National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Decision Making (1)
- Dental and Oral Health (1)
- Diagnostic Safety and Quality (2)
- Education: Patient and Caregiver (1)
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- Screening (3)
- Social Determinants of Health (1)
- Surgery (2)
- Urban Health (1)
- Vaccination (1)
- Vulnerable Populations (2)
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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 28 Research Studies DisplayedGanguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Diagnostic Safety and Quality
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
AHRQ-funded; HS024075.
Citation: Brewster AL, Fraze TK, Gottlieb LM .
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords: Payment, Social Determinants of Health, Practice Patterns, Vulnerable Populations, Screening, Risk, Nutrition
Skaathun B, Pho MT, Pollack HA
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
This analysis compared the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. The investigators performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men.
AHRQ-funded; HS000084.
Citation: Skaathun B, Pho MT, Pollack HA .
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
J Int AIDS Soc 2020 Oct;23(10):e25554. doi: 10.1002/jia2.25554..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Healthcare Costs, Prevention, Infectious Diseases
Encinosa WE
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
AHRQ-authored.
Citation: Encinosa WE .
Is it time for ACOs to start tackling the high costs of surgery?
Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment
Iglesia EGA, Greenhawt M, Shaker MS
Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
Researchers sought to define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists. A review of articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening was conducted. The researchers concluded that, as health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.
AHRQ-funded; HS024599.
Citation: Iglesia EGA, Greenhawt M, Shaker MS .
Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
Ann Allergy Asthma Immunol 2020 Aug;125(2):126-36. doi: 10.1016/j.anai.2020.04.007..
Keywords: Healthcare Delivery, Healthcare Costs
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
AHRQ-funded; HS024075.
Citation: Kennedy G, Lewis VA, Kundu S .
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment
Berlin NL, Skolarus TA, Kerr EA
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
The objectives of this surgical perspective are to discuss the unique aspects of surgical care delivery acting as barriers to de-implementation and to suggest potential strategies to reduce low-value surgery in the United States. Successful de-implementation of low-value surgery will depend on understanding why low-value procedures persist, leveraging quality collaboratives to monitor appropriateness, implementing clinical decision support systems, and developing incentives for de-implementation.
AHRQ-funded; HS026030.
Citation: Berlin NL, Skolarus TA, Kerr EA .
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
Ann Surg 2020 Jun;271(6):1020-22. doi: 10.1097/sla.0000000000003792..
Keywords: Surgery, Decision Making
Friedman Peahl A, Heisler M, Essenmacher LK
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
The authors compared U.S. to international prenatal care consensus guidelines for low-risk women to inform care delivery reforms. They found that U.S. and peer-country guidelines recommended similar prenatal education and psychosocial services for low-risk women; however, peer countries generally recommended fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care. They recommended that further investigation evaluate associations between recommended care and actual practice, as well as the effects of different components of prenatal care and delivery models on maternal-infant outcomes, patient-centeredness, and health care expenditures in the U.S.
AHRQ-funded; HS025465.
Citation: Friedman Peahl A, Heisler M, Essenmacher LK .
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
Am J Obstet Gynecol 2020 May;222(5):505-07. doi: 10.1016/j.ajog.2020.01.021..
Keywords: Maternal Care, Pregnancy, Women, Guidelines, Evidence-Based Practice, Healthcare Delivery
Socal MP, Anderson KE, Sen A
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
The purpose of this study was to examine the uptake of filgrastim-sndz (Zarxio), the first biosimilar to launch in the United States, in the Medicare Part B fee-for-service program from its launch in September 2015 to December 2017 and compare characteristics of patients and facilities that used filgrastim-sndz or originator filgrastim (Neupogen). The investigators concluded that uptake of biosimilar filgrastim in the Medicare Part B program occurred despite multiple challenges to the adoption of biosimilars in the US market, suggesting that substantial potential savings could be generated by improving biosimilar uptake.
AHRQ-funded; HS000029.
Citation: Socal MP, Anderson KE, Sen A .
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
Value Health 2020 Apr;23(4):481-86. doi: 10.1016/j.jval.2019.12.007..
Keywords: Medicare, Practice Patterns, Medication, Healthcare Costs
Bartsch SM, Asti L, Stokes-Cawley OJ
The potential economic value of a Zika vaccine for a woman of childbearing age.
The authors mapped the Zika vaccine and vaccination characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving. They developed a Markov model to simulate a woman of childbearing age to follow the potential risk and clinical course of a Zika infection. They found that, in some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500, the efficacy was as low as 25%, and the duration of protection was 1 year. They concluded that the thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Asti L, Stokes-Cawley OJ .
The potential economic value of a Zika vaccine for a woman of childbearing age.
Am J Prev Med 2020 Mar;58(3):370-77. doi: 10.1016/j.amepre.2019.10.023..
Keywords: Vaccination, Women, Infectious Diseases, Public Health, Healthcare Costs, Prevention
Markovitz AA, Rozier MD, Ryan AM
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
The purpose of this study was to assess Accountable Care Organization (ACO) engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. Participants included 1289 clinicians in the Physician Organization of Michigan ACO. Results showed that clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Rozier MD, Ryan AM .
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
J Gen Intern Med 2020 Jan;35(1):133-41. doi: 10.1007/s11606-019-05511-8..
Keywords: Medicare, Policy, Provider
Chrisinger BW, Grossestreuer AV, Laguna MC
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
The authors investigated how well the likelihood of out-of-hospital cardiac arrest was met by the supply of automated external defibrillators (AED) in a dense urban environment. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.
AHRQ-funded; HS018362.
Citation: Chrisinger BW, Grossestreuer AV, Laguna MC .
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
Resuscitation 2016 Dec;109:9-15. doi: 10.1016/j.resuscitation.2016.09.021.
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Keywords: Medical Devices, Health Insurance, Urban Health, Cardiovascular Conditions
Eaton EF, Tamhane A, Saag M
Cost considerations in the current antiretroviral era.
The authors analyzed the relative cost-effectiveness of contemporary antiretroviral therapy in real-world clinical settings. They found that, among the participants studied, raltegravir and efavirenz-based regimens were the most cost-effective options for treatment-naive patients. They suggested that these findings are relevant given changes in recommended regimens for treatment-naive persons. The authors recommended that further data on the comparative effectiveness of efavirenz and rilpivirine are needed.
AHRQ-funded; HS013852.
Citation: Eaton EF, Tamhane A, Saag M .
Cost considerations in the current antiretroviral era.
AIDS 2016 Sep 10;30(14):2115-9. doi: 10.1097/qad.0000000000001120.
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Keywords: Healthcare Costs, Human Immunodeficiency Virus (HIV), Medication
Abrahamson K, Davila H, Rehkamp N
Is there a business case for nursing home quality improvement?
The objective of this study was to investigate the economic or business perspective surrounding QI participation by exploring nursing home leader perceptions regarding market-based motivations for improvements, or a business case for engaging in a quality improvement project.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Rehkamp N .
Is there a business case for nursing home quality improvement?
Nurs Econ 2016 Sep-Oct;34(5):224-9, 35..
Keywords: Long-Term Care, Nursing Homes, Quality Improvement
Dorr DA, Anastas T, Ramsey K
Effect of a pragmatic, cluster-randomized controlled trial on patient experience with care: The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Study.
This study's objective is to understand whether focusing on high value elements (HVEs) would improve patient experience with care. The authors found that practices targeting HVEs showed significantly more improvement in patient experience of care. However, contemporaneous trends may have affected results, leading to declines in patient experience.
AHRQ-funded; HS017832.
Citation: Dorr DA, Anastas T, Ramsey K .
Effect of a pragmatic, cluster-randomized controlled trial on patient experience with care: The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Study.
Med Care 2016 Aug;54(8):745-51. doi: 10.1097/mlr.0000000000000552.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient-Centered Healthcare, Patient Experience
Friedman AS, Schpero WL, Busch SH
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
The authors examined the effect of tobacco surcharges on insurance status and smoking cessation in the first year of the health insurance exchanges' implementation, among adults most likely to purchase insurance from them. Their findings suggest that tobacco surcharges conflicted with a major goal of the Affordable Care Act - increased financial protection - without increasing smoking cessation.
AHRQ-funded; HS017589.
Citation: Friedman AS, Schpero WL, Busch SH .
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
Health Aff 2016 Jul;35(7):1176-83. doi: 10.1377/hlthaff.2015.1540.
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Keywords: Healthcare Costs, Health Insurance, Policy
Hefele JG, Acevedo A, Nsiah-Jefferson L
Choosing a nursing home: what do consumers want to know, and do preferences vary across race/ethnicity?
The researchers sought to identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity. They found that participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. Participants also wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families.
AHRQ-funded; HS021891.
Citation: Hefele JG, Acevedo A, Nsiah-Jefferson L .
Choosing a nursing home: what do consumers want to know, and do preferences vary across race/ethnicity?
Health Serv Res 2016 Jun;51 Suppl 2:1167-87. doi: 10.1111/1475-6773.12457.
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Keywords: Nursing Homes, Education: Patient and Caregiver, Racial and Ethnic Minorities
Silber JH, Rosenbaum PR, McHugh MD
Comparison of the value of nursing work environments in hospitals across different levels of patient risk.
This study tested whether hospitals with better nursing work environments displayed better value than those with worse nursing. It found that hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.
AHRQ-funded; HS018338.
Citation: Silber JH, Rosenbaum PR, McHugh MD .
Comparison of the value of nursing work environments in hospitals across different levels of patient risk.
JAMA Surg 2016 Jun;151(6):527-36. doi: 10.1001/jamasurg.2015.4908.
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Keywords: Healthcare Costs, Quality of Care, Nursing, Workforce
Frean M, Shelder S, Rosenthal MB
Health reform and coverage changes among Native Americans.
This study evaluated changes in insurance and Indian Health Service (IHS) coverage among Native Americans following the Affordable Care Act’s (ACA) implementation. It concluded that the ACA was associated with significant coverage increases for Native Americans, primarily in Medicaid expansion states, consistent with national trends for all racial/ethnic groups. Nationally, much of the coverage increase occurred among Native Americans without connections to IHS.
AHRQ-funded; HS021291.
Citation: Frean M, Shelder S, Rosenthal MB .
Health reform and coverage changes among Native Americans.
JAMA Intern Med 2016 Jun;176(6):858-60. doi: 10.1001/jamainternmed.2016.1695.
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Keywords: Policy, Health Insurance, Racial and Ethnic Minorities, Racial and Ethnic Minorities
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
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Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals
Das A, Norton EC, Miller DC
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, researchers found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
Health Aff 2016 May;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
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Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Figueiredo R, Dempster L, Quinonez C
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
The researchers evaluated emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). They found that over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. They concluded that access to dental care is inadequate and that ED settings are ineffective for treatment of dental problems.
AHRQ-funded; HS014129.
Citation: Figueiredo R, Dempster L, Quinonez C .
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
J Health Care Poor Underserved 2016;27(2):860-8. doi: 10.1353/hpu.2016.0081.
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Keywords: Access to Care, Dental and Oral Health, Emergency Department, Vulnerable Populations
Bailey M, Randall EC, Costa C
Analysis of urine, oral fluid and fingerprints by liquid extraction surface analysis coupled to high resolution MS and MS/MS - opportunities for forensic and biomedical science.
The authors assessed the suitability of Liquid Extraction Surface Analysis (LESA) for obtaining detailed chemical profiles of fingerprints, oral fluid, and urine, which may be used in the future for rapid medical diagnostics or metabolomics studies. They also showed how LESA can be used to detect illicit drugs and their metabolites, and they showed how LESA can be used to detect the explosive material RDX in contaminated artificial fingermarks.
AHRQ-funded; HS017487.
Citation: Bailey M, Randall EC, Costa C .
Analysis of urine, oral fluid and fingerprints by liquid extraction surface analysis coupled to high resolution MS and MS/MS - opportunities for forensic and biomedical science.
Anal Methods 2016 Apr 28;2016(16):3373-82. doi: 10.1039/c6ay00782a.
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Keywords: Diagnostic Safety and Quality
Wherry LR, Kenney GM, Sommers BD
The role of public health insurance in reducing child poverty.
The researchers reviewed a growing body of evidence that public health insurance provides important financial benefits to low-income families and also reviewed the potential poverty-reducing effects of public health insurance coverage. They found that Medicaid plays a significant role in decreasing poverty for many children and families. They also reviewed emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. They concluded that the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.
AHRQ-funded; HS021291.
Citation: Wherry LR, Kenney GM, Sommers BD .
The role of public health insurance in reducing child poverty.
Acad Pediatr 2016 Apr;16(3 Suppl):S98-s104. doi: 10.1016/j.acap.2015.12.011.
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Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Low-Income, Medicaid