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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 52 Research Studies Displayed
Vila PM, Olsen MA, Piccirillo JF
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
The purpose of this study was to determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, non-neoplastic submandibular salivary gland disease. Researchers conducted an epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database; 5,111 adults with sialadenitis who had a sialoendoscopy or submandibular gland excision were included. The results of this study indicate that the use of sialoendoscopy procedures has increased over time, while the overall rate of sialoadenectomy has decreased, but the authors conclude that both procedures are safe for the treatment of patients with sialadenitis and sialolithiasis.
Citation: Vila PM, Olsen MA, Piccirillo JF . Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance. Laryngoscope 2019 Dec 16;129(3):602-06. doi: 10.1002/lary.27243..
Keywords: Healthcare Utilization, Health Insurance, Surgery
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S . Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis. Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Byhoff E, Taylor LA
Massachusetts community-based organization perspectives on Medicaid redesign.
The purpose of the study was to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. Forty-six key informant interviews were conducted, representing 44 community-based organizations across Massachusetts. Findings showed that changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. Recommendations included having policymakers and healthcare leadership ensure that community-based organizations are part of strategy development and social service program implementation.
Citation: Byhoff E, Taylor LA . Massachusetts community-based organization perspectives on Medicaid redesign. Am J Prev Med 2019 Dec;57(6 Suppl 1):S74-s81. doi: 10.1016/j.amepre.2019.07.017..
Keywords: Medicaid, Social Determinants of Health, Policy, Health Insurance
Hu T, Decker SL, Chou SY
AHRQ Author: Decker SL
The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing.
Researchers tested the effect of the introduction of Medicare Part D on physician prescribing behavior using data on physician visits from the National Ambulatory Medical Care Survey (NAMCS). Subjects were patients aged 60-69. The researchers found a 32% increase in the number of prescription drugs prescribed or continued per visit and a 46% increase in the number of generic drugs prescribed or continued for the elderly after the introduction of Medicare Part D.
Citation: Hu T, Decker SL, Chou SY . The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing. https://www.ncbi.nlm.nih.gov/pubmed/28168448.
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicare, Medication, Practice Patterns, Elderly
Sun EC, Mello MM, Moshfegh J
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
This retrospective analysis used data from the Clinformatics Data Mart database (Optum) to examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. The investigators found that out-of-network billing appeared to have become common for privately insured patients even when they soughttreatment at in-network hospitals. They indicated that the mean amounts billed appeared to be sufficiently large that they may create financial strain for a substantial proportion of patients.
Citation: Sun EC, Mello MM, Moshfegh J . Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals. JAMA Intern Med 2019 Nov;179(11):1453-612. doi: 10.1001/jamainternmed.2019.3451..
Keywords: Health Insurance, Healthcare Costs, Payment, Hospitals, Emergency Department
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
Citation: Nguyen KH, Trivedi AN . Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California. J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial / Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Jacobs PD, Selden TM
AHRQ Author: Jacobs PD, Selden TM
Changes in the equity of US health care financing in the period 2005-16.
This study examined changes in how households pay for health care spending in the United States from 2005 to 2016. At the start of the study period, households in the bottom 20% of income paid 26.8% of their income for health care compared to about half that amount for those with income in the top 1 percent. By 2016 the percentages had become about the same across all income levels. This result reflected increases in coverage through Medicaid and the Affordable Care Act Marketplaces.
Citation: Jacobs PD, Selden TM . Changes in the equity of US health care financing in the period 2005-16. Health Aff 2019 Nov;38(11):1791-800. doi: 10.1377/hlthaff.2019.00625..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Medicare, Policy
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE . Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women. Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Huguet N, Angier H, Hoopes MJ
Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act.
Investigators assessed the prevalence of pre-existing conditions for community health center (CHC) patients who gained insurance coverage post-Affordable Care Act (ACA). They found that their study emphasized the high prevalence of pre-existing conditions among CHC patients and the large increase in the proportion of patients with at least one of these diagnoses post-ACA. They conclude that, given how common these conditions are, repealing pre-existing condition protections could be extremely harmful to millions of patients and would likely exacerbate health care and health disparities.
Citation: Huguet N, Angier H, Hoopes MJ . Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act. J Am Board Fam Med 2019 Nov-Dec;32(6):883-89. doi: 10.3122/jabfm.2019.06.190087..
Keywords: Health Status, Chronic Conditions, Health Insurance, Policy
McClellan C, Fingar KR, Ali MM
AHRQ Author: McClellan C
Price elasticity of demand for buprenorphine/naloxone prescriptions.
In this study, using the IBM MarketScan(R) Commercial Claims and Encounters Database for individuals with employer-sponsored private health insurance coverage, the researchers examined the relationship between cost sharing and the number of buprenorphine/naloxone prescription fills using enrollee-level longitudinal fixed effects models.
Citation: McClellan C, Fingar KR, Ali MM . Price elasticity of demand for buprenorphine/naloxone prescriptions. J Subst Abuse Treat 2019 Nov;106:4-11. doi: 10.1016/j.jsat.2019.08.001..
Keywords: Medication, Healthcare Costs, Health Insurance
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E . Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance. Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
Citation: Wood SJ, Albertson EM, Conrad DA . Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model. J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Healthcare Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
Citation: Springer R, Marino M,, Bailey SR . Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon. Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Maclean JC, Pesko MF, Hill SC
AHRQ Author: Hill SC
Public insurance expansions and smoking cessation medications.
The authors examined public insurance expansion on use of smoking cessation medications. The Affordable Care Act expanded coverage of these medications with financing with Medicaid. Data was analyzed from retail and online pharmacies from 2011 to 2017, and the expansion increased smoking cessation prescriptions by 24% in new medication use.
Citation: Maclean JC, Pesko MF, Hill SC . Public insurance expansions and smoking cessation medications. Econ Inq 2019 Oct;57(4):1798-820. doi: 10.1111/ecin.12794..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Health Insurance, Medication, Substance Abuse, Medicaid
Holderness H, Angier H, Huguet N
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
The purpose of this study was to understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act Medicaid expansion (emergency department, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Results showed that most newly and returning-insured Medicaid enrollees sought primary care rather than emergency department services and most became established with primary care, suggesting that both insurance and primary care continuity play a role in where patients seek health care services.
Citation: Holderness H, Angier H, Huguet N . Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion? Med Care 2019 Oct;57(10):788-94. doi: 10.1097/mlr.0000000000001189..
Keywords: Access to Care, Ambulatory Care and Surgery, Health Insurance, Healthcare Utilization, Medicaid, Policy
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
Citation: Kemmick Pintor J, Call KT . State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families. Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
Regenbogen SE, Cain-Nielsen AH, Syrjamaki JD
Spending on postacute care after hospitalization in commercial insurance and Medicare around age sixty-five.
Postacute care costs are the primary determinant of episode spending around hospitalization. Yet there is little evidence that greater spending on postacute care improves readmission rates or functional recovery. In a population-based, statewide collaborative of Michigan hospitals, the investigators used regression discontinuity design among propensity-weighted, age-adjusted cohorts to compare postacute care spending between patients with commercial insurance and those with Medicare around age sixty-five. This paper describes the study.
Citation: Regenbogen SE, Cain-Nielsen AH, Syrjamaki JD . Spending on postacute care after hospitalization in commercial insurance and Medicare around age sixty-five. Health Aff 2019 Sep;38(9):1505-13. doi: 10.1377/hlthaff.2018.05445..
Keywords: Healthcare Costs, Health Insurance, Medicare, Hospitalization
Meyerhoefer CD, Zuvekas SH, Farkhad BF
AHRQ Author: Zuvekas SH
The demand for preventive and restorative dental services among older adults.
This study examined the use of preventive and restorative dental services among older adults. Traditional Medicare does not have dental benefits, and older adults must either be employed, have post-retirement dental benefits or spousal coverage, or enroll in a Medicare Advantage program that includes dental coverage. The authors used 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices to estimate the demand for dental care. Dental service was not sensitive to out-of-pocket prices. Older adults with private dental insurance increased preventive service by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%. Women used dental insurance more than men.
Citation: Meyerhoefer CD, Zuvekas SH, Farkhad BF . The demand for preventive and restorative dental services among older adults. Health Econ 2019 Sep;28(9):1151-58. doi: 10.1002/hec.3921..
Keywords: Medical Expenditure Panel Survey (MEPS), Elderly, Dental and Oral Health, Medicare, Health Insurance, Access to Care
Gordon SH, Sommers BD, Wilson I
The impact of Medicaid expansion on continuous enrollment: a two-state analysis.
Researchers assessed the impact of Medicaid expansion under the Affordable Care Act on continuity of Medicaid coverage among those enrolled prior to expansion. Comparing Colorado to Utah, they found that, following Medicaid expansion, enrollees in Colorado gained an additional 2 months of coverage over two years of follow-up and were 16 percentage points less likely to experience a coverage disruption in a given year relative to enrollees in Utah. They concluded that increasing Medicaid eligibility levels appeared to be an effective strategy with important implications for other states that are considering Medicaid expansion.
Citation: Gordon SH, Sommers BD, Wilson I . The impact of Medicaid expansion on continuous enrollment: a two-state analysis. J Gen Intern Med 2019 Sep;34(9):1919-24. doi: 10.1007/s11606-019-05101-8..
Keywords: Medicaid, Health Insurance, Policy, Access to Care, Vulnerable Populations
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
Citation: Childrers CP, Dworsky JQ, Kominski G . A comparison of payments to a for-profit dialysis firm from government and commercial insurers. JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Dialysis, Payment, Health Insurance, Medicare, Medicaid
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
Citation: Rasmussen PW, Kominski GF . Sources of success in California's individual marketplace under the Affordable Care Act. J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
Citation: Dy CJ, Tipping AD, Nickel KB . Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region. J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB . Changes in hospital service demand, cost, and patient illness severity following health reform. Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Hill SC, Solomon KT, Maclean JC
AHRQ Author: Hill SC
Effects of improvements in the CPS on the estimated prevalence of medical financial burdens.
The authors sought to measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden. They found that the estimated prevalence increased among nonelderly adults with private insurance, decreased among nonelderly adults with public coverage, and decreased among elderly adults with Medicare and no private coverage. The authors concluded that improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups, and they recommended that researchers use caution when tracking burden across the time-period in which these improvements were implemented.
Citation: Hill SC, Solomon KT, Maclean JC . Effects of improvements in the CPS on the estimated prevalence of medical financial burdens. Health Serv Res 2019 Aug;54(4):920-29. doi: 10.1111/1475-6773.13158..
Keywords: Health Insurance, Healthcare Costs, Research Methodologies
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
Citation: Sankaran R, Sukul D, Nuliyalu U . Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)