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 43 Research Studies DisplayedSohn MW, Kang H, Park JS
Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region.
This study examined disparities in the receipt of preventive care recommended by the American Diabetes Association (ADA) between Appalachian and non-Appalachian counties and within Appalachian counties. It concluded that there are significant disparities in the uptake of many recommended preventive services between less and more affluent counties in the Appalachian region.
AHRQ-funded; HS018542.
Citation: Sohn MW, Kang H, Park JS .
Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region.
BMJ Open Diabetes Res Care 2016 Dec;4(1):e000284. doi: 10.1136/bmjdrc-2016-000284.
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Keywords: Diabetes, Disparities, Prevention, Chronic Conditions, Social Determinants of Health
Rice LJ, Hughes B, Briggs V
Perceived efficacy and control for neighborhood change: the cross-cutting role of collective efficacy.
The authors characterized perceived neighborhood control and efficacy for neighborhood change and evaluated independent associations between efficacy and control beliefs and sociodemographic factors, community involvement, and perceptions of social environment. They concluded that efforts are needed to improve residents' ability to become positive agents of change in their community, and that creating a research infrastructure within academic community partnerships that focus on strengthening advocacy and public policy may improve resident's efficacy and ability to seek and encourage neighborhood change.
AHRQ-funded; HS019339.
Citation: Rice LJ, Hughes B, Briggs V .
Perceived efficacy and control for neighborhood change: the cross-cutting role of collective efficacy.
J Racial Ethn Health Disparities 2016 Dec;3(4):667-75. doi: 10.1007/s40615-015-0185-9.
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Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health
Fiscella K, Sanders MR
Racial and ethnic disparities in the quality of health care.
The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability.
AHRQ-funded; HS022440.
Citation: Fiscella K, Sanders MR .
Racial and ethnic disparities in the quality of health care.
Annu Rev Public Health 2016;37:375-94. doi: 10.1146/annurev-publhealth-032315-021439.
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Keywords: Disparities, Quality of Care, Racial and Ethnic Minorities, Social Determinants of Health
Earnshaw VA, Rosenthal L, Lang SM
Stigma, activism, and well-being among people living with HIV.
The researchers examined associations between experiences of HIV stigma and HIV activism, and test whether HIV activists benefit from greater well-being than non-activists. Their results suggest that HIV activists reported greater social network integration, greater social well-being, greater engagement in active coping with discrimination, and greater meaning in life than non-activists.
AHRQ-funded; HS022986.
Citation: Earnshaw VA, Rosenthal L, Lang SM .
Stigma, activism, and well-being among people living with HIV.
AIDS Care 2016;28(6):717-21. doi: 10.1080/09540121.2015.1124978.
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Keywords: Human Immunodeficiency Virus (HIV), Quality of Life, Depression, Social Determinants of Health, Social Stigma
Abdus S, Selden TM, Keenan P
AHRQ Author: Abdus S, Selden TM, Keenan P
The financial burdens of high-deductible plans.
The increased prevalence of high-deductible health plans raises concerns regarding high financial burdens from health care, particularly for low-income adults.
AHRQ-authored.
Citation: Abdus S, Selden TM, Keenan P .
The financial burdens of high-deductible plans.
Health Aff 2016 Dec;35(12):2297-301. doi: 10.1377/hlthaff.2016.0842.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Social Determinants of Health
Heerman WJ, Mitchell SJ, Thompson J
Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.
The researchers examined the association of perceived availability, condition, and safety of the built environment with its self-reported use for physical activity among underserved families with children at risk for obesity. In their sample of underserved families, perceived availability and condition of built environment structures were associated with use rather than perceived safety.
AHRQ-funded; HS022990.
Citation: Heerman WJ, Mitchell SJ, Thompson J .
Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.
BMC Public Health 2016 Nov 22;16(1):1180. doi: 10.1186/s12889-016-3854-7.
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Keywords: Obesity, Social Determinants of Health, Children/Adolescents, Racial and Ethnic Minorities, Vulnerable Populations
Fraze T, Lewis VA, Rodriguez HP
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
The authors examined how accountable care organizations (ACOs) addressed the nonmedical needs of their patients. They found that ACOs most commonly addressed the need for transportation, housing, and food insecurity, which they identified through the primary care visit or care transformation programs. They concluded that their findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations.
AHRQ-funded; HS024792.
Citation: Fraze T, Lewis VA, Rodriguez HP .
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
Health Aff 2016 Nov;35(11):2109-15. doi: 10.1377/hlthaff.2016.0727.
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Keywords: Social Determinants of Health, Patient-Centered Healthcare, Health Insurance, Healthcare Delivery, Primary Care, Public Health
Arora A, Spatz E, Herrin J
Population well-being measures help explain geographic disparities in life expectancy at the county level.
This study investigated whether population well-being - a comprehensive measure of physical, mental, and social health - helps explain geographic variation in life expectancy. At the county level, it found that for every 1-standard-deviation (4.2-point) increase in the well-being score, life expectancy was 1.9 years higher for females and 2.6 years higher for males.
AHRQ-funded; HS023000.
Citation: Arora A, Spatz E, Herrin J .
Population well-being measures help explain geographic disparities in life expectancy at the county level.
Health Aff 2016 Nov 01;35(11):2075-82. doi: 10.1377/hlthaff.2016.0715.
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Keywords: Disparities, Health Status, Low-Income, Social Determinants of Health
Harrison KL, Adrion ER, Ritchie CS
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
The researchers investigated the strength and magnitude of the relationship between sociodemographic and health characteristics of older adults and engagement in advance care planning (ACP)using logistic regression analysis and predicted probabilities. Their findings suggest that, in 2012, more than a quarter of older Medicare beneficiaries had not engaged in ACP. Those who were Latino, African American, poorly educated, or low income were at highest risk.
AHRQ-funded; HS000053.
Citation: Harrison KL, Adrion ER, Ritchie CS .
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
JAMA Intern Med 2016 Oct 31;176(12):1872-75. doi: 10.1001/jamainternmed.2016.6751.
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Keywords: Elderly, Medicare, Disparities, Social Determinants of Health
Sumner JA, Khodneva Y, Muntner P
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, the authors examined associations among depressive symptoms and stress, alone and in combination, and incident cardiovascular disease (CVD) and all-cause mortality as a function of socioeconomic status. They found that screening for a combination of elevated depressive symptoms and stress in low-income persons may help identify those at increased risk of incident CVD and mortality.
AHRQ-funded; HS023009.
Citation: Sumner JA, Khodneva Y, Muntner P .
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
J Am Heart Assoc 2016 Oct 10;5(10). doi: 10.1161/jaha.116.003930.
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Keywords: Cardiovascular Conditions, Depression, Social Determinants of Health, Stress, Stroke
Houser SH, Au DW, Miller MJ
Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS).
The authors examined the primary sources of non-steroidal anti-inflammatory drugs (NSAIDs) risk information and the associations with patient socio-demographic factors. They found that the primary patient source of information on NSAID risks was physician, followed by internet, pharmacist, and other sources, such as nurses and family/friends. They concluded that patients obtain information from a variety of sources, but primarily from health care providers.
AHRQ-funded; HS021110.
Citation: Houser SH, Au DW, Miller MJ .
Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS).
Int J Med Inform 2016 Oct;94:222-7. doi: 10.1016/j.ijmedinf.2016.07.017.
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Keywords: Education: Patient and Caregiver, Medication, Social Determinants of Health
Folch DC, Arribas-Bel D, Koschinsky J
Spatial variation in the quality of American Community Survey estimates.
The authors use a series of multivariate spatial regression models to describe the patterns of association between uncertainty in estimates and economic, demographic, and geographic factors, controlling for the number of responses in the American Community Survey. They find that these demographic and geographic patterns in estimate quality persist even after accounting for the number of responses, and they present advice for data users and potential solutions to the challenges identified.
AHRQ-funded; HS021752.
Citation: Folch DC, Arribas-Bel D, Koschinsky J .
Spatial variation in the quality of American Community Survey estimates.
Demography 2016 Oct;53(5):1535-54. doi: 10.1007/s13524-016-0499-1.
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Keywords: Data, Research Methodologies, Social Determinants of Health
Sharifi M, Sequist TD, Rifas-Shiman SL
The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity.
The authors sought to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and the built environment. They concluded that SES and the built environment may be important drivers of childhood obesity disparities and that interventions must be tailored to the neighborhood contexts in which families live.
AHRQ-funded; HS022986.
Citation: Sharifi M, Sequist TD, Rifas-Shiman SL .
The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity.
Prev Med 2016 Oct;91:103-09. doi: 10.1016/j.ypmed.2016.07.009.
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Keywords: Children/Adolescents, Disparities, Obesity, Racial and Ethnic Minorities, Social Determinants of Health
Goodman SM, Mandl LA, Parks ML
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Race is an important predictor of total knee arthroplasty (TKA) outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. This study found that blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandl LA, Parks ML .
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Clin Orthop Relat Res 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8.
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Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Patient-Centered Outcomes Research, Surgery
Nieman CL, Tunkel DE, Boss EF
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
The study’s objective was to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for tympanostomy tube (TT). It found that among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of chronic otitis media with effusion (OME) as opposed to recurrent acute otitis media (RAOM).
AHRQ-funded; HS022932.
Citation: Nieman CL, Tunkel DE, Boss EF .
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
Int J Pediatr Otorhinolaryngol 2016 Sep;88:98-103. doi: 10.1016/j.ijporl.2016.06.029.
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Keywords: Children/Adolescents, Ear Infections, Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Low-Income
Mayberry LS, Harper KJ, Osborn CY
Family behaviors and type 2 diabetes: what to target and how to address in interventions for adults with low socioeconomic status.
The researchers studied adults with type 2 diabetes at a Federally Qualified Health Center to better understand experiences with diabetes-specific family behaviors and willingness to engage family members in diabetes interventions. They found that some participants (40 percent) said engaging family in interventions would positively affect all members; others (27 percent) did not want to involve family.
AHRQ-funded; HS022990.
Citation: Mayberry LS, Harper KJ, Osborn CY .
Family behaviors and type 2 diabetes: what to target and how to address in interventions for adults with low socioeconomic status.
Chronic Illn 2016 Sep;12(3):199-215. doi: 10.1177/1742395316644303.
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Keywords: Diabetes, Patient Self-Management, Social Determinants of Health, Lifestyle Changes, Education: Patient and Caregiver
Martsolf GR, Barrett ML, Weiss AJ
AHRQ Author: Steiner CA, Coffey R
Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty.
This study examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA). It found that inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at less than 3 percent of the hospitals.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Barrett ML, Weiss AJ .
Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty.
J Bone Joint Surg Am 2016 Aug 17;98(16):1385-91. doi: 10.2106/jbjs.15.00884.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Social Determinants of Health, Hospital Readmissions, Surgery
Perez SL, Kravitz RL, Bell RA
Characterizing internet health information seeking strategies by socioeconomic status: a mixed methods approach.
The authors investigated how the Internet is used to obtain health-related information and how individuals with differing socioeconomic resources navigate it when presented with a health decision. Their findings suggest that individuals with different levels of socioeconomic status vary in the heuristics and search patterns they rely upon to direct their searches and that the influence and use of credible information in the process of making a decision is associated with education and prior experiences with healthcare services.
AHRQ-funded; HS022236.
Citation: Perez SL, Kravitz RL, Bell RA .
Characterizing internet health information seeking strategies by socioeconomic status: a mixed methods approach.
BMC Med Inform Decis Mak 2016 Aug 9;16:107. doi: 10.1186/s12911-016-0344-x.
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Keywords: Education: Patient and Caregiver, Health Information Technology (HIT), Social Determinants of Health, Web-Based
Yaghjyan L, Carlsson NP, Ghita GL
Associations of individual characteristics and lifestyle factors with metabolism of di-2-ethylhexyl phthalate in NHANES 2001-2012.
The authors examined associations of several individual characteristics and lifestyle factors with the ratio of mono-2-ethylhexyl phthalate to mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHP:MEHHP) and %MEHP (the ratio of MEHP to the sum of the secondary metabolites). They found that non-Caucasian individuals had higher %MEHP, that age was inversely associated, that overweight individuals had lower MEHP:MEHHP, and that alcohol consumption was inversely associated with %MEHP among men. They concluded that individual and lifestyle characteristics are associated with differences in DEHP metabolism.
AHRQ-funded; HS022330.
Citation: Yaghjyan L, Carlsson NP, Ghita GL .
Associations of individual characteristics and lifestyle factors with metabolism of di-2-ethylhexyl phthalate in NHANES 2001-2012.
Environ Res 2016 Aug;149:23-31. doi: 10.1016/j.envres.2016.05.002.
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Keywords: Lifestyle Changes, Racial and Ethnic Minorities, Social Determinants of Health
Caldwell JT, Ford CL, Wallace SP
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
The researchers examined whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. They cocluded that rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
AHRQ-funded; HS022811.
Citation: Caldwell JT, Ford CL, Wallace SP .
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
Am J Public Health 2016 Aug;106(8):1463-9. doi: 10.2105/ajph.2016.303212.
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Keywords: Rural Health, Urban Health, Racial and Ethnic Minorities, Access to Care, Social Determinants of Health
Steve SL, Tung EL, Schlichtman JJ
Social disorder in adults with type 2 diabetes: building on race, place, and poverty.
The authors reported on their narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. They also proposed a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes.
AHRQ-funded; HS000078.
Citation: Steve SL, Tung EL, Schlichtman JJ .
Social disorder in adults with type 2 diabetes: building on race, place, and poverty.
Curr Diab Rep 2016 Aug;16(8):72. doi: 10.1007/s11892-016-0760-4.
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Keywords: Diabetes, Low-Income, Health Status, Racial and Ethnic Minorities, Social Determinants of Health
Ancker JS, Hafeez B, Kaushal R
Socioeconomic disparities in adoption of personal health records over time.
The authors sought to track personal health record (PHR) adoption and differences by sociodemographic group over time. Using data from the Empire State Poll, they found that during a 4-year period in which federal policies incentivized medical organizations to give medical record access to patients through PHRs and electronic portals, rates of PHR use increased rapidly in all sociodemographic groups, but with a digital divide remaining, linked to Hispanic ethnicity and lower income.
AHRQ-funded; HS021531.
Citation: Ancker JS, Hafeez B, Kaushal R .
Socioeconomic disparities in adoption of personal health records over time.
Am J Manag Care 2016 Aug;22(8):539-40.
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Keywords: Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Social Determinants of Health
Moore JX, Donnelly JP, Griffin R
Defining sepsis mortality clusters in the United States.
The researchers aimed to identify US counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. They found that sepsis mortality is higher in the southern United States and that regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.
AHRQ-funded; HS013852.
Citation: Moore JX, Donnelly JP, Griffin R .
Defining sepsis mortality clusters in the United States.
Crit Care Med 2016 Jul;44(7):1380-7. doi: 10.1097/ccm.0000000000001665.
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Keywords: Mortality, Sepsis, Social Determinants of Health
Karp DN, Wolff CS, Wiebe DJ
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
The researchers identified clusters of high stroke mortality and adjacent areas of low stroke mortality for US counties and evaluated for regional differences in county-level risk factors. They found that clusters of high stroke mortality exist beyond the 8-state stroke belt, and variation exists within the stroke belt. They recommended reconsideration of the stroke belt definition and suggested increased attention to local determinants of health underlying small area regional variability to inform targeted healthcare interventions.
AHRQ-funded; HS018362.
Citation: Karp DN, Wolff CS, Wiebe DJ .
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
Stroke 2016 Jul;47(7):1939-42. doi: 10.1161/strokeaha.116.012997.
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Keywords: Mortality, Risk, Stroke, Social Determinants of Health
Peek ME, Lopez FY, Williams HS
Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians.
The purpose of this review was to understand how race, sexual orientation and gender identity can simultaneously influence shared decision making (SDM) among African-American LGBT persons. It also presents a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making.
AHRQ-funded; HS023050.
Citation: Peek ME, Lopez FY, Williams HS .
Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians.
J Gen Intern Med 2016 Jun;31(6):677-87. doi: 10.1007/s11606-016-3616-3.
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Keywords: Shared Decision Making, Social Determinants of Health, Racial and Ethnic Minorities, Patient-Centered Outcomes Research