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
1 to 12 of 12 Research Studies DisplayedYu J, Huckfeldt PJ, Mink PJ
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
The purpose of this study was to compare rates of testing, follow-up health care use, and quality for urinary tract infections (UTIs) and sinusitis between direct-to-consumer (DTC) telemedicine and in-person visits. Primary outcomes included number of laboratory tests, antibiotics filled, office and outpatient visits, emergency department (ED) visits, and standardized spending, based on standardized health service prices. The UTI and sinusitis samples included 215,134 and 624,630 episodes of care, respectively. Following the introduction of coverage for DTC telemedicine, 15.7% of UTI episodes and 8.9% of sinusitis episodes were initiated with DTC telemedicine. When compared to episodes without coverage for DTC telemedicine, UTI episodes with coverage had 0.25 fewer lab tests, lower standardized spending for the first UTI visit, and no change in office and outpatient visits, ED visits, antibiotics filled, or standardized medical spending. Sinusitis episodes with coverage for DTC telemedicine had fewer antibiotics filled and a minor increase in ED visits but no difference in lab tests, office and outpatient visits, or standardized medical spending.
AHRQ-funded; HS026088.
Citation: Yu J, Huckfeldt PJ, Mink PJ .
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
Health Serv Res 2023 Oct; 58(5):976-87. doi: 10.1111/1475-6773.14129..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Utilization, Quality of Care
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
AHRQ-funded; HS024733.
Citation: Smith DC, Phillippi JC, Tilden EL .
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Lake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger D, Smith JG .
The association of missed nursing care with very low birthweight infant outcomes.
Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care
Smith LB, Desai NR, Dowd B
Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm.
High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, the investigators examined changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial).
AHRQ-funded; HS025164.
Citation: Smith LB, Desai NR, Dowd B .
Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm.
Int J Health Econ Manag 2020 Sep;20(3):299-317. doi: 10.1007/s10754-020-09282-2..
Keywords: Healthcare Utilization, Medication, Medication: Safety, Patient Safety, Quality of Care
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J .
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, Quality of Care
Arthur KC, Mangione-Smith R, Burkhart Q
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
The objective of this study was to examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination. The investigators measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. They concluded that continuity of care holds promise as a quality measure for CMC because of its association with lower ED utilization and more frequent receipt of care coordination.
AHRQ-funded; HS020506.
Citation: Arthur KC, Mangione-Smith R, Burkhart Q .
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
Acad Pediatr 2018 Aug;18(6):669-76. doi: 10.1016/j.acap.2018.04.009..
Keywords: Care Coordination, Children/Adolescents, Chronic Conditions, Emergency Department, Healthcare Utilization, Primary Care, Quality of Care, Quality Indicators (QIs), Quality Measures
Cole MB, Wright B, Wilson IB
Medicaid expansion and community health centers: care quality and service use increased for rural patients.
Investigators studied the impact of Medicaid expansion in rural areas. Data from 2011-2015 found that there was an 11.4% decline in uninsured patients and a 13.5% increase in Medicaid patients at community health centers (CHCs). Relative improvements were shown in patients with chronic conditions such as asthma and hypertension; and an increase in visits for mammograms and substance abuse disorders.
AHRQ-funded; HS024652.
Citation: Cole MB, Wright B, Wilson IB .
Medicaid expansion and community health centers: care quality and service use increased for rural patients.
Health Aff 2018 Jun;37(6):900-07. doi: 10.1377/hlthaff.2017.1542..
Keywords: Medicaid, Community-Based Practice, Rural Health, Access to Care, Quality of Care, Healthcare Utilization, Primary Care
Flieger SP
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. There were no statistically significant findings for utilization, cost, or quality in the expected direction. Medical Home Index (MHI) scores suggest variation in type and level of implemented features.
AHRQ-funded; HS021385.
Citation: Flieger SP .
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
J Ambul Care Manage 2017 Jul/Sep;40(3):228-37. doi: 10.1097/jac.0000000000000162.
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Keywords: Patient-Centered Healthcare, Quality of Care, Primary Care, Healthcare Costs, Healthcare Utilization
Morgan DJ, Leppin AL, Smith CD
A practical framework for understanding and reducing medical overuse: conceptualizing overuse through the patient-clinician interaction.
The authors used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care.
AHRQ-funded; HS018111.
Citation: Morgan DJ, Leppin AL, Smith CD .
A practical framework for understanding and reducing medical overuse: conceptualizing overuse through the patient-clinician interaction.
J Hosp Med 2017 May;12(5):346-51. doi: 10.12788/jhm.2738.
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Keywords: Decision Making, Healthcare Delivery, Quality of Care, Healthcare Utilization, Clinician-Patient Communication
Mendelson A, Kondo K, Damberg C
The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.
This review updated and expanded a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. It found that pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.
AHRQ-funded; HS022981.
Citation: Mendelson A, Kondo K, Damberg C .
The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.
Ann Intern Med 2017 Mar 7;166(5):341-53. doi: 10.7326/m16-1881.
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Keywords: Payment, Provider Performance, Healthcare Utilization, Quality of Care
Rosenthal MB, Landrum MB, Robbins JA
Pay for performance in Medicaid: evidence from three natural experiments.
This study examined the impact of pay for performance in Medicaid on the quality and utilization of care. Primary outcomes of interest were Healthcare Effectiveness Data and Information Set (HEDIS)-like process measures of quality, utilization by service category, and ambulatory care-sensitive admissions and emergency department visits. Its findings were mixed, with no measurable quality improvements across the three states (Pennsylvania, Minnesota, Alabama), but reductions in hospital admissions in two programs.
AHRQ-funded.
Citation: Rosenthal MB, Landrum MB, Robbins JA .
Pay for performance in Medicaid: evidence from three natural experiments.
Health Serv Res 2016 Aug;51(4):1444-66. doi: 10.1111/1475-6773.12426.
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Keywords: Medicaid, Payment, Provider Performance, Healthcare Utilization, Quality of Care, Hospitalization, Emergency Department
Kerr EA, Chen J, Sussman JB
Stress testing before low-risk surgery: so many recommendations, so little overuse.
The researchers sought to determine the prevalence of cardiac stress testing before low-risk surgeries, prior to commencement of a campaign to reduce routine stress testing, in order to estimate the potential effect of the campaign on future use of resources. Their study of VA and Medicare patients found that the use of routine preoperative stress testing before low-risk surgeries was very low, suggesting that interventions to further decrease testing would minimally improve quality.
AHRQ-funded; HS018781
Citation: Kerr EA, Chen J, Sussman JB .
Stress testing before low-risk surgery: so many recommendations, so little overuse.
JAMA Intern Med. 2015 Apr;175(4):645-7. doi: 10.1001/jamainternmed.2014.7877..
Keywords: Decision Making, Guidelines, Quality of Care, Healthcare Utilization, Surgery