National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 80 Research Studies DisplayedZhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
AHRQ-funded; HS021531.
Citation: Zhang Y, Johnson P, Jeng PJ .
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Sheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
AHRQ-funded; HS024266.
Citation: Agarwal D, Werner RM .
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023..
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
The purpose of this study was to estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). The investigators indicate that their findings add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. They assert that if MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.
AHRQ-authored.
Citation: Jacobs PD, Kronick R .
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
Health Serv Res 2018 Dec;53(6):4997-5015. doi: 10.1111/1475-6773.12977..
Keywords: Payment, Medicare
Selden TM, Karaca Z, Decker S
AHRQ Author: Selden TM, Karaca Z, Decker S
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
AHRQ-authored.
Citation: Selden TM, Karaca Z, Decker S .
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5..
Keywords: Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
Zhou M, Oakes AH, Bridges JFP
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
The goal of this study was to explore health care system factors associated with regional variation in overuse of resources, as measured by the Johns Hopkins Overuse Index (JHOI). Medicare fee-for-service claims data from beneficiaries age 65 was used to calculate the JHOI for 306 hospital referral regions in the U.S. Regions with a higher density of primary care physicians had a lower JHOI, which indicates less systemic overuse. Regional characteristics associated with higher JHOI included the number of acute care hospital beds per 1000 residents and number of hospital-based anesthesiologists, pathologists, and radiologists. The authors conclude that regional variations in health care resources are associated with the level of systemic overuse of health care, and that the role of primary care doctors in reducing overuse deserves further attention.
AHRQ-funded; T32 HS000029.
Citation: Zhou M, Oakes AH, Bridges JFP .
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
J Gen Intern Med 2018 Dec;33(12):2127-31. doi: 10.1007/s11606-018-4638-9..
Keywords: Access to Care, Elderly, Healthcare Delivery, Healthcare Utilization, Medicare, Practice Patterns
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation: Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords: Diagnostic Safety and Quality, Payment, Medical Errors, Medicare, Patient Safety, Quality of Care
Schulz J, DeCamp M, Berkowitz ASA
Spending patterns among Medicare ACOs that have reduced costs.
This study aimed to examine whether specific cost categories were disproportionately affected by accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) achieving overall spending reductions, and whether there were demonstrable differences in spending patterns between "low"- or "high"-cost ACOs. The investigators found that initial success in reducing the cost of care has been driven by reductions in inpatient costs due to a decline in the volume of patients admitted.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz ASA .
Spending patterns among Medicare ACOs that have reduced costs.
J Healthc Manag 2018 Nov-Dec;63(6):374-81. doi: 10.1097/jhm-d-17-00178..
Keywords: Healthcare Costs, Medicare
Angraal S, Khera R, Zhou S
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
In this study the investigators we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions or conditions not targeted by the HRRP in age-insurance groups defined by age group (>/=65 years or <65 years) and payer (Medicare, Medicaid, or private insurance). The investigators concluded that there appeared to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.
AHRQ-funded; HS022882.
Citation: Angraal S, Khera R, Zhou S .
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
Am J Med 2018 Nov;131(11):1324-31.e14. doi: 10.1016/j.amjmed.2018.06.013..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Medicaid, Medicare
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Goodwin JS, Li S, Middleton A
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
The objective of this study was to determine how the risk of subsequent long-term care (LTC) placement varied between skilled nursing facilities (SNFs) and the SNF characteristics associated with this risk. The investigators concluded that risk of subsequent LTC placement, an important and negatively viewed outcome for older adults, varied substantially between SNFs. Individuals in higher-quality SNFs were at lower risk.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Middleton A .
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
J Am Geriatr Soc 2018 Oct;66(10):1880-86. doi: 10.1111/jgs.15377..
Keywords: Nursing Homes, Long-Term Care, Elderly, Medicare
Middleton A, Kuo YF, Graham JE
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
This retrospective cohort study’s objective was to examine readmission patterns over 90-day episodes of care in patients discharged from hospitals to skilled nursing facilities (SNFs). Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The cohort studied were adults 65 years and older who were hospitalized for stroke, joint replacement, or hip fracture, and had survived 90 days post-discharge. Patients with hemorrhagic stroke were more likely than those with ischemic stroke to be rehospitalized over the first 30 days after discharge. For patients receiving nonelective joint replacements, readmissions increased from the 30 to 90-day period post-acute discharge.
AHRQ-funded; HS022134.
Citation: Middleton A, Kuo YF, Graham JE .
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
J Am Med Dir Assoc 2018 Oct;19(10):896-901. doi: 10.1016/j.jamda.2018.03.006..
Keywords: Hospital Readmissions, Hospital Discharge, Medicare, Hospitals, Elderly
Kundi H, Valsdottir LR, Popma JJ
Impact of a claims-based frailty indicator on the prediction of long-term mortality after transcatheter aortic valve replacement in Medicare beneficiaries.
In this study, the investigators sought to characterize the prognostic importance of frailty factors as identified in healthcare billing records in comparison to validated measures of frailty for the prediction of long-term mortality after transcatheter aortic valve replacement (TAVR). The authors suggest that risk prediction models that include frailty as identified in claims data can be used to predict long-term mortality risk after TAVR.
AHRQ-funded; HS024520.
Citation: Kundi H, Valsdottir LR, Popma JJ .
Impact of a claims-based frailty indicator on the prediction of long-term mortality after transcatheter aortic valve replacement in Medicare beneficiaries.
Circ Cardiovasc Qual Outcomes 2018 Oct;11(10):e005048. doi: 10.1161/circoutcomes.118.005048..
Keywords: Medicare, Mortality, Surgery, Outcomes
Bazzoli GJ, Thompson MP, Waters TM
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
The purpose of this study was to examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. The investigators conducted bivariate and multivariate analysis of pooled cross-sectional data and found that safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. They assert that while reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time.
AHRQ-funded; HS023783.
Citation: Bazzoli GJ, Thompson MP, Waters TM .
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
Health Serv Res 2018 Oct;53(5):3495-506. doi: 10.1111/1475-6773.12833.
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Keywords: Payment, Hospitals, Medicare
Modi PK, Kaufman SR, Qi J
National trends in active surveillance for prostate cancer: validation of medicare claims-based algorithms.
This study analyzed the use of active surveillance of low-risk prostate cancer among a wide variety of health care practices. Researchers identified men with prostate cancer from 2012-2014 using a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. They analyzed the performance of 8 claims-based algorithms that were used and selected 3 of them to apply to a 20% national Medicare sample. The 3 algorithms were determined to be either the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity. They found that use of surveillance for men increased from 2007 to 2014 but there was a large decrease in the rate of prostate cancer diagnosis. The rate of active surveillance either increased or remained stable depending on the algorithm used.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Qi J .
National trends in active surveillance for prostate cancer: validation of medicare claims-based algorithms.
Urology 2018 Oct;120:96-102. doi: 10.1016/j.urology.2018.06.037..
Keywords: Cancer, Cancer: Prostate Cancer, Medicare, Men's Health, Payment
Chung S, Romanelli RJ, Stults CD
Preventive visit among older adults with Medicare's introduction of annual wellness visit: closing gaps in underutilization.
The study of Medicare beneficiaries aged 65 to 85 from a mixed-payer multispecialty outpatient healthcare organization in northern California between 2007 and 2016, evaluated changes in preventive visit utilization with Medicare's introduction of Annual Wellness Visits (AWVs) in 2011. It further assessed how coverage expansion differentially affected older adults who were previously underutilizing the service.
AHRQ-funded; HS019815.
Citation: Chung S, Romanelli RJ, Stults CD .
Preventive visit among older adults with Medicare's introduction of annual wellness visit: closing gaps in underutilization.
Prev Med 2018 Oct;115:110-18. doi: 10.1016/j.ypmed.2018.08.018..
Keywords: Elderly, Healthcare Utilization, Medicare, Prevention
Fraze TK, Lewis VA, Tierney E
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
This study analyzed secondary data retrospectively to examine Medicare Shared Savings Program (MSSP) Accountable Care Organizations’ performance on diabetes metrics in the first 2 years of ACO contracts in order to determine how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Tierney E .
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
Popul Health Manag 2018 Oct;21(5):401-08. doi: 10.1089/pop.2017.0102..
Keywords: Diabetes, Quality of Care, Medicare, Provider Performance, Quality Improvement
Axeen S
Trends in opioid use and prescribing in Medicare, 2006-2012.
The purpose of this study was to determine characteristics and trends in opioid use, questionable use, and prescribing in Medicare. The investigators conducted a retrospective analysis of a 20 percent sample of Medicare claims data. Estimates were adjusted using multivariable regression analysis. They found that opioid utilization and prescribing were increasingly heterogeneous from 2006 to 2012.
AHRQ-funded; HS024251.
Citation: Axeen S .
Trends in opioid use and prescribing in Medicare, 2006-2012.
Health Serv Res 2018 Oct;53(5):3309-28. doi: 10.1111/1475-6773.12846..
Keywords: Medicare, Medication, Opioids, Practice Patterns
Rymer JA, Chen AY, Thomas L
Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction.
This study examines the prevalence of using advanced practice providers (APPs) for care following myocardial infarction as opposed to physicians due to physician shortages and reimbursement changes. Outpatient cardiology or primary care visits within 90 days of MI among 29,477 Medicare-insured patients aged 65 or older from 364 hospitals were examined from data in the Acute Coronary Treatment Intervention Outcomes Network Registry. Medicare adherence, all-cause readmission risk, mortality, and major adverse cardiovascular events were compared for patients seen by APPs versus physicians only. Patients seen by APPs were more likely to have diabetes mellitus, heart failure, be discharged to a nursing facility, and had more outpatient visits. There was no differences in the factors listed between patients seen by APPs or physicians. Patients seen by APPs were in more need of frequent monitoring and were more likely to have other chronic conditions leading to higher risk of post-MI complications.
AHRQ-funded; HS021092.
Citation: Rymer JA, Chen AY, Thomas L .
Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction.
J Am Heart Assoc 2018 Sep 4;7(17):e008481. doi: 10.1161/jaha.117.008481..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medicare, Outcomes, Patient-Centered Outcomes Research, Registries
Yazdany J, Dudley RA, Lin GA
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
This paper discusses the out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D. The investigators analyzed nationwide benefit design data for all Part D plans from the June 2017 Medicare Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files to calculate mean total cost and out-of-pocket cost requirements for infliximab-dyyb and infliximab assuming a standard 8-week dosing regimen.
AHRQ-funded; HS016772.
Citation: Yazdany J, Dudley RA, Lin GA .
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
JAMA 2018 Sep 4;320(9):931-33. doi: 10.1001/jama.2018.7316..
Keywords: Healthcare Costs, Health Insurance, Medicare, Medication, Arthritis
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy