National Healthcare Quality and Disparities Report
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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
26 to 50 of 83 Research Studies DisplayedNdumele CD, Schpero WL, Trivedi AN
Medicaid expansion and health plan quality in Medicaid managed care.
The purpose of the study was to assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality. The study concluded that Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.
AHRQ-funded; HS017589.
Citation: Ndumele CD, Schpero WL, Trivedi AN .
Medicaid expansion and health plan quality in Medicaid managed care.
Health Serv Res 2018 Aug;53 Suppl 1:2821-38. doi: 10.1111/1475-6773.12814..
Keywords: Policy, Health Services Research (HSR), Health Insurance, Medicaid
Quigley DD, Elliott MN, Setodji CM
Quantifying magnitude of group-level differences in patient experiences with health care.
The purpose of this paper is to review approaches for assessing magnitude of differences in patient experience scores between different providers. The authors suggest routine estimation of magnitude in patient experience research. More work is needed documenting magnitude of differences between providers to make patient experience data more interpretable and usable.
AHRQ-funded; HS016980.
Citation: Quigley DD, Elliott MN, Setodji CM .
Quantifying magnitude of group-level differences in patient experiences with health care.
Health Serv Res 2018 Aug;53 Suppl 1:3027-51. doi: 10.1111/1475-6773.12828..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Services Research (HSR), Patient Experience, Patient Experience, Quality Measures
Lyles CR, Lunn MR, Obedin-Maliver J
The new era of precision population health: insights for the All of Us Research Program and beyond.
This paper addresses the new era of precision population health. Although precision medicine has made advances in individualized patient treatments, the authors assert that there needs to be continued attention on tailored population health and prevention strategies. They provide specific recommendations from the All of Us Research Program and the Precision Public Health Summit as examples for moving this field forward.
AHRQ-funded; HS022408.
Citation: Lyles CR, Lunn MR, Obedin-Maliver J .
The new era of precision population health: insights for the All of Us Research Program and beyond.
J Transl Med 2018 Jul 27;16(1):211. doi: 10.1186/s12967-018-1585-5..
Keywords: Health Information Technology (HIT), Health Services Research (HSR), Patient-Centered Outcomes Research, Public Health
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
Walker DM, Hefner JL, Sieck CJ
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
Inpatient portals are emerging as an important tool to support patient care and are increasingly being adopted in hospitals. However, best practices concerning the implementation, use, and impact of these portals are poorly understood. To improve evaluation and implementation efforts, this paper develops a logic model that can help researchers and hospital managers in deploying and assessing the impact of inpatient portals.
AHRQ-funded; HS024349; HS024091.
Citation: Walker DM, Hefner JL, Sieck CJ .
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
J Med Syst 2018 Jul 16;42(9):158. doi: 10.1007/s10916-018-1009-3..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Hospitals, Web-Based
Zhou L, Blackley SV, Kowalski L
Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists.
The purpose of this study was to identify and analyze errors at each stage of the speech recognition (SR) assisted dictation process. The study concluded that seven in 100 words in SR-generated documents contain errors; many errors involve clinical information. That most errors were corrected before notes were signed demonstrates the importance of manual review, quality assurance, and auditing.
AHRQ-funded; HS024264.
Citation: Zhou L, Blackley SV, Kowalski L .
Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists.
JAMA Network Open 2018 Jul;1(3):e180530. doi: 10.1001/jamanetworkopen.2018.1627..
Keywords: Quality of Care, Health Information Technology (HIT), Health Services Research (HSR), Medical Errors, Patient Safety
Haverkamp MH, Peiris D, Mainor AJ
ACOs with risk-bearing experience are likely taking steps to reduce low-value medical services.
The authors of this study set out to identify accountable care organizations (ACO) characteristics associated with implementation of strategies to reduce overuse of low-value medical services. The study concluded that in the first year of implementation, just one-third of ACOs had taken steps to reduce the use of low-value medical services. Safety-net ACOs and those with little experience as a risk-bearing organization need more time and support from healthcare payers and the Choosing Wisely campaign to prioritize the reduction of overuse.
AHRQ-funded; HS023812; HS024075.
Citation: Haverkamp MH, Peiris D, Mainor AJ .
ACOs with risk-bearing experience are likely taking steps to reduce low-value medical services.
Am J Manag Care 2018 Jul;24(7):e216-e21..
Keywords: Shared Decision Making, Healthcare Utilization, Health Services Research (HSR)
Ly DP, Cutler DM
Factors of U.S. hospitals associated with improved profit margins: an observational study.
The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The study concluded that differential price increases have led to improved margins for some hospitals over time.
AHRQ-funded; HS024072.
Citation: Ly DP, Cutler DM .
Factors of U.S. hospitals associated with improved profit margins: an observational study.
J Gen Intern Med 2018 Jul;33(7):1020-27. doi: 10.1007/s11606-018-4347-4..
Keywords: Healthcare Costs, Health Services Research (HSR), Hospitals
Moffatt-Bruce S, Huerta T, Gaughan A
IDEA4PS: the development of a research-oriented learning healthcare system.
In this paper, the authors present the approach of one academic medical center in becoming a research-oriented Learning Healthcare System (ro-LHS). By reframing the role of research in improving outcomes, the organization was able to move beyond its focus on quality improvement to foster a culture in which feedback informs practice and research drives improvement.
AHRQ-funded; HS024091.
Citation: Moffatt-Bruce S, Huerta T, Gaughan A .
IDEA4PS: the development of a research-oriented learning healthcare system.
Am J Med Qual 2018 Jul;33(4):420-25. doi: 10.1177/1062860617751044..
Keywords: Health Services Research (HSR), Learning Health Systems, Outcomes, Quality Improvement
Henderson ML, DiBrito SR, Thomas AG
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
This registry-based cohort study examined the patient characteristics and outcomes associated with living multiorgan donation in the United States. The authors assert that careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
AHRQ-funded; HS024600.
Citation: Henderson ML, DiBrito SR, Thomas AG .
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
Transplantation 2018 Jul;102(7):1148-55. doi: 10.1097/tp.0000000000002082..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Baloh J, Zhu X, Ward MM
Types of internal facilitation activities in hospitals implementing evidence-based interventions.
The aim of the study was to examine internal facilitation activities at 10 critical access hospitals in rural Iowa during their implementation of TeamSTEPPS, a patient safety intervention, and to identify characteristics that distinguish different types of facilitation activities. The investigators concluded that there are four types of facilitation activities that hospitals engage in while implementing evidence-based practices, offering a parsimonious way to characterize facilitation activities.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM .
Types of internal facilitation activities in hospitals implementing evidence-based interventions.
Health Care Manage Rev 2018 Jul/Sep;43(3):229-37. doi: 10.1097/hmr.0000000000000145..
Keywords: TeamSTEPPS, Implementation, Hospitals, Evidence-Based Practice, Health Services Research (HSR)
Weller SC, Vickers B, Bernard HR
Open-ended interview questions and saturation.
Sample size determination for open-ended questions or qualitative interviews relies primarily on custom and finding the point where little new information is obtained (thematic saturation). In this paper, the authors propose and test a refined definition of saturation as obtaining the most salient items in a set of qualitative interviews (where items can be material things or concepts, depending on the topic of study) rather than attempting to obtain all the items.
AHRQ-funded; HS022134.
Citation: Weller SC, Vickers B, Bernard HR .
Open-ended interview questions and saturation.
PLoS One 2018 Jun 20;13(6):e0198606. doi: 10.1371/journal.pone.0198606..
Keywords: Health Services Research (HSR), Research Methodologies
Shah PD, Marciniak MW, Golden SD
Pharmacies versus doctors' offices for adolescent vaccination.
This study sought to understand the relative advantage of pharmacies compared to doctors' offices for delivering HPV vaccination to adolescents. The authors concluded that to be more appealing to parents as HPV vaccine providers, pharmacy providers within community and hospital settings should build on their relative advantage with respect to accessibility and enhance their appeal of their healthcare environment.
AHRQ-funded; HS000032.
Citation: Shah PD, Marciniak MW, Golden SD .
Pharmacies versus doctors' offices for adolescent vaccination.
Vaccine 2018 Jun 7;36(24):3453-59. doi: 10.1016/j.vaccine.2018.04.088..
Keywords: Children/Adolescents, Health Services Research (HSR), Ambulatory Care and Surgery, Provider: Pharmacist, Vaccination
Wey A, Gustafson SK, Salkowski N
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program-specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. In this study, the investigators evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low-priority candidates.
AHRQ-funded; HS024527.
Citation: Wey A, Gustafson SK, Salkowski N .
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
Am J Transplant 2018 Jun;18(6):1360-69. doi: 10.1111/ajt.14684..
Keywords: Transplantation, Registries, Health Services Research (HSR)
Patterson ES, Dewart CM, Stevenson K
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
The purpose of the study is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. This paper presents findings from applying a mixed methods approach to identifying and prioritizing antibiotic medications and associated contextual data to display in a clinical decision support tailored to the local hospital.
AHRQ-funded; HS024379.
Citation: Patterson ES, Dewart CM, Stevenson K .
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):224-31. doi: 10.1177/2327857918071053..
Keywords: Antibiotics, Clinical Decision Support (CDS), Evidence-Based Practice, Health Services Research (HSR), Hospitals
Harrison KL, Taylor HA, Merritt MW
Action guide for addressing ethical challenges of resource allocation within community-based healthcare organizations.
This article proposes an action guide to making decisions regarding the ethical allocation of resources that affect access to healthcare services offered by community-based healthcare organizations. The authors suggest that the action guide provides community-based healthcare organizations with a conceptually grounded, empirically informed framework for ethical decision making.
AHRQ-funded; HS000029.
Citation: Harrison KL, Taylor HA, Merritt MW .
Action guide for addressing ethical challenges of resource allocation within community-based healthcare organizations.
J Clin Ethics 2018 Summer;29(2):124-38..
Keywords: Community-Based Practice, Shared Decision Making, Health Services Research (HSR)
Regenhardt RW, Mecca AP, Flavin SA
Delays in the air or ground transfer of patients for endovascular thrombectomy.
This study’s objective was to examine associations between transfer time, modes of transfer, endovascular therapy (ET), and outcomes within a hub-and-spoke telestroke network. Results showed an association between longer transfer time and decreased likelihood of undergoing ET. Nocturnal transfers were associated with a substantial delay relative to daytime transfers. In contrast, delivery of tPA was not associated with delays, underscoring the impact of effective protocols at spoke hospitals. More efficient transfer may enable higher ET treatment rates.
AHRQ-funded; HS024561.
Citation: Regenhardt RW, Mecca AP, Flavin SA .
Delays in the air or ground transfer of patients for endovascular thrombectomy.
Stroke 2018 Jun;49(6):1419-25. doi: 10.1161/strokeaha.118.020618.
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Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Telehealth, Transitions of Care, Stroke
Xu X, Lee HC, Lin H
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
The purpose of this study was to examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation. The study concluded that cost of childbirth hospitalizations varied widely among hospitals in California. Institutional characteristics significantly contributed to this variation. Higher-cost hospitals did not have better outcomes, suggesting potential opportunities to enhance value in care.
AHRQ-funded; HS023801.
Citation: Xu X, Lee HC, Lin H .
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
BJOG 2018 Jun;125(7):829-39. doi: 10.1111/1471-0528.15007..
Keywords: Healthcare Costs, Health Services Research (HSR), Hospitals, Labor and Delivery, Pregnancy
Sarkhel R, Socha JJ, Mount-Campbell A
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, the authors began to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding was that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name.
AHRQ-funded; HS024379.
Citation: Sarkhel R, Socha JJ, Mount-Campbell A .
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):205-09. doi: 10.1177/2327857918071045..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Inpatient Care, Nursing
Luckenbaugh AN, Holllenbeck BK, Kaufman SR
Impact of accountable care organizations on diagnostic testing for prostate cancer.
The researchers sought to determine if Accountable Care Organizations (ACOs) have the potential to accelerate the impact of prostate cancer screening recommendations. They concluded that the rate of PSA testing was not differentially affected by ACO participation. Conversely, there was an increase in the rate of prostate biopsy among patients of ACO-aligned physicians.
AHRQ-funded; HS024728; HS025707; HS024525.
Citation: Luckenbaugh AN, Holllenbeck BK, Kaufman SR .
Impact of accountable care organizations on diagnostic testing for prostate cancer.
Urology 2018 Jun;116:68-75. doi: 10.1016/j.urology.2018.01.056.
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Keywords: Cancer: Prostate Cancer, Health Services Research (HSR), Screening
Ma Y, Zhang W, Lyman S
The HCUP SID imputation project: improving statistical inferences for health disparities research by imputing missing race data.
The purpose of this study was to identify the most appropriate imputation method for missing data in the HCUP State Inpatient Databases (SID) and assess the impact of different missing data methods on racial disparities research. The investigators found that conditional MI prediction was equivalent or superior to the best performing alternatives for all missing data structures and substantially outperformed each of the alternatives in various scenarios.
AHRQ-funded; HS021734.
Citation: Ma Y, Zhang W, Lyman S .
The HCUP SID imputation project: improving statistical inferences for health disparities research by imputing missing race data.
Health Serv Res 2018 Jun;53(3):1870-89. doi: 10.1111/1475-6773.12704.
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Keywords: Health Services Research (HSR), Healthcare Cost and Utilization Project (HCUP)
Terza JV
Two-stage residual inclusion estimation in health services research and health economics.
In the present paper, the author describes a two-stage residual inclusion (2SRI) how-to guide for practitioners and a step-by-step protocol that can be implemented with any of the popular statistical or econometric software packages.
AHRQ-funded; HS017434.
Citation: Terza JV .
Two-stage residual inclusion estimation in health services research and health economics.
Health Serv Res 2018 Jun;53(3):1890-99. doi: 10.1111/1475-6773.12714..
Keywords: Health Services Research (HSR)
Wu S, Leff B
Frailty measurement and its contribution to clinical care and health services: a commentary.
Frailty is associated with poorer quality of life and higher healthcare utilization and spending. Despite its importance, no clear consensus exists on the definition of frailty. The recent IJHPR article by Buch et al. significantly contributes to the advancement of Israel's understanding of frailty by estimating for the first time the prevalence of frailty in the country. This commentary discusses the context of past and current advancements in measuring frailty and discusses how frailty measurement can contribute to both clinical care and the organization of health services to care for frail older adults in Israel and other developed countries.
AHRQ-funded; HS000029.
Citation: Wu S, Leff B .
Frailty measurement and its contribution to clinical care and health services: a commentary.
Isr J Health Policy Res 2018 May 23;7(1):27. doi: 10.1186/s13584-018-0225-0.
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Keywords: Elderly, Health Services Research (HSR), Quality of Life
Lu B, Cai D, Tong X
Testing causal effects in observational survival data using propensity score matching design.
The researchers proposed a strategy to test for survival function differences based on the matching design and explored sensitivity of the P-values to assumptions about unmeasured confounding. Next, they applied their method to an observational cohort of chronic liver disease patients from a Mayo Clinic study. Results showed evidence of a significant treatment effect. They recommended caution, however, as the sensitivity analysis reveals that the P-value becomes non-significant if there exists an unmeasured confounder with a small impact.
AHRQ-funded; HS024263.
Citation: Lu B, Cai D, Tong X .
Testing causal effects in observational survival data using propensity score matching design.
Stat Med 2018 May 20;37(11):1846-58. doi: 10.1002/sim.7599.
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Keywords: Data, Health Services Research (HSR), Research Methodologies
Jones CD, Burke RE
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
The care provided after hospital discharge in skilled-nursing facilities and home health care is collectively termed postacute care (PAC). In this article, the authors outline 3 key problems with postacute care transitions and offer potential solutions.
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):HO2-HO3. doi: 10.7326/m18-0940..
Keywords: Health Services Research (HSR), Home Healthcare, Hospital Discharge, Long-Term Care, Transitions of Care