National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Blood Thinners (2)
- (-) Cardiovascular Conditions (19)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Decision Making (1)
- Diabetes (1)
- Diagnostic Safety and Quality (1)
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- Elderly (4)
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- Evidence-Based Practice (1)
- Healthcare Cost and Utilization Project (HCUP) (3)
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- Heart Disease and Health (11)
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- Pain (1)
- Palliative Care (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Practice Patterns (2)
- Prevention (1)
- Racial and Ethnic Minorities (1)
- Rehabilitation (3)
- Respiratory Conditions (2)
- Risk (1)
- Sex Factors (1)
- Sleep Problems (1)
- Social Determinants of Health (1)
- Stroke (2)
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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
1 to 19 of 19 Research Studies DisplayedCrook S, Dragan K, Woo JL
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
The purpose of this study was to examine the long-term burden of health care expenditures and utilization after pediatric cardiac surgery to improve care and reduce outcome inequities. The study compared children under the age of 18 undergoing cardiac surgery from 2006-2019 to a similar cohort of children without cardiac surgical disease. The research concluded that children after cardiac surgery have substantial long-term health care needs than noncardiac surgical comparators.
AHRQ-funded; HS000055.
Citation: Crook S, Dragan K, Woo JL .
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
J Am Coll Cardiol 2023 Apr 25; 81(16):1605-17. doi: 10.1016/j.jacc.2023.02.021..
Keywords: Children/Adolescents, Healthcare Utilization, Long-Term Care, Cardiovascular Conditions, Medicaid, Surgery
Wickwire EM, Bailey MD, Somers VK
CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease.
The purpose of this study was to examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on health care utilization among a nationally representative and sample of older adults with multiple morbidities and pre-existing cardiovascular disease and subsequently diagnosed with obstructive sleep apnea in the United States. The investigators concluded that in this nationally representative sample of older Medicare beneficiaries with multiple morbidities and relative to low adherers, high adherers demonstrated reduced inpatient utilization.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Bailey MD, Somers VK .
CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease.
J Clin Sleep Med 2022 Jan;18(1):39-45. doi: 10.5664/jcsm.9478..
Keywords: Elderly, Medicare, Sleep Problems, Cardiovascular Conditions, Patient Adherence/Compliance, Hospitalization, Healthcare Utilization, Respiratory Conditions
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Martsolf GR, Nuckols TK, Fingar KR
AHRQ Author: Stocks C, Owens PL
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
The purpose of this study was to compare the rate at which patients with nonspecific chest pain return to the hospital within 7 days after index observation visits versus after index emergency department and inpatient visits. Findings showed that up to 1 in 10 patients discharged with nonspecific chest pain returned to the hospital within 1week. Compared with emergency department and inpatient care, observation visits were associated with lower revisit rates. Recommendations include further research to refine clinical standards of care for nonspecific chest pain as well as to investigate the healthcare delivery and patient factors that influence 7-day revisit rates.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Nuckols TK, Fingar KR .
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
BMC Health Serv Res 2020 Jun 8;20(1):516. doi: 10.1186/s12913-020-05200-x..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Pain, Healthcare Utilization, Hospitals, Heart Disease and Health, Cardiovascular Conditions
Zachrison KS, Aaronson E, Mahmood S
Resource utilisation among patients transferred for intracerebral haemorrhage.
Patients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. The investigators aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital. They used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015.
hospital between 1 January 2005 and 31 December 2015.
AHRQ-funded; HS024561.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Aaronson E, Mahmood S .
Resource utilisation among patients transferred for intracerebral haemorrhage.
Stroke Vasc Neurol 2019 Dec;4(4):223-26. doi: 10.1136/svn-2019-000255..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Utilization, Hospitals
Ngo-Metzger Q, Zuvekas S, Shafer P
AHRQ Author: Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study was to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities.
AHRQ-authored.
Citation: Ngo-Metzger Q, Zuvekas S, Shafer P .
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
J Am Board Fam Med 2019 Nov-Dec;32(6):807-17. doi: 10.3122/jabfm.2019.06.180313..
Keywords: Medical Expenditure Panel Survey (MEPS), Cardiovascular Conditions, Medication, Healthcare Utilization, Prevention, Heart Disease and Health, Disparities
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Shah NR, Ahmed ST, Winchester DE
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
The aim of this study was to quantify variation in cardiac stress test utilization across the Veterans Health Administration (VA) in patients with established ischemic heart disease (IHD). The investigators used VA datasets to identify adults with IHD (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass grafting) with a primary care clinic visit at the VA in fiscal year 2014.
AHRQ-funded; HS022998.
Citation: Shah NR, Ahmed ST, Winchester DE .
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
JACC Cardiovasc Imaging 2019 Jul;12(7 Pt 1):1292-93. doi: 10.1016/j.jcmg.2019.02.020..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality, Healthcare Utilization, Practice Patterns, Imaging
Hirayama A, Goto T, Shimada YJ
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. The investigators found that among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Shimada YJ .
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Circ Arrhythm Electrophysiol 2018 Sep;11(9):e006322. doi: 10.1161/circep.118.006322..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Respiratory Conditions, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Hospitalization, Risk, Healthcare Utilization
Zhu J, Alexander GC, Nazarian S
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
This paper discusses trends in usage of oral anticoagulants in patients with atrial fibrillation from 2010 to 2017. Since 2010, several non-vitamin K antagonist oral coagulants (NOACs) have been brought to the US market. This study examined trends in usage. A cross-sectional analysis of medical and pharmacy claims was done for commercial and Medicare Advantage enrollees in a large, private, US Health plan. A total of 112,187 adults with nonvalvular AF starting OACs was identified. In the first quarter of 2017, out of 7502 patients starting OACs, 78.9% used NOACs and 21.1% warfarin. Usage of regular anticoagulants such as apixaban increases with age, female sex, stroke or bleeding risk and comorbidities. Warfarin and apixaban are generally preferred for elderly patients and patients with higher stroke or bleeding risk.
AHRQ-funded; HS024737.
Citation: Zhu J, Alexander GC, Nazarian S .
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
Pharmacotherapy 2018 Sep;38(9):907-20. doi: 10.1002/phar.2158..
Keywords: Blood Thinners, Cardiovascular Conditions, Healthcare Utilization, Heart Disease and Health, Medication
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.
AHRQ-funded; HS023000.
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 and Ethnic Minorities, Sex Factors
Hollingsworth JM, Nallamothu BK, Yan P
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
This study examined national Medicare data to determine whether or not Medicare accountable care organizations are associated with reductions in the use of low-value coronary revascularization. The investigators found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Nallamothu BK, Yan P .
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
Circ Cardiovasc Qual Outcomes 2018 Jun;11(6):e004492. doi: 10.1161/circoutcomes.117.004492..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Medicare, Heart Disease and Health
Kalbaugh CA, Loehr L, Wruck L
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
Researchers analyzed frequency of care and mortality date for patients with an initial peripheral artery disease (PAD) diagnosis in the outpatient or inpatient setting. Data was analyzed from the ARIC (Atherosclerosis Risk in Communities) study cohort linked with Centers for Medicare and Medicaid Services fee-for-services claims data for 2002-2012. Patients diagnosed in the outpatient setting had higher follow-up rates with lower hospitalizations and mortality than those diagnosed in the inpatient setting.
AHRQ-funded; HS000032; HS023728.
Citation: Kalbaugh CA, Loehr L, Wruck L .
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007332..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Hospitalization, Mortality, Outcomes
Pantalone KM, Misra-Hebert AD, Hobbs TM
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
The researchers evaluated real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD). Their data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
Cardiovasc Diabetol 2018 Apr 10;17(1):54. doi: 10.1186/s12933-018-0699-7.
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Keywords: Cardiovascular Conditions, Diabetes, Healthcare Utilization, Patient-Centered Healthcare
Bachmann JM, Huang S, Gupta DK
Association of neighborhood socioeconomic context with participation in cardiac rehabilitation.
This study investigated the association of neighborhood socioeconomic context with Cardiac Rehabilitation (CR) participation in the Southern Community Cohort Study- a prospective cohort study of 84 569 adults in the southeastern United States from 2002 to 2009, 52 117 of whom have Medicare or Medicaid claims. The study found that lower neighborhood socioeconomic context was associated with decreased CR participation independent of individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Huang S, Gupta DK .
Association of neighborhood socioeconomic context with participation in cardiac rehabilitation.
J Am Heart Assoc 2017 Oct 11;6(10). doi: 10.1161/jaha.117.006260..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Patient-Centered Outcomes Research, Rehabilitation, Social Determinants of Health
Yim CK, Barron Y, Moore S
Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization.
Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. This descriptive analysis of Medicare fee-for-service beneficiaries found that home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment.
AHRQ-funded; HS020257.
Citation: Yim CK, Barron Y, Moore S .
Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization.
Circ Heart Fail 2017 Mar;10(3). doi: 10.1161/circheartfailure.116.003335.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Healthcare Utilization, Medicare, Palliative Care
Kelly JP, Hammill BG, Doll JA
The potential impact of expanding cardiac rehabilitation in heart failure.
The authors sought to characterize the patient population newly eligible for cardiac rehabilitation (CR) based on the 2014 CMS expanded coverage criteria. Their findings suggested that expansion of coverage for the newly eligible group is an important systems process to undertake to rapidly increase the participating eligible patients and that extension of CR coverage to the ineligible group should be considered.
AHRQ-funded; HS021092.
Citation: Kelly JP, Hammill BG, Doll JA .
The potential impact of expanding cardiac rehabilitation in heart failure.
J Am Coll Cardiol 2016 Aug 30;68(9):977-8. doi: 10.1016/j.jacc.2016.05.081.
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Keywords: Cardiovascular Conditions, Elderly, Healthcare Utilization, Heart Disease and Health, Rehabilitation
Desai NR, Bradley SM, Parzynski CS
Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention.
The researchers examined trends in percutaneous coronary intervention (PCI) utilization, patient selection, and procedural appropriateness following the introduction of Appropriate Use Criteria. They concluded that there have been significant reductions in the volume of nonacute PCI. The proportion of nonacute PCIs classified as inappropriate has declined, although hospital-level variation in inappropriate PCI persists.
AHRQ-funded; HS023000.
Citation: Desai NR, Bradley SM, Parzynski CS .
Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention.
JAMA 2015 Nov 17;314(19):2045-53. doi: 10.1001/jama.2015.13764.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Healthcare Utilization
Dresden SM, O'Connor LM, Pearce CG
National trends in the use of postcardiac arrest therapeutic hypothermia and hospital factors influencing its use.
The goal of this study is to use population-based national hospital discharge data to examine trends in the use of therapeutic hypothermia (TH) in both in- and out-of-hospital cardiac arrest patients after implementation of the 2005 American Heart Association guidelines. Its findings demonstrate that while TH use is increasing, the overall utilization of TH relative to all cardiac arrests remains very low.
AHRQ-funded; HS000078.
Citation: Dresden SM, O'Connor LM, Pearce CG .
National trends in the use of postcardiac arrest therapeutic hypothermia and hospital factors influencing its use.
Ther Hypothermia Temp Manag 2015 Mar;5(1):48-54. doi: 10.1089/ther.2014.0023..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Cardiovascular Conditions, Healthcare Utilization