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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedJames TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study’s objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing receipt and health care use among adults with disabilities.
Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
James TG, Miller MD, McKee MM
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
This study assessed emergency department (ED) condition acuity, length of stay (LOS), and acute ED revisits among deaf and hard-of-hearing (DHH) patients. Findings identified that DHH American Sign Language users have longer ED LOS than non-DHH English-speakers.
AHRQ-funded; HS027537.
Citation: James TG, Miller MD, McKee MM .
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
Acad Emerg Med 2022 Nov;29(11):1290-300. doi: 10.1111/acem.14573..
Keywords: Emergency Department, Disabilities, Vulnerable Populations
Adolphe S, Fernandez-Pastrana I, Scott H
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Primary Care Providers (PCPs) are tasked by the American Academy of Pediatrics to identify children who need special education and ensure that those children receive appropriate related services provided by the Individuals with Disabilities Education Act (IDEA). The IDEA entitles children between the ages of 3 and 21 to free education through individualized education programs (IEPs), and other related supports. The extent of PCP knowledge about the IDEA, special education, and available related support services and how to assess them, is largely unknown. Existing research indicates there is a lack of knowledge, training, and confidence in providers about special education. Boston Medical Center’s (BMC) Engagement and Access to Special Education (EASE) clinic was developed to provide support to the parents and PCPs of children with special education needs. The purpose of this article was to introduce and describe the EASE clinical model as a useful method for PCPs to strengthen their ability to provide appropriate and available comprehensive care to their patients requiring special education. The authors reported that of the 14,000 pediatric patients at the Boston Medical Center, 308 children were referred to the EASE clinic between its inception in 2017 and May 2021. The majority of children were Black non-Hispanic, English-speaking, and male, with an average age of 8.3 at first clinic. During that same time 452 total visits were completed, with a waiting list of less than 90 days. The authors conclude that for primary care practices with patients with special education needs, the BMC EASE clinic can serve as a useful model for improving their ability to provide care.
AHRQ-funded; HS022242.
Citation: Adolphe S, Fernandez-Pastrana I, Scott H .
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Acad Pediatr 2022 May-Jun;24(4):705-07. doi: 10.1016/j.acap.2022.02.011..
Keywords: Children/Adolescents, Caregiving, Patient and Family Engagement, Vulnerable Populations, Disabilities
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing tenure among a heterogeneous population of adults with disabilities.
This study analyzed the permanent supportive housing (PSH) tenure among a heterogenous population of 2093 adults with disabilities participating in a North Carolina PSH program between 2015 and 2018. Participants had a 71% probability of remaining in the housing after 2 years. A lower hazard of PSH departure was associated with older age, female gender, and non-Hispanic/Black race/ethnicity. Severe mental illness was associated with greater departure hazard.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing tenure among a heterogeneous population of adults with disabilities.
Popul Health Manag 2022 Apr;25(2):227-34. doi: 10.1089/pop.2021.0348..
Keywords: Disabilities, Vulnerable Populations
Kenney MK, Chanlongbutra A, Fanflick PL
AHRQ Author: Chanlongbutra A
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
AHRQ-authored.
Citation: Kenney MK, Chanlongbutra A, Fanflick PL .
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords: Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Davidson L, Haynes SC, Favila-Meza A
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
This study investigated patient and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Study setting was four school-based clinics in Northern California with a total of 268 encounters (124 telemedicine and 144 in-person). Parent and therapists reported no difference in experience and perceived quality of care between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child’s subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 12 preferred a physiatrist in-person visit. There was also an average cost savings of $100 per clinic owing to physician milage for in-person visits.
AHRQ-funded; HS025714.
Citation: Davidson L, Haynes SC, Favila-Meza A .
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
Arch Phys Med Rehabil 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Healthcare Costs, Rural Health, Vulnerable Populations, Disabilities, Rural/Inner-City Residents
Horner-Johnson W, Klein KA, Campbell J
Experiences of women with disabilities in accessing and receiving contraceptive care.
This study explored the experiences of women with different types of disability when they attempted to obtain contraceptive care. Four semistructured focus groups were created to sample 17 women with different types of disabilities: physical, intellectual and developmental, blind or low vision, and deaf or hard of hearing. Three main themes were identified in challenges to obtaining high-quality contraceptive care: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Different challenges occurred with different types of disabilities such as inaccessible clinic rooms and examination tables, and inaccessible clinic forms and information. Processes and infrastructure of contraceptive care are based on an assumption of an able-bodied norm.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Klein KA, Campbell J .
Experiences of women with disabilities in accessing and receiving contraceptive care.
J Obstet Gynecol Neonatal Nurs 2021 Nov;50(6):732-41. doi: 10.1016/j.jogn.2021.07.005..
Keywords: Access to Care, Disabilities, Vulnerable Populations, Women, Sexual Health
Abdul-Chani MM, Moreno CP, Reeder JA
Perceived community disability stigma in multicultural, low-income populations: measure development and validation.
Investigators sought to develop and validate a brief bilingual (English/Spanish) perceived disability stigma measure, to compare perceived disability and autism stigma, and to examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity. They found that perceived autism stigma was greater than perceived disability stigma, with Latino parents reporting less perceived disability stigma than white parents. They concluded that their perceived disability stigma scale demonstrated sound psychometric properties, with results suggesting differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.
AHRQ-funded; HS000063.
Citation: Abdul-Chani MM, Moreno CP, Reeder JA .
Perceived community disability stigma in multicultural, low-income populations: measure development and validation.
Res Dev Disabil 2021 Aug;115:103997. doi: 10.1016/j.ridd.2021.103997..
Keywords: Disabilities, Low-Income, Vulnerable Populations, Social Stigma
Arana-Chicas E, Kioumarsi A, Carroll-Scott A
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
The purpose of this qualitative study was to examine barriers and facilitators to mammography among women with intellectual disabilities. During 2015-2016 the researchers administered in-depth interviews with 30 women with intellectual disabilities and their caregivers in Philadelphia. The study found additional evidence supporting prior research on barriers to mammography among women with intellectual disabilities as well as novel barriers (e.g., lack of awareness of breast ultrasound, sedation failing to work, and lack of mammogram education) and novel facilitators (e.g., extended family support and positive attitudes.) The researchers concluded that the study results support the need to address barriers and focus on facilitators to improve the mammography experience in women with intellectual disabilities.
AHRQ-funded; HS023966.
Citation: Arana-Chicas E, Kioumarsi A, Carroll-Scott A .
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
Disabil Soc 2020;35(8):1290-314. doi: 10.1080/09687599.2019.1680348..
Keywords: Women, Disabilities, Vulnerable Populations, Screening, Prevention, Cancer: Breast Cancer, Cancer, Imaging
Sonik RA, Parish SL, Mitra M
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
The objective of this study was to assess patterns of food insecurity before and after initial receipt of Supplemental Security Income (SSI) benefits. The investigators concluded that food insecurity rose prior to SSI entry but may be alleviated by programme benefits. They suggest that greater nutritional supports for SSI applicants awaiting decisions may reduce the burden of food insecurity in this population and improve health outcomes.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
Public Health Nutr 2019 Jul;22(10):1909-13. doi: 10.1017/s1368980019000570..
Keywords: Nutrition, Low-Income, Disabilities, Vulnerable Populations, Social Determinants of Health
Sonik RA, Parish SL, Mitra M
Association of health status with receipt of supplemental security income among individuals with severe disabilities and very low income and assets.
Supplemental Security Income (SSI) is a cash-transfer program for individuals with severe disabilities and very low incomes and assets. The investigators analyzed data from the first 12 waves of the 2008 panel of the Survey of Income and Program Participation. They found that there was a sharp decline in health status among eventual SSI recipients in the year before program entry and a modest improvement and stabilization in health status after entry. The investigators also discuss the limitations and implications of their study.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Association of health status with receipt of supplemental security income among individuals with severe disabilities and very low income and assets.
JAMA Intern Med 2019 Jun;179(6):842-43. doi: 10.1001/jamainternmed.2018.8609..
Keywords: Health Status, Vulnerable Populations, Nutrition, Disabilities, Social Determinants of Health
Wu J, Braunschweig Y, Harris LH
Looking back while moving forward: a justice-based, intersectional approach to research on contraception and disability.
This paper discusses the higher use of female sterilization than long-acting reversible contraception use among women with disabilities compared to women without disabilities. The reasons for that were discussed and the authors advocate for a justice-based intersectional approach to research on contraception and disability.
AHRQ-funded; HS022981.
Citation: Wu J, Braunschweig Y, Harris LH .
Looking back while moving forward: a justice-based, intersectional approach to research on contraception and disability.
Contraception 2019 May;99(5):267-71. doi: 10.1016/j.contraception.2019.01.006..
Keywords: Disabilities, Sexual Health, Vulnerable Populations, Women
Horner-Johnson W, Biel FM, Caughey AB
Differences in prenatal care by presence and type of maternal disability.
This study examined timing and frequency of prenatal care of women with disabilities by disability type. A retrospective cohort study was done of all births in California from 2000-2012. Women with intellectual/developmental disabilities, or limited hearing had the most significant risk of receiving less prenatal care compared to women with physical disabilities. However women with intellectual/developmental or physical disabilities may have a higher than normal number of prenatal visits. Delays in prenatal care may result in poorer birth outcomes.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Caughey AB .
Differences in prenatal care by presence and type of maternal disability.
Am J Prev Med 2019 Mar;56(3):376-82. doi: 10.1016/j.amepre.2018.10.021..
Keywords: Disabilities, Healthcare Utilization, Pregnancy, Vulnerable Populations, Women
Zuckerman KE, Chavez AE, Regalado Murillo C
Disparities in familiarity with developmental disabilities among low-income parents.
Parent knowledge about developmental disabilities (DDs) may facilitate access to DD care; however, parents may vary in their knowledge and familiarity with common DDs. The objective of this study was to assess racial/ethnic and language differences in low-income families' familiarity, knowledge, and personal experience with DDs. The investigators concluded that low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Chavez AE, Regalado Murillo C .
Disparities in familiarity with developmental disabilities among low-income parents.
Acad Pediatr 2018 Nov - Dec;18(8):944-51. doi: 10.1016/j.acap.2018.06.011..
Keywords: Disabilities, Children/Adolescents, Caregiving, Health Literacy, Low-Income, Vulnerable Populations, Racial and Ethnic Minorities
Perez Jolles M, Thomas KC
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
The purpose of this study was to examine variation in caregiver service experience concordant with care in patient-centered medical home (PCMH) over time and by the characteristics of separate groups of children with special health care needs (CSHCNs). Researchers used 2003-2012 Medical Expenditures Panel Survey data for CSHCNs for cross-sectional pooled data analysis. Their conclusions suggest that disparities remain among high-need CSHCNs. Future research that focuses on a better understanding of how clinical settings tailor this care model, particularly to provide increased access and patient-centered care, is recommended.
AHRQ-funded; HS000032.
Citation: Perez Jolles M, Thomas KC .
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
Med Care 2018 Oct;56(10):840-46. doi: 10.1097/mlr.0000000000000978..
Keywords: Access to Care, Children/Adolescents, Disabilities, Disparities, Medical Expenditure Panel Survey (MEPS), Patient-Centered Healthcare, Vulnerable Populations
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Navarra AM, Schlau R, Murray M
Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS).
The researchers designed and tested the Nursing-Kids Intensity of Care Survey (N-KICS) tool and describe intensity of nursing care for children with complex medical conditions. Their psychometric evaluation confirmed an acceptable standard for reliability and validity and feasibility. Intensity scores were highest for nursing care related to infection control, medication administration, nutrition, diaper changes, hygiene, neurological and respiratory support, and standing program.
AHRQ-funded; HS021470.
Citation: Navarra AM, Schlau R, Murray M .
Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS).
J Pediatr Nurs 2016 May-Jun;31(3):299-310. doi: 10.1016/j.pedn.2015.11.012.
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Keywords: Children/Adolescents, Chronic Conditions, Disabilities, Long-Term Care, Nursing, Vulnerable Populations