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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 8 of 8 Research Studies Displayed
Fraze TK, Beidler LB, Briggs ADM
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
Researchers sought to understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. After conducting semi-structured interviews with Medicare ACOs, they found that ACOs were using care plans for patients with complex needs, but their use of care plans did not always meet the best practices; ACOs were adapting use of care plans to better fit the needs of patients and providers.
Citation: Fraze TK, Beidler LB, Briggs ADM . Translating evidence into practice: ACOs' use of care plans for patients with complex health needs. J Gen Intern Med 2021 Jan;36(1):147-53. doi: 10.1007/s11606-020-06122-4..
Keywords: Implementation, Evidence-Based Practice, Medicare, Health Insurance, Healthcare Delivery
Makam AN, Nguyen OK, Miller ME
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
This study compared the effectiveness of long-term acute care hospital (LTACH) use versus skilled nursing facility (SNF) transfer after hospitalization. Medicare claims linked to electronic health record (EHR) data from six Texas hospitals between 2009 and 2010 were used to conduct a retrospective cohort study of hospitalized patients transferred to either an LTACH or SNF and followed for one year. Out of 3505 patients, 18% were transferred to an LTACH and overall were younger, less likely to be female, and white, but sicker than transfers to an SNF. Patients transferred to an LTACH were less likely to survive (59 vs. 65%) or recover (62.5 vs 66%). Adjusting for demographic and clinical confounders found in Medicare claims and EHR data, transfer location was not significantly associated with differences in mortality but was associated with greater Medicare spending.
Citation: Makam AN, Nguyen OK, Miller ME . Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer. BMC Health Serv Res 2020 Nov 11;20(1):1032. doi: 10.1186/s12913-020-05847-6..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Long-Term Care, Elderly, Medicare, Transitions of Care, Nursing Homes, Hospitals
Goldstone AB, Chiu P, Baiocchi M
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Researchers investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. Operative mortality and long-term survival were compared for Medicare beneficiaries diagnosed with an acute type A aortic dissection who were transferred versus not transferred, underwent surgery at high-volume versus low-volume hospitals, and were rerouted versus not rerouted to a high-volume hospital for treatment. The researchers found that, despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% absolute risk reduction in operative mortality. They recommended that policymakers evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.
Citation: Goldstone AB, Chiu P, Baiocchi M . Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States. Circulation 2019 Oct 8;140(15):1239-50. doi: 10.1161/circulationaha.118.038867..
Keywords: Transitions of Care, Medicare, Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Risk, Evidence-Based Practice, Mortality, Hospitals
Angraal S, Khera R, Wang Y
Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.
The authors sought to evaluate how the use of coronary artery bypass grafting (CABG) and its outcomes have evolved in different sex and racial subgroups. Using Medicare data, they found that women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. The authors conclude that these findings indicate progress, but further progress is needed.
Citation: Angraal S, Khera R, Wang Y . Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014. J Am Heart Assoc 2018 Jul 12;7(14). doi: 10.1161/jaha.118.009014..
Keywords: Cardiovascular Conditions, Elderly, Evidence-Based Practice, Heart Disease and Health, Healthcare Utilization, Medicare, Outcomes, Patient-Centered Outcomes Research, Racial / Ethnic Minorities, Sex Factors
Eze-Ajoku E, Lavoie M, DeCamp M
Exploring the evidence base behind quality measures.
This study examined the strength of evidence behind quality measures used in Medicare’s 2016 Shared Savings Program. These measures apply to more than 430 accountable care organizations (ACOs). Differences existed in the grading systems used and the evidentiary strength. Based on average ACO performance, performance appeared to be lower in the moderate evidence category (overall average, 61 percent) compared to the high evidence category (overall average, 77 percent).
Citation: Eze-Ajoku E, Lavoie M, DeCamp M . Exploring the evidence base behind quality measures. Am J Med Qual 2018 May/Jun;33(3):321-22. doi: 10.1177/1062860617721645.
Keywords: Evidence-Based Practice, Medicare, Payment, Provider Performance, Quality Measures
Cook EA, Schneider KM, Robinson J
Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates.
Comparative effectiveness studies using Medicare claims data are vulnerable to treatment selection biases and supplemental data from a sample of patients has been recommended for examining the magnitude of this bias. The investigators collected medical record data from a subsample of patients to assess the validity of assumptions and to aid in the interpretation of our estimates. In this paper, they sought to describe and document the process used to collect and validate this supplemental information.
Citation: Cook EA, Schneider KM, Robinson J . Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates. BMC Health Serv Res 2014 Sep 15;14:391. doi: 10.1186/1472-6963-14-391..
Keywords: Comparative Effectiveness, Medicare, Evidence-Based Practice, Research Methodologies
Stuart B, Davidoff A, Erten M
AHRQ Author: Davidoff A
How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction.
The authors assessed the impact of Medicare Part D benefit phases on adherence with evidence-based medications after hospitalization for an acute myocardial infarction (AMI). They found that as the Part D doughnut hole is gradually filled in by 2020, Medicare Part D enrollees with critical diseases such as AMI who rely heavily on brand name drugs are likely to exhibit modest increases in adherence, while those reliant on generic drugs are less likely to be affected.
Citation: Stuart B, Davidoff A, Erten M . How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction. Health Serv Res 2013 Dec;48(6 Pt 1):1960-77. doi: 10.1111/1475-6773.12073.
Keywords: Evidence-Based Practice, Medicare, Medication, Heart Disease and Health, Patient Adherence/Compliance
Suskind AM, Clemens JQ, Dunn RL
Effectiveness of mesh compared with nonmesh sling surgery in Medicare beneficiaries.
This study assessed the effectiveness of mesh compared to nonmesh slings in the surgical treatment of female incontinence. It found that overall rates of complications were similar for patients undergoing either mesh or nonmesh sling procedures. However, patients undergoing the nonmesh procedure were more likely to require a subsequent intervention for bladder outlet obstruction.
Citation: Suskind AM, Clemens JQ, Dunn RL . Effectiveness of mesh compared with nonmesh sling surgery in Medicare beneficiaries. Obstet Gynecol. 2013 Sep;122(3):546-52. doi: 10.1097/AOG.0b013e31829e8543..
Keywords: Comparative Effectiveness, Elderly, Patient-Centered Outcomes Research, Surgery, Women, Outcomes, Medicare, Evidence-Based Practice