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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.
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1 to 25 of 376 Research Studies DisplayedMeille G, Post B
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Wu AJ, Du N, Chen TY
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
The objective of this study was to examine sociodemographic differences between elective and nonelective admissions for failure to thrive. Researchers investigated associations between admission type and hospital resource utilization, including length of stay and feeding tube placement. The study included data on children less than 2 years old with failure to thrive in the Kids' Inpatient Database. The findings showed differences by race and ethnicity, income, and insurance type, among other factors. Nonelective admissions had higher proportions of infants who were Black, Hispanic, and of lower-income, and were associated with longer lengths of stay. The researchers concluded that future research is needed to elucidate drivers of these differences, particularly those related to racial and ethnic disparities and structural racism.
AHRQ-funded; HS000063.
Citation: Wu AJ, Du N, Chen TY .
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
J Pediatr Gastroenterol Nutr 2023 Mar;76(3):385-89. doi: 10.1097/mpg.0000000000003694.
Keywords: Newborns/Infants, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Healthcare Utilization, Children/Adolescents, Racial and Ethnic Minorities, Low-Income
Kalata S, Howard R, Diaz A
Association of skilled nursing facility ownership by health care networks with utilization and spending.
The objective of this cross-sectional study was to determine the association of vertical integration of skilled nursing facilities (SNFs) within hospital networks with SNF utilization, readmissions, and spending. Claims data from Medicare beneficiaries aged 66 to 99 who had undergone elective hip replacement in nonfederal acute care hospitals during the study period was analyzed. Results showed that vertical SNF integration was associated with a higher rate of SNF utilization and a lower 30-day readmission rate; in spite of higher utilization, 30-day episode payments were slightly lower. Adjusted readmission rates were especially low for patients who were not sent to an SNF but were significantly higher for patients with a length of stay of less than 5 days. The authors concluded these findings support the value of integrating SNFs into hospital networks, but there is room for improvement in postoperative care early in the SNF patients’ stay.
AHRQ-funded; HS028606.
Citation: Kalata S, Howard R, Diaz A .
Association of skilled nursing facility ownership by health care networks with utilization and spending.
JAMA Netw Open 2023 Feb; 6(2):e230140. doi: 10.1001/jamanetworkopen.2023.0140..
Keywords: Nursing Homes, Healthcare Utilization, Healthcare Costs, Medicare
Ehlers AP, Howard R, Lai YL
Postacute care utilization and episode of care payments following common elective operations.
The purpose of the cross-sectional study was to analyze post-acute care (PAC) usage and its associated costs for patients undergoing common elective procedures. The researchers examined adult patients in a statewide administrative claims database who underwent elective cholecystectomy, ventral or incisional hernia repair (VIHR), and groin hernia repair between 2012 and 2019. The study found that among the 34,717 patients who underwent elective cholecystectomy, PAC was utilized by 0.7%, resulting in significantly higher payments ($19,047 vs $7,830, P < 0.001). For the 29,826 patients who underwent VIHR, 1.7% utilized PAC, leading to significantly higher payments ($19,766 vs $9,439, P < 0.001). Of the 37,006 patients who underwent groin hernia repair, 0.3% utilized PAC services, incurring significantly higher payments ($14,886 vs $8,062, P < 0.001). The study identified both modifiable and non-modifiable risk factors associated with PAC utilization. Morbid obesity was linked to PAC usage following VIHR. Male gender was associated with reduced odds of PAC utilization for VIHR and groin hernia repair. The researchers concluded that the study identified both modifiable (e.g., obesity) and nonmodifiable (e.g., female gender) patient factors associated with PAC utilization. To optimize patients and minimize PAC usage, it is essential to understand patient risk factors and implement systems and processes that address these factors.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Howard R, Lai YL .
Postacute care utilization and episode of care payments following common elective operations.
Ann Surg 2023 Feb; 277(2):e266-e72. doi: 10.1097/sla.0000000000004814.
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Keywords: Surgery, Healthcare Utilization
Levander XA, Foot CA, Magnusson SL
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
This study’s goal was to compare contraceptive use prevalence among women who use drugs (WWUD) in rural communities with women who do not use drugs from similar rural areas. The authors used survey data from the Rural Opioids Initiative (ROI), a cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020) and the National Survey on Family Growth (NSFG), a nationally representative U.S. household reproductive health survey (2017-2019). Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use were included. Of 855 women in the ROI, 36.8% and 38.6% reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use. There was a positive association between contraception use and recent medications for opioid use disorder and prior 6-month primary care utilization that did not meet the threshold for statistical significance.
AHRQ-funded; HS02637; HS027088.
Citation: Levander XA, Foot CA, Magnusson SL .
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
J Gen Intern Med 2023 Jan; 38(1):98-106. doi: 10.1007/s11606-022-07558-6..
Keywords: Sexual Health, Women, Healthcare Utilization, Rural Health
Chang E, Ali R, Seibert J
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
The authors of this article reviewed evidence on the effectiveness of complex interventions designed to change the healthcare of high-need, high-cost patients. They found limited evidence of intervention effectiveness in relation to cost and use, but note that additional evidence is needed to strengthen their confidence in these findings. Few studies reported clinical/functional or social risk factor outcomes or sufficient details for determining why individual interventions work. They conclude that future evaluations could provide additional insights in assessing the impact of complex interventions.
AHRQ-funded; 290201500011I.
Citation: Chang E, Ali R, Seibert J .
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
J Gen Intern Med 2023 Jan; 38(1):185-94. doi: 10.1007/s11606-022-07809-6..
Keywords: Healthcare Costs, Healthcare Delivery, Chronic Conditions, Healthcare Utilization
Richmond J, Adams LB, Annis IE
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
The purpose of this cross-sectional survey study was to assess factors related with African American parents seeking care for their child within 30 days after identifying the child’s behavioral or emotional need and with postponing care for 1 year or more. The researchers surveyed 289 African American parents who were raising a child with emotional or developmental challenges to explore relationships between parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care (within 30 days after identifying a child’s need) and deferring care seeking. The study found that approximately 22% of parents rapidly sought care, and 49% deferred care for 1 year or more. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. The researchers concluded that when developing programs that support African American families, professionals should be advised about facilitators and barriers to mental health care seeking.
AHRQ-funded; HS026122.
Citation: Richmond J, Adams LB, Annis IE .
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
Psychiatr Serv 2022 Dec;73(12):1359-66. doi: 10.1176/appi.ps.202100553..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Behavioral Health, Healthcare Utilization
Clements KM, Kunte PS, Clark MA
Uptake of hepatitis C virus treatment in a multi-state Medicaid population, 2013-2017.
The purpose of this study was to explore trends in the direct acting antiviral (DAA) uptake in a multi-state Medicaid population with hepatitis C virus (HCV) prior to and after ledipasvir/sofosbuvir (LDV/SOF) approval and changes in prior authorization (PA) requirements. The researchers analyzed annual enrollment, medical, and pharmacy claims for 38,302 to 45,005 people per year in four states, between December 2013 and December 2017. The study found that uptake increased from 0.34% per month in October 2014 to 0.70% per month after LDV/SOF approval and increased relative to the pre-LDV/SOV trend through June 2016. Uptake increased to 1.18% per month after PA change and remained static through 2017. In plans with few or no requirements through 2017, uptake increased to 1.19% per month after LDV/SOF approval and remained static through 2017, with 22.2% cumulatively treated. Among plans that lifted PA requirements from three to zero in mid-2016, uptake did not increase after LDV/SOF approval but did increase to 1.41% per month after PA change, with 18.1% cumulatively treated. The researchers concluded that LDV/SOF approval and lifting PA requirements led to an increase in uptake followed by static monthly utilization, and HCV treatment increased through 2017.
AHRQ-funded; HS025717.
Citation: Clements KM, Kunte PS, Clark MA .
Uptake of hepatitis C virus treatment in a multi-state Medicaid population, 2013-2017.
Health Serv Res 2022 Dec;57(6):1312-20. doi: 10.1111/1475-6773.13994..
Keywords: Hepatitis, Medicaid, Infectious Diseases, Healthcare Utilization
Angier H, Kaufmann J, Heintzman J
Association of parent preventive care with their child's recommended well-child visits.
The purpose of this retrospective, cohort study was to explore whether there is a relationship between parent preventive care and their children's well-child visits. The researchers utilized electronic health record data to identify children and link them to parents both seen in an OCHIN network of 363 clinics from 17 states, then randomly selected a child between the ages of 3 and 17 with more than 1 ambulatory medical visit between the years 2015 and 2018. The study included a sample of 75,398 linked mother only pairs, 12,438 father only pairs, and 4,156 2-parent pairs. Children in the mother only sample had a 6% greater rate of yearly well-child visits when their mother received preventive care compared to no preventive care, children in the father only sample had a 7% greater rate of yearly well-child visits when their father received preventive care versus no preventive care, and children in the two parent sample had an 11% greater rate of yearly well-child visits when both parents received preventive care compared to neither receiving preventive care. The researchers concluded that well-child visit rates may improve when care is provided for the entire family.
AHRQ-funded; HS025962.
Citation: Angier H, Kaufmann J, Heintzman J .
Association of parent preventive care with their child's recommended well-child visits.
Acad Pediatr 2022 Nov-Dec;22(8):1422-28. doi: 10.1016/j.acap.2022.03.019..
Keywords: Children/Adolescents, Prevention, Family Health and History, Healthcare Utilization
Soltani Batt, RJ Bavafa, H
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
The purpose of this study was to evaluate the effects of Emergency Department (ED) crowding on the performance of systems outside of the ED: specifically, on the use of post-ED care. The researchers also examined the mediating effects of care intensity in the ED on post-ED use of care. The study utilized microdata from a large U.S. hospital dataset gathered from over four years of exhaustive billing data in an integrated health system. The study found that when ED provider workload increased from the 5th percentile to the median, the number of medical services for patients who were discharged home from the ED increased by 5% and was stable after. The researchers also discovered that when a physician is busier, they order a greater number of tests for patients who are less severe. The study concluded that "extra" testing by providers results in "extra" post-ED care use for those patients, and that earlier studies estimating the cost of ED crowding underestimate the actual effect, because they do not take into account the "extra" post-ED care use.
AHRQ-funded; HS024558.
Citation: Soltani Batt, RJ Bavafa, H .
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
Manuf Serv Oper Manag 2022 Nov-Dec;24(6):3079-98. doi: 10.1287/msom.2022.1110..
Keywords: Emergency Department, Healthcare Utilization
Williams PH, Gilmartin HM, Leonard C
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
This study’s objective was to examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for Veterans Affairs Healthcare System Rural Transitions Nurse Program (TNP) enrollees compared to controls. Although findings showed no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs, suggesting a shifting of costs from the inpatient to outpatient setting.
AHRQ-funded; HS024569.
Citation: Williams PH, Gilmartin HM, Leonard C .
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
J Gen Intern Med 2022 Nov;37(14):3529-34. doi: 10.1007/s11606-022-07401-y..
Keywords: Rural Health, Veterans, Nursing, Transitions of Care, Healthcare Utilization, Healthcare Costs
Abdus S, Selden TM
Well-child visit adherence.
This article presents updated evidence on well-child visit adherence, using MEPS data to conduct a cross-sectional study. The results indicate that average adherence increased between 2006-07 and 2016-17, but the authors note that large gaps remain in such areas as race and ethnicity, poverty level, insurance coverage, and geographic region.
AHRQ-authored.
Citation: Abdus S, Selden TM .
Well-child visit adherence.
JAMA Pediatr 2022 Nov;176(11):1143-45. doi: 10.1001/jamapediatrics.2022.2954..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Healthcare Utilization, Access to Care
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Sakai-Bizmark R, Kumamaru H, Estevez D
Association between suicide attempt and previous healthcare utilization among homeless youth.
The purpose of this study was to examine the association between prior emergency department visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old using New York statewide databases. Findings showed an association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth.
AHRQ-funded; 900014-17-05.
Citation: Sakai-Bizmark R, Kumamaru H, Estevez D .
Association between suicide attempt and previous healthcare utilization among homeless youth.
Suicide Life Threat Behav 2022 Oct;52(5):994-1001. doi: 10.1111/sltb.12897..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Healthcare Utilization
Chatterjee P, Liao JM, Wang E
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
The purpose of this study was to describe the distribution of outpatient care for dual-eligible Medicare beneficiaries ("duals") and characterize the intensity of outpatient care utilization of duals vs non-dual-eligible beneficiaries ("nonduals"). The researchers assessed the distribution of outpatient care across physician practices and compared the use of different outpatient services between duals and nonduals. The study found that nearly 80% of outpatient visits for duals were provided by 35% of practices. Compared with low-dual and no-dual practices, high-dual practices served more patients, with morhe comorbidities. Duals had 2 less outpatient visits per year compared with nonduals with substantially fewer subspecialty care visits despite having more comorbidities.
AHRQ-funded; HS027595.
Citation: Chatterjee P, Liao JM, Wang E .
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
Am J Manag Care 2022 Oct;28(10):e370-e77. doi: 10.37765/ajmc.2022.89189..
Keywords: Ambulatory Care and Surgery, Medicare, Medicaid, Care Management, Healthcare Utilization
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
This retrospective cohort study sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. The authors defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. The number of first-degree relatives (FDRs) living within 30 miles of the patient was measured using 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%), unplanned readmission, nonindex readmission; higher rates of home discharge. A larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission, 30-day unplanned readmission, nonindex readmission; higher likelihood of home discharge; and shorter index length of stay.
AHRQ-funded; HS025776.
Citation: Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R .
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
Ann Surg 2022 Oct 1;276(4):720-31. doi: 10.1097/sla.0000000000005584..
Keywords: Surgery, Hospital Discharge, Hospital Readmissions, Healthcare Utilization
Dixit RA, Ratwani RM, Bishop JA
The impact of expanded telehealth availability on primary care utilization.
This study examined the impact of telehealth availability due to the COVID-19 pandemic and whether it may result in an unnecessary increase in utilization. The authors analyzed 4,114,651 primary care encounters from three healthcare systems between 2019 and 2021 and found little change in telehealth utilization as it became widely available.
AHRQ-funded; HS028255.
Citation: Dixit RA, Ratwani RM, Bishop JA .
The impact of expanded telehealth availability on primary care utilization.
NPJ Digit Med 2022 Sep 9;5(1):141. doi: 10.1038/s41746-022-00685-8..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Utilization
Encinosa W, Lane K, Cornelio N
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
This article discusses the 2022 No Surprises Act whose goal was to prevent patients from receiving unexpected emergency department (ED) out-of-network physician bills and restrict out-of-network co-payments to in-network co-payment levels. Similar state bans were examined to determine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. The authors examined 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. They found that the bans reduced spending per visit by 14% but spurred a demand response with an increase of 3 percentage points in ED visits which wiped away the cost savings. The authors predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings.
AHRQ-authored; AHRQ-funded; HS027698.
Citation: Encinosa W, Lane K, Cornelio N .
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
Am J Manag Care 2022 Sep;28(9):e333-e38. doi: 10.37765/ajmc.2022.89226..
Keywords: Healthcare Costs, Emergency Department, Policy, Healthcare Utilization
Shankar LG, Habich M, Rosenman M
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Investigators described pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic. They found that mental health ED visit rates by children increased during the COVID-19 pandemic.
AHRQ-funded; HS026385.
Citation: Shankar LG, Habich M, Rosenman M .
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Acad Pediatr 2022 Sep-Oct;22(7):1127-32. doi: 10.1016/j.acap.2022.05.022..
Keywords: COVID-19, Children/Adolescents, Emergency Department, Behavioral Health, Healthcare Utilization, Public Health
Fleming MD, Evans JL, Graham-Squire D
Association of shelter-in-place hotels with health services use among people experiencing homelessness during the COVID-19 pandemic.
During the COVID-19 pandemic, some jurisdictions utilized shelter-in-place (SIP) hotels to provide emergency shelter and support services to people experiencing homelessness (PEH) to reduce the risk of COVID-19 infection. The purpose of this study was to evaluate the association of SIP hotel placements with prior high acute health service use and compare health services use between PEH with prior high service use who did and did not receive a SIP hotel placement. The researchers assessed 25 SIP hotels in San Francisco, California from April 2020 to April 2021 and analyzed data from February 2021 to May 2022. Study participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. The study reported that the mean number of ED visits decreased significantly in the high-user SIP group compared with high-user controls. The mean number of hospitalizations decreased significantly from 0.41 to 0.14 for SIP guests vs 0.27 to 0.22 for controls. Inpatient hospital days decreased significantly from a mean of 4.00 to 0.81 for SIP guests vs 2.27 to 1.85 for controls as did psychiatric emergency visits, from a mean of 0.03 to 0.01 visits for SIP guests vs no change in the control group. The researchers concluded that placement of PEH in SIP hotels was correlated with significantly reduced acute care use when compared with high acute care users with no SIP placement.
AHRQ-funded; HS027648.
Citation: Fleming MD, Evans JL, Graham-Squire D .
Association of shelter-in-place hotels with health services use among people experiencing homelessness during the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2223891. doi: 10.1001/jamanetworkopen.2022.23891..
Keywords: COVID-19, Access to Care, Healthcare Utilization, Public Health
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Newgard CD, Lin A, Caughey AB
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
The purpose of this study was to assess the prognoses, healthcare use, transitions to skilled nursing or hospice, and mortality of older, community-living adults after a fall. The researchers conducted a secondary analysis of all adults in 7 Northwest U.S. counties greater than or equal to 65 years of age who had been transported to one of 51 hospitals after a fall. The study analyzed Medicare claims, state trauma registry data, state inpatient data, and death records for outcomes which included healthcare use, new claims for skilled nursing and hospice for one year, and mortality. The researchers found that in 3,159 older adults there were 147 deaths within 30 days and 665 deaths within one year, and the following predictors of mortality: respiratory diagnosis, serious brain injury, having a baseline disability, or a score of greater than or equal to 2 on the Charlson Comorbidity Index. The study concluded that in the year after experiencing a fall, community-living older adults who require ambulance transport to the hospital have increases in institutionalized living, the utilization of health care, and mortality.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Caughey AB .
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
West J Emerg Med 2022 May 14;23(3):375-85. doi: 10.5811/westjem.2021.11.54327..
Keywords: Elderly, Falls, Emergency Department, Mortality, Healthcare Utilization
Green RK, Shah MN, Clark LR
Comparing emergency department use among individuals with varying levels of cognitive impairment.
This study compared the frequency of emergency department (ED) use among a cohort of individuals with mild to well-defined cognitive impairment. This retrospective cohort study of English-speaking, community-dwelling individuals was conducted at four health system-based multidisciplinary clinics from 2014 to 2016. The authors obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. They characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches. Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as having mild cognitive impairment (MCI), and 318 as having Alzheimer’s Disease and related dementias (ADRD). The proportion of subjects with any annual ED use did not significantly increase with greater cognitive impairment. The average number of ED visits also did not increase significantly with patients with MCI or ADRD having an elevated but non-significant risk of an ED visit compared to cognitively intact individuals.
AHRQ-funded; HS024558.
Citation: Green RK, Shah MN, Clark LR .
Comparing emergency department use among individuals with varying levels of cognitive impairment.
BMC Geriatr 2022 May 2;22(1):382. doi: 10.1186/s12877-022-03093-5..
Keywords: Emergency Department, Neurological Disorders, Healthcare Utilization
Mahony T, Harder VS, Ang N
Weekend versus weekday asthma-related emergency department utilization.
The objective of this study was to assess variation in pediatric asthma-related emergency department (ED) visits between weekends and weekdays. Data was taken from California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims sources for children and adolescents in stratified groups aged 3 to 21. The asthma-related ED visit rate was slightly lower on weekends. The authors concluded that their findings suggest the increase of access options during the weekend may not necessarily decrease asthma-related ED visits.
AHRQ-funded; HS025297; HS020518; 233201600221A; 233201550088A
Citation: Mahony T, Harder VS, Ang N .
Weekend versus weekday asthma-related emergency department utilization.
Acad Pediatr 2022 May-Jun;22(4):640-46. doi: 10.1016/j.acap.2021.09.005..
Keywords: Asthma, Respiratory Conditions, Emergency Department, Healthcare Utilization
Fritz CQ, Hall M, Bettenhausen JL
Child Opportunity Index 2.0 and acute care utilization among children with medical complexity.
This cross-sectional, multicenter study examined the association between ZIP code-level opportunity and acute care utilization among children with medical complexity (CMS). The authors assessed associations between the nationally-normed, multi-dimensional ZIP code-level Child Opportunity Index 2.0 (COI) and total utilization days (hospital bed-days + emergency department (ED) discharge encounters). In adjusted analyses, patients in the lowest COI quintile (lowest opportunity) utilized care at 1.22 times the rate of those from the highest COI quintile.
AHRQ-funded; HS026122.
Citation: Fritz CQ, Hall M, Bettenhausen JL .
Child Opportunity Index 2.0 and acute care utilization among children with medical complexity.
J Hosp Med 2022 Apr;17(4):243-51. doi: 10.1002/jhm.12810..
Keywords: Children/Adolescents, Hospitalization, Healthcare Utilization
