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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 69 Research Studies Displayed
Nanji KC, Shaikh SD, Jaffari A
A Monte Carlo simulation to estimate the additional cost associated with adverse medication events leading to intraoperative hypotension and/or hypertension in the United States.
This study’s objective was to estimate the rates of clinically significant intraoperative hypotension and hypertension. Systematic literature reviews were conducted to estimate incidence and additional costs of acute kidney injury (AKI), acute myocardial injury, and stroke after intraoperative hypotension and hypertension. The authors used Monte Carlo simulation to estimate annual costs to the U.S. healthcare system. Intraoperative hypotension occurred in 11 of 277 operations (3.97%), a >30% drop in baseline mean arterial pressure hypotension in patients with coronary artery disease in 9 operations (3.25%), and hypertension in 14 operations (5.05%). After hypertension, incremental stroke incidence was 4.76%. The authors estimated 11,513 cases of AKI, 5914 cases of acute myocardial injury, 345 cases of stroke after intraoperative hypotension, and 47,774 cases of stroke after intraoperative hypertension. Estimated costs were $1.7 billion, of which $923 million are preventable.
Citation: Nanji KC, Shaikh SD, Jaffari A . A Monte Carlo simulation to estimate the additional cost associated with adverse medication events leading to intraoperative hypotension and/or hypertension in the United States. J Patient Saf 2021 Dec 1;17(8):e758-e64. doi: 10.1097/pts.0000000000000926..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs
Greenberg JK, Olsen MA, Dibble CF
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Investigators sought to evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis. Using HCUP data, they found that 90-day inpatient costs were highly reliable for assessing variation across hospitals, whereas overall and serious complications were only moderately reliable for profiling performance. They concluded that their results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Dibble CF . Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis. Spine J 2021 Dec;21(12):2026-34. doi: 10.1016/j.spinee.2021.06.014..
Keywords: Healthcare Costs, Hospitals, Provider Performance, Surgery, Quality Measures, Quality of Care
Zuvekas SH, Kashihara D
AHRQ Author: Zuvekas SH
The impacts of the COVID-19 pandemic on the Medical Expenditure Panel Survey.
The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). In this study, the investigators described how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules.
Citation: Zuvekas SH, Kashihara D . The impacts of the COVID-19 pandemic on the Medical Expenditure Panel Survey. Am J Public Health 2021 Dec;111(12):2157-66. doi: 10.2105/ajph.2021.306534..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Healthcare Costs, Data
Duvalyan A, Pandey A, Vaduganathan M
Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019.
Researchers examined contemporary direct oral anticoagulant (DOAC) spending patterns within Medicare Part D and Medicaid between 2014 and 2019. They found that, although overall DOAC spending is increasing, DOAC use may be associated with lower downstream medical expenditures compared with warfarin stemming from decreased risk of major bleeding and stroke and reduced drug monitoring.
Citation: Duvalyan A, Pandey A, Vaduganathan M . Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019. J Am Heart Assoc 2021 Dec 21;10(24):e022644. doi: 10.1161/jaha.121.022644..
Keywords: Blood Thinners, Medication, Medicare, Medicaid, Healthcare Costs
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE . Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success. Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Healthcare Systems, Medicare, Healthcare Costs, Hospitals
Brown TT, Hurley VB, Rodriguez HP
Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices.
This cross-sectional study assessed the association of physician practice-level adoption of patient engagement strategies (PES), such as shared decision-making and motivational interviewing, with utilization and spending. The cohort included primary and secondary patients in 2190 practices who receiving treatment for hip (39,336), knee (48,362), and lower-back (67,940) issues who were Medicare beneficiaries that were matched to the 2017-2018 National Survey of Healthcare Organizations and Systems. Outcome measures were total knee replacement (TKR), total hip replacement (THR), 1-2 level posterior lumbar fusion (LF), total annual spending, and components of total annual spending. Spending was significantly lower in some categories for practices with relatively higher PES adoption, but did not differ for other practices. The odds of receiving THR were higher in independent practices for patients attributed to practices with moderate PES compared to patients in practices with low PES.
Citation: Brown TT, Hurley VB, Rodriguez HP . Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices. BMJ Open 2021 Nov 26;11(11):e053121. doi: 10.1136/bmjopen-2021-053121..
Keywords: Patient and Family Engagement, Healthcare Utilization, Healthcare Costs, Arthritis, Orthopedics
Cox SN, Wedlock PT, Pallas SW
A systems map of the economic considerations for vaccination: application to hard-to-reach populations.
The authors developed a systems map of the mechanisms involved in vaccination, and associated costs and benefits, focused at the service delivery level, in order to identify the mechanisms that may be different for hard-to-reach populations. They concluded that decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, their map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
AHRQ-funded; HS023317; HS028165.
Citation: Cox SN, Wedlock PT, Pallas SW . A systems map of the economic considerations for vaccination: application to hard-to-reach populations. Vaccine 2021 Nov 5;39(46):6796-804. doi: 10.1016/j.vaccine.2021.05.033..
Keywords: Vaccination, Healthcare Costs
Jacobs PD, Hill SC
AHRQ Author: Jacobs PD, Hill SC
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
This study calculated Marketplace premiums as a percentage of family income among middle-class families with incomes of 401-600% of poverty. The ACA premiums have been increasing since inception, with half of this population paying at least 7.7% of their income for the lowest-cost bronze plan, increasing to 11.3% in 2019. By 2019 half of the near elderly ages 55-64 would have paid at least 18.9% of their income for the lowest-cost bronze plan in their area. Results suggest that after the American Rescue Plan Act which temporarily expanded tax credit eligibility for 2021 and 2022 runs out, families will again face substantial financial burdens.
Citation: Jacobs PD, Hill SC . ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly. Health Aff 2021 Nov;40(11):1713-21. doi: 10.1377/hlthaff.2021.00945..
Keywords: Health Insurance, Healthcare Costs
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
Citation: Aouad M, Brown TT, Whaley CM . Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program. Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords: Health Insurance, Healthcare Costs
Desai SM, McWilliams JM
340B Drug Pricing Program and hospital provision of uncompensated care.
This study evaluated whether hospital entry into the 340B Drug Pricing Program is associated with changes in hospital provision of uncompensated care. The authors analyzed secondary data on 340B participation and uncompensated care provision among general acute care hospitals and critical access hospitals from 2003 to 2015. They constructed an annual, hospital-level data set on hospital 340B participation and on uncompensated care provision. They did not find evidence that hospitals increased provision of uncompensated care after entry into the 340B program differentially more than hospitals that never entered or had not yet entered the program.
AHRQ-funded; HS026980; HS024072.
Citation: Desai SM, McWilliams JM . 340B Drug Pricing Program and hospital provision of uncompensated care. Am J Manag Care 2021 Oct;27(10):432-37. doi: 10.37765/ajmc.2021.88761..
Keywords: Hospitals, Healthcare Costs, Medication
Taylor K, Compton S, Kolenic GE
Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.
Financial hardship affects health care access and health outcomes among peripartum women. The objective of this study was to evaluate the prevalence of financial hardship among peripartum women over time and by insurance type and income. The investigators concluded that financial hardship among peripartum women in the United States was common from 2013 to 2018, including 24% of pregnant and postpartum women reporting unmet health care need and 60% reporting health care unaffordability.
AHRQ-funded; HS023784; HS025465.
Citation: Taylor K, Compton S, Kolenic GE . Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018. JAMA Netw Open 2021 Oct;4(10):e2132103. doi: 10.1001/jamanetworkopen.2021.32103..
Keywords: Pregnancy, Healthcare Costs, Women, Access to Care
Parikh DA, Ragavan M, Dutta R
Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems.
The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. The investigators concluded that low AHI, high OOPCs, and employment changes contributed to financial toxicity; however, there were variations based on site of care.
Citation: Parikh DA, Ragavan M, Dutta R . Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems. JCO Oncol Pract 2021 Oct;17(10):e1450-e59. doi: 10.1200/op.20.00890..
Keywords: Cancer, Healthcare Costs
Pickens GT, Moore B, Smith MW
AHRQ Author: Karaca Z
Methods for estimating the cost of treat-and-release emergency department visits.
The objective of this study was to evaluate and compare approaches to estimating the service delivery cost of emergency department (ED) visits from total charge data only. The investigators concluded that when cost-center-level charge detail for ED visits is unavailable, alternative methods relying on total ED charges can estimate ED service costs for patient and hospital segments.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Pickens GT, Moore B, Smith MW . Methods for estimating the cost of treat-and-release emergency department visits. Health Serv Res 2021 Oct;56(5):953-61. doi: 10.1111/1475-6773.13709..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Costs
Taber DJ, Fleming JN, Su Z
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
This paper examined hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. This study was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits.
Citation: Taber DJ, Fleming JN, Su Z . Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. Am J Transplant 2021 Oct;21(10):3428-35. doi: 10.1111/ajt.16737..
Keywords: Healthcare Costs, Provider: Pharmacist, Telehealth, Health Information Technology (HIT), Transplantation, Hospitalization, Medication: Safety, Medication
Jacobs M, Ellis C
Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia.
This study assessed the cost, cost-effectiveness, and perceived value associated with improved functional communication in individuals receiving telerehabilitation treatment for aphasia. Twenty persons with aphasia completed between 5 and 12 telehealth sessions of 45-60 minutes within a 6-week timeframe using a Language-Oriented Treatment (LOT). Measures were used to obtain baseline and treatment status using the National Outcomes Measures (NOMS) comprehension and verbal expression and the ASHA Quality of Communication Life (QCL). African Americans were twice as likely as Whites to experience improvement after treatment. The likelihood of improvement also increased with each additional year of education but decreased with age. The average cost of treatment varied between $540 and $1,296. However, on average the monetary equivalent in patient’s improved QCL was between $1,790 to $3,912, showing the QCL far exceeded the financial cost of treatment.
Citation: Jacobs M, Ellis C . Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia. PLoS One 2021 Sep 17;16(9):e0257462. doi: 10.1371/journal.pone.0257462..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Costs, Outcomes
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
Citation: Abdus S . Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans. J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Hero JO, Sinaiko AD, Peltz A
In New England, partisan differences In ACA marketplace participation and potential financial harm.
This study examined how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. Using data from a large insurer in New England, findings showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers. However, results suggested that party effects on decision making may inversely relate to the magnitude of the financial consequence.
Citation: Hero JO, Sinaiko AD, Peltz A . In New England, partisan differences In ACA marketplace participation and potential financial harm. Health Aff 2021 Sep;40(9):1420-29. doi: 10.1377/hlthaff.2021.00624..
Keywords: Health Insurance, Healthcare Costs
Carey K, Luo Q, Dor A
Quality and cost in community health centers.
This study’s objective was to explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality. The authors used the Uniform Data System collected by the Bureau of Primary Care to construct composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. They explored different weighting schemes and different combinations of individual quality indicators. They used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. The average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varies with different weighting schemes.
Citation: Carey K, Luo Q, Dor A . Quality and cost in community health centers. Med Care 2021 Sep;59(9):824-28. doi: 10.1097/mlr.0000000000001571.
Keywords: Community-Based Practice, Quality of Care, Healthcare Costs
Zuvekas SH, Grosse SD, Lavelle TA
AHRQ Author: Zuvekas SH
Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015.
Published healthcare cost estimates for children with autism spectrum disorder (ASD) vary widely. One possible contributor is different methods of case ascertainment. In this study, autism spectrum disorder (ASD) case status was determined using two sources of parent reports among 45,944 children ages 3-17 years in the Medical Expenditure Panel Survey (MEPS) linked to the National Health Interview Survey (NHIS) Sample Child Core questionnaire. In this paper, the investigators describe their process and conclusions.
Citation: Zuvekas SH, Grosse SD, Lavelle TA . Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015. J Autism Dev Disord 2021 Aug;51(8):2950-58. doi: 10.1007/s10803-020-04704-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Autism, Healthcare Costs, Behavioral Health
Sherry MK, Bishai DM, Padula WV
Impact of neighborhood social and environmental resources on Medicaid spending.
In an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending, efforts to address the root causes of health are urgently needed. Research linking medical spending to variation in neighborhood resources is critical to building the case for increased funding for social conditions. However, few studies link neighborhood factors to medical spending. This study assessed the relationship between neighborhood social and environmental resources and medical spending across the spending distribution.
Citation: Sherry MK, Bishai DM, Padula WV . Impact of neighborhood social and environmental resources on Medicaid spending. Am J Prev Med 2021 Aug;61(2):e93-e101. doi: 10.1016/j.amepre.2021.02.019..
Keywords: Medicaid, Healthcare Costs
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation: Moloci NM, Si Y, Norton EC . Predicting losses from Medicare Shared Savings Program departures. J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords: Medicare, Health Insurance, Healthcare Costs
Ling VB, Levi EE, Harrington AR
The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes.
Researchers evaluated the cost of implementing immediate postpartum contraceptive services at four academic centers and one private hospital in the US. Using mixed-methods cost analysis, they found that pre-implementation activities required more resources than execution activities, and sites that used lower-cost employees observed lower costs per hour for implementation activities. Further, implementation activities and costs were associated with local contextual factors, including stakeholder acceptance, integration of employees, and infrastructure readiness for the change effort.
AHRQ-funded; HS025465; HS023784.
Citation: Ling VB, Levi EE, Harrington AR . The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes. BMJ Qual Saf 2021 Aug;30(8):658-67. doi: 10.1136/bmjqs-2020-011111..
Keywords: Healthcare Costs, Sexual Health, Women, Quality Improvement, Quality of Care
Andino J, Zhu A, Chopra Z
Video visits are practical for the follow-up and management of established male infertility patients.
This study looked at the use and benefits of video visits for the follow-up and management of established male infertility patients at a tertiary academic center in southeast Michigan. This review was conducted for visits prior to the COVID-19 pandemic. Most male infertility patients had an endocrinologic (29%) or anatomic (21%) cause for their infertility. The majority (73%) of visits involved reviewing results; 30% included counseling regarding assistive reproductive technologies; and 25% of visits resulted in prescribing hormonally active medications. No patients required an unplanned in-person visit with two patients coming in for an elective varicocelectomy. Cost savings ranged from $149 to $252 and they were estimated to save a median of 97 minutes of travel per visit.
Citation: Andino J, Zhu A, Chopra Z . Video visits are practical for the follow-up and management of established male infertility patients. Urology 2021 Aug;154:158-63. doi: 10.1016/j.urology.2021.03.050..
Keywords: Men's Health, Sexual Health, Telehealth, Health Information Technology (HIT), Healthcare Costs
Reid RO, Mafi JN, Baseman LH
Waste in the Medicare program: a national cross-sectional analysis of 2017 low-value service use and spending.
Low-value health care services offer patients little to no clinical benefit, increase spending, and may cause patient harm. In this analysis, the investigators provided updated national estimates of low-value service use and spending in Medicare in 2017. The investigators concluded that their findings suggest that targeted interventions to reduce low-value services—particularly the narrow subset responsible for the majority of spending—could substantially reduce wasteful Medicare spending.
Citation: Reid RO, Mafi JN, Baseman LH . Waste in the Medicare program: a national cross-sectional analysis of 2017 low-value service use and spending. J Gen Intern Med 2021 Aug;36(8):2478-82. doi: 10.1007/s11606-020-06061-0..
Keywords: Medicare, Value, Healthcare Costs
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
Citation: Eisenberg MD, Meiselbach MK, Bai G . Large self-insured employers lack power to effectively negotiate hospital prices. Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals