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 70 Research Studies DisplayedBartsch SM, Avelis CM, Asti L
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
Researchers evaluated the economic value of identifying and treatment Chagas disease patients as early as possible. Chagas disease is a parasitic disease which effects many people around the world. Investigators went to a village in Yucatan, Mexico with a population of 2,000 and evaluated impact and economic outcomes of identifying and treating patients in acute and indeterminate states of the disease. They estimated the number of acute cases averted, the number of chronic cases, disability-adjusted life years (DALYs), and savings from the cost of treating more advanced stages of the disease.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Avelis CM, Asti L .
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
PLoS Negl Trop Dis 2018 Nov 5;12(11):e0006809. doi: 10.1371/journal.pntd.0006809..
Keywords: Healthcare Costs, Infectious Diseases, Prevention
Tabano DC, Anderson ML, Ritzwoller DP
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
In this study, the investigators assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity (LP) among health care industry workers across two integrated health care systems. They concluded that the impact of DM was reflected in higher rates of LP and higher indirect costs for employers related to LP and higher health care resource use.
AHRQ-funded; HS018913.
Citation: Tabano DC, Anderson ML, Ritzwoller DP .
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
J Occup Environ Med 2018 Nov;60(11):e569-e74. doi: 10.1097/jom.0000000000001441..
Keywords: Diabetes, Healthcare Costs, Workforce
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Shaker M, Greenhawt M
The health and economic outcomes of peanut allergy management practices.
Peanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions. The objective of this study was to assess the health and economic benefits of pre-emptively injecting epinephrine for peanut ingestion in the absence of any symptoms, and to avoid products with peanut precautionary allergen labeling (PAL). The investigators concluded that pre-emptive epinephrine injection in the absence of symptoms, or universal avoidance of PAL, were not cost-effective when compared with administering epinephrine on symptom development or allowing PAL consumption.
AHRQ-funded; HS024599.
Citation: Shaker M, Greenhawt M .
The health and economic outcomes of peanut allergy management practices.
J Allergy Clin Immunol Pract 2018 Nov - Dec;6(6):2073-80. doi: 10.1016/j.jaip.2018.04.036..
Keywords: Healthcare Costs, Prevention
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
AHRQ-funded; HS022534.
Citation: Bradley CJ, Neumark D, Walker LS .
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Vulnerable Populations
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Ciotoli C, Smith AJ, Keeling RP
Call to action: better care, better health, and greater value in college health.
This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring quality improvement (QI) to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.
AHRQ-funded; HS022520.
Citation: Ciotoli C, Smith AJ, Keeling RP .
Call to action: better care, better health, and greater value in college health.
J Am Coll Health 2018 Oct;66(7):625-39. doi: 10.1080/07448481.2018.1431908..
Keywords: Education, Quality of Care, Quality Improvement
Shen NT, Schneider Y, Congly SE
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Treatment options for recurrent ascites resulting from decompensated cirrhosis include serial large-volume paracentesis and albumin infusion (LVP+A) or insertion of a transjugular intrahepatic portosystemic shunt (TIPS). In this study, the investigators examined whether TIPS insertion was cost effective. The investigators concluded that based on Markov model analysis, early placement of TIPSs appeared to be a cost-effective strategy for management of specific patients with cirrhosis and recurrent ascites.
AHRQ-funded; HS000066.
Citation: Shen NT, Schneider Y, Congly SE .
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Clin Gastroenterol Hepatol 2018 Sep;16(9):1503-10.e3. doi: 10.1016/j.cgh.2018.03.027..
Keywords: Healthcare Costs, Surgery, Patient-Centered Outcomes Research, Treatments
Whaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Calderwood MS, Kawai AT, Jin R
Centers for Medicare and Medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement.
In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). This study sought to understand why this policy did not impact central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Kawai AT, Jin R .
Centers for Medicare and Medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement.
Infect Control Hosp Epidemiol 2018 Aug;39(8):897-901. doi: 10.1017/ice.2018.137..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety
Markovitz AA, Ramsay PP, Shortell SM
Financial incentives and physician practice participation in Medicare's value-based reforms.
The purpose of this study was to evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. The authors concluded that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
AHRQ-funded; HS018546.
Citation: Markovitz AA, Ramsay PP, Shortell SM .
Financial incentives and physician practice participation in Medicare's value-based reforms.
Health Serv Res 2018 Aug;53 Suppl 1:3052-69. doi: 10.1111/1475-6773.12743..
Keywords: Payment, Medicare, Provider Performance
Ndumele CD, Schpero WL, Trivedi AN
Medicaid expansion and health plan quality in Medicaid managed care.
The purpose of the study was to assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality. The study concluded that Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.
AHRQ-funded; HS017589.
Citation: Ndumele CD, Schpero WL, Trivedi AN .
Medicaid expansion and health plan quality in Medicaid managed care.
Health Serv Res 2018 Aug;53 Suppl 1:2821-38. doi: 10.1111/1475-6773.12814..
Keywords: Policy, Health Services Research (HSR), Health Insurance, Medicaid
Lyles CR, Lunn MR, Obedin-Maliver J
The new era of precision population health: insights for the All of Us Research Program and beyond.
This paper addresses the new era of precision population health. Although precision medicine has made advances in individualized patient treatments, the authors assert that there needs to be continued attention on tailored population health and prevention strategies. They provide specific recommendations from the All of Us Research Program and the Precision Public Health Summit as examples for moving this field forward.
AHRQ-funded; HS022408.
Citation: Lyles CR, Lunn MR, Obedin-Maliver J .
The new era of precision population health: insights for the All of Us Research Program and beyond.
J Transl Med 2018 Jul 27;16(1):211. doi: 10.1186/s12967-018-1585-5..
Keywords: Health Information Technology (HIT), Health Services Research (HSR), Patient-Centered Outcomes Research, Public Health
Silber JH, Zeigler AE, Reiter JG
Using appendicitis to improve estimates of childhood Medicaid participation rates.
This study introduces appendectomy-based participation (ABP) to estimate statewide Medicaid/Children's Health Insurance Program participation rates using claims by taking advantage of a natural experiment around statewide appendicitis admissions to improve the accuracy of participation rate estimates. The study concluded that using the ABP rate derived from Medicaid Analytic eXtract (MAX) administrative claims is a valid method to estimate statewide public insurance participation rates in children.
AHRQ-funded; HS023258; HS021112.
Citation: Silber JH, Zeigler AE, Reiter JG .
Using appendicitis to improve estimates of childhood Medicaid participation rates.
Acad Pediatr 2018 Jul;18(5):593-600. doi: 10.1016/j.acap.2018.03.008..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Health Insurance, Medicaid
McCurdy RK, Encinosa WE
AHRQ Author: Encinosa, WE
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
The goal of the study was to assess medical office staff member perceptions of a workplace climate for value. The study’s findings highlight the need for management strategies that emphasize staff training and engagement and the use of performance data and that stress value principles across all organizational activities, including workforce development, performance management, and recruitment.
AHRQ-authored; AHRQ-funded
Citation: McCurdy RK, Encinosa WE .
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
Am J Accountable Care 2018 Jun;6(2):11-19..
Keywords: Payment, Provider: Health Personnel
de la Guardia FH, Hwang J, Adams JL
https://doi.org/10.1007/s10742-018-0179-2
Loss function-based evaluation of physician report cards.
The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom; selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They conlcuded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.
AHRQ-funded; HS021860.
Citation: de la Guardia FH, Hwang J, Adams JL .
Loss function-based evaluation of physician report cards.
Health Services and Outcomes Research Methodology 2018 Jun;18(2):96-108. doi: 10.1007/s10742-018-0179-2.
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Keywords: Quality of Care, Provider Performance, Quality Measures
Hollingsworth JM, Nallamothu BK, Yan P
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
This study examined national Medicare data to determine whether or not Medicare accountable care organizations are associated with reductions in the use of low-value coronary revascularization. The investigators found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Nallamothu BK, Yan P .
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
Circ Cardiovasc Qual Outcomes 2018 Jun;11(6):e004492. doi: 10.1161/circoutcomes.117.004492..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Medicare, Heart Disease and Health
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Henriksen K, Rodrick D, Grace EN
AHRQ Author: Henriksen K, Rodrick D, Grace EN, Brady PJ
Challenges in health care simulation: are we learning anything new?
Simulation training is considered a promising approach for improving the safety and quality of health services delivery. While it takes time for any new approach to gain momentum and learn from past efforts, it also will require addressing a systematic range of essential questions to improve existing knowledge on the optimal use of simulation, and to realize similar gains in safety that other high-risk industries have made.
AHRQ-authored.
Citation: Henriksen K, Rodrick D, Grace EN .
Challenges in health care simulation: are we learning anything new?
Acad Med 2018 May;93(5):705-08. doi: 10.1097/acm.0000000000001891.
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Keywords: Healthcare Delivery, Quality of Care, Patient Safety, Training
Nuckols TK, Keeler E, Anderson LJ
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
This study systematically reviewed economic evaluations of quality improvement (QI) interventions for glycemic control among adults with type 1 or type 2 diabetes. Using English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, the researchers extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost, incremental cost-effectiveness ratio, and study quality. They conclude that diverse and multifaceted QI interventions which lower HbA1c appear to be a fair-to-good value, relative to usual care.
AHRQ-funded; HS022644.
Citation: Nuckols TK, Keeler E, Anderson LJ .
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
Diabetes Care 2018 May;41(5):985-93. doi: 10.2337/dc17-1495..
Keywords: Diabetes, Healthcare Costs, Quality of Care, Quality Improvement
Stringer KL, Azuero A, Ott C
Feasibility and acceptability of real-time antiretroviral adherence monitoring among depressed women living with HIV in the deep south of the US.
The purpose of this study was to present feasibility and acceptability data on the use of an electronic adherence monitor (EAM) among African American women in remote areas of the Southeastern United States with HIV and co-occurring depression. EAM and self-reported antiretroviral therapy (ART) adherence was monitored among 25 participants recruited at four HIV clinics in Alabama. Intra-class correlation showed a low degree of concordance between EAM and self-reported adherence. 83% of data collected via EAM was transmitted in real-time; the remainder was delayed though technological failures or was lost entirely. The authors conclude that EAM monitoring is feasible in a rural US setting but that technological difficulties may impede the device's usefulness for just-in-time adherence interventions.
AHRQ-funded; HS013852.
Citation: Stringer KL, Azuero A, Ott C .
Feasibility and acceptability of real-time antiretroviral adherence monitoring among depressed women living with HIV in the deep south of the US.
AIDS Behav 2018 May;23(5):1306-14. doi: 10.1007/s10461-018-2322-z..
Keywords: Depression, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Medication, Behavioral Health, Patient Adherence/Compliance, Rural Health, Telehealth, Women
Bartsch SM, Huang SS, McKinnell JA
The economic value of the Centers for Disease Control and Prevention carbapenem-resistant Enterobacteriaceae Toolkit.
The authors investigated whether and when economic benefits occur with the toolkit for carbapenem-resistant Enterobacteriaceae. Using their Regional Healthcare Ecosystem Analyst-generated agent-based model of all inpatient healthcare facilities, they identified cost savings in year 1 of implementation when hospitals acted independently and by year 3 if all hospitals collectively implemented the toolkit in a coordinated manner.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Huang SS, McKinnell JA .
The economic value of the Centers for Disease Control and Prevention carbapenem-resistant Enterobacteriaceae Toolkit.
Infect Control Hosp Epidemiol 2018 May;39(5):516-24. doi: 10.1017/ice.2018.49.
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Keywords: Healthcare Costs, Patient Safety, Tools & Toolkits
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
de Montigny S, Adamson BJS, Masse BR
Projected effectiveness and added value of HIV vaccination campaigns in South Africa: a modeling study.
Sci Rep 2018 Apr 17;8(1):6066. doi: 10.1038/s41598-018-24268-4.
In this paper, the authors estimated the potential epidemiological and economic impact of HIV vaccine campaigns compared to continuous vaccination, assuming that vaccine efficacy was transient and dependent on immune response. The investigators concluded that results suggested a partially effective HIV vaccine would have substantial impact on the HIV epidemic in South Africa and offer good value if priced less than $105 for a five-dose series. They suggested that vaccination campaigns every two years may offer greater value for money than continuous vaccination reaching the same coverage level.
In this paper, the authors estimated the potential epidemiological and economic impact of HIV vaccine campaigns compared to continuous vaccination, assuming that vaccine efficacy was transient and dependent on immune response. The investigators concluded that results suggested a partially effective HIV vaccine would have substantial impact on the HIV epidemic in South Africa and offer good value if priced less than $105 for a five-dose series. They suggested that vaccination campaigns every two years may offer greater value for money than continuous vaccination reaching the same coverage level.
AHRQ-funded; HS013853.
Citation: de Montigny S, Adamson BJS, Masse BR .
Projected effectiveness and added value of HIV vaccination campaigns in South Africa: a modeling study.
Sci Rep 2018 Apr 17;8(1):6066. doi: 10.1038/s41598-018-24268-4..
Keywords: Health Services Research (HSR), Healthcare Costs, Human Immunodeficiency Virus (HIV), Public Health, Vaccination