National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- (-) Access to Care (16)
- Ambulatory Care and Surgery (1)
- Behavioral Health (2)
- Care Management (1)
- Children/Adolescents (3)
- Community-Based Practice (1)
- COVID-19 (1)
- Dental and Oral Health (1)
- Disparities (1)
- (-) Emergency Department (16)
- Emergency Medical Services (EMS) (3)
- Healthcare Cost and Utilization Project (HCUP) (4)
- Healthcare Costs (1)
- Healthcare Delivery (2)
- Healthcare Utilization (4)
- Health Information Technology (HIT) (1)
- Health Insurance (3)
- Health Services Research (HSR) (1)
- Hospitalization (1)
- Hospitals (5)
- Inpatient Care (1)
- Medicaid (3)
- Mortality (1)
- Opioids (1)
- Outcomes (2)
- Policy (2)
- Primary Care (1)
- Public Health (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Rural Health (2)
- Surgery (3)
- Telehealth (1)
- Vulnerable Populations (2)
- Workforce (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedDecker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
Cutler GJ, Bergmann KR, Doupnik SK
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
The purpose of this study was to explore the author’s previous research findings on trends in pediatric emergency department (ED) visits for mental health (MH) vs non-mental health in light of more recent related data corresponding with the COVID-19 pandemic. The study found that recent research supports the dramatic increase in pediatric MH ED visits found in the author’s previous research and provides additional evidence that the increase has been driven by specific MH diagnoses. The researchers conclude that depressive disorders, self-harm behavior, and non-alcohol substance use disorders should be prioritized for the development of ED- and hospital-based strategies, and that EDs, hospitals, health systems, and the government urgently need to increase capacity for MH services and identify innovative solutions to improve access to high quality MH care for children.
AHRQ-funded; HS026385.
Citation: Cutler GJ, Bergmann KR, Doupnik SK .
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
Acad Pediatr 2022 Aug;22(6):889-91. doi: 10.1016/j.acap.2022.03.015..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department, Access to Care, Public Health, Inpatient Care
Allen L, Cummings JR, Hockenberry JM
The impact of urgent care centers on nonemergent emergency department visits.
This study looked at the impact of urgent care centers on nonemergency emergency department (ED) use. Secondary data from a novel urgent care center database, linked to the HCUP State Emergency Department Databases (SEDD) from six states was used. Data from ZIP codes with no urgent care centers served as a control group compared to areas with local urgent care centers. Having an open urgent care center in a ZIP code reduced the total number of ED visits by residents by 17.2% largely due to visits for less urgent conditions. The effect was concentrated in areas with hospitals with the longest ED wait times. The total number of uninsured visits to the ED were reduced by 21% and for Medicaid visits by 29.1%.
AHRQ-funded; HS2484501.
Citation: Allen L, Cummings JR, Hockenberry JM .
The impact of urgent care centers on nonemergent emergency department visits.
Health Serv Res 2021 Aug;56(4):721-30. doi: 10.1111/1475-6773.13631..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Access to Care
Ingraham AM, Chaffee SM, Ayturk MD
Gaps in emergency general surgery coverage in the United States.
Researchers sought to measure gaps in round-the-clock emergency general surgery (EGS) care via a survey of all US adult acute care general hospitals with an emergency room, at least 1 operating room. They found that 17.1% of hospitals responding were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for this lack. However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
AHRQ-funded; HS025224; HS022694.
Citation: Ingraham AM, Chaffee SM, Ayturk MD .
Gaps in emergency general surgery coverage in the United States.
Ann Surg Open 2021 Mar;2(1). doi: 10.1097/as9.0000000000000043..
Keywords: Surgery, Emergency Department, Hospitals, Access to Care, Workforce
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
AHRQ-funded; HS025378.
Citation: Myong C, Hull P, Price M .
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords: Community-Based Practice, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, Policy
Melnikow J, Evans E, Xing G
Primary care access to new patient appointments for California Medicaid enrollees: a simulated patient study.
Investigators evaluated variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California and its relationship to emergency department (ED) use after Medicaid expansion. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used. The investigators found that access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Further, counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees.
AHRQ-funded; HS022236.
Citation: Melnikow J, Evans E, Xing G .
Primary care access to new patient appointments for California Medicaid enrollees: a simulated patient study.
Ann Fam Med 2020 May;18(3):210-17. doi: 10.1370/afm.2502..
Keywords: Primary Care, Access to Care, Medicaid, Health Insurance, Emergency Department, Healthcare Utilization
Mohr NM, Wu C, Ward MJ
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
The objective of this study was to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Results showed that VHA inter-facility transfer was commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.
AHRQ-funded; HS025753.
Citation: Mohr NM, Wu C, Ward MJ .
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
BMC Health Serv Res 2020 Feb 12;20(1):110. doi: 10.1186/s12913-020-4956-6..
Keywords: Emergency Department, Hospitals, Healthcare Delivery, Access to Care, Rural Health
Vakkalanka JP, Harland KK, Wittrock A
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
The purpose of this retrospective propensity-matched cohort study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt. The authors suggest that the role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.
AHRQ-funded; HS025753.
Citation: Vakkalanka JP, Harland KK, Wittrock A .
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
J Epidemiol Community Health 2019 Nov;73(11):1033-39. doi: 10.1136/jech-2019-212623..
Keywords: Telehealth, Rural Health, Access to Care, Behavioral Health, Health Information Technology (HIT), Healthcare Delivery, Care Management, Outcomes, Emergency Department
Ricci KB, Rushing AP, Ingraham AM
The association between self-declared acute care surgery services and operating room access: results from a national survey.
In this study, the investigators conducted a national survey on emergency general surgery (EGS) structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared with a traditional general surgeon on call (GSOC) approach.
AHRQ-funded; HS022694.
Citation: Ricci KB, Rushing AP, Ingraham AM .
The association between self-declared acute care surgery services and operating room access: results from a national survey.
J Trauma Acute Care Surg 2019 Oct;87(4):898-906. doi: 10.1097/ta.0000000000002394..
Keywords: Surgery, Emergency Department, Access to Care
Hsuan C, Hsia RY, Horwitz JR
Ambulance diversions following public hospital emergency department closures.
The purpose of this study was to examine whether hospitals are more likely to temporarily close their emergency departments to ambulances, through ambulance diversions, if neighboring diverting hospitals are public vs private. Results showed that sample hospitals respond differently to diversions by neighboring public (vs private) hospitals. The authors conclude that these findings suggest that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.
AHRQ-funded; HS024247.
Citation: Hsuan C, Hsia RY, Horwitz JR .
Ambulance diversions following public hospital emergency department closures.
Health Serv Res 2019 Aug;54(4):870-79. doi: 10.1111/1475-6773.13147..
Keywords: Access to Care, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Hospitals
Daniel VT, Rushing AP, Ingraham AM
Association between operating room access and mortality for life-threatening general surgery emergencies.
Few diseases truly require emergency surgery today. In this study, the authors investigated the relationship between access to operating room (OR) and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. The investigators concluded that round-the-clock availability of personnel, specifically emergency general surgeons and recovery room nurses, is associated with decreased mortality.
AHRQ-funded; HS022694.
Citation: Daniel VT, Rushing AP, Ingraham AM .
Association between operating room access and mortality for life-threatening general surgery emergencies.
J Trauma Acute Care Surg 2019 Jul;87(1):35-42. doi: 10.1097/ta.0000000000002267..
Keywords: Access to Care, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Surgery
Kenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
AHRQ-funded; HS024299.
Citation: Kenyon CC, Gruschow SM, Haaland WL .
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Ray KN, Olson LM, Edgerton EA
Access to high pediatric-readiness emergency care in the United States.
The researchers determined the geographic accessibility of emergency departments (EDs) with high pediatric readiness by assessing the percentage of US children living within a 30-minute drive time of an ED with high pediatric readiness, as defined by collaboratively developed published guidelines. They concluded that a significant proportion of US children do not have timely access to EDs with high pediatric readiness.
AHRQ-funded; HS022989.
Citation: Ray KN, Olson LM, Edgerton EA .
Access to high pediatric-readiness emergency care in the United States.
J Pediatr 2018 Mar;194:225-32.e1. doi: 10.1016/j.jpeds.2017.10.074.
.
.
Keywords: Access to Care, Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Children/Adolescents
Figueiredo R, Dempster L, Quinonez C
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
The researchers evaluated emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). They found that over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. They concluded that access to dental care is inadequate and that ED settings are ineffective for treatment of dental problems.
AHRQ-funded; HS014129.
Citation: Figueiredo R, Dempster L, Quinonez C .
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
J Health Care Poor Underserved 2016;27(2):860-8. doi: 10.1353/hpu.2016.0081.
.
.
Keywords: Access to Care, Dental and Oral Health, Emergency Department, Vulnerable Populations
Lee DC, Carr BG, Smith TE
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. Emergency volume increased nearly twice as fast at tertiary referral centers (4.8 percent) and nonurban hospitals (3.7 percent versus urban at 2.1 percent) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth.
AHRQ-funded; HS018362; HS010914.
Citation: Lee DC, Carr BG, Smith TE .
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
Popul Health Manag 2015 Dec;18(6):459-66. doi: 10.1089/pop.2014.0123.
.
.
Keywords: Emergency Medical Services (EMS), Emergency Department, Hospitals, Access to Care