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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 24 of 24 Research Studies DisplayedBlanco C, Kato EU, Aklin WM
Research to move policy - using evidence to advance health equity for substance use disorders.
This paper discusses ways that evidence-based research can advance health equity for substance use disorder (SUD) treatment. Racial and ethnic disparities in treatment access and outcomes have widened, despite substantial efforts to address the epidemic of overdose-related deaths in the US. Overdose rates are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in White populations. Possible opportunities to address these disparities include addressing social determinants of health, implementing prevention measures, and supporting data science. The steps to ensure that research reduces disparities are to: 1) include members of underrepresented groups in the development of preventive interventions and treatments, 2) adequately recruit members of historically represented groups and ensure that studies are large enough to measure differences in outcomes according to race and ethnic group, 3) establish equitable partnerships with people who currently have or have had SUDS and their families and engage these groups in evidence production, 4) diversify the scientific workforce, and 4) have investigators measure the effects of policies and interventions on equity.
AHRQ-authored.
Citation: Blanco C, Kato EU, Aklin WM .
Research to move policy - using evidence to advance health equity for substance use disorders.
N Engl J Med 2022 Jun 16;386(24):2253-55. doi: 10.1056/NEJMp2202740..
Keywords: Substance Abuse, Behavioral Health, Policy, Racial and Ethnic Minorities, Disparities, Social Determinants of Health
Steenland MW, Wilson IB, Matteson KA
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
This study’s objective was to measure the association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. A total of 60,990 childbirths were reviewed from January 1, 2014 on with a total of 72.3% paid for by Medicaid and 27.7% paid for by a commercial payer. The mean age of the birthing person was 27; with 67% White, 22% Black, and 7% Hispanic. Medicaid expansion in Arkansas was associated with a 27.8 percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 percentage points before expansion to -2.0 after. However, disparities in outpatient care after expansion persisted between Black and White individuals.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wilson IB, Matteson KA .
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
JAMA Health Forum 2021 Dec;2(12):e214167. doi: 10.1001/jamahealthforum.2021.4167..
Keywords: Medicaid, Maternal Care, Pregnancy, Racial and Ethnic Minorities, Disparities, Policy, Women, Access to Care
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.
AHRQ-funded; 233201600221A.
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
Hammad Mrig E
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with fundamental cause theory to address limitations in the latter theory, making it more useful in health disparities research. This work deepens appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.
AHRQ-funded; HS017589.
Citation: Hammad Mrig E .
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
Sociol Health Illn 2021 Jan;43(1):133-48. doi: 10.1111/1467-9566.13195..
Keywords: Social Determinants of Health, Disparities, Health Insurance, Access to Care, Genetics, Policy
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Senft N, Butler E, Everson J
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
This study examined trends in eHealth disparities before and after the introduction of US federal financial incentives. The investigators compared rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. The investigators concluded that disparities in provider messaging widened over time, particularly following federal financial incentives.
AHRQ-funded; HS26395; HS26122.
Citation: Senft N, Butler E, Everson J .
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
J Med Internet Res 2019 Oct 7;21(10):e14976. doi: 10.2196/14976..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Disparities, Clinician-Patient Communication, Communication, Policy
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
AHRQ-funded; HS021973.
Citation: Kemmick Pintor J, Call KT .
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
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
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
fRIEDMAN j, Saavedra-Avendano B, Schiavon R
Quantifying disparities in access to public-sector abortion based on legislative differences within the Mexico City metropolitan area.
This study examined abortion access and use in the Mexico City metropolitan area, where it is only legal in the city center. Researchers calculated abortion rates for 75 municipalities in the metropolitan area for 2011-2012. Abortion rates were much lower for women who had to travel into the city center (18.6%) than if they had local access. Each additional 15 minutes of travel reduced access by 33.7%. Women who did travel were most likely in a higher socioeconomic status with a higher education level.
AHRQ-funded; HS025155; HS022981.
Citation: fRIEDMAN j, Saavedra-Avendano B, Schiavon R .
Quantifying disparities in access to public-sector abortion based on legislative differences within the Mexico City metropolitan area.
Contraception 2019 Mar;99(3):160-64. doi: 10.1016/j.contraception.2018.11.012..
Keywords: Access to Care, Disparities, Policy, Women
Wisk LE, Sharma N
Inequalities in young adult health insurance coverage post-federal health reform.
The article investigates disparities in the insurance coverage of young adults before and after the implementation of the Affordable Care Act (ACA). Data from the 2000-2016 National Health Interview Survey was used to compare the effects of the ACA on three groups, aged 13 to 18, 19 to 25, and 26 to 30, with the 19 to 25 group considered as “young adults” for the purposed of this study. Respondents reported their types of health insurance coverage during the last 12 months, their reasons for being uninsured, and sociodemographic information. The article concludes that the ACA significantly impacted insurance coverage for young adults, but disparities remain.
AHRQ-funded; HS022986.
Citation: Wisk LE, Sharma N .
Inequalities in young adult health insurance coverage post-federal health reform.
J Gen Intern Med 2019 Jan;34(1):65-74. doi: 10.1007/s11606-018-4723-0..
Keywords: Disparities, Health Insurance, Policy, Social Determinants of Health, Young Adults
Barnett ML, Clark KL, Sommers BD
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
This study examined patient satisfaction among Medicaid enrollees nationally from 2014-2015. Significant disparities were found among racial/ethnic groups. Managed care enrollees had higher satisfaction ratings than those with fee-for-service. If the patient had a personal doctor that increased satisfaction for an average 4.6 percent.
AHRQ-funded; HS021291.
Citation: Barnett ML, Clark KL, Sommers BD .
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
Health Aff 2018 Oct;37(10):1647-55. doi: 10.1377/hlthaff.2018.0505..
Keywords: Access to Care, Disparities, Medicaid, Patient Experience, Policy, Racial and Ethnic Minorities
Mehrotra S, Kilambi V, Bui K
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Policymakers are deliberating policy reforms to reduce geographic disparity in liver allocation. This study conducted simulations comparing current allocation with the neighborhoods and sharing policies. The study concluded that the current 11 districts can be adapted systematically by adding neighboring donor service areas (DSAs) to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements.
AHRQ-funded; HS024840.
Citation: Mehrotra S, Kilambi V, Bui K .
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Transplantation 2018 Feb;102(2):255-78. doi: 10.1097/tp.0000000000001934..
Keywords: Access to Care, Disparities, Policy, Transplantation
Kumar K, Holscher CM, Luo X
Persistent regional and racial disparities in nondirected living kidney donation.
Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. The authors of this study hypothesized that the initial geographic clustering and racial disparities may have improved due to an increase in NDLDs. The authors found that despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.
AHRQ-funded; HS024600.
Citation: Kumar K, Holscher CM, Luo X .
Persistent regional and racial disparities in nondirected living kidney donation.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13135..
Keywords: Disparities, Health Services Research (HSR), Policy, Transplantation, Racial and Ethnic Minorities
Cook BL, Zuvekas SH, Chen J
Assessing the individual, neighborhood, and policy predictors of disparities in mental health care.
This study assessed individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. It found that racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with whites.
AHRQ-authored; AHRQ-funded; HS021486.
Citation: Cook BL, Zuvekas SH, Chen J .
Assessing the individual, neighborhood, and policy predictors of disparities in mental health care.
Med Care Res Rev 2017 Aug;74(4):404-30. doi: 10.1177/1077558716646898.
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Keywords: Disparities, Medical Expenditure Panel Survey (MEPS), Behavioral Health, Policy, Racial and Ethnic Minorities
Novak P, Williams-Parry KF, Chen J
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
The objective of this study is to explore the population characteristics of the remaining uninsured individuals with and without behavioral health disorders (BHDs) and to examine whether the factors that contribute to racial and ethnic disparities in the likelihood of being uninsured were different after ACA. The major factor associated with the ethnic disparity among those with BHDs was the immigrant status of Latinos, and the major factor associated with racial disparity was geographic location.
AHRQ-authored; AHRQ-funded; HS022135.
Citation: Novak P, Williams-Parry KF, Chen J .
Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the ACA expansion of dependent coverage.
J Racial Ethn Health Disparities 2017 Aug;4(4):607-14. doi: 10.1007/s40615-016-0264-6.
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Keywords: Behavioral Health, Disparities, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Heintzman J, Bailey SR, DeVoe J
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
This study compared the insurance status of low-income patients served in 23 community health centers (CHCs) in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion in 2014. It found that among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos.
AHRQ-funded; HS021522; HS024270.
Citation: Heintzman J, Bailey SR, DeVoe J .
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
J Racial Ethn Health Disparities 2017 Jun;4(3):329-36. doi: 10.1007/s40615-016-0232-1.
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Keywords: Disparities, Health Insurance, Policy, Low-Income, Racial and Ethnic Minorities
DeMeester RH, Xu LJ, Nocon RS
Solving disparities through payment and delivery system reform: a program to achieve health equity.
In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction.
AHRQ-funded; HS000084.
Citation: DeMeester RH, Xu LJ, Nocon RS .
Solving disparities through payment and delivery system reform: a program to achieve health equity.
Health Aff 2017 Jun;36(6):1133-39. doi: 10.1377/hlthaff.2016.0979.
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Keywords: Disparities, Healthcare Delivery, Payment, Policy
Sampson UK, Kaplan RM, Cooper RS
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. Details of the panel's remarks and recommendations are provided in this report.
AHRQ-authored.
Citation: Sampson UK, Kaplan RM, Cooper RS .
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
J Am Coll Cardiol 2016 Aug 2;68(5):517-24. doi: 10.1016/j.jacc.2016.04.059.
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Keywords: Access to Care, Disparities, Guidelines, Policy
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Ross RE, Garfield LD, Brown DS
The Affordable Care Act and implications for health care services for American Indian and Alaska Native individuals.
This paper summarizes the Affordable Care Act provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the Indian Health Service.
AHRQ-funded; HS020269.
Citation: Ross RE, Garfield LD, Brown DS .
The Affordable Care Act and implications for health care services for American Indian and Alaska Native individuals.
J Health Care Poor Underserved 2015 Nov;26(4):1081-8. doi: 10.1353/hpu.2015.0129.
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Keywords: Disparities, Policy, Health Status, Health Services Research (HSR), Racial and Ethnic Minorities
Davis AE, Mehrotra S, Ladner DP
Changes in geographic disparity in kidney transplantation since the final rule.
The researchers assessed the significance of changes of geographic disparities for four metrics since the 1998 adoption of HHS Final Rule’s emphasizing objective priority criteria: waiting times, transplant rates, pre-transplant mortality, and organ quality. They found that the ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Ladner DP .
Changes in geographic disparity in kidney transplantation since the final rule.
Transplantation 2014 Nov 15;98(9):931-6. doi: 10.1097/tp.0000000000000446..
Keywords: Transplantation, Disparities, Policy, Outcomes
Davis AE, Mehrotra S, Kilambi V
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
This study examined the effect of Statewide Sharing on geographic allocation disparity over time between donor service areas (DSAs) within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin). Findings suggested that changes which are untested run the risk of unintended consequences, and Statewide Sharing should be further studied and considered.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Kilambi V .
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
Clin J Am Soc Nephrol 2014 Aug 7;9(8):1449-60. doi: 10.2215/cjn.05350513.
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Keywords: Chronic Conditions, Disparities, Kidney Disease and Health, Policy, Transplantation
Clancy CM, Moy E
Commentary: measuring what matters most.
The authors discuss a Milbank Quarterly best practices article by Frank and Haw and how it relates to AHRQ's National Healthcare Disparities Report, concluding that helping policymakers glean the information they most need from an overload of data noise will improve the chances that critical disparities can be recognized, targeted, and eliminated.
AHRQ-authored.
Citation: Clancy CM, Moy E .
Commentary: measuring what matters most.
Milbank Q 2013 Mar;91(1):201-4. doi: 10.1111/milq.12008.
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Keywords: Disparities, Quality of Care, Health Status, Policy, Social Determinants of Health
