National Healthcare Quality and Disparities Report
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- Asthma (2)
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- (-) Chronic Conditions (13)
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- Patient Self-Management (2)
- Primary Care (2)
- Racial and Ethnic Minorities (2)
- Respiratory Conditions (1)
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- Screening (1)
- Social Determinants of Health (3)
- Telehealth (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 13 of 13 Research Studies DisplayedGlynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
AHRQ-funded; HS026727.
Citation: Glynn A, Hernandez I, Roberts ET .
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Feinberg E, Kuhn J, Eilenberg JS
Improving family navigation for children with autism: a comparison of two pilot randomized controlled trials.
This study looked at impacts of a modification to a pilot program called Family Navigation to help low-income, minority children needing autism-related diagnostic services receive those services. An advisory group recommended modifications to recruitment criteria and study conditions. 40 parent-child dyad participants were randomized between the two pilots to receive usual care (UC) or modified FN. Participant enrollment, satisfaction with clinical care, and timely completion of the diagnostic assessment were compared. Recruitment improved significantly with the modified protocol (4.8% vs. 19.5%) and no participants were excluded from study enrollment compared to the first pilot (43.6%). Families in the second pilot were more likely to complete diagnostic assessment and report greater satisfaction with clinical care.
AHRQ-funded; HS022155; HS022242.
Citation: Feinberg E, Kuhn J, Eilenberg JS .
Improving family navigation for children with autism: a comparison of two pilot randomized controlled trials.
Acad Pediatr 2021 Mar;21(2):265-71. doi: 10.1016/j.acap.2020.04.007..
Keywords: Children/Adolescents, Autism, Patient-Centered Healthcare, Care Coordination, Racial and Ethnic Minorities, Low-Income, Patient and Family Engagement, Chronic Conditions
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Aguilera A, Figueroa CA, Hernandez-Ramos R
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
In this randomized controlled trial, the researchers’ goal is to examine the effect of a text-messaging smartphone application to encourage physical activity in low-income ethnic minority patients with comorbid diabetes and depression. They will compare passively collected daily step counts, self-reported PHQ-8 and most recent hemoglobin A1c from medical records at baseline and at intervention completion at 6-month follow-up. They plan to submit manuscripts describing their user-designed methods and testing of the adaptive learning algorithm and will submit the results of the trial for publication in peer-reviewed journals and presentations at scientific meetings.
AHRQ-funded; HS025429.
Citation: Aguilera A, Figueroa CA, Hernandez-Ramos R .
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
BMJ Open 2020 Aug 20;10(8):e034723. doi: 10.1136/bmjopen-2019-034723..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Low-Income, Health Promotion
Mayberry LS, Lyles CR, Oldenburg B
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
The authors evaluate the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes. They found evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research to substantiate these early findings is recommended; the authors suggest that many issues remain in order to optimize the impact of digital interventions on the health outcomes of disadvantaged/vulnerable persons with diabetes.
AHRQ-funded; HS022408; HS025429.
Citation: Mayberry LS, Lyles CR, Oldenburg B .
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
Curr Diab Rep 2019 Nov 25;19(12):148. doi: 10.1007/s11892-019-1280-9.
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Keywords: Diabetes, Vulnerable Populations, Patient Self-Management, Telehealth, Health Information Technology (HIT), Patient-Centered Healthcare, Low-Income, Chronic Conditions
Heintzman J, Kaufmann J, Ezekiel-Herrera D
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. In this study, the investigators used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients.
AHRQ-funded; HS021522.
Citation: Heintzman J, Kaufmann J, Ezekiel-Herrera D .
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
J Immigr Minor Health 2019 Jun;21(3):659-63. doi: 10.1007/s10903-018-0798-2..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Disparities, Healthcare Utilization, Low-Income, Primary Care
Abdus S, Keenan PS
AHRQ Author: Abdus S, Keenan PS
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
In this research letter, the authors used 2011-2015 Medical Expenditure Panel Survey Household Component data on adults 19 to 64 years of age enrolled in employer-sponsored insurance plans throughout the year to examine the burden of high deductible health plans on low income adults with chronic health conditions.
AHRQ-authored.
Citation: Abdus S, Keenan PS .
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
JAMA Intern Med 2018 Dec;178(12):1706-08. doi: 10.1001/jamainternmed.2018.4706..
Keywords: Chronic Conditions, Healthcare Costs, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS)
Schnall R, Cho H, Mangone A
Mobile health technology for improving symptom management in low income persons living with HIV.
This study aimed to examine the impact of an mHealth application (app), comprised of evidence-based self-care strategies, on the symptom experience of persons living with HIV (PLWH). In this 12-week trial, an mHealth app, mobile Video Information Provider (mVIP), was associated with improved symptom burden and increased medication adherence in PLWH.
AHRQ-funded; HS023963.
Citation: Schnall R, Cho H, Mangone A .
Mobile health technology for improving symptom management in low income persons living with HIV.
AIDS Behav 2018 Oct;22(10):3373-83. doi: 10.1007/s10461-017-2014-0..
Keywords: Chronic Conditions, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Low-Income, Vulnerable Populations
Cardet JC, Louisias M, King TS
Income is an independent risk factor for worse asthma outcomes.
The authors investigated whether low income, low education, and high perceived stress were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. They found that participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
AHRQ-funded; HS022986.
Citation: Cardet JC, Louisias M, King TS .
Income is an independent risk factor for worse asthma outcomes.
J Allergy Clin Immunol 2018 Feb;141(2):754-60.e3. doi: 10.1016/j.jaci.2017.04.036..
Keywords: Asthma, Chronic Conditions, Low-Income, Outcomes, Patient-Centered Outcomes Research, Risk, Social Determinants of Health
Kangovi S, Mitra N, Grande D
Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial.
The researchers sought to determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. They concluded that a standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems.
AHRQ-funded; HS021706.
Citation: Kangovi S, Mitra N, Grande D .
Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial.
Am J Public Health 2017 Oct;107(10):1660-67. doi: 10.2105/ajph.2017.303985.
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Keywords: Chronic Conditions, Community-Based Practice, Low-Income, Patient-Centered Outcomes Research
Quan J, Lee AK, Handley MA
Automated telephone self-management support for diabetes in a low-income health plan: a health care utilization and cost analysis.
The objective was to determine whether automated telephone self-management support for low-income, linguistically diverse health plan members with diabetes affects health care utilization or cost. It found no significant differences in emergency department visits and hospitalizations or in costs.
AHRQ-funded; HS020684; HS017261; HS022561.
Citation: Quan J, Lee AK, Handley MA .
Automated telephone self-management support for diabetes in a low-income health plan: a health care utilization and cost analysis.
Popul Health Manag 2015 Dec;18(6):412-20. doi: 10.1089/pop.2014.0154.
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Keywords: Diabetes, Chronic Conditions, Patient Self-Management, Low-Income, Healthcare Costs
Buys DR, Howard VJ, McClure LA
Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging.
The investigators evaluated the effect of neighborhood disadvantage (ND) on older adults' prevalence, awareness, treatment, and control of hypertension. Using data from the University of Alabama at Birmingham Study of Aging along with US Census data, they created tertiles of ND and found that living in mid-ND and high-ND tertiles was associated with higher hypertension prevalence, and living in high-ND tertiles was further associated with lower odds of controlled hypertension.
AHRQ-funded; HS019465; HS013852.
Citation: Buys DR, Howard VJ, McClure LA .
Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging.
Am J Public Health 2015 Jun;105(6):1181-8. doi: 10.2105/ajph.2014.302048.
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Keywords: Elderly, Blood Pressure, Low-Income, Social Determinants of Health, Cardiovascular Conditions, Chronic Conditions