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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 199 Research Studies Displayed
Sorra J, Zebrak K, Yount N
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.
Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of this study was to develop survey items to assess clinician and staff perspectives about the extent to which the organizational culture in hospitals and medical offices supports value and efficiency. The investigators concluded when added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets they developed extended those surveys by assessing additional dimensions of organizational culture that affect care delivery.
Citation: Sorra J, Zebrak K, Yount N . Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Qual Saf 2022 Jul;31(7):493-502. doi: 10.1136/bmjqs-2020-012407..
Keywords: Surveys on Patient Safety Culture, Organizational Change, Value
Maughan BC, Lin A, Caughey AB
Field trauma triage among older adults: a cost-effectiveness analysis.
The authors evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults. They used a microsimulation model with a retrospective cohort of community-dwelling Medicare beneficiaries transported by emergency medical services after an acute injury. They found that high-sensitivity trauma field triage is not cost-effective among older adults.
Citation: Maughan BC, Lin A, Caughey AB . Field trauma triage among older adults: a cost-effectiveness analysis. J Am Coll Surg 2022 Feb 1;234(2):139-54. doi: 10.1097/xcs.0000000000000025..
Keywords: Elderly, Trauma, Healthcare Costs, Value
Ganguli I, Morden NE, Yang CW
Low-value care at the actionable level of individual health systems.
This study measured and reported low-value care use across and within individual health systems and to identify system characteristics associated with higher use using Medicare administrative data. This retrospective cohort study was conducted using 11,637,763 Medicare beneficiaries in 556 health systems in the AHRQ Compendium of US Health Systems. These Medicare beneficiaries were enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017. The most common low-value services include preoperative laboratory testing, prostate-specific antigen testing in men older than 70 years, and use of antipsychotic medications in patients with dementia. Forty-one low-value services were measured based on the Milliman MedInsight Health Waste Calculator. In multivariable analysis, the health system characteristics associated with higher use of low-value care were a smaller proportion of primary care physicians for systems with less than the median percentage of primary care physicians vs -0.16 for those with more than the median percentage of primary care physicians; no major teaching hospital without a teaching hospital vs -0.18 with a teaching hospital; larger proportion of non-White patients for systems with >20% of non-White beneficiaries vs -0.06 for systems with ≤20% of non-White beneficiaries; headquartered in the South or West for the South and 0.22 for the West compared with -0.09 for the Northeast and -0.44 for the Midwest;, and serving areas with more health care spending for areas above the median level of spending vs -0.24 for areas below the median level of spending.
Citation: Ganguli I, Morden NE, Yang CW . Low-value care at the actionable level of individual health systems. JAMA Intern Med 2021 Nov;181(11):1490-500. doi: 10.1001/jamainternmed.2021.5531..
Keywords: Healthcare Systems, Value, Primary Care
Schuttner L, Haraldsson B, Maynard C
Factors associated with low-value cancer screenings in the Veterans Health Administration.
Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. The objective of this study was to understand rates and factors associated with outpatient low-value cancer screenings.
Citation: Schuttner L, Haraldsson B, Maynard C . Factors associated with low-value cancer screenings in the Veterans Health Administration. JAMA Netw Open 2021 Oct;4(10):e2130581. doi: 10.1001/jamanetworkopen.2021.30581..
Keywords: Veterans, Screening, Value, Cancer
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
Chen HF, Rose AM, Waisbren S
Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness.
This study’s objective was to evaluate the cost-effectiveness of newborn screening and treatment for phenylketonuria (PKU) in the context of new data on adherence to a recommended diet treatment and a newly available drug (sapropterin dihydrochloride). A computer simulation model was developed to project outcomes for a hypothetical cohort of newborns which compared four strategies. The strategies compared were: 1) clinical identification (CI) with diet treatment; 2) newborn screening (NBS) with diet treatment; 3) CI with diet and medication; and 4) NBS with diet and medication. The range of incremental cost-effectiveness ratio went from $6400/QALY for newborn screening with diet treatment compared to clinical identification with diet treatment up to $16,000,000/QALY for adding medication to NBS with diet treatment. Future research is needed to consider conditions under which sapropterin dihydrochloride would be more economically attractive.
Citation: Chen HF, Rose AM, Waisbren S . Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness. Children 2021 May 12;8(5). doi: 10.3390/children8050381..
Keywords: Newborns/Infants, Neurological Disorders, Screening, Value, Healthcare Costs
Wang T, Bredbeck BC, Sinco B
Variations in persistent use of low-value breast cancer surgery.
Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. In this retrospective cohort study the investigators sought to identify variation and determinants of persistent use of low-value breast cancer surgical care.
Citation: Wang T, Bredbeck BC, Sinco B . Variations in persistent use of low-value breast cancer surgery. JAMA Surg 2021 Apr;156(4):353-62. doi: 10.1001/jamasurg.2020.6942..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Value, Women
Bartsch SM, O'Shea KJ, Wedlock PT
Potential clinical and economic value of norovirus vaccination in the community setting.
This paper examined the potential clinical and economic value of norovirus vaccination in a community setting using a transmission, clinical, and economics computation simulation model representing different U.S. population segments. The simulation looked at the impact of vaccinating children <5 years and older adults aged 65 and older. Compared with no vaccine, vaccinating preschool-aged children averted 8-7% of symptomatic norovirus cases in a community and vaccinating older adults averted 2-29% of symptomatic cases. Vaccination with a 25% vaccine efficacy was cost effective when vaccinations cost ≤$445 and cost saving at ≤$370 when vaccinating preschool-aged children and ≤$42 and ≤$30, respectively for older adults. With 50% efficacy, vaccination was cost effective when it cost ≤$1,190 and cost saving at ≤$930 when vaccinating preschool-aged children and ≤$110 and ≤$64, respectively, for older adults. At 75% vaccine efficacy the cost thresholds increased to ≤$1,600 and ≤$1,300 for preschool-aged children and ≤$165 and ≤$100 for older adults.
Citation: Bartsch SM, O'Shea KJ, Wedlock PT . Potential clinical and economic value of norovirus vaccination in the community setting. Am J Prev Med 2021 Mar;60(3):360-68. doi: 10.1016/j.amepre.2020.10.022..
Keywords: Infectious Diseases, Vaccination, Healthcare Costs, Value
Wang T, Baskin A, Miller J
Trends in breast cancer treatment de-implementation in older patients with hormone receptor-positive breast cancer: a mixed methods study.
Guidelines allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women >/= 70 years of age with hormone receptor-positive (HR +) breast cancer. Despite this, national data suggest these procedures have not been widely de-implemented. The objectives of this study were to evaluate trends in SLNB and post-lumpectomy radiotherapy utilization in patients who were eligible for omission and evaluate patient preferences as a target for de-implementation of low-value care.
Citation: Wang T, Baskin A, Miller J . Trends in breast cancer treatment de-implementation in older patients with hormone receptor-positive breast cancer: a mixed methods study. Ann Surg Oncol 2021 Feb;28(2):902-13. doi: 10.1245/s10434-020-08823-w..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Healthcare Utilization, Practice Patterns, Value, Women
Mafi JN, Reid RO, Baseman LH
Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018.
Researchers sought to assess national trends in low-value care use and spending. In this cross-sectional study, they found that among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018, despite a national education campaign in collaboration with clinician specialty societies and increased attention on low-value care. While most use of low-value care came from three services, one of these was opioid prescriptions, which increased over time despite the harms associated with their use. They concluded that their findings may represent several opportunities to prevent patient harm and lower spending.
Citation: Mafi JN, Reid RO, Baseman LH . Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018. JAMA Netw Open 2021 Feb;4(2):e2037328. doi: 10.1001/jamanetworkopen.2020.37328..
Keywords: Medicare, Healthcare Costs, Value
Rodriguez PJ, Roberts DA, Meisner J
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. In this study, the investigators aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. The authors concluded that incorporating dual rapid diagnostic tests in antenatal care could be cost-saving across countries with varying HIV prevalence.
Citation: Rodriguez PJ, Roberts DA, Meisner J . Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study. Lancet Glob Health 2021 Jan;9(1):e61-e71. doi: 10.1016/s2214-109x(20)30395-8..
Keywords: Human Immunodeficiency Virus (HIV), Infectious Diseases, Prevention, Pregnancy, Women, Diagnostic Safety and Quality, Healthcare Costs, Value
Ganguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
Citation: Ganguli I, Lupo C, Mainor AJ . Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit. JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Value, Diagnostic Safety and Quality
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
Citation: Brewster AL, Fraze TK, Gottlieb LM . The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians. Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords: Payment, Social Determinants of Health, Practice Patterns, Innovations and Emerging Issues, Screening, Risk, Value, Nutrition, Vulnerable Populations
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
Citation: Ganguli I, Lupo C, Mainor AJ . Association between specialist compensation and Accountable Care Organization performance. Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Value, Payment, Medicare
Skaathun B, Pho MT, Pollack HA
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
This analysis compared the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. The investigators performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men.
Citation: Skaathun B, Pho MT, Pollack HA . Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States. J Int AIDS Soc 2020 Oct;23(10):e25554. doi: 10.1002/jia2.25554..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Healthcare Costs, Prevention, Value, Infectious Diseases
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
Citation: Encinosa WE . Is it time for ACOs to start tackling the high costs of surgery? Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment, Value
Iglesia EGA, Greenhawt M, Shaker MS
Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
Researchers sought to define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists. A review of articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening was conducted. The researchers concluded that, as health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.
Citation: Iglesia EGA, Greenhawt M, Shaker MS . Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system. Ann Allergy Asthma Immunol 2020 Aug;125(2):126-36. doi: 10.1016/j.anai.2020.04.007..
Keywords: Value, Healthcare Delivery, Healthcare Costs
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ . Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model? Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Healthcare Systems, Hospitals, Orthopedics, Value, Healthcare Costs, Payment, Quality of Care
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
Citation: Kennedy G, Lewis VA, Kundu S . Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks. Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment, Value
Berlin NL, Skolarus TA, Kerr EA
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
The objectives of this surgical perspective are to discuss the unique aspects of surgical care delivery acting as barriers to de-implementation and to suggest potential strategies to reduce low-value surgery in the United States. Successful de-implementation of low-value surgery will depend on understanding why low-value procedures persist, leveraging quality collaboratives to monitor appropriateness, implementing clinical decision support systems, and developing incentives for de-implementation.
Citation: Berlin NL, Skolarus TA, Kerr EA . Too much surgery: overcoming barriers to deimplementation of low-value surgery. Ann Surg 2020 Jun;271(6):1020-22. doi: 10.1097/sla.0000000000003792..
Keywords: Surgery, Value, Decision Making
Friedman Peahl A, Heisler M, Essenmacher LK
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
The authors compared U.S. to international prenatal care consensus guidelines for low-risk women to inform care delivery reforms. They found that U.S. and peer-country guidelines recommended similar prenatal education and psychosocial services for low-risk women; however, peer countries generally recommended fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care. They recommended that further investigation evaluate associations between recommended care and actual practice, as well as the effects of different components of prenatal care and delivery models on maternal-infant outcomes, patient-centeredness, and health care expenditures in the U.S.
Citation: Friedman Peahl A, Heisler M, Essenmacher LK . A comparison of international prenatal care guidelines for low-risk women to inform high-value care. Am J Obstet Gynecol 2020 May;222(5):505-07. doi: 10.1016/j.ajog.2020.01.021..
Keywords: Maternal Care, Pregnancy, Women, Value, Guidelines, Evidence-Based Practice, Healthcare Delivery
Socal MP, Anderson KE, Sen A
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
The purpose of this study was to examine the uptake of filgrastim-sndz (Zarxio), the first biosimilar to launch in the United States, in the Medicare Part B fee-for-service program from its launch in September 2015 to December 2017 and compare characteristics of patients and facilities that used filgrastim-sndz or originator filgrastim (Neupogen). The investigators concluded that uptake of biosimilar filgrastim in the Medicare Part B program occurred despite multiple challenges to the adoption of biosimilars in the US market, suggesting that substantial potential savings could be generated by improving biosimilar uptake.
Citation: Socal MP, Anderson KE, Sen A . Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim. Value Health 2020 Apr;23(4):481-86. doi: 10.1016/j.jval.2019.12.007..
Keywords: Medicare, Practice Patterns, Medication, Healthcare Costs, Value
Bartsch SM, Asti L, Stokes-Cawley OJ
The potential economic value of a Zika vaccine for a woman of childbearing age.
The authors mapped the Zika vaccine and vaccination characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving. They developed a Markov model to simulate a woman of childbearing age to follow the potential risk and clinical course of a Zika infection. They found that, in some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500, the efficacy was as low as 25%, and the duration of protection was 1 year. They concluded that the thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.
Citation: Bartsch SM, Asti L, Stokes-Cawley OJ . The potential economic value of a Zika vaccine for a woman of childbearing age. Am J Prev Med 2020 Mar;58(3):370-77. doi: 10.1016/j.amepre.2019.10.023..
Keywords: Vaccination, Women, Infectious Diseases, Public Health, Healthcare Costs, Value, Prevention
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
Citation: Weerahandi H, Bao H, Herrin J . Home health care after skilled nursing facility discharge following heart failure hospitalization. J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Rehabilitation, Value
Markovitz AA, Rozier MD, Ryan AM
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
The purpose of this study was to assess Accountable Care Organization (ACO) engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. Participants included 1289 clinicians in the Physician Organization of Michigan ACO. Results showed that clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Rozier MD, Ryan AM . Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians. J Gen Intern Med 2020 Jan;35(1):133-41. doi: 10.1007/s11606-019-05511-8..
Keywords: Medicare, Policy, Value, Provider