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
101 to 125 of 431 Research Studies DisplayedReynolds EL, Kerber KA, Hill C
The effects of the Medicare NCS reimbursement policy: utilization, payments, and patient access.
The purpose of this research was to determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data. The investigators found that the Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected.
AHRQ-funded; HS017690; HS022258.
Citation: Reynolds EL, Kerber KA, Hill C .
The effects of the Medicare NCS reimbursement policy: utilization, payments, and patient access.
Neurology 2020 Aug 18;95(7):e930-e35. doi: 10.1212/wnl.0000000000010090..
Keywords: Payment, Medicare, Policy, Practice Patterns
Conover CJ, Bailey J
Certificate of need laws: a systematic review and cost-effectiveness analysis.
Researchers conducted a systematic review and cost-effectiveness analysis of Certificate of Need (CON) laws. Ninety articles were reviewed to summarize the evidence on how CON laws affect regulatory costs, health expenditures, health outcomes, and access to care; the researchers found that the literature has not yet reached a definitive conclusion. They state that while more and higher quality research is needed to reach confident conclusions, their cost-effectiveness analysis based on the existing literature indicates that the expected costs of CON exceeded its benefits.
AHRQ-funded; 290020025.
Citation: Conover CJ, Bailey J .
Certificate of need laws: a systematic review and cost-effectiveness analysis.
BMC Health Serv Res 2020 Aug 14;20(1):748. doi: 10.1186/s12913-020-05563-1..
Keywords: Healthcare Costs, Policy
Yakusheva O, Hoffman GJ
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program.
AHRQ-funded; HS025838.
Citation: Yakusheva O, Hoffman GJ .
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
Med Care Res Rev 2020 Aug;77(4):334-44. doi: 10.1177/1077558718795745..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs, Policy
Akincigil A, Mackie TI, Cook S
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
This retrospective observation study examined the effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children. Data was analyzed from Medicaid Analytical eXtracts (MAX) with administrative claims from 2006-2011 in Washington State. Within two years of policy implementation, prescription prevalence decreased from 6.17 to 4.04 while the synthetic control group remained stable at 6.47. The results show the effectiveness of the peer review program.
AHRQ-funded; HS026001.
Citation: Akincigil A, Mackie TI, Cook S .
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
Health Serv Res 2020 Aug;55(4):596-603. doi: 10.1111/1475-6773.13297..
Keywords: Children/Adolescents, Medication, Medicaid, Policy
Rhee TG, Wilkinson ST
Exploring the psychiatrist-industry financial relationship: insight from the open payment data of Centers for Medicare and Medicaid Services.
The Physician Payments Sunshine Act (PPSA) requires reporting of financial payments by pharmaceutical and medical device companies to teaching hospitals and individual physicians in the United States. In this study, industry payments made to psychiatrists were quantified. The investigators found that over half of active psychiatrists (55.7%) received some form of payments from pharmaceutical manufacturers.
AHRQ-funded; HS023000.
Citation: Rhee TG, Wilkinson ST .
Exploring the psychiatrist-industry financial relationship: insight from the open payment data of Centers for Medicare and Medicaid Services.
Adm Policy Ment Health 2020 Jul;47(4):526-30. doi: 10.1007/s10488-020-01009-2.
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Keywords: Provider: Physician, Provider, Behavioral Health, Payment, Policy
McDonald A, Francis L, Crouch BI
Legal aspects of information sharing and communication by poison centers in the United States.
This narrative review analyzes both typical activities and emerging innovations of poison control centers in relation to U.S. law and regulation regarding privacy, specifically the Health Insurance Portability and Accountability Act, the Substance Abuse and Mental Health Treatment Act, and the Federal Trade Commission Act. Text message exchanges present particularly difficult privacy challenges under these laws.
AHRQ-funded; HS021472.
Citation: McDonald A, Francis L, Crouch BI .
Legal aspects of information sharing and communication by poison centers in the United States.
Clin Toxicol 2020 Jul;58(7):669-75. doi: 10.1080/15563650.2019.1705478..
Keywords: Communication, Policy, Health Information Technology (HIT)
Myers CD, Gordon HG, Kim HM
Does group deliberation mobilize? The effect of public deliberation on willingness to participate in politics.
Proponents of public deliberation suggest that engaging in deliberation increases deliberators' subsequent participation in other forms of politics. In this paper, the authors evaluate this "deliberative participation hypothesis" using data drawn from a deliberative field experiment in which members of medically underserved communities in Michigan deliberated in small groups about the design of that state's Medicaid program.
AHRQ-funded; HS023566.
Citation: Myers CD, Gordon HG, Kim HM .
Does group deliberation mobilize? The effect of public deliberation on willingness to participate in politics.
Polit Behav 2020 Jun;42(2):557-80. doi: 10.1007/s11109-018-9507-z..
Keywords: Policy, Medicaid
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.
AHRQ-funded; HS025155.
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
Green TC, Davis C, Xuan Z
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Researchers sought to examine early impacts of laws that require naloxone to be prescribed to patients at increased overdose risk. Data from CVS Pharmacy 90 days before and after the naloxone-prescribing mandates took effect in Arizona, Florida, Rhode Island, Vermont, and Virginia were examined. The researchers concluded that mandating the prescribing of naloxone quickly expands access to this life-saving medication for more people in more places. They recommended that other states consider mandating the co-prescription of naloxone to individuals at increased risk of overdose.
AHRQ-funded; HS024021.
Citation: Green TC, Davis C, Xuan Z .
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Am J Public Health 2020 Jun;110(6):881-87. doi: 10.2105/ajph.2020.305620..
Keywords: Policy, Medication, Substance Abuse, Opioids
Hodgkin D, Moscarelli M, Rupp A
AHRQ Author: Zuvekas SH
Mental health economics: bridging research, practice and policy.
The authors discuss the past and current work of the World Psychiatric Association Section on Mental Health Economics. They conclude with stating that The Section strives for excellence in mental health economics research and education to promote the mission and fulfill the goals of the World Psychiatric Association.
Citation: Hodgkin D, Moscarelli M, Rupp A .
Mental health economics: bridging research, practice and policy.
World Psychiatry 2020 Jun;19(2):258-59. doi: 10.1002/wps.20753..
Keywords: Behavioral Health, Healthcare Costs, Health Services Research (HSR), Policy
Kunz SN, Phibbs CS, Profit J
The changing landscape of perinatal regionalization.
This article discusses the need for consistent perinatal regionalization policies across regions and between countries to reduce neonatal morbidity and mortality. Regionalization emphasizes matching patient needs with the capabilities of the hospital in which care is provided. The need to account for geographic and other regional differences when determining the feasibility of regionalization for a specific regions is emphasized.
AHRQ-funded; HS025749.
Citation: Kunz SN, Phibbs CS, Profit J .
The changing landscape of perinatal regionalization.
Semin Perinatol 2020 Jun;44(4):151241. doi: 10.1016/j.semperi.2020.151241..
Keywords: Pregnancy, Maternal Care, Women, Policy, Hospitals
Maclean JC, Halpern MT, Hill SC
AHRQ Author: Hill SC
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
The purpose of this study was to quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data from the Medicaid State Drug Utilization Database was used. Findings showed that Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
AHRQ-authored.
Citation: Maclean JC, Halpern MT, Hill SC .
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
Health Serv Res 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289..
Keywords: Medicaid, Cancer: Breast Cancer, Cancer, Medication, Policy, Women, Healthcare Utilization, Access to Care, Health Insurance
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
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, Policy, Uninsured, Women
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Ornelas IJ, Yamanis TJ, Ruiz RA
The health of undocumented Latinx immigrants: what we know and future directions.
This review article summarizes the limited but growing literature on the health of undocumented Latinx immigrations and how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect their mental and physical health. The authors discuss how policies and social ties can promote their health. They focus on areas of concern and recommend how future research should be conducted.
AHRQ-funded; HS013853.
Citation: Ornelas IJ, Yamanis TJ, Ruiz RA .
The health of undocumented Latinx immigrants: what we know and future directions.
Annu Rev Public Health 2020 Apr 2;41:289-308. doi: 10.1146/annurev-publhealth-040119-094211..
Keywords: Racial and Ethnic Minorities, Vulnerable Populations, Social Determinants of Health, Policy
Tseng CW, Masuda C, Chen R
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
In this study, the investigators examined how patients’ out-of-pocket costs for insulin would have dropped from 2014 to 2019 due to Part D policy changes and whether higher insulin prices offset these potential savings. The authors concluded that efforts to reduce patients’
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
AHRQ-funded; HS024227.
Citation: Tseng CW, Masuda C, Chen R .
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
Diabetes Care 2020 Apr;43(4):e50-e51. doi: 10.2337/dc19-1294..
Keywords: Medication, Healthcare Costs, Medicare, Health Insurance, Policy
Downing J, Cha P
Same-sex marriage and gains in employer-sponsored insurance for US adults, 2008-2017.
This study’s objective was examine the effects on employer-sponsored insurance of same-sex marriage for US adults from 2008-2017. Data from the American Community Survey was used for over 18 million adult respondents. The authors found a 0.61 percentage point increase in employer-sponsored health insurance coverage for men and women.
AHRQ-funded; HS000046.
Citation: Downing J, Cha P .
Same-sex marriage and gains in employer-sponsored insurance for US adults, 2008-2017.
Am J Public Health 2020 Apr;110(4):537-39. doi: 10.2105/ajph.2019.305510..
Keywords: Health Insurance, Policy
Tilhou AS, Huguet N, DeVoe J
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
In this paper, the investigators summarized their results to-date as experts in investigating the impact of the Patient Protection and Affordable Care Act (ACA) Medicaid expansion on Community Health Centers (CHCs) and the patients they serve. They found the ACA Medicaid expansion increased access to care and preventive services, primarily in Medicaid expansion states. Rates of physical and mental health conditions rose substantially from pre- to post-ACA in expansion states, suggesting underdiagnosis pre-ACA.
AHRQ-funded; HS024270.
Citation: Tilhou AS, Huguet N, DeVoe J .
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
J Gen Intern Med 2020 Apr;35(4):1292-95. doi: 10.1007/s11606-019-05571-w..
Keywords: Policy, Medicaid, Access to Care, Uninsured, Health Insurance
Rathi VK, McWilliams JM, Roberts ET
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
In this paper the authors discuss payment reform, global budget models and why incentives differ for health system versus physician group ACO’s. They indicate that incentives in new payment models are closely connected to the structure of the health care delivery system and that policies that ignore this relationship and focus only on the risk terms of payment contracts may miss opportunities for progress.
AHRQ-funded; HS026727.
Citation: Rathi VK, McWilliams JM, Roberts ET .
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
Ann Intern Med 2020 Mar 17;172(6):423-24. doi: 10.7326/m19-3178..
Keywords: Healthcare Costs, Policy, Payment
Takvorian SU, Oganisian A, Mamtani R
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. The objective of this study was to examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer.
AHRQ-funded; HS026116.
Citation: Takvorian SU, Oganisian A, Mamtani R .
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
JAMA Netw Open 2020 Feb 5;3(2):e1921653. doi: 10.1001/jamanetworkopen.2019.21653.
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Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer, Health Insurance, Medicaid, Policy, Health Services Research (HSR)
Heins SE, Frey KP, Alexander GC
Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017.
This paper looked at current state-level policies in the United States from January 2007-May 2017 limiting high morphine equivalent daily dose (MEDD) prescribing. State-level threshold policies were reviewed using LexisNexis and Westlaw Next for legislative acts and Google for nonlegislative state-level policies. State websites were also reviewed to identify additional policies. Policies were then independently double-coded on the categories: state, agency/organization, policy type, effective date, threshold level, and policy exceptions. Currently 22 states have at least 1 MEDD policy, most commonly guidelines (14 states). Other states have prior authorizations (4 states), rules/regulations (4 states), legislative acts (3 states), claim denials (2 states), and alert systems/automatic patient reports (2 states). Thresholds vary widely (30-300 mg MEDD), with higher thresholds corresponding to more restrictive policies (claim denial), and lower thresholds corresponding to less restrictive policies (guidelines). The majority of policies exclude patients with terminal illnesses or acute pain.
AHRQ-funded; HS025557.
Citation: Heins SE, Frey KP, Alexander GC .
Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017.
Pain Med 2020 Feb;21(2):308-16. doi: 10.1093/pm/pnz038..
Keywords: Opioids, Medication, Policy, Practice Patterns, Substance Abuse
Fashaw SA, Thomas KS, McCreedy E
Thirty-year trends in nursing home composition and quality since the passage of the Omnibus Reconciliation Act.
In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examined trends in facility, resident, and quality characteristics since passage of that legislation. The investigators indicated that the 30th anniversary of OBRA provided a unique opportunity to reflect, consider lessons learned, and think about the future of this and other sectors of long-term care
AHRQ-funded; HS000011.
Citation: Fashaw SA, Thomas KS, McCreedy E .
Thirty-year trends in nursing home composition and quality since the passage of the Omnibus Reconciliation Act.
J Am Med Dir Assoc 2020 Feb;21(2):233-39. doi: 10.1016/j.jamda.2019.07.004..
Keywords: Nursing Homes, Quality of Care, Long-Term Care, Policy
Heeringa J, Mutti A, Furukawa MF
AHRQ Author: Furukawa MF
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
The authors conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. They found that U.S. policymakers seek to promote provider integration and coordination. They conclude that emerging evidence suggested that organizational structures, composition, and other characteristics influence cost and quality performance. They recommend future research to examine systematically the role of organizational structure in cost and quality outcomes.
AHRQ-authored; AHRQ-funded.
Citation: Heeringa J, Mutti A, Furukawa MF .
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
Int J Integr Care 2020 Jan 20;20(1):2. doi: 10.5334/ijic.4635.
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Keywords: Health Systems, Healthcare Delivery, Patient-Centered Healthcare, Care Coordination, Organizational Change, Policy
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery