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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 66 Research Studies Displayed
Fichtenberg CM, Alley DE, Mistry KB
AHRQ Author: Mistry KB
Improving social needs intervention research: key questions for advancing the field.
This paper summarizes emerging evidence and identifies key areas where more research is needed to advance implementation and policy development. Gaps exist in terms of comparative effectiveness and cost effectiveness of social needs intervention approaches. Increased understanding of mechanisms of action to maximize practitioners' ability to tailor interventions would be a benefit. More research is recommended to guard against unintended consequences and ensure these interventions reduce health inequities. Implementation science research should identify supports and incentives for adoption of effective interventions. Focusing both public and private research efforts on these evidence gaps can help advance identification of interventions that maximize both health equity and healthcare value.
AHRQ-authored; AHRQ-funded; HS026664.
Citation: Fichtenberg CM, Alley DE, Mistry KB . Improving social needs intervention research: key questions for advancing the field. Am J Prev Med 2019 Dec;57(6s1):S47-s54. doi: 10.1016/j.amepre.2019.07.018..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Social Determinants of Health, Value
Nguyen JT, Cole AL, Leech AA
Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia.
Citation: Nguyen JT, Cole AL, Leech AA . Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia. Value Health 2020 Oct;23(10):1292-99. doi: 10.1016/j.jval.2020.05.019..
Keywords: Chronic Conditions, Medication, Healthcare Costs, Treatments, Value
O'Reilly-Jacob M, Perloff J, Buerhaus P
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
This study measures the rates of low-value back images ordered by primary care physicians and nurse practitioners for Medicare beneficiaries, and there was no detectable difference between the two groups in 2012 and 2013.
Citation: O'Reilly-Jacob M, Perloff J, Buerhaus P . Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care. Nurs Outlook 2019 Nov - Dec;67(6):713-24. doi: 10.1016/j.outlook.2019.05.005..
Keywords: Imaging, Value, Back Health and Pain, Primary Care, Imaging, Pain
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
Citation: Leeds IL, DiBrito SR, Canner JK . Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease. Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Value, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Decision Making, Medication
Smith JW, Knight Davis J, Quatman-Yates CC
Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease.
The purpose of this study was to examine the loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. The investigators concluded that older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. They indicate that long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most.
Citation: Smith JW, Knight Davis J, Quatman-Yates CC . Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease. J Am Geriatr Soc 2019 Nov;67(11):2289-97. doi: 10.1111/jgs.16046..
Keywords: Elderly, Surgery, Outcomes, Quality of Life, Value
Kunst NR, Alarid-Escudero F, Paltiel AD
A value of information analysis of research on the 21-gene assay for breast cancer management.
The authors aimed to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-gene assay Oncotype DX (21-GA). They found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women and recommended that further research focus on low-risk women.
Citation: Kunst NR, Alarid-Escudero F, Paltiel AD . A value of information analysis of research on the 21-gene assay for breast cancer management. Value Health 2019 Oct;22(10):1102-10. doi: 10.1016/j.jval.2019.05.004..
Keywords: Genetics, Cancer: Breast Cancer, Cancer, Decision Making, Research Methodologies, Value
Shaker M, Wallace D, Golden DBK
Simulation of health and economic benefits of extended observation of resolved anaphylaxis.
The objective of this study was to characterize the cost-effectiveness of short vs prolonged medical observation times after resolved anaphylaxis. The authors suggested that the study indicated prolonged medical observation (6-24 hours) for resolved anaphylaxis may not be cost-effective for patients at low risk for biphasic anaphylaxis; however, in particular clinical circumstances of low observation costs, high postdischarge risk of biphasic anaphylaxis, or large incremental fatality risk reduction associated with extended observation, longer medical observation could be justified.
Citation: Shaker M, Wallace D, Golden DBK . Simulation of health and economic benefits of extended observation of resolved anaphylaxis. JAMA Netw Open 2019 Oct 2;2(10):e1913951. doi: 10.1001/jamanetworkopen.2019.13951..
Keywords: Healthcare Costs, Value, Patient-Centered Outcomes Research
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
Citation: McGinn T, Cohen S, Khan S . The high cost of low value care. Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Value, Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Decision Making, Comparative Effectiveness
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
Citation: Kim KL, LI L, Kuang M . Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program. Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Value, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
Shaker M, Greenhawt M
Cost-effectiveness of stock epinephrine autoinjectors on commercial aircraft.
This study examined the cost-effectiveness of commercial airlines stocking epinephrine autoinjectors on every plane versus the standard emergency kit epinephrine ampules. The study assumed the autoinjectors reduced fatality risk by 10%. They used a Markov movule with microsimulation over an 80-year time horizon and concluded that it was cost-effective with a low annual cost per passenger-at-risk of 8 cents.
Citation: Shaker M, Greenhawt M . Cost-effectiveness of stock epinephrine autoinjectors on commercial aircraft. J Allergy Clin Immunol Pract 2019 Sep - Oct;7(7):2270-76. doi: 10.1016/j.jaip.2019.04.029..
Keywords: Value, Healthcare Costs, Medication
Ganguli I, Lupo C, Mainor AJ
Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries.
This study examined the use and outcomes of preoperative electrocardiogram (EKG) for cataract surgery recipients on Medicare. The outcomes measured were cascade events if the EKG results were problematic. The study compared 110,183 cataract surgery recipients with 97,775 non-surgery participants (63.1% female). For the recipient group, 12,408 (11.3%) received a preoperative EKG (65.6% of them were female). Of those, 1978 (15.9%) had at least 1 potential cascade event. Additional tests, treatments, and cardiology visits added an additional estimated $35 million in addition to the $3.2 million spent on preoperative EKGs. Preoperative EKG recipients who were older, had more chronic conditions, lived in more cardiologist-dense areas, or had their EKG performed by a cardiac specialist rather than a primary care physician were more likely to experience a cascade event.
Citation: Ganguli I, Lupo C, Mainor AJ . Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries. JAMA Intern Med 2019 Sep;179(9):1157-308. doi: 10.1001/jamainternmed.2019.1739..
Keywords: Healthcare Costs, Medicare, Healthcare Utilization, Value, Surgery, Elderly
Shaker M, Greenhawt M
Providing cost-effective care for food allergy.
This article discusses the cost-effectiveness of food allergy management strategies for children. Screening at-risk infants for peanut allergy in particular carries a risk of overdiagnosis and is not cost-effective. An evidence review of the literature using PubMed showed that cost-effective care could be optimized in minimizing delay in oral food challenges for at-risk patients and for school-age children to epinephrine pens available at reasonable cost.
Citation: Shaker M, Greenhawt M . Providing cost-effective care for food allergy. Ann Allergy Asthma Immunol 2019 Sep;123(3):240-48.e1. doi: 10.1016/j.anai.2019.05.015..
Keywords: Value, Healthcare Costs, Medication, Children/Adolescents
Bartsch SM, Asti L, Cox SN
What is the value of different Zika vaccination strategies to prevent and mitigate Zika outbreaks?
The authors developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination, and then introduced various Zika outbreaks. Their models showed that, when considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
Citation: Bartsch SM, Asti L, Cox SN . What is the value of different Zika vaccination strategies to prevent and mitigate Zika outbreaks? J Infect Dis 2019 Aug 9;220(6):920-31. doi: 10.1093/infdis/jiy688..
Keywords: Healthcare Costs, Vaccination, Value, Public Health, Infectious Diseases
Shaker M, Greenhawt M
A primer on cost-effectiveness in the allergy clinic.
This paper examines ways to incorporate cost-effectiveness into care at allergy clinics. The article discusses in general terms how to use cost-effective analyses (CEA) to grade health outcomes and economic benefits. The authors state that future research is needed to provide a better understanding of variation across population health state utilities for allergic conditions and to more accurately reflect quality adjusted life years for patients with allergies.
Citation: Shaker M, Greenhawt M . A primer on cost-effectiveness in the allergy clinic. Ann Allergy Asthma Immunol 2019 Aug;123(2):120-28.e1. doi: 10.1016/j.anai.2019.05.012..
Keywords: Healthcare Costs, Chronic Conditions, Value, Healthcare Delivery
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
Citation: Ingraham AM, Ayturk MD, Kiefe CI . Adherence to 20 emergency general surgery best practices: results of a national survey. Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement, Value
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
Citation: Perraillon MC, Brauner DJ, Konetzka RT . Nursing home response to Nursing Home Compare: the provider perspective. Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement, Value
Markovitz AA, Hollingsworth JM, Ayanian JZ
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
The purpose of this study was to evaluate the effect of the Medicare Shared Savings Program (MSSP) on spending and quality while accounting for clinicians' nonrandom exit. MSSP ACO participants were compared with control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. Results showed that, after adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects, including exit of high-cost clinicians, may drive estimates of savings in the MSSP.
AHRQ-funded; HS025615; HS024728; HS024525.
Citation: Markovitz AA, Hollingsworth JM, Ayanian JZ . Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis. Ann Intern Med 2019 Jul 2;171(1):27-36. doi: 10.7326/m18-2539..
Keywords: Healthcare Costs, Health Services Research (HSR), Medicare, Quality of Care, Value
Markovitz AA, Mullangi S, Hollingsworth JM
ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program.
This paper analyzed changes in spending among high-cost patients following the creation of accountable care organizations (ACOs), specifically for the Medicare Shared Savings Program – which is Centers for Medicare and Medicaid Services (CMS) flagship program. Changes in spending for Medicare fee-for-services were analyzed for different spending percentiles (50th, 90th, and 99th) as well as regionally. While there was a reduction in spending, it was not considered statistically significant and has not affected spending within or across regions. However, the authors note that the study is limited by the program’s voluntary nature and may be not a full reflection of the changes.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Mullangi S, Hollingsworth JM . ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program. J Gen Intern Med 2019 Jul;34(7):1116-18. doi: 10.1007/s11606-019-04963-2..
Keywords: Medicare, Healthcare Costs, Value, Payment
Colla CH, Lewis VA, Stachowski C
Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts.
In this study, researchers examined changes in more and less discretionary condition-specific postacute care use associated with Medicare accountable care organization (ACO) implementation. They found that ACOs decreased spending on postacute care by decreasing use of discretionary services. In addition, ACO implementation was associated with reduced length of stay in skilled nursing facilities, while hip fracture patients used institutional postacute settings at higher rates. The authors also observed decreases in spending, readmission days, and mortality among pneumonia patients.
Citation: Colla CH, Lewis VA, Stachowski C . Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts. Med Care 2019 Jun;57(6):444-52. doi: 10.1097/mlr.0000000000001121..
Keywords: Injuries and Wounds, Healthcare Costs, Healthcare Utilization, Hospitalization, Medicare, Pneumonia, Stroke, Value
Yoo BK, Schaffer SJ, Humiston SG
Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.
This paper describes a clinical trial which created a school-located influenza vaccination (SLIV) program in upstate New York. Researchers wanted to determine if this was a cost-effective alternative to vaccination in primary care practices. Two groups of students were vaccinated – one in an elementary school and the other in a secondary school. Secondary school vaccinations were more cost-effective than elementary schools with a lower median cost per vaccination. The authors concluded that it does raise vaccination rates, but it is not cost-effective due to the higher costs for consent systems and project coordination.
Citation: Yoo BK, Schaffer SJ, Humiston SG . Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Serv Res 2019 Jun 24;19(1):407. doi: 10.1186/s12913-019-4228-5..
Keywords: Children/Adolescents, Education, Healthcare Costs, Influenza, Public Health, Vaccination, Value
Mafi JN, Godoy-Travieso P, Wei E
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
This study analyzed the effects of an intervention program to reduce preoperative costs for care in patients undergoing cataract surgery. Most surgery centers require a battery of tests before surgery is approved. All patients must undergo primary care visits with chest x-rays, laboratory tests, and electrocardiograms required for many of them depending on age and presence of other conditions. This case-control study was conducted at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). All preoperative care decreased in the intervention group and mostly decreased in the control group. Financial losses occurred at these centers, but there was an overall savings for patients and society. These findings suggest that this may be a barrier to eliminating low-value care.
Citation: Mafi JN, Godoy-Travieso P, Wei E . Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system. JAMA Intern Med 2019 May;179(5):648-57. doi: 10.1001/jamainternmed.2018.8358..
Keywords: Healthcare Costs, Surgery, Eye Disease and Health, Value, Quality Improvement, Quality of Care
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
Citation: Aouad M, Brown TT, Whaley CM . Reference pricing: the case of screening colonoscopies. J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening, Value
Etz RS, Zyzanski SJ, Gonzalez MM
A new comprehensive measure of high-value aspects of primary care.
The authors of this article sought to develop and evaluate a concise measure of primary care grounded in the experience of patients, clinicians, and health care payers. They found that the person-centered primary care measure reliably assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. They recommended that the measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.
Citation: Etz RS, Zyzanski SJ, Gonzalez MM . A new comprehensive measure of high-value aspects of primary care. Ann Fam Med 2019 May;17(3):221-30. doi: 10.1370/afm.2393..
Keywords: Primary Care, Quality of Care, Quality Measures, Value
Bain AM, Werner RM, Yuan Y
Do hospitals participating in accountable care organizations discharge patients to higher quality nursing homes?
This study examined whether hospitals participating in Medicare's Shared Saving Program increased use of highly rated skilled nursing facilities (SNFs) or decreased the use of low-rated SNFs after initiation of accountable care organization (ACO) contracts, compared with non-ACO hospitals. The findings indicate that, after joining an ACO, the percentage of hospital discharges going to a high-quality SNF increased slightly; the probability of discharge from ACO-participating hospitals to low-quality SNFs did not change significantly in comparison with non-ACO hospitals.
Citation: Bain AM, Werner RM, Yuan Y . Do hospitals participating in accountable care organizations discharge patients to higher quality nursing homes? J Hosp Med 2019 May;14(5):288-89. doi: 10.12788/jhm.3147..
Keywords: Elderly, Hospital Discharge, Hospitals, Medicare, Nursing Homes, Quality of Care, Value
Borsky AE, Flores EJ, Berliner E
AHRQ Author: Borsky AE, Berliner E, Chang C, Chang SM
Next steps in improving healthcare value: AHRQ Evidence-based Practice Center Program-applying the knowledge to practice to data cycle to strengthen the value of patient care.
This paper discusses AHRQ’s Evidence-based Practice Center (EPC) Program which has been in existence for over 20 years. The EPC program and its objectives are described. The three phases of the Learning Healthcare System cycle is described. A sample topic (hospital medicine Clostridium difficile colitis prevention and treatment) is used to describe the process and results of the effectiveness of the EPC program.
Citation: Borsky AE, Flores EJ, Berliner E . Next steps in improving healthcare value: AHRQ Evidence-based Practice Center Program-applying the knowledge to practice to data cycle to strengthen the value of patient care. J Hosp Med 2019 May;14(5):311-14. doi: 10.12788/jhm.3157..
Keywords: Evidence-Based Practice, Learning Health Systems, Implementation, Value