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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
176 to 200 of 417 Research Studies DisplayedBerdahl T, Biener A, McCormick MC
AHRQ Author: Berdahl T
Annual report on children's healthcare: healthcare access and utilization by obesity status in the United States.
This study examined access to care and utilization patterns across a set of healthcare measures by obesity status and sociodemographic characteristics among children. Data from the Medical Expenditure Panel Survey (MEPS) from 2010-2015 was used to determine obesity status, number of well-child visits, access to a usual source of care, number of preventive dental visits and prescription medication fills in the past year. It was found that uninsured adolescents with obesity were less like to have a usual source of care provider than children without obesity. Among younger children, those living in the Northeast were more than twice as likely to have had a well-child visit than those living in the West. Preventive dental care was less likely to have occurred for children with obesity than non-obese children. More prescription refills were completed for obese adolescents than for younger children.
AHRQ-authored.
Citation: Berdahl T, Biener A, McCormick MC .
Annual report on children's healthcare: healthcare access and utilization by obesity status in the United States.
Acad Pediatr 2020 Mar;20(2):175-87. doi: 10.1016/j.acap.2019.11.020..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Access to Care, Healthcare Utilization, Obesity
Gregory EF, Upadhya KK, Cheng TL
AHRQ Author: Mistry KB
Enabling factors associated with receipt of interconception health care.
This study examined factors associated with receipt of preventive health care between pregnancies (interconception) using data from a study at four health centers in the Baltimore metropolitan area. The Anderson’s Model of Health Services Use model was used to identify data on factors up to 15 months postpartum. Factors included health history, self-rated health, demographics, predisposing factors, and enabling factors. The cohort included 376 women who were predominantly non-Hispanic Black (84%), and low income. Two enabling factors were associated with receipt of care: having a personal doctor or nurse and having non-Medicaid insurance.
AHRQ-authored
Citation: Gregory EF, Upadhya KK, Cheng TL .
Enabling factors associated with receipt of interconception health care.
Matern Child Health J 2020 Mar;24(3):275-82. doi: 10.1007/s10995-019-02850-0..
Keywords: Maternal Care, Prevention, Pregnancy, Healthcare Utilization, Women, Access to Care
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
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J .
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, Quality of Care
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery
Kirby JB, Yabroff KR
AHRQ Author: Kirby JB
Rural-urban differences in access to primary care: beyond the usual source of care provider.
This study used 2014-2016 MEPS data to analyze differences between rural and urban areas to primary care access beyond the usual source of care provider. While rural residents were more likely to have a usual source of care, they were less likely to have a provider with office hours on nights and weekends.
AHRQ-authored.
Citation: Kirby JB, Yabroff KR .
Rural-urban differences in access to primary care: beyond the usual source of care provider.
Am J Prev Med 2020 Jan;58(1):89-96. doi: 10.1016/j.amepre.2019.08.026..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Primary Care, Rural Health, Urban Health, Health Services Research (HSR)
Bernard D, Fang Z
AHRQ Author: Bernard D
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
Researchers examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Using MEPS data, they found that public insurance provides protection against high burdens but not against forgoing or delaying care. They recommended that future research investigate whether, and to what extent, barriers to care are associated with worse health outcomes and higher costs in the long term.
AHRQ-authored.
Citation: Bernard D, Fang Z .
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
J Am Heart Assoc 2019 Dec 17;8(24):e008831. doi: 10.1161/jaha.118.008831..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Heart Disease and Health, Cardiovascular Conditions, Access to Care
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Vu JV, Gunaseelan V, Dimick JB
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Black patients and older adults are less likely to receive minimally invasive hernia repair. In this study, the investigators explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. The investigators concluded that race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients.
AHRQ-funded; HS025778.
Citation: Vu JV, Gunaseelan V, Dimick JB .
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Surg Endosc 2019 Dec;33(12):4032-37. doi: 10.1007/s00464-019-06695-0..
Keywords: Racial and Ethnic Minorities, Surgery, Elderly, Access to Care, Healthcare Utilization
Kirby JB, Zuvekas SH, Borsky AE
AHRQ Author: Kirby JB, Zuvekas SH, Borsky AE, Ngo-Metzger Q.
Rural residents with mental health needs have fewer care visits than urban counterparts.
This analysis compared the number of adults with mental health needs living in rural areas compared to those in urban areas. A nationally representative sample of adults showed that there were fewer ambulatory mental health visits for rural residents, even with those already on prescription medications for mental health conditions.
AHRQ-authored.
Citation: Kirby JB, Zuvekas SH, Borsky AE .
Rural residents with mental health needs have fewer care visits than urban counterparts.
Health Aff 2019 Dec;38(12):2057-60. doi: 10.1377/hlthaff.2019.00369..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Rural Health, Access to Care, Healthcare Utilization
Wong MS, Arnold CM, Roberts ET
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
The primary aim of this study was to examine the relationship between participation in federal housing assistance programs and self-reported cancer screening among low-income adults. The investigators concluded that their results reinforced the need to improve rates of screening and suggested that providing housing assistance, in and of itself, may be insufficient to overcome the multiple access barriers that low-income populations face.
AHRQ-funded; HS000029.
Citation: Wong MS, Arnold CM, Roberts ET .
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
J Gen Intern Med 2019 Dec;34(12):2714-16. doi: 10.1007/s11606-019-05037-z..
Keywords: Cancer, Screening, Low-Income, Vulnerable Populations, Access to Care, Healthcare Utilization, Social Determinants of Health
Broder-Fingert S, Kuhn J, Sheldrick RC
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Researchers describe a study protocol for a large randomized controlled trial using the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions. They apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. In this paper, they describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.
AHRQ-funded; HS022242.
Citation: Broder-Fingert S, Kuhn J, Sheldrick RC .
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Trials 2019 Dec 16;20(1):728. doi: 10.1186/s13063-019-3853-y..
Keywords: Research Methodologies, Health Services Research (HSR), Healthcare Delivery, Behavioral Health, Evidence-Based Practice, Access to Care
Capo-Lugo CE, Askew RL, Naidech A
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
The goal of this single-center longitudinal observational study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Findings showed that approximately 1 in 4 study participants with acute stroke received neither a consultation nor an intervention. The authors conclude that efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
AHRQ-funded; HS000078.
Citation: Capo-Lugo CE, Askew RL, Naidech A .
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
Phys Ther 2019 Nov 25;99(11):1431-42. doi: 10.1093/ptj/pzz116..
Keywords: Disabilities, Stroke, Cardiovascular Conditions, Access to Care
Biener AI, Zuvekas SH
AHRQ Author: Zuvekas SH
Do racial and ethnic disparities in mental health treatment vary with underlying mental health?
AHRQ-authored.
Citation: Biener AI, Zuvekas SH .
Do racial and ethnic disparities in mental health treatment vary with underlying mental health?
Med Care Res Rev 2021 Aug;78(4):392-403. doi: 10.1177/1077558720903589..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Disparities, Racial and Ethnic Minorities, Access to Care
Olivieri-Mui BL, Koethe B, Briesacher B
Economic barriers to antiretroviral therapy in nursing homes.
In this study, the investigators’ aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). They concluded that people living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers.
AHRQ-funded; HS025662.
Citation: Olivieri-Mui BL, Koethe B, Briesacher B .
Economic barriers to antiretroviral therapy in nursing homes.
J Am Geriatr Soc 2020 Apr;68(4):777-82. doi: 10.1111/jgs.16288..
Keywords: Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Medication, Access to Care
Rice WS, Stringer KL, Sohail M
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
Limited studies to date assess barriers to and facilitators of pre-exposure prophylaxis (PrEP) uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. In this study, the investigators examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama.
AHRQ-funded; HS013852.
Citation: Rice WS, Stringer KL, Sohail M .
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
AIDS Behav 2019 Nov;23(11):2966-79. doi: 10.1007/s10461-019-02591-9..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Healthcare Utilization, Patient-Centered Healthcare, Racial and Ethnic Minorities, Health Literacy, Education: Patient and Caregiver, Access to Care, Health Promotion
Nguyen KH, Trivedi AN
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
This study compared coverage and access to care between non-Hispanic White and Asian American adults after the ACA in California. The data was disaggregated into the five most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). The outcomes measured were 1) being uninsured, 2) having a usual source of care, 3) delaying necessary medical care, and 4) delaying necessary prescription medications. The sample included 19,201 non-Hispanic White and 3077 Asian American adults aged 18 to 64 in California. Koreans were significantly less likely to report a usual source of care relative to non-Hispanic whites while Chinese and Vietnamese adults were significantly less likely to delay necessary care.
AHRQ-funded; HS000011.
Citation: Nguyen KH, Trivedi AN .
Asian American access to care in the Affordable Care Act era: findings from a population-based survey in California.
J Gen Intern Med 2019 Nov;34(11):2660-68. doi: 10.1007/s11606-019-05328-5..
Keywords: Racial and Ethnic Minorities, Access to Care, Disparities, Health Insurance, Uninsured, Policy
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE .
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Murphy CC, Lee SJC, Gerber DE
Patient and provider perspectives on delivery of oral cancer therapies.
Investigators conducted a qualitative study exploring the range of patient and provider perspectives on oral cancer therapies. Through semi-structured interviews with patients and providers at a tertiary referral center and a county safetynet hospital in Dallas, Texas, they found that nearly all providers described challenges engaging with and educating patients about oral cancer therapies. Despite their initial hypothesis, the researchers also found that safetynet patients encountered few barriers accessing oral therapies when compared to patients receiving care in the tertiary referral center.
AHRQ-funded; HS022418.
Citation: Murphy CC, Lee SJC, Gerber DE .
Patient and provider perspectives on delivery of oral cancer therapies.
Patient Educ Couns 2019 Nov;102(11):2102-09. doi: 10.1016/j.pec.2019.06.019..
Keywords: Cancer, Healthcare Delivery, Access to Care, Patient-Centered Outcomes Research, Care Management
Luo X, Mogul DB, Massie AB
Predicting chance of liver transplantation for pediatric wait-list candidates.
The authors sought to predict the chance of receiving a deceased donor liver transplant (DDLT) for pediatric patients. Their model accurately predicted chance of transplant and was able to predict DDLT at specific follow-up times. They conclude that their model can serve as the basis for an online tool that would provide useful information for pediatric wait-list candidates.
AHRQ-funded; HS023876.
Citation: Luo X, Mogul DB, Massie AB .
Predicting chance of liver transplantation for pediatric wait-list candidates.
Pediatr Transplant 2019 Nov;23(7):e13542. doi: 10.1111/petr.13542..
Keywords: Children/Adolescents, Transplantation, Healthcare Delivery, Access to Care
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
Kim B, Callander D, DiClemente R
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
This study analyzed the New York City geographic distribution of pre-exposure prophylaxis (PrEP) providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. Results showed that neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, and PrEP providers were located in high HIV-incidence neighborhoods. These findings validate the need for ongoing policy interventions in relation to PrEP provider locations in New York City and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
AHRQ-funded; HS026120.
Citation: Kim B, Callander D, DiClemente R .
Location of pre-exposure prophylaxis services across New York City neighborhoods: do neighborhood socio-demographic characteristics and HIV incidence Matter?
AIDS Behav 2019 Oct;23(10):2795-802. doi: 10.1007/s10461-019-02609-2..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Access to Care, Social Determinants of Health
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M,, Bailey SR .
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
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
Holderness H, Angier H, Huguet N
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
The purpose of this study was to understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act Medicaid expansion (emergency department, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Results showed that most newly and returning-insured Medicaid enrollees sought primary care rather than emergency department services and most became established with primary care, suggesting that both insurance and primary care continuity play a role in where patients seek health care services.
AHRQ-funded; HS024270.
Citation: Holderness H, Angier H, Huguet N .
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
Med Care 2019 Oct;57(10):788-94. doi: 10.1097/mlr.0000000000001189..
Keywords: Access to Care, Ambulatory Care and Surgery, Health Insurance, Healthcare Utilization, Medicaid, Policy