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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 387 Research Studies Displayed
Tzeng HM, Raji MA, Chou LN
Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: a national study in the United States.
The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. The investigators found that the PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018.
Citation: Tzeng HM, Raji MA, Chou LN . Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: a national study in the United States. J Nurs Care Qual 2022 Jan-Mar;37(1):6-13. doi: 10.1097/ncq.0000000000000595..
Keywords: Medication, Medication: Safety, Provider: Nurse, Adverse Drug Events (ADE), Adverse Events, Policy
Dorilas E, Hill SC, Pesko MF
AHRQ Author: Hill SC
Tobacco surcharges associated with reduced ACA marketplace enrollment.
Researchers used 2014-19 administrative data on enrollees in the federally facilitated Affordable Care Act Marketplace, HealthCare.gov, to examine the relationships among surcharge rates, total Marketplace enrollment, and enrollment by tobacco users. They found that the tobacco surcharge rate was associated with lower total enrollment as well as a reduced share of total enrollees who reported any tobacco use. Further, tobacco surcharges have a significantly larger effect on tobacco users' share of enrollment in rural areas than in urban areas, which may contribute to urban-rural health disparities.
Citation: Dorilas E, Hill SC, Pesko MF . Tobacco surcharges associated with reduced ACA marketplace enrollment. Health Aff 2022 Mar;41(3):398-405. doi: 10.1377/hlthaff.2021.01313..
Keywords: Tobacco Use, Policy, Health Insurance
Eliason EL, MacDougall H, Peterson L
Understanding the aggressive practices of nonprofit hospitals in pursuit of patient debt.
This study examined the prevalence of extraordinary collection actions (ECAs) and characteristics of nonprofit hospitals that reported this behavior from 2010 to 2016. The authors used Community Benefit Insight data to compare these hospitals with ones that did not report these practices. ECAs include reporting patient debt to credit and collection agencies, filing lawsuits, placing liens on residences, and issuing civil arrest. Hospitals that reported ECAs significantly differed in total revenue, system membership, bed size, urban location, financial assistance policy use, and use of poverty guidelines for discounted care. Lower total hospital revenue was a significant predictor of ECAs.
Citation: Eliason EL, MacDougall H, Peterson L . Understanding the aggressive practices of nonprofit hospitals in pursuit of patient debt. Health Soc Work 2022 Jan 31;47(1):36-44. doi: 10.1093/hsw/hlab034..
Keywords: Hospitals, Healthcare Costs, Policy
Pollack CE, Leifheit KM, McGinty EE
Public support for policies to increase housing stability during the COVID-19 pandemic.
The COVID-19 pandemic has exacerbated longstanding housing precarity. This study measured the public support for policies designed to increase housing stability and gauged whether support levels were associated with views about the role of evictions in COVID-19 transmission and the existence of racial inequities in the housing market. The investigators concluded that support for housing stability policies was strong among U.S. adults, particularly among those who agreed that preventing evictions slowed COVID-19 transmission and among those who acknowledged racial inequities in the housing market.
Citation: Pollack CE, Leifheit KM, McGinty EE . Public support for policies to increase housing stability during the COVID-19 pandemic. Am J Prev Med 2021 Dec;61(6):919-22. doi: 10.1016/j.amepre.2021.05.006..
Keywords: COVID-19, Policy, Public Health
Rao BR, Merchant FM, Howard DH
Shared decision-making for implantable cardioverter-defibrillators: policy goals, metrics, and challenges.
Researchers discussed shared decision-making for implantable cardioverter-defibrillators (ICDs), including the results from a case study implementing the shared decision-making mandate for ICDs, which involved providing patients with decision aids prior to or following the doctor consultation.
Citation: Rao BR, Merchant FM, Howard DH . Shared decision-making for implantable cardioverter-defibrillators: policy goals, metrics, and challenges. J Law Med Ethics 2021 Win;49(4):622-29. doi: 10.1017/jme.2021.85..
Keywords: Decision Making, Medical Devices, Policy, Cardiovascular Conditions
Cerda M, Wheeler-Martin K, Bruzelius E
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
The authors investigated the impact of pain management clinic laws. They analyzed data on county-level, opioid overdose deaths via the National Vital Statistics System and patients filling long-duration or high-dose opioid prescriptions in the US 2010-2018. Their findings suggested that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raised concerns regarding unintended consequences on heroin/synthetic overdoses.
Citation: Cerda M, Wheeler-Martin K, Bruzelius E . Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths. Am J Epidemiol 2021 Dec;190(12):2592-603. doi: 10.1093/aje/kwab192..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Practice Patterns, Policy
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM . Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid. J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Gigli KH, Rak KJ, Hershey TB
A roadmap for successful state sepsis regulations-lessons from New York.
This study looked at the reasons why New York State’s 2013 sepsis regulations were successful in improving mortality compared to less successful sepsis policies at the federal level. The authors recruited thirteen key stakeholders from three groups including four New Year State policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York State sepsis regulations, as well as two members of patient advocacy groups. The group identified themes related to participant perceptions of the sepsis policy, factors that influenced the policy’s perceived successes, and opportunities for improvement. A major factor that created early buy-in was engaging a diverse array of stakeholders in the development of the policy. Policymakers also worked to provide a balance between the desire for comprehensive reporting and the burden of data collection. The regulations also touched on all three major domains of sepsis quality: structure, process, and outcomes.
Citation: Gigli KH, Rak KJ, Hershey TB . A roadmap for successful state sepsis regulations-lessons from New York. Crit Care Explor 2021 Sep;3(9):e0521. doi: 10.1097/cce.0000000000000521..
Keywords: Sepsis, Policy
Heins SE, Castillo RC
Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population.
The study’s objective was to evaluate the impact of state-level morphine equivalent daily dose (MEDD) policies on opioid prescribing among the privately insured using claims data from 9 policy states and 2 control states and a comparative interrupted time series design. Findings showed that MEDD policies were associated with decreased use of any opioids relative to control states, but with no change in high-dose prescribing. Recommendations included further research to understand the mechanisms through which MEDD policies may influence prescribing behavior.
Citation: Heins SE, Castillo RC . Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population. Med Care 2021 Sep;59(9):801-07. doi: 10.1097/mlr.0000000000001587..
Keywords: Opioids, Medication, Policy, Practice Patterns
Chelen JSC, White DB, Zaza S
US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge.
Researchers assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. They found that their sample of policies reflected organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources.
Citation: Chelen JSC, White DB, Zaza S . US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge. Health Secur 2021 Sep-Oct;19(5):459-67. doi: 10.1089/hs.2020.0166..
Keywords: COVID-19, Public Health, Emergency Preparedness, Policy
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
This AHRQ-authored paper estimates insurance disparities across non-standard employment categories and determines how coverage disparities shifted following health reform in 2014. Data on working-age adults was analyzed from the 2010-2012 and 2015-2017 MEPS. Uninsurance decreased after health reform for all groups of nonstandard workers with a 10-14% point decline. Uninsurance remained high for all freelance workers at 30.8%, full-time temporary workers (25.1%) and part-time workers (17.9%) compared to full-time workers (11.9%). Lower uninsurance in a Medicaid expansion state was found for all categories of workers.
Citation: Berdahl TA, Moriya AS . Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017. J Gen Intern Med 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Policy, Uninsured, Medicaid, Low-Income
Mackie TI, Kovacs KM, Simmel C
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
This study utilized a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs, specifically in foster care children. Relevant parties included policymakers (n = 31), foster care alumni (n = 28), caseworkers (n=23), prescribing clinicians (n = 32), and caregivers (n = 18). Participants received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important. Safety indicators ranked among the top three candidate outcomes across respondent groups. Foster care alumni put “antipsychotic treatment reduction” and “increased psychosocial treatment” as the highest ranking. Caseworkers, prescribers, and caregivers gave top priority to “increased follow-up after treatment initiation”. Potential unintended consequences ranked lowest, including increased use of other psychotropic medication classes, increased psychiatric hospital stays, and increased emergency room utilization.
Citation: Mackie TI, Kovacs KM, Simmel C . A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs. Health Serv Res 2021 Jun;56(3):418-31. doi: 10.1111/1475-6773.13610..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Policy
Shortell SM, Gottlieb DJ, Martinez Camblor P
Hospital-based health systems 20 years later: a taxonomy for policy research and analysis.
Building on the original taxonomy of hospital-based health systems from 20 years ago, the investigators developed a new taxonomy to inform emerging public policy and practice developments. The study design included a cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.
Citation: Shortell SM, Gottlieb DJ, Martinez Camblor P . Hospital-based health systems 20 years later: a taxonomy for policy research and analysis. Health Serv Res 2021 Jun;56(3):453-63. doi: 10.1111/1475-6773.13621..
Keywords: Hospitals, Healthcare Systems, Health Services Research (HSR), Policy
Chow JY, Nijhawan AE, Mathews WC
Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014.
The purpose of this study was to investigate whether gaining inpatient healthcare coverage had an effect on hospitalization rates among persons with HIV following implementation of the Affordable Care Act in 2014. Hospitalization data from 2015 were obtained on adults receiving longitudinal care at HIV clinics; all patients were previously uninsured and supported by the Ryan White HIV/AIDS Program (RWHAP) in 2013. Findings showed that acquiring inpatient coverage was not associated with a change in hospitalization rates.
Citation: Chow JY, Nijhawan AE, Mathews WC . Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014. J Acquir Immune Defic Syndr 2021 Jun 1;87(2):776-80. doi: 10.1097/qai.0000000000002645..
Keywords: Human Immunodeficiency Virus (HIV), Hospitalization, Medicaid, Health Insurance, Access to Care, Policy
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
Citation: Tedesco D, Moghavem N, Weng Y . Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013. J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Roberts ET, James AE, Sabik LM
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
Medicaid serves as a supplemental insurer for eleven million low-income Medicare beneficiaries, known as duals. For these beneficiaries, Medicaid pays for Medicare’s out-of-pocket costs, including premiums, deductibles and coinsurance. This paper examined opportunities to close these gaps in Medicaid coverage and discussed how these reforms could complement other efforts to modernize Medicaid for low-income Medicare beneficiaries.
Citation: Roberts ET, James AE, Sabik LM . Modernizing Medicaid coverage for Medicare beneficiaries with low income. JAMA Health Forum 2021 Jun;2(6). doi: 10.1001/jamahealthforum.2021.0989..
Keywords: Medicaid, Medicare, Low-Income, Health Insurance, Policy
Kandrack R, Barnes H, Martsolf GR
Nurse practitioner scope of practice regulations and nurse practitioner supply.
This study’s objective was to estimate associations between adopting full nurse practitioner (NP) scope of practice (SOP) and improved access to care. The authors used county-level data to estimate the association between adopting full NP SOP and NP supply in general, and in rural and health professional shortage area-designed counties specifically. They estimated positive associations, although the relationship was only statistically significant in health professional shortage areas.
Citation: Kandrack R, Barnes H, Martsolf GR . Nurse practitioner scope of practice regulations and nurse practitioner supply. Med Care Res Rev 2021 Jun;78(3):208-17. doi: 10.1177/1077558719888424..
Keywords: Provider: Nurse, Provider: Clinician, Workforce, Policy
Springs S, Baruch J
Artists on the research team: an interdisciplinary approach to team science, research rigor, and creative dialogue.
Under the stewardship of two Rhode Island state agencies, an innovative research-driven enterprise, comprising researchers, clinicians, and community artists, was brought together to integrate arts-based interventions into statewide public health policy and practice. In this paper, the investigators discussed their work with the Rhode Island Arts and Health Advisory Group as a case study to illuminate their experiences in collaborating with artists on public health policy and practice research.
Citation: Springs S, Baruch J . Artists on the research team: an interdisciplinary approach to team science, research rigor, and creative dialogue. Health Promot Pract 2021 May;22(1_suppl):83s-90s. doi: 10.1177/1524839921996301..
Keywords: Public Health, Policy
Malhotra NA, Nevar A, Yearby R
Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health.
This paper discusses the Early and Periodic Screening, Diagnostic, and Treatment (EPDST) benefit which is a key component of Medicaid policy intended to define an essential set of services provided to patients age 21 and younger. This qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children’s health. Semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health (SDOH) screening. Findings suggest that with sufficient stakeholder advocacy given the evidence supporting social determinants of health as “medically necessary”, EPSDT benefits could be considered as a funding source to incentivize the incorporation of SDOH screening into the basic package of well-child care.
Citation: Malhotra NA, Nevar A, Yearby R . Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health. Med Care Res Rev 2021 Apr;78(2):87-102. doi: 10.1177/1077558719874211..
Keywords: Children/Adolescents, Medicaid, Social Determinants of Health, Screening, Disparities, Policy
Anderson KE, Shugarman LR, Davenport K
Regulation of provider networks in response to COVID-19.
The authors anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. They suggested that telehealth will have a larger role in care delivery than in the pre-pandemic period, and that regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
Citation: Anderson KE, Shugarman LR, Davenport K . Regulation of provider networks in response to COVID-19. Am J Manag Care 2021 Apr;27(4):e101-e04. doi: 10.37765/ajmc.2021.88614..
Keywords: Health Insurance, Policy, Access to Care, Healthcare Delivery, COVID-19
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
Citation: Jacobs PD, Kronick R . The effects of coding intensity in Medicare Advantage on plan benefits and finances. Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Health Insurance, Healthcare Costs, Policy
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
Citation: Chen G, Lewis VA, Gottlieb D . Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations. Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
Angier H, Garvey B, DeVoe JE. H, Angier H, Garvey B, DeVoe JE. B, DeVoe JE
Focus on families to improve child health during the COVID-19 pandemic and beyond.
This article discusses the need for policymakers to develop interventions designed to help entire families during the pandemic because children’s health is affected by parent health. The authors advocate creating family-centered health care and enable primary care practices and public health programs to help families apply for health insurance coverage. They also discuss work that must be done to address health equity and increasing health and health care disparities caused by the COVID-19 pandemic.
Citation: Angier H, Garvey B, DeVoe JE. H, Angier H, Garvey B, DeVoe JE. B, DeVoe JE . Focus on families to improve child health during the COVID-19 pandemic and beyond. JAMA Health Forum 2021 Mar;2(3). doi: 10.1001/jamahealthforum.2021.0238..
Keywords: Children/Adolescents, COVID-19, Family Health and History, Patient-Centered Healthcare, Policy, Public Health
Bossick AS, Brown J, Hanna A
Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era.
This literature review looked at the association between state-level reproductive laws and reproductive health outcomes related to services such as family planning, maternity care, abortion, and prenatal care use. A PubMed search was conducted for studies published between March 10, 2010 and August 31, 2019 and focused on research conducted after the implementation of the Affordable Care Act. Search results returned 1,529 articles with only 56 meeting the inclusion criteria for review. After further review, only 8 were selected for inclusion. Two included all 50 states and Washington, DC; one included Oregon and Washington; and the remaining 5 studies included single states (Texas, Arizona, Ohio, and Utah). Half of the studies focused solely on restrictive abortion legislation. Restricting access to family planning and abortion services were associated with negative outcomes. Expanding maternity care through Medicaid reform and autonomous midwifery laws were associated with positive outcomes for maternal and newborn health.
Citation: Bossick AS, Brown J, Hanna A . Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era. Womens Health Issues 2021 Mar-Apr;31(2):114-21. doi: 10.1016/j.whi.2020.11.005..
Keywords: Women, Policy, Maternal Care, Pregnancy
Valdez RS, Roger CC, Claypool H
Ensuring full participation of people with disabilities in an era of telehealth.
This paper discusses the benefits and drawbacks that the widespread use of telehealth resulting from the COVID-19 pandemic has on people with disabilities. For some it may result in reduced barriers to care, but for others inadequate attention to the design, implementation, and policy dimensions may be detrimental.
Citation: Valdez RS, Roger CC, Claypool H . Ensuring full participation of people with disabilities in an era of telehealth. J Am Med Inform Assoc 2021 Feb 15;28(2):389-92. doi: 10.1093/jamia/ocaa297..
Keywords: Disabilities, Telehealth, Health Information Technology (HIT), Access to Care, Policy, COVID-19