National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Arthritis (2)
- Asthma (1)
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- Children/Adolescents (3)
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- Mortality (1)
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- Orthopedics (1)
- (-) Outcomes (16)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (5)
- Prevention (1)
- Public Health (1)
- Quality Improvement (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Risk (2)
- (-) Social Determinants of Health (16)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedTaylor KK, Neiman PU, Bonner S
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
The objective of this study was to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. Researchers used the National Health Interview Survey for 2008-2018 to identify adults aged 18 and older who reported surgery in the past year. The results indicated that unmet social health needs varied significantly by race, ethnicity, and insurance, and were independently associated with poor health among surgical populations.
AHRQ-funded; HS028672; HS027788.
Citation: Taylor KK, Neiman PU, Bonner S .
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
Ann Surg 2023 Aug 1; 278(2):193-200. doi: 10.1097/sla.0000000000005689.
Keywords: Social Determinants of Health, Surgery, Disparities, Outcomes
Apathy NC, Dixit RA, Boxley CL
Variations in physician telemedicine provision.
This study’s objective was to quantify physician variation in telemedicine provisions and the extent to which telemedicine use is explainable by the individual physician, adjusting for temporal, patient, and visit factors. This cross-sectional study used data on adult primary care visits across MedStar Health, Stanford Health Care, and Intermountain Healthcare systems. Primary care physicians who conducted at least 1000 visits between March 13, 2020 and December 31, 2021 were included. Primary care visits were defined in the electronic health record and scheduling systems as completed outpatient visits with those included primary care physicians. The sample consisted of 2,410,471 visits total, with 25.6% via telemedicine seen by 729 physicians. Substantial variation in telemedicine provision was shown across physicians. At least 237 physicians (32.5%) had at least 1 high-outlier week of telemedicine provision. Patient demographics only accounted for 2.3% of the variation in telemedicine use, with the site accounting for 16.3% of the variation. Residual (unexplained) variation accounted for more than half of the explanations. Telemedicine use has slowly declined, largely due to the lack of physical examinations.
AHRQ-funded; HS028255.
Citation: Apathy NC, Dixit RA, Boxley CL .
Variations in physician telemedicine provision.
JAMA Netw Open 2023 Jul; 6(7):e2321955. doi: 10.1001/jamanetworkopen.2023.21955..
Keywords: Low-Income, Social Determinants of Health, Outcomes, Risk
Stransky ML, Fuchu P, Prendergast K
Beyond housing for health: using flexible funds to improve maternal and child health.
The purpose of this article is to describe the Upstreaming Housing for Health’s (UHfH) use of a flexible fund. The UHfH was a pilot program developed and implemented to improve housing stability and decrease health inequities among people with high-risk pregnancies and their babies. The flexible fund is a cash transfer policy that served 50 families from 2019 to 2020 and addressed housing stability and material needs that encouraged family stability within the context of their housing. The researchers found that 76% of the families accessed flexible funds for items such as rental assistance, cribs, and breast pumps, with average financial support of $1343 (standard deviation = $625). The researchers advise that cash transfer policies such as the flexible fund have been shown to positively impact family health and well-being around the world.
AHRQ-funded; HS022242.
Citation: Stransky ML, Fuchu P, Prendergast K .
Beyond housing for health: using flexible funds to improve maternal and child health.
J Urban Health 2022 Dec;99(6):1027-32. doi: 10.1007/s11524-022-00686-8..
Keywords: Children/Adolescents, Behavioral Health, Social Determinants of Health, Outcomes
de Loizaga SR, Schneider K, Beck AF
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
In a retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative, researchers investigated the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. They found that community deprivation was associated with mortality and length of stay for patients with single ventricle congenital heart disease. While patients near the mean deprivation index had a higher hazard of one year mortality compared to those at the extremes of the deprivation index, length of stay and deprivation index were linearly associated, demonstrating the complex nature of socioeconomic factors.
AHRQ-funded; HS021114.
Citation: de Loizaga SR, Schneider K, Beck AF .
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
Pediatr Cardiol 2022 Mar;43(3):605-15. doi: 10.1007/s00246-021-02763-2..
Keywords: Children/Adolescents, Social Determinants of Health, Quality Improvement, Quality of Care, Cardiovascular Conditions, Registries, Outcomes
Bell N, Wilkerson R, Mayfield-Smith K
Community social determinants and health outcomes drive availability of patient-centered medical homes.
This study assessed the geographic distribution of patient-centered medical homes and the community social determinants and health outcomes that drive availability. The authors assessed spatial clusters of mental and physical health surveys; health behaviors; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Counties having lower uninsured rates and lower poverty rates were more likely to have medical homes.
AHRQ-funded; HS026263.
Citation: Bell N, Wilkerson R, Mayfield-Smith K .
Community social determinants and health outcomes drive availability of patient-centered medical homes.
Health Place 2021 Jan;67:102439. doi: 10.1016/j.healthplace.2020.102439..
Keywords: Social Determinants of Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes
Kostelanetz S, Di Gravio C, Schildcrout JS
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
The authors compared patient-reported social determinants of health (SDOH) to the Brokamp Area Deprivation Index (ADI) and then evaluated the association of patient-reported SDOH and ADI with mortality in patients with cardiovascular disease (CVD). They found that the Brokamp ADI is associated with mortality in hospitalized patients with CVD. They recommended that, in the absence of available patient-reported data, hospitals implement the Brokamp ADI as an approximation for patient-reported data to enhance risk stratification of patients with CVD.
AHRQ-funded; HS026122.
Citation: Kostelanetz S, Di Gravio C, Schildcrout JS .
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
Ethn Dis 2021 Winter;31(1):9-22. doi: 10.18865/ed.31.1.9..
Keywords: Social Determinants of Health, Cardiovascular Conditions, Mortality, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Mehta B, Szymonifka J, Dey S
Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.
The objective of this study was to assess the relationship of neighborhood immigrant proportion (IP) to preoperative and 2-year postoperative pain and function after elective total knee arthroplasty (TKA) using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients in a high-volume institutional TKA registry were analyzed retrospectively, and demographics, pre-op and 2-year post-op WOMAC pain and function scores, and addresses obtained. Patient-level variables were linked to Census Bureau tract data. Researchers conclude that patients living in high IP neighborhoods do not have worse pre-op or 2-year post-op pain and function outcomes after TKA compared to those living in lower IP neighborhoods.
AHRQ-funded; HS016075.
Citation: Mehta B, Szymonifka J, Dey S .
Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.
BMC Musculoskelet Disord 2019 Feb 9;20(1):67. doi: 10.1186/s12891-019-2446-y..
Keywords: Arthritis, Outcomes, Patient-Centered Outcomes Research, Racial and Ethnic Minorities, Social Determinants of Health, Surgery
Goodman SM, Mandi LA, Mehta B
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
The authors assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. They found that having no college was associated with worse pain and function at baseline and 2 years and that living in a poor neighborhood was associated with worse 2-year pain and function. There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college; in wealthy communities, college was associated with a 1-point difference in pain. Function was similar. The authors recommended further study on how education protects those in impoverished communities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandi LA, Mehta B .
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
Arthritis Care Res 2018 Jun;70(6):884-91. doi: 10.1002/acr.23442..
Keywords: Arthritis, Education, Low-Income, Orthopedics, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Cardet JC, Louisias M, King TS
Income is an independent risk factor for worse asthma outcomes.
The authors investigated whether low income, low education, and high perceived stress were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. They found that participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
AHRQ-funded; HS022986.
Citation: Cardet JC, Louisias M, King TS .
Income is an independent risk factor for worse asthma outcomes.
J Allergy Clin Immunol 2018 Feb;141(2):754-60.e3. doi: 10.1016/j.jaci.2017.04.036..
Keywords: Asthma, Chronic Conditions, Low-Income, Outcomes, Patient-Centered Outcomes Research, Risk, Social Determinants of Health
Leeds IL, Alimi Y, Hobson DR
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
This study aims to demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup. It concluded that differences in outcomes by race and socioeconomic status did not arise following implementation of an enhanced recovery pathway. Differences in process measures by population subgroups highlight differences in care that require further investigation.
AHRQ-funded; HS024736; HS024547.
Citation: Leeds IL, Alimi Y, Hobson DR .
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
Dis Colon Rectum 2017 Oct;60(10):1092-101. doi: 10.1097/dcr.0000000000000879.
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Keywords: Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Outcomes, Adverse Events
Meddings J, Reichert H, Smith SN
The impact of disability and social determinants of health on condition-specific readmissions beyond Medicare risk adjustments: a cohort study.
This study assessed the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. Outcomes measured were readmissions </=30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. The study concluded that disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.
AHRQ-funded; HS018334.
Citation: Meddings J, Reichert H, Smith SN .
The impact of disability and social determinants of health on condition-specific readmissions beyond Medicare risk adjustments: a cohort study.
J Gen Intern Med 2017 Jan;32(1):71-80. doi: 10.1007/s11606-016-3869-x.
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Keywords: Disabilities, Hospital Readmissions, Outcomes, Social Determinants of Health
Kaplan RM, Milstein A
AHRQ Author: Kaplan RM
Financial strain and cancer outcomes.
This editorial discusses an article by Lathan et al. in the same issue that documents the strong associations between socioeconomic status and longevity. The editorial argues that many of the variables in that article are measured with error and, as a result, the multivariable analysis resulted in only partial adjustment. Two variables of particular importance, education and ethnicity, are discussed.
AHRQ-authored.
Citation: Kaplan RM, Milstein A .
Financial strain and cancer outcomes.
J Clin Oncol 2016 May 20;34(15):1711-2. doi: 10.1200/jco.2016.66.8079.
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Keywords: Cancer, Health Status, Healthcare Costs, Low-Income, Outcomes, Social Determinants of Health, Stress
Berian JR, Paruch JL, Cohen ME
Does performance vary within the same hospital when separately examining different patient subgroups?
The researchers sought to determine whether performance differs within a given hospital for 6 contrasting patient subgroups and to identify the percentage of hospitals with greater than chance differences in performance. They found that overall quality differed for elderly vs nonelderly, renal insufficiency vs normal renal function patients, cancer vs noncancer, and emergency vs nonemergency. They concluded that quality programs can consider separate reports for these subgroups to identify opportunities for quality improvement.
AHRQ-funded; HS021857.
Citation: Berian JR, Paruch JL, Cohen ME .
Does performance vary within the same hospital when separately examining different patient subgroups?
J Am Coll Surg 2016 May;222(5):790-97.e1. doi: 10.1016/j.jamcollsurg.2016.01.057.
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Keywords: Emergency Medical Services (EMS), Hospitals, Outcomes, Quality Improvement, Social Determinants of Health
Bradley EH, Canavan M, Rogan E
Variation in health outcomes: the role of spending on social services, public health, and health care, 2000-09.
This study found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes.
AHRQ-funded; HS017589.
Citation: Bradley EH, Canavan M, Rogan E .
Variation in health outcomes: the role of spending on social services, public health, and health care, 2000-09.
Health Aff 2016 May;35(5):760-8. doi: 10.1377/hlthaff.2015.0814.
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Keywords: Outcomes, Social Determinants of Health, Healthcare Costs, Health Status, Public Health
Cai L, Wu Y, Cheskin LI
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
This study, the first systematic, quantitative study of childhood obesity prevention programs on blood lipids in high-income countries found that most interventions (70 percent) showed similar significant or no effects on adiposity- and lipid outcomes; 15 percent of interventions improved both adiposity- and lipids outcomes; 55 percent had no significant effects on either. These programs had a significant desirable effect on LDL-C and HDL-C.
AHRQ-funded; 290200710061I
Citation: Cai L, Wu Y, Cheskin LI .
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
Obes Rev. 2014 Dec;15(12):933-44. doi: 10.1111/obr.12227..
Keywords: Children/Adolescents, Obesity, Prevention, Outcomes, Social Determinants of Health
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Decision Making, Outcomes, Social Determinants of Health