A committee of the National Academies of Sciences, Engineering, and Medicine is hosting a series of public workshops to explore potential ways to accelerate the use of patient-centered outcomes research (PCOR) findings in clinical practice to improve health and health care.

In the second workshop on June 17, 2022, SHADAC director Lynn Blewett presented on "State-Level Data Collaborations and Opportunities to Improve the Sustainability of Their Efforts."

Event Summary

These public workshops from the National Academies of Sciences, Engineering, and Medicine (the National Academies) feature invited presentations and discussions examining topics in 4 main categories:

1. Ways to revise and improve AHRQ’s proposed strategic plan, priorities, and strategies to make them clearer and more likely to lead to funding high-impact and complementary projects while being consistent with the Congressional mandate for investing funds from the PCOR Trust Fund (PCORTF), e.g.,

• Opportunities to train and educate PCOR investigators, while also addressing AHRQ’s PCORTF strategic priorities
• Development of digital tools to increase implementation of PCOR findings into practice
• Sustainable strategies for expanding implementation of PCOR findings
• The potential for development of an overall coordinated interdisciplinary approach to decisions about AHRQ’s PCORTF investments

2. Ways to measure progress and the impact of AHRQ’s PCORTF investments as a whole on meeting its goals (in the short-term, proximate, and long-term).

• Currently available metrics,
• Currently available data sources,
• Potential for novel metrics, analytics and data sources, and
• Ways to harmonize data elements across projects that could be included in evaluating the short- and long-term impact of AHRQ’s PCORTF investments.

3. Ways to better align priorities and strategies and to create complementary collaborations between the agencies charged with using the PCORTF to improve patient-centered outcomes research and practice (AHRQ, PCORI and ASPE), so as to increase the impact of AHRQ’s PCORTF investments and their potential to sustainably reduce disparities.

4. Ways AHRQ can apply communication science to improve dissemination of evidence, gaps in evidence, and policy gaps to inform health policies and decision-makers at the local, state, and federal levels.

With the Affordable Care Act's (ACA) expansion of Medicaid, approximately 15 million people were able to enroll in the program - many of whom were previously uninsured. However, researchers have long worried that an expansion of insurance coverage would not translate to an equal expansion in access to care. A particular point of concern is the worry that these newly eligible and enrolled individuals would not be able to find enough physicians who participate in Medicaid to treat them. 

Existing research has traditionally relied on physician survey data to study trends in physician acceptance of Medicaid and the factors associated with participation in the Medicaid program. For example, under contract with the Medicaid and CHIP Payment and Access Commission (MACPAC), SHADAC researchers used data from the National Electronic Health Records Survey (NEHRS) to create state-level estimates of physician participation in Medicaid before and after expansion and to study the physician- and practice-level characteristics associated with participation.

However, a new study led by Dr. Hannah Neprash is the first to provide direct answers about how clinicians responded to the Medicaid expansion. In their paper, "The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care” published in the December 2021 issue of the Journal of Health Economics, Dr. Neprash and her co-authors use all-payer claims and practice management data from 2012 through 2017 to examine how clinicians changed their labor supply and payer mix in response to Medicaid expansion.

This brief summarizes key findings from this study, including the effect of expansion on the number of Medicaid appointments and number of Medicaid patients seen by primary care clinicians (i.e., Medicaid participation), the total number of appointments provided (i.e., their labor supply) and the share of those appointments paid for by Medicaid versus private coverage or other payers (i.e., payer mix). The study also compares the relative change in participation in states subject to the Medicaid expansion compared to the change in states not subject to the expansion, estimating a causal effect of expansion on clinician participation in Medicaid.

Click on the image to the upper right to access and download a PDF of the full brief.

Related Resources

Physician Acceptance of New Medicaid Patients: Findings from the National Electronic Health Records Survey (MACPAC Fact Sheet)

Explore Physician Acceptance of New Medicaid Patients through Two New Measures on SHADAC’s State Health Compare and in a New MACPAC Factsheet (SHADAC Blog)

Physicians who accept new Medicaid patients (State Health Compare Data Measure)

   17 million report heavy drinking,
   40 million report binge drinking

In the past several years, researchers have shone new light on the public health threat of alcohol consumption in the United States. Nationally, life expectancy has declined, while deaths involving drugs and alcohol have increased.ⁱ Those findings are reinforced by studies finding increased high-risk alcohol consumption, such as binge drinking and heavy drinking.ⁱⁱ And early evidence indicates that the COVID-19 pandemic has only accelerated Americans’ alcohol consumption and risky drinking behaviors.ⁱⁱⁱ

The health toll of excessive alcohol consumption affects nearly every segment of the U.S. adult population, as shown by statistically significant growth in alcohol-involved deaths in almost every state and demographic subgroup in a recent SHADAC analysis.^iv However, alcohol-involved deaths have not affected the population evenly, with some states and some demographic subgroups experiencing much higher death rates than others.

The analysis in this new brief from SHADAC expert Colin Planalp focuses on high-risk alcohol consumption behaviors that can lead to death and other alcohol-involved diseases. Similar to alcohol-involved deaths, significant differences were found among demographic subgroups in the prevalence of binge drinking and heavy drinking.

Download a PDF of SHADAC's "Prevalence and disparities in excessive alcohol use among U.S. adults" brief.

Related Reading
Size of alcohol, drug overdose death increases in first pandemic year were unparalleled (Blog)
U.S. Health on the Rocks: The Quiet Threat of Growing Alcohol Deaths (Webinar)
Pandemic drinking may exacerbate upward-trending alcohol deaths (Blog)
Escalating Alcohol-Involved Death Rates: Trends and Variation across the Nation and in the States from 2006 to 2019 (Brief and Infographics)