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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
126 to 150 of 355 Research Studies DisplayedPredmore Z, Hatef E, Weiner JP
Integrating social and behavioral determinants of health into population health analytics: a conceptual framework and suggested road map.
There is growing recognition that social and behavioral risk factors impact population health outcomes. Interventions that target these risk factors can improve health outcomes. This study presents a review of existing literature and proposes a conceptual framework for the integration of social and behavioral data into population health analytics platforms. The authors describe several use cases for these platforms at the patient, health system, and community levels, and align these use cases with the different types of prevention identified by the Centers for Disease Control and Prevention.
AHRQ-funded; HS000029.
Citation: Predmore Z, Hatef E, Weiner JP .
Integrating social and behavioral determinants of health into population health analytics: a conceptual framework and suggested road map.
Popul Health Manag 2019 Dec;22(6):488-94. doi: 10.1089/pop.2018.0151..
Keywords: Social Determinants of Health, Risk, Research Methodologies
Byhoff E, Taylor LA
Massachusetts community-based organization perspectives on Medicaid redesign.
The purpose of the study was to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. Forty-six key informant interviews were conducted, representing 44 community-based organizations across Massachusetts. Findings showed that changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. Recommendations included having policymakers and healthcare leadership ensure that community-based organizations are part of strategy development and social service program implementation.
AHRQ-funded; HS026664.
Citation: Byhoff E, Taylor LA .
Massachusetts community-based organization perspectives on Medicaid redesign.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S74-s81. doi: 10.1016/j.amepre.2019.07.017..
Keywords: Medicaid, Social Determinants of Health, Policy, Health Insurance
De Marchis EH, Hessler D, Fichtenberg C
Part I: A quantitative study of social risk screening acceptability in patients and caregivers.
This study evaluated patient and caregiver acceptability of social risk screening. Adult patients and the adult caregivers of pediatric patients were recruited from primary care clinics and emergency departments across nine states for a survey; survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about the appropriateness of screening and including social risk data in electronic health records. Results showed that a strong majority of surveyed patients and caregivers found social risk screening to be appropriate. Most also felt comfortable including social risk data in electronic health records. The researchers conclude that lack of patient acceptability is unlikely to be a major implementation barrier.
AHRQ-funded; HS026664.
Citation: De Marchis EH, Hessler D, Fichtenberg C .
Part I: A quantitative study of social risk screening acceptability in patients and caregivers.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S25-s37. doi: 10.1016/j.amepre.2019.07.010..
Keywords: Children/Adolescents, Caregiving, Screening, Social Determinants of Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Huffstetler AN, Phillips RL
Payment structures that support social care integration with clinical care: social deprivation indices and novel payment models.
This perspective article focuses on four models employed both internationally and domestically to outline the implementation, successes, limitations, and research needed to support national application of social determinants of health (SDH) models. The association between high social risk and poor medical outcomes has been established globally; however, healthcare payment policies designed to respond to this relationship generally lack evidence of affecting outcomes. In countries with a legacy of adjusting healthcare payments for social risk, more robust evaluation of associated effects could be helpful. Payers, states, or health systems making similar resource commitments should build in robust longitudinal evaluations of outcomes to inform the evolution of their payment policies.
AHRQ-funded; HS026664.
Citation: Huffstetler AN, Phillips RL .
Payment structures that support social care integration with clinical care: social deprivation indices and novel payment models.
Am J Prev Med 2019 Dec;57(6s1):S82-s88. doi: 10.1016/j.amepre.2019.07.011..
Keywords: Payment, Social Determinants of Health, Policy
Krist AH, Davidson KW, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q, Mills J
Social determinants as a preventive service: U.S. Preventive Services Task Force methods considerations for research.
The authors offer a brief review of the social determinants of health that may be germane to the USPSTF, the methods the USPSTF uses to evaluate relevant evidence, and current evidence gaps for social risks. Their road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence.
AHRQ-authored; AHRQ-funded; HS026664.
Citation: Krist AH, Davidson KW, Ngo-Metzger Q .
Social determinants as a preventive service: U.S. Preventive Services Task Force methods considerations for research.
Am J Prev Med 2019 Dec;57(6s1):S6-s12. doi: 10.1016/j.amepre.2019.07.013..
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Research Methodologies, Evidence-Based Practice, Prevention
Roberts ET, Mellor JM, McInerney M
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
The purpose of this study was to examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. The investigators concluded that characteristics of dual enrollees differed substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerney M .
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
Health Serv Res 2019 Dec;54(6):1233-45. doi: 10.1111/1475-6773.13205..
Keywords: Medicare, Medicaid, Social Determinants of Health
Wong MS, Arnold CM, Roberts ET
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
The primary aim of this study was to examine the relationship between participation in federal housing assistance programs and self-reported cancer screening among low-income adults. The investigators concluded that their results reinforced the need to improve rates of screening and suggested that providing housing assistance, in and of itself, may be insufficient to overcome the multiple access barriers that low-income populations face.
AHRQ-funded; HS000029.
Citation: Wong MS, Arnold CM, Roberts ET .
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
J Gen Intern Med 2019 Dec;34(12):2714-16. doi: 10.1007/s11606-019-05037-z..
Keywords: Cancer, Screening, Low-Income, Vulnerable Populations, Access to Care, Healthcare Utilization, Social Determinants of Health
Cottrell EK, Dambrun K, Cowburn S
Variation in electronic health record documentation of social determinants of health across a national network of community health centers.
This paper described the adoption of an electronic health record-based social determinants of health screening tool in a national network of more than 100 community health centers. The investigators concluded that screening documentation patterns varied widely across the network of community health centers. The investigators suggested that despite the growing national emphasis on the importance of screening for social determinants of health, the findings suggested that simply activating electronic health record tools for social determinants of health screening did not lead to widespread adoption.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Dambrun K, Cowburn S .
Variation in electronic health record documentation of social determinants of health across a national network of community health centers.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S65-s73. doi: 10.1016/j.amepre.2019.07.014..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health
Roy B, Riley C, Herrin J
Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states.
The objective of this study was to evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates. The investigators found that community well-being was inversely associated with local hospitalisation rates. They suggest that in addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.
AHRQ-funded; HS023000.
Citation: Roy B, Riley C, Herrin J .
Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states.
BMJ Open 2019 Nov 27;9(11):e030017. doi: 10.1136/bmjopen-2019-030017..
Keywords: Hospitalization, Health Status, Quality of Life, Healthcare Utilization, Social Determinants of Health
Tung EL, Chua RFM, Besser SA
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP). They analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime in Chicago (2014-2016).The investigators concluded that rising violent crime was associated with increased BP during a temporal crime surge.
AHRQ-funded; HS023007.
Citation: Tung EL, Chua RFM, Besser SA .
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
Am J Hypertens 2019 Nov 15;32(12):1192-98. doi: 10.1093/ajh/hpz134..
Keywords: Blood Pressure, Social Determinants of Health, Risk
Calthorpe LM, Pantell MS
Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health.
This study examined differences in childhood exposures to adverse childhood experiences (ACEs) by geography and determined whether geography moderates the relationship between ACE exposure and health outcomes including overall health, asthma, ADHD, and special health care needs. Cross-sectional data from 2017-2017 National Survey of Children’s Health (NSCH) was analyzed. Rural residency was associated with 1.29 times increased odds of exposure to 4+ ACEs compared to suburban residency. Urban residency status was observed to increase the association between ACEs and asthma.
AHRQ-funded; HS026383.
Citation: Calthorpe LM, Pantell MS .
Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health.
Child Abuse Negl 2021 Jan;111:104804. doi: 10.1016/j.chiabu.2020.104804..
Keywords: Children/Adolescents, Social Determinants of Health, Health Status
Fleming MD, Guo C, Knox M
Impact of social needs case management on use of medical and behavioral health services: secondary analysis of a randomized controlled trial.
This research letter describes a secondary analysis that was conducted of a randomized encouragement study that assigned Medicaid beneficiaries with high risk for acute care use to social needs case management or to be administratively observed in the control group from August 2017 through December 2018. These services connect patients to resources such as food assistance, housing, transportation, or income benefits in addition to facilitating access to health care and behavioral health services. The study group included adults 18 years or older, who are residents of Contra Costa County in California, and enrolled in full-scope Medicaid. The case management enrollees were assigned to a case manager who assessed their needs, created a patient-centered care plan, and provided ongoing support including community resource referrals, coordination with primary care providers, and collaboration on applications for public benefits. Case managers had diverse backgrounds and included public health nurses, social workers, substance misuse counselors, mental health clinicians, homeless service specialists, and community health workers. Case management was offered either in-person or by remote telephonic services for 1 year. About 40% (n = 8577) of enrolled patients used the services. There were 21,422 intervention group enrollments and 22,839 in the weighted control group. The intervention group had significantly higher rates of primary care visits compared with the control group. No differences were found between the treatment groups for specialty care visits, behavioral health visits, psychiatric emergency visits, or jail intakes.
AHRQ-funded; HS027648.
Citation: Fleming MD, Guo C, Knox M .
Impact of social needs case management on use of medical and behavioral health services: secondary analysis of a randomized controlled trial.
Ann Intern Med 2023 Aug; 176(8):1139-41. doi: 10.7326/m23-0876..
Keywords: Medicaid, Vulnerable Populations, Social Determinants of Health, Care Management, Care Coordination
Bass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Zullo AR, Adams JW, Gantenberg JR
Examining neighborhood poverty-based disparities in HIV/STI prevalence: an analysis of Add Health data.
The purpose of the study was to estimate the effect of exposure to neighborhood poverty in adolescence on HIV/STI prevalence in early adulthood. The investigators found that strong evidence for neighborhood poverty-based differences in HIV/STI prevalence was not observed. They suggest that researchers should continue to investigate the effect of neighborhood-level socioeconomic position measures and, if warranted, identify etiologically relevant exposure periods.
AHRQ-funded; HS022998.
Citation: Zullo AR, Adams JW, Gantenberg JR .
Examining neighborhood poverty-based disparities in HIV/STI prevalence: an analysis of Add Health data.
Ann Epidemiol 2019 Nov;39:8-14.e4. doi: 10.1016/j.annepidem.2019.09.010..
Keywords: Children/Adolescents, Low-Income, Vulnerable Populations, Disparities, Social Determinants of Health, Human Immunodeficiency Virus (HIV), Infectious Diseases, Young Adults, Health Status
Qi AC, Peacock K, Luke AA
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
The purpose of this study was to determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, were associated with higher rates of surgical site infections (SSI) after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. The investigators report that inconsistent associations between social risk factors and SSIs were found.
AHRQ-funded; HS019455.
Citation: Qi AC, Peacock K, Luke AA .
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
JAMA Netw Open 2019 Oct 2;2(10):e1912339. doi: 10.1001/jamanetworkopen.2019.12339..
Keywords: Healthcare Cost and Utilization Project (HCUP), Risk, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Social Determinants of Health
Ke C, Kim SJ, Shah BR
AHRQ Author: Bierman AS
Impact of socioeconomic status on incidence of end-stage renal disease and mortality after dialysis in adults with diabetes.
The purpose of this study was to determine whether low socioeconomic status (SES), with or without universal drug coverage, predicts end-stage renal disease (ESRD) and survival after dialysis in patients with diabetes. Results showed that low SES was inversely associated with ESRD outcomes in individuals with diabetes, and this disparity was reduced in those age 65 and older who universally received prescription drug coverage. Low SES was associated with a higher mortality after dialysis, largely explained by lower kidney transplantation rates in poorer populations.
AHRQ-authored.
Citation: Ke C, Kim SJ, Shah BR .
Impact of socioeconomic status on incidence of end-stage renal disease and mortality after dialysis in adults with diabetes.
Can J Diabetes 2019 Oct;43(7):483-89.e4. doi: 10.1016/j.jcjd.2019.04.006..
Keywords: Diabetes, Kidney Disease and Health, Mortality, Social Determinants of Health
Smith NA, Voisin DR, Yang JP
Keeping your guard up: hypervigilance among urban residents affected by community and police violence.
This study’s aim was to quantify the effects of hypervigilance among urban residents affected by community and police violence. A survey of 504 adults in Chicago in 2018 was done in a neighborhood affected by high levels of violence. It was found that exposure to police violence was associated with a 9.8% increase in hypervigilance while exposure to community violence caused a 5.5% increase. Among participants who had a police stop, it was associated with 20% increase in hypervigilance. Overall, the highest quartile of hypervigilance was associated with higher systolic blood pressure.
AHRQ-funded; HS023007.
Citation: Smith NA, Voisin DR, Yang JP .
Keeping your guard up: hypervigilance among urban residents affected by community and police violence.
Health Aff 2019 Oct;38(10):1662-69. doi: 10.1377/hlthaff.2019.00560..
Keywords: Urban Health, Social Determinants of Health, Behavioral Health, Patient-Centered Outcomes Research, Evidence-Based Practice
Kim B, Callander D, DiClemente R
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
This study analyzed the New York City geographic distribution of pre-exposure prophylaxis (PrEP) providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. Results showed that neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, and PrEP providers were located in high HIV-incidence neighborhoods. These findings validate the need for ongoing policy interventions in relation to PrEP provider locations in New York City and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
AHRQ-funded; HS026120.
Citation: Kim B, Callander D, DiClemente R .
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
AIDS Behav 2019 Oct;23(10):2795-802. doi: 10.1007/s10461-019-02609-2..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Access to Care, Social Determinants of Health
Fraze TK, Brewster AL, Lewis VA
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
The purpose of this study was to characterize screening for social needs by physician practices and hospitals. The authors indicated that their study's findings suggest: that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes; that practices that serve disadvantaged patients reported higher screening rates.
AHRQ-funded; HS024075.
Citation: Fraze TK, Brewster AL, Lewis VA .
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
JAMA Netw Open 2019 Sep 4;2(9):e1911514. doi: 10.1001/jamanetworkopen.2019.11514..
Keywords: Domestic Violence, Nutrition, Practice Patterns, Screening, Social Determinants of Health, Vulnerable Populations
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Campbell AD, Baker EH
Do income inequalities in higher weight status depend on social integration?
In this study, the investigators use data from the 2003-2008 National Health and Nutrition Examination Survey (NHANES) to examine whether the association between higher weight status and social integration varies by income. The investigators concluded that the association between income and higher weight status operates differently for women and men and is dependent, in part, on their level of social integration.
AHRQ-funded; HS013852.
Citation: Campbell AD, Baker EH .
Do income inequalities in higher weight status depend on social integration?
Soc Sci Res 2019 Sep;83:102301. doi: 10.1016/j.ssresearch.2019.04.014..
Keywords: Health Status, Obesity, Obesity: Weight Management, Social Determinants of Health
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Senft N, Sanderson M, Selove R
Attitudes toward precision treatment of smoking in the Southern Community Cohort Study.
Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease. In this study, the investigators surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. The researchers concluded that among disproportionately burdened community smokers, most held favorable attitudes toward precision smoking treatment.
AHRQ-funded; HS026122.
Citation: Senft N, Sanderson M, Selove R .
Attitudes toward precision treatment of smoking in the Southern Community Cohort Study.
Cancer Epidemiol Biomarkers Prev 2019 Aug;28(8):1345-52. doi: 10.1158/1055-9965.Epi-19-0179..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Substance Abuse, Social Determinants of Health, Cancer: Lung Cancer, Cancer
Rundle AG, Chen Y, Quinn JW
Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the U.S. over the past three decades.
To examine how urban form shapes physical activity and health over time, a measure of neighborhood walkability is needed that can be linked to cohort studies with participants living across the United States (U.S.) that have been followed over the past decades. In this study, the Built Environment and Health-Neighborhood Walkability Index (BEH-NWI), a measure of neighborhood walkability that can be calculated for communities across the United States between 1990 and 2015, was conceptualized, developed, and tested using data from the New York City Tri-State Area.
AHRQ-funded; HS026120.
Citation: Rundle AG, Chen Y, Quinn JW .
Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the U.S. over the past three decades.
J Urban Health 2019 Aug;96(4):583-90. doi: 10.1007/s11524-019-00370-4
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Keywords: Urban Health, Lifestyle Changes, Health Status, Social Determinants of Health
Sonik RA, Parish SL, Mitra M
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
The objective of this study was to assess patterns of food insecurity before and after initial receipt of Supplemental Security Income (SSI) benefits. The investigators concluded that food insecurity rose prior to SSI entry but may be alleviated by programme benefits. They suggest that greater nutritional supports for SSI applicants awaiting decisions may reduce the burden of food insecurity in this population and improve health outcomes.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
Public Health Nutr 2019 Jul;22(10):1909-13. doi: 10.1017/s1368980019000570..
Keywords: Nutrition, Low-Income, Disabilities, Vulnerable Populations, Social Determinants of Health