National Healthcare Quality and Disparities Report
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Topics
- Access to Care (7)
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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 112 Research Studies DisplayedSmith JJ, Johnston JM, Hiratsuka VY
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
The researchers investigated changes in trend for type 2 diabetes mellitus (DM-II) quality indicators after patient-centered medical home (PCMH) implementation at Southcentral Foundation, a tribal health organization in Alaska. They found that rates of new DM-II diagnoses were stable prior to but increased after implementation. DM-II rates of HbA1c screening increased, though not significantly before and remained stable after implementation.
AHRQ-funded; HS019154.
Citation: Smith JJ, Johnston JM, Hiratsuka VY .
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
Prim Care Diabetes 2015 Apr;9(2):120-6. doi: 10.1016/j.pcd.2014.06.005..
Keywords: Diabetes, Patient-Centered Healthcare, Primary Care, Quality Measures, Racial and Ethnic Minorities
Bierman AS, Tinetti ME
AHRQ Author: Bierman AS
Precision medicine to precision care: managing multimorbidity.
Multimorbidity is the most common condition managed in practice. The authors argue that health-care delivery must be transformed to provide precision care to people with multimorbidity. Accomplishing this transition will require a change in practice, research, and policy from disease-specific to patient-centered models of care delivery.
AHRQ-authored.
Citation: Bierman AS, Tinetti ME .
Precision medicine to precision care: managing multimorbidity.
Lancet 2016 Dec 3;388(10061):2721-23. doi: 10.1016/s0140-6736(16)32232-2.
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Keywords: Healthcare Delivery, Chronic Conditions, Guidelines, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care
Schiff GD, Reyes Nieva H, Griswold P
Addressing ambulatory safety and malpractice: the Massachusetts PROMISES Project.
The researchers assembled a coalition of safety, regulatory, malpractice, and academic groups and recruited 25 primary care practices of which 16 were selected to receive a multifaceted improvement intervention. They describe how they developed and fielded the intervention, delineating some of the lessons learned in the course of the project and implications for future efforts in this field.
AHRQ-funded; HS019508.
Citation: Schiff GD, Reyes Nieva H, Griswold P .
Addressing ambulatory safety and malpractice: the Massachusetts PROMISES Project.
Health Serv Res 2016 Dec;51 Suppl 3:2634-41. doi: 10.1111/1475-6773.12621.
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Keywords: Patient Safety, Medical Liability, Primary Care
Silverberg JI, Hinami K, Trick WE
Itch in the general internal medicine setting: a cross-sectional study of prevalence and quality-of-life effects.
The researchers sought to determine the prevalence and impact of itch on quality of life (QOL) in the general internal medicine setting. They found that the patient burden of itch was similar to those of pain, constipation, sexual dysfunction, cough, and weight loss. They concluded that itch occurs commonly in the primary care setting and is associated with poor QOL.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Hinami K, Trick WE .
Itch in the general internal medicine setting: a cross-sectional study of prevalence and quality-of-life effects.
Am J Clin Dermatol 2016 Dec;17(6):681-90. doi: 10.1007/s40257-016-0215-3.
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Keywords: Quality of Life, Primary Care, Patient-Centered Outcomes Research
Komaromy M, Duhigg D, Metcalf A
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. It concluded that the ECHO model can promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.
AHRQ-funded; HS016510.
Citation: Komaromy M, Duhigg D, Metcalf A .
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
Subst Abus 2016;37(1):20-4. doi: 10.1080/08897077.2015.1129388.
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Keywords: Community-Based Practice, Primary Care, Substance Abuse, Training, Health Information Technology (HIT)
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Adams DR, Flores A, Coltri A
A missed opportunity to improve patient satisfaction? Patient perceptions of inpatient communication with their primary care physician.
Patient satisfaction could be driven by patient perception of hospital team communication with their primary care physician (PCP). A retrospective mixed methods approach was used to characterize the relationship between patient satisfaction and patient perception of hospital team-PCP communication.
AHRQ-funded; HS010597l; HS016967.
Citation: Adams DR, Flores A, Coltri A .
A missed opportunity to improve patient satisfaction? Patient perceptions of inpatient communication with their primary care physician.
Am J Med Qual 2016 Nov;31(6):568-76. doi: 10.1177/1062860615593339..
Keywords: Care Coordination, Hospitals, Patient Experience, Primary Care, Quality Improvement
Lee JL, Beach MC, Berger ZD
A qualitative exploration of favorite patients in primary care.
This study ascertained whether physicians have favorite patients, their experiences with such patients, and how such relationships may influence patients and physicians. It found that most participants (22/25) reported having favorite patients. For many physicians, favorite patients were not necessarily the most compliant patients, or those most similar to them. Instead, favorite patients were often very sick patients and/or those who have known their physicians for a long time.
AHRQ-funded; HS000029.
Citation: Lee JL, Beach MC, Berger ZD .
A qualitative exploration of favorite patients in primary care.
Patient Educ Couns 2016 Nov;99(11):1888-93. doi: 10.1016/j.pec.2016.06.023.
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Keywords: Patient Experience, Patient and Family Engagement, Primary Care, Clinician-Patient Communication
Nocon RS, Lee SM, Sharma R
AHRQ Author: Ngo-Metzger Q
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
This study compared health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth. It found that health center patients had lower use and spending than did non-health center patients across all services, with 22 percent fewer visits and 33 percent lower spending on specialty.
AHRQ-authored.
Citation: Nocon RS, Lee SM, Sharma R .
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
Am J Public Health 2016 Nov;106(11):1981-89. doi: 10.2105/ajph.2016.303341.
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Keywords: Medicaid, Healthcare Costs, Primary Care, Healthcare Utilization
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
Ferrante JM, Friedman A, Shaw EK
Lessons learned designing and using an online discussion forum for care coordinators in primary care.
In this paper, the authors comprehensively describe their experiences, from start to finish, of designing and using an asynchronous online discussion forum for collecting and analyzing information elicited from care coordinators in Patient-Centered Medical Homes across the United States. They conclude that an asynchronous online discussion forum is a feasible, efficient, and effective method to conduct a qualitative study, particularly when subjects are health professionals.
AHRQ-funded; HS020682.
Citation: Ferrante JM, Friedman A, Shaw EK .
Lessons learned designing and using an online discussion forum for care coordinators in primary care.
Qual Health Res 2016 Nov;26(13):1851-61. doi: 10.1177/1049732315609567..
Keywords: Care Coordination, Health Services Research (HSR), Patient-Centered Healthcare, Primary Care, Research Methodologies
Toomey SL, Elliott MN, Schwebel DC
Relationship between adolescent report of patient-centered care and of quality of primary care.
This study investigated whether adolescent self-report of patient-centered care (PCC) varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. It found that adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. The study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
AHRQ-funded; HS020513.
Citation: Toomey SL, Elliott MN, Schwebel DC .
Relationship between adolescent report of patient-centered care and of quality of primary care.
Acad Pediatr 2016 Nov - Dec;16(8):770-76. doi: 10.1016/j.acap.2016.01.006.
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Keywords: Children/Adolescents, Primary Care, Clinician-Patient Communication, Quality of Care, Access to Care
Patnode CD, Henninger ML, Senger CA
Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force.
This updated report found no significant association between interventions and breastfeeding initiation . There was limited mixed evidence of an association between system-level interventions and rates of breastfeeding from well-controlled studies as well as for harms related to breastfeeding interventions, including maternal anxiety scores, decreased confidence, and concerns about confidentiality.
AHRQ-funded.
Citation: Patnode CD, Henninger ML, Senger CA .
Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2016 Oct 25;316(16):1694-705. doi: 10.1001/jama.2016.8882.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Breast Feeding, Primary Care, Evidence-Based Practice, Guidelines
Parchman ML, Fagnan LJ, Dorr DA
Study protocol for "Healthy Hearts Northwest": a 2 x 2 randomized factorial trial to build quality improvement capacity in primary care.
The researchers describe the protocol of the "Healthy Hearts Northwest" (H2N) study, a randomized trial designed to address to quality improvement (QI) capacity within smaller primary care practices while improving risk factors for cardiovascular disease. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: practice facilitation (PF) alone, PF with educational outreach, PF with shared learning opportunities, or PF with both.
AHRQ-funded; HS023908.
Citation: Parchman ML, Fagnan LJ, Dorr DA .
Study protocol for "Healthy Hearts Northwest": a 2 x 2 randomized factorial trial to build quality improvement capacity in primary care.
Implement Sci 2016 Oct 13;11(1):138.
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Keywords: Primary Care, Evidence-Based Practice, Quality Improvement, Patient-Centered Outcomes Research, Cardiovascular Conditions
Halm EA, Beaber EF, McLerran D
Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach.
The researchers assessed associations between primary care provider (PCP) visits and receipt of colorectal cancer (CRC) screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). They found that patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs.
AHRQ-funded; HS022418.
Citation: Halm EA, Beaber EF, McLerran D .
Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach.
J Gen Intern Med 2016 Oct;31(10):1190-7. doi: 10.1007/s11606-016-3760-9..
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Patient-Centered Outcomes Research, Primary Care, Screening
Rodriguez HP, Chen X, Martinez AE
Availability of primary care team members can improve teamwork and readiness for change.
Researchers conducted a survey of adult primary care providers and staff in California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change. Greater team member availability was associated with greater readiness for change, but the relationship was stronger for staff than for primary care providers.
AHRQ-funded; HS020120.
Citation: Rodriguez HP, Chen X, Martinez AE .
Availability of primary care team members can improve teamwork and readiness for change.
Health Care Manage Rev 2016 Oct-Dec;41(4):286-95. doi: 10.1097/hmr.0000000000000082.
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Keywords: Primary Care, Teams, Patient-Centered Healthcare, Organizational Change, Practice Improvement
Fulford D, Tuot DS, Mangurian C
Electronic psychiatric consultation in primary care in the safety net.
The authors examined the feasibility and acceptability of implementing a psychiatric eReferral program in a publicly funded, community-based primary care clinic in San Francisco staffed by eight primary care practitioners (PCPs). They found feasibility and acceptability of implementing an integrated electronic psychiatry consultation and referral service in a community-based primary care clinic and recommended future trials designed to examine the impact of this type of service on the delivery of high-quality mental health care and its cost-effectiveness in a safety-net health care system.
AHRQ-funded; HS021700.
Citation: Fulford D, Tuot DS, Mangurian C .
Electronic psychiatric consultation in primary care in the safety net.
Psychiatr Serv 2016 Oct;67(10):1160-61. doi: 10.1176/appi.ps.671003.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Behavioral Health, Primary Care, Health Information Technology (HIT)
Raji MY, Chen NW, Raji M
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
The authors sought to examine rate and correlates of switching from exclusive nurse practitioner (NP) primary care to receiving some or all primary care from physicians. The study group consisted of Medicare beneficiaries with diabetes, congrestive heart failure, or chronic obstructive pulmonary disease. The researchers found that about half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period.
AHRQ-funded; HS022134; HS020642.
Citation: Raji MY, Chen NW, Raji M .
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
J Prim Care Community Health 2016 Oct;7(4):249-57. doi: 10.1177/2150131916659674.
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Keywords: Elderly, Medicare, Primary Care, Practice Patterns
Ray KN, Mehrotra A
Trends in access to primary care for children in the United States, 2002-2013.
Using MEPS data, the authors described how access to primary care has changed over the last decade for children. They found no change in the proportion of children with a usual source of care (USC). Other measures improved, but out-of-pocket costs increased among privately insured children. Results suggested that after-hours accommodation within the USC is worsening, despite the promotion of patient-centered medical home initiatives. All measures of acceptability improved, consistent with a growing focus on family-centeredness of care.
AHRQ-funded; HS022989.
Citation: Ray KN, Mehrotra A .
Trends in access to primary care for children in the United States, 2002-2013.
JAMA Pediatr 2016 Oct;170(10):1023-25. doi: 10.1001/jamapediatrics.2016.0985.
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Keywords: Access to Care, Children/Adolescents, Health Services Research (HSR), Medical Expenditure Panel Survey (MEPS), Primary Care
Breitenstein SM, Schoeny M, Risser H
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of implementing the tablet-based ezParent program in pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained at baseline, and at 3, 6, and 12 months post baseline. The authors suggest that the implementation of the ezParent is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care settings.
AHRQ-funded; HS024273.
Citation: Breitenstein SM, Schoeny M, Risser H .
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
Contemp Clin Trials 2016 Sep;50:229-37. doi: 10.1016/j.cct.2016.08.017.
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Keywords: Children/Adolescents, Healthcare Costs, Primary Care, Education: Patient and Caregiver, Caregiving
Gao Y, Nocon RS, Gunter KE
AHRQ Author: Ngo-Metzger Q
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. The researchers identified characteristics associated with HCs' PCMH capability. EHR adoption likely played a role in HCs' improvement in PCMH capability. Other factors include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
AHRQ-authored; AHRQ-funded; HS000084.
Citation: Gao Y, Nocon RS, Gunter KE .
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
J Gen Intern Med 2016 Sep;31(9):1041-51. doi: 10.1007/s11606-016-3729-8.
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Keywords: Patient-Centered Healthcare, Electronic Health Records (EHRs), Primary Care, Community-Based Practice, Vulnerable Populations
Gaglioti AH, Werner JJ, Rust G
Practice-based research networks (PBRNs) bridging the gaps between communities, funders, and policymakers.
In this commentary, the authors propose that practice-based research networks (PBRNs) engage with funders and policymakers by applying the same engagement strategies they have successfully used to build relationships with community stakeholders. A community engagement approach to achieve new funding streams for PBRNs should include a strategy to engage key stakeholders from the communities of funders, thought leaders, and policymakers using collaborative principles and methods.
AHRQ-funded; HS021639; HS021641; HS021648.
Citation: Gaglioti AH, Werner JJ, Rust G .
Practice-based research networks (PBRNs) bridging the gaps between communities, funders, and policymakers.
J Am Board Fam Med 2016 Sep-Oct;29(5):630-5. doi: 10.3122/jabfm.2016.05.160080.
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Keywords: Health Services Research (HSR), Practice-Based Research Network (PBRN), Primary Care, Policy
Biegler K, Mollica R, Sim SE
AHRQ Author: Ngo-Metzger Q
Rationale and study protocol for a multi-component health information technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.
The authors described the rationale and protocol of a clustered randomized controlled trial to test the effectiveness of a health information technology (HIT) intervention that provides a multi-component approach to delivering culturally competent mental health care in the primary care setting. They expect the outcomes to include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder. They suggest that this technology has the potential to be adapted in order to facilitate mental health screening and treatment in the primary care setting.
AHRQ-authored.
Citation: Biegler K, Mollica R, Sim SE .
Rationale and study protocol for a multi-component health information technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.
Contemp Clin Trials 2016 Sep;50:66-76. doi: 10.1016/j.cct.2016.07.001.
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Keywords: Health Information Technology (HIT), Behavioral Health, Depression, Screening, Primary Care
Walley AY, Green TC
Mainstreaming naloxone through coprescription to patients receiving long-term opioid therapy for chronic pain.
This editorial comments on the Coffin and colleagues' report of the Naloxone for Opioid Safety Evaluation (NOSE) study. The authors concluded that the NOSE study is a substantial step forward in demonstrating the feasibility of coprescription of rescue kits in primary care settings. (Coffin et al., Ann Intern Med. 2016 Aug 16;165(4):245-52.)
AHRQ-funded; HS024021.
Citation: Walley AY, Green TC .
Mainstreaming naloxone through coprescription to patients receiving long-term opioid therapy for chronic pain.
Ann Intern Med 2016 Aug 16;165(4):292-3. doi: 10.7326/m16-1348.
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Keywords: Chronic Conditions, Medication, Patient Safety, Primary Care
Holtrop JS, Potworowski G, Fitzpatrick L
Effect of care management program structure on implementation: a normalization process theory analysis.
This study used normalization process theory (NPT) to understand how care management structure affected how well care management became routine in practice. It concluded that, although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program.
AHRQ-funded; HS020108.
Citation: Holtrop JS, Potworowski G, Fitzpatrick L .
Effect of care management program structure on implementation: a normalization process theory analysis.
BMC Health Serv Res 2016 Aug 15;16(a):386. doi: 10.1186/s12913-016-1613-1.
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Keywords: Care Management, Chronic Conditions, Primary Care, Healthcare Delivery