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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 83 Research Studies Displayed
Semere W, Cemballi AG, Schillinger D
"We need to bring them out from the shadows:" a qualitative study of safety net physician leaders' perspectives on caregivers.
The purpose of the study was to examine the perspectives of physician leaders on methods and priorities for interacting with patient caregivers. The researchers interviewed 15 primary care physicians from 3 California safety net systems, all of whom were in care management leadership, to evaluate their experiences managing complex patients with caregivers. Interview transcripts were analyzed using thematic analysis, and a research team approach was utilized to derive major themes. The themes included: challenges uncovering caregiver identities, engaging caregivers in patient care, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, and caring for the caregiver. The study concluded that health systems do not tend to recognize caregiver participation in patient care, must overcome language and literacy barriers when attempting to include caregivers in visit communications; all these issues create challenges when attempting to engage caregivers. The researchers advised that outcomes for patients could be improved if methods and processes were developed to identify and communicate with caregivers.
AHRQ-funded; HS027844; HS022408.
Citation: Semere W, Cemballi AG, Schillinger D . "We need to bring them out from the shadows:" a qualitative study of safety net physician leaders' perspectives on caregivers. Patient Educ Couns 2022 Jun;105(6):1663-70. doi: 10.1016/j.pec.2021.10.019..
Keywords: Caregiving, Safety Net, Provider: Physician
Behr CL, Hull P, Hsu J
Geographic access to federally qualified health centers before and after the Affordable Care Act.
Funding for Federally Qualified Health Centers (FQHCs) increased with the advent of the Affordable Care Act (ACA). The purpose of this study was to define FQHC service areas based on patient use and examine the characteristics of areas that gained FQHC access post-ACA. The researchers first defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and then compared that approach with other methods. The authors then compared the characteristics of ZIP codes from Medically Underserved Areas/ Populations (MUA/Ps) that gained access to FQHCs between 2011-2015, with MUA/P ZIP codes that did not gain access to FQHCs during that same time period. The study found that FQHC service areas based on the UDS data included a larger percentage of FQHC patients and a higher use of FQHCs among low-income residents, on average, than Primary Care Service Areas or counties. The researchers also discovered that MUA/Ps that gained access to an FQHC between 2011 and 2015 included more poor, publicly insured, uninsured, and foreign born residents than underserved areas that did not gain access. The study concluded that measures of actual patient use are a useful method of assessing FQHC service areas and access.
Citation: Behr CL, Hull P, Hsu J . Geographic access to federally qualified health centers before and after the Affordable Care Act. BMC Health Serv Res 2022 Mar 23;22(1):385. doi: 10.1186/s12913-022-07685-0..
Keywords: Access to Care, Uninsured, Safety Net, Vulnerable Populations
Reid LD, Weiss AJ, Fingar KR
AHRQ Author: Reid LD
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
The authors assessed how patient, hospital, and community characteristics explain the safety-net hospital (SNH)/non-SNH disparity in postpartum readmission rates. Using HCUP data, they found that higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. They recommended hospital initiatives to reduce the risk of postpartum readmissions among SNH patients. They concluded that improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, will require enduring investments in public health.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Reid LD, Weiss AJ, Fingar KR . Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis. J Hosp Med 2022 Feb;17(2):77-87. doi: 10.1002/jhm.2769..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Safety Net, Hospital Readmissions, Pregnancy, Labor and Delivery, Women, Maternal Care
Peipert JD, Lad T, Khosla PG
A low literacy, multimedia health information technology intervention to enhance patient-centered cancer care in safety net settings increased cancer knowledge in a randomized controlled trial.
In this study, the investigators tested whether a low-literacy-friendly, multimedia information and assessment system used in daily clinical practice enhanced patient-centered care and improved patient outcomes. This was a prospective, parallel-group, randomized controlled trial with 2 arms, CancerHelp-Talking Touchscreen (CancerHelp-TT) versus control, among adults with Stage I-III breast or colorectal cancer receiving chemotherapy and/or radiation therapy in safety net settings.
Citation: Peipert JD, Lad T, Khosla PG . A low literacy, multimedia health information technology intervention to enhance patient-centered cancer care in safety net settings increased cancer knowledge in a randomized controlled trial. Cancer Control 2021 Jan-Dec;28:10732748211036783. doi: 10.1177/10732748211036783..
Keywords: Health Literacy, Patient-Centered Healthcare, Cancer, Safety Net, Education: Patient and Caregiver, Health Information Technology (HIT)
Valdovinos C, Perez-Aguilar G, Huerta RG
Electronic health literacy among linguistically diverse patients in the Los Angeles County safety net health system.
Few studies have been conducted which evaluate levels of eHealth literacy in underserved populations, yet eHealth literacy may affect telehealth utilization. The objective of this study was to describe eHealth literacy levels as well as technology use and access patterns among English-speaking and Limited English Proficiency (LEP) patients from three Los Angeles clinics for uninsured, Medicaid, and other vulnerable patients (“safety-net” clinics). Between June and July of 2017, patients aged 18 or over with diabetes mellitus and/ or hypertension and their caregivers were recruited for the study. The researchers asked both English-speaking and LEP Spanish-speaking patients about their technology use and access, and assessed their levels of health literacy using the eHealth Literacy Scale (eHeals). A total of 62 patients and 9 caregivers, with a mean age of 56, completed the questionnaire. The study found that 67% of participants used a telephone that had internet access. For the 10 items on the eHEALS instrument, the mean score was in the moderate range at 26/50 points. There was no difference in the mean eHEALS score between the English-speaking and LEP Spanish speaking groups, however 68% of English-speaking participants “agreed/ strongly agreed” that they knew how to use the internet to answer their health questions, compared to 47% of the Spanish-speaking participants (P<.05). The study concluded that despite moderate levels of electronic health literacy, participant’s perceived confidence and skills in engaging with electronic health systems were low.
Citation: Valdovinos C, Perez-Aguilar G, Huerta RG . Electronic health literacy among linguistically diverse patients in the Los Angeles County safety net health system. Ethn Dis 2022 Winter;32(1):21-30. doi: 10.18865/ed.32.1.21..
Keywords: Health Literacy, Health Information Technology (HIT), Racial / Ethnic Minorities, Safety Net
Liao JM, Chatterjee P, Wang E
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
This study evaluated whether hospital safety net status affected the association between bundled payment participation and medical outcomes. The hospitals included were participants in Medicare’s Bundled Payments for Care Improvement (BCPI) program from 2011-2016. Data from Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease were used. Among BCPI hospitals, safety net status was not associated with differential postdischarge spending or quality. However, BPCI safety net hospitals had differentially greater discharge due to institutional post-acute care and lower discharge home with home health than BPCI non-safety net hospitals.
Citation: Liao JM, Chatterjee P, Wang E . The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes. J Hosp Med 2021 Dec;16(12):716-23. doi: 10.12788/jhm.3722..
Keywords: Medicare, Payment, Safety Net, Hospitals
Holcomb J, Ferguson G, Roth I
Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics.
This paper describes an evidence-based intervention that was created to reduce mammography appointment no-show rates in underserved women at safety net clinics. An academic-community partnership was used to implement four strategies to improve the adoption and scale-up of the interventions with Federally Qualified Health Centers and charity care clinics. The interventions implemented were: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers.
Citation: Holcomb J, Ferguson G, Roth I . Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics. Front Public Health 2021 Nov 4;9:748361. doi: 10.3389/fpubh.2021.748361..
Keywords: Evidence-Based Practice, Imaging, Screening, Safety Net, Women, Community-Based Practice
Lewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
Citation: Lewis VA, Spivack S, Murray GF . FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality. J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords: Safety Net, Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Gerber DE, Hamann HA, Dorsey O
Clinician variation in ordering and completion of low-dose computed tomography for lung cancer screening in a safety-net medical system.
Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined. In this study the investigators examined medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. The investigators concluded that in an integrated safety-net healthcare system, most adult primary care providers ordered LDCT.
Citation: Gerber DE, Hamann HA, Dorsey O . Clinician variation in ordering and completion of low-dose computed tomography for lung cancer screening in a safety-net medical system. Clin Lung Cancer 2021 Jul;22(4):e612-e20. doi: 10.1016/j.cllc.2020.12.001..
Keywords: Imaging, Cancer: Lung Cancer, Cancer, Safety Net
Nguyen KH, Fields JD JD, Cemballi AG
The role of community-based organizations in improving chronic care for safety-net populations.
Researchers conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. Participants were patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, community leaders serving the same neighborhoods, or providers from San Francisco's public health care delivery system. The researchers identified several key themes. They concluded that their results contributed new evidence toward the community domain of the Chronic Care Model, and health care systems must intentionally partner with community-based organizations to address social determinants of health and improve community resources for chronic care management.
Citation: Nguyen KH, Fields JD JD, Cemballi AG . The role of community-based organizations in improving chronic care for safety-net populations. J Am Board Fam Med 2021 Jul-Aug;34(4):698-708. doi: 10.3122/jabfm.2021.04.200591..
Keywords: Community Partnerships, Safety Net, Chronic Conditions, Social Determinants of Health, Care Management
Chatterjee P, Qi M, Werner RM
Association of Medicaid expansion with quality in safety-net hospitals.
The authors compared changes in quality from 2012 to 2018 between safety net hospitals (SNHs) in states that expanded Medicaid vs those in states that did not. They found that, despite reductions in uncompensated care and improvements in operating margins, there appeared to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
Citation: Chatterjee P, Qi M, Werner RM . Association of Medicaid expansion with quality in safety-net hospitals. JAMA Intern Med 2021 May;181(5):590-97. doi: 10.1001/jamainternmed.2020.9142..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Safety Net, Hospitals, Medicaid, Quality Improvement, Quality of Care
Langston DM, Oslock WM, Paredes AZ
Hospital location and socioeconomic disadvantage of emergency general surgery patients.
This study’s purpose was to test the hypothesis that a hospital’s neighborhood disadvantage is associated with vulnerability of its emergency general surgery (EGS) patients. An area deprivation index (ADI), which is a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospitals in more disadvantaged areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons.
Citation: Langston DM, Oslock WM, Paredes AZ . Hospital location and socioeconomic disadvantage of emergency general surgery patients. J Surg Res 2021 May;261:376-84. doi: 10.1016/j.jss.2020.12.028..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Social Determinants of Health, Vulnerable Populations, Critical Care, Safety Net
Hsuan C, Braun TM, Ponce NA
Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)?
This study examined whether modifications to the Medicare Hospital Readmissions Reduction Program (HRRP) addressed concerns that it unfairly penalized safety net hospitals treating patients with high social and functional risks. Data from 2000-2014 Medicare hospital discharge, Health and Retirement Study, and other community-level data was used. The authors estimated risk-standardized readmission rates (RSRRs) for peer groups and by safety net status using four hierarchical logistic regression models. Patient data used was from 20,255 fee-for-service Medicare beneficiaries (65+) with eligible index hospitalizations. Hospitals were categorized by peer group, with 1 having the lowest number of at-risk patients, and 5 categorized as a safety-net hospital. Under the modifications fewer safety-net hospitals were penalized, but worsened for those in peer groups 1,2, and 3.
Citation: Hsuan C, Braun TM, Ponce NA . Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)? J Gen Intern Med 2020 Dec;35(12):3564-71. doi: 10.1007/s11606-020-06222-1..
Keywords: Hospital Readmissions, Hospitals, Medicare, Safety Net
Aguirre A, Trupin L, Margaretten M
Using process improvement and systems redesign to improve rheumatology care quality in a safety net clinic.
Researchers sought to develop and evaluate interventions to improve quality of care in four priority areas in an urban safety net adult rheumatology clinic serving a racially/ethnically and socioeconomically diverse patient population. Clinical processes were redesigned to achieve pre-specified benchmarks in the following four areas: 13-valent pneumococcal conjugate vaccine (PCV13) administered to immunocompromised patients; Clinical Disease Activity Index (CDAI) disease activity monitoring for patients with rheumatoid arthritis; latent tuberculosis infection (LTBI) screening for new biologic users with rheumatoid arthritis; reproductive health counseling among women receiving potentially teratogenic medications. Through an interprofessional approach, the researchers achieved durable improvements in key rheumatology quality measures largely by enhancing workflow, engaging non-physician providers, and managing practice variation.
AHRQ-funded; HS024412; HS025638.
Citation: Aguirre A, Trupin L, Margaretten M . Using process improvement and systems redesign to improve rheumatology care quality in a safety net clinic. J Rheumatol 2020 Nov;47(11):1712-20. doi: 10.3899/jrheum.190472..
Keywords: Urban Health, Safety Net, Quality Improvement, Quality of Care, Healthcare Delivery
Kranz AM, Ryan J, Mahmud A, AM, Ryan J, Mahmud A
Association of primary and specialty care integration on physician communication and cancer screening in safety-net clinics.
Lack of cancer screenings are more common in community health centers (CHCs) which provide primary care to disadvantaged populations due to difficulty accessing specialty care for their patients. This study’s objective was to describe CHCs use to integrate care with specialists and examine whether strongly integrated CHCs have higher rates of screening colorectal and cervical cancers. A 2017 survey of CHCs in 12 states and the District of Columbia was used to estimate the association between a composite measure of CHC/specialist integration and cancer screening rates and 4 measures of CHC/specialist communication using multivariate regression models. More integrated CHCs had higher screening rates of colorectal and cervical cancer and had significantly higher rates of knowing that specialist visits happened, knowing visit outcomes, receiving information after visits, and timely receipt of information.
Citation: Kranz AM, Ryan J, Mahmud A, AM, Ryan J, Mahmud A . Association of primary and specialty care integration on physician communication and cancer screening in safety-net clinics. Prev Chronic Dis 2020 Oct 29;17:E134. doi: 10.5888/pcd17.200025..
Keywords: Cancer, Screening, Communication, Prevention, Safety Net, Patient-Centered Healthcare, Healthcare Delivery
Hoffman GJ, Tilson S, Yakusheva O
The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program.
This study examined the financial incentives to avoid readmissions under Medicare’s Hospital Readmission Reduction Program for teaching hospitals (THs) and safety-net hospitals (SNHs). Readmissions data for 2,465 hospitals was analyzed using Medicare’s FY 2016 Hospital Compare. The authors tested for differential revenue gains for SNHs relative to non-SNHs and for major and minor THs relative to non-THs. They found that revenue gains of an avoided readmission were 10-15% greater for major THs compared with non-THs, but no different for SNHs compared with non-SNHs.
Citation: Hoffman GJ, Tilson S, Yakusheva O . The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program. Med Care Res Rev 2020 Aug;77(4):324-33. doi: 10.1177/1077558718795733..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs, Safety Net
Casillas A, Cemballi AG, Abhat A
An untapped potential in primary care: semi-structured interviews with clinicians on how patient portals will work for caregivers in the safety net.
Researchers used qualitative methods to explore safety net providers' perspectives on portal use among caregivers for their patients. They found that providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. Further, caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency.
AHRQ-funded; HS022408; HS022561.
Citation: Casillas A, Cemballi AG, Abhat A . An untapped potential in primary care: semi-structured interviews with clinicians on how patient portals will work for caregivers in the safety net. J Med Internet Res 2020 Jul 20;22(7):e18466. doi: 10.2196/18466..
Keywords: Primary Care, Caregiving, Electronic Health Records (EHRs), Health Information Technology (HIT), Safety Net
Hsu HE, Wang R, Broadwell C
Association between federal value-based incentive programs and health care-associated infection rates in safety-net and non-safety-net hospitals.
The authors assessed the association of Hospital-Acquired Condition Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) implementation with changes in rates of targeted health care-associated infections and disparities in rates among safety-net and non-safety-net hospitals. They found that HACRP and HVBP implementation was not associated with any improvements in targeted health care-associated infections among safety-net or non-safety-net hospitals or with changes in disparities in infection rates. They concluded that, given the persistent health care-associated infection rate disparities, these programs appear to function as a disproportionate penalty system for safety-net hospitals that offer no measurable benefits for patients.
Citation: Hsu HE, Wang R, Broadwell C . Association between federal value-based incentive programs and health care-associated infection rates in safety-net and non-safety-net hospitals. JAMA Netw Open 2020 Jul;3(7):e209700. doi: 10.1001/jamanetworkopen.2020.9700..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Safety Net, Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Medicare, Patient Safety
Darney BG, Jacob RL, Hoopes M
Evaluation of Medicaid expansion under the Affordable Care Act and contraceptive care in US community health centers.
This study examined whether Medicaid expansion under the Affordable Care Act increased contraceptive use for women who are underserved in the US health care safety net. The authors used electronic health record (EHR) data from a clinical research network of community health centers across 24 states. The sample included all female patients ages 15 to 44 years at risk for pregnancy with an ambulatory care visit. The study compared receipt of contraception before (2013) vs immediately after (2014) and then in 2016 after a longer period of Medicaid expansion. The sample included 310,132 women from expansion states and 234,508 women from nonexpansion states. There was an associated increase in long-acting reversible contraceptive method prescriptions among women in the expansion states, with adolescents having the largest increase.
Citation: Darney BG, Jacob RL, Hoopes M . Evaluation of Medicaid expansion under the Affordable Care Act and contraceptive care in US community health centers. JAMA Netw Open 2020 Jun;3(6):e206874. doi: 10.1001/jamanetworkopen.2020.6874..
Keywords: Medicaid, Women, Policy, Sexual Health, Safety Net
Darney BG, Biel FM, Rodriguez MI
Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs.
This study examined trends in uninsured contraceptive visits before and after Medicaid expansion under the Affordable Care Act (ACA) in a large network of safety-net clinics. Their sample included 237 safety net clinics in 11 states with a common electronic health record. The authors identified 162,666 contraceptive visits in 219 clinics and found a significant decline in uninsured visits. There was a slightly greater decline in expansion states than in non-expansion states.
AHRQ-funded; HS022981; HS025155.
Citation: Darney BG, Biel FM, Rodriguez MI . Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs. Med Care 2020 May;58(5):453-60. doi: 10.1097/mlr.0000000000001309..
Keywords: Sexual Health, Safety Net, Policy, Uninsured, Women
Lee SJC, Hamann HA, Browning T
Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system.
The authors sought to develop a population-based lung cancer screening program using low-dose computed tomography imaging at Parkland Health & Hospital System, Dallas County, Texas, providing coverage of uninsured patients through a combination of Medicare, Medicaid, and the Dallas medical assistance program for under- and uninsured, low-income county residents. They found that establishing a uniform clinical pathway connecting different clinical specialists requires a system-level view of care coordination to ensure that referrals trigger appointments, result reporting, and follow-up. Additionally, primary care providers need to educate and refer patients, address smoking cessation needs, and document shared decision-making counseling between the referring provider and the patient.
Citation: Lee SJC, Hamann HA, Browning T . Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system. Healthc 2020 Mar;8(1):100370. doi: 10.1016/j.hjdsi.2019.100370.
Keywords: Cancer: Lung Cancer, Cancer, Screening, Prevention, Urban Health, Safety Net, Case Study
Yu K, Westbrook M, Brodie S
Gaps in treatment and surveillance: head and neck cancer care in a safety-net hospital.
Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aimed to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco.
Citation: Yu K, Westbrook M, Brodie S . Gaps in treatment and surveillance: head and neck cancer care in a safety-net hospital. OTO Open 2020 Jan-Mar;4(1):2473974x19900761. doi: 10.1177/2473974x19900761..
Keywords: Cancer, Safety Net, Hospitals, Outcomes
Hanchate AD, Paasche-Orlow MK, Baker WE
Association of race/ethnicity with emergency department destination of emergency medical services transport.
The authors examined the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity and compared the patterns between those transported by EMS and those who did not draw on EMS. Using Medicare claims data, they found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.
Citation: Hanchate AD, Paasche-Orlow MK, Baker WE . Association of race/ethnicity with emergency department destination of emergency medical services transport. JAMA Netw Open 2019 Sep 4;2(9):e1910816. doi: 10.1001/jamanetworkopen.2019.10816..
Keywords: Emergency Medical Services (EMS), Emergency Department, Racial / Ethnic Minorities, Safety Net, Medicare, Disparities
Emani S, Sequist TD, Lacson R
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management. In this paper, two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer.
Citation: Emani S, Sequist TD, Lacson R . Ambulatory safety nets to reduce missed and delayed diagnoses of cancer. Jt Comm J Qual Patient Saf 2019 Aug;45(8):552-57. doi: 10.1016/j.jcjq.2019.05.010.
Keywords: Cancer, Safety Net, Diagnostic Safety and Quality, Cancer: Lung Cancer, Cancer: Colorectal Cancer, Ambulatory Care and Surgery
Popescu I, Fingar KR, Cutler E
AHRQ Author: Jiang HJ
Comparison of 3 safety-net hospital definitions and association with hospital characteristics.
This study compared three different definitions of safety-net hospitals (SNHs) and how it to determine the concordance between them. A cross-sectional analysis was done of noncritical-access hospitals in the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) from 47 US states for fiscal year 2015, the Centers for Medicare & Medicaid Services Hospital Cost Reports, and the American Hospital Association Annual Survey. Definitions were based on Medicaid and Medicare Supplemental Security inpatient days used to determine Medicare Disproportionate Share Hospital (DSH) payments; Medicaid and uninsured caseload; and uncompensated care costs. The majority of hospitals (38.2%) were based in the South (790), and the Northeast having 16.5%, Midwest 28.4%, and West 16.9%. Concordance between definitions was low, with 13% or fewer defined as SNHs under any 2 definitions. This concordance results with funding differences but a new DSH formula may lead to redistributed payments across hospitals.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Popescu I, Fingar KR, Cutler E . Comparison of 3 safety-net hospital definitions and association with hospital characteristics. JAMA Netw Open 2019 Aug 2;2(8):e198577. doi: 10.1001/jamanetworkopen.2019.8577..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Safety Net