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
176 to 200 of 431 Research Studies DisplayedBlecker S, Herrin J, Li L
Trends in hospital readmission of Medicare-covered patients with heart failure.
This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal heart failure (HF) hospitalizations and other hospitalizations with HF. The investigators found that patients with HF are often hospitalized for other causes, and these hospitalizations have high readmission rates. Policy changes led to decreases in readmission rates for both principal and secondary HF hospitalizations. Readmission rates in both groups remained high, suggesting that initiatives targeting all hospitalized patients with HF continue to be warranted.
AHRQ-funded; HS022882; HS023683.
Citation: Blecker S, Herrin J, Li L .
Trends in hospital readmission of Medicare-covered patients with heart failure.
J Am Coll Cardiol 2019 Mar 12;73(9):1004-12. doi: 10.1016/j.jacc.2018.12.040..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Hospitalization, Medicare, Policy
Schlesinger MJ, Rybowski L, Shaller D
Americans' growing exposure to clinician quality information: insights and implications.
The authors of this article examined the impact of changes in the growth of consumer information seeking and the availability of patient narratives about care on consumer awareness of quality information and sociodemographic differences. Public exposure to quality information of any type doubled between 2010 and 2015, ad exposure to patient narratives and experience surveys tripled. Minority consumers were better informed than whites consistently over this period, although there were differences across subgroups regarding the types of information encountered. An education-related gradient in quality awareness also emerged. The authors conclude that public policy should respond to these emerging trends in information exposure by establishing standards for rigorous elicitation of narratives and assisting consumer learning via a combination of narratives and quantified clinician quality metrics.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Schlesinger MJ, Rybowski L, Shaller D .
Americans' growing exposure to clinician quality information: insights and implications.
Health Aff 2019 Mar;38(3):374-82. doi: 10.1377/hlthaff.2018.05006..
Keywords: Policy, Provider Performance, Public Reporting, Quality of Care, Quality Measures
fRIEDMAN j, Saavedra-Avendano B, Schiavon R
Quantifying disparities in access to public-sector abortion based on legislative differences within the Mexico City metropolitan area.
This study examined abortion access and use in the Mexico City metropolitan area, where it is only legal in the city center. Researchers calculated abortion rates for 75 municipalities in the metropolitan area for 2011-2012. Abortion rates were much lower for women who had to travel into the city center (18.6%) than if they had local access. Each additional 15 minutes of travel reduced access by 33.7%. Women who did travel were most likely in a higher socioeconomic status with a higher education level.
AHRQ-funded; HS025155; HS022981.
Citation: fRIEDMAN j, Saavedra-Avendano B, Schiavon R .
Quantifying disparities in access to public-sector abortion based on legislative differences within the Mexico City metropolitan area.
Contraception 2019 Mar;99(3):160-64. doi: 10.1016/j.contraception.2018.11.012..
Keywords: Access to Care, Disparities, Policy, Women
Hung A, Mullins CD, Slejko JF
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
This study projected cost savings to the TRICARE program from changes to the antidiabetic formulary and utilization management (UM) policies. Budgetary impacts for 3 years as projected using a Microsoft Excel spreadsheet. This model projected a savings of up to $43 million in the third year from revisions to the payer’s formulary.
AHRQ-funded; HS024857.
Citation: Hung A, Mullins CD, Slejko JF .
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
J Manag Care Spec Pharm 2019 Mar;25(3):342-49. doi: 10.18553/jmcp.2019.25.3.342..
Keywords: Care Management, Elderly, Healthcare Costs, Medication, Policy
Shaker MS, Greenhawt MJ
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
Children experiencing anaphylaxis at school may lack access to a personal epinephrine device, prompting recent legislation permitting undesignated (eg, non-student specific) stock epinephrine autoinjector units at school. However, epinephrine device costs vary, and the cost-effectiveness of undesignated school stock epinephrine is uncharacterized to date. The objective of this study was to define value-based strategies for undesignated school stock epinephrine programs.
AHRQ-funded; HS024599.
Citation: Shaker MS, Greenhawt MJ .
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
JAMA Pediatr 2019 Feb;173(2):169-75. doi: 10.1001/jamapediatrics.2018.4275..
Keywords: Healthcare Costs, Education, Policy, Medication
Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA
Perceived impact of state-mandated reporting on infection prevention and control departments.
Currently, most US states have adopted legislation requiring hospitals to submit health care-associated infection (HAI) data. In this study, the authors evaluated the perceived impact of state HAI laws on infection prevention and control (IPC) departments. They concluded that respondents in states with laws reported negative effects on their IPC department, beyond what was required by federal mandates.
AHRQ-funded; HS024339.
Citation: Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA .
Perceived impact of state-mandated reporting on infection prevention and control departments.
Am J Infect Control 2019 Feb;47(2):118-22. doi: 10.1016/j.ajic.2018.08.012..
Keywords: Public Reporting, Policy, Public Health, Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Hospitals
Rees DI, Sabia JJ, Argys LM
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
This study examined the effect of good Samaritan and naxolone access laws (NALs) on opioid-related mortality. Most states have adopted these laws, and the early adopters had the most negative association between NALs and overdose deaths. There was a negative but not statistically significant effect on opioid-related deaths for states with Good Samaritan laws.
AHRQ-funded; HS025014.
Citation: Rees DI, Sabia JJ, Argys LM .
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
J Law Econ 2019 Feb;62(1). doi: 10.1086/700703..
Keywords: Opioids, Mortality, Policy, Medication
Lines LM, Li NC, Mick EO
Emergency department and primary care use in Massachusetts 5 years after health reform.
The goal of this study was to identify characteristics of insured Massachusetts residents associated with primary care sensitive (PCS) emergency department (ED) use, and compare such use for public versus private insurees. The researchers used data on people under age 65 taken from the Massachusetts All-Payer Claims Data for 2011-2012. Their conclusions indicate that public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
AHRQ-funded; HS022194.
Citation: Lines LM, Li NC, Mick EO .
Emergency department and primary care use in Massachusetts 5 years after health reform.
Med Care 2019 Feb;57(2):101-08. doi: 10.1097/mlr.0000000000001025..
Keywords: Emergency Department, Health Insurance, Policy, Primary Care
Chui PW, Parzynski CS, Ross JS
Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes.
This study sought to characterize the association between state certificate of need (CON) regulations and percutaneous coronary interventions (PCI) appropriateness. The investigators found that states with CON had lower proportions of rarely appropriate PCI s, but the absolute differences were small. The investigators note that the findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without acute coronary syndrome.
AHRQ-funded; HS023000.
Citation: Chui PW, Parzynski CS, Ross JS .
Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes.
J Am Heart Assoc 2019 Jan 22;8(2):e010373. doi: 10.1161/jaha.118.010373..
Keywords: Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Heart Disease and Health, Policy, Surgery
de Cordova PB, Steck MBW, Vermeesch A
Health policy engagement among graduate nursing students in the United States.
This study researched the availability and requirements for graduate nursing students to take a dedicated health policy course. American Association of College of Nursing (AACN) member institution students were polled and over 75% reported taking a health policy course. There was an equal distribution between master’s and doctoral students.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Steck MBW, Vermeesch A .
Health policy engagement among graduate nursing students in the United States.
Nurs Forum 2019 Jan;54(1):38-44. doi: 10.1111/nuf.12295..
Keywords: Education: Continuing Medical Education, Nursing, Policy, Provider: Nurse
Wisk LE, Sharma N
Inequalities in young adult health insurance coverage post-federal health reform.
The article investigates disparities in the insurance coverage of young adults before and after the implementation of the Affordable Care Act (ACA). Data from the 2000-2016 National Health Interview Survey was used to compare the effects of the ACA on three groups, aged 13 to 18, 19 to 25, and 26 to 30, with the 19 to 25 group considered as “young adults” for the purposed of this study. Respondents reported their types of health insurance coverage during the last 12 months, their reasons for being uninsured, and sociodemographic information. The article concludes that the ACA significantly impacted insurance coverage for young adults, but disparities remain.
AHRQ-funded; HS022986.
Citation: Wisk LE, Sharma N .
Inequalities in young adult health insurance coverage post-federal health reform.
J Gen Intern Med 2019 Jan;34(1):65-74. doi: 10.1007/s11606-018-4723-0..
Keywords: Disparities, Health Insurance, Policy, Social Determinants of Health, Young Adults
Anderson VR, Ouyang F, Tu W
Medicaid coverage and continuity for juvenile justice-involved youth.
This retrospective cohort study examined Medicaid coverage and continuity for youth with varying levels of justice system involvement and the impact of a policy change allowing Medicaid suspension, rather than termination. The study highlighted the importance of maximizing opportunities to keep youth enrolled, as gaps in coverage likely affect juveniles' access to physical, mental, and behavioral health care.
AHRQ-funded; HS022681.
Citation: Anderson VR, Ouyang F, Tu W .
Medicaid coverage and continuity for juvenile justice-involved youth.
J Correct Health Care 2019 Jan;25(1):45-54. doi: 10.1177/1078345818820043..
Keywords: Access to Care, Children/Adolescents, Medicaid, Policy, Vulnerable Populations
Gordon SH, Sommers BD, Wilson IB
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
This study looked at risk factors for early disenrollment from Colorado’s Affordable Care Act marketplace. Researchers used all-payer claims data from individual market enrollees from 2014-2016. They discovered that nearly 25% Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollement was 30% lower in individuals with cost-sharing plans and 21% lower for those enrolled in gold plans compared to those enrolled in silver plans without cost-sharing subsidies. There was greater disenrollment in beneficiaries with greater hospital and emergency utilization before disenrollment. Also, young adults were 70% more likely to disenroll than older adults.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
Med Care 2019 Jan;57(1):49-53. doi: 10.1097/mlr.0000000000001020..
Keywords: Healthcare Costs, Health Insurance, Policy, Risk, Uninsured
Wilcox L, Sharko M, Hong M
The need for guidance and consistency in adolescent privacy policies: a survey of CMIOs.
Research examining whether and how adolescent patients should gain access to their electronic health records is gaining momentum. In this study, the investigators conducted a survey to explore diversity in adolescent privacy policies and identify common approaches in health information technology management for adolescent patients. Through descriptive analyses of survey data, they found a wide range of institutional policies regarding adolescent patient privacy, and large variations in health IT executives' baseline knowledge of access policies.
AHRQ-funded; HS021531.
Citation: Wilcox L, Sharko M, Hong M .
The need for guidance and consistency in adolescent privacy policies: a survey of CMIOs.
AMIA Annu Symp Proc 2018 Dec 5;2018:1084-92..
Keywords: Children/Adolescents, Policy, Electronic Health Records (EHRs), Health Information Technology (HIT)
Cohen JFW, Gorski Findling MT, Rosenfeld L
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. The investigators concluded that with the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school.
AHRQ-funded; HS000055.
Citation: Cohen JFW, Gorski Findling MT, Rosenfeld L .
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
J Acad Nutr Diet 2018 Dec;118(12):2296-301. doi: 10.1016/j.jand.2018.07.009..
Keywords: Children/Adolescents, Education, Nutrition, Policy
Jacobs PD
AHRQ Author: Jacobs PD
Mandating health insurance coverage for high-income individuals.
In this study, the author describes the effect of the Affordable Care Act’s (ACA’s) individual mandate for health coverage by focusing on higher-income non-elderly adults and exploiting state differences in the rules governing premium setting and coverage issuance in the non-group market prior to 2014.
AHRQ-authored.
Citation: Jacobs PD .
Mandating health insurance coverage for high-income individuals.
National Tax Journal 2018 Dec;71(4):807-28. doi: 10.17310/ntj.2018.4.10..
Keywords: Health Insurance, Policy, Uninsured
Coupet E, Karp D, Wiebe DJ
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
In this study, the investigators determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. The investigators suggest that these findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
AHRQ-funded; HS000028.
Citation: Coupet E, Karp D, Wiebe DJ .
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
Am J Emerg Med 2018 Dec;36(12):2192-96. doi: 10.1016/j.ajem.2018.03.070..
Keywords: Domestic Violence, Emergency Department, Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Medicaid
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Huguet N, Springer R, Marino M
The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers.
The objectives of this study were to: (1) compare clinic-level uninsured, Medicaid-insured, and privately insured visit rates within and between expansion and nonexpansion states before and after the Affordable Care Act (ACA) Medicaid expansion among the 3 cohorts of patient populations; and (2) assess whether there was a change in clinic-level overall, primary care visits, preventive care visits, and diabetes screening rates in expansion versus nonexpansion states from pre-ACA to post-ACA Medicaid expansion.
AHRQ-funded; HS024270.
Citation: Huguet N, Springer R, Marino M .
The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers.
J Am Board Fam Med 2018 Nov-Dec;31(6):905-16. doi: 10.3122/jabfm.2018.06.180075..
Keywords: Diabetes, Healthcare Utilization, Policy, Medicaid
Angraal S, Khera R, Zhou S
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
In this study the investigators we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions or conditions not targeted by the HRRP in age-insurance groups defined by age group (>/=65 years or <65 years) and payer (Medicare, Medicaid, or private insurance). The investigators concluded that there appeared to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.
AHRQ-funded; HS022882.
Citation: Angraal S, Khera R, Zhou S .
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
Am J Med 2018 Nov;131(11):1324-31.e14. doi: 10.1016/j.amjmed.2018.06.013..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Medicaid, Medicare
McManus KA, McManus K, Dillingham R
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
The objective of the study was to explore HIV medical providers' knowledge and attitudes about the Affordable Care Act (ACA). The investigators concluded that: medical providers in Medicaid expansion states were more optimistic about the ACA's likelihood to improve their patients' HIV outcomes; there are gaps in HIV medical providers' understanding of the ACA; and education could enhance systems-based practice.
AHRQ-funded; HS024196.
Citation: McManus KA, McManus K, Dillingham R .
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
Clin Infect Dis 2018 Oct 15;67(9):1403-10. doi: 10.1093/cid/ciy296..
Keywords: Policy, Human Immunodeficiency Virus (HIV), Medicaid, Provider
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ .
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid
Barnett ML, Clark KL, Sommers BD
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
This study examined patient satisfaction among Medicaid enrollees nationally from 2014-2015. Significant disparities were found among racial/ethnic groups. Managed care enrollees had higher satisfaction ratings than those with fee-for-service. If the patient had a personal doctor that increased satisfaction for an average 4.6 percent.
AHRQ-funded; HS021291.
Citation: Barnett ML, Clark KL, Sommers BD .
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
Health Aff 2018 Oct;37(10):1647-55. doi: 10.1377/hlthaff.2018.0505..
Keywords: Access to Care, Disparities, Medicaid, Patient Experience, Policy, Racial and Ethnic Minorities
Law AC, Stevens JP, Hohmann S
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
The objective of this study was to assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. The investigators found that state regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Hohmann S .
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
Crit Care Med 2018 Sep 4;46(10):1563-69. doi: 10.1097/ccm.0000000000003286..
Keywords: Intensive Care Unit (ICU), Policy, Nursing, Outcomes, Patient Safety
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy