AHRQ Electronic Newsletter, August 4, 2015, Issue #481

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August 4, 2015, Issue #481

AHRQ Stats: Hospital Mortality Rates

Hospital mortality rates among adults declined from 2002 to 2012 for four common health conditions, decreasing by 45 percent for pneumonia, 41 percent for heart attack, 29 percent for congestive heart failure and 27 percent for stroke. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #194: Trends in Observed Adult Inpatient Mortality for High-Volume Conditions, 2002-2012.)

Today's Headlines:

AHRQ Study: New Tool Identifies Causes of Pediatric Patient Harm

A new tool to identify the most common causes of harm in pediatric inpatient environments could improve patient safety for hospitalized children, according to an AHRQ-funded study. An article published online with an abstract May 18 in Pediatrics described the development and pilot-testing of the tool. Six academic children’s hospitals used the tool to review 100 randomly selected inpatient records from patients discharged from each site in February 2012. Of 600 patient charts evaluated, 240 harmful events (“harms”) were identified, for a rate of 40 harms per 100 patients admitted and 54.9 harms per 1,000 patient days across the six hospitals. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain and surgical complications. One of every four pediatric admissions had at least one identified harm. Nearly half (45 percent) of the harms were deemed preventable. The authors concluded that, like adult hospital patients, harm occurs at high rates among hospitalized children. 

Success of HIV Treatment May Be Undercounted, New Study Says

Traditional methods of counting patients being treated for HIV may underestimate the success of treatment, a new AHRQ-funded study found. The study examined the HIV continuum of care, which consists of diagnosis, linkage to and retention in care, receipt of antiretroviral therapy and suppression of the virus. Steps in this continuum are typically calculated in a conditional manner, with the number of people completing the prior step serving as the base population for the next step. However, researchers hypothesized, this approach may underestimate the prevalence of viral suppression. In this study, researchers followed 17,140 patients between 2010 and 2012, classifying them as to whether they completed the continuum of care or skipped steps in the process. They found that the virus was suppressed in some patients who had minimal contact with providers. Ignoring this group, researchers said, underestimates the proportion of patients suppressed by 13 percent. The article and abstract, “The HIV Care Continuum: Changes over Time in Retention in Care and Viral Suppression,” were published June 18 in the journal PLOS One.

Postoperative Risks Posed by Coronary Stents Explored in AHRQ Study

Patients who have surgery to receive coronary stents have an approximately 2 percent risk of heart attack within one year of the surgery, but no difference in mortality is shown between those patients and matched surgery patients who did not receive stents, according to an AHRQ-funded study. Researchers used data for patients with coronary stents implanted in a Veterans Affairs hospital from 2000 to 2010. Each patient with a stent was matched with two surgical patients without stents on surgical characteristics and cardiac risk factors. Adverse cardiac events followed surgery in 5.7 percent of the 9,391 patients with stents and 3.6 percent of the 18,782 patients without stents. The trends for two years after stent placement revealed that the incremental risk for heart attack decreased from 5 percent immediately after stent placement to 2 percent one year later, and then was no longer significantly elevated. The incremental risk did not vary by stent type. “The Incremental Risk of Coronary Stents on Postoperative Adverse Events” appeared online with an abstract April 17 in the journal Annals of Surgery.

Study Examines Persistent High Spending Among Under-65 Population

Fewer than one-third of enrollees in a national database of people under age 65 were among the top 10 percent of health care spenders in any year between 2003 and 2008, an AHRQ-funded study found. Meanwhile, more than two-thirds of enrollees were never among the top 10 percent of health spenders in any of the years examined by researchers. To better assess the long-term spending patterns of people under age 65, a population with increased access to insurance coverage through the Affordable Care Act, researchers analyzed data of more than 8 million enrollees in the Truven Health MarketScan database during a six-year period from 2003 to 2008. Considerable persistence occurred among both the top and bottom spenders. Some comorbid conditions, including rheumatological conditions, renal disease, diabetes and AIDS, were associated with higher spending during the study period. The findings support the use of disease management, especially for patients with costly conditions that are strong predictors of high long-term costs, the authors concluded. The study, "New Evidence on the Persistence of Health Spending," and abstract were published February 19 in the journal Medical Care Research and Review.

Register Now: August 18 Webinar on Adaptive Trial Design and Learning Evaluation

AHRQ’s Practice-Based Research Network is hosting a research methodology webinar August 18 from 12:30 to 2 p.m. ET. Presenters will discuss the standards recommended for the design, conduct and reporting of adaptive clinical trials as applied to patient-centered outcomes research. Also included will be a detailed overview of how to apply the learning evaluation approach to quality improvement assessments across multiple organizations. Application for CME credit has been filed with the American Academy of Family Physicians; determination of credit is pending. Registration is open.

Register Now: AHRQ Research Conference October 4-6

Registration is open for the 2015 AHRQ Research Conference, “Producing Evidence and Engaging Partners to Improve Health Care,” scheduled for October 4-6 at the Crystal Gateway Marriott Hotel and Convention Center in Crystal City, Virginia. The conference, which is being co-hosted by AcademyHealth, will bring together authorities in health care research and policy to participate in sessions focused on addressing today’s challenges in improving quality, safety, access and value in health care. In addition, AHRQ and AcademyHealth will team with the Patient-Centered Outcomes Research Institute to hold sessions October 6, also at the Crystal Gateway Marriott. Those sessions will address key issues in dissemination and implementation of patient-centered outcomes research.

Featured Impact Case Study: AHRQ’s Emergency Severity Index Used in Development of Obstetric Triage Tool

The Association of Women’s Health, Obstetric and Neonatal Nurses used AHRQ’s Emergency Severity Index to develop its Maternal Fetal Triage Index, a tool that improves communication and patient tracking in obstetric settings and helps prioritize the evaluation and treatment of pregnant women. 

AHRQ in the Professional Literature

Baillie CA, Epps M, Hanish A, et al. Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections. Infect Control Hosp Epidemiol. 2014 Sep;35(9):1147-55. Epub 2014 Jul 25. Select to access the abstract on PubMed®. 

Schwartz AL, Landon BE, Elshaug AG, et al. Measuring low-value care in Medicare. JAMA Intern Med. 2014 Jul;174(7):1067-76. Select to access the abstract on PubMed®. 

Wright B, Jung HY, Feng Z, et al. Trends in observation care among Medicare fee-for-service beneficiaries at critical access hospitals, 2007-2009. J Rural Health. 2013 Aug;29 Suppl 1:s1-6. Epub 2013 Feb 22. Select to access the abstract on PubMed®. 

Ryan AM, McCullough CM, Shih SC, et al. The intended and unintended consequences of quality improvement interventions for small practices in a community-based electronic health record implementation project. Med Care. 2014 Sep;52(9):826-32. Select to access the abstract on PubMed®. 

Pitts SI, Maruthur NM, Millar KR, et al. A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med. 2014 Sep;47(3):330-40. Select to access the abstract on PubMed®.

Odden AJ, Rohde JM, Bonham C, et al. Functional outcomes of general medical patients with severe sepsis. BMC Infect Dis. 2013 Dec 12;13:588. Select to access the abstract on PubMed®.

Halbert CH, Bellamy S, Briggs V, et al. Intervention completion rates among African Americans in a randomized effectiveness trial for diet and physical activity changes. Cancer Epidemiol Biomarkers Prev. 2014 Jul;23(7):1306-13. Epub 2014 Apr 22. Select to access the abstract on PubMed®.

Moskowitz D, Lyles CR, Karter AJ, et al. Patient reported interpersonal processes of care and perceived social position: the Diabetes Study of Northern California (DISTANCE). Patient Educ Couns. 2013 Mar; 90(3):392-8. Epub 2011 Aug 19. Select to access the abstract on PubMed®.

Contact Information

Please address comments and questions about the AHRQ Electronic Newsletter to Jeff Hardy at: (301) 427-1802 or Jeff.Hardy@ahrq.hhs.gov.