National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- (-) Access to Care (10)
- Cardiovascular Conditions (5)
- Critical Care (2)
- Disabilities (1)
- Disparities (3)
- Elderly (1)
- Emergency Medical Services (EMS) (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Health Services Research (HSR) (1)
- Hospitals (1)
- Mortality (1)
- Nursing Homes (1)
- Racial and Ethnic Minorities (1)
- Rehabilitation (1)
- (-) Stroke (10)
- Telehealth (2)
- Uninsured (1)
- Urban Health (1)
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 10 of 10 Research Studies DisplayedZachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
KS Cash, RE Adeoye, O
AHRQ Author: Zachrison
Estimated population access to acute stroke and telestroke centers in the US, 2019.
In order to provide an update on population-level access to stroke care, the investigators estimated the proportion of the US population with access to an ED with acute stroke capabilities and assessed the specific contribution of telestroke services to US population access. They observed a substantial increase in population access to acute stroke care in this cross-sectional study relative to previous reports using alternative methods, likely due to the extensive and ongoing work to improve stroke systems of care, including greater stroke center accreditation and expansion of telestroke capacity.
AHRQ-funded; HS024561.
Citation: KS Cash, RE Adeoye, O .
Estimated population access to acute stroke and telestroke centers in the US, 2019.
JAMA Netw Open 2022 Feb;5(2):e2145824. doi: 10.1001/jamanetworkopen.2021.45824..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Critical Care, Access to Care
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Capo-Lugo CE, Askew RL, Naidech A
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
The goal of this single-center longitudinal observational study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Findings showed that approximately 1 in 4 study participants with acute stroke received neither a consultation nor an intervention. The authors conclude that efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
AHRQ-funded; HS000078.
Citation: Capo-Lugo CE, Askew RL, Naidech A .
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
Phys Ther 2019 Nov 25;99(11):1431-42. doi: 10.1093/ptj/pzz116..
Keywords: Disabilities, Stroke, Cardiovascular Conditions, Access to Care
Lyerly MJ, Wu TC, Mullen MT
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
The authors sought to determine the effect of telemedicine on access to acute stroke care for racial and ethnic minorities in the state of Texas. They found that telemedicine increased access to acute stroke care for 1.5 million Texans, and they found no evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
AHRQ-funded; HS013852.
Citation: Lyerly MJ, Wu TC, Mullen MT .
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
J Telemed Telecare 2016 Mar;22(2):114-20. doi: 10.1177/1357633x15589534.
.
.
Keywords: Access to Care, Disparities, Racial and Ethnic Minorities, Stroke, Telehealth
Ripley DC, Kwong PL, Vogel WB
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
This study examined the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke. It found that even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with inhospital mortality.
AHRQ-funded; HS018540.
Citation: Ripley DC, Kwong PL, Vogel WB .
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
Med Care 2015 Jun;53(6):501-9. doi: 10.1097/mlr.0000000000000366..
Keywords: Stroke, Mortality, Access to Care
Mullen MT, Branas CC, Kasner SE
Optimization modeling to maximize population access to comprehensive stroke centers.
This report demonstrates how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of primary stroke centers into comprehensive stroke centers (CSCs). Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes.
AHRQ-funded; HS013852; HS017960; HS010914.
Citation: Mullen MT, Branas CC, Kasner SE .
Optimization modeling to maximize population access to comprehensive stroke centers.
Neurology 2015 Mar 24;84(12):1196-205. doi: 10.1212/wnl.0000000000001390..
Keywords: Stroke, Access to Care, Health Services Research (HSR)
Mullen MT, Wiebe DJ, Bowman A
Disparities in accessibility of certified primary stroke centers.
These authors examined the proportion of the U.S. population with less than 60-minute access to Primary Stroke Centers (PSCs). They found significant geographic disparities in access to the PSCs. Stroke belt States have a higher burden of stroke and more limited access to PSCs.
AHRQ-funded; HS013852; HS017960; HS010914
Citation: Mullen MT, Wiebe DJ, Bowman A .
Disparities in accessibility of certified primary stroke centers.
Stroke. 2014 Nov;45(11):3381-8. doi: 10.1161/strokeaha.114.006021..
Keywords: Stroke, Access to Care, Disparities
Adeoye O, Albright KC, Carr BG
Geographic access to acute stroke care in the United States.
In this article the authors describe access of the US population to all facilities that actually provide intravenous recombinant tissue-type plasminogen activator (r-tPA) or endovascular therapy for acute ischemic stroke. The investigators concluded that more than half of the US population has geographic access to hospitals that actually deliver acute stroke care but treatment rates remain low.
AHRQ-funded; HS013852.
Citation: Adeoye O, Albright KC, Carr BG .
Geographic access to acute stroke care in the United States.
Stroke 2014 Oct;45(10):3019-24. doi: 10.1161/strokeaha.114.006293.
.
.
Keywords: Access to Care, Stroke