National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- (-) Ambulatory Care and Surgery (17)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
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- Healthcare-Associated Infections (HAIs) (1)
- (-) Healthcare Costs (17)
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- Inpatient Care (1)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (4)
- Medication (2)
- Patient Safety (1)
- Payment (3)
- Pregnancy (1)
- Prevention (1)
- Primary Care (1)
- Surgery (5)
- Treatments (1)
- Urinary Tract Infection (UTI) (1)
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 17 of 17 Research Studies DisplayedLevine 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
Rinke ML, Oyeku SO, Ford WJH
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This retrospective case control study estimated additional costs associated with pediatric ambulatory central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery. The authors concluded that ambulatory HAI in pediatric patients were associated with significant additional costs.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Ford WJH .
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Infect Control Hosp Epidemiol 2020 Nov;41(11):1292-97. doi: 10.1017/ice.2020.305..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Ambulatory Care and Surgery, Healthcare Costs, Surgery
Brown TT, Guo C, Whaley C
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
This study examined how reference-based benefits (RBB) affect out-of-pocket payments across outpatient procedures. The California Public Employees’ Retirement System (CalPERS) applied RBB only to outpatient procedures performed in a hospital outpatient department (HOPD) and not to outpatient procedures performed in a lower cost ambulatory surgery center. Claims from 2009-2013 on arthroscopy and colonoscopy services were analyzed. CalPERS patients paid an average of 63.9% more for HOPDs than ambulatory surgery centers in 2012, but for arthroscopy there was no statistically different cost sharing. This led to high-priced HOPDs being less likely to be chosen by CalPERS patients for both procedures.
AHRQ-funded; HS022098.
Citation: Brown TT, Guo C, Whaley C .
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
Med Care Res Rev 2020 Jun;77(3):261-73. doi: 10.1177/1077558718793325..
Keywords: Payment, Healthcare Costs, Health Insurance, Ambulatory Care and Surgery
Carey K, Mitchell JM
Specialization as an organizing principle: the case of ambulatory surgery centers.
The authors conducted an empirical investigation of the relative cost of production in ambulatory surgical centers (ASCs) over varying degrees of specialization. They found that for the majority of ASCs, focus on a specialty was associated with lower facility costs and ASCs appeared to be capturing economies of scale over a broad range of service volume. The authors concluded that these results support the focused factory model of production in the ASC sector.
AHRQ-funded; HS023768.
Citation: Carey K, Mitchell JM .
Specialization as an organizing principle: the case of ambulatory surgery centers.
Med Care Res Rev 2019 Aug;76(4):386-402. doi: 10.1177/1077558717729228..
Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Costs
Brown TT, Atal JP
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
This study assessed the robustness of using preprocessing techniques for difference-in differences in reference pricing studies for outpatient medical procedures. Three different approaches were tested: propensity score reweighting, exact matching, and genetic matching. The three approaches did not yield statistically different results from those previously published.
AHRQ-funded; HS022098.
Citation: Brown TT, Atal JP .
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
Health Econ 2019 Feb;28(2):280-98. doi: 10.1002/hec.3841..
Keywords: Ambulatory Care and Surgery, Healthcare Costs
San Juan J, Hou H, Ghani KR
Variation in spending around surgical episodes of urinary stone disease: findings from Michigan.
This study examined variations in outpatient procedure costs for patients undergoing uretoscopy or shock wave lithotripsy at 62 hospitals in Michigan from 2012 to 2015. Expenditures were totals for all relevant procedures during the 30-day surgical episodes. A total of 9,449 uteroscopy and 6,446 shock wave lithotripsy procedures were performed. The main variations were explained by payment differences for the index procedure and postacute care services.
AHRQ-funded; HS024525; HS024728.
Citation: San Juan J, Hou H, Ghani KR .
Variation in spending around surgical episodes of urinary stone disease: findings from Michigan.
J Urol 2018 May;199(5):1277-82. doi: 10.1016/j.juro.2017.11.075..
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Hospitals, Surgery
Carey K, Mitchell JM
Specialization and production cost efficiency: evidence from ambulatory surgery centers.
This study took a multiple output cost function approach to an empirical investigation that compared production economies in single specialty ambulatory surgery centers (ASCs) with those in multispecialty ASCs. The study results indicated that both types of ASC had small room for expansion. The results provided support for the focused factory model of production in the ASC sector.
AHRQ-funded; HS023768.
Citation: Carey K, Mitchell JM .
Specialization and production cost efficiency: evidence from ambulatory surgery centers.
Int J Health Econ Manag 2018 Mar;18(1):83-98. doi: 10.1007/s10754-017-9225-9..
Keywords: Surgery, Ambulatory Care and Surgery, Healthcare Costs
Biener AI, Selden TM
AHRQ Author: Biener AI, Selden TM
Public and private payments for physician office visits.
Using data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance, researchers found that adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance.
AHRQ-authored.
Citation: Biener AI, Selden TM .
Public and private payments for physician office visits.
Health Aff 2017 Dec;36(12):2160-64. doi: 10.1377/hlthaff.2017.0749.
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Keywords: Healthcare Costs, Payment, Health Insurance, Ambulatory Care and Surgery, Medical Expenditure Panel Survey (MEPS)
Carey K
Ambulatory surgery centers and prices in hospital outpatient departments.
Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25 percent to 5.15 percent lower for each additional ASC per 100,000 persons in a market.
AHRQ-funded; HS023780.
Citation: Carey K .
Ambulatory surgery centers and prices in hospital outpatient departments.
Med Care Res Rev 2017 Apr;74(2):236-48. doi: 10.1177/1077558716633010.
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Keywords: Ambulatory Care and Surgery, Healthcare Costs, Payment, Hospitals
Predmore Z, Nie X, Main R
Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high.
Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data. It found that during 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.
AHRQ-funded; HS000029.
Citation: Predmore Z, Nie X, Main R .
Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high.
Am J Gastroenterol 2017 Feb;112(2):297-302. doi: 10.1038/ajg.2016.266.
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Keywords: Digestive Disease and Health, Ambulatory Care and Surgery, Healthcare Costs
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Carey K
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid. It found that for six common outpatient surgical procedures, prices paid to ASCs on the whole grew in line with general medical care prices, while overall prices paid to hospital outpatient departments for the same procedures climbed sharply.
AHRQ-funded; HS023780.
Citation: Carey K .
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
Health Aff 2015 Oct;34(10):1738-44. doi: 10.1377/hlthaff.2015.0252..
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Surgery
Ray KN, Chari AV, Engberg J
Opportunity costs of ambulatory medical care in the United States.
The authors aimed to quantify the opportunity costs for adults seeking medical care for themselves or others. Using the 2003-2010 American Time Use Survey, they found that total opportunity costs per year for all physician visits in the United States were $52 billion in 2010. They concluded that, for every dollar spent in visit reimbursement, an additional 15 cents were spent in opportunity costs.
AHRQ-funded; HS022989.
Citation: Ray KN, Chari AV, Engberg J .
Opportunity costs of ambulatory medical care in the United States.
Am J Manag Care 2015 Aug;21(8):567-74.
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Keywords: Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Ambulatory Care and Surgery
Robinson JC, Brown T, Whaley C
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
The researchers analyzed the impact of reference-based benefit (RBB) designs on cataract surgery patients choice of less-expensive ambulatory surgery centers over more expensive hospital outpatient departments. Examining two groups of patients, one in plans incorporating RBB and the other in non-RBB plans, they found that the shift to RBB led to an 8.6 percent increase in ambulatory surgery centers as well as a 19.7 percent decrease in payments per procedure.
AHRQ-funded; HS022098
Citation: Robinson JC, Brown T, Whaley C .
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
Health Aff. 2015 Mar;34(3):415-22. doi: 10.1377/hlthaff.2014.1198..
Keywords: Ambulatory Care and Surgery, Eye Disease and Health, Health Insurance, Healthcare Costs, Health Insurance
Dalton VK, Liang A, Hutton DW
Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.
The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss treatment beyond expectant management and operating room surgical evacuation (usual care). It found that the cost per case was $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model.
AHRQ-funded; HS015491.
Citation: Dalton VK, Liang A, Hutton DW .
Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.
Am J Obstet Gynecol 2015 Feb;212(2):177.e1-6. doi: 10.1016/j.ajog.2014.08.031..
Keywords: Healthcare Costs, Pregnancy, Treatments, Ambulatory Care and Surgery
Galarraga JE, Mutter R, Pines JM
AHRQ Author: Mutter R
Costs associated with ambulatory care sensitive conditions across hospital-based settings.
The objective of this study was to identify the cost differences in payments and charges for ambulatory care-sensitive conditions (ACSC) visits in three different hospital-based settings: outpatient visits, ED visits, and inpatient admissions. After adjusting for patient demographics and comorbid conditions, charges for an inpatient ACSC visit were four times higher ($11,414 vs. $2,563) when compared to an ED visit.
AHRQ-authored.
Citation: Galarraga JE, Mutter R, Pines JM .
Costs associated with ambulatory care sensitive conditions across hospital-based settings.
Acad Emerg Med. 2015 Feb;22(2):172-81. doi: 10.1111/acem.12579..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Emergency Medical Services (EMS), Ambulatory Care and Surgery, Inpatient Care
Forrester SH, Hepp Z, Roth JA
Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care.
The study objective was to estimate the cost-effectiveness of computerized provider order entry versus traditional paper-based prescribing in reducing medications errors and adverse drug events in the ambulatory setting of mid-sized medical group. Using a decision-analytic model, the researchers found that the adoption of CPOE in the ambulatory setting provides excellent value for the investment.
AHRQ-funded; HS014739
Citation: Forrester SH, Hepp Z, Roth JA .
Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care.
Value Health. 2014 Jun;17(4):340-9. doi: 10.1016/j.jval.2014.01.009..
Keywords: Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Medical Errors, Medication, Patient Safety, Healthcare Costs, Ambulatory Care and Surgery, Prevention