National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Access to Care (2)
- Adverse Events (1)
- Cancer (1)
- Cancer: Breast Cancer (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Comparative Effectiveness (1)
- Digestive Disease and Health (1)
- Disparities (1)
- Elderly (2)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (10)
- Healthcare Delivery (1)
- Healthcare Utilization (5)
- (-) Health Insurance (20)
- Heart Disease and Health (1)
- Hospitalization (1)
- Medicaid (3)
- Medicare (3)
- Mortality (1)
- Obesity (2)
- Obesity: Weight Management (2)
- Orthopedics (2)
- Outcomes (4)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient Safety (1)
- Payment (6)
- Pneumonia (1)
- Policy (2)
- Sleep Problems (1)
- Social Determinants of Health (1)
- (-) Surgery (20)
- Treatments (1)
- Uninsured (1)
- Women (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedRoberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Scott JW, Neiman PU, Scott KW
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
This retrospective analysis of claims data examined the association of a high-deductible health insurance plan (HDHP) with severe disease and catastrophic out-of-pocket payments for emergency surgical conditions (e.g., appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (e.g., perforation, abscess, diffuse peritonitis). The secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. Among 43,516 patients [mean age 48.4 years; 51% female], 41% were enrolled in HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%); even after adjusting for relevant demographics. HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%).
AHRQ-funded; HS027788; HS028672.
Citation: Scott JW, Neiman PU, Scott KW .
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
Ann Surg 2023 Oct 1; 278(4):e667-e74. doi: 10.1097/sla.0000000000005819..
Keywords: Health Insurance, Healthcare Costs, Payment, Surgery
Chhabra KR, Fan Z, Chao GF
The role of commercial health insurance characteristics in bariatric surgery utilization.
The goal of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients. Over 73,000 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014-17 were retroactively reviewed. Findings showed that insurance plan types with higher cost sharing have lower utilization of bariatric surgery.
AHRQ-funded; HS025778; HS000053.
Citation: Chhabra KR, Fan Z, Chao GF .
The role of commercial health insurance characteristics in bariatric surgery utilization.
Ann Surg 2021 Jun;273(6):1150-56. doi: 10.1097/sla.0000000000003569..
Keywords: Health Insurance, Obesity, Obesity: Weight Management, Surgery, Healthcare Costs, Healthcare Utilization
Encinosa WE
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.
AHRQ-authored.
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
Modi PK, Moloci N, Herrel LA
Medicare accountable care organizations reduce spending on surgery.
This study examined the impact that Medicare accountable care organization (ACO) alignment has on spending for inpatient and outpatient surgical care. Researchers identified adults 65 years of age and older enrolled in fee-for-service Medicare from among a 20% random sample of beneficiaries and distinguished between those aligned and unaligned with a Medicare ACO, then measured payments for surgical services made on the enrollees’ behalf. Findings showed that ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care to improve the ability of ACOs to control healthcare spending was recommended.
AHRQ-funded; HS024728; HS024525; HS026908.
Citation: Modi PK, Moloci N, Herrel LA .
Medicare accountable care organizations reduce spending on surgery.
Am J Accountable Care 2020 Sep;8(3):12-19..
Keywords: Medicare, Surgery, Healthcare Costs, Health Insurance, Elderly
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Chhabra KR, Sheetz KH, Nuliyalu U
Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities.
This study evaluated the prevalence of out-of-network billing for in-network elective surgery for 7 common procedures. The study used retrospective claims data from a large US commercial insurer of 347,356 patients who had undergone 1 of 7 common elective operations. The procedures performed were: arthroscopic meniscal repair [116,749]; laparoscopic cholecystectomy [82,372]; hysterectomy [67,452]; total knee replacement [42,313]; breast lumpectomy [18,018]; colectomy [14,074]; and coronary artery bypass graft surgery [6378]. These were performed by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017. A total of 20.5% of episodes had an out-of-network bill. The most common bills were associated with surgical assistants (37%) and anesthesiologists (37%). Surgical complications were associated with a higher risk of out-of-network bills as well.
AHRQ-funded; HS000053; HS023597.
Citation: Chhabra KR, Sheetz KH, Nuliyalu U .
Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities.
JAMA 2020 Feb 11;323(6):538-47. doi: 10.1001/jama.2019.21463..
Keywords: Healthcare Costs, Health Insurance, Surgery
Chhabra KR, Fan Z, Chao GF
Impact of statewide essential health benefits on utilization of bariatric surgery.
This study looked at the utilization of bariatric surgery after it was included in the Affordable Care Act’s essential health benefits program. The program required individual and small-group insurance plans in 23 states to cover the surgery. Investigators used IBM MarketScan commercial claims data from 2009 to 2016. While bariatric surgery utilization increased in all states after ACA implementation, it was no greater in states with a bariatric surgery essential health benefit. Reasons why can be explored in further studies.
AHRQ-funded; HS000053; HS025778.
Citation: Chhabra KR, Fan Z, Chao GF .
Impact of statewide essential health benefits on utilization of bariatric surgery.
Obes Surg 2020 Jan;30(1):374-77. doi: 10.1007/s11695-019-04092-z..
Keywords: Surgery, Healthcare Utilization, Policy, Health Insurance
Vila PM, Olsen MA, Piccirillo JF
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
The purpose of this study was to determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, non-neoplastic submandibular salivary gland disease. Researchers conducted an epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database; 5,111 adults with sialadenitis who had a sialoendoscopy or submandibular gland excision were included. The results of this study indicate that the use of sialoendoscopy procedures has increased over time, while the overall rate of sialoadenectomy has decreased, but the authors conclude that both procedures are safe for the treatment of patients with sialadenitis and sialolithiasis.
AHRQ-funded; HS019455.
Citation: Vila PM, Olsen MA, Piccirillo JF .
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
Laryngoscope 2019 Dec 16;129(3):602-06. doi: 10.1002/lary.27243..
Keywords: Healthcare Utilization, Health Insurance, Surgery
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Tipping AD, Nickel KB .
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
.
.
Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Daniel VT, Ayturk D, Ward DV
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. In this study, the investigators evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Ward DV .
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
Am J Surg 2019 Jan;217(1):121-25. doi: 10.1016/j.amjsurg.2018.06.025..
Keywords: Adverse Events, Digestive Disease and Health, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Patient Safety, Surgery, Uninsured
Kelsall AC, Cassidy R, Ghaferi AA
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
The authors described hospital-level variation in roux-en-Y gastric bypass and sleeve gastrectomy in Michigan. Their findings suggested that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. The authors also suggested that sleeve gastrectomy may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and post-discharge payments.
AHRQ-funded; HS023621; HS024403.
Citation: Kelsall AC, Cassidy R, Ghaferi AA .
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
Ann Surg 2018 Dec;268(6):1014-18. doi: 10.1097/sla.0000000000002462..
Keywords: Surgery, Obesity: Weight Management, Obesity, Payment, Health Insurance, Healthcare Costs
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Whaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
AHRQ-funded; HS023418.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK .
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women
Ellimoottil C, Miller S, Davis M
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
The researchers examined rates of elective surgery in previously insured individuals before and after Massachusetts health care reform. They observed no increase in the overall rate of selected discretionary inpatient surgeries in Massachusetts versus control states for the entire population , as well as among the white and low-income subgroups.
AHRQ-funded; HS018346.
Citation: Ellimoottil C, Miller S, Davis M .
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
Surg Innov 2015 Dec;22(6):588-92. doi: 10.1177/1553350615573579.
.
.
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Health Insurance, Policy, Hospitalization
Boss EF, Benke JR, Tunkel DE
Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing.
The purpose of this study was (1) to evaluate receipt and timing of polysomnography (PSG) in relation to ultimate surgical therapy with adenotonsillectomy for children undergoing evaluation for sleep-disordered breathing and (2) to evaluate differences based on socioeconomic status. It found that referral for PSG resulted in significant loss to follow-up for all children and delayed definitive surgical treatment for children with public insurance.
AHRQ-funded; HS022932.
Citation: Boss EF, Benke JR, Tunkel DE .
Public insurance and timing of polysomnography and surgical care for children with sleep-disordered breathing.
JAMA Otolaryngol Head Neck Surg 2015 Feb;141(2):106-11. doi: 10.1001/jamaoto.2014.3085..
Keywords: Children/Adolescents, Sleep Problems, Social Determinants of Health, Access to Care, Health Insurance, Surgery
Ellimoottil C, Miller S, Ayanian JZ
Effect of insurance expansion on utilization of inpatient surgery.
The researchers examined the differential effect of the Massachusetts insurance expansion on the use of discretionary vs. nondiscretionary surgical procedures. They found that discretionary surgery increased 9.3 percent while nondiscretionary surgery decreased by 4.5 percent. The greatest increase in discretionary surgery was observed for nonwhite participants.
AHRQ-funded; HS018346.
Citation: Ellimoottil C, Miller S, Ayanian JZ .
Effect of insurance expansion on utilization of inpatient surgery.
JAMA Surg. 2014 Aug;149(8):829-36. doi: 10.1001/jamasurg.2014.857..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Health Insurance, Healthcare Utilization
Martin BI, Franklin GM, Deyo RA
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, this study compared the use of complex fusion techniques, adverse outcomes within 3 months, and costs for California and Washington State with workers’ compensation policies that differed in their coverage restrictions. The researchers found that California’s broader coverage policy was associated with more aggressive practice, higher rates of reoperation, readmission and other complications.
AHRQ-funded; HS018405
Citation: Martin BI, Franklin GM, Deyo RA .
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
Spine J. 2014 Jul;14(7):1237-46. doi: 10.1016/j.spinee.2013.08..
Keywords: Health Insurance, Surgery, Healthcare Costs, Healthcare Utilization
Pan IW, Smith BD, Shih YC
Factors contributing to underuse of radiation among younger women with breast cancer.
This study explores factors associated with noncompliance of RT among insured young patients. It found that competing demands from child care, especially the presence of a young child in the home, can constitute a barrier to complete guideline-concordant breast cancer therapy.
AHRQ-funded; HS018535.
Citation: Pan IW, Smith BD, Shih YC .
Factors contributing to underuse of radiation among younger women with breast cancer.
J Natl Cancer Inst 2014 Jan;106(1):djt340. doi: 10.1093/jnci/djt340..
Keywords: Cancer: Breast Cancer, Health Insurance, Patient Adherence/Compliance, Surgery, Treatments