Agency for Healthcare Research and Quality

Illness severity may influence the relationship between opioid use disorder (OUD) and adverse outcomes, yet factors affecting severity are not fully understood. The objective of this study is to examine sociodemographic and hospital-related factors associated with severity among OUD-related hospitalizations. We used data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2015 to 2022. The HCUP NIS includes severity measures that assign patients overall severity of illness (SOI) and risk of mortality (ROM) subclasses (ie, minor, moderate, major, and extreme) based on their secondary diagnoses and other clinical characteristics (eg, age, procedures). Partial proportional odds models were used to measure the association between sociodemographic/clinical factors and SOI/ROM subclass severity among OUD-related hospitalizations. SOI shifted toward more severe subclasses in 2019-2022 and ROM in 2015-2022 (higher share major/extreme). Medicare and self-pay, compared with private insurance, were associated with higher odds (adjusted odds ratio [aOR] [95% CI]) of extreme SOI (vs. minor, moderate, or major) (Medicare: 1.07 [1.05, 1.09]; self-pay: 1.08 [1.05, 1.11]). Rural hospitals, compared with urban ones, had lower odds of higher SOI severity (aOR 0.80 [0.77, 0.82]). Results were similar for ROM. Age, sex, race, income, region, hospital size, admission timing, and admission type were also significantly associated with SOI/ROM. Structural/systematic factors play a role in shaping the course of inpatient OUD. These findings highlight the need to strengthen hospital addiction care capacity, address insurance and income-related inequities, and develop targeted inpatient risk stratification strategies to improve outcomes for patients with OUD.

Purpose of ReviewTo report on the relationship between neuroinflammation and chronic pain, especially in the pediatric population.Summary of Recent FindingsPediatric chronic pain is prevalent, affecting about 20% of the population. Neuroinflammation is now recognized as a putative contributing factor to the development and maintenance of chronic pain. Strides have been made in understanding neuroinflammatory processes in the context of pain, as research begins to unravel the involvement of glial cells (e.g., microglia, astrocytes), pro-inflammatory markers (e.g., interleukins, Tumor Necrosis Factor-alpha [TNF-α]), and metabolic pathways (e.g., oxidative stress). In children, the vulnerability of a developing nervous system, life stressors (e.g., adjustment periods/transitions, social stress, family dynamics) and hormonal changes can further impact neuroinflammation and promote pain. Investigating this complex web of factors that contribute to pediatric pain has implications for both clinical practice and research.SummaryThis review aims to summarize recent literature on the role of neuroinflammation in pediatric chronic pain, highlighting novel insights and areas for future clinical exploration. Targeting neuroinflammation shows promise for advancing pediatric chronic pain management, but pediatric-specific studies remain quite limited, and urgently needed.

With global population growth and advancing age, fragility fractures present a major healthcare challenge that current approaches have not resolved. Although pharmacological agents have been shown to reduce fragility fracture risk, there remain unmet needs in clinical care, especially for patients at imminent risk of hip fracture, given the delay between treatment initiation and observed protective effect. This gap suggests a need for novel approaches, including hip procedures that strengthen bone locally and quickly. The purpose of this report is to describe a procedural technique that has been shown in ex vivo and clinical studies to rapidly enhance proximal femur biomechanical properties and leads to new bone formation. Local osteo-enhancement procedure (LOEP) is a minimally invasive surgical procedure to address bone voids in the pelvis and extremities, including in the proximal femur, due to trauma and disease such as osteoporosis. After surgical preparation of voids within the femoral neck and intertrochanteric regions of the proximal femur, a resorbable, triphasic, calcium-based implant material, AGN1, is delivered to that site. Clinical studies demonstrate consistent implant material resorption, concurrent replacement of the material with bone, and a significant, durable increase in areal bone mineral density (aBMD). The procedural technique has been studied as a standalone procedure and as concomitant surgery taking place in the same operative session as the surgical treatment of a contralateral index hip fragility fracture. In the study of concomitant use, LOEP was reported not to disrupt the standard of care for mobilization and rehabilitation for hip fracture. The clinical studies completed suggest that the procedure demonstrates an acceptable safety profile and has the potential to reduce the incidence of hip fragility fractures.

In the US, a physician can be paid very different amounts for treating different patients, even when providing identical services. Understanding physician practices' financial incentives to serve different racial and ethnic groups may help inform payment policies to reduce health disparities. To measure disparities across patient racial and ethnic groups in per-visit payment to physician practices from health insurers and other sources, adjusted for visit content, geographic market, and year, and to quantify the role of health insurance source and other factors in these disparities. A unique, nationally representative dataset of outpatient visits containing survey-obtained patient race and ethnicity and payment amounts to physician practices from health insurers and other sources was analyzed. Data were collected from 2014 to 2021. Payment disparities were defined as gaps between patient groups defined by race and ethnicity in total payments per visit to physician practices, adjusted for visit content, geographic market, and year. Kitagawa-Oaxaca-Blinder decompositions were used to estimate the magnitude of these disparities and to quantify the roles of factors like health insurance. The sample included 38 722 patients and 152 336 outpatient visits for evaluation and management services; a total of 8126 (21.0%) were Hispanic, 6150 (15.9%) were non-Hispanic Black, and 24 446 (63.1%) were non-Hispanic White. A total of 152 336 outpatient visits were included for evaluation and management services. In adjusted analyses, outpatient payments were 8.8% (95% CI, 6.7-11.0) less for visits with non-Hispanic Black patients and 9.8% (95% CI, 7.2-12.4) less for visits with Hispanic patients compared with visits with non-Hispanic White patients. Payment gaps were largest for children (13.9% [95% CI, 11.8-16.0] for non-Hispanic Black children; 15.1% [95% CI, 12.8-17.4] for Hispanic children), smaller when adjusted for insurance source (4.9% [95% CI, 2.7-7.1] for non-Hispanic Black patients; 5.6% [95% CI, 3.0-8.3] for Hispanic patients), and absent among patients with fee-for-service Medicare (1.2% [95% CI, -1.5 to 3.9] for non-Hispanic Black patients; -0.6% [95% CI, -4.4 to 3.2] for Hispanic patients). In this study, US physician practices were paid more for outpatient visits with non-Hispanic White patients than for outpatient visits with Hispanic or non-Hispanic Black patients. Payment disparities were larger in pediatrics and partly explained by insurance. Differential financial incentives to serve non-Hispanic White patients may worsen disparities in health care access, utilization, and quality.

Although the recent proliferation of telemental health care has transformed the delivery of outpatient mental health care for many individuals in the US, little is known about how outpatients are distributed across telehealth, hybrid, and in-person care. To characterize the national distribution of sociodemographic and clinical outpatient mental health groups across telehealth, hybrid, and in-person mental health care. This was a cross-sectional analysis of all telehealth, hybrid, and all in-person mental health care by adults (aged ≥18 years) in the 2021-2022 Medical Expenditure Panel Survey (n = 4720). Data were analyzed from January to August 2025. Average annual percentages of adult mental health outpatients who used all telemental health care, hybrid, and all in-person mental health care were calculated overall and stratified by sociodemographic and clinical characteristics. Differences in percentages using each modality were evaluated by sociodemographic and clinical strata adjusted for age, sex, and distress level (Kessler-6 scale). Type of mental health treatment used (telemental health, hybrid, or in-person). The analysis involved 4720 participants (2235 aged 18-44 years; 3007 female). Approximate one-fourth (27.8%; 95% CI, 25.7-29.8) of mental health outpatients received all telemental health care, 21.5% (95% CI, 19.8-23.1) received hybrid care, and 50.6% (95% CI, 48.2-53.1) received all in-person care. The percentage of patients receiving all telemental health care was higher for younger (aged 18-44 years; 31.7%; 95% CI, 29.0-34.3) than middle age (aged 45-64 years; 24.2%; 95% CI, 21.1-27.4) or older (aged ≥65 years; 19.4%; 95% CI, 16.1-22.7) adults, high school (23.1% 95% CI, 20.4-25.8) and college (34.5%; 95% CI, 31.5-37.5) graduates than those without a high school diploma (19.9%; 95% CI, 13.7-26.1), patients with incomes >400% federal poverty level (33.8%; 95% CI, 30.9-36.7) than lower (range, 20.6% to 23.7%), private (30.8%; 95% CI, 28.5-33.1) than public (20.2%; 95% CI, 17.4-23.0) insurance, and urban (29.2%; 95% CI, 27.0-31.3) than rural (14.0%; 95% CI, 8.6-19.3) residence. Compared to patients receiving medication alone (15.4%; 95% CI, 12.5-18.3), those receiving psychotherapy with (25.9%; 95% CI, 23.2-28.6) or without (41.6%; 95% CI, 38.0-45.2) medication were more likely to use all telemental health. Patients with less than moderate distress (29.2%; 95% CI, 26.1-32.3) were also more likely than those with serious distress (21.2%; 95% CI, 16.7-25.6) to use all telemental health. In adjusted analyses, patients treated by mental health counselors (10.9%; 95% CI, 7.0-14.7) or social workers (8.4%; 95% CI, 4.1-12.7) were also more likely to receive all telemental health than were patients treated by other mental health clinicians. The findings of this cross-sectional study indicate that telehealth has become a common means of receiving outpatient mental health care in the US, especially for resourced patients with less serious psychological distress who receive psychotherapy from mental health specialists.

To rapidly advance patient safety research, in 2014 the US Agency for Healthcare Research and Quality launched a radically different research initiative by supporting patient safety learning laboratories (PSLLs) using systems perspectives and engineering approaches to advance patient safety. The 5-phase systems engineering methodology uses diverse methods and devotes particular attention to health care safety problem analysis, followed by design, development, implementation, and evaluation. PSLL projects have demonstrated decreases in mortality as well as increases in diagnostic accuracy, reduction in adverse drug events, decreased medication errors, improved early detection of adverse events, and reduction in the number of prenatal adverse events. PSLLs have developed guidance and resources to prevent as well as mitigate patient harm and improve the safety, efficiency, and effectiveness of health care delivery. By fusing approaches ranging from human-centered design to AI-driven analytics applied to health services research, PSLLs have produced influential, evidence-based, scalable interventions that strengthen health care delivery processes and improve outcomes for society, health care organizations, providers, and—most importantly—patients and their families.

The Agency for Healthcare Research and Quality encouraged a re-examination of the concept, process, and measurement of shared decision-making (SDM) in 2016. Progress, however, has been slow. One illustrative example is SDM's relationship with the concept of equipoise: there remains little consensus on what equipoise means in the context of SDM, creating confusion about when SDM is and is not indicated. In this paper, we describe the ways in which this focus on equipoise in SDM is counter-productive and argue that equipoise is neither a necessary nor sufficient criterion in determining the need for SDM. Moreover, we suggest that what is needed to move the field of SDM forward is a shift away from focusing on when SDM is needed to instead focusing on how best to accomplish SDM across a variety of contexts by advancing the science of SDM implementation.

Background: The United States is proposing to ban menthol cigarettes. Our objective is to examine the extent of menthol smoking among pregnant women and its association with their health. Methods: Nationally representative study of 14,226 pregnant women aged 18-44 years using the 2004-2022 National Survey on Drug Use and Health. Multivariate regressions estimate the association between menthol smoking and emergency department (ED) and office visits, poor health, mental health, and smoking cessation. Results: In total, 7.0% of pregnant women smoked menthol cigarettes, 7.3% smoked nonmenthol, 11.0% recently quit, and 74.7% were nonsmoking. Lesbian/gay/bisexual women had the highest rates: 18.6% menthol and 11.0% nonmenthol. In the third trimester, 10.4% of Black women smoked menthol and 0.6% smoked nonmenthol (p < 0.01), whereas 5.4% of White women smoked menthol and 8.6% smoked nonmenthol (p < 0.01). From 2004 to 2022, maternal smoking decreased from 16.3% to 5.1%. However, the percentage of pregnant smoking women using menthol increased from 47.0% to 60.1%, with the largest increase among Hispanic women from 43.4% to 78.8% (p < 0.05), compared with a rate of 96.1% among Black women and 49.0% for White women. Pregnant women smoking menthol had 1.6 ED annual visits compared with 1.2 ED visits (p < 0.05) for nonmenthol and 0.6 ED visits (p < 0.05) among the nonsmoking. Among those smoking menthol, 73.7% reported mental health issues compared with 64.4% for nonmenthol. Conclusions: Women who smoke menthols report worse health compared with those smoking nonmenthol. Policies designed to reduce menthol smoking would improve maternal health, especially for minoritized women and those at higher risk for poor birthing outcomes.

Abstract Patient-centered data is critical for providing high-value care and assessing quality including functional and cognitive status, goals, and outcomes that matter most to people; these are often missing in Electronic Health Records (EHRs). Furthermore, lack of interoperability makes it challenging to share and aggregate data across clinicians and care settings, leading to fragmented and/or duplicative care. E-care plans (eCP) and data standards that focus on goal setting and outcome management are in development, and hold promise to support person- centered care planning across sites and settings of care. E-Care Plans support care coordination and quality improvement and inform future healthcare value-focused policies—such as those related to equitable coverage, quality improvement, measurement, payment, and innovation model planning. Interoperable eCPs could be integrated into clinical care and across the healthcare ecosystem. This integration will enhance care coordination and facilitate seamless information exchange. In this session, Federal officials from the CMS, VA, and AHRQ will explore the benefits of eCPs and discuss the work underway to support the implementation of these plans in clinical care. This presentation will also discuss efforts to develop value sets and FHIR mappings to enable bidirectional information exchange and the concurrent pilot testing of applications with patient data. E-care plans have the potential improve patient safety, reduce burden, support the efficient exchange of patient data such as cognitive function, physical function, and individual goals to support improving person-centered outcomes, advancing health equity, conducting economic analysis, and tailored program development.