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 68 Research Studies DisplayedHerring B, Trish E
Explaining the growth in US health care spending using state-level variation in income, insurance, and provider market dynamics.
The authors estimated a regression model for state personal health care spending for 1991-2009, then used the results to produce state-level projections of health care spending for 2010-2013 and compared those average projected state values with actual national spending for 2010-2013. They found that at least 70% of the recent slowdown in health care spending can likely be explained by long-standing patterns.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
Explaining the growth in US health care spending using state-level variation in income, insurance, and provider market dynamics.
Inquiry 2015 Dec 9;52. doi: 10.1177/0046958015618971.
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Keywords: Healthcare Costs, Health Insurance, Provider: Health Personnel, Policy, Policy
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Whicher D, Wu AW
Ethics review of survey research: a mandatory requirement for publication?
The authors provided guidance for journals to consider when making determinations about the necessity of ethical review for survey research projects. They stated that in situations where there is greater than minimal risk of informational or psychological harms, the survey research should have received institutional ethics oversight. They also specified that survey research projects that enroll vulnerable individuals with diminished autonomy should receive institutional ethics oversight.
AHRQ-funded; HS000029.
Citation: Whicher D, Wu AW .
Ethics review of survey research: a mandatory requirement for publication?
Patient 2015 Dec;8(6):477-82. doi: 10.1007/s40271-015-0141-0.
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Keywords: Evidence-Based Practice, Policy, Patient Safety, Research Methodologies
Hellinger FJ
AHRQ Author: Hellinger FJ
In four ACA expansion states, the percentage of uninsured hospitalizations for people with HIV declined, 2012-14.
This study examines the influence of the Affordable Care Act's optional state Medicaid expansion on insurance coverage and health outcomes for hospitalized patients with HIV. It found that the percentage of hospitalizations of uninsured people with HIV in the four expansion states fell from 13.7 percent to 5.5 percent in the study period, while the percentage in the two nonexpanding states increased from 14.5 percent to 15.7 percent.
AHRQ-authored.
Citation: Hellinger FJ .
In four ACA expansion states, the percentage of uninsured hospitalizations for people with HIV declined, 2012-14.
Health Aff 2015 Dec;34(12):2061-8. doi: 10.1377/hlthaff.2015.0718..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Human Immunodeficiency Virus (HIV), Medicaid, Uninsured
Ellimoottil C, Miller S, Davis M
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
The researchers examined rates of elective surgery in previously insured individuals before and after Massachusetts health care reform. They observed no increase in the overall rate of selected discretionary inpatient surgeries in Massachusetts versus control states for the entire population , as well as among the white and low-income subgroups.
AHRQ-funded; HS018346.
Citation: Ellimoottil C, Miller S, Davis M .
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
Surg Innov 2015 Dec;22(6):588-92. doi: 10.1177/1553350615573579.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Health Insurance, Policy, Hospitalization
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
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Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
Luft HS
Policy-oriented research on improved physician incentives for higher value health care.
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered focusing on fundamental "building block" studies.
AHRQ-funded.
Citation: Luft HS .
Policy-oriented research on improved physician incentives for higher value health care.
Health Serv Res 2015 Dec;50 Suppl 2:2187-215. doi: 10.1111/1475-6773.12423.
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Keywords: Policy, Health Insurance, Payment, Health Services Research (HSR)
Lemke AA, Harris-Wai JN
Stakeholder engagement in policy development: challenges and opportunities for human genomics.
The purpose of this paper is to examine how stakeholder engagement is used to develop policies in genomics research and public health areas, as well as to identify future priorities for conducting evidence-based stakeholder engagements. It concluded that several challenges of using stakeholder engagement as a tool for genomics policy development remain, and little evidence regarding how to best incorporate stakeholder feedback into policy-making processes is currently available.
AHRQ-funded; HS023547.
Citation: Lemke AA, Harris-Wai JN .
Stakeholder engagement in policy development: challenges and opportunities for human genomics.
Genet Med 2015 Dec;17(12):949-57. doi: 10.1038/gim.2015.8.
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Keywords: Evidence-Based Practice, Genetics, Patient and Family Engagement, Policy, Public Health
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Meeker D, Jiang X, Matheny ME
A system to build distributed multivariate models and manage disparate data sharing policies: implementation in the scalable national network for effectiveness research.
The authors’ objective was to implement infrastructure that supports the functionality of some existing research networks (e.g., cohort discovery, workflow management, and estimation of multivariate analytic models on centralized data) while adding additional important new features. They were able to implement massively parallel (map-reduce) computation methods and a new policy management system to enable each study initiated by network participants to define the ways in which data may be processed, managed, queried, and shared.
AHRQ-funded; HS019913.
Citation: Meeker D, Jiang X, Matheny ME .
A system to build distributed multivariate models and manage disparate data sharing policies: implementation in the scalable national network for effectiveness research.
J Am Med Inform Assoc 2015 Nov;22(6):1187-95. doi: 10.1093/jamia/ocv017..
Keywords: Communication, Comparative Effectiveness, Data, Health Information Technology (HIT), Policy, Research Methodologies
Ross RE, Garfield LD, Brown DS
The Affordable Care Act and implications for health care services for American Indian and Alaska Native individuals.
This paper summarizes the Affordable Care Act provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the Indian Health Service.
AHRQ-funded; HS020269.
Citation: Ross RE, Garfield LD, Brown DS .
The Affordable Care Act and implications for health care services for American Indian and Alaska Native individuals.
J Health Care Poor Underserved 2015 Nov;26(4):1081-8. doi: 10.1353/hpu.2015.0129.
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Keywords: Disparities, Policy, Health Status, Health Services Research (HSR), Racial and Ethnic Minorities
Whittle HJ, Palar K, Hufstedler LL
Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: an example of structural violence in United States public policy.
This study sought to explore the experiences and structural determinants of food insecurity among a group of low-income PLHIV in the San Francisco Bay Area. It found that the lived experience of food insecurity among participants included periods of insufficient quantity of food and resultant hunger, as well as long-term struggles with quality of food that led to concerns about the poor health effects of a cheap diet.
AHRQ-funded; HS000046.
Citation: Whittle HJ, Palar K, Hufstedler LL .
Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: an example of structural violence in United States public policy.
Soc Sci Med 2015 Oct;143:154-61. doi: 10.1016/j.socscimed.2015.08.027..
Keywords: Chronic Conditions, Policy, Social Determinants of Health, Nutrition, Vulnerable Populations
DeLia D
Monte Carlo analysis of payer and provider risks in shared savings arrangements.
This article provides a thorough empirical analysis of random variation in shared savings arrangements. Among all the accountable care organizations (ACOs) examined, the observed savings rate can be several percentage points higher or lower than the assumed true savings rate, leading to large probabilities of Type I and Type II error in determining the existence of savings.
AHRQ-funded; HS023493.
Citation: DeLia D .
Monte Carlo analysis of payer and provider risks in shared savings arrangements.
Med Care Res Rev 2015 Oct;73(5):511-31. doi: 10.1177/1077558715618320.
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Keywords: Healthcare Costs, Policy
Polisena J, Garritty C, Umscheid CA
Rapid Review Summit: an overview and initiation of a research agenda.
This discussion paper highlights the important discussions that occurred during the Rapid Review Summit: Then, Now and in the Future, focusing on the initial development of a research agenda that resulted from the presentations and discussions. The research topics centered on three key areas of interest: (1) how to conduct a rapid review; (2) investigating the validity and utility of rapid reviews; and (3) how to improve access to rapid reviews.
AHRQ-funded; HS018987.
Citation: Polisena J, Garritty C, Umscheid CA .
Rapid Review Summit: an overview and initiation of a research agenda.
Syst Rev 2015 Sep 26;4:111. doi: 10.1186/s13643-015-0111-6.
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Keywords: Evidence-Based Practice, Healthcare Delivery, Policy, Research Methodologies
Portela M, Sommers BD
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
This article presents an overview of Puerto Rico’s health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. It found that uninsured rates were significantly lower in Puerto Rico;. Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year.
AHRQ-funded; HS021291.
Citation: Portela M, Sommers BD .
On the outskirts of national health reform: a comparative assessment of health insurance and access to care in Puerto Rico and the United States.
Milbank Q 2015 Sep;93(3):584-608. doi: 10.1111/1468-0009.12138..
Keywords: Health Insurance, Access to Care, Policy, Medicaid, Uninsured
Song Z, Chopra V, McMahon LF
Addressing the primary care workforce crisis.
In this commentary, the authors propose that CMS explicitly reward teaching hospitals if a certain share of their graduates (they propose 30%) remain in primary care 3 years after residency, either through additional payments or release of a withhold. This step could help address the shortage of primary care physicians that now calls for more policy attention and urgency.
AHRQ-funded; HS022835.
Citation: Song Z, Chopra V, McMahon LF .
Addressing the primary care workforce crisis.
Am J Manag Care 2015 Aug;21(8):e452-4..
Keywords: Education: Continuing Medical Education, Policy, Primary Care, Provider, Workforce
Kawai AT, Calderwood MS, Jin R
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
The 2008 Centers for Medicare & Medicaid Services (CMS) hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. This study examined whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). The CMS policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates.
AHRQ-funded; HS018414.
Citation: Kawai AT, Calderwood MS, Jin R .
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
Infect Control Hosp Epidemiol 2015 Aug;36(8):871-7. doi: 10.1017/ice.2015.86.
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Keywords: Healthcare-Associated Infections (HAIs), Policy, Medicare, Payment, Hospitals, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare Costs
Hoffman JA, Rosenfeld L, Schmidt N
Implementation of competitive food and beverage standards in a sample of Massachusetts Schools: the NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health).
This study examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulation. The multilevel models used in the study demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013.
AHRQ-funded; HS000055.
Citation: Hoffman JA, Rosenfeld L, Schmidt N .
Implementation of competitive food and beverage standards in a sample of Massachusetts Schools: the NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health).
J Acad Nutr Diet 2015 Aug;115(8):1299-307.e2. doi: 10.1016/j.jand.2015.04.019..
Keywords: Nutrition, Children/Adolescents, Education, Policy
Schulz J, DeCamp M, Berkowitz SA
Medicare Shared Savings Program: public reporting and shared savings distributions.
The objectives of this paper are to determine if Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) are meeting public reporting requirements related to shared savings plans, to quantitate the composition of shared savings distribution plans, and to investigate whether early ACO success is associated with specific plan or ACO characteristics. The authors found that just over one-half of MSSP ACOs report detailed shared savings distribution plans online, and these plans vary widely. They concluded that there appears to be no single shared savings distribution plan determinate of ACO success.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Medicare Shared Savings Program: public reporting and shared savings distributions.
Am J Manag Care 2015 Aug;21(8):546-53.
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Keywords: Quality of Care, Payment, Policy, Medicare, Public Reporting
Toro-Diaz H, Mayorga ME, Barritt AS
Predicting liver transplant capacity using discrete event simulation.
The researchers constructed a discrete event simulation model informed by current donor characteristics to predict future liver transplant trends through the year 2030. They found that by altering assumptions about the future donor pool, their model can be used to develop policy interventions to prevent a further decline in this lifesaving therapy.
AHRQ-funded; HS019468.
Citation: Toro-Diaz H, Mayorga ME, Barritt AS .
Predicting liver transplant capacity using discrete event simulation.
Med Decis Making 2015 Aug;35(6):784-96. doi: 10.1177/0272989x14559055.
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Keywords: Access to Care, Health Services Research (HSR), Policy, Transplantation
Dusetzina SB, Ellis S, Freedman RA
How do payers respond to regulatory actions? The case of bevacizumab.
This study examined payer-specific trends in bevacizumab use after the FDA's regulatory actions in granting and revoking an approved indication for metastatic breast cancer. It concluded that although insurers varied in public statements regarding coverage intentions, bevacizumab use declined similarly among all payers, suggesting that provider decision making, rather than payer-specific coverage policies, drove reductions.
AHRQ-funded; HS0189960.
Citation: Dusetzina SB, Ellis S, Freedman RA .
How do payers respond to regulatory actions? The case of bevacizumab.
J Oncol Pract 2015 Jul;11(4):313-8. doi: 10.1200/jop.2015.004218.
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Keywords: Policy, Medication, Health Insurance, Policy
Bachhuber MA, McGinty EE, Kennedy-Hendricks A
Messaging to increase public support for naloxone distribution policies in the United States: results from a randomized survey experiment.
The investigators conducted a web-based survey (GfK Knowledge Panel) about barriers to public support for naloxone distribution. They concluded that public support for naloxone distribution can be improved through education and sympathetic portrayals of the population who stands to benefit from these policies.
AHRQ-funded; HS000029.
Citation: Bachhuber MA, McGinty EE, Kennedy-Hendricks A .
Messaging to increase public support for naloxone distribution policies in the United States: results from a randomized survey experiment.
PLoS One 2015 Jul;10(7):e0130050. doi: 10.1371/journal.pone.0130050.
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Keywords: Medication, Opioids, Policy, Substance Abuse
Feemster KA
Remembering the benefits of vaccination.
This commentary discussed the issue of vaccination and tightening exemptions for school entry. The author pointed out that events show that the success of vaccines can be fragile, as the measles cases associated with Disneyland were preceded by 644 cases in 2014. And 2012 saw more than 40,000 cases of pertussis, the largest number since 1960. These events provided a dramatic reminder that vaccines remain an important and necessary public health tool.
AHRQ-funded; HS020939.
Citation: Feemster KA .
Remembering the benefits of vaccination.
JAMA Pediatr 2015 Jul;169(7):624-6. doi: 10.1001/jamapediatrics.2015.0647.
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Keywords: Children/Adolescents, Infectious Diseases, Patient Safety, Policy, Vaccination
Herring B, Trish E
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
The authors discuss a provision of the ACA that will introduce a 40 percent excise tax on health benefits exceeding a $10,200 threshold for single coverage and a $27,500 threshold for family coverage, annually. They argue that the low-income workers receive a relatively smaller subsidy to offset a portion of the Cadillac tax while the high-income workers receive a relatively larger subsidy to offset a portion of the Cadillac tax. All this adds up to a regressive effect.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
AMA J Ethics 2015 Jul;17(7):672-9. doi: 10.1001/journalofethics.2015.17.7.sect1-1507..
Keywords: Healthcare Costs, Health Insurance, Policy