Improving health equity through health care systems research.

Objective: To describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes.

Data Sources And Study Setting: This project was conducted as a component of the Agency for Healthcare Research and Quality's (AHRQ) stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. Recommendations were developed and refined based on expert input, evidence review, and stakeholder engagement.

The effect of prescription drug insurance on the incidence of potentially inappropriate prescribing: Evidence from Medicare Part D.

The Medicare Part D program has been documented to increase the affordability and accessibility of drugs and improve the quality of prescription drug use; however, less is known about the equity impact of the Part D program on potentially inappropriate prescribing-specifically, incidences of polypharmacy and potentially inappropriate medication (PIM) use based on different racial/ethnic groups. Using a difference in the regression discontinuity design, we found that among Whites, Part D was associated with increases in polypharmacy and "broadly defined" PIM use, while the use of "always avoid" PIM remained unchanged. Conversely, Blacks and Hispanics reported no changes in such drug utilization patterns.

Medicaid Expansions and Access to Substance Abuse Treatment Services Among Limited English Proficiency Populations.

Background: Although the myriad of provisions under the Affordable Care Act (ACA) have generally increased coverage and financial access to the health systems, language barriers represent a serious challenge to access to care among Limited English Proficiency (LEP) populations.

Objective: The aim of this study was to examine the effect of Medicaid expansions under the ACA on the availability of language services and Medicaid acceptance in substance abuse treatment (SAT) facilities.

Research Design: A quasi-experimental difference-in-differences design with multiple time periods was used to compare changes in the availability of language services and Medicaid as a payment source between Medicaid expansion and nonexpansion states.

Association between precarious employment and BMI in the United States.

Objective: There is growing recognition that precarious employment is an important determinant of health, which may increase BMI through multiple mechanisms, including stress. It was investigated whether increases in precarious employment were associated with changes in BMI in the United States.

Methods: Data were from the National Longitudinal Survey of Youth adult cohort (1996-2016) (N = 7280).

Addressing hygiene needs of housing insecure populations: A qualitative analysis of Seattle and King County's mobile hygiene station intervention.

Objective: To evaluate the Seattle Public Utility mobile hygiene station program, a program deployed using public funds in response to the large-scale closures of public hygiene facilities due to COVID-19.

Study Design: We conduct a qualitative analysis using semi-structured interviews.

Methods: We interviewed four Seattle Public Utility (SPU) and Public Health Seattle & King County (PHSKC) employees involved in the design, deployment, and management of the hygiene station intervention.

Examining the effects of social and cash transfer programs for homeless adults: Evidence from the Samaritan pilot.

Objective: To conduct a program evaluation of a technology-based intervention for a housing insecure population.

Study Design: We conduct a quantitative analysis of Samaritan pilot administrative records.

Methods: Samaritan conducted an initial single-arm pilot of their technology platform among a housing insecure population ( = 500).

Effects of inadequate coverage on healthcare utilization: A regression discontinuity analysis.

To examine the impact of inadequate health insurance coverage on physician utilization among older adults using a novel quasi-experimental design in the time period following the elimination of cost sharing for most preventative services under the US Affordable Care Act of 2010.The Medical Expenditure Panel Survey full year consolidated data files for the period 2010 to 2017 were used to construct a pooled cross-sectional dataset of adults aged 60 to 70. Regression discontinuity design was used to estimate the impact of transitioning between non-Medicare and Medicare plans on use of routine office-based physician visits and emergency room visits.

Impact of the supplemental nutritional assistance program on diet-related disease morbidity among older adults.

Objectives: To examine the health effects of the Supplemental Nutritional Assistance Program (SNAP) and the differential impact of SNAP across race/ethnicity among older adults.

Data Source/study Setting: 2008-2013 Medical Expenditure Panel Survey, a nationally representative population-based complex sample survey.

Study Design: A difference-in-regression-discontinuity (DRD) design is used to assess the impacts of SNAP on diet-related disease morbidity.

Effects of health insurance on patient demand for physician services.

Background: In recent years, policymakers have sought to reduce health disparities between the insured and uninsured through a federal health insurance expansion policy; however, disparities continue to persist among the insured population. One potential explanation is that the use of healthcare services varies by the type of health insurance coverage due to differences in the design of coverage. The aim of this study is to examine whether health insurance coverage type is associated with the structure and use of healthcare services.

Effects of a trauma-informed curriculum on depression, self-efficacy, economic security, and substance use among TANF participants: Evidence from the Building Health and Wealth Network Phase II.

Rationale: Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market.

Fixed effects analysis of the incidence of cardiovascular outcomes under managed care following the managed care backlash.

To examine the impact of increased managed care activity on 30-day readmission and mortality for acute myocardial infarctions and congestive heart failure in U.S. hospitals following the managed care backlash against managed care cost containment practices.

Trauma-Informed Financial Empowerment Programming Improves Food Security Among Families With Young Children.

Objective: To determine how trauma-informed programming affects household food insecurity (HFI) over 12 months.

Design: Change was assessed in HFI from baseline to 12 months in response to a single-arm cohort intervention. Measures were taken at baseline and in every quarter.

Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact.

Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support).

Trends in Managed Care Cost Containment: An Analysis of the Managed Care Backlash.

Consumer dissatisfaction with the quality and limitations of managed health care led to rapid disenrollment from managed care plans and demands for regulation between 1998 and 2003. Managed care organizations, particularly health maintenance organizations (HMOs), now face quality and coverage mandates that restrict them from using their most aggressive strategies for managing costs. This paper examines the effect of this backlash on managed care's ability to contain costs among short-term, non-federal hospitals between 1998 and 2008.

Medicare eligibility and physician utilization among adults with coronary heart disease and stroke.

Background: Although Medicare eligibility has been shown to generally increase health care access and utilization, few studies have investigated the association between Medicare eligibility and health care utilization among the chronically ill.

Objective: This study examines changes in health care access and utilization associated with Medicare eligibility among adults with coronary heart disease and stroke (CHDS).

Methods: Descriptive statistics and regression discontinuity analysis were used to examine health care access and utilization at age 65 when Medicare eligibility begins for 176,611 National Health Interview Survey respondents aged 55-74 surveyed between 1997 and 2010.