February 8, 2013, Issue # 367
Hospital admissions for heart disease are projected to plunge by 60 percent between 2001 and 2012 -- from about 298,000 per quarter, or 1.2 million in 2001, to roughly 120,000 per quarter in 2012, or 480,000 in 2012. (Source: Agency for Healthcare Research and Quality, Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012).
AHRQ Director Carolyn Clancy, M.D., is planning to step down later this year after a decade of leading the Agency. HHS Secretary Kathleen Sebelius, in a January 31 e-mail to HHS leaders and AHRQ staff, said she was “deeply grateful” for Dr. Clancy’s service. “Under Carolyn’s leadership, AHRQ has undertaken innovative new work that has improved the quality, safety, efficiency, and effectiveness of the nation’s health care delivery system,” Secretary Sebelius noted. “Carolyn has been passionate about the importance of linking quality improvement with the urgency of reducing disparities in health care. During her tenure, the agency produced the nation’s first annual reports on quality, safety, and disparities in care. AHRQ has supported groundbreaking research on patient safety and related interventions, such as TeamSTEPPS, the Comprehensive Unit-based Safety Program, and other efforts to reduce health care associated infections, now implemented both nationwide and internationally.” Dr. Clancy will continue to serve while HHS leaders continue their national search for a new AHRQ director.
The benefits of electronic health records (EHRs) may become more widely available to children through a model EHR format for children’s health care, AHRQ and CMS announced on February 6. While the growing use of EHRs is shown to improve the quality and safety of health care, many existing systems are not tailored to capture or process information about children. The new format includes recommendations for child-specific data elements such as vaccines and functionality that will enable EHR developers to broaden their products. The children’s EHR format was authorized by the 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) and developed by AHRQ and CMS. The format is designed for EHR developers and providers who wish to augment existing systems or to build new systems that include children’s services. Select to read details from the AHRQ press release. Select for more information about the children’s EHR format. Select for more information about Medicaid and CHIP.
A new AHRQ-funded online toolkit, Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care, focuses on reducing falls that occur during a patient’s hospital stay. Nearly one million patients fall in U.S. hospitals each year. The toolkit is organized under six major areas that address hospital readiness, program management, choosing fall prevention practices, implementation, measurement and sustainability. Fall prevention programs require an interdisciplinary approach to care in order to manage a patient’s underlying fall risk factors, such as problems with walking and transfers, medication side effects, confusion and frequent toileting needs.
AHRQ has released a new Patient Safety Education and Training Catalog that describes 333 patient safety programs currently available in the United States. The catalog offers an easily navigable database of education and training programs including a robust collection of information tagged for easy searching and browsing. The database identifies program characteristics, including clinical area, program and learning objectives, evaluation measures and cost. The clinical areas align with AHRQ’s Patient Safety Network (PSNet) Collections. The catalog was developed by the American Institutes for Research through a review of available programs between 2010 and 2011.
Primary care providers can address their patients’ health literacy needs by using a Health Literate Care Model, according to a new study published in the February 4 online issue of Health Affairs. More than one-third of patients in the United States lack the health literacy skills to take care of their health, according to study authors, HHS Assistant Secretary for Health Howard K. Koh, M.D., AHRQ’s Cindy Brach, M.P.P., and others. The Care Model, currently used by medical providers to improve the quality of their patients’ care, has drawn attention to the importance of informed patient engagement, but it does not include specific strategies to make sure all patients understand health information and can navigate the complex health care system. The proposed Health Literate Care Model would integrate tools from AHRQ’s 2010 Health Literacy Universal Precautions Toolkit into each of the Care Model’s six elements -- health care organization, self-management support, delivery system redesign, decision support, clinical information systems, and community linkages. According to the authors, use of the Health Literate Care Model will make health literacy an organizational value while introducing health literacy universal precautions such as confirming patient understanding through “teach back” into the care system. Select to access the PubMed® abstract of the study, titled “A Proposed 'Health Literate Care Model' Would Constitute a Systems Approach to Improving Patients' Engagement in Care.” Select to access information about AHRQ’s Health Literacy Universal Precautions Kit.
Health information technology (IT) can be effectively used to deliver patient-centered care and improve relevant outcomes, according to a new AHRQ-funded report that highlights findings and lessons from the Enabling Patient-Centered Care through Health IT Grant Initiative. However, the effectiveness of these interventions is impacted by how well they are designed and implemented, and the extent to which intervention addresses the unique needs of diverse patient populations. Grantees studied different approaches for using technologies to create or enhance the delivery of patient-centered care in ambulatory care settings. All of the studies examined ways to improve patient self-management, defined as patients’ skills and confidence to manage their own health. In addition, 10 projects explored ways to provide patients, their caregivers, or providers access to medical information. Select to read the report or to access a brief video that highlights the research of Dr. James Mold.
AHRQ’s Evaluation Highlight No. 1 reports on the early accomplishments, challenges and lessons learned on practice-level quality measurement and reporting from four States that received grants to improve health care quality under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). AHRQ is leading a national evaluation of the CHIPRA Quality Demonstration Grant Program, which provided funds to 18 States to improve the quality of health care for children enrolled in Medicaid and CHIP. This first report is the first in a series of reports that will present descriptive and analytic findings from the national evaluation. A supplemental report provides detailed descriptions of the approaches taken by the four States (Maine, Massachusetts, North Carolina and Pennsylvania) featured in the Evaluation Highlight. Learn more about the evaluation.
Last month, CMS notified State Medicaid and CHIP programs of improvements to the core set of voluntary CHIPRA quality measures. Changes to the core measure set, based in large part on work done by the AHRQ-CMS CHIPRA Pediatric Quality Measures Program (PQMP) Centers of Excellence and the AHRQ National Advisory Council’s Subcommittee on Children's Healthcare Quality Measures, include the addition of three new measures and the retirement of one measure. Select to read the CMS letter to States, the background report prepared by AHRQ, and for more information on the CHIPRA PQMP program.
AHRQ in the Professional Literature
Grembowski D, Anderson ML, Ralston JD, et al. Does a large-scale organizational transformation toward patient-centered access change the utilization and costs of care for patients with diabetes? Med Care Res Rev 2012 Oct; 69(5):519-39. Select to access the abstract on PubMed.®
Parisi SM, Zikovich S, Chuang CH, et al. Primary care physicians' perceptions of rates of unintended pregnancy. Contraception 2012 Jul; 86(1):48-54. Select to access the abstract on PubMed.®
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes 2012 Sep 18. Select to access the abstract on PubMed.®
Hendel RC, Ruthazer R, Chaparro S, et al. Cocaine-using patients with a normal or nondiagnostic electrocardiogram: single-photon emission computed tomography myocardial perfusion imaging and outcome. Clin Cardiol 2012 Jun; 35(6):354-8. Select to access the abstract on PubMed.®
Kesselheim AS. Ethical considerations in orphan drug approval and use. Clin Pharmacol Ther 2012 Aug; 92(2):153-5. Select to access the abstract on PubMed.®
Siegel MJ, Lucas JA, Akincigil A, Gaboda D, Hoover DR, Kalay E, Crystal S. Race, education, and the treatment of depression in nursing homes. J Aging Health 2012 Aug; 24(5):752-78. Select to access the abstract on PubMed.®
Zhang Y, Gellad WF, Zhou L, et al. Access to and use of $4 generic programs in Medicare. J Gen Intern Med 2012 Oct; 27(10):1251-7. Select to access the abstract on PubMed.®
Crowne SS, Gonsalves K, Burrell L, et al. Relationship between birth spacing, child maltreatment, and child behavior and development outcomes among at-risk families. Matern Child Health J 2012 Oct; 16(7):1413-20. Select to access the abstract on PubMed.®
Please address comments and questions about the AHRQ Electronic Newsletter to Linwood Norman at:
Linwood.Norman@ahrq.hhs.gov or (301) 427-1248