AHRQ Electronic Newsletter, December 8, 2015

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December 8, 2015, #497

AHRQ Stats: Access to Medical Specialists

Among adults treated for multiple chronic conditions who reported they needed to see a specialist in 2012, Hispanics were more likely than non-Hispanic blacks or whites to report difficulty in gaining access to specialists. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #482, Specialist Need and Access Among Adults with Multiple Chronic Conditions, U.S. Civilian Noninstitutionalized Population, 2012.)

Today's Headlines:

AHRQ Studies in Health Affairs Examine Divide in Hospital Reimbursements, Other Trends

Four studies produced by AHRQ researchers are featured in the December issue of Health Affairs, each providing new insight into recent health care trends. One article, “The Growing Difference Between Public and Private Payment Rates for Inpatient Hospital Care,” co-authored by AHRQ Director Richard Kronick, Ph.D., found that while private health insurers have traditionally reimbursed hospitals more than Medicare and Medicaid for inpatient stays, the difference between private and public reimbursements grew substantially between 2001 and 2012. Dr. Kronick and his colleagues found that payments to hospitals for inpatient services from private insurers in 2012 were 75 percent greater than payments from Medicare, a sharp increase from the approximate 10 percent difference annually between 1996 and 2001. Another of the articles, “In Four ACA Expansion States, The Percentage of Uninsured Hospitalizations for People With HIV Declined, 2012–14,” analyzed four states that expanded Medicaid coverage under the Affordable Care Act and found that among hospitalizations for patients with HIV, the percentage of patients who were uninsured fell from 13.7 percent in 2012 to 5.5 percent during the first half of 2014. The remaining two articles are “Insurer Competition in Federally Run Marketplaces Is Associated With Lower Premiums” and “Several Factors Responsible for the Recent Slowdown in Premium Growth in Employer-Sponsored Insurance.”

AHRQ Announces Grant Opportunities To Address Opioid Abuse Disorder in Rural Areas

In support of growing federal efforts to reduce the abuse of opioid drugs, AHRQ has issued a funding opportunity announcement for research to expand access to evidence-based treatment for opioid abuse disorders in rural areas. Up to $12 million will be available to fund as many as four research demonstration projects to support implementation of medication-assisted treatment (MAT) for opioid use disorder in rural primary care practices. MAT is an evidence-based approach that uses Food and Drug Administration-approved medications combined with psychosocial treatments. The projects will explore and test solutions aimed at overcoming barriers to the use of MAT in rural primary care settings. Known barriers include limited continuing training opportunities for prescribing physicians, negative perceptions about people with substance abuse disorders, negative expectations about the effectiveness of treatment and lack of social support services in rural communities. Researchers may examine how online training for physicians, in-office practice coaching and virtual counseling sessions for patients can overcome these and other barriers. The projects will also create training resources to expand patients’ access to MAT. Grant applications are due March 4.

AHRQ’s Nationwide Readmissions Database Highlighted in December 9, 16 Webinars, New Online Course

Registration is open for December 9 and December 16 webinars to introduce researchers to AHRQ’s Nationwide Readmissions Database (NRD). The resource is part of the Agency’s Healthcare Cost and Utilization Project (HCUP). The December 9 webinar, Overview of the HCUP Nationwide Readmissions Database (NRD), will provide an introduction to the NRD. The second, Utilization of the HCUP Nationwide Readmissions Database (NRD), will educate users on how to produce and explore variances in rates of readmissions. In addition, HCUP has released Nationwide Readmissions Database Tutorial, an online course for researchers to use the NRD to produce national readmissions estimates. The tutorial’s first section, Database Design, provides background on the NRD, its design, its key data elements and its limitations. A second section, Using the NRD, provides sample event criteria to help researchers calculate national estimates of readmission rates using the database. Email HCUP User Support for more information.

Designing Health Information Technology Interfaces To Improve Patient Outcomes

Further research is needed to establish best practices for integrating patient-reported information into practice through health information technology (HIT), according to AHRQ-funded research. The research is part of a special issue of eGEMS (Generating Evidence and Methods to Improve Patient Outcomes), an open-access journal that aims to accelerate research and quality improvement using electronic health data. The special issue, “Evidence Into Action: Improving User Interface To Improve Patient Outcomes,” includes AHRQ-funded studies that examined clinical decision support and the concept of usability. The issue highlights lessons learned based on the experiences of researchers who developed and tested HIT interfaces, such as websites, apps or dashboards. One study, for example, focused on a web application that enabled Rhode Island consumers to compare home health agencies based on services offered and health outcomes. In another study, researchers examined the design process used to integrate patient-reported outcomes into a visual dashboard to help spine surgeons understand a patient’s level of pain or disability following surgery.

New Research and Evidence From AHRQ

AHRQ Study: Ambulatory ‘Revisits’ Occur Frequently, Often Due to Complications

Ambulatory “revisits”—the outpatient equivalent of hospital readmissions—occur frequently and are often associated with complications, a new AHRQ-funded study found. The study, published as a research letter in JAMA, used AHRQ’s Healthcare Cost and Utilization Project to analyze data from more than 480,000 low- to moderate-risk ambulatory operations. Researchers found a rate of 95 all-cause revisits per 1,000 operations; most revisits were to emergency departments (59 per 1,000 operations) followed by inpatient surgery settings (27 per 1,000 operations). Across all operations and settings, two-thirds of the revisits (65 per 1,000) were for complications related to the procedure, with the remaining being attributed to unrelated conditions. The authors concluded that more detailed study is needed to understand the nature of these revisits and determine which complications may be preventable. Read the research letter.

AHRQ Study: Older Patients May Not Benefit From Implantable Defibrillators

Older patients who receive a primary implantable cardioverter defibrillator (ICD) during acute hospitalizations may not have substantially different mortality or sudden cardiac death rates compared with those who are discharged without an ICD, according to an AHRQ-funded study published in BMJ. Receiving a primary ICD while hospitalized for heart failure or other acute conditions (representing approximately 40 percent of ICD implantations in Medicare patients) might not confer the same benefit demonstrated for patients in previous landmark trials, in which the candidates were selected in a stable outpatient setting and ICDs were received as an elective procedure. The BMJ study was based on data of more than 23,000 patients age 66 and older who were hospitalized between 2005 and 2008 for heart failure exacerbation or other acute comorbidities and were eligible for a primary ICD. More research is needed to identify subgroups of elderly patients who are more likely to benefit from ICDs, according to the authors. Read the study, “Real World Effectiveness of Primary Implantable Cardioverter Defibrillators Implanted During Hospital Admissions for Exacerbation of Heart Failure or Other Acute Co-Morbidities: Cohort Study of Older Patients.”

Featured Case Study: Kansas City Medical Center’s Video Promotes AHRQ Patient Safety Program

The Graduate Nurse Residency Program at Research Medical Center in Kansas City, Missouri, created a video, Tackling Effective Communication Using TeamSTEPPS, to energize the hospital’s ongoing patient safety training program. The nurses used a football-team theme to help staff rally around the TeamSTEPPS® program. Read the case study.

AHRQ in the Professional Literature

Outreach for annual colorectal cancer screening: a budget impact analysis for community health centers. Liss DT, French DD, Buchanan DR, et al. Am J Prev Med. 2015 Sep 8. pii: S0749-3797(15)00353-0. Select to access the abstract on PubMed®. 

Prevalence of chronic kidney disease among individuals with diabetes in the Supreme-DM Project, 2005-2011. Schroeder EB, Powers JD, O’Connor PJ, et al. J Diabetes Complications. 2015 Jul;29(5):637-43. Epub 2015 Apr 16. Select to access the abstract on PubMed®.

Trajectories of symptoms and function in older adults with low back disorders. Deyo RA, Bryan M, Comstock BA, et al. Spine. 2015 Sep 1;40(17):1352-62. Select to access the abstract on PubMed®. 

Transforming patient-centered care: development of the evidence informed decision making through engagement model. Moore JE, Titler MG, Kane Low L, et al. Womens Health Issues. 2015 May-Jun;25(3):276-82. Epub 2015 Apr 9. Select to access the abstract on PubMed®. 

Impact of cognitive training on balance and gait in older adults. Smith-Ray RL, Hughes SL, Prohaska TR, et al. J Gerontol B Psychol Sci Soc Sci. 2015 May;70(3):357-66. Epub 2013 Nov 5. Select to access the abstract on PubMed®.

An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Angier H, Hoopes M, Gold R, et al. Ann Fam Med. 2015 Jan-Feb;13(1):10-6. Select to access the abstract on PubMed®. 

Rheumatoid arthritis is associated with higher ninety-day hospital readmission rates compared to osteoarthritis after hip or knee arthroplasty: a cohort study. Singh JA, Inacio MC, Namba RS, et al. Arthritis Care Res. 2015 May;67(5):718-24.Select to access the abstract on PubMed®. 

The incremental risk of coronary stents on postoperative adverse events: a matched cohort study. Holcomb CN, Graham LA, Richman JS, et al. Ann Surg. 2015 Apr 17. Select to access the abstract on PubMed®. 

Contact Information

Please address comments and questions about the AHRQ Electronic Newsletter to Bruce Seeman at: (301) 427-1998 or Bruce.Seeman@ahrq.hhs.gov.