AHRQ Electronic Newsletter, Issue #354

AHRQ Electronic Newsletter - Agency for Healthcare Research and Quality

September 11, 2012, Issue #354

AHRQ Stats

Elderly patients’ hospital costs have increased the most for stays involving respiratory and mechanical ventilation, cardiac pacemaker or cardioverter/defibrillator procedures, and knee surgery.  [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #133:  Components of Cost Increases for Inpatient Hospital Procedures, 1997-2009.]

Today's Headlines:

  1. AHRQ patient safety project reduces bloodstream infections by 40 percent
  2. Comment period for new Beta Version of Common Format on Readmissions closes on September 20  
  3. New surveys evaluate culturally competent and health literate care
  4. Study finds correlation between patient safety culture and positive  assessment of care  
  5.  Improved outcomes for chronic heart failure patients who follow discharge instructions
  6. AHRQ’s evidence on multigene panels for prostate cancer risk assessment
  7.  September issue of AHRQ Web M&M discusses best practices to prevent catheter complications
  8. AHRQ’s Health Care Innovations Exchange focuses on enhancing primary care access after ED visits
  9.  Register for AHRQ’s MEPS Data Users’ Workshop set for September 24–25
  10. Register for September 28 AHRQ webinar on Funding and Evaluating Primary Care Practice Facilitation Programs

AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent

A unique nationwide patient safety project funded by AHRQ reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) by 40 percent, according to preliminary findings of the largest national effort to combat CLABSIs to date.  The project used AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to achieve its landmark results that include preventing more than 2,000 CLABSIs, saving more than 500 lives, and avoiding more than $34 million in health care costs. The Agency and key project partners from the American Hospital Association and Johns Hopkins Medicine discussed these findings at a September 10 press event held in conjunction with the AHRQ annual conference in Bethesda, MD.  The CUSP helps hospital units address the foundation of how clinical teams care for patients by combining clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork.  The CUSP toolkit helps doctors, nurses, and other members of the clinical team understand how to identify safety problems and includes teaching tools and resources to support implementation at the unit level.  The national project involved hospital teams at more than 1,100 adult ICUs in 44 states over a 4-year period.   Preliminary findings indicate that hospitals participating in this project reduced the rate of CLABSIs nationally from 1.903 infections per 1,000 central line days to 1.137 infections per 1,000 line days, an overall reduction of 40 percent.  Select for details from the press event; for more information about AHRQ’s national CUSP project and AHRQ’s CUSP toolkit.

Comment Period for New Beta Version of Common Format on Readmissions Closes on September 20

The National Quality Forum is working with AHRQ in gathering and analyzing feedback for the beta version of a new Common Format to track hospital readmission.   AHRQ and the interagency Federal Patient Safety Workgroup developed Common Format–Readmissions Version 0.1 Beta to allow hospitals to aggregate data on readmissions.  Using this standardized method of review, hospitals can identify factors associated with unnecessary readmissions.  These include:          
  • Actions taken at the index hospitalization (or at discharge) to prevent a readmission
  • Risk factors for readmission
  • Length of stay
  • Presence of an adverse event
  • Location of discharge setting  
In addition, hospitals can compare their data to others and analyze trends on a community, regional, and national level.  All feedback received will be reviewed and considered to guide the development of a revised version of this Common Format.  Select to access the Common Format—Readmissions Version 0.1 Beta and post comments by September 20.

New Surveys Evaluate Culturally Competent and Health Literate Care

A series of new AHRQ-funded studies focus on the development and evaluation of new questions, or "item sets," that have been added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys to assess culturally competent and health literate care.  The goal of the CAHPS surveys is to provide patients with a way of reporting on their experiences with health care services.  These surveys go beyond standard patient satisfaction ratings by asking patients to provide specific and actionable feedback.   The CAHPS Cultural Competence item set was developed to measure whether care is provided in a culturally and linguistically appropriate manner.  Patients are asked to share their experiences on issues such as language access, trust, complementary and alternative medicine, communication, and discrimination.  Other studies cover the development and evaluation of two supplemental CAHPS item sets – one for the Clinician/Group CAHPS and one for Hospital CAHPS – that evaluate how well providers address health literacy.  Both supplements to the Clinician/Group CAHPS have been endorsed by the National Quality Forum.  The studies were published August 16 in a special supplement to Medical Care.

Study Finds Correlation Between Patient Safety Culture and Positive Assessment of Care

A new AHRQ-funded study found that hospitals whose staff members have more positive perceptions of patient safety culture tend to receive more positive assessments of care from patients.  The study was based on data from 73 hospitals that participated in two surveys of hospital patient safety and quality: AHRQ’s Hospital Survey on Patient Safety Culture, which measures hospital patient safety culture; and the Consumer Assessment of Healthcare Providers and Systems ® Hospital Survey, which measures adult inpatients’ experiences with hospital care and services.  Two patient safety culture areas -- organizational learning/continuous improvement, and teamwork within units -- showed the strongest relationship to patients’ experiences with care.  Four patient experience measures -- communication with nurses, communication about medicines, responsiveness of hospital staff, and hospital environment -- showed the strongest relationships to patient safety culture.  The study suggests that efforts aimed at improving organizational patient safety culture among staff members may have a positive impact on patients’ experience of care.  The article, “Exploring Relationships Between Patient Safety Culture and Patients’ Assessments of Hospital Care,” was published in the September issue of the Journal of Patient Safety.  Select to access the abstract on PubMed.®

Improved Outcomes for Chronic Heart Failure Patients Who Follow Discharge Instructions

A new AHRQ-funded study examines the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at 7 days, 30 days, 90 days, and 1 year for patients with chronic heart failure.  A retrospective cohort study of 3,011 acute care hospitals, using quarterly data measures from the Joint Commission’s ORYX initiative, found that on average, higher adherence with most of the ORYX heart failure performance measures was not associated with lower mortality.  The level of hospital market competition also was not associated with any differences in mortality.  However, higher adherence to the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentile of the mortality distribution was associated with incrementally lower mortality rates.  These findings, by authors Jared Lane K. Maeda, Ph.D., and Anthony T. Lo Sasso, Ph.D., suggest that targeting evidence-based processes of care may have a stronger impact in improving patient outcomes.  Results of the study can be found in the article, “The Relationship between Hospital Market Competition, Evidence-Based Performance Measures, and Mortality for Chronic Heart Failure” in the Summer 2012 issue of Inquiry.  Select to access the abstract on PubMed.®

AHRQ’s Evidence on Multigene Panels for Prostate Cancer Risk Assessment

A new evidence report found insufficient evidence to conclude whether single nucleotide polymorphism-based (SNP) panels perform adequately as screening or risk-stratification tools to genetically assess whether a man is at increased risk for prostate cancer.  The evidence review, by AHRQ’s McMaster University Evidence-based Practice Center in Hamilton, Ontario, Canada, was conducted to address questions about the accuracy of prostate-specific antigen screening (PSA) in asymptomatic men, the difficulty of determining prognosis in many affected men, and the lack of clarity on the utility of different therapeutic approaches.  Given the issues with PSA testing, SNP panels were seen as possible substitutes for or as a supplement to PSA screening.  Prostate cancer, one of the most common types of cancer, led to more than 36,000 deaths among men in North America in 2010.  Select to access the executive summary and full report.

September Issue of AHRQ Web M&M Discusses Best Practices to Prevent Catheter Complications

The September issue of AHRQ Web M&M features a Spotlight Case that describes a case involving an elderly man admitted to the hospital with congestive heart failure who acquired an infection around his peripheral IV site, accompanied by fever, chills, and back pain.  He developed methicillin-resistant Staphylococcus aureus bacteremia and an epidural abscess.  A commentary, written by Chi-Tai Fang, M.D, Ph.D., of National Taiwan University, details best practices to reduce the risk of catheter-related infection complications.  The Perspectives on Safety section features an interview with Jack Needleman, Ph.D., of the UCLA School of Public Health, about how the nursing workforce influences health outcomes.  Physicians and nurses can receive free CME, CEU, or training certification by taking the Spotlight Quiz.  Select to access AHRQ's Web M&M site.

AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience.  Access to the abstracts may be blocked because of firewalls or specific settings on individual computer systems.  If you are having problems, ask your technical support staff for possible remedies.
Palmsten K, Setoguchi S, Margulis AV, e tal.  Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants?  Am J Epidemiol 2012 May 15; 175(10):988-97.  Select to access the abstract on PubMed.®
Hilligoss B, Cohen MD.  The unappreciated challenges of between-unit handoffs: negotiating and coordinating across boundaries.  Ann Emerg Med 2012 May 4.  [Epub ahead of print.]  Select to access the abstract on PubMed.®
Alper SJ, Holden RJ, Scanlon MC, et al.  Self-reported violations during medication administration in two paediatric hospitals.  BMJ Qual Saf 2012 May; 21(5):408-15.  Select to access the abstract on PubMed.® 
Souza LC, Payabvash S, Wang Y, et al.  Admission CT perfusion is an independent predictor of hemorrhagic transformation in acute stroke with similar accuracy to DWI.  Cerebrovasc Dis 2012; 33(1):8-15.  Select to access the abstract on PubMed.®
Tsai CL, Lee WY, Hanania NA, et al.  Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008.  J Allergy Clin Immunol 2012 May; 129(5):1252-8.e1.  Select to access the abstract on PubMed.®
Curtis JR, Luijtens K, Kavanaugh A.  Predicting future response to certolizumab pegol in rheumatoid arthritis patients: features at 12 weeks associated with low disease activity at 1 year.  Arthritis Care Res 2012 May; 64(5):658-67.  Select to access the abstract on PubMed.®
West DR, Radcliff TA, Brown T, et al.  Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.  J Am Board Fam Med 2012 May; 25(3):275-82.  Select to access the abstract on PubMed.®
Speroff T, Ely EW, Greevy R, et al.  Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches.  J Hosp Med 2011 May; 6(5):271-8.  Select to access the abstract on PubMed.®
Skolarus LE, Meurer WJ, Burke JF, et al.  Effect of insurance status on postacute care among working age stroke survivors.  Neurology 2012 May 15; 78(20):1590-5.  Select to access the abstract on PubMed.®

Rassen JA, Shelat AA, Myers J, et al.  One-to-many propensity score matching in cohort studies.  Pharmacoepidemiol Drug Saf 2012 May; 21 Suppl 2:69-80.  Select to access the abstract on PubMed.®

Contact Information

Comments and questions on AHRQ Electronic Newsletter: Nancy.Comfort@ahrq.hhs.gov or (301) 427-1866