National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
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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 21 of 21 Research Studies DisplayedKranz AM, DeYoreo M, shete-Roesler B
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
The goal of this study was to test the hypothesis that health systems provide better care to patients with high needs compared to nonaffiliated physician organizations (POs). The 2015 Medicare Data on Provider Practice and Specialty linked physicians’ database was linked to POs Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and IRS Form 990 data to identify health system affiliations. Among 2,323,301 beneficiaries with high needs, 52.3% received care from system-affiliated practices. The emergency department (ED) visit rate was statistically significantly different in system-affiliated POs and nonaffiliated POs. There were small differences for the remaining five of six quality measures examined: continuity of care, follow-up visits, all-cause readmissions, and ambulatory care-sensitive hospitalizations. Within systems there was substantial variation for rates of continuity of care and follow-up after ED visits.
AHRQ-funded; HS024067.
Citation: Kranz AM, DeYoreo M, shete-Roesler B .
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
Health Serv Res 2020 Dec;55(Suppl 3):1118-28. doi: 10.1111/1475-6773.13570..
Keywords: Health Systems, Medicare, Quality of Care, Healthcare Delivery
Qureshi N, Quigley DD, Hays RD
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
The purpose of this study was to examine reasons practices obtained and maintained patient-centered medical home (PCMH) recognition and what resources were needed. The investigators concluded that PCMH efforts necessitated support and assistance to frontline, on-site practice leaders leading care delivery changes. They suggested that change efforts should include financial incentives (e.g., direct payment or additional reimbursement), leadership direction and support, and internal or external staff with experience with the PCMH application process, implementation changes, and QI expertise in monitoring process and outcome data.
AHRQ-funded; HS016980.
Citation: Qureshi N, Quigley DD, Hays RD .
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
J Gen Intern Med 2020 Dec;35(12):3501-09. doi: 10.1007/s11606-020-06052-1..
Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Healthcare Delivery
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
AHRQ-funded; HS024067.
Citation: Agniel D, Haviland A, Shekelle P .
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Health Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Sloan CE, Zhong J, Mohottige D
Fragmentation of care as a barrier to optimal ESKD management.
This article describes the role of care fragmentation in the delivery of optimal ESKD care and identifies research gaps in the evidence across the continuum of care. The authors consider the impact of care fragmentation on ESKD care from the patient and health system perspectives and explore opportunities for system-level interventions aimed at improving care for patients with ESKD.
AHRQ-funded.
Citation: Sloan CE, Zhong J, Mohottige D .
Fragmentation of care as a barrier to optimal ESKD management.
Semin Dial 2020 Nov;33(6):440-48. doi: 10.1111/sdi.12929..
Keywords: Kidney Disease and Health, Care Management, Healthcare Delivery, Quality of Care
Aguirre A, Trupin L, Margaretten M
Using process improvement and systems redesign to improve rheumatology care quality in a safety net clinic.
Researchers sought to develop and evaluate interventions to improve quality of care in four priority areas in an urban safety net adult rheumatology clinic serving a racially/ethnically and socioeconomically diverse patient population. Clinical processes were redesigned to achieve pre-specified benchmarks in the following four areas: 13-valent pneumococcal conjugate vaccine (PCV13) administered to immunocompromised patients; Clinical Disease Activity Index (CDAI) disease activity monitoring for patients with rheumatoid arthritis; latent tuberculosis infection (LTBI) screening for new biologic users with rheumatoid arthritis; reproductive health counseling among women receiving potentially teratogenic medications. Through an interprofessional approach, the researchers achieved durable improvements in key rheumatology quality measures largely by enhancing workflow, engaging non-physician providers, and managing practice variation.
AHRQ-funded; HS024412; HS025638.
Citation: Aguirre A, Trupin L, Margaretten M .
Using process improvement and systems redesign to improve rheumatology care quality in a safety net clinic.
J Rheumatol 2020 Nov;47(11):1712-20. doi: 10.3899/jrheum.190472..
Keywords: Urban Health, Rural/Inner-City Residents, Quality Improvement, Quality of Care, Healthcare Delivery
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Jaffe TA, Goldstein JN, Yun BJ
Impact of emergency department crowding on delays in acute stroke care.
This study examined the relationship between emergency department (ED) crowding and timely delivery of emergency stroke care. The authors prospectively collected data from their own institution’s Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients who came to their urban academic ED from July 2016-August 2018. ED conditions were categorized as normal capacity, high ED crowding, and severe crowding. Of the 1379 patients presenting with ischemic stroke during the study period, 78% presented at normal, 15% during high ED crowding, and 7% during severe crowding times. Outcomes of interest were door-to-imaging (DIT) time. There were no significant delays in stroke care delivery associated with ED crowding.
AHRQ-funded; HS024561.
Citation: Jaffe TA, Goldstein JN, Yun BJ .
Impact of emergency department crowding on delays in acute stroke care.
West J Emerg Med 2020 Jul 8;21(4):892-99. doi: 10.5811/westjem.2020.5.45873..
Keywords: Emergency Department, Stroke, Cardiovascular Conditions, Healthcare Delivery, Quality of Care
Rudin RS, Friedberg MW, Shekelle P
Getting value from electronic health records: research needed to improve practice.
Electronic health records (EHRs) are now widely adopted in the United States, but health systems have barely begun using them to deliver high-value care. This article describes 4 potential benefits of EHR-based research: improving clinical decisions, supporting triage decisions, enabling collaboration among the care team (including patients), and increasing productivity via automation of tasks.
AHRQ-funded; HS024067.
Citation: Rudin RS, Friedberg MW, Shekelle P .
Getting value from electronic health records: research needed to improve practice.
Ann Intern Med 2020 Jun 2;172(11 Suppl):S130-s36. doi: 10.7326/m19-0878..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care, Healthcare Delivery
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY .
Impact of flow disruptions in the delivery room.
Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
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Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, Quality Improvement, Quality of Care
Singer SJ, Kerrissey M, Friedberg M
A comprehensive theory of integration.
Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Drawing on previous work, in this study the investigators presented a comprehensive theoretical model of relationships between types of integration and proposed how to measure them.
AHRQ-funded; HS024067.
Citation: Singer SJ, Kerrissey M, Friedberg M .
A comprehensive theory of integration.
Med Care Res Rev 2020 Apr;77(2):196-207. doi: 10.1177/1077558718767000..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Quality of Care
Persell SD, Liss DT, Walunas TL
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
Effective quality improvement (QI) strategies are needed for small practices. The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. The investigators concluded that facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
AHRQ-funded; HS023921.
Citation: Persell SD, Liss DT, Walunas TL .
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
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Keywords: Cardiovascular Conditions, Prevention, Primary Care: Models of Care, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery
Grembowsk D, Conrad DA, Naranjo D
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
The authors sought to present the state-level evaluation methods for Washington State's State Innovation Models (SIM). They applied the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure their evaluation, then created a conceptual model and plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
AHRQ-funded; HS013853.
Citation: Grembowsk D, Conrad DA, Naranjo D .
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
Qual Manag Health Care 2020 Apr/Jun;29(2):81-94. doi: 10.1097/qmh.0000000000000246..
Keywords: Healthcare Delivery, Quality of Care
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J .
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, 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
Shen NT, Wu A, Farrell K
Patient perspectives of high-quality care on the liver transplant waiting list: a qualitative study.
The prevalence of advanced liver disease and listing for liver transplantation is increasing. Prior assessments of quality of care neither incorporate nor emphasize the patient perspective on quality of care, which may impact clinical outcomes. In this study the investigators aimed to identify patients' perceptions on what constitutes high quality of care, comparing the findings to existing frameworks and assessments to determine if a patient-derived tool assessing quality of care could facilitate efforts to improve health care.
AHRQ-funded; HS000066.
Citation: Shen NT, Wu A, Farrell K .
Patient perspectives of high-quality care on the liver transplant waiting list: a qualitative study.
Liver Transpl 2020 Feb;26(2):238-46. doi: 10.1002/lt.25645..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Transplantation, Quality of Care, Healthcare Delivery, Patient Experience
Conway PH, Mostashari F, Clancy CM
AHRQ Author: Clancy CM
The future of quality measurement for improvement and accountability.
The authors describe the characteristics of the quality measurement enterprise of the future, outline a potential roadmap for the transition, and identify a set of opportunities for public- and private-sector collaboration.
AHRQ-authored.
Citation: Conway PH, Mostashari F, Clancy CM .
The future of quality measurement for improvement and accountability.
JAMA 2013 Jun 5;309(21):2215-6. doi: 10.1001/jama.2013.4929.
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Keywords: Healthcare Delivery, Policy, Organizational Change, Quality Indicators (QIs), Quality Measures, Quality of Care
McNellis RJ, Genevro JL, Meyers DS
AHRQ Author: McNellis RJ, Genevro JL, Meyers DS
Lessons learned from the study of primary care transformation.
This article discusses the patient-centered medical home (PCMH) model. The authors conclude that the transformation of primary care is essential to achieving the triple aim of better outcomes, better value, and better experience of care, and that the PCMH may be the most viable solution in the current health care environment.
AHRQ-authored.
Citation: McNellis RJ, Genevro JL, Meyers DS .
Lessons learned from the study of primary care transformation.
Ann Fam Med 2013 May-Jun;11 Suppl 1:S1-5. doi: 10.1370/afm.1548.
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Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Organizational Change, Quality Improvement, Quality of Care
Kleinman LC, Dougherty D
AHRQ Author: Dougherty D
Assessing quality improvement in health care: theory for practice.
The authors reviewed the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. They concluded that such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies.
AHRQ-authored.
Citation: Kleinman LC, Dougherty D .
Assessing quality improvement in health care: theory for practice.
Pediatrics 2013 Mar;131 Suppl 1:S110-9. doi: 10.1542/peds.2012-1427n.
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Keywords: Quality Improvement, Healthcare Delivery, Organizational Change, Quality of Care, Health Services Research (HSR)
Taylor EF, Machta RM, Meyers DS
AHRQ Author: Meyers DS, Genevro J
Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
This article discusses how practice facilitators and care managers can play important but distinct roles in redesigning and improving care delivery in order to deliver coordinated, accessible, comprehensive, and patient-centered care.
AHRQ-authored.
Citation: Taylor EF, Machta RM, Meyers DS .
Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
Ann Fam Med 2013 Jan-Feb;11(1):80-3. doi: 10.1370/afm.1462.
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Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Organizational Change, Quality Improvement, Quality of Care