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
151 to 175 of 431 Research Studies DisplayedEllis RJ, Angelos P, Jarnagin WR
Abrupt Discontinuation of the Codman hepatic artery infusion pump: considerations in the era of precision medicine.
In this article, the authors use the discontinuation of the Codman hepatic artery infusion pump as a cautionary example to highlight issues with economic viability in narrow-indication medicine. The authors note that withdrawal of the Codman HAIP from the market without notice or plans for replacement raised several ethical and industry-specific concerns. They discuss the need for mechanisms to ensure sustainability of these treatments as the number of individualized therapies continues to expand.
AHRQ-funded; HS023011; HS000078.
Citation: Ellis RJ, Angelos P, Jarnagin WR .
Abrupt Discontinuation of the Codman hepatic artery infusion pump: considerations in the era of precision medicine.
J Am Coll Surg 2019 Aug;229(2):217-19. doi: 10.1016/j.jamcollsurg.2019.03.002..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Policy
Chang SH, Wang M, Liu X
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. The investigators study whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival. The investigators concluded that in the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT.
AHRQ-funded; HS022330.
Citation: Chang SH, Wang M, Liu X .
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Transplantation 2019 Aug;103(8):1663-74. doi: 10.1097/tp.0000000000002574..
Keywords: Access to Care, Disparities, Kidney Disease and Health, Outcomes, Policy, Transplantation
Rasmussen PW, Kominski GF
Sources of success in California's individual marketplace under the Affordable Care Act.
When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. Although, the ACA has not been uniformly embraced, California has been a leader. In this paper, the authors discuss sources of success in California's individual marketplace under the Affordable Care Act.
AHRQ-funded; HS000046.
Citation: Rasmussen PW, Kominski GF .
Sources of success in California's individual marketplace under the Affordable Care Act.
J Health Polit Policy Law 2019 Aug 1;44(4):679-706. doi: 10.1215/03616878-7530849..
Keywords: Policy, Health Insurance, Uninsured, Medicaid, Medicare
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Kahn JM, Davis BS, Yabes JG
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
The purpose of this study was to evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. Results showed that, in New York State, mandated protocolized sepsis care was associated with a greater decrease in sepsis mortality compared with sepsis mortality in control states (Florida, Maryland, Massachusetts, and New Jersey) that did not implement sepsis regulations. The authors add that, because baseline mortality rates differ between New York and the comparison states, it is uncertain whether these findings will be generalizable to other states.
AHRQ-funded; HS025146.
Citation: Kahn JM, Davis BS, Yabes JG .
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
JAMA 2019 Jul 16;322(3):240-50. doi: 10.1001/jama.2019.9021..
Keywords: Guidelines, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality, Outcomes, Policy, Sepsis
Roberts ET, Hayley Welsh J, Donohue JM
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
This study examined the role that state policies play in Medicaid disenrollment among low-income Medicare beneficiaries. Medicaid disenrollment among fee-for-service Medicare beneficiaries was examined for the period 2012-2016. During that period, 18.2% of beneficiaries disenrolled for reasons other than death. Disenrollment was 24% lower in states that automatically enrolled recipients of the Supplemental Security Income program in full Medicaid, 33% lower in states with more generous provider payment policies, and 37% lower in states with less restrictive asset limits for partial Medicaid.
AHRQ-funded; HS026727.
Citation: Roberts ET, Hayley Welsh J, Donohue JM .
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
Health Aff 2019 Jul;38(7):1153-62. doi: 10.1377/hlthaff.2018.05165..
Keywords: Medicare, Medicaid, Low-Income, Policy, Vulnerable Populations
Agarwal SD, Goldman AL, Sommers BD
Blue-collar workers had greatest insurance gains after ACA implementation.
The authors analyzed national survey data and found that workers in traditionally blue-collar industries experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. They found that, compared to other occupations, this group had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly-purchased non-group insurance.
AHRQ-funded.
Citation: Agarwal SD, Goldman AL, Sommers BD .
Blue-collar workers had greatest insurance gains after ACA implementation.
Health Aff 2019 Jul;38(7):1140-44. doi: 10.1377/hlthaff.2018.05454..
Keywords: Health Insurance, Policy, Access to Care, Uninsured
Heintzman J, Cottrell E, Angier H
Impact of alternative payment methodology on primary care visits and scheduling.
The authors used electronic health record data to evaluate the impact of Oregon’s Alternative Payment Methodology (APM) on visit and scheduling metrics in the first wave of experiment clinics. They found that APM clinics experienced a greater increase in same-day visits but did not significantly differ from comparators in other visit metrics.
AHRQ-funded; HS022651.
Citation: Heintzman J, Cottrell E, Angier H .
Impact of alternative payment methodology on primary care visits and scheduling.
J Am Board Fam Med 2019 Jul-Aug;32(4):539-49. doi: 10.3122/jabfm.2019.04.180368..
Keywords: Payment, Medicaid, Health Insurance, Policy
Johnson EK, Hardy R, Santos T
State laws and nonprofit hospital community benefit spending.
The authors of this article sought to determine the association of state laws on nonprofit hospital community benefit spending. Participants included 2421 nonprofit short-term acute care hospital organizations. The authors found that state laws are associated with nonprofit hospital community benefit spending and recommended that policymakers use community benefit laws to increase nonprofit hospital engagement with public health.
AHRQ-funded; HS024959.
Citation: Johnson EK, Hardy R, Santos T .
State laws and nonprofit hospital community benefit spending.
J Public Health Manag Pract 2019 Jul/Aug;25(4):E9-e17. doi: 10.1097/phh.0000000000000885.
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Keywords: Hospitals, Policy, Healthcare Costs
Huguet N, Angier H, Rdesinski R
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
This study assessed changes in the prevalence of cervical and colorectal cancer screening from before and after the Affordable Care Act in Medicaid expansion and non-expansion states among patients seen in community health centers. Results showed that, despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Rdesinski R .
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Prev Med 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003..
Keywords: Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Delivery, Healthcare Utilization, Medicaid, Policy, Prevention, Screening
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
Cottrell E, Darney BG, Marino M
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
In this paper, the authors describe a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. They conclude that the findings will be relevant to policy and practice, informing efforts that enhance the provision of timely, evidence-based reproductive care, to improve health outcomes, and to reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualize their findings and to develop subsequent studies and interventions to support women's healthcare provision in community health center settings.
AHRQ-funded; HS025155.
Citation: Cottrell E, Darney BG, Marino M .
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
Health Res Policy Syst 2019 Jun 11;17(1):58. doi: 10.1186/s12961-019-0445-y..
Keywords: Women, Access to Care, Medicaid, Policy, Prevention, Maternal Care, Sexual Health
Wisk LE, Levy S, Weitzman ER
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Given a rapidly changing policy landscape, the investigators sought to characterize the effects of state marijuana laws on parents' views of marijuana use by their teenage children. The investigators found that among parents of medically vulnerable children, perceiving state marijuana policies as more permissive was strongly associated with lower perceived riskiness of marijuana use for their children.
AHRQ-funded; HS022986.
Citation: Wisk LE, Levy S, Weitzman ER .
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Drug Alcohol Depend 2019 Jun 1;199:59-67. doi: 10.1016/j.drugalcdep.2018.12.027..
Keywords: Children/Adolescents, Policy, Vulnerable Populations, Chronic Conditions, Substance Abuse
Kamal AH, Wolf SP, Troy J
Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
The authors used 2018 clinician survey data to model risk factors associated with palliative care clinicians leaving the field early. Their modeling revealed an impending "workforce valley." They recommended policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams.
AHRQ-funded; HS023681.
Citation: Kamal AH, Wolf SP, Troy J .
Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
Health Aff 2019 Jun;38(6):910-18. doi: 10.1377/hlthaff.2019.00018..
Keywords: Palliative Care, Policy, Provider, Teams, Workforce
Londhe S, Ritter G, Schlesinger M
Medicaid expansion in social context: examining relationships between Medicaid enrollment and county-level food insecurity.
This study examined the relationship between states’ expansion of Medicaid and county-level food insecurity. They examined county Medicaid enrollment in early expansion states and found that increased Medicaid enrollment was associated with lower food insecurity during two expansion periods (2009-2012; 2012-2014). In California the most pronounced associations were evident in counties with the largest Medicaid expansions.
AHRQ-funded; HS017589.
Citation: Londhe S, Ritter G, Schlesinger M .
Medicaid expansion in social context: examining relationships between Medicaid enrollment and county-level food insecurity.
J Health Care Poor Underserved 2019;30(2):532-46. doi: 10.1353/hpu.2019.0033..
Keywords: Medicaid, Nutrition, Policy
Delling FN, Vittinghoff E, Dewland TA
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
Researchers studied whether the legalization of cannabis in Colorado has affected healthcare utilization compared to two states where it is still illegal (New York and Oklahoma). ICD-9 was used to determine changes in healthcare utilization relative to various medical diagnoses. According to the National Academy of Science (NAS), legal cannabis use creates an increase in cannabis abuse hospitalizations and also linked to motor vehicle accidents, alcohol abuse, and overdose injury and that was true in CO. There was not a change in hospital stays and costs in CO compared to NY and OK.
AHRQ-funded.
Citation: Delling FN, Vittinghoff E, Dewland TA .
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
BMJ Open 2019 May 15;9(5):e027432. doi: 10.1136/bmjopen-2018-027432..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Policy, Substance Abuse
O'Leary MC, Lich KH, Gu Y
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
The goal of this study was to determine the impact of national and state policies enacted to increase access to Medicaid and to promote colorectal cancer (CRC) screening on newly enrolled, age-eligible Oregon Medicaid beneficiaries. 2010 - 2015 Oregon Medicaid claims data was used to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening. Individuals newly enrolled in Medicaid in 2013 or 2014 were more likely to initiate CRC screening than those enrolled by 2010, associated with the timing of policies such as Medicaid expansion and federal matching for preventive services. A primary care visit during the calendar year, one or more chronic conditions, and Hispanic ethnicity were also associated with CRC screening initiation.
AHRQ-funded; HS022981.
Citation: O'Leary MC, Lich KH, Gu Y .
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
BMC Health Serv Res 2019 May 9;19(1):298. doi: 10.1186/s12913-019-4113-2..
Keywords: Access to Care, Cancer, Cancer: Colorectal Cancer, Medicaid, Policy, Prevention, Screening
Seo V, Baggett TP, Thorndike AN
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
This study assessed differences in access to care for patients at Community Health Centers (CHCs) between those with continuous Medicaid coverage and those with gaps in insurance coverage, in order to examine the role of Medicaid coverage on care patterns for those with available safety net care. Data on adult patients with continuous Medicaid coverage and those with a period without insurance coverage in the last 12 months was gathered from the 2014 Health Center Patient Survey. Reported need for various types of care, prescription drugs, or referrals to care outside of the CHC, and reports of being delayed or unable to get needed care by insurance status were examined. Patients with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. The authors conclude that continuous Medicaid coverage appears to mitigate barriers to care for CHC patients when compared to those who have intermittent or no insurance coverage. Policies that increase disruptions in coverage could adversely impact access to care, even among those with available safety net care.
AHRQ-funding; HS025378.
Citation: Seo V, Baggett TP, Thorndike AN .
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
BMC Health Serv Res 2019 May 8;19(1):291. doi: 10.1186/s12913-019-4124-z..
Keywords: Access to Care, Health Insurance, Medicaid, Policy, Uninsured
de Cordova PB, Rogowski J, Riman KA
Effects of public reporting legislation of nurse staffing: a trend analysis.
The authors examined nurse staffing trends after the New Jersey enactment of P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. They found that the number of patients per registered nurse decreased for ten specialties, and conclude that this indicates the importance of public reporting in improving patient safety.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Rogowski J, Riman KA .
Effects of public reporting legislation of nurse staffing: a trend analysis.
Policy Polit Nurs Pract 2019 May;20(2):92-104. doi: 10.1177/1527154419832112..
Keywords: Hospitals, Patient Safety, Workforce, Policy, Provider, Provider: Nurse
Perito ER, Mogul DB, VanDerwerken D
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
This study examined the impact of prioritizing infants, children, adolescents, and the sickest adults (designated Status 1) for deceased donor livers. They compared outcomes for two “SharePeds” allocation schema to the allocation plan approved by the Organ Procurement and Transplant Network (OPTN) in December 2017. Both schemas would decrease waitlist deaths for infants, children, and Status 1 adults and increase access to all donors younger than 35 years.
AHRQ-funded; HS023876.
Citation: Perito ER, Mogul DB, VanDerwerken D .
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
J Pediatr Gastroenterol Nutr 2019 Apr;68(4):472-79. doi: 10.1097/mpg.0000000000002287.
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Keywords: Children/Adolescents, Transplantation, Policy
Dalglish SL, Sriram V, Scott K
A framework for medical power in two case studies of health policymaking in India and Niger.
Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. In this study, the authors explore medical power in national health policymaking for child survival in Niger (late 1990s-2012) and emergency medicine specialisation in India (early 1990s-2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking.
AHRQ-funded; HS000078.
Citation: Dalglish SL, Sriram V, Scott K .
A framework for medical power in two case studies of health policymaking in India and Niger.
Glob Public Health 2019 Apr;14(4):542-54. doi: 10.1080/17441692.2018.1457705..
Keywords: Case Study, Policy
Peterson E, Busch S
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
This article reviews the history and measures benefits from the 2008 passing of the Mental Health Parity and Addiction Equity Act (MHPAEA). It led to significant improvements in mental health care coverage. Directions for future research are also discussed.
AHRQ-funded; HS017589.
Citation: Peterson E, Busch S .
Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research.
Annu Rev Public Health 2018 Apr 1;39:421-35. doi: 10.1146/annurev-publhealth-040617-013603..
Keywords: Access to Care, Behavioral Health, Disparities, Health Insurance, Policy, Substance Abuse
Patel EY, Petemann V, Mark BA
Does state-level nurse practitioner scope-of-practice policy affect access to care?
This study attempts to fill a critical gap between policy reform that grants state-level nurse practitioners (NPs) scope of practice (SOP) and a useful synthesis of empirical studies that assesses the relationship of NP SOP policy to its impact on access to care. Researchers applied Aday and Andersen's Access Framework to operationalize access to care and to map components of access to care that might relate to NP SOP through concepts identified in their review. Their findings suggest that full state-level NP SOP policy is associated with increases in various components of access to care, but that additional work will be required to evaluate causality and underlying mechanisms behind the policy's effect on access.
AHRQ-funded; HS000032.
Citation: Patel EY, Petemann V, Mark BA .
Does state-level nurse practitioner scope-of-practice policy affect access to care?
West J Nurs Res 2019 Apr;41(4):488-518. doi: 10.1177/0193945918795168..
Keywords: Access to Care, Policy, Provider, Provider: Clinician
Modi PK, Kaufman SR, Caram MV
Impact of Medicare office visit payment reform on urologic practices.
This study analyzed the impact of the 2019 Medicare Physician Fee Schedule on urologic practices. This new payment system modifies reimbursement for office evaluation and management visits. Researchers used a sample of 20% of National Medicare claims. They identified 2822 practices ranging from solo to multispecialty groups. Solo practices had the least benefit in reimbursement with most practices having a small increase in payment.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Caram MV .
Impact of Medicare office visit payment reform on urologic practices.
Urology 2019 Apr;126:83-88. doi: 10.1016/j.urology.2019.01.013..
Keywords: Medicare, Ambulatory Care and Surgery, Payment, Policy
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.
AHRQ-funded; HS000032.
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