National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- (-) Access to Care (20)
- Cancer (6)
- Cancer: Breast Cancer (1)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (3)
- Children/Adolescents (3)
- Colonoscopy (1)
- Community-Based Practice (2)
- Dental and Oral Health (2)
- Disparities (2)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Healthcare Costs (1)
- Healthcare Utilization (5)
- Health Insurance (4)
- Health Literacy (1)
- Health Promotion (1)
- Health Services Research (HSR) (1)
- Human Immunodeficiency Virus (HIV) (3)
- Imaging (1)
- Infectious Diseases (1)
- Low-Income (1)
- Maternal Care (2)
- Medicaid (8)
- Medical Expenditure Panel Survey (MEPS) (3)
- Medicare (3)
- Patient-Centered Healthcare (2)
- Patient Adherence/Compliance (1)
- Policy (4)
- Pregnancy (1)
- (-) Prevention (20)
- Primary Care (2)
- Racial and Ethnic Minorities (3)
- Rural Health (1)
- Screening (5)
- Sexual Health (2)
- Social Determinants of Health (1)
- Uninsured (2)
- Women (5)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedHatch B, Tillotson C, Hoopes M
Patient-level factors associated with receipt of preventive care in the safety net.
Researchers used electronic health record data from a national network of community health centers in the U.S. to measure patient-level status with preventive ratios for twelve preventive services and an aggregate preventive index. The results indicated that smoking, homelessness, and lack of health insurance were associated with lower preventive ratios for cancer and cardiovascular screenings; more ambulatory visits, better continuity of care, and enrollment in the patient portal were associated with higher preventive ratios for most services but the receipt of preventive services overall was low. The researchers concluded that these associations should inform future efforts to improve delivery of preventive healthcare.
AHRQ-funded; HS025155.
Citation: Hatch B, Tillotson C, Hoopes M .
Patient-level factors associated with receipt of preventive care in the safety net.
Prev Med 2022 May; 158:107024. doi: 10.1016/j.ypmed.2022.107024..
Keywords: Prevention, Community-Based Practice, Access to Care
Jacobs PD, Abdus S
AHRQ Author: Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
AHRQ-authored.
Citation: Jacobs PD, Abdus S .
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Ellison J, Griffith K, Thursby M
The impact of driving time to family planning facilities on preventive service use in Ohio.
This study examined the impact of driving time to family planning facilities for preventive service use in Ohio due to newly enacted restrictions in public funding for organizations that provide or refer patients to abortion care, often resulting in clinic closures. Data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System was assessed for female respondents aged 18-45 years with household incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP codes to compute driving times to the nearest family planning clinic. Each additional 10 minutes of driving time was associated with an 8.9 percentage point increase in the likelihood of avoided care owing to cost, a 10.4 percentage point decrease in the likelihood of a mammogram during the past 12 months, and a 12.5 percentage point decrease in the likelihood of ever receiving a clinical breast examination. Results were similar for driving distance increases.
AHRQ-funded; HS026395.
Citation: Ellison J, Griffith K, Thursby M .
The impact of driving time to family planning facilities on preventive service use in Ohio.
Am J Prev Med 2021 Apr;60(4):542-45. doi: 10.1016/j.amepre.2020.11.009..
Keywords: Access to Care, Women, Prevention, Screening
Sanchez JI, Shankaran V, Unger JM
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assessed the association between patient and neighborhood factors and receipt of surveillance colonoscopy. The investigators concluded that receipt of initial surveillance colonoscopy remained low, and that there were acute disparities between Black and NHW patients.
AHRQ-funded; HS013853.
Citation: Sanchez JI, Shankaran V, Unger JM .
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
Cancer 2021 Feb;127(3):412-21. doi: 10.1002/cncr.33262..
Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Access to Care, Screening, Prevention, Disparities, Medicare
Hill SC, Abdus S
AHRQ Author: Hill SC Abdus S
The effects of Medicaid on access to care and adherence to recommended preventive services.
Using MEPS data, the authors sought to quantify the impact of Medicaid enrollment on access to care and adherence to recommended preventive services. They found that Medicaid enrollment decreased the probability of having unmet needs for medical care and of experiencing delays getting prescription drugs. Medicaid enrollment increased the probability of having a usual source of care, of having a routine checkup, and of having a flu shot in past year.
AHRQ-authored.
Citation: Hill SC, Abdus S .
The effects of Medicaid on access to care and adherence to recommended preventive services.
Health Serv Res 2021 Feb;56(1):84-94. doi: 10.1111/1475-6773.13603..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Access to Care, Prevention, Patient Adherence/Compliance
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Gregory EF, Upadhya KK, Cheng TL
AHRQ Author: Mistry KB
Enabling factors associated with receipt of interconception health care.
This study examined factors associated with receipt of preventive health care between pregnancies (interconception) using data from a study at four health centers in the Baltimore metropolitan area. The Anderson’s Model of Health Services Use model was used to identify data on factors up to 15 months postpartum. Factors included health history, self-rated health, demographics, predisposing factors, and enabling factors. The cohort included 376 women who were predominantly non-Hispanic Black (84%), and low income. Two enabling factors were associated with receipt of care: having a personal doctor or nurse and having non-Medicaid insurance.
AHRQ-authored
Citation: Gregory EF, Upadhya KK, Cheng TL .
Enabling factors associated with receipt of interconception health care.
Matern Child Health J 2020 Mar;24(3):275-82. doi: 10.1007/s10995-019-02850-0..
Keywords: Maternal Care, Prevention, Pregnancy, Healthcare Utilization, Women, Access to Care
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Rice WS, Stringer KL, Sohail M
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
Limited studies to date assess barriers to and facilitators of pre-exposure prophylaxis (PrEP) uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. In this study, the investigators examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama.
AHRQ-funded; HS013852.
Citation: Rice WS, Stringer KL, Sohail M .
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
AIDS Behav 2019 Nov;23(11):2966-79. doi: 10.1007/s10461-019-02591-9..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Healthcare Utilization, Patient-Centered Healthcare, Racial and Ethnic Minorities, Health Literacy, Education: Patient and Caregiver, Access to Care, Health Promotion
Kim B, Callander D, DiClemente R
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
This study analyzed the New York City geographic distribution of pre-exposure prophylaxis (PrEP) providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. Results showed that neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, and PrEP providers were located in high HIV-incidence neighborhoods. These findings validate the need for ongoing policy interventions in relation to PrEP provider locations in New York City and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
AHRQ-funded; HS026120.
Citation: Kim B, Callander D, DiClemente R .
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
AIDS Behav 2019 Oct;23(10):2795-802. doi: 10.1007/s10461-019-02609-2..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Access to Care, Social Determinants of Health
Cottrell E, Darney BG, Marino M
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
In this paper, the authors describe a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. They conclude that the findings will be relevant to policy and practice, informing efforts that enhance the provision of timely, evidence-based reproductive care, to improve health outcomes, and to reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualize their findings and to develop subsequent studies and interventions to support women's healthcare provision in community health center settings.
AHRQ-funded; HS025155.
Citation: Cottrell E, Darney BG, Marino M .
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
Health Res Policy Syst 2019 Jun 11;17(1):58. doi: 10.1186/s12961-019-0445-y..
Keywords: Women, Access to Care, Medicaid, Policy, Prevention, Maternal Care, Sexual Health
O'Leary MC, Lich KH, Gu Y
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
The goal of this study was to determine the impact of national and state policies enacted to increase access to Medicaid and to promote colorectal cancer (CRC) screening on newly enrolled, age-eligible Oregon Medicaid beneficiaries. 2010 - 2015 Oregon Medicaid claims data was used to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening. Individuals newly enrolled in Medicaid in 2013 or 2014 were more likely to initiate CRC screening than those enrolled by 2010, associated with the timing of policies such as Medicaid expansion and federal matching for preventive services. A primary care visit during the calendar year, one or more chronic conditions, and Hispanic ethnicity were also associated with CRC screening initiation.
AHRQ-funded; HS022981.
Citation: O'Leary MC, Lich KH, Gu Y .
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
BMC Health Serv Res 2019 May 9;19(1):298. doi: 10.1186/s12913-019-4113-2..
Keywords: Access to Care, Cancer, Cancer: Colorectal Cancer, Medicaid, Policy, Prevention, Screening
Sun CJ, Anderson KM, Bangsberg D
Access to HIV pre-exposure prophylaxis in practice settings: a qualitative study of sexual and gender minority adults' perspectives.
Sexual and gender minority (SGM) populations remain at disproportionate risk of HIV infection. Despite the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV, PrEP uptake has been slow. The objective of this study was to identify barriers and facilitators of PrEP access by examining SGM patients' experiences with accessing health care systems and engaging with providers about PrEP in a variety of practice settings.
AHRQ-funded; HS022981.
Citation: Sun CJ, Anderson KM, Bangsberg D .
Access to HIV pre-exposure prophylaxis in practice settings: a qualitative study of sexual and gender minority adults' perspectives.
J Gen Intern Med 2019 Apr;34(4):535-43. doi: 10.1007/s11606-019-04850-w..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Infectious Diseases, Sexual Health, Racial and Ethnic Minorities, Access to Care
Rivera-Hernandez M, Rahman M, Galarraga O
Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012.
This study examined the effect of the Seguro Popular (SP) program in Mexico on preventive care utilization among low-income and uninsured elder beneficiaries. Results of three rounds of the Mexican National Health and Nutrition Survey from 2000, 2006, and 2012 was used. The findings show there was no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer for adults aged 50 to 75 years.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Rahman M, Galarraga O .
Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012.
Salud Publica Mex 2019 Jan-Feb;61(1):46-53. doi: 10.21149/9185..
Keywords: Elderly, Low-Income, Prevention, Healthcare Utilization, Access to Care, Uninsured
Burgette JM, Preisser JS, Rozier RG
Access to preventive services after the integration of oral health care into early childhood education and medical care.
The authors compared children enrolled in North Carolina Early Head Start (EHS) programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates.
AHRQ-funded; HS000032.
Citation: Burgette JM, Preisser JS, Rozier RG .
Access to preventive services after the integration of oral health care into early childhood education and medical care.
J Am Dent Assoc 2018 Dec;149(12):1024-31.e2. doi: 10.1016/j.adaj.2018.07.019..
Keywords: Access to Care, Children/Adolescents, Dental and Oral Health, Health Services Research (HSR), Medicaid, Patient-Centered Healthcare, Prevention
Lee SC, Higashi RT, Sanders JM
Effects of program scale-up on time to resolution for patients with abnormal screening mammography results.
Effects of geographic program expansion to rural areas on mammogram screening program outcomes are understudied. The authors of this study sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties.
AHRQ-funded; HS022418.
Citation: Lee SC, Higashi RT, Sanders JM .
Effects of program scale-up on time to resolution for patients with abnormal screening mammography results.
Cancer Causes Control 2018 Oct;29(10):995-1005. doi: 10.1007/s10552-018-1074-4..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Women, Rural Health, Access to Care, Prevention
Aalsma MC, Gilbert AL, Xiao S
Parent and adolescent views on barriers to adolescent preventive health care utilization.
The objective of the study was to determine adolescent and parent views of barriers to annual adolescent preventive care. Barriers for parents and adolescents include the belief that an appointment is only needed when a child is sick and family cannot afford cost. Barriers for parents include having their child see a specialist.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Gilbert AL, Xiao S .
Parent and adolescent views on barriers to adolescent preventive health care utilization.
J Pediatr 2016 Feb;169:140-5. doi: 10.1016/j.jpeds.2015.10.090.
.
.
Keywords: Children/Adolescents, Access to Care, Prevention, Primary Care, Healthcare Utilization
Marino M, Bailey SR, Gold R
Receipt of preventive services after Oregon's randomized Medicaid experiment.
This study examined the three-year impact of Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment") on receipt of 12 preventive care services in community health centers using electronic health record data. They found that Medicaid coverage significantly increased the odds of receipt of most preventive services. They concluded that rates of preventive services receipt will likely increase as community health center patients gain insurance through Affordable Care Act expansions. They recommended continued effort to increase health insurance coverage in an effort to decrease health disparities in vulnerable populations.
AHRQ-funded; HS021522.
Citation: Marino M, Bailey SR, Gold R .
Receipt of preventive services after Oregon's randomized Medicaid experiment.
Am J Prev Med 2016 Feb;50(2):161-70. doi: 10.1016/j.amepre.2015.07.032.
.
.
Keywords: Access to Care, Community-Based Practice, Health Insurance, Medicaid, Prevention
Beil H, Rozier RG, Preisser JS
Effects of early dental office visits on dental caries experience.
This study determined the association between timing of a first dentist office visit before age 5 and dental disease in kindergarten. It found that children with early dental visits (before age 2) had higher rates of tooth decay than those who had later visits (between ages 3 and 5).
AHRQ-funded; HS018076.
Citation: Beil H, Rozier RG, Preisser JS .
Effects of early dental office visits on dental caries experience.
Am J Public Health. 2014 Oct;104(10):1979-85. doi: 10.2105/AJPH.2013.301325..
Keywords: Dental and Oral Health, Children/Adolescents, Access to Care, Medicaid, Prevention
Robin Yabroff K, Short PF, Machlin S
AHRQ Author: Machlin S
Access to preventive health care for cancer survivors.
The researchers evaluated the association between cancer survivorship and access to primary and preventive health care. They concluded that, although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18-64 years suggest that improvements in survivor care are needed.
AHRQ-authored.
Citation: Robin Yabroff K, Short PF, Machlin S .
Access to preventive health care for cancer survivors.
Am J Prev Med 2013 Sep;45(3):304-12. doi: 10.1016/j.amepre.2013.04.021.
.
.
Keywords: Access to Care, Cancer, Medical Expenditure Panel Survey (MEPS), Prevention, Primary Care