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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 10 of 10 Research Studies Displayed
Mark BA, Patel E
Nurse practitioner scope of practice: what do we know and where do we go?
This article discusses how state-level nurse practitioner (NP) scope of practice (SOP) policies effect access to primary care. In states where SOP policies became less restrictive, patients reported better access to healthcare including increased availability of appointments, greater checkup utilization, decreased emergency visits for ambulatory care, and decreased administrative burden for physicians. There have been a number of studies in states that have restrictive NP SOP policies, and they do not improve quality of care. It was found that states that still had restrictive policies tended to have more political pressure by physician groups than those states and repealed it.
Citation: Mark BA, Patel E . Nurse practitioner scope of practice: what do we know and where do we go? West J Nurs Res 2019 Apr;41(4):483-87. doi: 10.1177/0193945918820338..
Keywords: Policy, Primary Care, Provider: Nurse, Provider: Clinician, Provider
Lines LM, Li NC, Mick EO
Emergency department and primary care use in Massachusetts 5 years after health reform.
The goal of this study was to identify characteristics of insured Massachusetts residents associated with primary care sensitive (PCS) emergency department (ED) use, and compare such use for public versus private insurees. The researchers used data on people under age 65 taken from the Massachusetts All-Payer Claims Data for 2011-2012. Their conclusions indicate that public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
Citation: Lines LM, Li NC, Mick EO . Emergency department and primary care use in Massachusetts 5 years after health reform. Med Care 2019 Feb;57(2):101-08. doi: 10.1097/mlr.0000000000001025..
Keywords: Emergency Department, Health Insurance, Policy, Primary Care
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
Citation: Skinner D, Franz B, Howard J . The politics of primary care expansion: lessons from cancer survivorship and substance abuse. J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
AHRQ Author: Decker SL
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians. This study used nationally representative data to examine the association between this Medicaid "fee bump" and physician-reported measures of participation in Medicaid. No such association was found. The lack of a sizable change in measures of physician participation in Medicaid may have been due to the temporary nature of the fee bump.
Citation: Decker SL . No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid. Health Aff 2018 Jul;37(7):1092-98. doi: 10.1377/hlthaff.2018.0078..
Keywords: Healthcare Costs, Payment, Medicaid, Policy, Primary Care
Halle AD, Mroz TM, Fogelberg DJ
Occupational therapy and primary care: updates and trends.
This paper identifies new initiatives and opportunities in primary care, explores common challenges to integrating occupational therapy in primary care environments, and highlights international works that can support the authors’ efforts.
Citation: Halle AD, Mroz TM, Fogelberg DJ . Occupational therapy and primary care: updates and trends. Am J Occup Ther 2018 May/Jun;72(3):7203090010p1-10p6. doi: 10.5014/ajot.2018.723001..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Policy, Primary Care, Rehabilitation
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
Citation: Cottrell EK, Hall JD, Kautz G . Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers. J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
Leland NE, Fogelberg DJ, Halle AD
Occupational therapy and management of multiple chronic conditions in the context of health care reform.
One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. Occupational therapy is uniquely positioned to contribute to more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, the authors aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system.
Citation: Leland NE, Fogelberg DJ, Halle AD . Occupational therapy and management of multiple chronic conditions in the context of health care reform. Am J Occup Ther 2017 Jan/Feb;71(1):7101090010p1-10p6. doi: 10.5014/ajot.2017.711001.
Keywords: Chronic Conditions, Policy, Patient-Centered Outcomes Research, Primary Care
Gaglioti AH, Werner JJ, Rust G
Practice-based research networks (PBRNs) bridging the gaps between communities, funders, and policymakers.
In this commentary, the authors propose that practice-based research networks (PBRNs) engage with funders and policymakers by applying the same engagement strategies they have successfully used to build relationships with community stakeholders. A community engagement approach to achieve new funding streams for PBRNs should include a strategy to engage key stakeholders from the communities of funders, thought leaders, and policymakers using collaborative principles and methods.
AHRQ-funded; HS021639; HS021641; HS021648.
Citation: Gaglioti AH, Werner JJ, Rust G . Practice-based research networks (PBRNs) bridging the gaps between communities, funders, and policymakers. J Am Board Fam Med 2016 Sep-Oct;29(5):630-5. doi: 10.3122/jabfm.2016.05.160080.
Keywords: Health Services Research (HSR), Practice-Based Research Network (PBRN), Primary Care, Policy
Beck AF, Tschudy MM, Coker TR
AHRQ Author: Mistry KB
Determinants of health and pediatric primary care practices.
This article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. It also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health.
Citation: Beck AF, Tschudy MM, Coker TR . Determinants of health and pediatric primary care practices. Pediatrics 2016 Mar;137(3):e20153673. doi: 10.1542/peds.2015-3673.
Keywords: Primary Care, Low-Income, Children/Adolescents, Health Services Research (HSR), Policy
Song Z, Chopra V, McMahon LF
Addressing the primary care workforce crisis.
In this commentary, the authors propose that CMS explicitly reward teaching hospitals if a certain share of their graduates (they propose 30%) remain in primary care 3 years after residency, either through additional payments or release of a withhold. This step could help address the shortage of primary care physicians that now calls for more policy attention and urgency.
Citation: Song Z, Chopra V, McMahon LF . Addressing the primary care workforce crisis. Am J Manag Care 2015 Aug;21(8):e452-4..
Keywords: Education: Continuing Medical Education, Policy, Primary Care, Provider, Workforce