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
1 to 25 of 46 Research Studies DisplayedMcCleskey SG, Shek L, Grein J
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.
This systematic review looked at economic evaluations of quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). A literature review was conducted for conference abstracts and studies from January 2000 to October 2020. Dual reviewers assessed study design, effectiveness, costs and study quality for eligibility. The reviewers performed a cost-consequence analysis from the hospital perspective, estimating the incidence rate ratio and increment net cost/savings per hospital over 3 years for each eligible study. Fifteen unique economic evaluations were eligible, and 12 studies were amenable to standardization. QI interventions were associated with a 43% decline in infections and wide ranges of net costs relative to usual care.
AHRQ-funded; HS022644.
Citation: McCleskey SG, Shek L, Grein J .
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.
BMJ Qual Saf 2022 Apr;31(4):308-21. doi: 10.1136/bmjqs-2021-013839..
Keywords: Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Hospitals, Healthcare Costs
Zimmerman S, Carder P, Schwartz L
The imperative to reimagine assisted living.
Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.
AHRQ-funded; HS026893.
Citation: Zimmerman S, Carder P, Schwartz L .
The imperative to reimagine assisted living.
J Am Med Dir Assoc 2022 Feb;23(2):225-34. doi: 10.1016/j.jamda.2021.12.004..
Keywords: Elderly, Long-Term Care, Healthcare Delivery, Workforce, Quality of Care, Quality of Life, Healthcare Costs
Greenberg JK, Olsen MA, Dibble CF
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Investigators sought to evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis. Using HCUP data, they found that 90-day inpatient costs were highly reliable for assessing variation across hospitals, whereas overall and serious complications were only moderately reliable for profiling performance. They concluded that their results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Dibble CF .
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Spine J 2021 Dec;21(12):2026-34. doi: 10.1016/j.spinee.2021.06.014..
Keywords: Healthcare Costs, Hospitals, Provider Performance, Surgery, Quality Measures, Quality of Care
Carey K, Luo Q, Dor A
Quality and cost in community health centers.
This study’s objective was to explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality. The authors used the Uniform Data System collected by the Bureau of Primary Care to construct composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. They explored different weighting schemes and different combinations of individual quality indicators. They used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. The average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varies with different weighting schemes.
AHRQ-funded; HS026816.
Citation: Carey K, Luo Q, Dor A .
Quality and cost in community health centers.
Med Care 2021 Sep;59(9):824-28. doi: 10.1097/mlr.0000000000001571.
AHRQ-funded; HS026816..
AHRQ-funded; HS026816..
Keywords: Community-Based Practice, Quality of Care, Healthcare Costs
Ling VB, Levi EE, Harrington AR
The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes.
Researchers evaluated the cost of implementing immediate postpartum contraceptive services at four academic centers and one private hospital in the US. Using mixed-methods cost analysis, they found that pre-implementation activities required more resources than execution activities, and sites that used lower-cost employees observed lower costs per hour for implementation activities. Further, implementation activities and costs were associated with local contextual factors, including stakeholder acceptance, integration of employees, and infrastructure readiness for the change effort.
AHRQ-funded; HS025465; HS023784.
Citation: Ling VB, Levi EE, Harrington AR .
The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes.
BMJ Qual Saf 2021 Aug;30(8):658-67. doi: 10.1136/bmjqs-2020-011111..
Keywords: Healthcare Costs, Sexual Health, Women, Quality Improvement, Quality of Care
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
AHRQ-funded; HS024072.
Citation: Zhou RA, Beaulieu ND, Cutler D .
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
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Keywords: Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Merkow RP, Shan Y, Gupta AR
A comprehensive estimation of the costs of 30-day postoperative complications using actual costs from multiple, diverse hospitals.
The objective of this study was to define the cost of individual, 30-day postoperative complications using robust cost data from a diverse group of hospitals. Findings showed that the three complications associated with the highest independent adjusted cost per event were prolonged ventilation, unplanned intubation, and renal failure, while the three complications associated with the lowest independent adjusted cost per event were urinary tract infection, superficial surgical site infection and venous thromboembolism. The authors indicated that the actual hospital costs of complications were estimated using cost data from four diverse hospitals, and that these data can be used by hospitals to estimate the financial benefit of reducing surgical complications.
AHRQ-funded; HS024516; HS026385.
Citation: Merkow RP, Shan Y, Gupta AR .
A comprehensive estimation of the costs of 30-day postoperative complications using actual costs from multiple, diverse hospitals.
The objective of this study was to define the cost of individual, 30-day postoperative .
Keywords: Surgery, Healthcare Costs, Adverse Events, Quality Improvement, Quality of Care
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
Ho V, Metcalfe L, Vu L
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
This study examined whether there are patient spending differences between practices owned by hospitals versus independent physician practices. The study used data from patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Preferred Provider organization in the four largest metropolitan areas in Texas. Spending was found to be significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care in hospital-owned practices. Estimates were that expenses were 5.8% higher in those practices.
AHRQ-funded; HS024727.
Citation: Ho V, Metcalfe L, Vu L .
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
J Gen Intern Med 2020 Mar;35(3):649-55. doi: 10.1007/s11606-019-05312-z..
Keywords: Hospitals, Healthcare Costs, Quality of Care
Amin AP, Spertus JA, Kulkarni H
Improving care pathways for acute coronary syndrome: patients undergoing percutaneous coronary intervention.
This study examined ways to improve care pathways for acute coronary syndrome (ACS) patients who are low-risk with no complications. They looked at 434,172 low-risk uncomplicated ACS patients eligible for early discharge from the Premier database and identified ACS care pathways. They compared percutaneous coronary intervention (PCI) types (trans-radial intervention [TRI] vs. transfemoral intervention (TFI) and by length of stay (LOS). Associations with costs and outcomes were tested using hierarchical, mixed-effects regression and projections of cost savings were obtained using modeling. More cost-savings were associated with TRI versus TFI. There was not an increased risk of adverse outcomes with a shorter LOS.
AHRQ-funded; HS022481.
Citation: Amin AP, Spertus JA, Kulkarni H .
Improving care pathways for acute coronary syndrome: patients undergoing percutaneous coronary intervention.
Am J Cardiol 2020 Feb;125(3):354-61. doi: 10.1016/j.amjcard.2019.10.019..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Quality Improvement, Quality of Care, Healthcare Delivery, Registries, Healthcare Costs
Sukul D, Ryan AM, Yan P
Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease.
Despite widespread adoption of Medicare accountable care organizations (ACOs), healthcare spending reductions have been modest. This may relate to variable participation in ACOs by specialist physicians, who disproportionately drive spending. In this study, the investigators analyzed national Medicare data to examine whether specialist participation in Medicare ACOs was associated with changes in healthcare spending and clinical quality.
AHRQ-funded; HS024728; HS025615; HS024525.
Citation: Sukul D, Ryan AM, Yan P .
Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease.
Circ Cardiovasc Qual Outcomes 2019 Sep;12(9):e005438. doi: 10.1161/circoutcomes.118.005438..
Keywords: Cardiovascular Conditions, Healthcare Costs, Heart Disease and Health, Medicare, Quality of Care
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
Mafi JN, Godoy-Travieso P, Wei E
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
This study analyzed the effects of an intervention program to reduce preoperative costs for care in patients undergoing cataract surgery. Most surgery centers require a battery of tests before surgery is approved. All patients must undergo primary care visits with chest x-rays, laboratory tests, and electrocardiograms required for many of them depending on age and presence of other conditions. This case-control study was conducted at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). All preoperative care decreased in the intervention group and mostly decreased in the control group. Financial losses occurred at these centers, but there was an overall savings for patients and society. These findings suggest that this may be a barrier to eliminating low-value care.
AHRQ-funded; HS024067.
Citation: Mafi JN, Godoy-Travieso P, Wei E .
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
JAMA Intern Med 2019 May;179(5):648-57. doi: 10.1001/jamainternmed.2018.8358..
Keywords: Healthcare Costs, Surgery, Eye Disease and Health, Quality Improvement, Quality of Care
Diaz-Perez MJ, Hanover R, Sites E
Producing comparable cost and quality results from all-payer claims databases.
This study describes how all-payer claims databases (APCDs) can produce comparable cost and quality results for 4 states using a multistate analysis. Data was used from 2014 commercial claims in Colorado, Massachusetts, Oregon, and Utah. The partners standardized the rules for including payers, data set elements, measure specifications, SAS code and adjustments for population differences in age and gender. A Uniform Data Structure file format was created which can be used across multiple population, measures, and research dimensions.
AHRQ-funded; HS024072.
Citation: Diaz-Perez MJ, Hanover R, Sites E .
Producing comparable cost and quality results from all-payer claims databases.
Am J Manag Care 2019 May;25(5):e138-e44..
Keywords: Healthcare Costs, Payment, Quality of Care
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Nathan H, Thumma JR, Ryan AM
Early impact of Medicare accountable care organizations on inpatient surgical spending.
This study evaluated whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. Medicare Shared Savings Programs (MSSP) have shown some modest success in reducing overall medical spending, but has not been studied on its impact in reducing surgical spending. Medicare claims from 2010 to 2014 were evaluated for patients aged 65 to 99 years undergoing 6 common elective surgical procedures: abdominal aortic aneurysm, colectomy, coronary artery bypass grafting, hip or knee replacement, or lung resection. A total of 341,675 patients at 427 ACO hospitals and over 1 million matched controls at non-ACO hospitals were used to compare surgical costs. There was not an overall reducing in total Medicare patients between the two hospital types.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Ryan AM .
Early impact of Medicare accountable care organizations on inpatient surgical spending.
Ann Surg 2019 Feb;269(2):191-96. doi: 10.1097/sla.0000000000002819..
Keywords: Healthcare Costs, Hospitals, Inpatient Care, Medicare, Surgery, Quality of Care
Weech-Maldonado R, Pradhan R, Dayama N
Nursing home quality and financial performance: is there a business case for quality?
This study examined the relationship between nursing home quality and financial performance. The study found that the operating margin was lower in nursing homes that: reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggested that there was a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Pradhan R, Dayama N .
Nursing home quality and financial performance: is there a business case for quality?
Inquiry 2019 Jan-Dec;56:46958018825191. doi: 10.1177/0046958018825191..
Keywords: Nursing Homes, Quality of Care, Healthcare Costs
Comfort LN, Shortell SM, Rodriguez HP
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
The purpose of this study was to examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) was associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). The investigators found that there was greater heterogeneity within ACO types than between ACO types; there were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year; and was evidence for higher spending on physician services for physician-led ACOs.
AHRQ-funded; HS024075.
Citation: Comfort LN, Shortell SM, Rodriguez HP .
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
Health Serv Res 2018 Aug;53(4):2303-23. doi: 10.1111/1475-6773.12829..
Keywords: Medicare, Healthcare Costs, Quality Indicators (QIs), Quality of Care
Nuckols TK, Keeler E, Anderson LJ
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
This study systematically reviewed economic evaluations of quality improvement (QI) interventions for glycemic control among adults with type 1 or type 2 diabetes. Using English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, the researchers extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost, incremental cost-effectiveness ratio, and study quality. They conclude that diverse and multifaceted QI interventions which lower HbA1c appear to be a fair-to-good value, relative to usual care.
AHRQ-funded; HS022644.
Citation: Nuckols TK, Keeler E, Anderson LJ .
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
Diabetes Care 2018 May;41(5):985-93. doi: 10.2337/dc17-1495..
Keywords: Diabetes, Healthcare Costs, Quality of Care, Quality Improvement
Rahman F, Guan J, Glazier RH
AHRQ Author: Bierman AS
Association between quality domains and health care spending across physician networks.
One of the more fundamental health policy questions is the relationship between health care quality and spending. Researchers measured 65 validated quality indicators (QI) across Ontario physician networks. Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations and higher rates of timely hospital-community transitions and moderately associated with lower readmission rates.
AHRQ-authored.
Citation: Rahman F, Guan J, Glazier RH .
Association between quality domains and health care spending across physician networks.
PLoS One 2018 Apr 3;13(4):e0195222. doi: 10.1371/journal.pone.0195222.
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Keywords: Healthcare Costs, Quality of Care, Patient-Centered Outcomes Research, Quality Indicators (QIs)
Chen LM, Ryan AM, Shih T
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
This study evaluated whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program-an early, small, voluntary episode-based payment program-was associated with a change in expenditures or quality of care. Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.
AHRQ-funded; HS018546; HS024698; HS020671.
Citation: Chen LM, Ryan AM, Shih T .
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
Health Serv Res 2018 Apr;53(2):632-48. doi: 10.1111/1475-6773.12681.
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Keywords: Healthcare Costs, Payment, Quality of Care, Surgery
Alderwick H, Shortell SM, Briggs ADM
Can accountable care organisations really improve the English NHS? Lessons from the United States.
The authors summarize evidence on accountable care organizations in the US - including what they look like, their effect on the quality and cost of healthcare, and how they are redesigning care. Recognizing major differences in context, they offer lessons from the US experience for National Health Service policy makers as they consider the future of similar ventures in England.
AHRQ-funded; HS022241; HS024075.
Citation: Alderwick H, Shortell SM, Briggs ADM .
Can accountable care organisations really improve the English NHS? Lessons from the United States.
BMJ 2018 Mar 2;360:k921. doi: 10.1136/bmj.k921.
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Keywords: Healthcare Costs, Quality of Care, Health Services Research (HSR), Policy
Shubeck SP, Thumma JR, Dimick JB
Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
The authors evaluated the potential interactive effect of hospital quality and patient risk on expenditures for cancer resections. They found that the total episode expenditures for cancer resections were lower when care was delivered at low-complication, high-quality hospitals. Expenditure differences were particularly large for high-risk patients, suggesting that the selective referral of high-risk patients to high-quality centers may be an effective strategy for optimizing value in cancer surgery.
AHRQ-funded; HS024763.
Citation: Shubeck SP, Thumma JR, Dimick JB .
Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
Cancer 2018 Feb 15;124(4):826-32. doi: 10.1002/cncr.31120.
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Keywords: Cancer, Healthcare Costs, Quality of Care, Hospitals, Surgery
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
Parasrampuria S, Oakes AH, Wu SS
Value and performance of accountable care organizations: a cost-minimization analysis.
The goal of this study was to determine the relationship between the quality of accountable care organizations (ACOs) and their long-term reduction in healthcare costs by conducting a cost minimization analysis. Centers for Medicare and Medicaid cost and quality data was used to calculate weighted composite quality scores for each ACO and organization-level cost savings. Markov modeling was used to compute the probability that an ACO transitioned between different quality levels in successive years and Monte Carlo simulations were conducted to project long-term cost savings by quality level over a 10-year period. The authors conclude that ACOs are a mechanism for decreasing costs by improving quality of care within the current fee-for-service healthcare model; higher quality ACOs incorporate higher levels of care coordination, which is associated with greater cost savings.
AHRQ-funded; HS000029.
Citation: Parasrampuria S, Oakes AH, Wu SS .
Value and performance of accountable care organizations: a cost-minimization analysis.
Int J Technol Assess Health Care 2018 Jan;34(4):388-92. doi: 10.1017/s0266462318000399..
Keywords: Healthcare Costs, Quality of Care