National Healthcare Quality and Disparities Report
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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 10 of 10 Research Studies DisplayedLopez JM, Wing H, Ackerman SL
Community health center staff perspectives on financial payments for social care.
The purpose of this study was to examine how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams' engagement in these activities. The researchers interviewed 42 clinicians, frontline staff, and administrative leaders employed by12 Oregon CHC clinical sites about their social care initiatives. The study grouped the findings into three categories: 1. participants' awareness of existing or anticipated financial incentives, 2. uses for incentive dollars, and 3. perceived impact of financial incentives on social care activities in clinical practices. Current or anticipated important uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest influence on clinic social care practices was the ability to provide responsive social services. Clinic leaders reported that for financial incentives to significantly change CHC practices would necessitate payments large enough to expand the social care workforce as well.
AHRQ-funded; HS026435.
Citation: Lopez JM, Wing H, Ackerman SL .
Community health center staff perspectives on financial payments for social care.
Milbank Q 2023 Dec; 101(4):1304-26. doi: 10.1111/1468-0009.12667..
Keywords: Community-Based Practice, Payment, Healthcare Delivery
Kandel ZK, Rittenhouse DR, Bibi S
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. The authors investigated whether SIM improved health information technology (HIT) and care management capabilities of physician practices. They found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
AHRQ-funded; HS024075.
Citation: Kandel ZK, Rittenhouse DR, Bibi S .
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
Med Care Res Rev 2021 Aug;78(4):350-60. doi: 10.1177/1077558719901217..
Keywords: Health Information Technology (HIT), Healthcare Delivery, Payment, Health Systems
Post B, Norton EC, Hollenbeck B
Hospital-physician integration and Medicare's site-based outpatient payments.
AHRQ-funded; HS027044.
Citation: Post B, Norton EC, Hollenbeck B .
Hospital-physician integration and Medicare's site-based outpatient payments.
Health Serv Res 2021 Feb;56(1):7-15. doi: 10.1111/1475-6773.13613..
Keywords: Hospitals, Payment, Medicare, Ambulatory Care and Surgery, Healthcare Delivery
Cottrell EK, Dambrun K, O'Malley J
Documenting new ways of delivering care under Oregon's Alternative Payment and Advanced Care Model.
This study’s objective was to describe trends in rates of traditional face-to-face office visits and “Care Services That Engage Patients” (Care STEPs) documentation among community health centers (CHCs) involved in the first 3 phases Oregon’s Alternative Payment and Advanced Care Model (APCM) pilot program. In this program, participating community health centers (CHCs) received per-member-per-month payments for empaneled Medicaid patients in lieu of standard fee-for-service Medicaid payments. Among participating CHCs, the mean rate of face-to-face visits with billable providers declined. Care STEPS documentation increased, but the difference was not statistically significant. The Care STEPs category New Visit Types were documented most frequently. There were significant increases in document of Patient Care Coordination and Integration, and a smaller but still significant increase in Reducing Barriers to Health. There was a significant decrease in documentation done by physicians and advanced practice providers with an increase by ancillary staff.
AHRQ-funded; R01 HS022651.
Citation: Cottrell EK, Dambrun K, O'Malley J .
Documenting new ways of delivering care under Oregon's Alternative Payment and Advanced Care Model.
J Am Board Fam Med 2021 Jan-Feb;34(1):78-88. doi: 10.3122/jabfm.2021.01.200027..
Keywords: Healthcare Delivery, Payment, Community-Based Practice, Medicaid
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Hall JD, Kautz G .
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
DeMeester RH, Xu LJ, Nocon RS
Solving disparities through payment and delivery system reform: a program to achieve health equity.
In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction.
AHRQ-funded; HS000084.
Citation: DeMeester RH, Xu LJ, Nocon RS .
Solving disparities through payment and delivery system reform: a program to achieve health equity.
Health Aff 2017 Jun;36(6):1133-39. doi: 10.1377/hlthaff.2016.0979.
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Keywords: Disparities, Healthcare Delivery, Payment, Policy
Kondo KK, Damberg CL, Mendelson A
Implementation processes and pay for performance in healthcare: A systematic review.
The authors conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of pay for performance (P4P). They concluded that P4P programs should undergo regular evaluation and should target areas of poor performance, and also that measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.
AHRQ-funded; HS022981.
Citation: Kondo KK, Damberg CL, Mendelson A .
Implementation processes and pay for performance in healthcare: A systematic review.
J Gen Intern Med 2016 Apr;31 Suppl 1:61-9. doi: 10.1007/s11606-015-3567-0.
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Keywords: Healthcare Delivery, Provider Performance, Payment, Quality of Care
Hollingsworth JM, Birkmeyer JD, Ye Z
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
The authors sought to assess the prevalence and distribution of outpatient surgery across specialties. They found that several specialties - urology, gastroenterology, plastic surgery, and ophthalmology - perform most of their cases in outpatient settings. They suggested that incorporating these findings into the design of future payment and delivery system reforms will help to ensure adequate surgeon exposure to the efficiency gains that evolve from them.
AHRQ-funded; HS020927; HS018346.
Citation: Hollingsworth JM, Birkmeyer JD, Ye Z .
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
Surg Innov 2014 Dec;21(6):560-5. doi: 10.1177/1553350613520515.
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Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Delivery, Payment
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R .
Aligning provider incentives to improve primary healthcare delivery in the United States.
OA Fam Med 2013 Jun 1;1(1):7.
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Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement