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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cardiovascular Conditions (1)
- Caregiving (2)
- Children/Adolescents (2)
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- Obesity (1)
- Obesity: Weight Management (1)
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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 23 of 23 Research Studies DisplayedDecker SL, Zuvekas SH
AHRQ Author: Decker SL, Zuvekas SH
Primary care spending in the US population.
This AHRQ-authored research letter describes an analysis of primary care spending estimates in the US population using MEPS data. This survey study looked at the entire population, regardless of insurance source. The authors reported 2019 estimates of primary care spending, total medical spending, percentage of medical spending on primary care visits, and percentage with 0 spending on primary care visits. They analyzed race and ethnicity data to test whether primary care spending was greater in some groups compared with others. A total of 28,512 MEPS participants were included in the sample with a mean age of 38.6 and weighted percentages of 51.1% female, 18.5% Hispanic, 12.3% non-Hispanic Black, 59.7% non-Hispanic White, and 9.6% non-Hispanic individuals of other races and ethnicities. Primary care spending totaled $439 per person in 2019. Spending was highest for the Medicare population, Hispanics (52.7%), non-Hispanic Black (49.0%), and non-Hispanic other (44.3%), 79.9% for uninsured individuals and lowest for the uninsured. Average spending was $461 for those with group private insurance. The percentage of medical spending on primary care was 7.0% for the population and was lower for those younger than age 65 (5.1%), those in worse health (5.6%), and those with Medicare (5.3%). Almost 41% of the population had no primary care spending.
AHRQ-authored.
Citation: Decker SL, Zuvekas SH .
Primary care spending in the US population.
JAMA Intern Med 2023 Aug; 183(8):880-81. doi: 10.1001/jamainternmed.2023.1551..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Primary Care
Encinosa W, Nguyen P
AHRQ Author: Encinosa W
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
This article revisits earlier integration studies using IBM MarketScan data 2010–2016 to re-examine the relationship between primary care physicians integrated with hospitals and spending under the Affordable Care Act (ACA) during that period. The authors observe an association between physician-hospital integration and overall cost-savings, a reversal of the relationship noted in earlier studies. They recommend that future research examine the precise mechanism of physician-hospital clinical integration in greater detail.
AHRQ-authored.
Citation: Encinosa W, Nguyen P .
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
J Gen Intern Med 2022 Dec;37(16):4289-91. doi: 10.1007/s11606-022-07634-x..
Keywords: Healthcare Costs, Provider: Physician, Hospitals, Primary Care
Markovitz AA, Ryan AM, Peterson TA
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
This research letter describes a survey that was conducted to compare accountable care organization (ACO) awareness and perceptions among specialists versus primary care physicians (PCPs). The survey was administered in 2018 to clinicians in the Physician Organization of Michigan ACO, which was the largest Medicare Shared Savings Program (MSSP) in Michigan and among the ten largest nationally at the time. The analysis focused on 1022 non-pediatrician physician respondents practicing within 10 provider organizations. Physician respondents included PCPs (23%) and specialists (77%). The most common specialty was internal medicine (20%), followed by surgeons (14%). Specialists were less likely to be aware of ACO participation and incentives. They were also 25% less likely to know they were in an ACO compared to PCPs. In addition, specialists were 18% less likely to know their ACO was accountable for both spending and quality or that their ACO had lowered spending in the previous year. This difference in perception may help to explain ACOs’ modest impact on spending and quality.
AHRQ-funded; HS025615.
Citation: Markovitz AA, Ryan AM, Peterson TA .
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
J Gen Intern Med 2022 Feb;37(2):492-94. doi: 10.1007/s11606-020-06556-w..
Keywords: Primary Care, Healthcare Costs, Medicare, Provider: Physician
Whaley CM, Zhao X, Richards M
Higher Medicare spending on imaging and lab services after primary care physician group vertical integration.
This study looked at the impact of direct ownership of physician practices by hospitals and health systems (vertical integration) on Medicare spending for imaging and lab services. A 100% sample of 2013-16 Medicare fee-for-service claims data was examined to determine if vertical integration was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries increased in a hospital setting by 26.3 per 1000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests. This translates to $40.2 million increase for imaging and $32.9 million increase for laboratory tests in Medicare spending for the study period.
AHRQ-funded; HS024067.
Citation: Whaley CM, Zhao X, Richards M .
Higher Medicare spending on imaging and lab services after primary care physician group vertical integration.
Health Aff 2021 May;40(5):702-09. doi: 10.1377/hlthaff.2020.01006..
Keywords: Medicare, Healthcare Costs, Imaging, Primary Care
Gold HT, Siman N, Cuthel AM
A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: a cost analysis.
In this randomized controlled trial, researchers estimated the associated cost of practice facilitation (PF) for guideline adoption in small, private primary care practices. They found that the PF strategy cost approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. They indicated that whether or not this program is worthwhile to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.
AHRQ-funded; HS023922.
Citation: Gold HT, Siman N, Cuthel AM .
A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: a cost analysis.
Implement Sci Commun 2021 Feb 6;2(1):15. doi: 10.1186/s43058-021-00116-x..
Keywords: Primary Care, Cardiovascular Conditions, Guidelines, Prevention, Evidence-Based Practice, Primary Care: Models of Care, Healthcare Costs
Yeung K, Richards J, Goemer E
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
The purpose of this study was to describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018). The investigators concluded that when spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests).
AHRQ-funded; HS023173.
Citation: Yeung K, Richards J, Goemer E .
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
Health Serv Res 2020 Dec;55(6):913-23. doi: 10.1111/1475-6773.13592..
Keywords: Healthcare Costs, Evidence-Based Practice, Implementation, Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
AHRQ-funded; HS024072.
Citation: Zhou RA, Beaulieu ND, Cutler D .
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
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Keywords: Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Lin SC, Yan PL, Moloci NM
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, the investigators evaluated the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15.
AHRQ-funded; HS024728; HS024525; HS025165; HS025875.
Citation: Lin SC, Yan PL, Moloci NM .
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Health Aff 2020 Feb;39(2):310-18. doi: 10.1377/hlthaff.2019.00181..
Keywords: Healthcare Costs, Primary Care, Medicare, Health Insurance
Drouin O, Sharifi M, Gerber M
Parents' willingness to pay for pediatric weight management programs.
This study examined parents’ interested in continuing and willingness to pay (WTP) for 2 pediatric weight management programs after their childrens’ participation. Participants were parents of 2- to 12-year-old children with a body mass index equal to or greater than the 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other group EPC plus individualized coaching (EPC+C). After 1 year, they assessed parents’ self-reported WTP for a similar program and the maximum amount they would pay. Of 638 parents polled, 85% were interested in continuing and 38% of them were willing to pay. The median amount they were willing to pay was $25/month. Parents of Hispanic/Latino children versus white ethnicity and those reporting a higher satisfaction with the program more most likely to endorse WTP. Parents of children getting EPC+C were also more willing to pay.
AHRQ-funded; HS024332; HS022986.
Citation: Drouin O, Sharifi M, Gerber M .
Parents' willingness to pay for pediatric weight management programs.
Acad Pediatr 2019 Sep - Oct;19(7):764-72. doi: 10.1016/j.acap.2019.05.124..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Healthcare Costs, Caregiving, Primary Care, Primary Care: Models of Care
Reid R, Damberg C, Friedberg MW
Primary care spending in the fee-for-service Medicare population.
This research letter examine primary care spending in the fee-for-service Medicare population the US for 2015. Data was analyzed for all Medicare beneficiaries 65 years or older with 12 months of Part A and B fee-for-service medical coverage and Part D prescription cover. They used narrow and broad definitions of primary care practitioners (PCPs) and primary care services. The narrow definition only included physicians, while the broader definition included care by nurse practitioners, physician assistants, geriatric medicine and gynecology. Both definitions did not include care in hospitals. Primary care spending was analyzed for over 16 million beneficiaries, and spending represented 2.12% of total medical and prescription spending for the narrow definitions and 4.88% for the broad definitions. Spending was lower among older beneficiaries, black or North American Native, dually eligible for Medicare and Medicaid, and those with chronic conditions. Spending also varied state to state ranging from 1.59% in North Dakota to 4.74% in Iowa.
AHRQ-funded; HS024067.
Citation: Reid R, Damberg C, Friedberg MW .
Primary care spending in the fee-for-service Medicare population.
JAMA Intern Med 2019 Jul;179(7):977-80. doi: 10.1001/jamainternmed.2018.8747..
Keywords: Elderly, Medicare, Primary Care, Healthcare Costs
Meyers DJ, Chien AT, Nguyen KH
Association of team-based primary care with health care utilization and costs among chronically ill patients.
This study analyzed the value of team-based care practice on the treatment of patients, especially those with multiple chronic conditions. A large study was conducted using data from 18 academically affiliated primary care practices in the Boston, Massachusetts, area between 2011 and 2015. The study included 83,953 patients total with 19% of patients being younger than 18 years and the rest from 19-64 years of age. For patients with multiple chronic conditions, there was a statistically significant reduction in hospitalizations and emergency department visits. Among patients with less than 2 comorbidities, there was an increase in outpatient visits, hospitalizations and ambulatory care hospitalizations.
AHRQ-funded; HS000011.
Citation: Meyers DJ, Chien AT, Nguyen KH .
Association of team-based primary care with health care utilization and costs among chronically ill patients.
JAMA Intern Med 2019 Jan;179(1):54-61. doi: 10.1001/jamainternmed.2018.5118..
Keywords: Chronic Conditions, Emergency Department, Healthcare Costs, Healthcare Utilization, Primary Care, Teams
Bustamante AV, Martinez A, Rich J
Comparing costs of a senior wellness care redesign in group and independent physician practices of an accountable care organization.
Primary care redesign for older adult patients is currently ongoing in countries with aging populations. One of the main challenges of this type of transformations is how to estimate implementation costs in different types of health care delivery organizations. This study compares start-up and incremental expenses of implementing a primary care redesign across 2 organization types.
AHRQ-funded; HS022634.
Citation: Bustamante AV, Martinez A, Rich J .
Comparing costs of a senior wellness care redesign in group and independent physician practices of an accountable care organization.
Int J Health Plann Manage 2019 Jan;34(1):241-50. doi: 10.1002/hpm.2622..
Keywords: Elderly, Healthcare Costs, Healthcare Delivery, Primary Care
Decker SL
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.
AHRQ-authored.
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
da Graca B, Ogola GO, Fullerton C
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
The purpose of this study was to examine potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS). The researchers found that with PMPM, breaking even required that 2.4% to 6.4% of commercially insured patients per physician to be covered; with MIPS incentive payments, they would exceed PCMH costs by 2022.
AHRQ-funded; HS022621.
Citation: da Graca B, Ogola GO, Fullerton C .
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
J Ambul Care Manage 2018 Apr/Jun;41(2):105-13. doi: 10.1097/jac.0000000000000224..
Keywords: Healthcare Costs, Medicare, Patient-Centered Healthcare, Payment, 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
Fritz JM, Kim M, Magel JS
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
The objective of this study was to compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain with or without the addition of early physical therapy. The authors suggest that their results support early physical therapy as cost-effective relative to usual primary care after 1 year for patients with acute, nonspecific lower back pain.
AHRQ-funded; HS018672.
Citation: Fritz JM, Kim M, Magel JS .
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
Spine 2017 Mar;42(5):285-90. doi: 10.1097/brs.0000000000001729..
Keywords: Back Health and Pain, Healthcare Costs, Pain, Primary Care
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Nocon RS, Lee SM, Sharma R
AHRQ Author: Ngo-Metzger Q
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
This study compared health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth. It found that health center patients had lower use and spending than did non-health center patients across all services, with 22 percent fewer visits and 33 percent lower spending on specialty.
AHRQ-authored.
Citation: Nocon RS, Lee SM, Sharma R .
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
Am J Public Health 2016 Nov;106(11):1981-89. doi: 10.2105/ajph.2016.303341.
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Keywords: Medicaid, Healthcare Costs, Primary Care, Healthcare Utilization
Breitenstein SM, Schoeny M, Risser H
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of implementing the tablet-based ezParent program in pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained at baseline, and at 3, 6, and 12 months post baseline. The authors suggest that the implementation of the ezParent is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care settings.
AHRQ-funded; HS024273.
Citation: Breitenstein SM, Schoeny M, Risser H .
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
Contemp Clin Trials 2016 Sep;50:229-37. doi: 10.1016/j.cct.2016.08.017.
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Keywords: Children/Adolescents, Healthcare Costs, Primary Care, Education: Patient and Caregiver, Caregiving
Mukamel DB, White LM, Nocon RS
AHRQ Author: Ngo-Metzger Q
Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings.
The purpose of this study was to compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers (HCs) to Medicare beneficiaries in physician offices and outpatient clinics. It found that total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580).
AHRQ-authored.
Citation: Mukamel DB, White LM, Nocon RS .
Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings.
Health Serv Res 2016 Apr;51(2):625-44. doi: 10.1111/1475-6773.12339..
Keywords: Medicare, Healthcare Costs, Primary Care
Magill MK, Ehrenberger D, Scammon DL
The cost of sustaining a patient-centered medical home: experience from 2 states.
This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. It found that costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices.
AHRQ-funded; HS022620.
Citation: Magill MK, Ehrenberger D, Scammon DL .
The cost of sustaining a patient-centered medical home: experience from 2 states.
Ann Fam Med 2015 Sep;13(5):429-35. doi: 10.1370/afm.1851..
Keywords: Patient-Centered Healthcare, Healthcare Costs, Quality of Care, Primary Care
Field TS, Ogarek J, Garber L
Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.
The researchers aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization. Of 3,661 patients discharged to home during the study year, 1,808 received an office visit within 7 days and of these, 1,000 were with a primary care physician. No protective effect for office visits within 7 days was found.
AHRQ-funded; HS017203.
Citation: Field TS, Ogarek J, Garber L .
Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.
J Gen Intern Med 2015 May;30(5):565-71. doi: 10.1007/s11606-014-3106-4..
Keywords: Hospital Readmissions, Primary Care, Hospital Discharge, Elderly, Healthcare Costs
Berner ES, Burkhardt JH, Panjamapirom A
Cost implications of human and automated follow-up in ambulatory care.
This study tracked costs associated with using nurse-initiated telephone calls or interactive voice response (IVR) over the first two years of followup for a practice assumed to have 4800 acute care patient visits per year. For the first two years, costs were approximately the same but, in subsequent years, IVR followup is approximately $9000 per year less expensive than nurse followup.
AHRQ-funded; HS017060
Citation: Berner ES, Burkhardt JH, Panjamapirom A .
Cost implications of human and automated follow-up in ambulatory care.
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP531-40..
Keywords: Healthcare Costs, Primary Care, Quality of Care, Critical Care