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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.
Results1 to 25 of 378 Research Studies Displayed
Alvarado F, Cervantes CE, Crews DC
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
The purpose of this systematic qualitative review was to evaluate outcomes in Hispanic donors and examine how Hispanic ethnicity was presented. In October 2021, the researchers reviewed PubMed, EMBASE, and Scopus for studies, with 18 meeting the inclusion criteria. Across the studies, Hispanic donors ranged between 6% and 21% of the donor populations. The study found that Hispanic donors were not at increased risk for end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, overall perioperative surgical complications or post-donation mortality compared to non-Hispanic White donors. Also compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were observed regarding the risk for post-donation chronic kidney disease and hypertension. The researchers concluded that future studies should explain variation in health outcomes by considering and assessing differences within the Hispanic donor population.
Citation: Alvarado F, Cervantes CE, Crews DC . Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review. Am J Transplant 2022 Jul;22(7):1737-53. doi: 10.1111/ajt.17017..
Keywords: Transplantation, Kidney Disease and Health, Chronic Conditions, Racial / Ethnic Minorities, Disparities
Blanco C, Kato EU, Aklin WM
AHRQ Author: Kato EU, Tong ST, Bierman A, Meyers D
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.
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 / Ethnic Minorities, Disparities, Social Determinants of Health
Sanchez JI, Shankaran V, Unger JM
Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors.
This population-based study assesses individual- and neighborhood-level factors associated with receipt of carcinoembryonic antigen (CEA) and computer tomography (CT) surveillance testing. Using SEER-Medicare data to identify beneficiaries diagnosed with colorectal cancer (CRC) stages II-III, they found that, overall, 78% and 58% of CRC survivors received CEA and CT testing, respectively. Further, Medicare-Medicaid dual coverage was associated with 39% lower odds of receipt of CEA tests among non-Hispanic Whites, while Blacks with dual coverage had almost two times the odds of receiving CEA tests compared to Blacks without dual coverage. Although this study did not find significant differences in receipt of initial CEA and CT surveillance testing across racial/ethnic groups, the assessment of the factors that measure access to care suggests differences in access to these procedures within racial/ethnic groups.
Citation: Sanchez JI, Shankaran V, Unger JM . Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors. J Cancer Surviv 2022 Jun;16(3):638-49. doi: 10.1007/s11764-021-01057-z..
Keywords: Disparities, Cancer: Colorectal Cancer, Cancer
Mobley EM, Moke DJ, Milam J
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
This scoping review’s aim was to demonstrate evidence-based approaches to alleviate barriers and decrease disparities among childhood cancer survivors. A literature review identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including 9 clinical practice guidelines, 4 policy statements, and 3 recommendations. Twenty-seven published studies evaluated an intervention; however these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Interventions most commonly evaluated survivorship care plans (n = 11), or models of care (n = 11) followed by individual survivorship care services (n= 9). Interventions predominantly targeted patients rather than providers or systems.
Citation: Mobley EM, Moke DJ, Milam J . Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review. J Cancer Surviv 2022 Jun;16(3):667-76. doi: 10.1007/s11764-021-01060-4..
Keywords: Children/Adolescents, Disparities, Cancer
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
Citation: Jin MC, Hsin G, Ratliff J . Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors. Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Jacobs PD, Abdus S
AHRQ Author: Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
Citation: Jacobs PD, Abdus S . Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States. Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial / Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Kemme S, Yoeli D, Sundaram SS
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
The purpose of the study was to explore and understand the impact of the COVID-19 pandemic on nationwide pediatric liver transplants. The researchers compared data for transplant waiting list additions, removals, and liver transplants during pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020). The study results showed a 38% decrease in liver transplantations during early COVID-19, recovering to pre-pandemic rates during late COVID-19. White children had a 30% decrease in overall liver transplantation, while non-White children had a 44% decrease in overall liver transplantation. Additions to the waiting list decreased 25% during COVID-19, with Black transplant candidates the most affected, and children spent longer on the waiting list during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days). The study concluded that the COVID-19 pandemic decreased access to pediatric liver transplants, especially during early COVID-19. The researchers discussed that although the rate of pediatric liver transplants has resumed to pre-COVID-19 levels, racial disparities must be addressed.
Citation: Kemme S, Yoeli D, Sundaram SS . Decreased access to pediatric liver transplantation during the COVID-19 pandemic. Pediatr Transplant 2022 Mar;26(2):e14162. doi: 10.1111/petr.14162..
Keywords: Children/Adolescents, COVID-19, Transplantation, Access to Care, Disparities
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
Citation: Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA . Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA . Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment. Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial / Ethnic Minorities, Risk
Radhakrishnan A, Reyes-Gastelum D, Abrahamse P
Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities.
The authors sought to characterize providers involved in diagnosing and treating thyroid cancer. Patients with differentiated thyroid cancer from the Georgia and Los Angeles County Surveillance, Epidemiology and End Results registries were surveyed. The authors found that, among thyroid cancer patients, 40.6% reported being informed of their diagnosis by their surgeon, 37.9% by their endocrinologist, and 13.5% by their primary care physician (PCP). The researchers concluded that PCPs were involved in thyroid cancer diagnosis and treatment, and their involvement was greater among older patients and patients of minority race/ethnicity.
Citation: Radhakrishnan A, Reyes-Gastelum D, Abrahamse P . Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities. J Clin Endocrinol Metab 2022 Feb 17;107(3):e1096-e105. doi: 10.1210/clinem/dgab781..
Keywords: Cancer, Disparities, Diagnostic Safety and Quality, Practice Patterns, Quality Improvement, Quality of Care
Reid LD, Weiss AJ, Fingar KR
AHRQ Author: Reid LD
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
The authors assessed how patient, hospital, and community characteristics explain the safety-net hospital (SNH)/non-SNH disparity in postpartum readmission rates. Using HCUP data, they found that higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. They recommended hospital initiatives to reduce the risk of postpartum readmissions among SNH patients. They concluded that improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, will require enduring investments in public health.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Reid LD, Weiss AJ, Fingar KR . Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis. J Hosp Med 2022 Feb;17(2):77-87. doi: 10.1002/jhm.2769..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Safety Net, Hospital Readmissions, Pregnancy, Labor and Delivery, Women, Maternal Care
Lin JS, Hoffman L, Bean SI
Addressing racism in preventive services: methods report to support the US Preventive Services Task Force.
The purpose of this report was to articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. An audit was conducted assessing published literature on policy and position statements addressing racism, a subset of cancer and cardiovascular topics in USPSTF reports, recent systematic reviews on interventions to reduce health inequities, and societies, organizations, agencies, and funding bodies to gather information about how they address racism and health equity. Findings showed that racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. The most directly relevant and immediately useful guidance identified is that from the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group.
Citation: Lin JS, Hoffman L, Bean SI . Addressing racism in preventive services: methods report to support the US Preventive Services Task Force. JAMA 2021 Dec 21;326(23):2412-20. doi: 10.1001/jama.2021.17579..
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Racial / Ethnic Minorities, Disparities, Research Methodologies, Prevention, Evidence-Based Practice
Vervoort D, Canner JK, Haut ER
Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair.
In this study, the authors’ goal was to examine racial disparities associated with reinterventions following elective endovascular abdominal aortic aneurysm repair (EVAR) in a real-world cohort. Using the Vascular Quality Initiative EVAR dataset, they found that Black patients requiring reintervention were more frequently female, more frequently current or former smokers, and less frequently insured by Medicare/Medicaid. After adjusting for baseline differences, the risk of reintervention after elective EVAR was significantly lower for Black versus White patients, and all-cause mortality was comparable between groups. The authors recommended further investigation.
Citation: Vervoort D, Canner JK, Haut ER . Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair. J Surg Res 2021 Dec;268:381-88. doi: 10.1016/j.jss.2021.07.010..
Keywords: Racial / Ethnic Minorities, Disparities, Outcomes
Parikh K, Hall M, Kaiser SV
Development of a health disparities index: proof of concept with chest radiography in asthma.
The objective of this study was to develop a tool for quantifying health disparity (Health Disparity Index[HDI]) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept. The investigators concluded that the HDI provided a practical measure of disparity. They suggested that to improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable.
Citation: Parikh K, Hall M, Kaiser SV . Development of a health disparities index: proof of concept with chest radiography in asthma. J Pediatr 2021 Nov;238:290-95.e1. doi: 10.1016/j.jpeds.2021.07.022..
Keywords: Asthma, Respiratory Conditions, Disparities
Hsueh L, Huang J, Millman AK
Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic.
The authors hypothesized that limited English proficiency (LEP) would be associated with lower video use compared with telephone, especially among patients without prior video visit experience. They found that one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, even after adjusting for technology factors. However, among patients with prior video visit experience, no significant difference in video visit use by LEP was found.
Citation: Hsueh L, Huang J, Millman AK . Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic. JAMA Netw Open 2021 Nov;4(11):e2133129. doi: 10.1001/jamanetworkopen.2021.33129..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Disparities, Communication
Gorman DC, Ham SA, Staab EM
Medical assistant protocol improves disparities in depression screening rates.
This study examined the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting. Findings showed that implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
Citation: Gorman DC, Ham SA, Staab EM . Medical assistant protocol improves disparities in depression screening rates. Am J Prev Med 2021 Nov;61(5):692-700. doi: 10.1016/j.amepre.2021.05.010..
Keywords: Disparities, Depression, Behavioral Health, Screening, Racial / Ethnic Minorities
Ingraham NE, Purcell LN, Karam BS
Racial and ethnic disparities in hospital admissions from COVID-19: determining the impact of neighborhood deprivation and primary language.
This retrospective cohort study evaluated neighborhood-level deprivation and English language proficiency effects on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19. Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4 and August 19, 2020 were used. COVID-19 hospitalization rates were evaluated against the patient’s Area Deprivation Index (ADI) and primary language. A total of 5577 individuals were included, with 866 hospitalized within 45 days of diagnosis. Hospitalized patients were older, and more likely to be male. Minority/race ethnicity was associated with COVID-19 severity, but ADI was not associated with increased hospitalization. Non-English speaking significantly increased odds of hospital admission across and within minority groups.
AHRQ-funded; HS024532; HS26732; HS026379.
Citation: Ingraham NE, Purcell LN, Karam BS . Racial and ethnic disparities in hospital admissions from COVID-19: determining the impact of neighborhood deprivation and primary language. J Gen Intern Med 2021 Nov;36(11):3462-70. doi: 10.1007/s11606-021-06790-w..
Keywords: COVID-19, Hospitalization, Racial / Ethnic Minorities, Disparities
Herb J, Staley BS, Roberson M
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
The investigators’ objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. Data was obtained using Medicare claims. They found that parathyroidectomy was underused and recommended that quality improvement efforts, rooted in equitable care, be undertaken to increase access to parathyroidectomy for this disease.
Citation: Herb J, Staley BS, Roberson M . Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population. Surgery 2021 Nov;170(5):1376-82. doi: 10.1016/j.surg.2021.05.026..
Keywords: Elderly, Disparities, Medicare, Surgery, Racial / Ethnic Minorities
Grafova IB, Jarrín OF
Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity.
This study examined state-level variation in racial/ethnic misclassification of race and ethnicity in the Centers for Medicare and Medicaid Services administrative database using the enrollment database (EDB) beneficiary race code and the Research Triangle Institute (RTI) race code. The cohort included 4,231,370 Medicare beneficiaries who utilized home health care services in 2015. The authors found substantial variation between states in misclassification of self-identified Hispanic, Asian American/Pacific Islander, and American Indian/Alaska Native beneficiaries.
Citation: Grafova IB, Jarrín OF . Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity. Med Care Res Rev 2021 Oct;78(5):616-26. doi: 10.1177/1077558720935733..
Keywords: Medicare, Racial / Ethnic Minorities, Disparities
Nguyen KH, Thorsness R, Hayes S
Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic.
This study examined the impact of COVID-19 on initiation of kidney failure treatment during the first 4 months of the pandemic with a focus on racial, ethnic, and socioeconomic disparities. The study population included 127,149 patients with incident kidney failure between January 2018 and June 2020. The mean age of patients was 62.8 years, and were 41.7% female, 25.9% non-Hispanic Black and 15.6% Hispanic/Latino. There were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation and initiating hemodialysis treatment with an arteriovenous fistula during the first 4 months of the pandemic compared to the pre-COVID-19 period. These decreases were most significant among non-Hispanic Black patients. There were also significant decreases in patients residing in counties in the highest quintile of COVID-19 mortality rates, but not for patients residing in other counties. Treatment initiation was approximately 30% lower than projected in April 2020.
Citation: Nguyen KH, Thorsness R, Hayes S . Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic. JAMA Netw Open 2021 Oct;4(10):e2127369. doi: 10.1001/jamanetworkopen.2021.27369..
Keywords: COVID-19, Kidney Disease and Health, Racial / Ethnic Minorities, Disparities
O'Kane M, Agrawal S, Binder L
AHRQ Author: Meyers D
An equity agenda for the field of health care quality improvement.
The authors of this paper assert that the U.S. health system must take action to centralize equity, particularly racial equity (including ethnicity), in discussions of quality. In this discussion paper, the authors provide an analysis and delineation of the key elements of their racial equity agenda for the field of health care quality improvement.
Citation: O'Kane M, Agrawal S, Binder L . An equity agenda for the field of health care quality improvement. NAM Perspect 2021 Sep 15;2021. doi: 10.31478/202109b..
Keywords: Quality Improvement, Quality of Care, Racial / Ethnic Minorities, Disparities, Social Determinants of Health
Curry CW, Felt D, Kan K
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
Researchers sought to examine adjusted odds of non-remitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional non-remitting asthma risk factors and victimization. Using data from the Youth Risk Behavior Survey, they found that, at the intersections, 8 sexual minority and racial/ethnic minority subpopulations were significantly more likely to have non-remitting asthma compared with White heterosexual sex-matched peers. They concluded that the evidence suggests that traditional non-remitting asthma risk factors and victimization may partly explain disparities in non-remitting asthma.
Citation: Curry CW, Felt D, Kan K . Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017. J Allergy Clin Immunol Pract 2021 Sep;9(9):3396-406. doi: 10.1016/j.jaip.2021.04.046..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Disparities
Trent SA, George N, Havranek EP
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. The objective of this study was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. The investigators concluded that longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care.
Citation: Trent SA, George N, Havranek EP . Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care. Acad Emerg Med 2021 Sep;28(9):1051-60. doi: 10.1111/acem.14235..
Keywords: Evidence-Based Practice, Guidelines, Emergency Department, Disparities, Quality of Care
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
Citation: Markovitz AA, Ayanian JZ, Warrier A . Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements. Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial / Ethnic Minorities
Goyal MK, Chamberlain JM, Webb M
Racial and ethnic disparities in the delayed diagnosis of appendicitis among children.
The objective of this 3-year multicenter retrospective cohort study of children was to determine if there are race/ethnicity differences in rates of appendiceal perforation, delayed diagnosis of appendicitis, and diagnostic imaging during prior visit(s). Delayed diagnosis was defined as having at least one emergency department (ED) visit within 7 days preceding the appendicitis diagnosis. Out of 7,298 patients diagnosed with appendicitis and documented race/ethnicity, 2,567 had appendiceal perforation. Non-Hispanic (NH) Black children had a higher likelihood of perforation (36.5% versus 34.9%) then non-Hispanic whites. They also were over twice as likely to have delayed diagnosis (4.7% versus 2.0%). Eighty-nine patients (43.2%) patients with delayed diagnosis had abdominal imaging during the prior visits. However, NH-Black children were less likely to have any imaging (28.2% versus 46.2%) or definitive imaging (10.3% versus 35.9%).
Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142.
Citation: Goyal MK, Chamberlain JM, Webb M . Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142..
Keywords: Children/Adolescents, Racial / Ethnic Minorities, Disparities, Diagnostic Safety and Quality