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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 25 Research Studies Displayed
Galbraith AA, Meyers DJ, Ross-Degnan D
Long-term impact of a postdischarge community health worker intervention on health care costs in a safety-net system.
This study evaluated the impact of a patient navigator (PN) intervention on health system costs in the 180 days after discharge for high-risk patients in a safety-net system. Total costs per patient over the 180 days postindex discharge for those aged >/=60 years were significantly lower for PN patients compared to controls ($5,676 vs. $7,640); differences for patients aged <60 ($9,942 vs. $9,046) or for the entire cohort ($7,092 vs. $7,953) were not significant.
Citation: Galbraith AA, Meyers DJ, Ross-Degnan D . Long-term impact of a postdischarge community health worker intervention on health care costs in a safety-net system. Health Serv Res 2017 Dec;52(6):2061-78. doi: 10.1111/1475-6773.12790.
Keywords: Healthcare Costs, Patient Experience, Hospital Readmissions, Safety Net, Value
Yu H, Greenberg M, Haviland A
The impact of state medical malpractice reform on individual-level health care expenditures.
This study aims to fill the evidence gap concerning the effect of different types of malpractice reform by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. It found that only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures.
Citation: Yu H, Greenberg M, Haviland A . The impact of state medical malpractice reform on individual-level health care expenditures. Health Serv Res 2017 Dec;52(6):2018-37. doi: 10.1111/1475-6773.12789.
Keywords: Healthcare Costs, Policy, Medical Liability, Policy, Value
Prochaska MT, Hohmann SF, Modes M
Trends in troponin-only testing for AMI in academic teaching hospitals and the impact of Choosing Wisely(R).
This study examined the variation in cardiac biomarker testing and the effect of the Choosing Wisely(R) troponin-only recommendation for the diagnosis of acute myocardial infarction (AMI). It concluded that in institutions with low rates of troponin-only testing prior to the Choosing Wisely(R) recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.
Citation: Prochaska MT, Hohmann SF, Modes M . Trends in troponin-only testing for AMI in academic teaching hospitals and the impact of Choosing Wisely(R). J Hosp Med 2017 Dec;12(12):957-62. doi: 10.12788/jhm.2846.
Keywords: Cardiovascular Conditions, Medication, Heart Disease and Health, Patient-Centered Outcomes Research, Value
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
Citation: Paddock SM, Damberg CL, Yanagihara D . What role does efficiency play in understanding the relationship between cost and quality in physician organizations? Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
Keywords: Value, Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Shih YT, Shen C, Hu JC
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant after controlling for other hospital characteristics.
AHRQ-funded; HS020263; HS024608.
Citation: Shih YT, Shen C, Hu JC . Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals. Value Health 2017 Sep;20(8):1221-25. doi: 10.1016/j.jval.2017.05.010.
Keywords: Healthcare Costs, Hospitals, Surgery, Value
Jolley SE, Hough CL, Clermont G
Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial.
Short-term follow-up in the Fluid and Catheter Treatment Trial (FACTT) suggested differential mortality by race with conservative fluid management, but no significant interaction. A post hoc analysis of FACTT and the Economic Analysis of Pulmonary Artery Catheters (EAPAC) study was performed. The researchers found that in their cohort, conservative fluid management may have improved 1-year mortality for non-Hispanic black patients with ARDS. However, they found no long-term benefit of conservative fluid management in white subjects.
Citation: Jolley SE, Hough CL, Clermont G . Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial. Ann Am Thorac Soc 2017 Sep;14(9):1443-49. doi: 10.1513/AnnalsATS.201611-906OC..
Keywords: Racial / Ethnic Minorities, Respiratory Conditions, Mortality, Value
Robinson JC, Whaley CM, Brown TT
Association of reference pricing with drug selection and spending.
This study used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1,302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. It concluded that mplementation of reference pricing was associated with a higher rate of copayment by patients than in the comparison group.
Citation: Robinson JC, Whaley CM, Brown TT . Association of reference pricing with drug selection and spending. N Engl J Med 2017 Aug 17;377(7):658-65. doi: 10.1056/NEJMsa1700087.
Keywords: Healthcare Costs, Medication, Value
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
Citation: Chen LM, Epstein AM, Orav EJ . Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program. JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care, Value
Schpero WL, Morden NE, Sequist TD
For selected services, blacks and Hispanics more likely to receive low-value care than whites.
US minority populations receive fewer effective health services than whites. Using Medicare administrative data for 2006-11, the researchers found no consistent, corresponding protection against the receipt of ineffective health services. Compared with whites, blacks and Hispanics were often more likely to receive the low-value services studied.
Citation: Schpero WL, Morden NE, Sequist TD . For selected services, blacks and Hispanics more likely to receive low-value care than whites. Health Aff 2017 Jun;36(6):1065-69. doi: 10.1377/hlthaff.2016.1416.
Keywords: Disparities, Racial / Ethnic Minorities, Value, Quality of Care, Racial / Ethnic Minorities
ML Linder, JA Clark, CR
AHRQ Author: Barnett
Low-value medical services in the safety-net population.
The objective of this study was to measure rates of low-value care and high-value care received by patients without insurance or with Medicaid, compared with privately insured patients, and provided by safety-net physicians vs non-safety-net physicians. The study concluded that rates of low-value and high-value care were similar among physicians serving vulnerable patients and other physicians. Overuse of low-value care is a potentially important focus for state Medicaid programs and safety-net institutions to pursue cost savings and improved quality of health care delivery.
Citation: ML Linder, JA Clark, CR . Low-value medical services in the safety-net population. JAMA Intern Med 2017 Jun;177(6):829-37. doi: 10.1001/jamainternmed.2017.0401..
Keywords: Access to Care, Quality of Care, Safety Net, Value, Vulnerable Populations
Carey K, Dor A
Price variations and their trends in U.S. hospitals.
This study tracked trends in prices paid to hospitals by commercial insurers over the period 2008 to 2014 using private sector claims data that contain actual payments. It contrasted these with trends in the CMS published charges. Results indicated that variation in actual commercially-transacted prices is substantially lower than variation in published charges.
Citation: Carey K, Dor A . Price variations and their trends in U.S. hospitals. J Health Care Finance 2017 Sum;44(1).
Keywords: Healthcare Costs, Payment, Health Insurance, Hospitals, Value
Allen NB, Zhao L, Liu L
Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry).
The researchers examined the association of cardiovascular health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. They found that individuals in favorable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity.
Citation: Allen NB, Zhao L, Liu L . Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry). Circulation 2017 May 2;135(18):1693-701. doi: 10.1161/circulationaha.116.026252.
Keywords: Healthcare Costs, Cardiovascular Conditions, Health Status, Value
Adamson BJS, Carlson JJ, Kublin JG
The potential cost-effectiveness of pre-exposure prophylaxis combined with HIV vaccines in the United States.
This economic evaluation found that at current prices, pre-exposure prophylaxis (PrEP) was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective as compared to vaccination alone. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness.
Citation: Adamson BJS, Carlson JJ, Kublin JG . The potential cost-effectiveness of pre-exposure prophylaxis combined with HIV vaccines in the United States. Vaccines 2017 May 24;5(2). doi: 10.3390/vaccines5020013.
Keywords: Human Immunodeficiency Virus (HIV), Vaccination, Healthcare Costs, Value, Prevention
Krinsky S, Ryan AM, Mijanovich T
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
The researchers measured variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identified the main payment adjustments that drive variation. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations.
Citation: Krinsky S, Ryan AM, Mijanovich T . Variation in payment rates under Medicare's Inpatient Prospective Payment System. Health Serv Res 2017 Apr;52(2):676-96. doi: 10.1111/1475-6773.12490.
Keywords: Payment, Medicare, Healthcare Costs, Hospitals, Value
Eaton EF, Hudak K, Muzny CA
Budgetary impact of compliance with STI screening guidelines in persons living with HIV.
The study objective was to evaluate the budgetary impact of sexually transmitted infection (STI) screening. At one HIV clinic where the number of patients receiving care from August 2014 to August 2015 was 3,163, the study found that annual screening for N. gonorrhoeae, C. trachomatis, syphilis, and T. vaginalis would lead to a mean net loss of $129,416, $118,304, $72,625, and $13,523, respectively.
AHRQ-funded; HS013852; HS023009.
Citation: Eaton EF, Hudak K, Muzny CA . Budgetary impact of compliance with STI screening guidelines in persons living with HIV. J Acquir Immune Defic Syndr 2017 Mar;74(3):303-08. doi: 10.1097/qai.0000000000001212.
Keywords: Human Immunodeficiency Virus (HIV), Guidelines, Screening, Sexual Health, Value
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
Citation: Yeung K, Basu A, Marcum ZA . Impact of a value-based formulary in three chronic disease cohorts. .
Keywords: Chronic Conditions, Diabetes, Health Insurance, Hypertension, Medication, Patient Adherence/Compliance, Payment, Value
Robinson JC, Brown TT, Whaley C
Reference pricing changes the 'choice architecture' of health care for consumers.
This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers.
Citation: Robinson JC, Brown TT, Whaley C . Reference pricing changes the 'choice architecture' of health care for consumers. Health Aff 2017 Mar;36(3):524-30. doi: 10.1377/hlthaff.2016.1256.
Keywords: Decision Making, Education: Patient and Caregiver, Healthcare Costs, Healthcare Delivery, Value
Adamson B, Dimitrov D, Devine B
The potential cost-effectiveness of HIV vaccines: a systematic review.
The aim of this paper was to review and compare HIV vaccine uncertainty in model, methodology, and parameterization. Model assumptions about vaccine price, HIV treatment costs, epidemic context, and willingness to pay influenced results more consistently than assumptions on HIV transmission dynamics.
Citation: Adamson B, Dimitrov D, Devine B . The potential cost-effectiveness of HIV vaccines: a systematic review. Pharmacoeconom Open 2017 Mar;1(1):1-12. doi: 10.1007/s41669-016-0009-9.
Keywords: Human Immunodeficiency Virus (HIV), Healthcare Costs, Vaccination, Value, Research Methodologies
Schlesinger M, Grob R
Treating, fast and slow: Americans' understanding of and responses to low-value care.
This article explores Americans’ understanding of low-value care in 2015, assesses the impact of media messaging, and tests alternative message framing. The study concluded that the public’s awareness of low-value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status.
AHRQ-funded; HS021858; HS016978.
Citation: Schlesinger M, Grob R . Treating, fast and slow: Americans' understanding of and responses to low-value care. Milbank Q 2017 Mar;95(1):70-116. doi: 10.1111/1468-0009.12246..
Keywords: Healthcare Delivery, Decision Making, Healthcare Costs, Quality of Care, Value
Yeung K, Basu A, Hansen RN
Impact of a value-based formulary on medication utilization, health services utilization, and expenditures.
The objective of the study was to determine the impact of the value-based formulary (VBF). It found that cost-sharing informed by cost-effectiveness analysis reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.
Citation: Yeung K, Basu A, Hansen RN . Impact of a value-based formulary on medication utilization, health services utilization, and expenditures. Med Care 2017 Feb;55(2):191-98. doi: 10.1097/mlr.0000000000000630.
Keywords: Value, Medication, Healthcare Utilization, Healthcare Costs, Health Services Research (HSR)
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
Citation: Fain KM, Castillo-Salgado C, Dore DD . Inappropriate fentanyl prescribing among nursing home residents in the United States. J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns, Value
Armstrong MJ, Mullins CD
Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values.
In this commentary, the authors propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. Their draft taxonomy describes four categories of patient values: global, decisional, situational, and external, highlights different values impacting decision making and facilitates a more complete value assessment at the point of care.
Citation: Armstrong MJ, Mullins CD . Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values. Value Health 2017 Feb;20(2):292-95. doi: 10.1016/j.jval.2016.11.008.
Keywords: Decision Making, Healthcare Delivery, Patient and Family Engagement, Value
Rocque GB, Williams CP, Jackson BE
Choosing Wisely: opportunities for improving value in cancer care delivery?
The researchers conducted a retrospective analysis of Medicare claims data to examine concordance with Choosing Wisely recommendations across 12 cancer centers in the southeastern United States. Significant variability was noted across centers for all recommendations. The researchers concluded that if concordance were to increase to 95 percent for all measures, an estimated $19 million difference in total cost of care per quarter would be saved.
Citation: Rocque GB, Williams CP, Jackson BE . Choosing Wisely: opportunities for improving value in cancer care delivery? J Oncol Pract 2017 Jan;13(1):e11-e21. doi: 10.1200/jop.2016.015396.
Keywords: Cancer, Guidelines, Healthcare Delivery, Medicare, Value
Sood N, Alpert A, Barnes K
Effects of payment reform in more versus less competitive markets.
In this paper, the authors exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, they find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets..
Citation: Sood N, Alpert A, Barnes K . Effects of payment reform in more versus less competitive markets. J Health Econ 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006.
Keywords: Healthcare Costs, Payment, Home Healthcare, Policy, Value
George EI, Ročková V, Rosenbaum PR
Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare.
The authors calibrated Bayesian recommendation systems by checking, out of sample, whether predictions aggregate to give correct general advice derived from another sample. Their process leads to substantial revisions in the Hospital Compare model for acute myocardial infarction mortality. They found that indirect standardization, as currently used by Hospital Compare, fails to adequately control for differences in patient risk factors and systematically underestimates mortality rates at the low volume hospitals. They proposed direct standardization instead.
Citation: George EI, Ročková V, Rosenbaum PR . Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare. Journal of the American Statistical Association 2017;112(519):933-47. doi: 10.1080/01621459.2016.1276021.
Keywords: Hospitals, Medicare, Mortality, Public Reporting, Value