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
AHRQ Research Studies Date
Topics
- Access to Care (3)
- Ambulatory Care and Surgery (2)
- Cancer (2)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (1)
- Care Coordination (1)
- Community-Based Practice (1)
- COVID-19 (2)
- Decision Making (3)
- Disparities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (3)
- (-) Healthcare Delivery (23)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (2)
- Health Insurance (4)
- Health Services Research (HSR) (1)
- Health Systems (1)
- Home Healthcare (1)
- Hospitals (1)
- Kidney Disease and Health (1)
- Maternal Care (1)
- Medicaid (4)
- Organizational Change (3)
- Patient-Centered Healthcare (4)
- Patient and Family Engagement (1)
- Payment (2)
- (-) Policy (23)
- Pregnancy (1)
- Prevention (1)
- Primary Care (4)
- Primary Care: Models of Care (1)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
- Screening (1)
- Substance Abuse (1)
- Transplantation (1)
- Uninsured (1)
- Women (2)
- Workforce (1)
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 23 of 23 Research Studies DisplayedSmith LB
The effect of nurse practitioner scope of practice laws on primary care delivery.
Nurse practitioners (NPs) are an increasingly integral part of the primary care workforce. NPs' authority to practice without physician oversight is regulated by state-level scope of practice (SOP) restrictions. To the extent that SOP restrictions prevent NPs from practicing to their full abilities and capacity, they could create inefficiencies and restrict access to health care. The purpose of this paper was to explore what occurs at primary care practices when states ease their scope of practice (SOP) laws. The researcher utilized a novel dataset of claims and electronic health records to quantify the effects of easing SOP laws in 3 areas: 1. Nurse Practitioners' autonomy in their everyday jobs; 2. Total workload and the allocation of patients between physicians and NPs; and 3. The delivery of low-value services at primary care practices. The study found no evidence that easing SOP laws impacts neither the volume or allocation of patients to NPs, nor the delivery of low-value services.
AHRQ-funded; HS026659.
Citation: Smith LB .
The effect of nurse practitioner scope of practice laws on primary care delivery.
Health Econ 2022 Jan; 31(1):21-41. doi: 10.1002/hec.4438..
Keywords: Primary Care, Healthcare Delivery, Policy, Provider: Clinician, Provider: Nurse
Anderson KE, Shugarman LR, Davenport K
Regulation of provider networks in response to COVID-19.
The authors anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. They suggested that telehealth will have a larger role in care delivery than in the pre-pandemic period, and that regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
AHRQ-funded; HS000029.
Citation: Anderson KE, Shugarman LR, Davenport K .
Regulation of provider networks in response to COVID-19.
Am J Manag Care 2021 Apr;27(4):e101-e04. doi: 10.37765/ajmc.2021.88614..
Keywords: Health Insurance, Policy, Access to Care, Healthcare Delivery, COVID-19
Huguet N, Schmidt T, Larson A
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
Researchers described the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. Electronic health record data from OCHIN, a network of 396 community health centers across 14 states, was used. They concluded that since the future of the Patient Protection and Affordable Care Act is uncertain, and since the long-term health effects of COVID-19 are largely unknown, ensuring that people with pre-existing conditions can acquire health insurance is essential to achieving health equity.
AHRQ-funded; HS025962.
Citation: Huguet N, Schmidt T, Larson A .
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
J Am Board Fam Med 2021 Feb;34(Suppl):S247-s49. doi: 10.3122/jabfm.2021.S1.200571..
Keywords: Electronic Health Records (EHRs), COVID-19, Racial and Ethnic Minorities, Policy, Healthcare Delivery
de Cordova PB, Jones T, Riman KA
Staffing trends in magnet and non-magnet hospitals after state legislation.
This study examined whether there was a difference in staffing of registered nurses in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. This secondary analysis of longitudinal RN staffing data was conducted using 64 hospitals representing 12 nursing specialties during the time span of 2008 to 2015. There was a slight increase in staffing at Magnet hospitals compared to non-Magnet hospitals, but RN staffing improved in all hospitals. No meaningful difference in staffing for all 12 specialties was found.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Jones T, Riman KA .
Staffing trends in magnet and non-magnet hospitals after state legislation.
J Nurs Care Qual 2020 Oct/Dec;35(4):323-28. doi: 10.1097/ncq.0000000000000479..
Keywords: Hospitals, Policy, Healthcare Delivery, Workforce
Heeringa J, Mutti A, Furukawa MF
AHRQ Author: Furukawa MF
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
The authors conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. They found that U.S. policymakers seek to promote provider integration and coordination. They conclude that emerging evidence suggested that organizational structures, composition, and other characteristics influence cost and quality performance. They recommend future research to examine systematically the role of organizational structure in cost and quality outcomes.
AHRQ-authored; AHRQ-funded.
Citation: Heeringa J, Mutti A, Furukawa MF .
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
Int J Integr Care 2020 Jan 20;20(1):2. doi: 10.5334/ijic.4635.
.
.
Keywords: Health Systems, Healthcare Delivery, Patient-Centered Healthcare, Care Coordination, Organizational Change, Policy
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery
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
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
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
Halle AD, Mroz TM, Fogelberg DJ
Occupational therapy and primary care: updates and trends.
This paper identifies new initiatives and opportunities in primary care, explores common challenges to integrating occupational therapy in primary care environments, and highlights international works that can support the authors’ efforts.
AHRQ-funded; HS022907.
Citation: Halle AD, Mroz TM, Fogelberg DJ .
Occupational therapy and primary care: updates and trends.
Am J Occup Ther 2018 May/Jun;72(3):7203090010p1-10p6. doi: 10.5014/ajot.2018.723001..
Keywords: Healthcare Delivery, Primary Care, Policy, Patient-Centered Healthcare
Berridge C
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
This study examined passive remote monitoring technologies in state Medicaid programs. Its goals were to identify which states allowed location tracking, sensor systems, and cameras, what policies were in place to track usage, what implementation processes and program monitoring mechanisms were in place, and what related insights Medicaid program stakeholders would like to learn. Interviews were conducted with state, federal, and managed care organization (MCO) Medicaid program stakeholders about the use of these technologies in state waivers that served community-dwelling older adults in 15 states. While two-thirds of the states covered location tracking and activity-monitoring sensors and one-third covered cameras, only 3 states had specific service categories that allowed tracking of when they pay for these technologies. The authors conclude that technologies that have great potential to alter the way older adults receive supportive services are often used without research on their use, social or ethical implications, or outcomes. New service categories are needed to enable oversight, and more interaction between policymakers and researchers in this field would aid in the prioritization of research aims to inform practice.
AHRQ-funded; HS000011.
Citation: Berridge C .
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
J Med Internet Res 2018 Feb 21;20(2):e66. doi: 10.2196/jmir.9650..
Keywords: Elderly, Health Information Technology (HIT), Health Insurance, Healthcare Delivery, Home Healthcare, Medicaid, Policy
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Hall JD, Kautz G .
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
Ahluwalia SC, Damberg CL, Silverman M
What defines a high-performing health care delivery system: a systematic review.
A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a "high-performing" health care delivery system. No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93 percent of articles), cost (67 percent), access (35 percent), equity (26 percent), patient experience (21 percent), and patient safety (18 percent).
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Silverman M .
What defines a high-performing health care delivery system: a systematic review.
Jt Comm J Qual Patient Saf 2017 Sep;43(9):450-59. doi: 10.1016/j.jcjq.2017.03.010.
.
.
Keywords: Healthcare Delivery, Quality of Care, Policy, Quality Measures
DeMeester RH, Xu LJ, Nocon RS
Solving disparities through payment and delivery system reform: a program to achieve health equity.
In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction.
AHRQ-funded; HS000084.
Citation: DeMeester RH, Xu LJ, Nocon RS .
Solving disparities through payment and delivery system reform: a program to achieve health equity.
Health Aff 2017 Jun;36(6):1133-39. doi: 10.1377/hlthaff.2016.0979.
.
.
Keywords: Disparities, Healthcare Delivery, Payment, Policy
Califf RM, Robb MA, Bindman AB
AHRQ Author: Bindman AB, Dymek C
Transforming evidence generation to support health and health care decisions.
Collaborations among federal health agencies involved in biomedical research and health care delivery with regard to data sharing, research infrastructure, and computational capabilities require combining expertise and resources and will entail substantial changes to the culture of clinical research, In this article, the authors propose a set of core principles for data collaboration and system organizational design that they believe will further enable research efforts by both the private sector and government agencies.
AHRQ-authored.
Citation: Califf RM, Robb MA, Bindman AB .
Transforming evidence generation to support health and health care decisions.
N Engl J Med 2016 Dec 15;375(24):2395-400. doi: 10.1056/NEJMsb1610128.
.
.
Keywords: Healthcare Delivery, Decision Making, Evidence-Based Practice, Policy
Adler-Milstein J, Embi PJ, Middleton B
Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care.
There is a chasm between the current health IT ecosystem and the health IT ecosystem. In this paper, the authors identify a set of focal goals and associated near-term achievable actions that are critical to pursue in order to enable the health IT ecosystem to meet the acute needs of modern health care delivery. These ideas emerged from discussions that occurred during the 2015 American Medical Informatics Association Policy Invitational Meeting.
AHRQ-funded; HS023969.
Citation: Adler-Milstein J, Embi PJ, Middleton B .
Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care.
J Am Med Inform Assoc 2017 Sep 1;24(5):1036-43. doi: 10.1093/jamia/ocx017.
.
.
Keywords: Healthcare Delivery, Health Information Technology (HIT), Patient and Family Engagement, Policy, Health Information Technology (HIT)
Colla CH, Lewis VA, Bergquist SL
Accountability across the continuum: the participation of postacute care providers in accountable care organizations.
The authors examined the extent to which accountable care organizations (ACOs) formally incorporate postacute care providers. They found that ACOs with a relationship with a postacute care provider are more likely to have advanced transition management, end of life planning, readmission prevention, and care management capabilities. However, many ACOs have not formally engaged postacute care.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Bergquist SL .
Accountability across the continuum: the participation of postacute care providers in accountable care organizations.
Health Serv Res 2016 Aug;51(4):1595-611. doi: 10.1111/1475-6773.12442.
.
.
Keywords: Policy, Healthcare Delivery, Health Insurance
Melcher ML, Roberts JP, Leichtman AB
Utilization of deceased donor kidneys to initiate living donor chains.
The authors proposed that some deceased donor kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor kidney transplants. They hypothesized that a pilot program would show a positive impact on patients of all ethnicities and blood types.
AHRQ-funded; HS020610.
Citation: Melcher ML, Roberts JP, Leichtman AB .
Utilization of deceased donor kidneys to initiate living donor chains.
Am J Transplant 2016 May;16(5):1367-70. doi: 10.1111/ajt.13740.
.
.
Keywords: Healthcare Delivery, Kidney Disease and Health, Policy, Transplantation
Carman KL, Maurer M, Mangrum R
Understanding an informed public's views on the role of evidence in making health care decisions.
The Community Forum Deliberative Methods Demonstration project, sponsored by AHRQ, obtained informed public views on the role of evidence in health care decisions through seventy-six deliberative groups involving 907 people overall, in the period August-November 2012. Although participants perceived evidence as being essential to high-quality care, they also believed that personal choice or clinical judgment could trump evidence.
AHRQ-funded; 290201000005C.
Citation: Carman KL, Maurer M, Mangrum R .
Understanding an informed public's views on the role of evidence in making health care decisions.
Health Aff 2016 Apr;35(4):566-74. doi: 10.1377/hlthaff.2015.1112.
.
.
Keywords: Healthcare Delivery, Decision Making, Evidence-Based Practice, Policy
Polisena J, Garritty C, Umscheid CA
Rapid Review Summit: an overview and initiation of a research agenda.
This discussion paper highlights the important discussions that occurred during the Rapid Review Summit: Then, Now and in the Future, focusing on the initial development of a research agenda that resulted from the presentations and discussions. The research topics centered on three key areas of interest: (1) how to conduct a rapid review; (2) investigating the validity and utility of rapid reviews; and (3) how to improve access to rapid reviews.
AHRQ-funded; HS018987.
Citation: Polisena J, Garritty C, Umscheid CA .
Rapid Review Summit: an overview and initiation of a research agenda.
Syst Rev 2015 Sep 26;4:111. doi: 10.1186/s13643-015-0111-6.
.
.
Keywords: Evidence-Based Practice, Healthcare Delivery, Policy, Research Methodologies
Clancy CM, Collins Sharp BA
AHRQ Author: Clancy CM, Collins Sharp BA
Women's health during health care transformation.
This article describes health care transformation as it affects women as a result of the Affordable Care Act of 2010. Topics discussed include USPSTF-recommended preventve services, patient-centered medical homes, access, health disparities, and the Veterans Health Administration healthcare system.
AHRQ-authored.
Citation: Clancy CM, Collins Sharp BA .
Women's health during health care transformation.
J Gen Intern Med 2013 Jul;28 Suppl 2:S500-3. doi: 10.1007/s11606-013-2473-6.
.
.
Keywords: Healthcare Delivery, Policy, Policy, Women
Conway PH, Mostashari F, Clancy CM
AHRQ Author: Clancy CM
The future of quality measurement for improvement and accountability.
The authors describe the characteristics of the quality measurement enterprise of the future, outline a potential roadmap for the transition, and identify a set of opportunities for public- and private-sector collaboration.
AHRQ-authored.
Citation: Conway PH, Mostashari F, Clancy CM .
The future of quality measurement for improvement and accountability.
JAMA 2013 Jun 5;309(21):2215-6. doi: 10.1001/jama.2013.4929.
.
.
Keywords: Healthcare Delivery, Policy, Organizational Change, Quality Indicators (QIs), Quality Measures, Quality of Care
Siegel JE, Heeringa JW, Carman KL
AHRQ Author: Siegel JE
Public deliberation in decisions about health research.
This paper provides a brief overview of public deliberation and describes its emerging role in health and health care research.
AHRQ-authored.
Citation: Siegel JE, Heeringa JW, Carman KL .
Public deliberation in decisions about health research.
Virtual Mentor 2013 Jan;15(1):56-64. doi: 10.1001/virtualmentor.2013.15.1.pfor2-1301.
.
.
Keywords: Decision Making, Healthcare Delivery, Health Services Research (HSR), Policy