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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results
1 to 25 of 32 Research Studies Displayed
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation:
Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords:
Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Keeney T, Joyce NR, Meyers DJ
Persistence of high-need status over time among fee-for-service Medicare beneficiaries.
This study looked outcomes of fee-for-service (FFS) Medicare beneficiaries identified as high-need (HN). The authors used national-level claims data to classify FFS beneficiaries as HN annually among continuously enrolled beneficiaries between 2013 and 2015. They categorized longitudinal patterns in HN status into being never, newly, transiently, and persistently HN and examined differences in patients’ demographic characteristics and outcomes. Beneficiaries were found to break up into 4% persistently HN, 13% transiently HN, and 6% newly HN. Beneficiaries classified as persistently HN had higher mortality, utilization and expenditures, but classification as HN at any time was associated with poor outcomes.
AHRQ-funded; HS000011.
Citation:
Keeney T, Joyce NR, Meyers DJ .
Persistence of high-need status over time among fee-for-service Medicare beneficiaries.
Med Care Res Rev 2021 Oct;78(5):591-97. doi: 10.1177/1077558719901219..
Keywords:
Medicare, Healthcare Utilization
Burgdorf JG, Stuart EA, Arbaje AI
Family caregiver training needs and Medicare home health visit utilization.
This study looked at family caregiver training needs and Medicare home health visit utilization. Medicare home health providers are now required to give family caregiver training, but service intensity is not known. This observational study linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information (OASIS), and Medicare claims data to evaluate the relationship between caregivers’ training needs and number/type of home health visits. A total of 1217 NHATS participants receiving Medicare-funded home health between 2011 and 2016 were included. Nurse visits were more likely when family caregivers had medication management or household chore training needs. Therapy visits were more likely when caregivers had self-care training needs. Aide visits were more likely when caregivers had household chore or self-care training needs. Medication management training needs resulted in an additional 1.06 nursing visits, and household chore training an additional 3.24 total and a subset of 1.32 aide visits.
AHRQ-funded; HS000029.
Citation:
Burgdorf JG, Stuart EA, Arbaje AI .
Family caregiver training needs and Medicare home health visit utilization.
Med Care 2021 Apr;59(4):341-47. doi: 10.1097/mlr.0000000000001487..
Keywords:
Caregiving, Elderly, Home Healthcare, Medicare, Training, Healthcare Utilization
Dinan MA, Wilson LE, Reed SD
Association of 21-gene assay (OncotypeDX) testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption.
This study looked at trends in the association of 21-gene assay testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption from 2001 to 2011. The investigators looked at updated SEER-Medicare data from 2004 and 2011. The cohort included 26,009 patients who met inclusion criteria. Assay use was associated with a decrease in absolute percentage use of chemotherapy by 4.5%, which became even more pronounced from 2008-2011 with a decrease of 6.8%.
AHRQ-funded; HS022189.
Citation:
Dinan MA, Wilson LE, Reed SD .
Association of 21-gene assay (OncotypeDX) testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption.
Clin Breast Cancer 2020 Dec;20(6):487-94.e1. doi: 10.1016/j.clbc.2020.05.010..
Keywords:
Cancer: Breast Cancer, Cancer, Treatments, Genetics, Medicare, Women, Healthcare Utilization
Nazareno J, Zhang W, Silver B
Home health utilization in assisted living settings.
The authors explored the growth in the delivery of home health agency (HHA) services to Medicare beneficiaries in assisted living (AL) compared with other home settings between 2012 and 2014. Their findings suggested that there was a slight growth in the share of HHA services being delivered in AL. HHA recipients in AL were more likely to have cognitive and activities of daily living impairments than those receiving HHA services in other settings. This study is among the first of those to examine HHA utilization in AL.
AHRQ-funded; HS000011.
Citation:
Nazareno J, Zhang W, Silver B .
Home health utilization in assisted living settings.
Med Care Res Rev 2020 Dec;77(6):620-29. doi: 10.1177/1077558719835049..
Keywords:
Elderly, Home Healthcare, Medicare, Healthcare Utilization
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
AHRQ-funded; HS024725.
Citation:
Fung V, Price M, Nierenberg AA .
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords:
Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Wu SS, Bellantoni m, Weiner JP
Geriatric syndrome risk factors among hospitalized postacute Medicare patients.
The purpose of this study was to assess the association of geriatric syndrome risk factors with postacute utilization among hospitalized Medicare patients (both Medicare Advantage [MA] and fee-for-service [FFS] cohorts) and to examine patterns of postacute care for MA and FFS cohorts with high geriatric syndrome risk. The investigators found that geriatric syndrome risk factors not only play a role in postacute care and inpatient utilization in MA and FFS cohorts but also explain different utilizations between MA and FFS cohorts.
AHRQ-funded; HS000029.
Citation:
Wu SS, Bellantoni m, Weiner JP .
Geriatric syndrome risk factors among hospitalized postacute Medicare patients.
Am J Manag Care 2020 Oct;26(10):e319-e26. doi: 10.37765/ajmc.2020.88505..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Risk, Healthcare Utilization, Hospitalization
Wu S, Mulcahy J, Kasper JD
Comparing survey-based frailty assessment to Medicare claims in predicting health outcomes and utilization in Medicare beneficiaries.
The purpose of this study was to assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study.
AHRQ-funded; HS000029.
Citation:
Wu S, Mulcahy J, Kasper JD .
Comparing survey-based frailty assessment to Medicare claims in predicting health outcomes and utilization in Medicare beneficiaries.
J Aging Health 2020 Aug-Sep;32(7-8):764-77. doi: 10.1177/0898264319851995..
Keywords:
Elderly, Medicare, Healthcare Utilization, Risk
Cook BL, Flores M, 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
Hong AS, Levin D, Parker L
Trends in diagnostic imaging utilization among Medicare and commercially insured adults from 2003 through 2016.
This study examined trends in use of noninvasive diagnostic imaging (NDI) among commercially insured individuals compared to Medicare enrollees from 2003 through 2016. There was more of an increase among Medicare enrollees than commercially insured patients, but both showed upward trends until the early 2010’s where trends began to be flat or decline. The notable exception was for CT imaging among commercially insured patients aged 45-64 years and Medicare enrollees after 2012.
AHRQ-funded; HS022418.
Citation:
Hong AS, Levin D, Parker L .
Trends in diagnostic imaging utilization among Medicare and commercially insured adults from 2003 through 2016.
Radiology 2020 Feb;294(2):342-50. doi: 10.1148/radiol.2019191116..
Keywords:
Diagnostic Safety and Quality, Medicare, Imaging, Healthcare Utilization, Health Insurance
Ganguli I, Lupo C, Mainor AJ
Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries.
This study examined the use and outcomes of preoperative electrocardiogram (EKG) for cataract surgery recipients on Medicare. The outcomes measured were cascade events if the EKG results were problematic. The study compared 110,183 cataract surgery recipients with 97,775 non-surgery participants (63.1% female). For the recipient group, 12,408 (11.3%) received a preoperative EKG (65.6% of them were female). Of those, 1978 (15.9%) had at least 1 potential cascade event. Additional tests, treatments, and cardiology visits added an additional estimated $35 million in addition to the $3.2 million spent on preoperative EKGs. Preoperative EKG recipients who were older, had more chronic conditions, lived in more cardiologist-dense areas, or had their EKG performed by a cardiac specialist rather than a primary care physician were more likely to experience a cascade event.
AHRQ-funded; HS023812.
Citation:
Ganguli I, Lupo C, Mainor AJ .
Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries.
JAMA Intern Med 2019 Sep;179(9):1157-308. doi: 10.1001/jamainternmed.2019.1739..
Keywords:
Healthcare Costs, Medicare, Healthcare Utilization, Value, Surgery, Elderly
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
AHRQ-funded; HS023128.
Citation:
Song LD, Newhouse JP, Garcia-De-Albeniz X .
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150..
Keywords:
Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Colla CH, Lewis VA, Stachowski C
Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts.
In this study, researchers examined changes in more and less discretionary condition-specific postacute care use associated with Medicare accountable care organization (ACO) implementation. They found that ACOs decreased spending on postacute care by decreasing use of discretionary services. In addition, ACO implementation was associated with reduced length of stay in skilled nursing facilities, while hip fracture patients used institutional postacute settings at higher rates. The authors also observed decreases in spending, readmission days, and mortality among pneumonia patients.
AHRQ-funded; HS024698.
Citation:
Colla CH, Lewis VA, Stachowski C .
Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts.
Med Care 2019 Jun;57(6):444-52. doi: 10.1097/mlr.0000000000001121..
Keywords:
Injuries and Wounds, Healthcare Costs, Healthcare Utilization, Hospitalization, Medicare, Pneumonia, Stroke, Value
Wickwire EM, Tom SE, Scharf SM
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
The purpose of this study was to examine the impact of untreated insomnia on health care utilization (HCU) among a representative sample of Medicare beneficiaries. Insomnia was defined as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on ICD-9 or at least one prescription filled for an insomnia-related medication in Part D prescription drug files. Researchers compared HCU in the year prior to insomnia diagnosis with non-sleep disordered controls during the same period. The researchers conclude that the individuals in this randomly selected, representative sample with untreated insomnia demonstrated increased HCU and costs across all points of service.
AHRQ-funded; HS024560.
Citation:
Wickwire EM, Tom SE, Scharf SM .
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
Sleep 2019 Apr;42(4). doi: 10.1093/sleep/zsz007..
Keywords:
Healthcare Costs, Healthcare Utilization, Medicare, Sleep Problems
Hanchate AD, Dyer KS, Paasche-Orlow MK
Disparities in emergency department visits among collocated racial/ethnic Medicare enrollees.
In this retrospective cohort study, the investigators estimated emergency department (ED) use differences across Medicare enrollees of different race/ethnicity who were residing in the same zip codes. The investigators found that among Medicare enrollees, blacks and Hispanics had higher ED use rates than whites overall and among subgroups by demographics and socioeconomic status.
AHRQ-funded; HS022242.
Citation:
Hanchate AD, Dyer KS, Paasche-Orlow MK .
Disparities in emergency department visits among collocated racial/ethnic Medicare enrollees.
Ann Emerg Med 2019 Mar;73(3):225-35. doi: 10.1016/j.annemergmed.2018.09.007..
Keywords:
Disparities, Emergency Department, Healthcare Utilization, Medicare, Racial / Ethnic Minorities
Zhou M, Oakes AH, Bridges JFP
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
The goal of this study was to explore health care system factors associated with regional variation in overuse of resources, as measured by the Johns Hopkins Overuse Index (JHOI). Medicare fee-for-service claims data from beneficiaries age 65 was used to calculate the JHOI for 306 hospital referral regions in the U.S. Regions with a higher density of primary care physicians had a lower JHOI, which indicates less systemic overuse. Regional characteristics associated with higher JHOI included the number of acute care hospital beds per 1000 residents and number of hospital-based anesthesiologists, pathologists, and radiologists. The authors conclude that regional variations in health care resources are associated with the level of systemic overuse of health care, and that the role of primary care doctors in reducing overuse deserves further attention.
AHRQ-funded; T32 HS000029.
Citation:
Zhou M, Oakes AH, Bridges JFP .
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
J Gen Intern Med 2018 Dec;33(12):2127-31. doi: 10.1007/s11606-018-4638-9..
Keywords:
Access to Care, Elderly, Healthcare Delivery, Healthcare Utilization, Medicare, Practice Patterns
Chung S, Romanelli RJ, Stults CD
Preventive visit among older adults with Medicare's introduction of annual wellness visit: closing gaps in underutilization.
The study of Medicare beneficiaries aged 65 to 85 from a mixed-payer multispecialty outpatient healthcare organization in northern California between 2007 and 2016, evaluated changes in preventive visit utilization with Medicare's introduction of Annual Wellness Visits (AWVs) in 2011. It further assessed how coverage expansion differentially affected older adults who were previously underutilizing the service.
AHRQ-funded; HS019815.
Citation:
Chung S, Romanelli RJ, Stults CD .
Preventive visit among older adults with Medicare's introduction of annual wellness visit: closing gaps in underutilization.
Prev Med 2018 Oct;115:110-18. doi: 10.1016/j.ypmed.2018.08.018..
Keywords:
Elderly, Healthcare Utilization, Medicare, Prevention
Modi PK, Kaufman SR, Borza T
Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations.
This study assessed whether the level of engagement in accountable care organizations (ACOs) by urologists affected rates of treatment, overtreatment, and spending. The investigators found that ACOs vary widely in treatment, potential overtreatment, and spending for prostate cancer. ACOs with stronger urologist engagement were less likely to treat men with a high risk of noncancer mortality, and this suggests that organizations that better engage specialists may be able to improve the value of specialty care.
AHRQ-funded; HS024728; HS025707; HS024525.
Citation:
Modi PK, Kaufman SR, Borza T .
Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations.
Cancer 2018 Aug;124(16):3364-71. doi: 10.1002/cncr.31573..
Keywords:
Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Medicare
Angraal S, Khera R, Wang Y
Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.
The authors sought to evaluate how the use of coronary artery bypass grafting (CABG) and its outcomes have evolved in different sex and racial subgroups. Using Medicare data, they found that women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. The authors conclude that these findings indicate progress, but further progress is needed.
AHRQ-funded; HS023000.
Citation:
Angraal S, Khera R, Wang Y .
Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among Medicare beneficiaries, 1999-2014.
J Am Heart Assoc 2018 Jul 12;7(14). doi: 10.1161/jaha.118.009014..
Keywords:
Cardiovascular Conditions, Elderly, Evidence-Based Practice, Heart Disease and Health, Healthcare Utilization, Medicare, Outcomes, Patient-Centered Outcomes Research, Racial / Ethnic Minorities, Sex Factors
Hollingsworth JM, Nallamothu BK, Yan P
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
This study examined national Medicare data to determine whether or not Medicare accountable care organizations are associated with reductions in the use of low-value coronary revascularization. The investigators found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.
AHRQ-funded; HS024525; HS024728.
Citation:
Hollingsworth JM, Nallamothu BK, Yan P .
Medicare accountable care organizations are not associated with reductions in the use of low-value coronary revascularization.
Circ Cardiovasc Qual Outcomes 2018 Jun;11(6):e004492. doi: 10.1161/circoutcomes.117.004492..
Keywords:
Cardiovascular Conditions, Healthcare Utilization, Medicare, Heart Disease and Health, Value
Werner RM, Konetzka RT
Trends in post-acute care use among Medicare beneficiaries: 2000 to 2015.
In this research letter, the authors discuss trends in post-acute care use among Medicare beneficiaries from 2000 to 2015. The authors indicate that it is uncertain whether the use of post–acute care benefits patients. They suggest that despite its proliferation, there is little evidence that post–acute care improves key patient outcomes— preventing rehospitalizations or improving functional recovery.
AHRQ-funded; HS024266.
Citation:
Werner RM, Konetzka RT .
Trends in post-acute care use among Medicare beneficiaries: 2000 to 2015.
JAMA 2018 Apr 17;319(15):1616-17. doi: 10.1001/jama.2018.2408.
.
.
Keywords:
Healthcare Utilization, Medicare
Colla CH, Morden NE, Sequist TD
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
This study compared low-value health service use among commercially insured and Medicare populations and explored the influence of payer type on the provision of low-value care. In measuring use of seven Choosing Wisely-identified low-value services, it concluded that low-value care appears driven by factors unrelated to payer type or anticipated reimbursement.
AHRQ-funded; HS023812.
Citation:
Colla CH, Morden NE, Sequist TD .
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
Health Serv Res 2018 Apr;53(2):730-46. doi: 10.1111/1475-6773.12665.
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.
Keywords:
Payment, Healthcare Utilization, Health Services Research (HSR), Medicare, Value
Adrion ER, Kocher KE, Nallamothu BK
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Using multipayer commercial claims for the period 2009-13, the investigators evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In their study period, the use of observation care increased relative to that of short-stay hospitalizations. In addition, total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly--and at rates much higher than spending in the inpatient setting--over the study period.
AHRQ-funded; HS000053.
Citation:
Adrion ER, Kocher KE, Nallamothu BK .
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Health Aff 2017 Dec;36(12):2102-09. doi: 10.1377/hlthaff.2017.0774..
Keywords:
Health Insurance, Healthcare Costs, Healthcare Delivery, Healthcare Utilization, Hospitalization, Hospitals, Medicare
Keohane LM, Trivedi AN, Mor V
Recent health care use and Medicaid entry of Medicare beneficiaries.
The purpose of this study was to examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period.
AHRQ-funded; HS023016.
Citation:
Keohane LM, Trivedi AN, Mor V .
Recent health care use and Medicaid entry of Medicare beneficiaries.
Gerontologist 2017 Oct 1;57(5):977-86. doi: 10.1093/geront/gnw189..
Keywords:
Elderly, Healthcare Utilization, Health Services Research (HSR), Medicaid, Medicare
Yim CK, Barron Y, Moore S
Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization.
Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. This descriptive analysis of Medicare fee-for-service beneficiaries found that home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment.
AHRQ-funded; HS020257.
Citation:
Yim CK, Barron Y, Moore S .
Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization.
Circ Heart Fail 2017 Mar;10(3). doi: 10.1161/circheartfailure.116.003335.
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Keywords:
Cardiovascular Conditions, Heart Disease and Health, Healthcare Utilization, Medicare, Palliative Care
