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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 109 Research Studies DisplayedSheetz 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
Kelsall AC, Cassidy R, Ghaferi AA
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
The authors described hospital-level variation in roux-en-Y gastric bypass and sleeve gastrectomy in Michigan. Their findings suggested that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. The authors also suggested that sleeve gastrectomy may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and post-discharge payments.
AHRQ-funded; HS023621; HS024403.
Citation: Kelsall AC, Cassidy R, Ghaferi AA .
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
Ann Surg 2018 Dec;268(6):1014-18. doi: 10.1097/sla.0000000000002462..
Keywords: Surgery, Obesity: Weight Management, Obesity, Payment, Health Insurance, Healthcare Costs
Bateni SB, Olson JL, Hoch JS
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Researchers compared healthcare costs of pancreatic surgery between high- and low-volume centers. They found there was no significant difference in costs, however high-volume centers have better outcomes for morbidity and mortality.
AHRQ-funded; HS022236.
Citation: Bateni SB, Olson JL, Hoch JS .
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Ann Surg Oncol 2018 Dec;25(13):3804-11. doi: 10.1245/s10434-018-6758-1..
Keywords: Healthcare Costs, Hospitals, Outcomes, Patient Safety, Surgery
Abdus S, Keenan PS
AHRQ Author: Abdus S, Keenan PS
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
In this research letter, the authors used 2011-2015 Medical Expenditure Panel Survey Household Component data on adults 19 to 64 years of age enrolled in employer-sponsored insurance plans throughout the year to examine the burden of high deductible health plans on low income adults with chronic health conditions.
AHRQ-authored.
Citation: Abdus S, Keenan PS .
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
JAMA Intern Med 2018 Dec;178(12):1706-08. doi: 10.1001/jamainternmed.2018.4706..
Keywords: Chronic Conditions, Healthcare Costs, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS)
Kempker JA, Martin GS
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Sepsis disproportionately affects older adults (mean age, 65 yr); is predominantly community acquired (87%); is expensive (mean hospital costs $21,500); and is associated with high hospital mortality (one in eight patients) and high rates of 30-day readmission for survivors (one in eight patients). In this editorial, the authors discuss an article- by Paoli et al, published in 2018 in Volume 46 of Critical Care Medicine- on sepsis epidemiology.
AHRQ-funded; HS025240.
Citation: Kempker JA, Martin GS .
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Crit Care Med 2018 Dec;46(12):2043-44. doi: 10.1097/ccm.0000000000003376..
Keywords: Healthcare Costs, Mortality, Outcomes, Sepsis
Coupet E, Karp D, Wiebe DJ
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
In this study, the investigators determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. The investigators suggest that these findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
AHRQ-funded; HS000028.
Citation: Coupet E, Karp D, Wiebe DJ .
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
Am J Emerg Med 2018 Dec;36(12):2192-96. doi: 10.1016/j.ajem.2018.03.070..
Keywords: Domestic Violence, Emergency Department, Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Medicaid
Williams CN, Piantino J, McEvoy C
The burden of pediatric neurocritical care in the United States.
This article attempts to quantify the burden of pediatric neurocritical care (PNCC) by developing national estimates of disease incidence, evaluating use of critical care interventions (CCI), and examining hospital outcomes. The Kids Inpatient Database (KID) was analyzed to evaluate cohorts with the following conditions: traumatic brain injury, neuro-infection, or inflammatory diseases; status epilepticus; stroke; hypoxic ischemic injury after cardiac arrest; or spinal cord injury.
AHRQ-funded; HS022981.
Citation: Williams CN, Piantino J, McEvoy C .
The burden of pediatric neurocritical care in the United States.
Pediatr Neurol 2018 Dec;89:31-38. doi: 10.1016/j.pediatrneurol.2018.07.013..
Keywords: Children/Adolescents, Critical Care, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Neurological Disorders, Stroke, Trauma
Kwa MC, Silverberg JI, Ardalan K
Inpatient burden of juvenile dermatomyositis among children in the United States.
The purpose of this study was to determine the prevalence and risk factors for hospitalization with juvenile dermatomyositis and assess inpatient burden of juvenile dermatomyositis (JDM). The study authors found that JDM contributes to both increased length of hospitalization and inpatient cost of care. Non-Medicaid government insurance was associated with higher rates of hospitalization for JDM while Hispanic and other non-white racial/ethnic groups demonstrated increased length of stay and cost of care.
AHRQ-funded; HS023011.
Citation: Kwa MC, Silverberg JI, Ardalan K .
Inpatient burden of juvenile dermatomyositis among children in the United States.
Pediatr Rheumatol Online J 2018 Nov 13;16(1):70. doi: 10.1186/s12969-018-0286-1..
Keywords: Children/Adolescents, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Skin Conditions
Bartsch SM, Taitel MS, DePasse JV
Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic.
During an influenza epidemic, where early vaccination is crucial, pharmacies may be a resource to increase vaccine distribution reach and capacity. In this paper, the investigators utilized an agent-based model of the US and a clinical and economics outcomes model to simulate the impact of different influenza epidemics and the impact of utilizing pharmacies in addition to traditional (hospitals, clinic/physician offices, and urgent care centers) locations for vaccination for the year 2017.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Taitel MS, DePasse JV .
Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic.
Vaccine 2018 Nov 12;36(46):7054-63. doi: 10.1016/j.vaccine.2018.09.040..
Keywords: Healthcare Costs, Influenza, Provider: Pharmacist, Public Health, Vaccination
Amin AP, Miller S, Rahn B
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
Bleeding avoidance strategies (BAS) are effective, but are paradoxically used less often with patients at high risk of bleeding. This article describes the implementation of an intervention in a St. Louis, MO, hospital intended to reverse the bleeding risk-treatment paradox. Temporal trends in BAS use and the association of risk-concordant BAS use with bleeding as well as hospital costs of percutaneous coronary intervention were examined. Patient-centered care that aimed directly toward making treatment-related decisions based on predicted risk of bleeding led to a more risk-concordant use of BAS and a reversal of the risk-treatment paradox. The authors conclude that larger multicentered studies will be needed to corroborate these results.
AHRQ-funded; HS022481.
Citation: Amin AP, Miller S, Rahn B .
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
J Am Heart Assoc 2018 Nov 6;7(21):e008551. doi: 10.1161/jaha.118.008551..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Risk, Surgery, Cardiovascular Conditions, Healthcare Costs
Bartsch SM, Avelis CM, Asti L
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
Researchers evaluated the economic value of identifying and treatment Chagas disease patients as early as possible. Chagas disease is a parasitic disease which effects many people around the world. Investigators went to a village in Yucatan, Mexico with a population of 2,000 and evaluated impact and economic outcomes of identifying and treating patients in acute and indeterminate states of the disease. They estimated the number of acute cases averted, the number of chronic cases, disability-adjusted life years (DALYs), and savings from the cost of treating more advanced stages of the disease.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Avelis CM, Asti L .
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
PLoS Negl Trop Dis 2018 Nov 5;12(11):e0006809. doi: 10.1371/journal.pntd.0006809..
Keywords: Healthcare Costs, Infectious Diseases, Prevention
Kline SE, Sanstead EC, Johnson JR
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
In this study, the investigators developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. The investigators predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, they concluded that because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
AHRQ-funded; HS022912.
Citation: Kline SE, Sanstead EC, Johnson JR .
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1340-46. doi: 10.1017/ice.2018.228..
Keywords: Surgery, Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Healthcare Costs
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
Tabano DC, Anderson ML, Ritzwoller DP
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
In this study, the investigators assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity (LP) among health care industry workers across two integrated health care systems. They concluded that the impact of DM was reflected in higher rates of LP and higher indirect costs for employers related to LP and higher health care resource use.
AHRQ-funded; HS018913.
Citation: Tabano DC, Anderson ML, Ritzwoller DP .
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
J Occup Environ Med 2018 Nov;60(11):e569-e74. doi: 10.1097/jom.0000000000001441..
Keywords: Diabetes, Healthcare Costs, Workforce
Yeung K, Basu A, Hansen RN
Price elasticities of pharmaceuticals in a value based-formulary setting.
This study examined price elasticities of demand (PED) for pharmaceuticals. Normally pharmaceuticals are relatively price inelastic. But in many settings a medication and its substitutes face simultaneous difference changes in prices that affected the observed “composite” PED. The researched looked at implementation of a value-based formulary (VBF) that utilized drug-specific incremental cost-effectiveness ratios to inform drug copayments. This resulted in increases in copayments for some medications and decreases in others. They then empirically estimated PED and welfare effects using a consumer surplus approach. Overall the net welfare increase was $147,000 for the cohort or $28 per member over the postpolicy year.
AHRQ-funded; HS023346.
Citation: Yeung K, Basu A, Hansen RN .
Price elasticities of pharmaceuticals in a value based-formulary setting.
Health Econ 2018 Nov;27(11):1788-804. doi: 10.1002/hec.3801..
Keywords: Medication, Healthcare Costs
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Shaker M, Greenhawt M
The health and economic outcomes of peanut allergy management practices.
Peanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions. The objective of this study was to assess the health and economic benefits of pre-emptively injecting epinephrine for peanut ingestion in the absence of any symptoms, and to avoid products with peanut precautionary allergen labeling (PAL). The investigators concluded that pre-emptive epinephrine injection in the absence of symptoms, or universal avoidance of PAL, were not cost-effective when compared with administering epinephrine on symptom development or allowing PAL consumption.
AHRQ-funded; HS024599.
Citation: Shaker M, Greenhawt M .
The health and economic outcomes of peanut allergy management practices.
J Allergy Clin Immunol Pract 2018 Nov - Dec;6(6):2073-80. doi: 10.1016/j.jaip.2018.04.036..
Keywords: Healthcare Costs, Prevention
Annapureddy A, Valero-Elizondo J, Khera R
Association between financial burden, quality of life, and mental health among those with atherosclerotic cardiovascular disease in the United States.
Currently, there is little information about the relationship between the financial burden of healthcare for patients with atherosclerotic cardiovascular disease (ASCVD) and their health-related quality of life (HRQoL), well-being, and psychological health. Accordingly, the authors of this study, determined the relationship between healthcare financial burden and patient-reported HRQoL, self-perception of health, psychological distress, and risk of depression in a nationally representative US adult population with established ASCVD.
AHRQ-funded; HS023000.
Citation: Annapureddy A, Valero-Elizondo J, Khera R .
Association between financial burden, quality of life, and mental health among those with atherosclerotic cardiovascular disease in the United States.
Circ Cardiovasc Qual Outcomes 2018 Nov;11(11):e005180. doi: 10.1161/circoutcomes.118.005180..
Keywords: Cardiovascular Conditions, Healthcare Costs, Behavioral Health, Quality of Life
Amin AP, Pinto D, House JA
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
The purpose of this study was to examine (1) the incidence and trends in same day discharge (SDD); (2) hospital variation in SDD; (3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers.
AHRQ-funded; HS022418.
Citation: Amin AP, Pinto D, House JA .
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
JAMA Cardiol 2018 Nov;3(11):1041-49. doi: 10.1001/jamacardio.2018.3029..
Keywords: Healthcare Costs, Hospital Discharge, Patient-Centered Outcomes Research, Heart Disease and Health
Bettenhausen JL, Richardson TE, Shah SS
Medicaid expenditures among children with noncomplex chronic diseases.
This study analyzed Medicaid use by children with noncomplex chronic diseases (NC-CDs). The objective was to describe patient characteristics, expenditures, and use patterns. The researchers used the 2014 Truven Medicaid MarketScan Database to analyze claims from 11 states. Mental health conditions accounted for half of the inpatient diagnosis, with the expenditures high as well. One-percent of children with the highest expenditures accounted for 20% of the total Medicaid expenditures.
AHRQ-funded; HS024735.
Citation: Bettenhausen JL, Richardson TE, Shah SS .
Medicaid expenditures among children with noncomplex chronic diseases.
Pediatrics 2018 Nov;142(5). doi: 10.1542/peds.2018-0286..
Keywords: Children/Adolescents, Chronic Conditions, Healthcare Costs, Medicaid
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
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Hsu J, Newhouse J, Overhage LN
AHRQ Author: Zuvekas S
Fiscal difficulties of cities, the labor market, and health care.
Researchers investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. Using MEPS data, they found that the rate of separation from local public employment fell in the cities with downgrades relative to the comparison group. They concluded that self-reported health may have worsened, but there were no statistically significant effects on health care use or spending.
AHRQ-authored.
Citation: Hsu J, Newhouse J, Overhage LN .
Fiscal difficulties of cities, the labor market, and health care.
J Pension Econ Financ 2018 Oct;18(4):565-78..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs
Cartmell KB, Dismuke CE, Dooley M
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. This paper examined whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital.
AHRQ-funded; HS023863.
Citation: Cartmell KB, Dismuke CE, Dooley M .
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
Med Care 2018 Oct;56(10):883-89. doi: 10.1097/mlr.0000000000000979..
Keywords: Healthcare Costs, Inpatient Care, Screening, Substance Abuse, Tobacco Use: Smoking Cessation
D'Agata EMC, Tran D, Bautista J
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
In this study, the authors developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The authors found that the model suggested that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.
AHRQ-funded; R18 HS021666.
Citation: D'Agata EMC, Tran D, Bautista J .
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
Clin J Am Soc Nephrol 2018 Sep 7;13(9):1389-97. doi: 10.2215/cjn.12521117..
Keywords: Antimicrobial Stewardship, Decision Making, Antibiotics, Medication, Healthcare Costs, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs)