National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 167 Research Studies DisplayedPaddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
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Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Shih YT, Shen C, Hu JC
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant after controlling for other hospital characteristics.
AHRQ-funded; HS020263; HS024608.
Citation: Shih YT, Shen C, Hu JC .
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
Value Health 2017 Sep;20(8):1221-25. doi: 10.1016/j.jval.2017.05.010.
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Keywords: Healthcare Costs, Hospitals, Surgery
Jolley SE, Hough CL, Clermont G
Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial.
Short-term follow-up in the Fluid and Catheter Treatment Trial (FACTT) suggested differential mortality by race with conservative fluid management, but no significant interaction. A post hoc analysis of FACTT and the Economic Analysis of Pulmonary Artery Catheters (EAPAC) study was performed. The researchers found that in their cohort, conservative fluid management may have improved 1-year mortality for non-Hispanic black patients with ARDS. However, they found no long-term benefit of conservative fluid management in white subjects.
AHRQ-funded; HS011620.
Citation: Jolley SE, Hough CL, Clermont G .
Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial.
Ann Am Thorac Soc 2017 Sep;14(9):1443-49. doi: 10.1513/AnnalsATS.201611-906OC..
Keywords: Racial and Ethnic Minorities, Respiratory Conditions, Mortality
Robinson JC, Whaley CM, Brown TT
Association of reference pricing with drug selection and spending.
This study used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1,302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. It concluded that mplementation of reference pricing was associated with a higher rate of copayment by patients than in the comparison group.
AHRQ-funded; HS22098.
Citation: Robinson JC, Whaley CM, Brown TT .
Association of reference pricing with drug selection and spending.
N Engl J Med 2017 Aug 17;377(7):658-65. doi: 10.1056/NEJMsa1700087.
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Keywords: Healthcare Costs, Medication
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
AHRQ-funded; HS024698.
Citation: Chen LM, Epstein AM, Orav EJ .
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care
Schpero WL, Morden NE, Sequist TD
For selected services, blacks and Hispanics more likely to receive low-value care than whites.
US minority populations receive fewer effective health services than whites. Using Medicare administrative data for 2006-11, the researchers found no consistent, corresponding protection against the receipt of ineffective health services. Compared with whites, blacks and Hispanics were often more likely to receive the low-value services studied.
AHRQ-funded; HS017589.
Citation: Schpero WL, Morden NE, Sequist TD .
For selected services, blacks and Hispanics more likely to receive low-value care than whites.
Health Aff 2017 Jun;36(6):1065-69. doi: 10.1377/hlthaff.2016.1416.
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Keywords: Disparities, Racial and Ethnic Minorities, Quality of Care, Racial and Ethnic Minorities
Carey K, Dor A
http://www.healthfinancejournal.com/index.php/johcf/article/view/114
Price variations and their trends in U.S. hospitals.
This study tracked trends in prices paid to hospitals by commercial insurers over the period 2008 to 2014 using private sector claims data that contain actual payments. It contrasted these with trends in the CMS published charges. Results indicated that variation in actual commercially-transacted prices is substantially lower than variation in published charges.
AHRQ-funded; HS023610.
Citation: Carey K, Dor A .
Price variations and their trends in U.S. hospitals.
J Health Care Finance 2017 Sum;44(1).
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Keywords: Healthcare Costs, Payment, Health Insurance, Hospitals
Allen NB, Zhao L, Liu L
Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry).
The researchers examined the association of cardiovascular health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. They found that individuals in favorable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity.
AHRQ-funded; HS020263.
Citation: Allen NB, Zhao L, Liu L .
Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry).
Circulation 2017 May 2;135(18):1693-701. doi: 10.1161/circulationaha.116.026252.
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Keywords: Healthcare Costs, Cardiovascular Conditions, Health Status
Krinsky S, Ryan AM, Mijanovich T
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
The researchers measured variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identified the main payment adjustments that drive variation. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations.
AHRQ-funded; HS018546.
Citation: Krinsky S, Ryan AM, Mijanovich T .
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
Health Serv Res 2017 Apr;52(2):676-96. doi: 10.1111/1475-6773.12490.
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Keywords: Payment, Medicare, Healthcare Costs, Hospitals
Robinson JC, Brown TT, Whaley C
Reference pricing changes the 'choice architecture' of health care for consumers.
This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Reference pricing changes the 'choice architecture' of health care for consumers.
Health Aff 2017 Mar;36(3):524-30. doi: 10.1377/hlthaff.2016.1256.
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Keywords: Decision Making, Education: Patient and Caregiver, Healthcare Costs, Healthcare Delivery
Schlesinger M, Grob R
Treating, fast and slow: Americans' understanding of and responses to low-value care.
This article explores Americans’ understanding of low-value care in 2015, assesses the impact of media messaging, and tests alternative message framing. The study concluded that the public’s awareness of low-value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status.
AHRQ-funded; HS021858; HS016978.
Citation: Schlesinger M, Grob R .
Treating, fast and slow: Americans' understanding of and responses to low-value care.
Milbank Q 2017 Mar;95(1):70-116. doi: 10.1111/1468-0009.12246..
Keywords: Healthcare Delivery, Decision Making, Healthcare Costs, Quality of Care
Yeung K, Basu A, Hansen RN
Impact of a value-based formulary on medication utilization, health services utilization, and expenditures.
The objective of the study was to determine the impact of the value-based formulary (VBF). It found that cost-sharing informed by cost-effectiveness analysis reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.
AHRQ-funded; HS023346.
Citation: Yeung K, Basu A, Hansen RN .
Impact of a value-based formulary on medication utilization, health services utilization, and expenditures.
Med Care 2017 Feb;55(2):191-98. doi: 10.1097/mlr.0000000000000630.
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Keywords: Medication, Healthcare Utilization, Healthcare Costs, Health Services Research (HSR)
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Armstrong MJ, Mullins CD
Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values.
In this commentary, the authors propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. Their draft taxonomy describes four categories of patient values: global, decisional, situational, and external, highlights different values impacting decision making and facilitates a more complete value assessment at the point of care.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Mullins CD .
Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values.
Value Health 2017 Feb;20(2):292-95. doi: 10.1016/j.jval.2016.11.008.
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Keywords: Decision Making, Healthcare Delivery, Patient and Family Engagement
Rocque GB, Williams CP, Jackson BE
Choosing Wisely: opportunities for improving value in cancer care delivery?
The researchers conducted a retrospective analysis of Medicare claims data to examine concordance with Choosing Wisely recommendations across 12 cancer centers in the southeastern United States. Significant variability was noted across centers for all recommendations. The researchers concluded that if concordance were to increase to 95 percent for all measures, an estimated $19 million difference in total cost of care per quarter would be saved.
AHRQ-funded; HS023009.
Citation: Rocque GB, Williams CP, Jackson BE .
Choosing Wisely: opportunities for improving value in cancer care delivery?
J Oncol Pract 2017 Jan;13(1):e11-e21. doi: 10.1200/jop.2016.015396.
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Keywords: Cancer, Guidelines, Healthcare Delivery, Medicare
Sood N, Alpert A, Barnes K
Effects of payment reform in more versus less competitive markets.
In this paper, the authors exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, they find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets..
AHRQ-funded; HS018541.
Citation: Sood N, Alpert A, Barnes K .
Effects of payment reform in more versus less competitive markets.
J Health Econ 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006.
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Keywords: Healthcare Costs, Payment, Home Healthcare, Policy
Chrisinger BW, Grossestreuer AV, Laguna MC
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
The authors investigated how well the likelihood of out-of-hospital cardiac arrest was met by the supply of automated external defibrillators (AED) in a dense urban environment. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.
AHRQ-funded; HS018362.
Citation: Chrisinger BW, Grossestreuer AV, Laguna MC .
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
Resuscitation 2016 Dec;109:9-15. doi: 10.1016/j.resuscitation.2016.09.021.
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Keywords: Medical Devices, Health Insurance, Urban Health, Cardiovascular Conditions
Eaton EF, Tamhane A, Saag M
Cost considerations in the current antiretroviral era.
The authors analyzed the relative cost-effectiveness of contemporary antiretroviral therapy in real-world clinical settings. They found that, among the participants studied, raltegravir and efavirenz-based regimens were the most cost-effective options for treatment-naive patients. They suggested that these findings are relevant given changes in recommended regimens for treatment-naive persons. The authors recommended that further data on the comparative effectiveness of efavirenz and rilpivirine are needed.
AHRQ-funded; HS013852.
Citation: Eaton EF, Tamhane A, Saag M .
Cost considerations in the current antiretroviral era.
AIDS 2016 Sep 10;30(14):2115-9. doi: 10.1097/qad.0000000000001120.
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Keywords: Healthcare Costs, Human Immunodeficiency Virus (HIV), Medication
Abrahamson K, Davila H, Rehkamp N
Is there a business case for nursing home quality improvement?
The objective of this study was to investigate the economic or business perspective surrounding QI participation by exploring nursing home leader perceptions regarding market-based motivations for improvements, or a business case for engaging in a quality improvement project.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Rehkamp N .
Is there a business case for nursing home quality improvement?
Nurs Econ 2016 Sep-Oct;34(5):224-9, 35..
Keywords: Long-Term Care, Nursing Homes, Quality Improvement
Dorr DA, Anastas T, Ramsey K
Effect of a pragmatic, cluster-randomized controlled trial on patient experience with care: The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Study.
This study's objective is to understand whether focusing on high value elements (HVEs) would improve patient experience with care. The authors found that practices targeting HVEs showed significantly more improvement in patient experience of care. However, contemporaneous trends may have affected results, leading to declines in patient experience.
AHRQ-funded; HS017832.
Citation: Dorr DA, Anastas T, Ramsey K .
Effect of a pragmatic, cluster-randomized controlled trial on patient experience with care: The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Study.
Med Care 2016 Aug;54(8):745-51. doi: 10.1097/mlr.0000000000000552.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient-Centered Healthcare, Patient Experience
Friedman AS, Schpero WL, Busch SH
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
The authors examined the effect of tobacco surcharges on insurance status and smoking cessation in the first year of the health insurance exchanges' implementation, among adults most likely to purchase insurance from them. Their findings suggest that tobacco surcharges conflicted with a major goal of the Affordable Care Act - increased financial protection - without increasing smoking cessation.
AHRQ-funded; HS017589.
Citation: Friedman AS, Schpero WL, Busch SH .
Evidence suggests that the ACA's tobacco surcharges reduced insurance take-up and did not increase smoking cessation.
Health Aff 2016 Jul;35(7):1176-83. doi: 10.1377/hlthaff.2015.1540.
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Keywords: Healthcare Costs, Health Insurance, Policy
Hefele JG, Acevedo A, Nsiah-Jefferson L
Choosing a nursing home: what do consumers want to know, and do preferences vary across race/ethnicity?
The researchers sought to identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity. They found that participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. Participants also wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families.
AHRQ-funded; HS021891.
Citation: Hefele JG, Acevedo A, Nsiah-Jefferson L .
Choosing a nursing home: what do consumers want to know, and do preferences vary across race/ethnicity?
Health Serv Res 2016 Jun;51 Suppl 2:1167-87. doi: 10.1111/1475-6773.12457.
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Keywords: Nursing Homes, Education: Patient and Caregiver, Racial and Ethnic Minorities
Silber JH, Rosenbaum PR, McHugh MD
Comparison of the value of nursing work environments in hospitals across different levels of patient risk.
This study tested whether hospitals with better nursing work environments displayed better value than those with worse nursing. It found that hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.
AHRQ-funded; HS018338.
Citation: Silber JH, Rosenbaum PR, McHugh MD .
Comparison of the value of nursing work environments in hospitals across different levels of patient risk.
JAMA Surg 2016 Jun;151(6):527-36. doi: 10.1001/jamasurg.2015.4908.
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Keywords: Healthcare Costs, Quality of Care, Nursing, Workforce
Frean M, Shelder S, Rosenthal MB
Health reform and coverage changes among Native Americans.
This study evaluated changes in insurance and Indian Health Service (IHS) coverage among Native Americans following the Affordable Care Act’s (ACA) implementation. It concluded that the ACA was associated with significant coverage increases for Native Americans, primarily in Medicaid expansion states, consistent with national trends for all racial/ethnic groups. Nationally, much of the coverage increase occurred among Native Americans without connections to IHS.
AHRQ-funded; HS021291.
Citation: Frean M, Shelder S, Rosenthal MB .
Health reform and coverage changes among Native Americans.
JAMA Intern Med 2016 Jun;176(6):858-60. doi: 10.1001/jamainternmed.2016.1695.
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Keywords: Policy, Health Insurance, Racial and Ethnic Minorities, Racial and Ethnic Minorities
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
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Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals