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
151 to 167 of 167 Research Studies DisplayedGeorge AJ, Boehme AK, Dunn CR
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
The authors questioned the utility of routine 24-h computed tomography imaging and looked at the National Institutes of Health Stroke Scale as a possible clinical screen for selecting candidates for 24-h imaging. They found that routine 24-h computed tomography scan in patients without 24-h National Institutes of Health Stroke Scale worsening was less likely to yield information that results in a deviation from standard acute stroke care, and that no patient without worsening had parenchymal hematoma on 24-h computed tomography. They concluded that application of this Stroke Scale to distinguish patients who should have 24-h follow-up imaging from those who will not benefit is a potential avenue for improving utilization of resources and warrants further study.
AHRQ-funded; HS013852.
Citation: George AJ, Boehme AK, Dunn CR .
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
Int J Stroke 2015 Jan;10(1):37-41. doi: 10.1111/ijs.12293.
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Keywords: Decision Making, Imaging, Stroke
Geynisman DM, Chien CR, Smieliauskas F
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
The researchers performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. They discussed the implications surrounding the economic factors involved in cancer immunotherapies and suggested that further research on cost and cost-effectiveness of newer cancer vaccines and immunotherapies were warranted as this is a rapidly growing field with many new drugs on the horizon.
AHRQ-funded; HS018535.
Citation: Geynisman DM, Chien CR, Smieliauskas F .
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
Hum Vaccin Immunother 2014;10(11):3415-24. doi: 10.4161/hv.29407.
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Keywords: Cancer, Healthcare Costs, Vaccination
Gilmer TP, Stefancic A, Katz ML
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
This paper examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. They concluded that programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.
AHRQ-funded; HS019986.
Citation: Gilmer TP, Stefancic A, Katz ML .
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
Psychiatr Serv 2014 Nov;65(11):1311-7. doi: 10.1176/appi.ps.201300447.
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Keywords: Vulnerable Populations
Ostrowsky B, Ruiz R, Brown S
Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.
The researchers sought to determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates. They found that decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, but many valuable lessons were learned.
AHRQ-funded; 290200600012I.
Citation: Ostrowsky B, Ruiz R, Brown S .
Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S86-95. doi: 10.1086/677828.
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Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety
Starner CI, Alexander GC, Bowen K
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
The investigators examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. They found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. They highlighted that, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs.
AHRQ-funded; HS018960.
Citation: Starner CI, Alexander GC, Bowen K .
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
Health Aff 2014 Oct;33(10):1761-9. doi: 10.1377/hlthaff.2014.0497.
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Keywords: Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Arling PA, Abrahamson K, Miech EJ
Communication and effectiveness in a US nursing home quality-improvement collaborative.
The investigators explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. They found that reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings. Clinician and practitioner observations were discussed.
AHRQ-funded; HS018464.
Citation: Arling PA, Abrahamson K, Miech EJ .
Communication and effectiveness in a US nursing home quality-improvement collaborative.
Nurs Health Sci 2014 Sep;16(3):291-7. doi: 10.1111/nhs.12098.
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Keywords: Communication, Falls, Nursing Homes, Quality of Care, Prevention, Quality Improvement
Holzer J, Canavan M, Bradley E
County-level correlation between adult obesity rates and prevalence of dentists.
The researchers conducted a study to examine the association between the prevalence of dentists and the rates of adult obesity. They found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity. This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population.
AHRQ-funded; HS017589.
Citation: Holzer J, Canavan M, Bradley E .
County-level correlation between adult obesity rates and prevalence of dentists.
J Am Dent Assoc 2014 Sep;145(9):932-9. doi: 10.14219/jada.2014.48.
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Keywords: Dental and Oral Health, Obesity, Risk, Social Determinants of Health
David G, Lindrooth RC, Helmchen LA
Do hospitals cross-subsidize?
The authors used repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. They studied how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. They estimated that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose.
AHRQ-funded; HS010730.
Citation: David G, Lindrooth RC, Helmchen LA .
Do hospitals cross-subsidize?
J Health Econ 2014 Sep;37:198-218. doi: 10.1016/j.jhealeco.2014.06.007.
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Keywords: Healthcare Costs, Quality of Care, Hospitals
Hockenberry JM, Helmchen LA
The nature of surgeon human capital depreciation.
The authors estimated how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). They found that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points but reduced total hospitalization costs by up to 0.59 percentage points, and among emergent patients treated by high-volume providers, an additional day away raised mortality risk by 0.398 percentage points but reduced cost by up to 1.4 percentage points. They concluded that their results are consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications.
AHRQ-funded; HS019743.
Citation: Hockenberry JM, Helmchen LA .
The nature of surgeon human capital depreciation.
J Health Econ 2014 Sep;37:70-80. doi: 10.1016/j.jhealeco.2014.06.001.
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Keywords: Healthcare Costs, Mortality, Provider Performance, Surgery
Schwartz AL, Landon BE, Elshaug AG
Measuring low-value care in Medicare.
To study health care overuse, this study developed claims-based measures of low-value services ranging from low-value cancer screening and preoperative testing to low-value surgical procedures. Services detected by a limited number of measures of low-value care constituted modest proportions of overall spending, but affected substantial proportions of Medicare beneficiaries and may reflect overuse.
AHRQ-funded; HS00055
Citation: Schwartz AL, Landon BE, Elshaug AG .
Measuring low-value care in Medicare.
JAMA Intern Med. 2014 Jul;174(7):1067-76. doi: 10.1001/jamainternmed.2014.1541..
Keywords: Medicare, Healthcare Costs
Zhang Y, Zhou C, Baik SH
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
The authors used an intelligent reassignment algorithm and 2008-09 Medicare Part D drug use and spending data to match enrollees to available Part D plans according to their medication needs. They found that such a reassignment approach, compared to the current approach, could have saved the federal government over $5 billion in 2009.
AHRQ-funded; HS018657.
Citation: Zhang Y, Zhou C, Baik SH .
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
Health Aff 2014 Jun;33(6):940-5. doi: 10.1377/hlthaff.2013.1083.
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Keywords: Healthcare Costs, Low-Income, Medicare, Medication
Forrester SH, Hepp Z, Roth JA
Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care.
The study objective was to estimate the cost-effectiveness of computerized provider order entry versus traditional paper-based prescribing in reducing medications errors and adverse drug events in the ambulatory setting of mid-sized medical group. Using a decision-analytic model, the researchers found that the adoption of CPOE in the ambulatory setting provides excellent value for the investment.
AHRQ-funded; HS014739
Citation: Forrester SH, Hepp Z, Roth JA .
Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care.
Value Health. 2014 Jun;17(4):340-9. doi: 10.1016/j.jval.2014.01.009..
Keywords: Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Medical Errors, Medication, Patient Safety, Healthcare Costs, Ambulatory Care and Surgery, Prevention
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life
Ryan AM, Mushlin AI
The Affordable Care Act's payment reforms and the future of hospitals.
The author places likely hospital responses to the Affordable Care Act’s payment reforms in the historical context of their previous responses to such reforms as price controls, certificate-of-need laws, and prospective payment systems. He then discusses possible hospital responses to counter readmission penalties, revenue reductions, bundled payment strategies, and accountable care organizations.
AHRQ-funded; HS018546
Citation: Ryan AM, Mushlin AI .
The Affordable Care Act's payment reforms and the future of hospitals.
Ann Intern Med. 2014 May 20;160(10):729-30. doi: 10.7326/M13-2033..
Keywords: Healthcare Costs, Payment, Hospitals, Policy
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare
Schwartz AL, Sommers BD
Moving for Medicaid? Recent eligibility expansions did not induce migration from other states.
This study used 26 measures of low value services to examine service use and associated spending detected by these measures in Medicaid. In the six categories of care measured, services detected by a limited number of measures of low-value care constituted modest proportions of overall spending (2.7 percent) but affected 42 percent of beneficiaries.
AHRQ-funded; HS00055; HS021291
Citation: Schwartz AL, Sommers BD .
Moving for Medicaid? Recent eligibility expansions did not induce migration from other states.
Health Aff. 2014 Jan;33(1):88-94. doi: 10.1377/hlthaff.2013.0910..
Keywords: Medicaid, Healthcare Costs, Low-Income, Healthcare Utilization
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R .
Aligning provider incentives to improve primary healthcare delivery in the United States.
OA Fam Med 2013 Jun 1;1(1):7.
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Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement