National Healthcare Quality and Disparities Report
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Topics
- Access to Care (3)
- Alcohol Use (1)
- Ambulatory Care and Surgery (3)
- Antibiotics (1)
- Asthma (1)
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- Patient-Centered Outcomes Research (5)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (1)
- Patient Experience (2)
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- Payment (2)
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- (-) Primary Care (55)
- Primary Care: Models of Care (6)
- Provider (4)
- Provider: Clinician (1)
- Provider: Health Personnel (2)
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- Provider: Physician (1)
- Quality Improvement (3)
- Quality Measures (1)
- Quality of Care (7)
- Respiratory Conditions (1)
- Risk (1)
- Rural Health (2)
- Screening (3)
- Social Determinants of Health (3)
- Substance Abuse (1)
- Teams (2)
- Telehealth (1)
- Tobacco Use (1)
- Tools & Toolkits (2)
- Transitions of Care (1)
- U.S. Preventive Services Task Force (USPSTF) (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 55 Research Studies DisplayedStevens JP, Nyweide DJ, Maresh S
Comparison of hospital resource use and outcomes among hospitalists, primary care physicians, and other generalists.
The purpose of this study was to examine differences in the use of health care resources and outcomes among hospitalized patients cared for by hospitalists, their own primary care physicians (PCPs), or other generalists. The investigators found that a PCP's prior experience with a patient may be associated with inpatient use of resources and patient outcomes.
AHRQ-funded; HS024288.
Citation: Stevens JP, Nyweide DJ, Maresh S .
Comparison of hospital resource use and outcomes among hospitalists, primary care physicians, and other generalists.
JAMA Intern Med 2017 Dec;177(12):1781-87. doi: 10.1001/jamainternmed.2017.5824..
Keywords: Healthcare Utilization, Hospitalization, Outcomes, Primary Care
Edwards ST, Peterson K, Chan B
Effectiveness of intensive primary care interventions: a systematic review.
This study systematically reviewed the impact of intensive primary care programs on all-cause mortality, hospitalization, and emergency department use. The authors found that intensive primary care interventions demonstrated varying effectiveness in reducing hospitalizations, and noted there was limited evidence that these interventions were associated with changes in mortality.
AHRQ-funded; HS022981.
Citation: Edwards ST, Peterson K, Chan B .
Effectiveness of intensive primary care interventions: a systematic review.
J Gen Intern Med 2017 Dec;32(12):1377-86. doi: 10.1007/s11606-017-4174-z..
Keywords: Hospitalization, Mortality, Patient-Centered Outcomes Research, Primary Care
Raven MC, Guzman D, Chen AH
Out-of-network emergency department use among managed Medicaid beneficiaries.
The researchers examined factors associated with out-of-network ED use among Medicaid beneficiaries. They concluded that there are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care.
AHRQ-funded; HS021700.
Citation: Raven MC, Guzman D, Chen AH .
Out-of-network emergency department use among managed Medicaid beneficiaries.
Health Serv Res 2017 Dec;52(6):2156-74. doi: 10.1111/1475-6773.12604.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Medicaid, Primary Care, Social Determinants of Health
Ganiats TG, Bierman AS
AHRQ Author: Ganiats TG, Bierman AS
AHRQ's tools for better practice: helping family physicians manage today's challenges.
AHRQ is engaged in the dissemination and widespread implementation of what works in primary care. The agency’s main point of contact with the primary care community is the National Center for Excellence in Primary Care Research (NCEPCR). The authors discuss the variety of tools and resources made available by the NCEPCR.
AHRQ-authored.
Citation: Ganiats TG, Bierman AS .
AHRQ's tools for better practice: helping family physicians manage today's challenges.
Am Fam Physician 2017 Nov 1;96(9):569-70.
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Keywords: Communication, Evidence-Based Practice, Provider: Physician, Primary Care, Tools & Toolkits
Lapham GT, Lee AK, Caldeiro RM
Frequency of cannabis use among primary care patients in Washington state.
This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. The study concluded that cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.
AHRQ-funded; HS023173.
Citation: Lapham GT, Lee AK, Caldeiro RM .
Frequency of cannabis use among primary care patients in Washington state.
J Am Board Fam Med 2017 Nov/Dec;30(6):795-805. doi: 10.3122/jabfm.2017.06.170062..
Keywords: Complementary and Alternative Medicine, Primary Care, Practice Patterns
Lowry C, Orr K, Embry B
Primary care scribes: writing a new story for safety net clinics.
The researchers conducted an evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR between 2011 and 2014. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.
AHRQ-funded; HS022561; HS023558.
Citation: Lowry C, Orr K, Embry B .
Primary care scribes: writing a new story for safety net clinics.
BMJ Open Qual 2017 Oct 25;6(2):e000124. doi: 10.1136/bmjoq-2017-000124.
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Keywords: Electronic Health Records (EHRs), Patient Experience, Primary Care, Health Information Technology (HIT), Workflow
Linder JA, Meeker D, Fox CR
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
This study examines the persistence of effects 12 months after stopping behavioral interventions on inappropriate antibiotic prescribing. In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increased relative to control practices—whose inappropriate prescribing rates continued to decrease.
AHRQ-funded; HS019913.
Citation: Linder JA, Meeker D, Fox CR .
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
JAMA 2017 Oct 10;318(14):1391-92. doi: 10.1001/jama.2017.11152.
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Keywords: Antibiotics, Practice Patterns, Primary Care, Comparative Effectiveness, Respiratory Conditions
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Hubley S, Uebelacker LA, Nash J
Open trial of integrated primary care consultation for medically unexplained symptoms.
In this study, a behavioral consultation intervention for primary care patients with medically unexplained symptoms (n = 10) was developed and assessed. Notwithstanding the limitations of open trial designs, the findings demonstrated high feasibility for a behavioral health consultation treatment model for patients with medically unexplained symptoms and highlight the need for further research.
AHRQ-funded; HS022401.
Citation: Hubley S, Uebelacker LA, Nash J .
Open trial of integrated primary care consultation for medically unexplained symptoms.
J Behav Health Serv Res 2017 Oct;44(4):590-601. doi: 10.1007/s11414-016-9528-5..
Keywords: Behavioral Health, Primary Care, Primary Care: Models of Care
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Hall JD, Kautz G .
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
Xue Y, Goodwin JS, Adhikari D
Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
This study documented the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examined the role of these models in serving elders with multiple chronic conditions. It found a decrease in the physician model and an increase in the shared care model and NP/PA model from 2008 to 2014.
AHRQ-funded; HS020642; HS022134.
Citation: Xue Y, Goodwin JS, Adhikari D .
Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
J Prim Care Community Health 2017 Oct;8(4):256-63. doi: 10.1177/2150131917736634.
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Keywords: Chronic Conditions, Elderly, Healthcare Delivery, Primary Care, Medicare
Bobb JF, Lee AK, Lapham GT
Evaluation of a pilot implementation to integrate alcohol-related care within primary care.
Researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). The authors describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. They found that alcohol screening increased from 8.9 percent of patients pre-implementation to 62 percent post-implementation.
AHRQ-funded; HS023173.
Citation: Bobb JF, Lee AK, Lapham GT .
Evaluation of a pilot implementation to integrate alcohol-related care within primary care.
Int J Environ Res Public Health 2017 Sep 8;14(9). doi: 10.3390/ijerph14091030.
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Keywords: Alcohol Use, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Nagykaldi ZJ, Scheid D, Zhao D
An innovative community-based model for improving preventive care in rural counties.
This quasi-experimental pilot study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices (PCPs) located in a rural county in Oklahoma. Six of the 7 PCPs in the county expressed interest in the project with the result that three of these practices fully implemented the 1-year outreach program starting in mid-2015.
AHRQ-funded; HS023237.
Citation: Nagykaldi ZJ, Scheid D, Zhao D .
An innovative community-based model for improving preventive care in rural counties.
J Am Board Fam Med 2017 Sep-Oct;30(5):583-91. doi: 10.3122/jabfm.2017.05.170035.
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Keywords: Community Partnerships, Patient-Centered Healthcare, Prevention, Primary Care, Rural Health
Monroe AK, Fleishman JA, Voss CC
AHRQ Author: Fleishman JA
Assessing antiretroviral use during gaps in HIV primary care using multisite Medicaid claims and clinical data.
Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. Researchers examined whether individuals with a gap in HIV primary care (>/=180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days. They found that Medicaid-insured individuals commonly receive ART during gaps in HIV primary care, but almost half do not.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Monroe AK, Fleishman JA, Voss CC .
Assessing antiretroviral use during gaps in HIV primary care using multisite Medicaid claims and clinical data.
J Acquir Immune Defic Syndr 2017 Sep 1;76(1):82-89. doi: 10.1097/qai.0000000000001469.
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Keywords: Access to Care, Human Immunodeficiency Virus (HIV), Primary Care
Kronish IM, Kent S, Moise N
Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.
The goal of the study was to determine the most important barriers to primary care providers' ordering ambulatory and home BP monitoring in the United States. The study found that top-ranked barriers to home BP monitoring were concerns about compliance with the correct test protocol, accuracy of tests results, out-of-pocket costs of home BP devices, and time needed to instruct patients on home BP monitoring protocol.
AHRQ-funded; HS024262.
Citation: Kronish IM, Kent S, Moise N .
Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.
J Am Soc Hypertens 2017 Sep;11(9):573-80. doi: 10.1016/j.jash.2017.06.012..
Keywords: Blood Pressure, Primary Care, Diagnostic Safety and Quality, Screening
Angier H, Hoopes M, Marino M
Uninsured primary care visit disparities under the Affordable Care Act.
The researchers aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity. After the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states.
AHRQ-funded; HS024270.
Citation: Angier H, Hoopes M, Marino M .
Uninsured primary care visit disparities under the Affordable Care Act.
Ann Fam Med 2017 Sep;15(5):434-42. doi: 10.1370/afm.2125.
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Keywords: Uninsured, Primary Care, Disparities, Healthcare Utilization, Access to Care
Misra-Hebert AD, Hu B, Klein EA
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
The researchers assessed prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men. Prostate cancer screening declined from 2007 to 2014 even in higher-risk groups and follow-up screening rates were not related to previous PSA level.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Klein EA .
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
BJU Int 2017 Aug;120(2):257-64. doi: 10.1111/bju.13793.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Prostate Cancer, Screening, Primary Care, Practice Patterns
Bailey SR, Heintzman JD, Marino M
Smoking-cessation assistance: before and after stage 1 meaningful use implementation.
This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 Meaningful Use (MU) implementation. Its findings suggest that incentives for MU of electronic health records increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations.
AHRQ-funded; HS021522.
Citation: Bailey SR, Heintzman JD, Marino M .
Smoking-cessation assistance: before and after stage 1 meaningful use implementation.
Am J Prev Med 2017 Aug;53(2):192-200. doi: 10.1016/j.amepre.2017.02.006.
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Keywords: Behavioral Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Primary Care, Tobacco Use
Ray KN, Martsolf GR, Mehrotra A
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
The purpose of this study is to examine trends in specialist physician visits where nurse practitioners (NPs) and physician assistants (PAs) provide care, based on the hypothesis that NPs and PAs provide care to patients of specialist physicians in increasing numbers, primarily for routine follow-up visits. Using the National Ambulatory Medical Care Survey (NAMCS) information on samples office visits, researchers identified visits to specialist physicians, divided these into surgical and medical specialists and examined unadjusted trends from 2001 - 2013 in the percentage of visits with NP or PA involvement. Visit characteristics associated with higher likelihood of NP or PA involvement were examined.
AHRQ-funded; HS022989.
Citation: Ray KN, Martsolf GR, Mehrotra A .
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
JAMA Intern Med 2017 Aug;177(8):1213-16. doi: 10.1001/jamainternmed.2017.1630..
Keywords: Access to Care, Ambulatory Care and Surgery, Healthcare Delivery, Primary Care, Provider
Zieve GG, Richardson LP, Katzman K
Adolescents' perspectives on personalized e-feedback in the context of health risk behavior screening for primary care: Qualitative study.
The aim of this study was to explore youth perceptions of and preferences for receiving personalized feedback for multiple health risk behaviors and reinforcement for health promoting behaviors from an electronic health screening tool for primary care settings, using qualitative methodology. Overall, the tool was well-received by participants who perceived it as a way to enhance-but not replace-their interactions with providers.
AHRQ-funded; HS023383.
Citation: Zieve GG, Richardson LP, Katzman K .
Adolescents' perspectives on personalized e-feedback in the context of health risk behavior screening for primary care: Qualitative study.
J Med Internet Res 2017 Jul 20;19(7):e261. doi: 10.2196/jmir.7474.
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Keywords: Children/Adolescents, Health Information Technology (HIT), Health Promotion, Primary Care, Screening
Davis MM, Howk S, Spurlock M
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
Researchers conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. They found that participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired.
AHRQ-funded; HS022981.
Citation: Davis MM, Howk S, Spurlock M .
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
BMC Health Serv Res 2017 Jul 18;17(1):497. doi: 10.1186/s12913-017-2413-y.
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Keywords: Provider: Health Personnel, Ambulatory Care and Surgery, Primary Care, Tools & Toolkits, Implementation
Hoff T, Scott S
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
The purpose of this study was to gain insight into patient-centered medical home (PCMH) implementation at the workplace level by understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands. The investigators indicated that the findings showed that particular forms of PCMH work not only advanced patient care in favorable ways but also enhanced individual and organizational capacity for adapting to this innovative model and its demands.
AHRQ-funded; HS020931.
Citation: Hoff T, Scott S .
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
Health Care Manage Rev 2017 Jul/Sep;42(3):226-36. doi: 10.1097/hmr.0000000000000109..
Keywords: Patient-Centered Healthcare, Primary Care, Organizational Change, Practice Improvement, Implementation
Grove LR, Olesiuk WJ, Ellis AR
Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.
This study examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. It concluded that medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence.
AHRQ-funded; HS019659; HS000032.
Citation: Grove LR, Olesiuk WJ, Ellis AR .
Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.
Gen Hosp Psychiatry 2017 Jul;47:14-19. doi: 10.1016/j.genhosppsych.2017.03.002.
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Keywords: Medication, Behavioral Health, Patient-Centered Healthcare, Patient Adherence/Compliance, Primary Care
Flieger SP
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. There were no statistically significant findings for utilization, cost, or quality in the expected direction. Medical Home Index (MHI) scores suggest variation in type and level of implemented features.
AHRQ-funded; HS021385.
Citation: Flieger SP .
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
J Ambul Care Manage 2017 Jul/Sep;40(3):228-37. doi: 10.1097/jac.0000000000000162.
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Keywords: Patient-Centered Healthcare, Quality of Care, Primary Care, Healthcare Costs, Healthcare Utilization
Fiscella K, Mauksch L, Bodenheimer T
Improving care teams' functioning: recommendations from team science.
In this paper, the authors examine the application of team science to developing and sustaining primary care teams. They highlight six core team elements and conclude that implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief.
AHRQ-funded; HS022440.
Citation: Fiscella K, Mauksch L, Bodenheimer T .
Improving care teams' functioning: recommendations from team science.
Jt Comm J Qual Patient Saf 2017 Jul;43(7):361-68. doi: 10.1016/j.jcjq.2017.03.009..
Keywords: Teams, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Provider