guidelines, Healthcare Delivery, Organizational Change, Implementation
Bates KE, Davis CS, Reeves SL
Designing a multistakeholder collaboration to improve preventive care for children with sickle cell anemia.
Researchers organized two novel multi-stakeholder design meetings to identify potential interventions to deliver high-quality preventive care for children with sickle cell anemia (SCA). Invitees included patients with SCA, patients’ families, and representatives from pediatric hematology clinics, Medicaid health plans, community organizations, and one state Medicaid program. The researchers found that bridging gaps between stakeholder groups identified many potential interventions to improve SCA preventive care delivery at all levels of the health care system. They concluded that similar multi-stakeholder discussions may be useful for other communities interested in improving preventive care for children with SCA or other chronic pediatric diseases.
AHRQ-funded; HS025292.
Citation: Bates KE, Davis CS, Reeves SL .
Designing a multistakeholder collaboration to improve preventive care for children with sickle cell anemia.
J Pediatr Hematol Oncol 2020 Apr;42(3):e152-e58. doi: 10.1097/mph.0000000000001666..
Keywords: Children/Adolescents, Sickle Cell Disease, Prevention, Chronic Conditions, Healthcare Delivery
Persell SD, Liss DT, Walunas TL
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
Effective quality improvement (QI) strategies are needed for small practices. The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. The investigators concluded that facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
AHRQ-funded; HS023921.
Citation: Persell SD, Liss DT, Walunas TL .
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
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Keywords: Cardiovascular Conditions, Prevention, Primary Care: Models of Care, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Briggs ADM, Fraze TK, Glick AL
How do accountable care organizations deliver preventive care services? A mixed-methods study.
The authors sought to understand how Medicare accountable care organizations (ACOs) provide preventive care services to their attributed patients. They found that offering annual wellness visits and having a system-wide approach to closing preventive care gaps are key mechanisms used by high-performing ACOs to address patients' preventive care needs; however, few programs or initiatives were identified that specifically target clinically complex patients. They concluded that understanding the mechanisms and motivations used by high-performing ACOs may help both providers and payers to increase the use of preventive care.
AHRQ-funded; HS024075.
Citation: Briggs ADM, Fraze TK, Glick AL .
How do accountable care organizations deliver preventive care services? A mixed-methods study.
J Gen Intern Med 2019 Nov;34(11):2451-59. doi: 10.1007/s11606-019-05271-5..
Keywords: Prevention, Healthcare Delivery, Medicare
Knerr S, Bowles EJA, Leppig KA
Trends in BRCA test utilization in an integrated health system, 2005-2015.
The authors reported 10-year trends in BRCA testing in an integrated health-care system with long-standing access to genetic services. They found that many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, thus underscoring challenges to primary and secondary hereditary cancer prevention.
AHRQ-funded; HS022982.
Citation: Knerr S, Bowles EJA, Leppig KA .
Trends in BRCA test utilization in an integrated health system, 2005-2015.
J Natl Cancer Inst 2019 Aug;111(8):795-802. doi: 10.1093/jnci/djz008..
Keywords: Cancer: Breast Cancer, Cancer: Ovarian Cancer, Cancer, Genetics, Screening, Prevention, Healthcare Utilization, Healthcare Delivery, Women
Hatch BA, Tillotson CJ, Huguet N
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applied a new measurement approach and assessed clinic-level factors associated with preventive care delivery. The investigators concluded that approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time.
AHRQ-funded; HS024270.
Citation: Hatch BA, Tillotson CJ, Huguet N .
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
Am J Prev Med 2019 Aug;57(2):241-49. doi: 10.1016/j.amepre.2019.03.016..
Keywords: Prevention, Healthcare Delivery, Health Services Research (HSR)
Huguet N, Angier H, Rdesinski R
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
This study assessed changes in the prevalence of cervical and colorectal cancer screening from before and after the Affordable Care Act in Medicaid expansion and non-expansion states among patients seen in community health centers. Results showed that, despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Rdesinski R .
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Prev Med 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003..
Keywords: Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Delivery, Healthcare Utilization, Medicaid, Policy, Prevention, Screening
Thomas T, Samuel-Hodge CD, Porterfield DS
Scaling up diabetes prevention programs in North Carolina: perceptions of demand from potential program recipients and providers.
The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) guided by a conceptual framework conducted with potential DPP participants and providers and taken from their perspective. Providers considered prediabetes to be an important health problem. Potential DPP participants expressed less urgency related to a diagnosis of prediabetes and felt they were more likely to adopt a diabetes prevention program if it were affordable and convenient. Both participants and providers cited existing barriers to the use of these programs such as transportation, cost, and health insurance reimbursement.
AHRQ-funded; HS000032.
Citation: Thomas T, Samuel-Hodge CD, Porterfield DS .
Scaling up diabetes prevention programs in North Carolina: perceptions of demand from potential program recipients and providers.
Diabetes Educ 2019 Feb;45(1):116-24. doi: 10.1177/0145721718811564..
Keywords: Diabetes, Healthcare Delivery, Prevention
Chou AF, Homco JB, Nagykaldi Z
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
The Healthy Hearts for Oklahoma (H2O) Study proposes to build a quality improvement (QI) infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; and (2) providing QI support in primary care practices to better manage patients at risk for cardiovascular disease (CVD) events. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) performance. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations.
AHRQ-funded; HS023919.
Citation: Chou AF, Homco JB, Nagykaldi Z .
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
BMC Health Serv Res 2018 Jun 4;18(1):404. doi: 10.1186/s12913-018-3189-4.
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Keywords: Cardiovascular Conditions, Communication, Heart Disease and Health, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Prevention, Quality of Care, Quality Improvement
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation: Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords: Primary Care, Implementation, Cardiovascular Conditions, Evidence-Based Practice, Healthcare Delivery, Practice Improvement, Quality Improvement, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention
Doherty JA, Crelia SJ, Smith MW
AHRQ Author: Mabry-Hernandez IR, Ngo-Metzger Q
Large health systems' prevention guideline implementation: a qualitative study.
In 2015, researchers conducted and analyzed interviews with quality leaders from eight hospital-based systems and one physician organization who explained organizational processes to adapt, adopt, disseminate, and incentivize adherence to preventive services guidelines. Nearly all have a formal process for reviewing and refining guidelines, developing clinician support, and disseminating the approved guidelines.
AHRQ-authored.
Citation: Doherty JA, Crelia SJ, Smith MW .
Large health systems' prevention guideline implementation: a qualitative study.
Am J Prev Med 2018 Jan;54(1s1):S88-s94. doi: 10.1016/j.amepre.2017.07.025.
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Keywords: Primary Care, Guidelines, Evidence-Based Practice, Prevention, Implementation, Healthcare Delivery
Kass AE, Balantekin KN, Fitzsimmons-Craft EE
The economic case for digital interventions for eating disorders among United States college students.
This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses.
AHRQ-funded; HS000078.
Citation: Kass AE, Balantekin KN, Fitzsimmons-Craft EE .
The economic case for digital interventions for eating disorders among United States college students.
Int J Eat Disord 2017 Mar;50(3):250-58. doi: 10.1002/eat.22680.
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Keywords: Behavioral Health, Healthcare Delivery, Healthcare Costs, Prevention, Primary Care: Models of Care, Telehealth, Young Adults, Web-Based
Kantor R, Silverberg JI
Environmental risk factors and their role in the management of atopic dermatitis.
The authors review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on atopic dermatitis (AD). They argue that understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions.
AHRQ-funded; HS023011.
Citation: Kantor R, Silverberg JI .
Environmental risk factors and their role in the management of atopic dermatitis.
Expert Rev Clin Immunol 2017 Jan;13(1):15-26. doi: 10.1080/1744666x.2016.1212660.
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Keywords: Risk, Prevention, Healthcare Delivery
Wen KY, Miller SM, Roussi P
A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population.
The researchers conducted in-person interviews to characterize the barriers and facilitators that prevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population. They found that participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health, and receiving positive social support from families and friends.
AHRQ-funded; HS019001.
Citation: Wen KY, Miller SM, Roussi P .
A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population.
Health Educ Res 2015 Feb;30(1):140-51. doi: 10.1093/her/cyu048.
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Keywords: Education: Patient and Caregiver, Healthcare Delivery, Prevention, Tobacco Use, Vulnerable Populations
Pavlik VN, Chan W, Hyman DJ
Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials.
This study conducted a pooled analysis of three projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of African American patients with controlled blood pressure (BP). The analysis of trial results to determine the magnitude of the combined intervention effect found that pooled BP did not differ significantly between intervention and control clusters.
AHRQ-funded; HS021667.
Citation: Pavlik VN, Chan W, Hyman DJ .
Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials.
Curr Hypertens Rev 2015;11(2):123-31..
Keywords: Blood Pressure, Racial and Ethnic Minorities, Healthcare Delivery, Prevention, Care Management
Laiteerapong N, Kirby J, Gao Y
AHRQ Author: Kirby J, Ngo-Metzger Q
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
The investigators compared utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. They found that HC patients had fewer office visits and hospitalizations, were more likely to receive breast cancer screening, had fewer outpatient and emergency room visits, and were more likely to receive dietary advice compared to non-HC patients.
AHRQ-authored.
Citation: Laiteerapong N, Kirby J, Gao Y .
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
Health Serv Res 2014 Oct;49(5):1498-518. doi: 10.1111/1475-6773.12178.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Utilization, Prevention, Community-Based Practice, Healthcare Delivery