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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 19 of 19 Research Studies DisplayedEliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Jain A, Brooks JR, Alford CC
AHRQ Author: Jain A, Alford CC, Chang CS, Mueller NM, Umscheid CA, Bierman AS
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
This AHRQ-authored study examined the increased use of health care algorithms in health decision tools, and whether including a patient's race or ethnicity among their inputs can lead clinicians and decision-makers to make choices that vary by race and potentially affect inequities. This qualitative survey included 42 organization representatives (e.g., clinical professional societies, universities, government agencies, payers, and health technology organizations) and individuals. The respondents identified 18 algorithms currently in use with the potential for bias. Seven qualitative themes with 31 subthemes were identified including: (1) algorithms are in widespread use and have significant repercussions, (2) bias can result from algorithms whether or not they explicitly include race, (3) clinicians and patients are often unaware of the use of algorithms and potential for bias, (4) race is a social construct used as a proxy for clinical variables, (5) there is a lack of standardization in how race and social determinants of health are collected and defined, (6) bias can be introduced at all stages of algorithm development, and (7) algorithms should be discussed as part of shared decision-making between the patient and clinician.
AHRQ-authored.
Citation: Jain A, Brooks JR, Alford CC .
Awareness of racial and ethnic bias and potential solutions to address bias with use of health care algorithms.
JAMA Health Forum 2023 Jun 2; 4(6):e231197. doi: 10.1001/jamahealthforum.2023.1197..
Keywords: Racial and Ethnic Minorities, Disparities, Healthcare Delivery, Evidence-Based Practice
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation: Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial and Ethnic Minorities
Han B, Chen PG, Yu H
Access to after-hours primary care: a key determinant of children's medical home status.
Researchers sought to identify individual survey items or domains that best predict medical home (MH) status for children and use them to develop brief markers of MH status. Using MEPS data, they found that accessibility, especially the ability to access health care after regular office hours, appeared to be the major predictor of having a MH among children. They recommended that the ongoing efforts to promote the MH model target improving accessibility of health care after regular hours for children overall and especially for Latino children.
AHRQ-funded; HS023336.
Citation: Han B, Chen PG, Yu H .
Access to after-hours primary care: a key determinant of children's medical home status.
BMC Health Serv Res 2021 Feb 27;21(1):185. doi: 10.1186/s12913-021-06192-y..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Access to Care, Healthcare Delivery, Disparities, Racial and Ethnic Minorities
Huguet N, Schmidt T, Larson A
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
Researchers described the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. Electronic health record data from OCHIN, a network of 396 community health centers across 14 states, was used. They concluded that since the future of the Patient Protection and Affordable Care Act is uncertain, and since the long-term health effects of COVID-19 are largely unknown, ensuring that people with pre-existing conditions can acquire health insurance is essential to achieving health equity.
AHRQ-funded; HS025962.
Citation: Huguet N, Schmidt T, Larson A .
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
J Am Board Fam Med 2021 Feb;34(Suppl):S247-s49. doi: 10.3122/jabfm.2021.S1.200571..
Keywords: Electronic Health Records (EHRs), COVID-19, Racial and Ethnic Minorities, Policy, Healthcare Delivery
Kubi B, Enumah ZO, Lee KT
Theory-based development of an implementation intervention using community health workers to increase palliative care use.
This study used the Behavior Change Wheel and Theoretical Domains Framework models to help design an implementation intervention using community health workers (CHWs) to increase palliative care use in African American communities. There were two phases to the study. In Phase 1, focus group sessions were conducted to identify barriers and facilitators of palliative care use. Phase 2 consisted of a stakeholder meeting to select intervention content and prioritize modes of delivery after applying the framework. There were 15 stakeholders total that participated in the study. Interventions identified were designed to improve patient capability and motivation, physician capability and motivation, and increase patient opportunities to use palliative care services. The strategies were all facilitated by CHWs and included creation and dissemination of brochures, empowerment and activation of patients to initiate goals-of-care discussions, outreach to community churches, and expanding patient social support.
AHRQ-funded; HS024736.
Citation: Kubi B, Enumah ZO, Lee KT .
Theory-based development of an implementation intervention using community health workers to increase palliative care use.
J Pain Symptom Manage 2020 Jul;60(1):10-19. doi: 10.1016/j.jpainsymman.2020.02.009..
Keywords: Community-Based Practice, Palliative Care, Healthcare Utilization, Racial and Ethnic Minorities, Implementation, Disparities, Healthcare Delivery
Fabius CD, Robison J
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examined the influence of these factors on living arrangements for 659 program participants age 65 or older.
AHRQ-funded; HS000011.
Citation: Fabius CD, Robison J .
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
J Appl Gerontol 2019 Apr;38(4):454-78. doi: 10.1177/0733464816687496..
Keywords: Elderly, Transitions of Care, Racial and Ethnic Minorities, Medicaid, Nursing Homes, Home Healthcare, Healthcare Delivery
Johnston FM, Neiman JH, Parmley LE
Stakeholder perspectives on the use of community health workers to improve palliative care use by African Americans with cancer.
This study focused on the issue of lack of palliative care for African-Americans with cancer. Stakeholder interviews and focus groups were conducted with cancer patients, caregivers, health care administrators, oncologists, and community health workers (CHWs). Participants felt that CHWs could play a central role in bridging patients with their providers, information and resources. They also felt that CHWs should either come from the community, or be familiar with the history, culture, and norms of the communities from which they operate.
AHRQ-funded; HS024736.
Citation: Johnston FM, Neiman JH, Parmley LE .
Stakeholder perspectives on the use of community health workers to improve palliative care use by African Americans with cancer.
J Palliat Med 2019 Mar;22(3):302-06. doi: 10.1089/jpm.2018.0366..
Keywords: Access to Care, Cancer, Healthcare Delivery, Healthcare Utilization, Cultural Competence, Disparities, Palliative Care, Racial and Ethnic Minorities
Wahl TS, Goss LE, Morris MS
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
The purpose of this study was to investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. The authors hypothesized that ERAS would reduce disparities in pLOS between black and white patients. They concluded that ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications.
AHRQ-funded; HS013852.
Citation: Wahl TS, Goss LE, Morris MS .
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
Ann Surg 2018 Dec;268(6):1026-35. doi: 10.1097/sla.0000000000002307..
Keywords: Surgery, Racial and Ethnic Minorities, Disparities, Care Management, Healthcare Delivery, Hospitalization, Patient-Centered Outcomes Research, Outcomes
Behler RL, Cornwell BT, Schneider JA
Patterns of social affiliations and healthcare engagement among young, black, men who have sex with men.
This study investigates how individuals’ social affiliations affect their knowledge of and engagement with public health services. A sample of 618 young black men who have sex with men (YBMSM) in Chicago were used to identify connections within their social networks. Men who had stronger affiliations with the Chicago gay community had more knowledge of pre-exposure prophylaxis (PrEP), while men who had stronger affiliations with the black community had improved HIV treatment outcomes.
AHRQ-funded; HS024167.
Citation: Behler RL, Cornwell BT, Schneider JA .
Patterns of social affiliations and healthcare engagement among young, black, men who have sex with men.
AIDS Behav 2018 Mar;22(3):806-18. doi: 10.1007/s10461-016-1668-3..
Keywords: Disparities, Healthcare Delivery, Human Immunodeficiency Virus (HIV), Men's Health, Racial and Ethnic Minorities
Davis CM, Guo M, Miyamura J
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. This survey found that the top three health decision-makers for both those Asian American and Pacific Islanders (AAPIs) with limited English proficiency and English-proficient AAPIs were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency.
AHRQ-funded; HS021903.
Citation: Davis CM, Guo M, Miyamura J .
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Hawaii J Med Public Health 2017 Oct;76(10):279-86.
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Keywords: Healthcare Delivery, Cultural Competence, Shared Decision Making, Pregnancy, Racial and Ethnic Minorities
Boehme AK, Carr BG, Kasner SE
Sex differences in rt-PA utilization at hospitals treating stroke: the National Inpatient Sample.
The researchers sought to explore sex and race differences in the utilization of recombinant tissue plasminogen activator (rt-PA) at primary stroke centers (PSCs) compared to non-PSCs across the US. They found that women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women.
AHRQ-funded; HS17960; HS018362; HS013852.
Citation: Boehme AK, Carr BG, Kasner SE .
Sex differences in rt-PA utilization at hospitals treating stroke: the National Inpatient Sample.
Front Neurol 2017 Sep 27;8:500. Original Research. doi: 10.3389/fneur.2017.00500.
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Keywords: Healthcare Delivery, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Sex Factors, Stroke
Karter AJ, Lipska KJ, O'Connor PJ
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
This seven-year surveillance study (2005-2011) evaluated race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. Annual SH rates ranged from 1.8 percent to 2.1 percent during this 7-year observation period. African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years.
AHRQ-funded; HS019859.
Citation: Karter AJ, Lipska KJ, O'Connor PJ .
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
J Diabetes Complications 2017 May;31(5):869-73. doi: 10.1016/j.jdiacomp.2017.02.009.
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Keywords: Chronic Conditions, Diabetes, Healthcare Delivery, Health Status, Racial and Ethnic Minorities
Stepanikova I, Oates GR
Dimensions of racial identity and perceived discrimination in health care.
Drawing from the scholarship on multidimensionality of race, this study examined the relationships between perceived discrimination in health care and two dimensions of racial identity: self-identified race/ethnicity and perceived attributed race/ethnicity (respondents' perceptions of how they are racially classified by others). The investigators used Behavioral Risk Factor Surveillance System data collected in 2004-2013 for their analysis.
AHRQ-funded; HS023009.
Citation: Stepanikova I, Oates GR .
Dimensions of racial identity and perceived discrimination in health care.
Ethn Dis 2016 Oct 20;26(4):501-12. doi: 10.18865/ed.26.4.501..
Keywords: Disparities, Healthcare Delivery, Racial and Ethnic Minorities
Farmer C, Yehia BR, Fleishman JA
AHRQ Author: Fleishman JA
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
The researchers evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention in care 1 year after initiating care and in the 2 years thereafter. They concluded that patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care.
AHRQ-authored.
Citation: Farmer C, Yehia BR, Fleishman JA .
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
J Pediatric Infect Dis Soc 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102.
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Keywords: Healthcare Delivery, Children/Adolescents, Human Immunodeficiency Virus (HIV), Risk, Racial and Ethnic Minorities
Roberts MC, Weinberger M, Dusetzina SB
Racial variation in the uptake of oncotype DX testing for early-stage breast cancer.
Oncotype DX (ODX) has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. The researchers examined racial disparities in ODX testing uptake. They did not find racial disparities in ODX testing for node-negative patients for whom ODX testing is guideline recommended and widely covered by insurers.
HS019468; HS022189
Citation: Roberts MC, Weinberger M, Dusetzina SB .
Racial variation in the uptake of oncotype DX testing for early-stage breast cancer.
J Clin Oncol 2016 Jan 10;34(2):130-8. doi: 10.1200/jco.2015.63.2489..
Keywords: Cancer: Breast Cancer, Healthcare Delivery, Treatments, Disparities, Racial and Ethnic Minorities
Chao MT, Handley MA, Quan J
Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes.
The authors identified sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes. Disclosure was associated with language concordance, physicians' interpersonal communication scores, shared decision making, and explanatory-type communication.
AHRQ-funded; HS020684; HS017261; HS022561.
Citation: Chao MT, Handley MA, Quan J .
Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes.
Patient Educ Couns 2015 Nov;98(11):1360-6. doi: 10.1016/j.pec.2015.06.011.
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Keywords: Low-Income, Diabetes, Complementary and Alternative Medicine, Racial and Ethnic Minorities, Healthcare Delivery
Aparicio HJ, Carr BG, Kasner SE
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
The researechers found that racial disparities in intravenous recombinant tissue plasminogen activator (rt-PA) use were not reduced by presentation to primary stroke centers (PSCs). Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
AHRQ-funded; HS018362; HS017960; HS013852.
Citation: Aparicio HJ, Carr BG, Kasner SE .
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
J Am Heart Assoc 2015 Oct 14;4(10):e001877. doi: 10.1161/jaha.115.001877.
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Keywords: Healthcare Delivery, Disparities, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Stroke
Pavlik VN, Chan W, Hyman DJ
Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials.
This study conducted a pooled analysis of three projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of African American patients with controlled blood pressure (BP). The analysis of trial results to determine the magnitude of the combined intervention effect found that pooled BP did not differ significantly between intervention and control clusters.
AHRQ-funded; HS021667.
Citation: Pavlik VN, Chan W, Hyman DJ .
Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials.
Curr Hypertens Rev 2015;11(2):123-31..
Keywords: Blood Pressure, Racial and Ethnic Minorities, Healthcare Delivery, Prevention, Care Management