National Healthcare Quality and Disparities Report
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- Access to Care (4)
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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 9 of 9 Research Studies DisplayedFraze TK, Lewis VA, Wood A
Configuration and delivery of primary care in rural and urban settings.
This study examined configuration and delivery of rural primary care of Medicare beneficiaries compared to more urban settings. The study included over 27 million participants with qualifying visits who were assigned to practices. The authors characterized practices’ structures, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Rural practices were smaller, more primary care dominant and system owned with more beneficiaries per practice. Rural area beneficiaries were more likely to be from high-poverty areas and disabled. There was less engagement in quality-focused payment programs than in metropolitan practices. There was less preventive care, such as fewer beneficiaries with diabetes receiving an eye exam, fewer mammograms, and higher overall and condition-specific readmissions. While most isolated beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Wood A .
Configuration and delivery of primary care in rural and urban settings.
J Gen Intern Med 2022 Sep;37(12):3045-53. doi: 10.1007/s11606-022-07472-x..
Keywords: Primary Care, Healthcare Delivery, Rural Health, Urban Health, Medicare
Gilmartin HM, Warsavage T, Hines A
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
This study evaluated the effectiveness of the rural Transitions Nurse Program (TNP), a program to help veterans transferred from rural areas to urban VA Medical Centers for care. A case-control study was conducted from April 2017 to September 2019 with 3001 veterans enrolled in TNP and 6002 matched controls. Interventions were led by a transition nurse who assessed discharge readiness, provided postdischarge communication with primary care providers (PCPs), and called the Veteran within 72 h of discharge home to assess needs, and encouraged follow-up appointment attendance. Controls had no change to their care. Primary outcomes evaluated were PCP visits within 14 days of discharge and all-cause 30-day readmissions, with secondary outcomes 30-day emergency department (ED) visits and 30-day mortality. Patients were matched by their length of stay, prior hospitalizations and PCP visits, urban/rural status, and 32 Elixhauser comorbidities. The veterans enrolled in TNP were more likely to see their PCP within 14 days of discharge than their matched controls. TNP enrollment was not associated with reduced 30-day ED visits or readmissions but was associated with reduced 30-day mortality.
AHRQ-funded; HS024569.
Citation: Gilmartin HM, Warsavage T, Hines A .
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
J Hosp Med 2022 Mar;17(3):149-57. doi: 10.1002/jhm.12802..
Keywords: Rural Health, Transitions of Care, Nursing, Healthcare Delivery
Mohr NM, Harland KK, Okoro UE
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study was to evaluate the impact of tele-ED consultation on sepsis care and outcomes in rural ED patients.
AHRQ-funded; HS025753.
Citation: Mohr NM, Harland KK, Okoro UE .
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
J Comp Eff Res 2021 Feb;10(2):77-91. doi: 10.2217/cer-2020-0141..
Keywords: Sepsis, Telehealth, Health Information Technology (HIT), Emergency Department, Comparative Effectiveness, Evidence-Based Practice, Rural Health, Healthcare Delivery
Sutherland BL, Pecanac K, Bartels CM
Expect delays: poor connections between rural and urban health systems challenge
Rural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. In this study, the investigators sought to identify health system barriers contributing to this disparity. The investigators concluded that poor connections across rural and urban healthcare systems were described as the primary health system barrier driving the rural disparity in major amputations.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, Bartels CM .
Expect delays: poor connections between rural and urban health systems challenge
J Foot Ankle Res 2020 Jun 16;13(1):32. doi: 10.1186/s13047-020-00395-y..
Keywords: Rural Health, Health Systems, Disparities, Diabetes, Chronic Conditions, Healthcare Delivery
Mohr NM, Wu C, Ward MJ
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
The objective of this study was to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Results showed that VHA inter-facility transfer was commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.
AHRQ-funded; HS025753.
Citation: Mohr NM, Wu C, Ward MJ .
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
BMC Health Serv Res 2020 Feb 12;20(1):110. doi: 10.1186/s12913-020-4956-6..
Keywords: Emergency Department, Hospitals, Healthcare Delivery, Access to Care, Rural Health
Parchman ML, Ike B, Osterhage KP
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
This paper discusses the barriers and facilitators to implementing changes in opioid prescription in rural areas using the Six Building Blocks evidence-based program to reduce opioid prescription in primary care practices. The program was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. Interviews and focus groups with conducted with the organizations at the end of the program period. Facilitators included a desire to help patients and their community; external pressures to make changes in opioid management; a desire to reduce workplace stress; external support for the clinic; supportive clinic leadership; and receptivity of patients. Barriers included competing demands on clinicians and staff; a culture of clinician autonomy; inadequate data systems; and a lack of patient resources in rural areas.
AHRQ-funded; HS023750.
Citation: Parchman ML, Ike B, Osterhage KP .
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
J Clin Transl Sci 2020 Jan 10;4(5):425-30. doi: 10.1017/cts.2019.448..
Keywords: Opioids, Medication, Rural Health, Primary Care, Primary Care: Models of Care, Implementation, Pain, Chronic Conditions, Healthcare Delivery
Vakkalanka JP, Harland KK, Wittrock A
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
The purpose of this retrospective propensity-matched cohort study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt. The authors suggest that the role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.
AHRQ-funded; HS025753.
Citation: Vakkalanka JP, Harland KK, Wittrock A .
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
J Epidemiol Community Health 2019 Nov;73(11):1033-39. doi: 10.1136/jech-2019-212623..
Keywords: Telehealth, Rural Health, Access to Care, Behavioral Health, Health Information Technology (HIT), Healthcare Delivery, Care Management, Outcomes, Emergency Department
Cochran G, Cole ES, Warwick J
Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers.
This paper reports the design and protocol of an implementation study seeking to advance availability of medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. Results showed an urgent need in the US to expand access to high quality, evidence-based OUD treatment, particularly in rural areas where capacity is limited for service delivery, in order to improve patient health and protect lives. Further, results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
AHRQ-funded; HS025072.
Citation: Cochran G, Cole ES, Warwick J .
Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers.
Addict Sci Clin Pract 2019 Aug 1;14(1):25. doi: 10.1186/s13722-019-0154-4..
Keywords: Opioids, Substance Abuse, Rural Health, Medication, Access to Care, Implementation, Primary Care, Healthcare Delivery, Medicaid
Cole ES, DiDomenico E, Cochran G
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
The authors examined the degree to which rural residents with opioid use disorder (OUD) are engaged with primary care providers (PCPs); they also described the role of rural PCPs in medication-assisted treatment (MAT) delivery, and estimated the association between enrollee distance to MAT prescribers and MAT utilization. They concluded that PCP utilization among rural Medicaid enrollees diagnosed with OUD is high, presenting a potential intervention point to treat OUD, particularly if the enrollee's PCP is located nearer than their MAT prescriber.
AHRQ-funded; HS025072.
Citation: Cole ES, DiDomenico E, Cochran G .
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
J Gen Intern Med 2019 Jun;34(6):936-43. doi: 10.1007/s11606-019-04943-6..
Keywords: Opioids, Substance Abuse, Rural Health, Medication, Access to Care, Implementation, Primary Care, Healthcare Delivery, Medicaid