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Topics
- Ambulatory Care and Surgery (1)
- Cancer (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Diagnostic Safety and Quality (1)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (2)
- Healthcare Delivery (6)
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- Health Services Research (HSR) (1)
- (-) Health Systems (16)
- Hospitals (8)
- Implementation (3)
- Learning Health Systems (4)
- Medicare (3)
- Orthopedics (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (1)
- Patient Experience (1)
- Patient Safety (1)
- Payment (2)
- Practice Improvement (1)
- Provider Performance (5)
- Quality Improvement (7)
- Quality Indicators (QIs) (2)
- Quality Measures (3)
- (-) Quality of Care (16)
- Research Methodologies (1)
- Risk (1)
- Surgery (2)
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 16 of 16 Research Studies DisplayedBeaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Khodyakov D, Buttorff C, Xenakis L
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
This study was a survey of health system executives to examine whether their performance assessments match objective performance assessments and qualitatively explore ways to achieve high performance. Interviews were conducted with 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. The interviews were focused on executives’ perceptions of their own health system’s performance and factors they perceived generally contributed to high performance. The authors grouped health systems based on objective performance levels used in sampling and compared the ratings to executives’ subjective performance assessments. There was poor agreement between objective and subjective performance assessments. Executives whose views were inconsistent with objective assessments did not cite clinical care quality as their basis for their assessment but focused instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics had subjective ratings consistent with objective ratings.
AHRQ-funded; HS024067.
Citation: Khodyakov D, Buttorff C, Xenakis L .
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
J Healthc Manag 2021 Sep-Oct;66(5):380-94. doi: 10.1097/jhm-d-20-00249..
Keywords: Health Systems, Quality of Care, Practice Improvement, Provider Performance
Kranz AM, DeYoreo M, shete-Roesler B
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
The goal of this study was to test the hypothesis that health systems provide better care to patients with high needs compared to nonaffiliated physician organizations (POs). The 2015 Medicare Data on Provider Practice and Specialty linked physicians’ database was linked to POs Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and IRS Form 990 data to identify health system affiliations. Among 2,323,301 beneficiaries with high needs, 52.3% received care from system-affiliated practices. The emergency department (ED) visit rate was statistically significantly different in system-affiliated POs and nonaffiliated POs. There were small differences for the remaining five of six quality measures examined: continuity of care, follow-up visits, all-cause readmissions, and ambulatory care-sensitive hospitalizations. Within systems there was substantial variation for rates of continuity of care and follow-up after ED visits.
AHRQ-funded; HS024067.
Citation: Kranz AM, DeYoreo M, shete-Roesler B .
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
Health Serv Res 2020 Dec;55(Suppl 3):1118-28. doi: 10.1111/1475-6773.13570..
Keywords: Health Systems, Medicare, Quality of Care, Healthcare Delivery
Short MN, Ho V
Weighing the effects of vertical integration versus market concentration on hospital quality.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. In this study, the investigators analyzed 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influenced patient outcomes.
AHRQ-funded; HS024727.
Citation: Short MN, Ho V .
Weighing the effects of vertical integration versus market concentration on hospital quality.
Med Care Res Rev 2020 Dec;77(6):538-48. doi: 10.1177/1077558719828938.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Hospitals, Medicare, Provider Performance, Health Systems
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
AHRQ-funded; HS024067.
Citation: Agniel D, Haviland A, Shekelle P .
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Health Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Hernandez AV, Roman YM, White CM
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
This paper describes AHRQ’s efforts to collate and assess quality improvement studies to support learning health systems (LHS). The authors identified quality improvement studies and evaluated the consistency of data extraction from two experienced independent reviewers at three time points: baseline, first revision, and final revision. Six investigators looked at the data extracted by the independent reviewers and determined the extent of similarity on a scale of 0 to 10. Two LHS participants were then asked to assess the relative value of their criteria. The consistency of extraction improved from a mean 1.17 score at baseline to 6.07 at first revision, and 6.81 at the final revision. There was not a significant improvement from the first to final revision. However, the LHS participants rated the value of these ratings a 9 and a 6, demonstrating that there is value in developing criteria.
AHRQ-funded; 290201500012I.
Citation: Hernandez AV, Roman YM, White CM .
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
J Gen Intern Med 2020 Nov;35(Suppl 2):802-07. doi: 10.1007/s11606-020-06098-1..
Keywords: Quality Improvement, Quality of Care, Learning Health Systems, Health Systems, Health Services Research (HSR), Research Methodologies
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
White CM, Coleman CI, Jackman K
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
This paper analyzed ways to enhance usability of AHRQ’s Evidence-based Practice Center (EPC) reports. The reports are often lengthy and difficult for users to navigate. A quality measure index was created to allow health systems to more efficiently access relevant information. A test was created where two tables were embedded in an EPC report. The first identified quality measures covered by the report descriptively. The second contained page numbers in the executive summary which hyperlinked to those pages with the quality measures. An exercise with two health system-targeted scenarios was then created. The participants were timed how long it took to find answers to scenario questions and gave feedback. It was found that it took 63.4% less time to find quality measure information with the hyperlinked indexing tables than without. The participants felt that the tables were easy to use and more user friendly to health systems.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002.
Citation: White CM, Coleman CI, Jackman K .
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002..
Keywords: Implementation, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Outcomes Research, Provider Performance, Quality Measures, Quality Improvement, Quality of Care
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
AHRQ-authored.
Citation: Henke RM, Karaca Z, Moore B .
Impact of health system affiliation on hospital resource use intensity and quality of care.
Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Health Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords: Evidence-Based Practice, Health Systems, Health Information Technology (HIT), Implementation, Quality Improvement, Hospitals, Quality of Care
Nix M, McNamara P, Genevro J
AHRQ Author: Nix M, McNamara P, Genevro J, Vargas N, Mistry K, Fournier A, Shofer M, Lomotan E, Miller T, Ricciardi R, Bierman AS
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
The authors examined AHRQ's experience with learning collaboratives to characterize their attributes, identify factors that might contribute to their success or failure, and assess the challenges they encountered. Building on the literature and insights from AHRQ's experience, they propose a taxonomy that can offer guidance to decision makers and funders about the factors they should consider in developing collaboratives.
AHRQ-authored.
Citation: Nix M, McNamara P, Genevro J .
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
Health Aff 2018 Feb;37(2):205-12. doi: 10.1377/hlthaff.2017.1144.
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Keywords: Learning Health Systems, Health Systems, Quality Improvement, Quality of Care, Healthcare Delivery
Fisher ES, Shortell SM, Savitz LA
Implementation science: A potential catalyst for delivery system reform.
Understanding which of the multitude of technological, policy, and organizational changes under way are most effective at improving care is a critical challenge. This article describes 3 ideas that could be helpful: application of a well-grounded conceptual framework; distinguishing 3 distinct types of innovations that health systems are using to improve care; and a focus on building the information systems needed to accelerate timely learning.
AHRQ-funded; HS024075.
Citation: Fisher ES, Shortell SM, Savitz LA .
Implementation science: A potential catalyst for delivery system reform.
JAMA 2016 Jan 26;315(4):339-40. doi: 10.1001/jama.2015.17949..
Keywords: Healthcare Delivery, Implementation, Quality Improvement, Quality of Care, Health Systems