National Healthcare Quality and Disparities Report
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- Elderly (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 10 of 10 Research Studies DisplayedSanghavi P, Jena AB, Newhouse JP
Identifying outlier patterns of inconsistent ambulance billing in Medicare.
The objective of this study was to illustrate a method that accounts for sampling variation in identifying suppliers and counties with outlying rates of a particular pattern of inconsistent billing for ambulance services to Medicare. The investigators concluded that health care fraud and abuse were frequently asserted but could be difficult to detect. They suggested that their data-driven approach may be a useful starting point for further investigation.
AHRQ-funded; 6HS022798; HS025720.
Citation: Sanghavi P, Jena AB, Newhouse JP .
Identifying outlier patterns of inconsistent ambulance billing in Medicare.
Health Serv Res 2021 Apr;56(2):188-92. doi: 10.1111/1475-6773.13622..
Keywords: Medicare, Payment, Health Services Research (HSR)
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Keeney T, Belanger E, Jones RN
High-need phenotypes in Medicare beneficiaries: drivers of variation in utilization and outcomes.
The goal of this study was to identify distinct clinical phenotypes present within high-need Medicare beneficiaries and to examine differences in outcomes between phenotypes. Researchers identified five phenotypes and concluded that their findings represented a first step toward classifying the heterogeneity among high-need Medicare beneficiaries. They recommend further work to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations.
AHRQ-funded; HS000011.
Citation: Keeney T, Belanger E, Jones RN .
High-need phenotypes in Medicare beneficiaries: drivers of variation in utilization and outcomes.
J Am Geriatr Soc 2020 Jan;68(1):70-77. doi: 10.1111/jgs.16146..
Keywords: Medicare, Research Methodologies, Outcomes, Health Services Research (HSR)
Markovitz AA, Hollingsworth JM, Ayanian JZ
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
The purpose of this study was to evaluate the effect of the Medicare Shared Savings Program (MSSP) on spending and quality while accounting for clinicians' nonrandom exit. MSSP ACO participants were compared with control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. Results showed that, after adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects, including exit of high-cost clinicians, may drive estimates of savings in the MSSP.
AHRQ-funded; HS025615; HS024728; HS024525.
Citation: Markovitz AA, Hollingsworth JM, Ayanian JZ .
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
Ann Intern Med 2019 Jul 2;171(1):27-36. doi: 10.7326/m18-2539..
Keywords: Healthcare Costs, Health Services Research (HSR), Medicare, Quality of Care
Werner RM, Kanter GP, Polsky D
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
The goal of this retrospective cohort study was to estimate the association between the patient characteristics of a physician group and the group's participation in a newly formed accountable care organization (ACOs). A random sample of Medicare fee-for-service beneficiaries attributed to physician groups were identified by Medicare claims made before ACO participation. Physician groups that participated and did not participate in the Medicare Shared Savings Program (MSSP) were then identified. ACO-participating physician groups were compared with non-participating groups for reference, and estimates were made at both the physician and patient level. The study found that physician groups that participated in the MSSP ACO program cared for more vulnerable patients than non-participating groups did; ACO-participating physician groups cared for an equally large number of vulnerable patients compared with non-participating groups. The authors conclude that ACOs may be an effective approach to target care among high-risk patients.
AHRQ-funded; HS025184.
Citation: Werner RM, Kanter GP, Polsky D .
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
JAMA Netw Open 2019 Jan 4;2(1):e187220. doi: 10.1001/jamanetworkopen.2018.7220..
Keywords: Health Services Research (HSR), Medicare, Vulnerable Populations
Holmgren AJ, Adler-Milstein J, Chen LM
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
This research letter addresses spending on post–acute care (PAC), or care provided after a stay in an acute care hospital. PAC is the largest driver of variation in total per capita Medicare spending. To address this, Medicare has targeted PAC spending in payment reforms including voluntary bundled payment programs. This letter discusses participation in these voluntary payment programs.
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AHRQ-funded; HS024698
Citation: Holmgren AJ, Adler-Milstein J, Chen LM .
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
JAMA 2018 Jul 24;320(4):402-04. doi: 10.1001/jama.2018.8666..
Keywords: Payment, Health Services Research (HSR), Health Services Research (HSR), Hospitalization, Medicare
Colla CH, Morden NE, Sequist TD
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
This study compared low-value health service use among commercially insured and Medicare populations and explored the influence of payer type on the provision of low-value care. In measuring use of seven Choosing Wisely-identified low-value services, it concluded that low-value care appears driven by factors unrelated to payer type or anticipated reimbursement.
AHRQ-funded; HS023812.
Citation: Colla CH, Morden NE, Sequist TD .
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
Health Serv Res 2018 Apr;53(2):730-46. doi: 10.1111/1475-6773.12665.
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Keywords: Payment, Healthcare Utilization, Health Services Research (HSR), Medicare
Keohane LM, Trivedi AN, Mor V
Recent health care use and Medicaid entry of Medicare beneficiaries.
The purpose of this study was to examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi AN, Mor V .
Recent health care use and Medicaid entry of Medicare beneficiaries.
Gerontologist 2017 Oct 1;57(5):977-86. doi: 10.1093/geront/gnw189..
Keywords: Elderly, Healthcare Utilization, Health Services Research (HSR), Medicaid, Medicare
Arbaje AI, Yu Q, Wang J J
Senior services in US hospitals and readmission risk in the Medicare population.
The purpose of this study was to determine whether hospitals' Senior Care Services Scale (SCSS) scores were associated with risk of readmission among Medicare beneficiaries. The study concluded that senior services at the hospital-level represented a modifiable risk factor with important impact. Employing organization-level characteristics in readmission risk prediction tools should be expanded.
AHRQ-funded; HS022916
Citation: Arbaje AI, Yu Q, Wang J J .
Senior services in US hospitals and readmission risk in the Medicare population.
Int J Qual Health Care 2017 Oct 1;29(6):845-52. doi: 10.1093/intqhc/mzx112..
Keywords: Elderly, Health Services Research (HSR), Hospital Readmissions, Hospitals, Medicare
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care