National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data & Analytics
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Program
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- National Healthcare Quality and Disparities Report Data Tools
- AHRQ Quality Indicator Tools for Data Analytics
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (77)
- Adverse Drug Events (ADE) (2)
- Adverse Events (7)
- Ambulatory Care and Surgery (3)
- Arthritis (2)
- Asthma (7)
- Autism (1)
- Behavioral Health (27)
- Blood Pressure (4)
- Brain Injury (2)
- Breast Feeding (1)
- Cancer (40)
- Cancer: Breast Cancer (14)
- Cancer: Cervical Cancer (3)
- Cancer: Colorectal Cancer (10)
- Cancer: Lung Cancer (6)
- Cancer: Prostate Cancer (5)
- Cardiovascular Conditions (24)
- Care Coordination (2)
- Caregiving (2)
- Care Management (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (51)
- Chronic Conditions (31)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (11)
- Colonoscopy (5)
- Communication (7)
- Community-Based Practice (5)
- Community Partnerships (1)
- Comparative Effectiveness (2)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (3)
- COVID-19 (21)
- Critical Care (3)
- Cultural Competence (9)
- Data (4)
- Dementia (2)
- Dental and Oral Health (3)
- Depression (7)
- Diabetes (19)
- Diagnostic Safety and Quality (11)
- Dialysis (2)
- Digestive Disease and Health (3)
- Disabilities (4)
- (-) Disparities (463)
- Ear Infections (1)
- Education (1)
- Education: Continuing Medical Education (1)
- Education: Curriculum (2)
- Education: Patient and Caregiver (4)
- Elderly (31)
- Electronic Health Records (EHRs) (10)
- Emergency Department (11)
- Emergency Medical Services (EMS) (5)
- Evidence-Based Practice (9)
- Eye Disease and Health (1)
- Genetics (2)
- Guidelines (7)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (26)
- Healthcare Costs (13)
- Healthcare Delivery (19)
- Healthcare Utilization (13)
- Health Information Technology (HIT) (21)
- Health Insurance (31)
- Health Literacy (1)
- Health Promotion (6)
- Health Services Research (HSR) (7)
- Health Status (26)
- Health Systems (6)
- Heart Disease and Health (14)
- Home Healthcare (5)
- Hospital Discharge (6)
- Hospitalization (22)
- Hospital Readmissions (5)
- Hospitals (13)
- Human Immunodeficiency Virus (HIV) (10)
- Imaging (4)
- Implementation (4)
- Infectious Diseases (4)
- Influenza (2)
- Injuries and Wounds (4)
- Inpatient Care (4)
- Kidney Disease and Health (18)
- Labor and Delivery (3)
- Learning Health Systems (2)
- Lifestyle Changes (1)
- Long-Term Care (6)
- Low-Income (19)
- Maternal Care (13)
- Medicaid (20)
- Medical Devices (2)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (22)
- Medicare (21)
- Medication (22)
- Medication: Safety (1)
- Men's Health (4)
- Mortality (23)
- Newborns/Infants (5)
- Nursing (2)
- Nursing Homes (5)
- Nutrition (2)
- Obesity (7)
- Obesity: Weight Management (4)
- Opioids (7)
- Orthopedics (3)
- Osteoporosis (2)
- Outcomes (22)
- Pain (4)
- Palliative Care (7)
- Patient-Centered Healthcare (10)
- Patient-Centered Outcomes Research (24)
- Patient Adherence/Compliance (4)
- Patient and Family Engagement (5)
- Patient Experience (9)
- Patient Safety (7)
- Patient Self-Management (1)
- Payment (2)
- Policy (25)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (9)
- Pregnancy (11)
- Pressure Ulcers (1)
- Prevention (21)
- Primary Care (12)
- Primary Care: Models of Care (1)
- Provider (3)
- Provider Performance (5)
- Public Health (1)
- Public Reporting (1)
- Quality Improvement (9)
- Quality Indicators (QIs) (6)
- Quality Measures (4)
- Quality of Care (35)
- Quality of Life (4)
- Racial and Ethnic Minorities (274)
- Registries (1)
- Research Methodologies (4)
- Respiratory Conditions (9)
- Risk (17)
- Rural/Inner-City Residents (2)
- Rural Health (12)
- Screening (21)
- Sepsis (3)
- Sex Factors (16)
- Sexual Health (4)
- Shared Decision Making (8)
- Sickle Cell Disease (1)
- Sleep Problems (2)
- Social Determinants of Health (81)
- Social Stigma (3)
- Stroke (10)
- Substance Abuse (10)
- Surgery (32)
- Teams (1)
- TeamSTEPPS (1)
- Telehealth (10)
- Tobacco Use (1)
- Training (1)
- Transitions of Care (1)
- Transplantation (17)
- Trauma (5)
- Treatments (5)
- U.S. Preventive Services Task Force (USPSTF) (2)
- Uninsured (8)
- Urban Health (12)
- Vaccination (5)
- Vulnerable Populations (20)
- Web-Based (3)
- Women (28)
- Workforce (2)
- Young Adults (5)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 463 Research Studies DisplayedZhang Y, Leifheit KM, Lee KT
The association of oncology provider density with black-white disparities in cancer mortality in US counties.
In an ecological study of 1048 U.S. counties, researchers examined the association between oncology provider density and Black-White cancer mortality disparities. Oncology provider density was estimated using National Plan and Provider Enumeration System data; the cancer mortality ratio was calculated using cancer mortality rates from State Cancer Profiles. The results showed that higher provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. The researchers concluded that higher density alone may not resolve cancer mortality disparities, and that attention to ensuring equitable care is critical.
AHRQ-funded; HS000046.
Citation: Zhang Y, Leifheit KM, Lee KT .
The association of oncology provider density with black-white disparities in cancer mortality in US counties.
Cancer Control 2024 Jan-Dec; 31:10732748241244929. doi: 10.1177/10732748241244929..
Keywords: Cancer, Mortality, Racial and Ethnic Minorities, Disparities, Provider
Smith B, Smith BP, Hollis RH
Development of a comprehensive survey to assess key socioecological determinants of health.
The purpose of this study was to develop and evaluate a comprehensive tool assessing socioecological determinants of health in patients requiring colorectal surgery. The study utilized a modified Delphi process to develop a comprehensive tool that included 31 socioecological determinants of health. Analysis indicated acceptability and feasibility were positive for all domains. Overall, 83% of participants confirmed that others would have no challenges completing the survey, 90.4% of respondents reported the survey was not burdensome, 97.6% of patients reported having enough time to complete the survey, and 80.9% agreed the survey was well integrated into their appointment.
AHRQ-funded; HS023009.
Citation: Smith B, Smith BP, Hollis RH .
Development of a comprehensive survey to assess key socioecological determinants of health.
Surgery 2024 Apr; 175(4):991-99. doi: 10.1016/j.surg.2023.11.011..
Keywords: Social Determinants of Health, Disparities, Surgery
Armstrong-Hough M, Lin P, Venkatesh S
Ethnic disparities in deep sedation of patients with acute respiratory distress syndrome in the United States: secondary analysis of a multicenter randomized trial.
A recent study reveals that Hispanic patients with acute respiratory distress syndrome (ARDS) are five times more likely to be placed under deep sedation compared to non-Hispanic White patients. This disparity was observed across 48 U.S. hospitals participating in a clinical trial. The study also found that hospitals with at least one Hispanic ARDS patient tended to keep all their patients, regardless of ethnicity, in deep sedation for longer durations. These findings highlight a significant disparity in sedation practices and call for urgent investigation into the underlying causes and potential solutions to address this inequity in critical care.
AHRQ-funded; HS028038.
Citation: Armstrong-Hough M, Lin P, Venkatesh S .
Ethnic disparities in deep sedation of patients with acute respiratory distress syndrome in the United States: secondary analysis of a multicenter randomized trial.
Ann Am Thorac Soc 2024 Apr; 21(4):620-26. doi: 10.1513/AnnalsATS.202307-600OC..
Keywords: Disparities, Racial and Ethnic Minorities, Respiratory Conditions
Siddique SM, Tipton K, Leas B
The impact of health care algorithms on racial and ethnic disparities : a systematic review.
The purpose of this systematic review was to examine evidence on the effect of health care algorithms and associated mitigation strategies on racial and ethnic disparities. The authors concluded that algorithms can mitigate, perpetuate, and exacerbate racial and ethnic disparities, but the evidence is heterogeneous. They noted that results are mostly based on modeling studies and may be highly context specific.
AHRQ-funded; 75Q80120D00002.
Citation: Siddique SM, Tipton K, Leas B .
The impact of health care algorithms on racial and ethnic disparities : a systematic review.
Ann Intern Med 2024 Apr; 177(4):484-96. doi: 10.7326/m23-2960..
Keywords: Disparities, Racial and Ethnic Minorities
Brokamp C, Jones MN, Duan Q
Causal mediation of neighborhood-level pediatric hospitalization inequities.
This study’s objective was to estimate the total inequities in population-level hospitalization rates of children and determine how much is mediated by place-based exposures and community characteristics. The authors employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. They defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. They analyzed 50,719 hospitalizations experienced by 28,390 patients and calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2%. After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%). There were different results when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders.
AHRQ-funded; HS027996.
Citation: Brokamp C, Jones MN, Duan Q .
Causal mediation of neighborhood-level pediatric hospitalization inequities.
Pediatrics 2024 Apr; 153(4):e2023064432. doi: 10.1542/peds.2023-064432..
Keywords: Children/Adolescents, Medication, Disparities, Hospitalization
Marcotte LM, Langevin R, Hempstead BR
Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening.
This study’s goal was to describe an approach that combines community-engaged methods, human-centered design (HCD) methods, and causal pathway diagramming (CPD) - a tool to map an implementation strategy as it is intended to work - to develop innovative implementation strategies. The authors used a case example of developing a conversational agent or chatbot to address racial inequities in breast cancer screening via mammography. With an interdisciplinary team including community members and operational leaders, they conducted a rapid evidence review and elicited qualitative data through interviews and focus groups using HCD methods to identify and prioritize key determinants (facilitators and barriers) of the evidence-based intervention (breast cancer screening) and the implementation strategy (chatbot). They identified key determinants for breast cancer screening and for the chatbot implementation strategy. They found that mistrust was a key barrier to both completing breast cancer screening and using the chatbot. They focused design for the initial chatbot interaction to engender trust and developed a CPD to guide chatbot development. They used the persuasive health message framework and conceptual frameworks about trust from marketing and artificial intelligence disciplines. They developed a CPD for the initial interaction with the chatbot with engagement as a mechanism to use and trust as a proximal outcome leading to further engagement with the chatbot.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Langevin R, Hempstead BR .
Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening.
Implement Sci Commun 2024 Mar 28; 5(1):31. doi: 10.1186/s43058-024-00569-w..
Keywords: Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Screening, Disparities
Lin JS, Webber EM, Bean SI
Development of a health equity framework for the US Preventive Services Task Force.
The objective of this study was to develop a framework to allow the U.S. Preventive Services Task Force (USPSTF) to incorporate a health equity lens spanning the entirety of its recommendation-making process. Key guidance, policy, and explanatory frameworks related to health equity were identified, and their recommendations and findings mapped to current USPSTF methods. An equity framework was developed that could be applied to all phases of the recommendation process. The authors concluded that executing this framework will be challenging and take additional time and resources, but it will offer guidance to the USPSTF and other evidence-based guideline entities in developing a more transparent, consistent, and intentional approach to addressing health equity in their recommendations.
AHRQ-funded; 75Q80121C00001.
Citation: Lin JS, Webber EM, Bean SI .
Development of a health equity framework for the US Preventive Services Task Force.
JAMA Netw Open 2024 Mar 4; 7(3):e241875. doi: 10.1001/jamanetworkopen.2024.1875..
Keywords: U.S. Preventive Services Task Force (USPSTF), Disparities, Evidence-Based Practice, Guidelines
Powell-Wiley TM, Martinez MF, Heneghan J
Health and economic value of eliminating socioeconomic disparities in US youth physical activity.
The purpose of this study was to determine the potential public health and economic effects of eliminating disparities in youth physical activity (PA) levels among US youth socioeconomic status SES groups. The researchers utilized a model representing all 6- to 17-year-old children in the US to simulate epidemiological, clinical, and economic effects of disparities in PA levels among different SES groups and the effect of reducing these disparities. The study found that if the US eliminates the disparity in youth PA levels across SES groups, absolute overweight and obesity prevalence would decrease by 0.826% resulting in approximately 383,000fewer cases of overweight and obesity and 101,000 fewer cases of weight-related diseases. This would result in more than $15.60 billion in cost savings over the youth cohort's lifetime.
AHRQ-funded; HS028165.
Citation: Powell-Wiley TM, Martinez MF, Heneghan J .
Health and economic value of eliminating socioeconomic disparities in US youth physical activity.
JAMA Health Forum 2024 Mar; 5(3):e240088. doi: 10.1001/jamahealthforum.2024.0088..
Keywords: Children/Adolescents, Disparities, Social Determinants of Health
Feinberg E, Eilenberg JS
Role of community health workers in promoting health equity in pediatrics.
This progress report describes 2 pilot RCTs that examined the feasibility and acceptability of using a community health worker (CHW) implemented intervention as a strategy to improve timely completion of autism diagnostic evaluations among young children from historically marginalized communities. The authors describe the research that has been published on the topic since they submitted their original study report on November 17, 2019. Their team conducted a subsequent large multisite RCT (“Project EARLY”) as part of National Institute of Mental Health’s Autism Spectrum Disorder Pediatric Early Detection, Engagement and Services Network, whose aim was to develop and test interventions that coordinate early autism screening, evaluation, and engagement in services. Their findings confirmed the efficacy of family navigation to reduce time to autism diagnostic resolution while also uncovering family navigation’s differential impact by ethnicity. Positive effects of using a CHW were significantly greater for Hispanic families compared to non-Hispanic families, suggesting that the intervention may be an effective strategy to reduce disparities by minoritized subgroups. The authors also discussed recent funding through grants, and the fact that Medicaid reimburses CHWs for patient education and health care navigation in 29 US states. They also discuss future directions for investigating the impact of CHWs on autism outcomes specifically, and child well-being more generally.
AHRQ-funded; HS022155.
Citation: Feinberg E, Eilenberg JS .
Role of community health workers in promoting health equity in pediatrics.
Acad Pediatr 2024 Mar; 24(2):199-200. doi: 10.1016/j.acap.2023.09.005..
Keywords: Children/Adolescents, Disparities, Access to Care
Parikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Hsieh N
Unpacking intersectional inequities in flu vaccination by sexuality, gender, and race-ethnicity in the United States.
This study examined influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity using data from the 2013 to 2018 National Health Interview Survey (N = 166,908). It found that White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Sexual minority women (Black or Hispanic) had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. While economic enabling, noneconomic enabling, and need-based factors all help to explain a substantial portion of these gaps, they cannot explain all the disadvantages faced by Black lesbian, bisexual, heterosexual women, and Black heterosexual men.
AHRQ-funded; HS029329.
Citation: Hsieh N .
Unpacking intersectional inequities in flu vaccination by sexuality, gender, and race-ethnicity in the United States.
J Health Soc Behav 2024 Mar; 65(1):38-59. doi: 10.1177/00221465231199276.
Keywords: Influenza, Vaccination, Disparities
Barwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Jindal M, Barnert E, Chomilo N
AHRQ Author: Mistry KB
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
This partly AHRQ-authored paper is part of a series on Racism and Child Health in the USA, which builds on Paper 1's summary of existing disparities in health-care delivery and highlights policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improves the health of racially and ethnically minoritized children. The authors discuss current and historical policy approaches across housing, employment, health insurance, immigration, and criminal which have the potential to affect child health equity. They commented that these policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. If these policy efforts do not directly address structural racism, they will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism.
AHRQ-authored.
Citation: Jindal M, Barnert E, Chomilo N .
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
Lancet Child Adolesc Health 2024 Feb; 8(2):159-74. doi: 10.1016/s2352-4642(23)00262-6..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Policy
Nash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Cron DC, Braun HJ, Ascher NL
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
The objective of this study was to determine association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Using national transplant registry data, researchers compared liver offer acceptance and waitlist outcomes by sex for waitlisted liver transplant candidates who reached MELD 40. Results showed that even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. The researchers concluded that policies addressing this disparity should consider factors beyond MELD score adjustments.
AHRQ-funded; HS028476.
Citation: Cron DC, Braun HJ, Ascher NL .
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
Ann Surg 2024 Jan; 279(1):112-18. doi: 10.1097/sla.0000000000005933..
Keywords: Disparities, Access to Care, Sex Factors, Transplantation
Teeple S, Smith A, Toerper M
Exploring the impact of missingness on racial disparities in predictive performance of a machine learning model for emergency department triage.
The purpose of this study was to examine how missing data in the patient problem list may affect racial disparities in the predictive performance of an emergency department (ED) triage machine learning (ML) model. The researchers utilized an ML model that predicts patients’ risk for adverse events to produce triage-level recommendations and compared the model’s predictive performance on sets of observed versus manipulated test data. Differences were compared between Black and non-Hispanic White patient groups using multiple performance measures relevant to health equity. The study found there were modest, but significant, changes in predictive performance comparing the observed to manipulated models across both Black and non-Hispanic White patient groups. Problem list missingness affected model performance for both patient groups.
AHRQ-funded; HS02664002.
Citation: Teeple S, Smith A, Toerper M .
Exploring the impact of missingness on racial disparities in predictive performance of a machine learning model for emergency department triage.
JAMIA Open 2023 Dec; 6(4):ooad107. doi: 10.1093/jamiaopen/ooad107..
Keywords: Racial and Ethnic Minorities, Disparities, Emergency Department, Health Information Technology (HIT)
Squires A, Gerchow L, Ma C
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
The objective of this study was to understand the experience of limited English proficiency patients with health care services in an urban setting. Individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews. A major theme that emerged throughout all interviews was a sense that the language barrier with clinicians posed a threat to safety when receiving healthcare. Participants also identified factors they felt would improve their sense of security specific to clinician interactions. The authors concluded that these findings highlight ongoing challenges that spoken language barriers pose at multiple points of care in the US health care system.
AHRQ-funded; HS023593.
Citation: Squires A, Gerchow L, Ma C .
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
PEC Innov 2023 Dec; 2:100177. doi: 10.1016/j.pecinn.2023.100177..
Keywords: Patient Experience, Disparities, Vulnerable Populations
Jindal M, Chaiyachati KH, Fung V
Eliminating health care inequities through strengthening access to care.
The objective of this study was to provide a research agenda and recommendations to address inequities in access to health care based on findings from AHRQ's 2022 Health Equity Summit and subsequent meetings of access and equity experts from academia, industry, and the government. The authors noted that addressing access inequities cannot be done without considering the roles of racism and intersectionality. Their recommendations included funding research that measures racism within health care as well as tests burgeoning anti-racist practices, synthesizing best practices to mitigate racism, and forging a path forward for research on equity and access. They concluded that AHRQ is well-positioned to develop and fund an action plan and convene stakeholders across the health care spectrum to employ these recommendations.
AHRQ-funded.
Citation: Jindal M, Chaiyachati KH, Fung V .
Eliminating health care inequities through strengthening access to care.
Health Serv Res 2023 Dec; 58(suppl 3):300-10. doi: 10.1111/1475-6773.14202..
Keywords: Disparities, Access to Care, Healthcare Delivery
Chin MH, Afsar-Manesh N, Bierman AS
AHRQ Author: Bierman AS, Chang C, Jain A, Umscheid C
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
A panel of experts was convened by AHRQ and the National Institute for Minority Health and Health Disparities to provide a conceptual framework and guiding principles for preventing bias in health care algorithms to promote health care equity. Multiple stakeholders can mitigate bias at each phase of the algorithm life cycle. Five principles should guide these efforts: promoting health and health care equity during all phases of the algorithm life cycle; ensuring algorithm use is transparent and explainable; engaging patients and communities during all phases of the algorithm life cycle to earn trustworthiness; identifying algorithmic fairness issues and establishing accountability for equity and fairness in outcomes from health care algorithms.
AHRQ-authored; AHRQ-funded.
Citation: Chin MH, Afsar-Manesh N, Bierman AS .
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
JAMA Netw Open 2023 Dec; 6(12):e2345050. doi: 10.1001/jamanetworkopen.2023.45050..
Keywords: Racial and Ethnic Minorities, Disparities
Chisolm DJ, Dugan JA, Figueroa JF
Improving health equity through health care systems research.
This study’s objective was to describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. This project was conducted as a component of the AHRQ stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. The stakeholders included experts from academia, health care organizations, industry, and government. Five priority themes were derived iteratively through experts from academia, health care organizations, industry, and government. They identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. They also suggested cross-cutting themes regarding research workforce and research timelines.
AHRQ-funded.
Citation: Chisolm DJ, Dugan JA, Figueroa JF .
Improving health equity through health care systems research.
Health Serv Res 2023 Dec; 58(suppl 3):289-99. doi: 10.1111/1475-6773.14192..
Keywords: Health Systems, Disparities, Social Determinants of Health, Healthcare Delivery
Bierman AS, Mistry KB
AHRQ Author: Bierman AS, Mistry KB
Commentary: Achieving health equity - the role of learning health systems.
The article discussed learning health systems and their role in achieving health equity. Issues considered were prioritization of health equity, development and implementation of models of care, partnerships with patients and communities, research on the effectiveness of interventions across diverse populations, integration strategies, and multisector collaborations to address social needs. The authors concluded that by considering these issues, learning health systems can play a pivotal role in eliminating health inequities.
AHRQ-authored.
Citation: Bierman AS, Mistry KB .
Commentary: Achieving health equity - the role of learning health systems.
Healthc Policy 2023 Nov; 19(2):21-27. doi: 10.12927/hcpol.2023.27236..
Keywords: Learning Health Systems, Health Systems, Disparities
Vasan A, Kyle MA, Venkataramani AS
Inequities in time spent coordinating care for children and youth with special health care needs.
The purpose of this cross-sectional study was to examine sociodemographic inequities in time spent coordinating care for children and youth with special health care needs (CYSHCN) and examine the relationship between time spent coordinating care and forgone medical care. The study utilized 2018-2020 data from the National Survey of Children's Health, which included 102,740 children across all 50 states. The researchers characterized the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). Race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN were examined, and multivariable logistic regression was utilized to explore the relationship between time spent coordinating care and forgone medical care. The study found that over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent 5 hours per week or more on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was related with an increasing probability of forgone medical care.
AHRQ-funded; HS028555.
Citation: Vasan A, Kyle MA, Venkataramani AS .
Inequities in time spent coordinating care for children and youth with special health care needs.
Acad Pediatr 2023 Nov-Dec; 23(8):1526-34. doi: 10.1016/j.acap.2023.03.002..
Keywords: Children/Adolescents, Care Coordination, Vulnerable Populations, Disparities
Agniel D, Cabreros I, Damberg CL
A formal framework for incorporating equity into health care quality measurement.
This paper examines how tying incentives on the basis of stratification or disparities in quality measurement may have unintended consequences or limited effects. Addressing one aspect of equity may be in competition with addressing others. The authors proposed equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. They used colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
AHRQ-funded; HS024067.
Citation: Agniel D, Cabreros I, Damberg CL .
A formal framework for incorporating equity into health care quality measurement.
Health Aff 2023 Oct; 42(10):1383-91. doi: 10.1377/hlthaff.2022.01483..
Keywords: Quality Measures, Quality Improvement, Quality of Care, Disparities