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
AHRQ Research Studies Date
Topics
- Access to Care (8)
- Ambulatory Care and Surgery (1)
- Behavioral Health (3)
- Cancer (2)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (2)
- Children/Adolescents (5)
- Chronic Conditions (1)
- Communication (1)
- Community Partnerships (1)
- Comparative Effectiveness (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Data (1)
- Diabetes (2)
- Disparities (5)
- Electronic Health Records (EHRs) (2)
- Emergency Department (2)
- Emergency Medical Services (EMS) (1)
- Healthcare Cost and Utilization Project (HCUP) (4)
- Healthcare Costs (18)
- Healthcare Delivery (1)
- Healthcare Utilization (5)
- Health Information Technology (HIT) (2)
- (-) Health Insurance (51)
- Health Services Research (HSR) (3)
- Health Status (1)
- Hospitalization (5)
- Hospitals (4)
- Inpatient Care (1)
- Lifestyle Changes (1)
- Low-Income (5)
- Medicaid (9)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (9)
- Medical Liability (1)
- Medicare (5)
- Medication (3)
- Mortality (2)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Experience (1)
- Patient Safety (1)
- Payment (5)
- Policy (17)
- Prevention (1)
- Primary Care (1)
- Quality Measures (1)
- Quality of Care (4)
- Racial and Ethnic Minorities (4)
- Skin Conditions (1)
- Social Determinants of Health (2)
- Substance Abuse (1)
- Surgery (1)
- Tobacco Use (1)
- Uninsured (9)
- Vaccination (1)
- Vulnerable Populations (1)
- Women (2)
- Young Adults (2)
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
26 to 50 of 51 Research Studies DisplayedThalmayer AG, Friedman SA, Azocar F
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
This study assessed Mental Health Parity and Addiction Equity Act’s (MHPAEA) effect on the prevalence of behavioral health quantitative treatment limits (QTLs). It concluded that, before MHPAEA, QTLs were common. Postimplementation, virtually all plans dropped such limits, suggesting that MHPAEA was effective at eliminating QTLs.
AHRQ-funded; HS024866.
Citation: Thalmayer AG, Friedman SA, Azocar F .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: impact on quantitative treatment limits.
Psychiatr Serv 2017 May;68(5):435-42. doi: 10.1176/appi.ps.201600110.
.
.
Keywords: Access to Care, Health Insurance, Policy, Behavioral Health
Zullo AR, Howe CJ, Galarraga O
Estimating the effect of health insurance on personal prescription drug importation.
Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. The investigators used inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations.
AHRQ-funded; HS022998.
Citation: Zullo AR, Howe CJ, Galarraga O .
Estimating the effect of health insurance on personal prescription drug importation.
Med Care Res Rev 2017 Apr;74(2):178-207. doi: 10.1177/1077558716629039..
Keywords: Health Insurance, Healthcare Costs, Medication
Sohn H
Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course.
This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. The authors assert that a formal decomposition on increment-decrement life-tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups' greater propensity to lose the insurance that they already have. They note that uninsured African Americans were faster to gain insurance than non-Hispanic whites but their high rates of insurance loss more than negated this advantage.
AHRQ-funded; HS000046.
Citation: Sohn H .
Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course.
Popul Res Policy Rev 2017 Apr;36(2):181-201. doi: 10.1007/s11113-016-9416-y.
.
.
Keywords: Disparities, Health Insurance, Racial and Ethnic Minorities, Uninsured
Jacobs PD, Cohen ML, Keenan P
AHRQ Author: Jacobs PD; Keenan P
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
To assess the impact of a risk adjustment program and a temporary reinsurance program, the researchers compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. They found that both programs were relatively well targeted in the first two years.
AHRQ-authored.
Citation: Jacobs PD, Cohen ML, Keenan P .
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
Health Aff 2017 Apr;36(4):755-63. doi: 10.1377/hlthaff.2016.1456.
.
.
Keywords: Health Insurance, Healthcare Costs, Policy
Abdelsattar ZM, Hendren S, Wong SL
The impact of health insurance on cancer care in disadvantaged communities.
The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown. This study of cancer patients diagnosed with the 4 leading causes of cancer deaths between 2007 and 2011 found that patients from disadvantaged communities benefit most from health insurance, and there is a reduction in disparities in outcome.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Hendren S, Wong SL .
The impact of health insurance on cancer care in disadvantaged communities.
Cancer 2017 Apr 1;123(7):1219-27. doi: 10.1002/cncr.30431.
.
.
Keywords: Cancer, Health Insurance, Patient-Centered Outcomes Research, Vulnerable Populations
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on medication adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
AHRQ-funded; HS022982.
Citation: Yeung K, Basu A, Marcum ZA .
Impact of a value-based formulary in three chronic disease cohorts.
Am J Manag Care 2017 Mar; 23(3 Suppl):S46-s53..
Keywords: Chronic Conditions, Health Insurance, Patient Adherence/Compliance, Medication, Healthcare Costs
Sohn H
Medicaid's lasting impressions: population health and insurance at birth.
This article examines lasting mortality improvements associated with availability of Medicaid at time and place of birth. Being born after Medicaid was associated with between 2.03 and 3.64 fewer deaths per 100,000 person-years in childhood and between 1.35 and 3.86 fewer deaths per 100,000 person-years in the thirties. The association between Medicaid at birth and mortality was the strongest in the oldest age group (36-40) in this study.
AHRQ-funded; HS000046.
Citation: Sohn H .
Medicaid's lasting impressions: population health and insurance at birth.
Soc Sci Med 2017 Mar;177:205-12. doi: 10.1016/j.socscimed.2017.01.043.
.
.
Keywords: Access to Care, Health Insurance, Health Services Research (HSR), Medicaid, Mortality
Huguet N, Angier H, Marino M
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. Data collection will include information on changes in health insurance, service receipt, and health outcomes, spanning 9 years (pre- and post-expansion), comparing states that expanded Medicaid, and those that did not.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Marino M .
Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers.
Implement Sci 2017 Feb 10;12(1):14. doi: 10.1186/s13012-017-0543-6.
.
.
Keywords: Diabetes, Policy, Access to Care, Health Insurance
Hines AL, Raetzman SO, Barrett ML
AHRQ Author: Moy E, Andrews RM
Managed care and inpatient mortality in adults: effect of primary payer.
This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service (FFS) plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS.
AHRQ-authored.
Citation: Hines AL, Raetzman SO, Barrett ML .
Managed care and inpatient mortality in adults: effect of primary payer.
BMC Health Serv Res 2017 Feb 8;17(1):121. doi: 10.1186/s12913-017-2062-1.
.
.
Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Inpatient Care, Mortality, Outcomes, Hospitalization, Medicare
Lion KC, Wright DR, Desai AD
Costs of care for hospitalized children associated with preferred language and insurance type.
The study sought to determine whether preferred language for care and insurance type are associated with cost among hospitalized children. It concluded that hospital costs varied significantly according to preferred language and insurance type, even adjusting for length of stay and medical complexity. These differences in the amount of billable care provided to medically similar patients may represent either underprovision or overprovision of care.
AHRQ-funded; HS024299.
Citation: Lion KC, Wright DR, Desai AD .
Costs of care for hospitalized children associated with preferred language and insurance type.
Hosp Pediatr 2017 Feb;7(2):70-78. doi: 10.1542/hpeds.2016-0051.
.
.
Keywords: Children/Adolescents, Communication, Health Insurance, Hospitalization, Racial and Ethnic Minorities
Popescu I, Heslin KC, Coffey RM
AHRQ Author: Heslin KC, Washington RE
Differences in use of high-quality and low-quality hospitals among working-age individuals by insurance type.
This study found that compared with patients who have private insurance, those with Medicaid or no insurance were more likely to be minorities and to reside in areas with low-socioeconomic status. The probability of admission to high-quality hospitals was similar for patients with Medicaid (23.3 percent) and private insurance (23.0 percent) but was significantly lower for patients without insurance (19.8 percent) compared with the other 2 insurance groups.
AHRQ-authored.
Citation: Popescu I, Heslin KC, Coffey RM .
Differences in use of high-quality and low-quality hospitals among working-age individuals by insurance type.
Med Care 2017 Feb;55(2):148-54. doi: 10.1097/mlr.0000000000000633.
.
.
Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Disparities, Quality of Care, Hospitals
Jacobs PD, Hill SC, Abdus S
AHRQ Author: Jacobs PD, Hill SC, Abdus S
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
The researchers simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Their simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment.
AHRQ-authored.
Citation: Jacobs PD, Hill SC, Abdus S .
Adults are more likely to become eligible for Medicaid during future recessions if their state expanded Medicaid.
Health Aff 2017 Jan;36(1):32-39. doi: 10.1377/hlthaff.2016.1076.
.
.
Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Pelech D
Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage.
This paper explored how provider and insurer market power affect which markets an insurer chooses to operate in. The investigators found that overall, insurers in the most concentrated hospital and physician markets were 9 and 13 percentage points more likely to exit, respectively, than those in the least concentrated markets. Conversely, insurers with more market power were less likely to exit than those with less, and an insurer's market power had the largest effect on exit in concentrated hospital markets.
AHRQ-funded; HS023477.
Citation: Pelech D .
Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage.
J Health Econ 2017 Jan;51:98-112. doi: 10.1016/j.jhealeco.2016.11.003..
Keywords: Health Insurance, Medicare
Decker SL, Lipton BJ
AHRQ Author: Decker SL, Lipton BJ
Most newly insured people in 2014 were long-term uninsured.
This study found that in 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
AHRQ-authored.
Citation: Decker SL, Lipton BJ .
Most newly insured people in 2014 were long-term uninsured.
Health Aff 2017 Jan;36(1):16-20. doi: 10.1377/hlthaff.2016.0984.
.
.
Keywords: Health Insurance, Uninsured, Medicaid, Policy
Christensen AL, Petersen DM, Burton RA
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures . Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures.
AHRQ-funded; 290200900019I; 29032004T.
Citation: Christensen AL, Petersen DM, Burton RA .
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
Matern Child Health J 2017 Jan;21(1):187-98. doi: 10.1007/s10995-016-2108-8.
.
.
Keywords: Quality Measures, Quality of Care, Children's Health Insurance Program (CHIP), Children/Adolescents, Medicaid, Health Insurance, Policy, Case Study
Schiff GD, Puopolo AL, Huben-Kearney A
Primary care closed claims experience of Massachusetts malpractice insurers.
The researchers studied patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. In Massachusetts, most primary care claims filed were related to alleged misdiagnosis.
AHRQ-funded; HS019508.
Citation: Schiff GD, Puopolo AL, Huben-Kearney A .
Primary care closed claims experience of Massachusetts malpractice insurers.
JAMA Intern Med 2013 Dec 9-23;173(22):2063-8. doi: 10.1001/jamainternmed.2013.11070..
Keywords: Primary Care, Medical Errors, Health Insurance, Patient Safety, Medical Liability
Chambers C, Chiu S, Katic M
High utilizers of emergency health services in a population-based cohort of homeless adults.
This study identified predictors of frequent emergency department (ED) use among a population-based sample of homeless adults in Toronto, Ontario. It found that among homeless adults with universal health insurance, a small subgroup accounted for the majority of visits to emergency services. Frequent use was driven by multiple predisposing, enabling, and need factors.
AHRQ-funded; HS014129.
Citation: Chambers C, Chiu S, Katic M .
High utilizers of emergency health services in a population-based cohort of homeless adults.
Am J Public Health 2013 Dec;103 Suppl 2:S302-10. doi: 10.2105/ajph.2013.301397..
Keywords: Emergency Department, Social Determinants of Health, Health Insurance, Healthcare Utilization
Hatch B, Angier H, Marino M
Using electronic health records to conduct children's health insurance surveillance.
The purpose of this study is to demonstrate secondary usage of electronic health records (EHRs) as an emerging data source for health insurance surveillance by community health centers and other primary care providers to track patients’ insurance coverage status and to identify patients most likely to benefit from outreach and support to obtain and maintain coverage.
AHRQ-funded; HS018569.
Citation: Hatch B, Angier H, Marino M .
Using electronic health records to conduct children's health insurance surveillance.
Pediatrics 2013 Dec;132(6):e1584-91. doi: 10.1542/peds.2013-1470..
Keywords: Electronic Health Records (EHRs), Children/Adolescents, Health Insurance, Children's Health Insurance Program (CHIP), Health Information Technology (HIT)
Abdus S, Selden TM
AHRQ Author: Abdus S, Selden TM
Preventive services for adults: how have differences across subgroups changed over the past decade?
This study uses MEPS data to track changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. The analysis found that differences across subgroups tended to persist over time, with some of the largest gaps between adults with and without coverage. Regional differences persisted or widened over the study period.
AHRQ-authored.
Citation: Abdus S, Selden TM .
Preventive services for adults: how have differences across subgroups changed over the past decade?
Med Care 2013 Nov;51(11):999-1007. doi: 10.1097/MLR.0b013e3182a97bc0.
.
.
Keywords: Healthcare Utilization, Health Insurance, Medical Expenditure Panel Survey (MEPS), Prevention, Social Determinants of Health
Zhang M, Shubina M, Morrison F
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
To find out whether copied documentation of lifestyle counseling was used to justify higher evaluation and management (E&M) charges, researchers investigated 12,527 patient encounters in which lifestyle counseling was documented. When time spent on counseling was recorded, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charges.
AHRQ-funded; HS017030
Citation: Zhang M, Shubina M, Morrison F .
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
BMC Health Serv Res. 2013 Oct 2;13:377. doi: 10.1186/1472-6963-13-377..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Insurance, Lifestyle Changes, Payment
Kirby JB, Kaneda T
AHRQ Author: Kirby JB
'Double jeopardy' measure suggests blacks and Hispanics face more severe disparities than previously indicated.
The authors proposed a new way of conceptualizing and quantifying the racial and ethnic disadvantages of uninsurance over the course of a lifetime. Their measures indicated that, compared to whites, Hispanics and blacks are more likely not only to be uninsured at any point throughout most of their lives, but also to spend more years uninsured and spend more of these uninsured years at high risk of needing medical care. They concluded that these life expectancy measures have the potential to reframe the discussion of disparities and monitor progress toward their elimination.
AHRQ-authored.
Citation: Kirby JB, Kaneda T .
'Double jeopardy' measure suggests blacks and Hispanics face more severe disparities than previously indicated.
Health Aff 2013 Oct;32(10):1766-72. doi: 10.1377/hlthaff.2013.0434.
.
.
Keywords: Disparities, Health Insurance, Health Status, Racial and Ethnic Minorities, Uninsured
Lieberthal RD
Analyzing the health care cost curve: a case study.
The author uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. He finds that costs rise continuously, not on an annual or monthly basis as typically charted by actuarial models. He concludes that population health management programs and health policy should be based on continuous analysis and adaption.
AHRQ-funded; HS018835
Citation: Lieberthal RD .
Analyzing the health care cost curve: a case study.
Popul Health Manag. 2013 Oct;16(5):341-8. doi: 10.1089/pop.2012.0102..
Keywords: Healthcare Costs, Health Insurance, Health Insurance
Tsui J, Gee GC, Rodriguez HP
Exploring the role of neighborhood socio-demographic factors on HPV vaccine initiation among low-income, ethnic minority girls.
This study of neighborhood factors associated with human papillomavirus (HPV) vaccine uptake, especially among disadvantaged groups, found that initiation rates were highest among girls from the most disadvantaged neighborhoods. However, mother’s awareness of HPV, age, and insurance status were also strong predictors for initiation.
AHRQ-funded; HS020172
Citation: Tsui J, Gee GC, Rodriguez HP .
Exploring the role of neighborhood socio-demographic factors on HPV vaccine initiation among low-income, ethnic minority girls.
J Immigr Minor Health. 2013 Aug;15(4):732-40. doi: 10.1007/s10903-012-9736-x..
Keywords: Vaccination, Children/Adolescents, Women, Health Insurance, Disparities
Cohen SB, Cohen JW
AHRQ Author: Cohen SB, Cohen JW
The capacity of the Medical Expenditure Panel Survey to inform the Affordable Care Act.
The authors provided a summary of the capacity of the Medical Expenditure Panel Survey to inform program planning, implementation, and evaluations of program performance for several components of the Affordable Care Act.
AHRQ-authored.
Citation: Cohen SB, Cohen JW .
The capacity of the Medical Expenditure Panel Survey to inform the Affordable Care Act.
Inquiry 2013 May;50(2):124-34. doi: 10.1177/0046958013513678.
.
.
Keywords: Data, Healthcare Costs, Health Insurance, Policy, Medical Expenditure Panel Survey (MEPS)
Miller GE, Selden TM
AHRQ Author: Miller GE, Selden TM
Tax subsidies for employer-sponsored health insurance: updated microsimulation estimates and sensitivity to alternative incidence assumptions.
Using MEPS data, the authors estimated 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and explored the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. They concluded that the aggregate value of the ESI tax subsidy and its distribution across firms can be reliably estimated using simplified incidence assumptions.
AHRQ-authored.
Citation: Miller GE, Selden TM .
Tax subsidies for employer-sponsored health insurance: updated microsimulation estimates and sensitivity to alternative incidence assumptions.
Health Serv Res 2013 Apr;48(2 Pt 2):866-83. doi: 10.1111/1475-6773.12037.
.
.
Keywords: Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS)