National Healthcare Quality and Disparities Report
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Topics
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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
51 to 75 of 105 Research Studies DisplayedTimbie JW, Kranz AM, DeYoreo M
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
The purpose of this study was to assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs. The investigators found no evidence that system-affiliated POs had smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, DeYoreo M .
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
Health Serv Res 2020 Dec;55(Suppl 3):1107-17. doi: 10.1111/1475-6773.13581..
Keywords: Racial and Ethnic Minorities, Disparities, Medicare, Health Systems
Ridgely MS, Buttorff C, Wolf L
The importance of understanding and measuring health system structural, functional, and clinical integration.
In this study, the authors explored if there were ways to characterize health systems-not already revealed by secondary data-that could provide new insights into differences in health system performance. The investigators sought to collect rich qualitative data to reveal whether and to what extent health systems varied in important ways across dimensions of structural, functional, and clinical integration.
AHRQ-funded; HS024067.
Citation: Ridgely MS, Buttorff C, Wolf L .
The importance of understanding and measuring health system structural, functional, and clinical integration.
Health Serv Res 2020 Dec;55(Suppl 3):1049-61. doi: 10.1111/1475-6773.13582..
Keywords: Health Systems, Healthcare Delivery
Harvey JB, Vanderbrink J, Mahmud Y
Understanding how health systems facilitate primary care redesign.
The objectives of this study were to understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. A sample of 24 health systems in 4 states was used to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Codes based on the theoretical PCR literature was used and researchers also created new codes. Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems were conducted. Initiatives to redesign the delivery of primary care were described by leaders, but many were still in the early stages. Motivating factors for team-based care included improvement efficiency and enhancing clinician job satisfaction. Changes in payment and risk assumption as well as community needs were commonly cited as motivators for population health management and care coordination. Challenges health systems face in redesigning primary included return on investment and slower than anticipated rate in moving from fee-for-service to value-based payment.
AHRQ-funded; HS024067.
Citation: Harvey JB, Vanderbrink J, Mahmud Y .
Understanding how health systems facilitate primary care redesign.
Health Serv Res 2020 Dec;55(Suppl 3):1144-54. doi: 10.1111/1475-6773.13576..
Keywords: Health Systems, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Short MN, Ho V
Weighing the effects of vertical integration versus market concentration on hospital quality.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. In this study, the investigators analyzed 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influenced patient outcomes.
AHRQ-funded; HS024727.
Citation: Short MN, Ho V .
Weighing the effects of vertical integration versus market concentration on hospital quality.
Med Care Res Rev 2020 Dec;77(6):538-48. doi: 10.1177/1077558719828938.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Hospitals, Medicare, Provider Performance, Health Systems
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
AHRQ-funded; HS024067.
Citation: Agniel D, Haviland A, Shekelle P .
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Health Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Hernandez AV, Roman YM, White CM
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
This paper describes AHRQ’s efforts to collate and assess quality improvement studies to support learning health systems (LHS). The authors identified quality improvement studies and evaluated the consistency of data extraction from two experienced independent reviewers at three time points: baseline, first revision, and final revision. Six investigators looked at the data extracted by the independent reviewers and determined the extent of similarity on a scale of 0 to 10. Two LHS participants were then asked to assess the relative value of their criteria. The consistency of extraction improved from a mean 1.17 score at baseline to 6.07 at first revision, and 6.81 at the final revision. There was not a significant improvement from the first to final revision. However, the LHS participants rated the value of these ratings a 9 and a 6, demonstrating that there is value in developing criteria.
AHRQ-funded; 290201500012I.
Citation: Hernandez AV, Roman YM, White CM .
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
J Gen Intern Med 2020 Nov;35(Suppl 2):802-07. doi: 10.1007/s11606-020-06098-1..
Keywords: Quality Improvement, Quality of Care, Learning Health Systems, Health Systems, Health Services Research (HSR), Research Methodologies
Fischer SH, Rudin RS, Shi Y
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
This study examined trends in the use of computerized physical order entry (CPOE) by health-system affiliated ambulatory clinics from 2014-2016 in the United States. A total of 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey was analyzed. They calculated descriptive statistics to examine overall trends in use, location of order entry, and system-level use of CPOE. The use of CPOE increased from than 9 percentage points from 2015 to 2016, from 58% to 67%. Larger clinics and those affiliated with multi-health hospital systems were more likely to use CPOE.
AHRQ-funded; HS024067.
Citation: Fischer SH, Rudin RS, Shi Y .
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
BMC Health Serv Res 2020 Sep 7;20(1):836. doi: 10.1186/s12913-020-05679-4..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Systems
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Furukawa MF, Kimmey L, Jones DJ
AHRQ Author: Furukawa MF, Guo J
Consolidation of providers into health systems increased substantially, 2016-18.
This article reports that provider consolidation into vertically-integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Kimmey L, Jones DJ .
Consolidation of providers into health systems increased substantially, 2016-18.
Health Aff 2020 Aug;39(8):1321-25. doi: 10.1377/hlthaff.2020.00017..
Keywords: Health Systems, Provider
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Furukawa MF, Machta RM, Barrett KA
AHRQ Author: Furukawa MF
Landscape of health systems in the United States.
This paper describes AHRQ’s development of the Compendium of U.S. Health Systems to help identify and describe health systems. This data resource supports research on comparative health system performance. The authors describe the methods used to create the compendium and create a picture of vertical integration. They identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. The systems varied by key structural attributes, including size, ownership, and geographic prevalence.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Machta RM, Barrett KA .
Landscape of health systems in the United States.
Med Care Res Rev 2020 Aug;77(4):357-66. doi: 10.1177/1077558718823130..
Keywords: Health Systems, Healthcare Delivery, Hospitals
Nguyen AM, Johnson CE, Wood SJ
The contribution of physician-system integrating structure to select health system outcomes.
Physician groups are increasingly being vertically integrated with hospitals and health systems; yet, the evidence on the impact of physician-system integration on health system outcomes is mixed. The objective of this mixed-methods study was to examine the impact of increased physician-system integration on select health system outcomes.
AHRQ-funded; HS024895.
Citation: Nguyen AM, Johnson CE, Wood SJ .
The contribution of physician-system integrating structure to select health system outcomes.
J Ambul Care Manage 2020 Jul/Sep;43(3):237-56. doi: 10.1097/jac.0000000000000331..
Keywords: Health Systems, Healthcare Delivery, Outcomes
Sutherland BL, Pecanac K, Bartels CM
Expect delays: poor connections between rural and urban health systems challenge
Rural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. In this study, the investigators sought to identify health system barriers contributing to this disparity. The investigators concluded that poor connections across rural and urban healthcare systems were described as the primary health system barrier driving the rural disparity in major amputations.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, Bartels CM .
Expect delays: poor connections between rural and urban health systems challenge
J Foot Ankle Res 2020 Jun 16;13(1):32. doi: 10.1186/s13047-020-00395-y..
Keywords: Rural Health, Health Systems, Disparities, Diabetes, Chronic Conditions, Healthcare Delivery
Lin JS, Murad MH, Leas B
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
This paper addresses when and how the use of health system data might make systematic reviews more useful to decisionmakers. The authors have developed a framework to guide the use of health system data alongside systematic reviews based on a narrative review of the literature and empirical experience. They recommend future methodological work on how best to handle internal and external validity concerns of health system data in the context of systematically reviewed data and work on developing infrastructure to do this type of work.
AHRQ-funded; 290201500007I; 29032001T05; 290201500005I; 290201500009I.
Citation: Lin JS, Murad MH, Leas B .
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
J Gen Intern Med 2020 Jun;35(6):1830-35. doi: 10.1007/s11606-020-05783-5..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Data, Shared Decision Making
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
Niedzwiecki MJ, Machta RM, Reschovsky JD
Characteristics of academic-affiliated health systems.
Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Niedzwiecki MJ, Machta RM, Reschovsky JD .
Characteristics of academic-affiliated health systems.
AHRQ-authored; AHRQ-funded; 290201600001C..
Keywords: Health Systems, Hospitals
Dukhanin V, Feeser S, Berkowitz SA
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
This study examined what expectations would be from patients who are not patient and family advisory council (PFAC) members of PFACs. Patients and caregivers from the Johns Hopkins Medical Alliance for Patients, LLC were recruited in 2014. This Medicare accountable care organization has an established PFAC, the Beneficiary Advisory Council. Five focus groups with 42 patients and caregivers participated. Most participants were not aware of PFACs and wanted to know more about representation, what they could do and expected that patients could communicate with PFACs if desired.
AHRQ-funded; HS023684.
Citation: Dukhanin V, Feeser S, Berkowitz SA .
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
Health Expect 2020 Feb;23(1):148-58. doi: 10.1111/hex.12983..
Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Healthcare Delivery, Health Systems
Heeringa J, Mutti A, Furukawa MF
AHRQ Author: Furukawa MF
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
The authors conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. They found that U.S. policymakers seek to promote provider integration and coordination. They conclude that emerging evidence suggested that organizational structures, composition, and other characteristics influence cost and quality performance. They recommend future research to examine systematically the role of organizational structure in cost and quality outcomes.
AHRQ-authored; AHRQ-funded.
Citation: Heeringa J, Mutti A, Furukawa MF .
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
Int J Integr Care 2020 Jan 20;20(1):2. doi: 10.5334/ijic.4635.
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Keywords: Health Systems, Healthcare Delivery, Patient-Centered Healthcare, Care Coordination, Organizational Change, Policy
Guise JM, Reid E, Fiordalisi CV
AHRQ Author: Borsky A, Chang S
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
The authors discuss the articles in the AHRQ EPC series published in this journal over the past six months. They state that satisfaction, care, and costs would all improve if health care delivery were as efficient and effective as possible given current knowledge. They conclude that millions of health decisions must be made by clinicians, patients, and health care systems, and they believe better decisions will be made with evidence.
AHRQ-authored; AHRQ-funded; 290201700003C.
Citation: Guise JM, Reid E, Fiordalisi CV .
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
Jt Comm J Qual Patient Saf 2020 Jan;46(1):51-52. doi: 10.1016/j.jcjq.2019.10.008..
Keywords: Implementation, Evidence-Based Practice, Learning Health Systems, Health Systems, Healthcare Delivery, Shared Decision Making
Shi Y, Amill-Rosario A, Rudin RS
Health information technology for ambulatory care in health systems.
The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. In this study, the authors examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs.
AHRQ-funded; HS024067.
Citation: Shi Y, Amill-Rosario A, Rudin RS .
Health information technology for ambulatory care in health systems.
Am J Manag Care 2020 Jan;26(1):32-38..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Systems, Healthcare Delivery
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Stadnick NA, Sadler E, Sandall J
Comparative case studies in integrated care implementation from across the globe: a quest for action.
There are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. In this paper, the investigators use a multiple case study design to highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and to synthesize the shared and unique challenges and successes across studies using the EPIS framework.
AHRQ-funded; HS024192.
Citation: Stadnick NA, Sadler E, Sandall J .
Comparative case studies in integrated care implementation from across the globe: a quest for action.
BMC Health Serv Res 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5..
Keywords: Healthcare Delivery, Health Services Research (HSR), Health Systems, Implementation, Case Study
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
AHRQ-funded; HS013853.
Citation: Wood SJ, Albertson EM, Conrad DA .
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Health Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
White CM, Coleman CI, Jackman K
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
This paper analyzed ways to enhance usability of AHRQ’s Evidence-based Practice Center (EPC) reports. The reports are often lengthy and difficult for users to navigate. A quality measure index was created to allow health systems to more efficiently access relevant information. A test was created where two tables were embedded in an EPC report. The first identified quality measures covered by the report descriptively. The second contained page numbers in the executive summary which hyperlinked to those pages with the quality measures. An exercise with two health system-targeted scenarios was then created. The participants were timed how long it took to find answers to scenario questions and gave feedback. It was found that it took 63.4% less time to find quality measure information with the hyperlinked indexing tables than without. The participants felt that the tables were easy to use and more user friendly to health systems.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002.
Citation: White CM, Coleman CI, Jackman K .
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002..
Keywords: Implementation, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Outcomes Research, Provider Performance, Quality Measures, Quality Improvement, Quality of Care
Vest JR, Unruh MA, Freedman S
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The investigators concluded that reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggested that HIE technologies can better support the aim of higher quality care.
AHRQ-funded; HS024717.
Citation: Vest JR, Unruh MA, Freedman S .
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
J Am Med Inform Assoc 2019 Oct;26(10):989-98. doi: 10.1093/jamia/ocz116..
Keywords: Health Systems, Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions, Hospitals