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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results101 to 125 of 11623 Research Studies Displayed
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW . Documentation dynamics: note composition, burden, and physician efficiency. Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Roberts ET, Mellor JM, McInerny MP
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Medicare beneficiaries with income levels slightly exceeding the thresholds of eligibility for Medicaid have few affordable options for dental coverage. This gap results in a dental coverage “cliff” above these thresholds. The purpose of this study was to assess how a sudden drop-off in dental coverage from Medicaid impacts access to dental care in low-income Medicare beneficiaries. The researchers studied low-income community resident Medicare recipients whose incomes were within approximately 75 percentage points of state-specific Medicaid income eligibility thresholds. The study found that Medicare beneficiaries whose income was higher than Medicaid eligibility thresholds were 5.0 percentage points more likely to report challenges accessing dental care because of cost concerns or a lack of insurance than beneficiaries below the thresholds.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerny MP . Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries. Health Serv Res 2023 Jun; 58(3):589-98. doi: 10.1111/1475-6773.13981..
Keywords: Dental and Oral Health, Medicaid, Medicare, Health Insurance, Access to Care
Guo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
Citation: Guo W, Cai S, Caprio T . End-of-life care transitions in assisted living: associations with state staffing and training regulations. J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
Citation: Saldanha IJ, Adam GP, Kanaan G . Health insurance coverage and postpartum outcomes in the US: a systematic review. JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Tracer H, Haselby C
AHRQ Author: Tracer H
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
This case study described a 50-year-old woman whose last menstrual cycle was more than a year previous. Case study questions related to the USPSTF recommendation on hormone therapy addressed whether this patient would benefit from hormone therapy to prevent the onset of chronic conditions that become more common after menopause.
Citation: Tracer H, Haselby C . Hormone therapy for the primary prevention of chronic conditions in postmenopausal people. Am Fam Physician 2023 Jun; 107(6):645-46..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Prevention, Chronic Conditions, Women
Harrison MI, Borsky AE
AHRQ Author: Harrison MI
How alignment between health systems and their embedded research units contributes to system learning.
This AHRQ-authored paper examined the organization of learning health system (LHS) research units and conditions affecting their contributions to system improvement and learning. The authors conducted 12 key-informant and 44 semi-structured interviews in six delivery systems engaged in LHS research. Using rapid qualitative analysis, they identified themes and compared successful versus challenging projects; LHS units and other research units in the same system; and LHS units in different systems. They found that LHS units operate both independently and as subunits within larger research centers. Key alignment factors identified were availability of internal (system) funding directing researchers' work toward system priorities; researchers' skills and experiences that fit a system's operational needs; LHS unit subculture supporting system improvement and collaboration with clinicians and other internal stakeholders; applications of external funding to system priorities; and executive leadership for system-wide learning. Direct consultation between LHS unit leaders and system executives and engagement of researchers in clinical and operational activities fostered mutual understanding and collaboration between researchers, clinicians, and leaders.
Citation: Harrison MI, Borsky AE . How alignment between health systems and their embedded research units contributes to system learning. Healthc 2023 Jun; 11(2):100688. doi: 10.1016/j.hjdsi.2023.100688..
Keywords: Health Systems, Learning Health Systems
Ayers DC, Zheng H, Yang W
How back pain affects patient satisfaction after primary total knee arthroplasty.
This study looked at patient-reported outcomes (PROs) for patients with back pain (BP) who underwent total knee arthroscopy (TKA) surgery for pre- and postoperatively. This multicenter cohort study included 9,057 patients undergoing primary unilateral TKA who were enrolled in FORCE-TJ. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire, with BP severity then classified into 4 categories. PROs were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). At 1 year a total of 18.3% TKA patients were dissatisfied. At the time of surgery, a total of 4,765 patients (52.6%) reported back pain, divided into mild BP (24.9%), moderate (20.3%), and severe (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA. The predictive variables for dissatisfaction include age [odds ratio (OR) for younger patients <65 years versus older patients ≥65 years], educational level [OR for post high school versus less], smoking [OR for nonsmoker versus current smoker)], and Charlson comorbidity index [OR for CCI ≥2 versus 0]. The authors recommend surgeons consider a spine evaluation in patients who have severe BP prior to TKA.
Citation: Ayers DC, Zheng H, Yang W . How back pain affects patient satisfaction after primary total knee arthroplasty. J Arthroplasty 2023 Jun; 38(6s):S103-s08. doi: 10.1016/j.arth.2023.03.072..
Keywords: Back Health and Pain, Pain, Pain, Patient Experience, Orthopedics, Surgery
Loomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
Citation: Loomer L, Rahman M, Mroz TM . Impact of higher payments for rural home health episodes on rehospitalizations. J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
Hogg-Graham R, Mamaril CB, Benitez JA
Impact of state Medicaid expansion on cross-sector health and social service networks: evidence from a longitudinal cohort study.
This study’s objective was to examine the impact of state Medicaid expansion on the delivery of population health activities in cross-sector health and social services networks. The authors used data measuring the composition of cross-sector population health networks from the 2006-2018 National Longitudinal Survey of Public Health Systems (NALSYS) linked with the Area Health Resource File. They restricted their data to jurisdictions serving populations of 100,000 or more and states that had NALSYS observations across all time periods, resulting in a final sample size of 667. Results indicated that Medicaid expansion was associated with a 2.3 percentage point increase in the density of population health networks. Communities in states with expanded Medicaid experienced significant increases in the participation of local public health, local government, hospitals, nonprofits, insurers, and K-12 schools. Of the organizations with significant increases in expansion communities, nonprofits (7.7 percentage points,), local public health agencies (6.5 percentage points), hospitals (5.8 percentage points), and local government agencies (6.0 percentage points) had the largest gains.
Citation: Hogg-Graham R, Mamaril CB, Benitez JA . Impact of state Medicaid expansion on cross-sector health and social service networks: evidence from a longitudinal cohort study. Health Serv Res 2023 Jun; 58(3):634-41. doi: 10.1111/1475-6773.14144..
Keywords: Medicaid, Health Insurance, Community-Based Practice, Access to Care
Teixeira da Silva D, Makeneni S, Wall H
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
The purpose of this study was to develop and apply a cross-setting, sexually transmitted infection (STI) Care Continuum to improve STI care quality, to assess adherence to guideline-recommended care, and to standardize progress measurement toward National Strategic goals. Review of the CDC STI treatment guidelines identified seven distinct steps of care for gonorrhea, chlamydia, and syphilis; researchers used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7. The researchers concluded that local application of an STI Care Continuum identified STI testing, retesting, and HIV testing as areas for improvement. Similar methods may be applied to target resources, standardize data collection and reporting, and improve STI care quality.
Citation: Teixeira da Silva D, Makeneni S, Wall H . Measuring quality STI care among adolescent female primary care patients in Philadelphia. Sex Transm Infect 2023 Jun; 99(4):272-75. doi: 10.1136/sextrans-2022-055623..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Women, Human Immunodeficiency Virus (HIV), Quality Measures, Quality of Care
Griesemer I, Birken SA, Rini C
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
The purpose of this study was to explore the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) program, which altered systems of care at two United States cancer centers and eliminated the Black-White racial disparity in treatment completion in patients with early-stage breast and lung cancer. The study objective was to identify and document critical characteristics of ACCURE to enable translation of the intervention to other care settings. The researchers conducted semi-structured interviews with 18 participants who were involved in the design and implementation of ACCURE. The study found that participants described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key features. Intervention features were designed to improve either institutional transparency or accountability of the care system to community values and patient needs for minimally biased, tailored communication, and support.
Citation: Griesemer I, Birken SA, Rini C . Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention. SSM Qual Res Health 2023 Jun; 3:100204. doi: 10.1016/j.ssmqr.2022.100204..
Keywords: Racial and Ethnic Minorities, Disparities, Quality Improvement, Quality of Care
Trenaman L, Harrison M, Hoch JS
Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment.
The objective of this study was to estimate the relative importance of the 4 quality domains in the Medicare's Hospital Value-Based Purchasing (HVBP) program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in FY 2019. A nationally representative sample of 1025 Medicare beneficiaries was recruited through Ipsos KnowledgePanel for an online survey. Hospital performance on clinical outcomes was most highly valued by beneficiaries, followed by safety, patient experience, and efficiency. The authors concluded that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
Citation: Trenaman L, Harrison M, Hoch JS . Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment. JAMA Netw Open 2023 Jun; 6(6):e2319047. doi: 10.1001/jamanetworkopen.2023.19047..
Keywords: Medicare, Inpatient Care, Hospitals
Anderson NW, Halfon N, Eisenberg D
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
The authors of this paper suggest that policies targeting social indicators of youth status may not have improved overall mental health and well-being. They contend this absence of impact is evidenced by the divergence between social indicators which are improving, such as high school graduation, food insecurity, and smoking, and those which are worsening, such as mental health and well-being. The researchers report that available data indicates that one or more common exposures may be to blame, including those inadequately captured by existing social indicators.
Citation: Anderson NW, Halfon N, Eisenberg D . Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring. Milbank Q 2023 Jun; 101(2):259-86. doi: 10.1111/1468-0009.12634..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Ambulatory Care and Surgery, Cardiovascular Conditions
Taaffe K, Ferrand YB, Khoshkenar A
Operating room design using agent-based simulation to reduce room obstructions.
The purpose of this study was to improve the safety of clinical care provided in operating rooms (ORs) by examining wats in which characteristics of both the procedure and the physical environment affect surgical team movement and contacts. Researchers video recorded staff movements during surgical procedures, then divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination. Results showed that OR size, the circulating nurse workstation location, and team size significantly affected surgical team contacts; two- and three-way interactions between staff, procedure type, table orientation, and workstation location also significantly affected contacts. Implications of these findings for OR managers and for future research about designing future ORs are discussed.
Citation: Taaffe K, Ferrand YB, Khoshkenar A . Operating room design using agent-based simulation to reduce room obstructions. Health Care Manag Sci 2023 Jun; 26(2):261-78. doi: 10.1007/s10729-022-09622-3..
Keywords: Surgery, Simulation
Mehta SD, Congdo M, Phillips CA
Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.
This study’s objective was to apply diagnostic process improvement frameworks to identify missed opportunities for improvement in diagnosis (MOID) in pediatric emergency transfers (ETs) and evaluate their association with outcomes. ET is defined as hospitalized patients who require ICU interventions within 1 hour of ICU transfer, which is a proximal measure of late recognition associated with increased mortality and length of stay (LOS). This single-center retrospective cohort study was conducted from January 2015 to June 2019. Primary outcome was the presence of missed opportunities for improvement in diagnosis (MOID), determined using SaferDx. MOID was identified in 37 of 129 ETs (29%). Cases with MOID differed in originating service, but not demographically, with failure to recognize urgency of an identified condition the most common diagnostic process opportunity. ET cases with MOID had higher odds of mortality and longer post-transfer LOS.
Citation: Mehta SD, Congdo M, Phillips CA . Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit. J Hosp Med 2023 Jun; 18(6):509-18. doi: 10.1002/jhm.13103..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Intensive Care Unit (ICU)
Hansen CJ, Rayo MF, Patterson ES
Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals.
Emergency alarms are the most urgent of hospital alarms, necessitating immediate attention and action to address a dangerous situation. These alarms are triggered by clinicians and have greater positive predictive value (PPV). High-priority alarms are different from emergency alarms, are automatically triggered, and have lower PPV. The purpose of this retrospective pre-post study was to decrease nurse response time for emergency alarms and high-priority alarms by improving the discernability between emergency alarms and all other alarms, as well as by suppressing redundant and false alarms in a secondary alarm notification system (SANS). The researchers analyzed data 15 months prior to and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, the researchers integrated digitized human speech features to distinguish the emergency alarms from the automatically triggered alarms, leaving their onset and escalation pathways unaltered. The researchers suppressed some of the automatically triggered alarms by delaying their initial onset and escalation by 20 seconds. The study found that response time for emergency alarms decreased at all hospitals ad the improvements were sustained. The use of automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals.
Citation: Hansen CJ, Rayo MF, Patterson ES . Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals. Hum Factors 2023 Jun; 65(4):636-50. doi: 10.1177/00187208211032870..
Keywords: Hospitals, Nursing
Chatrath S, Silverberg JI
Phenotypic differences of atopic dermatitis stratified by age.
Atopic dermatitis (AD) is a prevalent condition affecting individuals of all age groups. A deeper understanding of the diverse age-related phenotypes can enhance AD treatment strategies. The purpose of this study was to identify clinical phenotypes of AD associated with different age groups. A prospective study involving 380 participants was conducted in a dermatology practice setting. AD severity was assessed through questionnaires and comprehensive physical examinations. The study included 23 (6.1%) pediatric patients (<18 years), 176 (46.3%) young adults (18-39 years), and 181 (47.6%) older adults (≥ 40 years). The study found that both young and older adults displayed a lower likelihood of AD on the ankles, moderate to severe AD on flexures, pityriasis alba, weeping lesions, moderate to severe excoriations, and intense itching in comparison to pediatric patients. Young adults had more AD around the eyes. Older adults exhibited increased AD on elbows, nipples, knees, keratosis pilaris, and lichenification. Four distinct classes were identified regarding AD distribution and related signs.
Citation: Chatrath S, Silverberg JI . Phenotypic differences of atopic dermatitis stratified by age. JAAD Int 2023 Jun;11:1-7. doi: 10.1016/j.jdin.2022.08.026.
Keywords: Skin Conditions
Cusick MM, Tisdale RL, Chertow GM
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
The purpose of this study was to assess the cost-effectiveness of adding population-wide screening for chronic kidney disease (CKD), specifically; screening for albuminuria with and without adding Sodium-glucose cotransporter-2 (SGLT2) inhibitors to the current standard of care for CKD. The study found that one-time CKD screening at the age 55 years had an ICER of $86,300 per QALY gained by increasing costs from $249,800 to $259,000 and increasing QALYs from 12.61 to 12.72; this result was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. In the group aged 35 to 75 years, screening one time prevented dialysis or transplant in 398, 000 people and screening every 10 years until age the age of 75 years cost less than $100,000 per QALY gained. The study’s sensitivity analysis found that when SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145,400 and $182,600 per QALY gained, and decreases in the price would be necessary for screening to be cost-effective.
Citation: Cusick MM, Tisdale RL, Chertow GM . Population-wide screening for chronic kidney disease : a cost-effectiveness analysis. Ann Intern Med 2023 Jun; 176(6):788-97. doi: 10.7326/m22-3228..
Keywords: Kidney Disease and Health, Screening, Healthcare Costs, Chronic Conditions
Blecker S, Gannon M, De Leon S
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
This paper describes a protocol for a study that will be conducted to compare the effect of hypertension-focused clinical decision support (CDS) plus practice facilitation on blood pressure (BP) control, as compared to CDS alone. The investigators will conduct a cluster randomized control trial that will include initial training on the CDS and a review of current guidelines along with follow-up for coaching and integration support. They will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. They will also assess implementation of CDS in all practices and practice facilitation in the intervention group.
Citation: Blecker S, Gannon M, De Leon S . Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial. Contemp Clin Trials 2023 Jun; 129:107177. doi: 10.1016/j.cct.2023.107177..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Blood Pressure, Cardiovascular Conditions
Auerbach AD, Astik GJ, O'Leary KJ
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
During the COVID-19 pandemic, clinicians were required to address a disease with continuously changing traits while simultaneously complying with changes in care (e.g., physical distancing) that could contribute to diagnostic errors (DEs). The purpose of this study was to examine the frequency of DEs and their causes in patients hospitalized under investigation (PUI) for COVID-19. The researchers randomly selected up to 8 cases per site per month for evaluation, with each case evaluated by two clinicians to determine whether a DE occurred, and whether any diagnostic process faults took place. The study found that wo hundred and fifty-seven patient charts were evaluated, of which 14% contained a DE. Patients with and without DE were statistically similar in socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. The most common diagnostic process issues contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination. Diagnostic process issues related with COVID-19 policies and procedures were not related with DE risk. 35.9% of patients with errors and 5.4% of patients overall suffered harm or death due to diagnostic error.
Citation: Auerbach AD, Astik GJ, O'Leary KJ . Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. J Gen Intern Med 2023 Jun; 38(8):1902-10. doi: 10.1007/s11606-023-08176-6..
Keywords: COVID-19, Diagnostic Safety and Quality, Hospitals, Inpatient Care, Quality of Care
Feyman Y, Avila CJ, Auty S
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
This study examined whether minority veterans experienced higher rates of all-cause mortality than White veterans during the COVID-19 pandemic. The authors used administrative data from the Veterans Health Administration’s Corporate Data Warehouse. Veterans were excluded in the analysis if they were missing county of residence or race-ethnicity data. Overall, veteran mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. Non-Hispanic White veterans experienced the smallest relative increase in mortality (17%), while Native American veterans had the highest increase (40%). Black Veterans (32%) and Hispanic Veterans (26%) had somewhat lower excess mortality, although these changes were significantly higher compared to White veterans. Disparities were smaller compared to the general population.
Citation: Feyman Y, Avila CJ, Auty S . Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic. Health Serv Res 2023 Jun; 58(3):642-53. doi: 10.1111/1475-6773.14112..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities, Disparities
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
Citation: Roberts ET, Kwon Y, Hames AG . Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level. JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Khor S, Heagerty PJ, Basu A
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
This study examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, the authors identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. The recurrence proxy was found to have excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower among Hispanic patients and 4.3% lower among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6%. Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91). The authors theorize that higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns.
Citation: Khor S, Heagerty PJ, Basu A . Racial disparities in the ascertainment of cancer recurrence in electronic health records. JCO Clin Cancer Inform 2023 Jun; 7:e2300004. doi: 10.1200/cci.23.00004..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Disparities
Rees CA, Stewart AM, Portillo EN
Reporting of important social determinants of health in pediatric clinical trials.
The purpose of this study was to assess the rates and trends in the reporting of sexual orientation, gender identity, preferred language, and socioeconomic factors in published pediatric clinical trials. The researchers conducted a cross-sectional study of pediatric clinical trials in the United States published from January 1, 2011 through December 31, 2020 in 5 general pediatric and 5 general medical journals with the highest impact factor in their respective fields. Outcomes included reporting of sexual orientation, gender identity, socioeconomic factors, and preferred language. The study found that in 612 trials, 29.6% reported preferred language. Among these, 64.6% exclusively enrolled participants whose preferred language was English. From 2011 to 2020, there was a relative increase in the reporting of preferred language. Socioeconomic factors were reported in 47.9% of trials. There was no significant change in the reporting of socioeconomic factors of published trial results among adolescent participants reported any measure of sexual orientation, and 1.1% reported gender identity. The researchers concluded that despite sexual orientation, gender identity, preferred language, and socioeconomic factors being increasingly recognized as social determinants of health these variables were infrequently included in pediatric clinical trial results reporting.
Citation: Rees CA, Stewart AM, Portillo EN . Reporting of important social determinants of health in pediatric clinical trials. Am J Prev Med 2023 Jun; 64(6):918-26. doi: 10.1016/j.amepre.2022.12.004..
Keywords: Children/Adolescents, Social Determinants of Health, Health Services Research (HSR)
Lake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
Citation: Lake ET, Staiger D, Smith JG . The association of missed nursing care with very low birthweight infant outcomes. Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care