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
126 to 150 of 167 Research Studies DisplayedDas A, Norton EC, Miller DC
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, researchers found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
Health Aff 2016 May;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
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Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Figueiredo R, Dempster L, Quinonez C
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
The researchers evaluated emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). They found that over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. They concluded that access to dental care is inadequate and that ED settings are ineffective for treatment of dental problems.
AHRQ-funded; HS014129.
Citation: Figueiredo R, Dempster L, Quinonez C .
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
J Health Care Poor Underserved 2016;27(2):860-8. doi: 10.1353/hpu.2016.0081.
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Keywords: Access to Care, Dental and Oral Health, Emergency Department, Vulnerable Populations
Bailey M, Randall EC, Costa C
Analysis of urine, oral fluid and fingerprints by liquid extraction surface analysis coupled to high resolution MS and MS/MS - opportunities for forensic and biomedical science.
The authors assessed the suitability of Liquid Extraction Surface Analysis (LESA) for obtaining detailed chemical profiles of fingerprints, oral fluid, and urine, which may be used in the future for rapid medical diagnostics or metabolomics studies. They also showed how LESA can be used to detect illicit drugs and their metabolites, and they showed how LESA can be used to detect the explosive material RDX in contaminated artificial fingermarks.
AHRQ-funded; HS017487.
Citation: Bailey M, Randall EC, Costa C .
Analysis of urine, oral fluid and fingerprints by liquid extraction surface analysis coupled to high resolution MS and MS/MS - opportunities for forensic and biomedical science.
Anal Methods 2016 Apr 28;2016(16):3373-82. doi: 10.1039/c6ay00782a.
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Keywords: Diagnostic Safety and Quality
Wherry LR, Kenney GM, Sommers BD
The role of public health insurance in reducing child poverty.
The researchers reviewed a growing body of evidence that public health insurance provides important financial benefits to low-income families and also reviewed the potential poverty-reducing effects of public health insurance coverage. They found that Medicaid plays a significant role in decreasing poverty for many children and families. They also reviewed emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. They concluded that the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.
AHRQ-funded; HS021291.
Citation: Wherry LR, Kenney GM, Sommers BD .
The role of public health insurance in reducing child poverty.
Acad Pediatr 2016 Apr;16(3 Suppl):S98-s104. doi: 10.1016/j.acap.2015.12.011.
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Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Low-Income, Medicaid
Donnelly JP, Franco RA, Wang HE
Emergency department screening for hepatitis C virus: geographic reach and spatial clustering in central Alabama.
Hepatitis C virus (HCV) infection is a growing problem, disproportionately affecting those born between 1945 and 1965. Here, we demonstrate the wide geographic reach and surveillance potential of emergency department-based screening and identify areas of elevated HCV infection in central Alabama that were socioeconomically disadvantaged compared with surrounding communities.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Franco RA, Wang HE .
Emergency department screening for hepatitis C virus: geographic reach and spatial clustering in central Alabama.
Clin Infect Dis 2016 Mar 1;62(5):613-6. doi: 10.1093/cid/civ984.
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Keywords: Hepatitis, Screening, Emergency Department, Emergency Medical Services (EMS)
Driessen J, Baik SH, Zhang Y
Explaining improved use of high-risk medications in Medicare between 2007 and 2011.
The researchers explored the reasons for the great decline in the use of high-risk medications between 2007 and 2011. They found that the FDA’s ban on propoxyphene beginning in 2010 led to the huge decrease in high-risk prescribing. For non-propoxyphene drugs included in the high-risk measure, the rate of prescribing showed minimal improvement, decreasing from 21.0 percent to 18.6 percent from 2007 to 2011.
AHRQ-funded; HS018657.
Citation: Driessen J, Baik SH, Zhang Y .
Explaining improved use of high-risk medications in Medicare between 2007 and 2011.
J Am Geriatr Soc 2016 Mar;64(3):674-6. doi: 10.1111/jgs.14000.
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Keywords: Medication, Medicare
Friedman A, Howard J, Shaw EK
Facilitators and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators' perspectives.
This is the first study describing experiences of care coordinators across the US from their own perspectives. It concluded that while all the barriers and facilitators were important to performing coordinators' roles, relationship building was key to effective care coordination, whether with clinicians, patients, or outside organizations.
AHRQ-funded; HS020682.
Citation: Friedman A, Howard J, Shaw EK .
Facilitators and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators' perspectives.
J Am Board Fam Med 2016 Jan-Feb;29(1):90-101. doi: 10.3122/jabfm.2016.01.150175.
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Keywords: Care Coordination, Patient-Centered Healthcare, Healthcare Delivery
Rundell SD, Goode AP, Friedly JL
Role of health services research in producing high-value rehabilitation care.
The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. The authors believe that rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful.
AHRQ-Funded HS022982.
Citation: Rundell SD, Goode AP, Friedly JL .
Role of health services research in producing high-value rehabilitation care.
Phys Ther 2015 Dec;95(12):1703-11. doi: 10.2522/ptj.20150033..
Keywords: Health Services Research (HSR), Rehabilitation, Patient-Centered Outcomes Research, Comparative Effectiveness
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
Luft HS
Policy-oriented research on improved physician incentives for higher value health care.
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered focusing on fundamental "building block" studies.
AHRQ-funded.
Citation: Luft HS .
Policy-oriented research on improved physician incentives for higher value health care.
Health Serv Res 2015 Dec;50 Suppl 2:2187-215. doi: 10.1111/1475-6773.12423.
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Keywords: Policy, Health Insurance, Payment, Health Services Research (HSR)
Kerlin MP, Cooke CR
Understanding costs when seeking value in critical care.
The authors discuss a study by Gershengorn and colleagues about daily ICU costs in five ICUs within a single medical center. They argue that although the authors should be commended on advancing the understanding of ICU costs, we should also recognize that efforts to reduce ICU length of stay will necessarily be insufficient to make a real dent in our health care economy.
AHRQ-funded; HS020672.
Citation: Kerlin MP, Cooke CR .
Understanding costs when seeking value in critical care.
Ann Am Thorac Soc 2015 Dec;12(12):1743-4. doi: 10.1513/AnnalsATS.201510-660ED.
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Keywords: Critical Care, Healthcare Costs, Intensive Care Unit (ICU)
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Anderson GF, Ballreich J, Bleich S
Attributes common to programs that successfully treat high-need, high-cost individuals.
The authors identified 8 attributes common to programs that successfully treat high-need, high-cost individuals. They then illustrated these attributes with specific examples.
AHRQ-funded; HS000029.
Citation: Anderson GF, Ballreich J, Bleich S .
Attributes common to programs that successfully treat high-need, high-cost individuals.
Am J Manag Care 2015 Nov;21(11):e597-600.
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Keywords: Healthcare Costs, Patient-Centered Healthcare
He D, Konetzka RT
Public reporting and demand rationing: evidence from the nursing home industry.
The authors examined a consequence of public reporting: the potential for demand rationing. They found that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints.
AHRQ-funded; HS021877.
Citation: He D, Konetzka RT .
Public reporting and demand rationing: evidence from the nursing home industry.
Health Econ 2015 Nov;24(11):1437-51. doi: 10.1002/hec.3097.
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Keywords: Public Reporting, Medicare, Nursing Homes
McConnochie KM
Pursuit of value in connected healthcare.
The authors highlighted differences in care models to mitigate controversy and to distinguish capacities of these different models. They concluded that the pursuit of value in connected care is fundamentally the same as with in-person care.
AHRQ-funded; HS016871; HS015165; HS018912.
Citation: McConnochie KM .
Pursuit of value in connected healthcare.
Telemed J E Health 2015 Nov;21(11):863-9. doi: 10.1089/tmj.2015.0111.
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Keywords: Healthcare Delivery, Quality of Care, Health Services Research (HSR), Telehealth
Hernandez I, Zhang Y
Comparing clinical and economic outcomes of biologic and conventional medications in postmenopausal women with osteoporosis.
This study compared clinical and economic outcomes between teriparatide (monthly costs $1120) and bisphosphonates (monthly costs $14) among postmenopausal women with osteoporosis. It found that teriparatide users had higher risk of fracture and higher costs, compared with similar bisphosphonates users. The hazard ratios of fracture for teriparatide relative to bisphosphonates ranged from 1.37 to 2.12, depending on methods.
AHRQ-funded; HS018657.
Citation: Hernandez I, Zhang Y .
Comparing clinical and economic outcomes of biologic and conventional medications in postmenopausal women with osteoporosis.
J Eval Clin Pract 2015 Oct;21(5):840-7. doi: 10.1111/jep.12389.
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Keywords: Medication, Women, Osteoporosis, Healthcare Costs
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
AHRQ-funded; HS018657.
Citation: Zhang Y, Talisa V, Baik SH .
Part D plan switching among Medicare beneficiaries with schizophrenia.
Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
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Keywords: Healthcare Costs, Medicare, Behavioral Health
Lee BY, Bartsch SM, Mvundura M
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
The researchers utilized a susceptible-exposed-infectious-recovered transmission model linked to an economic influenza outcomes model to assess the economic value of introducing the microneedle patch (MNP) into the U.S. influenza vaccine market from the third-party payer and societal perspectives. They concluded that if healthcare providers administered the MNP, its introduction would be less costly and more effective in the majority of scenarios assessed.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Mvundura M .
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
Vaccine 2015 Sep 08;33(37):4727-36. doi: 10.1016/j.vaccine.2015.02.076.
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Keywords: Healthcare Delivery, Healthcare Costs, Influenza, Vaccination
Ryan AM, Burgess JF, Dimick JB
Why we should not be indifferent to specification choices for difference-in-differences.
The purpose of this study was to evaluate the effects of specification choices on the accuracy of estimates in difference-in-differences models. They found that performance of alternative specifications varied dramatically when the probability of treatment was correlated with pre-intervention levels or trends. In these cases, propensity score matching resulted in much more accurate point estimates.
AHRQ-funded; HS018546.
Citation: Ryan AM, Burgess JF, Dimick JB .
Why we should not be indifferent to specification choices for difference-in-differences.
Health Serv Res 2015 Aug;50(4):1211-35. doi: 10.1111/1475-6773.12270..
Keywords: Quality of Care, Health Services Research (HSR)
Balaban RB, Galbraith AA, Burns ME
A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: a randomized controlled trial.
The researchers sough to determine if an intervention by patient navigators, hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. They found that, overall, 30-day readmission rates did not differ between intervention and control patients.
AHRQ-funded; HS020628.
Citation: Balaban RB, Galbraith AA, Burns ME .
A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: a randomized controlled trial.
J Gen Intern Med 2015 Jul;30(7):907-15. doi: 10.1007/s11606-015-3185-x..
Keywords: Hospital Readmissions, Low-Income, Social Determinants of Health, Patient Safety
Carey K
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
This paper investigates the relationship between length of stay and readmission within 30 days of discharge from an acute care hospitalization. It found that the cost of an additional day of stay was offset by expected cost savings from an avoided readmission in the range of 15 to 65 percent.
AHRQ-funded; HS020995.
Citation: Carey K .
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
Health Econ 2015 Jul;24(7):790-802. doi: 10.1002/hec.3061..
Keywords: Hospital Readmissions, Hospitalization, Elderly, Hospital Discharge, Medicare
Zhang Y, Baik SH, Newhouse JP
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
The investigators simulated Medicare Part D savings from replacing random assignment with an "intelligent assignment" algorithm that would assign beneficiaries to the least expensive plan in 2010 based on their drug usage in the previous year. They found that intelligent assignment could have saved about $150 million for Medicare and beneficiaries with schizophrenia combined in 2010.
AHRQ-funded; HS018657.
Citation: Zhang Y, Baik SH, Newhouse JP .
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
Health Aff 2015 Mar;34(3):455-60. doi: 10.1377/hlthaff.2014.1227.
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Keywords: Healthcare Costs, Medicare, Medication, Behavioral Health
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
AHRQ-funded; HS018546
Citation: Ryan AM, Burgess JF, Pesko MF .
The early effects of Medicare's mandatory hospital pay-for-performance program.
Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Quality Improvement, Quality of Care, Patient Experience