November 1, 2012
AHRQ News and Numbers
Hospital stays for gunshot wounds declined 29 percent between 1993 and 2009. [Source: Agency for Healthcare Research and Quality (AHRQ), HCUP Statistical Brief #135: Hospital Visits in the U.S. for Firearm-Related Injuries, 2009. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb135.jsp].
- AHRQ offers free toolkit to improve medication reconciliation.
- One in seven injury-related hospital stays among elderly results in readmission.
- Primary care practice-based research networks on the rise, offering more advanced research capacity.
- Telephone medication coaching benefits patients following strokes.
- New AHRQ tool assesses patient safety culture in pharmacies.
- 6ools to improve safety for patients with limited English proficiency.
- New report finds medication adherence tactics work.
- Evidence lacking on benefits of screening or treating early stage chronic kidney disease.
- Procalcitonin guidance may lead to decreased antibiotic usage.
- AHRQ's Health Care Innovations Exchange focuses on integrated end-of-life care.
- 2014 Clinical Quality Measures now available.
- AHRQ in the professional literature.
1. AHRQ Offers Free Toolkit to Improve Medication Reconciliation
AHRQ has a free toolkit available to help acute care and post-acute care facilities evaluate and improve their current medication reconciliation process. The toolkit, Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation http://www.ahrq.gov/qual/match/, can help facilities reduce patient harm due to adverse drug events or medication errors. The MATCH toolkit:
- Promotes compliance with The Joint Commission's National Patient Safety Goal for maintaining and communicating accurate patient medication information.
- Can lead to better care transitions and fewer unnecessary readmissions by helping to ensure patients receive the right medication in the right dose at the right time.
- Provides a framework to capture complete, accurate medication information through electronic health records (EHRs).
- Enables the creation of a medication reconciliation process from scratch or redesigning an existing process.
The MATCH toolkit features a comprehensive work plan with procedural guidelines and flowcharts, modifiable templates, pilot-test recommendations, and other resources to help facilities improve medication reconciliation processes. A print copy is available by sending an Email to AHRQpubs@ahrq.hhs.gov.
2. One in Seven Injury-related Hospital Stays among Elderly Results in Readmission
A new AHRQ-funded study finds that about one in seven elderly patients (14 percent) admitted to the hospital for an injury will be readmitted within 30 days. The study examined 2006 data from hospitals in 11 States for admissions with a principal diagnosis of injury using AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases. The most common reasons for readmission were surgery of the upper or lower extremities, pneumonia, heart failure, septicemia and urinary tract infection. Three-quarters of patients admitted for injury were discharged to nursing homes or home health care. Patients who had severe injuries, received transfusions, experienced a patient safety event, had an infection, or were discharged to a nursing home or home health care had higher readmission rates. The study's authors suggest that strategies to reduce readmission rates among elderly injury patients should focus on preventing complications and infections during the hospital stay and also address nursing home and home health care. The report, Thirty-Day, All-Cause Readmissions for Elderly Patients Who Have an Injury-related Inpatient Stay, was published in the October issue of Medical Care. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22929994 on PubMed®.
3. Primary Care Practice-based Research Networks on the Rise, Offering More Advanced Research Capacity
A new AHRQ-funded study describes the rapid growth in the number of primary care Practice-based Research Networks (PBRNs) registered with AHRQ. The 143 PBRNs registered in 2011, an increase of 30 from 2010, included 12,981 practices with more than 63,000 providers who care for approximately 47.5 million people, or about 15 percent of the U.S. population. The study found these PBRNs conducted an average of four studies per year, and that 70 percent of PBRNs have used electronic health record (EHR) data for research. More than 60 percent of PBRNs focus their research efforts on underserved, low-income, and minority populations. Diabetes accounted for half (50 percent) of the most commonly studied health conditions, followed by obesity (42 percent). PBRNs are adopting more advanced study designs and have developed valuable capacity for investigating questions of importance to clinical practice, disseminating results, and implementing evidence-based strategies, the authors conclude. The study, Supporting Better Science in Primary Care: A Description of Practice-based Research Networks in 2011, was published in the September/October issue of the Journal of the American Board of Family Medicine. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22956691 on PubMed®.
4. Telephone Medication Coaching Benefits Patients Following Strokes
Patients discharged from the hospital after a minor stroke or transient ischemic attack (TIA) with at least two new or adjusted medications benefitted from follow-up telephone medication coaching, according to an AHRQ-supported pilot study. Following discharge, 20 patients in the intervention group of the study were contacted by a medication coach by phone to discuss risk factors, review medications, and triage patients' questions to a nurse or pharmacist. Ten control group patients were not contacted. The average times for the first call and follow-up were 27 and 12 minutes, respectively. After three months, participants in the intervention group were found to be more likely to keep their primary care provider appointments (94 percent) than those in the control group (60 percent). Contacting patients by phone soon after discharge is a convenient and relatively inexpensive way to provide assistance to patients and caregivers, the study found. Medication Coaching Program for Patients with Minor Stroke or TIA: A Pilot Study, was published online July 25 in BMC Public Health. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22830539 on PubMed®.
5. New AHRQ Tool Assesses Patient Safety Culture in Pharmacies
AHRQ has released the Pharmacy Survey on Patient Safety Culture and a free toolkit of materials that helps community pharmacies assess their culture of patient safety. It is the latest survey in AHRQ's suite of patient safety culture surveys now being used by hospitals, nursing homes and medical offices. The new survey is designed for pharmacy staff, including clerks, technicians and pharmacists. It includes 36 survey items that measure 11 areas of patient safety culture such as physical space and environment, patient counseling, communication about prescriptions across shifts, and teamwork. It also includes items about the frequency of documenting mistakes and an overall rating on patient safety. Toolkit materials include the survey form, a document identifying items by composite, a survey user's guide, and results from 55 pharmacies that participated in the 2012 pilot study. Select to download the survey http://www.ahrq.gov/qual/patientsafetyculture/pharmsurvindex.htm.
6. Tools to Improve Safety for Patients with Limited English Proficiency
Research shows that safety events that affect patients with limited English proficiency tend to be more severe and occur more frequently due to communication errors. Two new tools are now available to help improve patient safety in those with limited English proficiency. The TeamSTEPPS® Limited English Proficiency module http://teamstepps.ahrq.gov/about-2cl_3.htm developed by AHRQ and the Department of Defense can help staff reduce medical errors for patients with limited English skills. Approximately 57 million people—20 percent of the U.S. population—speak a language other than English at home, and approximately 25 million—nearly 9 percent of the U.S. population—are defined as limited English proficient, meaning that they speak English less than "very well." The module is available in CD format and includes PowerPoint presentations, teaching modules, and video vignettes that can be used to train staff. As a companion to the TeamSTEPPS module, Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals, helps hospital leaders learn how to identify, report, monitor, and prevent medical errors among patients with limited English Proficiency. Select to access the TeamSTEPPS Limited English Proficiency module and Hospital Guide http://www.ahrq.gov/teamsteppstools/lep/. Copies of the module CD are available by sending an Email to AHRQPubs@ahrq.hhs.gov.
7. New Report Finds Medication Adherence Tactics Work
A new report from AHRQ's Effective Health Care Program found that a variety of methods are effective at improving medication adherence among patients with diabetes and other chronic conditions. Patients managed for most chronic illnesses, including diabetes, asthma, heart disease, and depression, were more consistently likely to follow their medication instructions when given an incentive such as reduced out-of-pocket prescription drug costs or improved prescription drug coverage. Case management and educational interventions were also found to improve medication adherence. The strongest evidence came from studies using medication self-management for asthma patients, collaborative care or case management for patients taking drugs for depression, and pharmacist-led approaches to improve systolic blood pressure in hypertensive patients. The study, led by Meera Viswanathan, Ph.D., at AHRQ's RTI-University of North Carolina Evidence-based Practice Center, found limited evidence as to whether the approaches studied can be broadly applied for chronic conditions and patient populations. Researchers also found limited evidence for long-term medication adherence or impacts on health outcomes. The review is part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, and builds on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Select to read the report, Medication Adherence Interventions: Comparative Effectiveness, at http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1249. An article on this report was published September 11 in the Annals of Internal Medicine. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22964778 on PubMed®.
8. Evidence Lacking on Benefits of Screening or Treating Early-Stage Chronic Kidney Disease
A new AHRQ research review found no or limited evidence that screening, monitoring, and treating adults with early-stage chronic kidney disease was beneficial to patients. The condition affects more than 44 percent of U.S. adults over the age of 70. The review examined screening, monitoring, and treatment of adults in stage 1, 2 or 3 of the five stages of chronic kidney disease. Select to read Chronic Kidney Disease Stages 1-3: Screening, Monitoring, and Treatment at http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=809&PCem=EN.
9. Procalcitonin Guidance May Lead to Decreased Antibiotic Usage
Using procalcitonin as part of antibiotic therapy management has been shown to reduce the use of antibiotics, according to a new AHRQ Effective Health Care Program review. Using procalcitonin to inform decisions about antibiotic therapy was associated with reductions in antibiotic usage, while procalcitonin-guided antibiotic discontinuation did not increase morbidity in critically ill patients, the review found. However, procalcitonin-guided intensification of antibiotic therapy to broaden the spectrum of bacterial coverage was not found to improve outcomes in critically ill patients. The review also found strong evidence that procalcitonin-guided treatment reduced antibiotic prescription rates and duration of antibiotic therapy in various clinical settings, without increasing morbidity or mortality.This evidence was especially strong among patients with respiratory tract infections, which are prone to antibiotic misuse. Future studies will help determine if these findings will translate to high-risk groups, such as pregnant, immunocompromised, neonatal, and pediatric patients. Select to access the review at http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1273&PCem=EN.
10. AHRQ's Health Care Innovations Exchange Focuses on Integrated End-of-Life Care
The October 24 issue of AHRQ's Health Care Innovations Exchange (http://www.innovations.ahrq.gov) features three profiles of programs that use palliative care and care coordination to help elderly and terminally ill patients make greater use of hospice and home care services, thereby reducing the incidence of inpatient stays. One innovation was spurred by home and hospice service line leaders in California who realized that patients frequently came to hospice care late in the end-of-life process. These leaders sought to create a new type of service that would not discourage patients and physicians from using it. Their vision was realized in Sutter Health's Advance Illness Management program (http://www.innovations.ahrq.gov/content.aspx?id=3370), a systems-based model that connects hospitals, physician offices, and home-based services in bridging the gap between acute care and end-of-life care for Medicare patients with late-stage chronic illness. It provides ongoing counseling to patients and families to help them understand their options, focuses on helping patients with serious illness clarify their personal care goals, designs care plans to support and achieve these goals, and helps patients control the symptoms of their advanced illness. The program increased use of hospice care, reduced inpatient and ambulatory care utilization and overall care costs, and generated high levels of patient, caregiver, and physician satisfaction. Select to read more innovation profiles related to end-of-life care at http://www.innovations.ahrq.gov/innovations_qualitytools.aspx?categoryID=54552&taxonomyID=9290 on the Innovations Exchange Web site, which contains more than 725 searchable innovations and 1,500 QualityTools.
11. 2014 Clinical Quality Measures Now Available
The final 2014 clinical quality measures (CQMs) for health professional and hospitals are now available, along with the specifications for electronic reporting and access to the related data elements and value sets. The value sets define clinical concepts, providing a list of numerical values (e.g., code values from the vocabularies of ICD-9, SNOMED CT, etc.) and individual descriptions for the clinical concepts used to define the quality measures. Each clinical concept referenced in a clinical quality measure is represented by a set of code values, also known as value sets. To help providers and vendors navigate the new CQM specifications, AHRQ has developed the U. S. Healthcare Knowledgebase (USHIK) with both Meaningful Use Stage 1 and State 2 (2014) clinical quality measures. The USHIK Web site provides different formats for viewing, downloading, and comparing versions of electronic CQMs and their value sets in response to user requests. AHRQ's USHIK is a metadata registry of health care-related standards, their data elements, and metadata funded and directed by AHRQ, in partnership with the Centers for Medicare and Medicaid Services and the Veterans Administration. USHIK's Meaningful Use portal is a comprehensive resource for accessing an organized presentation of Meaningful Use clinical quality measures and value sets. It is unique in allowing users to compare present, past, and future proposed versions of Meaningful Use quality measure and value sets. USHIK allow researchers to browse, compare, and synchronize diverse data sets in order to promote interoperability, uniformity, and comparability of health data. Select to access USHIK Meaningful Use information at http://ushik.ahrq.gov/MeaningfulUseMeasures?system=mu&enableAsynchronousLoading=true
. CMS has developed guidance for understanding and using the final CQMs, as well as human readable files, and e-specifications
12. 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.
Nichols GA, Desai J, Elston Lafata J, et al. Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: the SUPREME-DM project. Prev Chronic Dis 2012 Jun; 9:E110. Select to access the abstract on PubMed®.
Tsai CL, Delclos GL, Camargo CA Jr. Emergency department case volume and patient outcomes in acute exacerbations of chronic obstructive pulmonary disease. Acad Emerg Med 2012 Jun; 19(6):656-63. Select to access the abstract on PubMed®.
Hu CY, Chan W, Delclos GP, et al. Adjuvant chemotherapy and risk of gastrointestinal, hematologic, and cardiac toxicities in elderly patients with stage III colon cancer. Am J Clin Oncol 2012 Jun; 35(3):228-36. Select to access the abstract on PubMed®.
Zhang J, Xie F, Delzell E, et al. Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases. JAMA 2012 Jul 4; 308(1):43-9. Select to access the abstract on PubMed®.
Dalal AK, Schnipper JL, Poon EG, et al. Design and implementation of an automated email notification system for results of tests pending at discharge. J Am Med Inform Assoc 2012 Jul; 19(4):523-8. Select to access the abstract on PubMed®.
Secola R, Lewis MA, Pike N, et al. Feasibility of the use of a reliable and valid central venous catheter blood draw bundle checklist. J Nurs Care Qual 2012 Jul; 27(3):218-25. Select to access the abstract on PubMed®.
Liang L, Meyerhoefer C, Wang J. Obesity counseling by pediatric health professionals: an assessment using nationally representative data. Pediatrics 2012 Jul; 130(1):67-77. Select to access the abstract on PubMed®.
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Current as of November 2012
AHRQ Electronic Newsletter, November 1, 2012, Issue 357. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews357.htm