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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 104 Research Studies DisplayedHassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Byhoff E, Taylor LA
Massachusetts community-based organization perspectives on Medicaid redesign.
The purpose of the study was to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. Forty-six key informant interviews were conducted, representing 44 community-based organizations across Massachusetts. Findings showed that changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. Recommendations included having policymakers and healthcare leadership ensure that community-based organizations are part of strategy development and social service program implementation.
AHRQ-funded; HS026664.
Citation: Byhoff E, Taylor LA .
Massachusetts community-based organization perspectives on Medicaid redesign.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S74-s81. doi: 10.1016/j.amepre.2019.07.017..
Keywords: Medicaid, Social Determinants of Health, Policy, Health Insurance
Huffstetler AN, Phillips RL
Payment structures that support social care integration with clinical care: social deprivation indices and novel payment models.
This perspective article focuses on four models employed both internationally and domestically to outline the implementation, successes, limitations, and research needed to support national application of social determinants of health (SDH) models. The association between high social risk and poor medical outcomes has been established globally; however, healthcare payment policies designed to respond to this relationship generally lack evidence of affecting outcomes. In countries with a legacy of adjusting healthcare payments for social risk, more robust evaluation of associated effects could be helpful. Payers, states, or health systems making similar resource commitments should build in robust longitudinal evaluations of outcomes to inform the evolution of their payment policies.
AHRQ-funded; HS026664.
Citation: Huffstetler AN, Phillips RL .
Payment structures that support social care integration with clinical care: social deprivation indices and novel payment models.
Am J Prev Med 2019 Dec;57(6s1):S82-s88. doi: 10.1016/j.amepre.2019.07.011..
Keywords: Payment, Social Determinants of Health, Policy
Ancker JS, Sharko M, Hong M
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
Parents routinely access young children's medical records, but medical societies strongly recommend confidential care during adolescence, and most medical centers restrict parental records access during the teen years. In this study, the investigators sought to assess public opinion about adolescent medical privacy. The investigators concluded that although medical societies recommend confidential care for adolescents, public opinion was largely in favor of parental access.
AHRQ-funded; HS021531.
Citation: Ancker JS, Sharko M, Hong M .
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
J Am Med Inform Assoc 2018 Dec;25(12):1593-99. doi: 10.1093/jamia/ocy120..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Keohane LM, Trivedi A, Mor V
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs. However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with an increase in the probability of switching to partial Medicaid and an increase in the probability of exiting Medicaid within 12 months. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi A, Mor V .
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Med Care Res Rev 2019 Dec;76(6):711-35. doi: 10.1177/1077558717737152..
Keywords: Vulnerable Populations, Low-Income, Medicaid, Medicare, Policy
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Jacobs PD, Selden TM
AHRQ Author: Jacobs PD, Selden TM
Changes in the equity of US health care financing in the period 2005-16.
This study examined changes in how households pay for health care spending in the United States from 2005 to 2016. At the start of the study period, households in the bottom 20% of income paid 26.8% of their income for health care compared to about half that amount for those with income in the top 1 percent. By 2016 the percentages had become about the same across all income levels. This result reflected increases in coverage through Medicaid and the Affordable Care Act Marketplaces.
AHRQ-authored.
Citation: Jacobs PD, Selden TM .
Changes in the equity of US health care financing in the period 2005-16.
Health Aff 2019 Nov;38(11):1791-800. doi: 10.1377/hlthaff.2019.00625..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Medicare, Policy
Solotke MT, Ross JS, Shah ND
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
This study investigated whether Medicare prescription drug plan formulary restrictions were enacted after the FDA issued black box warnings for drugs that are now considered problematic. Investigators looked at drugs that were issued new or updated black box warnings from 2008 to 2015 and found there was only a 3% decrease in drug formularies providing unrestricted prescriptions.
AHRQ-funded; HS025164.
Citation: Solotke MT, Ross JS, Shah ND .
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
J Manag Care Spec Pharm 2019 Nov;25(11):1201-17. doi: 10.18553/jmcp.2019.25.11.1201..
Keywords: Medication, Medicare, Policy
Huguet N, Angier H, Hoopes MJ
Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act.
Investigators assessed the prevalence of pre-existing conditions for community health center (CHC) patients who gained insurance coverage post-Affordable Care Act (ACA). They found that their study emphasized the high prevalence of pre-existing conditions among CHC patients and the large increase in the proportion of patients with at least one of these diagnoses post-ACA. They conclude that, given how common these conditions are, repealing pre-existing condition protections could be extremely harmful to millions of patients and would likely exacerbate health care and health disparities.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Hoopes MJ .
Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act.
J Am Board Fam Med 2019 Nov-Dec;32(6):883-89. doi: 10.3122/jabfm.2019.06.190087..
Keywords: Health Status, Chronic Conditions, Health Insurance, Policy
Boudreaux M, Gangopadhyaya A, Long SK
AHRQ Author: Karaca Z
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Investigators describe the opportunities and challenges of using HCUP data to conduct state health policy research and to provide empirical examples of what can go wrong when using the national HCUP data inappropriately. Analyzing cesarean delivery rates, discharges per capita, and discharges by the payer, they found that state-level estimates are volatile and often provide misleading policy conclusions. They conclude that the Nationwide Inpatient Sample should not be used for state-level research and specified that AHRQ provides resources to assist analysts with state-specific studies using State Inpatient Database files.
AHRQ-authored.
Citation: Boudreaux M, Gangopadhyaya A, Long SK .
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Med Care 2019 Nov;57(11):855-60. doi: 10.1097/mlr.0000000000001196..
Keywords: Healthcare Cost and Utilization Project (HCUP), Policy, Health Services Research (HSR), Healthcare Costs, Data, Research Methodologies
Springs S, Rofeberg V, Brown S
Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study.
This case study documents the work of the Rhode Island Arts and Health Advisory Group, which convened in 2016 to develop a set of policy, clinical practice, and research recommendations for implementation by the Rhode Island Department of Health, The Rhode Island State Council on the Arts, and partners. Comprised of artists, clinicians, community members, and patients, the group partnered with researchers to complete an evidence synthesis project of arts-based health care interventions.
AHRQ-funded; HS023299; HS022998.
Citation: Springs S, Rofeberg V, Brown S .
Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study.
Med Care 2019 Oct;57 Suppl 10 Suppl 3:S253-s58. doi: 10.1097/mlr.0000000000001180..
Keywords: Public Health, Policy, Case Study, Evidence-Based Practice, Implementation, Patient-Centered Outcomes Research
Senft N, Butler E, Everson J
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
This study examined trends in eHealth disparities before and after the introduction of US federal financial incentives. The investigators compared rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. The investigators concluded that disparities in provider messaging widened over time, particularly following federal financial incentives.
AHRQ-funded; HS26395; HS26122.
Citation: Senft N, Butler E, Everson J .
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
J Med Internet Res 2019 Oct 7;21(10):e14976. doi: 10.2196/14976..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Disparities, Clinician-Patient Communication, Communication, Policy
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M,, Bailey SR .
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Holderness H, Angier H, Huguet N
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
The purpose of this study was to understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act Medicaid expansion (emergency department, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Results showed that most newly and returning-insured Medicaid enrollees sought primary care rather than emergency department services and most became established with primary care, suggesting that both insurance and primary care continuity play a role in where patients seek health care services.
AHRQ-funded; HS024270.
Citation: Holderness H, Angier H, Huguet N .
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
Med Care 2019 Oct;57(10):788-94. doi: 10.1097/mlr.0000000000001189..
Keywords: Access to Care, Ambulatory Care and Surgery, Health Insurance, Healthcare Utilization, Medicaid, Policy
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
AHRQ-funded; HS021973.
Citation: Kemmick Pintor J, Call KT .
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
Zhang AD, Schwartz JL, Ross JS
Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015.
In this paper, the authors examined the association between Food and Drug Administration Advisory Committee Recommendations and agency actions for a time period of 2008-2015. The investigators concluded that the FDA disagrees with the recommendations of its advisory committees a minority of the time, and in these cases it tends to be less likely to approve new products or supplemental indications and take safety actions.
AHRQ-funded; HS022882.
Citation: Zhang AD, Schwartz JL, Ross JS .
Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015.
Milbank Q 2019 Sep;97(3):796-819. doi: 10.1111/1468-0009.12403..
Keywords: Medical Devices, Policy, Patient Safety
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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.
Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Shorr RI, Staggs VS, Waters TM
Impact of the hospital-acquired conditions initiative on falls and physical restraints: a longitudinal study.
The Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions (HACs) Initiative in October 2008; the CMS no longer reimbursed hospitals for fall injury. The aim of this study was to examine the effects of the 2008 HACs Initiative on the rates of falls, injurious falls, and physical restraint use. The investigators concluded that since the HACs Initiative, there was at best a modest decline in the rates of falls and injurious falls observed primarily in larger, major teaching hospitals. An increase in restraint use was not observed.
AHRQ-funded; HS020627.
Citation: Shorr RI, Staggs VS, Waters TM .
Impact of the hospital-acquired conditions initiative on falls and physical restraints: a longitudinal study.
J Hosp Med 2019 Sep 6;14:E31-E36. doi: 10.12788/jhm.3295..
Keywords: Falls, Adverse Events, Hospitals, Payment, Policy, Elderly
Vistnes JP, Hill SC
AHRQ Author: Vistnes JP, Hill SC
The dynamics Of Medicaid enrollment, employment, and beneficiary health status.
In this article, the authors discuss the dynamics of Medicaid enrollment, employment and beneficiary status. Using national data, the investigators found that 13.9 percent of new, nonelderly adult Medicaid beneficiaries in 2015-16 had experienced a decline in health before enrollment, and a similar percentage had had jobs that ended before they enrolled.
AHRQ-authored.
Citation: Vistnes JP, Hill SC .
The dynamics Of Medicaid enrollment, employment, and beneficiary health status.
Health Aff 2019 Sep;38(9):1491-95. doi: 10.1377/hlthaff.2019.00066..
Keywords: Health Status, Medicaid, Medical Expenditure Panel Survey (MEPS), Policy
Gordon SH, Sommers BD, Wilson I
The impact of Medicaid expansion on continuous enrollment: a two-state analysis.
Researchers assessed the impact of Medicaid expansion under the Affordable Care Act on continuity of Medicaid coverage among those enrolled prior to expansion. Comparing Colorado to Utah, they found that, following Medicaid expansion, enrollees in Colorado gained an additional 2 months of coverage over two years of follow-up and were 16 percentage points less likely to experience a coverage disruption in a given year relative to enrollees in Utah. They concluded that increasing Medicaid eligibility levels appeared to be an effective strategy with important implications for other states that are considering Medicaid expansion.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson I .
The impact of Medicaid expansion on continuous enrollment: a two-state analysis.
J Gen Intern Med 2019 Sep;34(9):1919-24. doi: 10.1007/s11606-019-05101-8..
Keywords: Medicaid, Health Insurance, Policy, Access to Care, Vulnerable Populations
Ellis RJ, Angelos P, Jarnagin WR
Abrupt Discontinuation of the Codman hepatic artery infusion pump: considerations in the era of precision medicine.
In this article, the authors use the discontinuation of the Codman hepatic artery infusion pump as a cautionary example to highlight issues with economic viability in narrow-indication medicine. The authors note that withdrawal of the Codman HAIP from the market without notice or plans for replacement raised several ethical and industry-specific concerns. They discuss the need for mechanisms to ensure sustainability of these treatments as the number of individualized therapies continues to expand.
AHRQ-funded; HS023011; HS000078.
Citation: Ellis RJ, Angelos P, Jarnagin WR .
Abrupt Discontinuation of the Codman hepatic artery infusion pump: considerations in the era of precision medicine.
J Am Coll Surg 2019 Aug;229(2):217-19. doi: 10.1016/j.jamcollsurg.2019.03.002..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Policy
Chang SH, Wang M, Liu X
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. The investigators study whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival. The investigators concluded that in the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT.
AHRQ-funded; HS022330.
Citation: Chang SH, Wang M, Liu X .
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Transplantation 2019 Aug;103(8):1663-74. doi: 10.1097/tp.0000000000002574..
Keywords: Access to Care, Disparities, Kidney Disease and Health, Outcomes, Policy, Transplantation
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
AHRQ-funded; HS000046.
Citation: Rasmussen PW, Kominski GF .
Sources of success in California's individual marketplace under the Affordable Care Act.
J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Kahn JM, Davis BS, Yabes JG
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
The purpose of this study was to evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. Results showed that, in New York State, mandated protocolized sepsis care was associated with a greater decrease in sepsis mortality compared with sepsis mortality in control states (Florida, Maryland, Massachusetts, and New Jersey) that did not implement sepsis regulations. The authors add that, because baseline mortality rates differ between New York and the comparison states, it is uncertain whether these findings will be generalizable to other states.
AHRQ-funded; HS025146.
Citation: Kahn JM, Davis BS, Yabes JG .
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
JAMA 2019 Jul 16;322(3):240-50. doi: 10.1001/jama.2019.9021..
Keywords: Guidelines, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality, Outcomes, Policy, Sepsis