AHRQ Electronic Newsletter, Feb. 23, 2016

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February 23, 2016, Issue #506

AHRQ Stats: Per-Person Health Care Expenses

Among the U.S. noninstitutionalized population in 2013, the 1 percent of Americans with the highest health care expenses accounted for nearly 22 percent of the nation’s total health care expenditures. Members of that group had annual average expenses of $95,200. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #480: Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2013.)

Today's Headlines:

AHRQ Data: Mastectomies Increased 36 Percent From 2005 to 2013

While breast cancer rates remained constant between 2005 and 2013, the rate of women undergoing mastectomies increased 36 percent, including a more than tripling of double mastectomies, according to new AHRQ data. Both single and double mastectomies are increasingly performed as outpatient procedures, and the overall proportion of mastectomies performed in hospital-based ambulatory surgery settings reached 45 percent in 2013. “This brief highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety,” said AHRQ Director Richard Kronick, Ph.D. “More women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures.” Choosing a mastectomy rather than breast-conserving treatment, or electing to undergo a double mastectomy rather than single mastectomy, may be based on physician advice, fear of cancer recurrence or desire for cosmetic symmetry. The choice may also be influenced by a family history of breast cancer, or mutations in the BRCA1 and BRCA2 gene. AHRQ’s analysis shows a twofold increase in double mastectomies for women who don’t have cancer, although the number of women making this choice remains low. Find more data on the topic in “Trends in Bilateral and Unilateral Mastectomies in Hospital Inpatient and Ambulatory Settings, 2005-2013,” a statistical brief from AHRQ’s Healthcare Cost and Utilization Project.  Click here for an infographic and here for a blog post from AHRQ’s Claudia Steiner, M.D., M.P.H., about the findings.

AHRQ: Electronic Health Record Food Allergy Safety Warnings Need Improvement

Improvement is needed in the accuracy and terminology of food allergy safety warnings in hospitals’ electronic health records (EHR), according to an AHRQ-funded study. Researchers examined more than 158,000 records at two large Boston academic hospitals to determine the accuracy of how food sensitivities were described in their EHR systems. The study found that existing standard terminologies had gaps in food sensitivity definitions and that more precise terminology was needed to improve EHR documentation. “Food Entries in a Large Allergy Data Repository” and abstract were published in the Journal of the American Medical Informatics Association.

Financial Burdens More Likely Among Patients With Functional Limitations and Chronic Conditions: AHRQ Study

A recent AHRQ study found that patients are more likely to face financial burdens if they have functional limitations – meaning they need assistance with activities of daily living – and chronic conditions. Patients with financial burdens are those whose medical spending exceeds 20 percent of family income. Researchers used data from AHRQ’s Medical Expenditure Panel Survey to examine financial burdens among adults ages 19 to 64. They found that, among single adults, financial burdens were more common for those with functional limitations (20 percent) than those without (8 percent). Moreover, among those with functional limitations, those with three or more chronic conditions were twice as likely to have high financial burdens (22 percent) compared with those without chronic conditions (11 percent). Functional limitations and chronic conditions were also strongly associated with financial barriers to care (delaying care or being unable to get care for financial reasons). The authors asserted that functional limitations should not be treated as another chronic condition but instead be used as a separate measure in analyzing health care burdens. The study, “Financial Burdens and Barriers to Care Among Nonelderly Adults: The Role of Functional Limitations and Chronic Conditions,” and abstract appeared in Disability and Health Journal.

New Research and Data From AHRQ

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Register Now: AHRQ Webinars on Health Information Exchange

Registration is open for a pair of AHRQ-sponsored webinars on the topic of health information exchange (HIE). A March 16 webinar from 12:30 to 2 p.m. ET will highlight a recent evidence report on HIE effectiveness, usability, facilitators and barriers to use, implementation and sustainability. This webinar will also include a discussion on the use of HIE in long-term post–acute-care settings. An April 21 webinar from 12:30 to 2 p.m. ET will feature discussions on the use of HIE in health care collaboration and improvement as well as the role of geography in defining service areas and HIE membership. Continuing education credits are available at no cost to eligible health care professionals.

AHRQ’s Primary Care Practice Facilitation Curriculum: An Expanded Resource for Workforce Development

AHRQ’s recently released Primary Care Practice Facilitation Curriculum is a resource designed to help train practice facilitators (also known as practice coaches), quality improvement coaches or practice enhancement assistants to work with primary care practices. Practice facilitation is an evidence-based approach to quality improvement in primary care practices. This is the latest addition to the portfolio of AHRQ products that support the growth of practice facilitation. The practice facilitation curriculum is organized into five parts: Use of Adult Education Methods in Teaching PCPF Core Competencies; Introduction to Practice Facilitation; Competencies for Practice Facilitators; In the Practice; and Implementing the Care Model and Patient-Centered Medical Home.

AHRQ Releases Second Edition of Health Literacy Universal Precautions Toolkit

The recently released AHRQ Health Literacy Universal Precautions Toolkit, Second Edition can help primary care practices reduce the complexity of health care, increase patient understanding of health information and enhance support for patients of all health literacy levels. Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex health care system, and their ability to absorb and use health information can be compromised by stress or illness. Experts recommend assuming that everyone may have difficulty understanding in order to create an environment in which all patients can thrive. As with blood safety, health professionals should take universal precautions to address health literacy because they can't know which patients are challenged by health care information and tasks at any given time. Additional tools for improving health literacy are located here:

Featured Case Study: AHRQ Resources Enhance Georgia Southern University’s Nursing Course

Nurse practitioner students at Georgia Southern University are using information from an AHRQ webinar, “A Review on How to Access and Implement AHRQ’s Evidence-Based Resources to Inform Your Clinical Practice,” to learn how to better assess patient health problems and develop treatment plans. Students consult AHRQ resources and make care management decisions for their case studies based on best practices. Read the case study.

AHRQ in the Professional Literature

Chronic opioid use emerging after bariatric surgery. Raebel MA, Newcomer SR, Bayliss EA, et al. Pharmacoepidemiol Drug Saf. 2014 Dec;23(12):1247-57. Epub 2014 Apr 14. Access the abstract in PubMed®. 

Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses. Kappagoda S, Ioannidis JP. Bull World Health Organ. 2014 May 1;92(5):356-66c. Epub 2014 Mar 13. Access the abstract in PubMed®. 

Quality of life and satisfaction among prostate cancer patients followed in a dedicated survivorship clinic. Gilbert SM, Dunn RL, Wittmann D, et al. Cancer. 2015 May 1;121(9):1484-91. Epub 2014 Dec 23. Access the abstract in PubMed®. 

Psychosocial stress as a risk factor for sepsis: a population-based cohort study. Ojard C, Donnelly JP, Safford MM, et al. Psychosom Med. 2015 Jan;77(1):93-100. Access the abstract in PubMed®. 

Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Althoff KN, McGinnis KA, Wyatt CM, et al. Clin Infect Dis. 2015 Feb 15;60(4):627-38. Epub 2014 Oct 30. Access the abstract in PubMed®. 

The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature. Desai AD, Popalisky J, Simon TD, et al. Hosp Pediatr. 2015 Apr;5(4):219-31. Access the abstract in PubMed®. 

Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5,383 consecutive examinations. Samim M, Goss S, Luty S, et al. J Am Coll Radiol. 2015 Jan;12(1):63-9. Access the abstract in PubMed®. 

Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis. Vazquez-Benitez G, Desai JR, Xu S, et al. Diabetes Care. 2015 May; 38(5):905-12. Epub 2015 Feb 20. Access the abstract in 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.