December 14, 2012
Treating broken bones, sprains and other trauma injuries cost $81 billion in 2009. Of this total, 36 percent went to hospital care, 29 percent to medical office-based care, and the rest paid for care in emergency rooms, outpatient and home settings, as well as prescription drugs, according to an AHRQ statistical brief. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #387: Expenditures for Trauma-Related Disorders, 2009: Estimates for the U.S. Civilian Noninstitutionalized Population.]
- AHRQ to host December 18 Web conference on patient-clinician communication using health IT.
- AHRQ report examines effect of quality improvement interventions on palliative care.
- Medicare Advantage patients more likely to be readmitted.
- Teamwork key to long-term sustainability of health IT systems.
- New review evaluates non-oral medications to treat acute migraine.
- AHRQ's Health Care Innovations Exchange focuses on using information systems to promote prevention.
- Combining strategies cuts hospitals' healthcare-associated infection rates.
- New research on effectiveness and safety of aldosterone antagonist therapy among patients with heart failure.
- AHRQ in the professional literature.
1. AHRQ To Host December 18 Web Conference on Patient-Clinician Communication Using Health IT
AHRQ is hosting a free Web conference on December 18 from 2:30 p.m. to 4:00 p.m. EST to discuss models to improve patient and clinician communication. The Web conference will identify ways in which health IT can be used to support the delivery of patient-centered care by promoting more effective communication during the clinical encounter. Expert panel members will present projects that address interventions to increase preventive care, cancer survivorship planning, and appropriate medication management. Participants will earn 1.5 contact credit hours for their participation and must complete an online evaluation in order to obtain a CE certificate.
2. AHRQ Report Examines Effect of Quality Improvement Interventions on Palliative Care
Patient education and self-management can help reduce pain in patients with advanced and serious illnesses, according to a new AHRQ report on the impact of quality improvement interventions on outcomes. The authors, affiliated with the AHRQ-supported Johns Hopkins University Evidence-based Practice Center in Baltimore, MD, also reviewed the evidence for the impact of quality improvement strategies on quality of life, patient and family satisfaction, health care utilization, and other outcomes. Select to access the report, Improving Health Care and Palliative Care for Advanced and Serious Illness. Closing the Quality Gap: Revisiting the State of the Science. The report is part of the Closing the Quality Gap: Revisiting the State of the Science series and builds on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Select to access the full list of completed AHRQ evidence reports.
3. Medicare Advantage Patients More Likely To Be Readmitted
People with Medicare Advantage coverage are 6 percent more likely to be readmitted within 30 days of an initial hospitalization compared with people who have traditional Medicare fee-for-service coverage, according to a new AHRQ-funded study. Even though Medicare Advantage enrollees typically are younger and have fewer serious illnesses, they had a higher likelihood of readmission even after study authors controlled for risk and self-selection bias. Publishing readmission rates among Medicare plans can offer enrollees new insights about each plan's quality of care and could spur development of programs to reduce readmissions. The study, Likelihood of Hospital Readmission after First Discharge in the Year: Medicare Advantage vs. Fee-for-Service Patients, was published November 9 in Inquiry. A print copy is available by sending an Email to firstname.lastname@example.org.
4. Teamwork Key to Long Term Sustainability of Health IT Systems
Researchers who sustain health IT projects are able to demonstrate their benefits to organizations and to clinicians and show their cost benefit, according to a new AHRQ report. The report, Effective Teamwork and Sustainability in Health IT Implementation, highlights the experiences of over 100 grantees that implemented major health IT projects between 2004 and 2007. It reviewed grantee experiences related to planning, long-term use, partnerships, vendor relationships, and end-user perceptions following the conclusion of the project period. Grantees reported that most health IT products that were implemented and upgraded during the study continue to be used. However, clinician buy-in and support must be established early in the planning period and be sustained during implementation and maintenance phases. Effective planning, including completing a detailed workflow analysis, implementation plan and process redesign assessment prior to implementation were strong markers of long-term viability. Strategic partnerships were another indicator for success; trusted partners with implementation experience provided practical advice that helped grantees navigate challenges in health IT implementation. Most grantees reported that health IT upgrades were beneficial to the organization and that ongoing investments in health IT infrastructure were warranted. Select to access the report.
5. New Review Evaluates Non-Oral Medications to Treat Acute Migraine
Many non-oral agents, such as NSAIDS, opioids, and triptans, appear to be effective at treating acute migraine headache when compared with placebo for patients seeking treatment at the emergency department, a new research review from AHRQ finds. However, evidence is insufficient to show that any one treatment is better than another. The review compares the effectiveness of non-oral medications versus standard care, placebo, or other treatments. Nine different classes of drugs are reviewed: antiemetics (metoclopramide), neuroleptics, ergotamines, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, triptans, magnesium sulfate (MgSO4), and antihistamines. Select to read the findings in the full research review, Acute Migraine Treatment in Emergency Setting.
6. AHRQ's Health Care Innovations Exchange Focuses on Using Information Systems to Promote Prevention
The December 5 issue of AHRQ's Health Care Innovations Exchange features profiles that describe ways health information technologies can be used to promote access to preventive services. In one such program, patients served by 14 medical practices in Virginia use an interactive preventive health record to learn about their preventive health needs and obtain relevant educational information and tools. Patients sign on to the system before each visit to view health information drawn from the practice's electronic health record and complete a health risk assessment. The system then generates a summary page that lists the dates of past preventive services and associated test results, highlights missing information, and makes evidence-based recommendations on needed preventive services. The process has improved access to preventive health services, including cancer screenings and immunizations, and has generated high levels of satisfaction among providers. Read more innovation profiles related to using information systems to promote prevention on the Innovations Exchange Web site, which contains more than 750 searchable innovations and 1,500 QualityTools.
7. Combining Strategies Cuts Hospitals' Healthcare-Associated Infection Rates
Basic quality improvement strategies are more effective at reducing healthcare-associated infections when coupled with audits and clinician feedback, a new evidence report from AHRQ shows. Prevention of Healthcare-Associated Infections concludes that combined strategies were also effective at increasing hospital staff adherence to infection-specific patient safety protocols. Select to access the report. This report is part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, developed by AHRQ's Effective Health Care Program, which funds effectiveness and comparative effectiveness research and makes findings available for clinicians, consumers, and policymakers.
8. New Research on Effectiveness and Safety of Aldosterone Antagonist Therapy in Patients with Heart Failure
Older patients with heart failure and reduced ejection fraction who use aldosterone antagonist therapy after being discharged from the hospital did not experience improved mortality or reduced readmission rates due to cardiovascular conditions, new research from AHRQ's Effective Health Care Program finds. However, this therapy was associated with a modest reduction in the risk of hospitalization for heart failure. Additional research is needed to evaluate the clinical effectiveness of aldosterone antagonists in the broad population of patients with heart failure, the report concludes. Select to access the abstract, Associations Between Aldosterone Antagonist Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Reduced Ejection Fraction, on PubMed®.
9. AHRQ in the Professional Literature
Winterstein AG, Gerhard T, Kubilis P, et al. Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. BMJ 2012 Aug 11; 345(7869):e4627. Select to access the abstract on PubMed®.
Sarkar U, Bonacum D, Strull W, et al. Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians. BMJ Qual Saf 2012 Aug; 21(8):641-8. Select to access the abstract on PubMed®.
Pumberger M, Chiu YL, Ma Y, et al. Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors. Eur Spine J 2012 Aug; 21(8):1633-9. Select to access the abstract on PubMed®.
Nembhard IM, Singer SJ, Shortell SM, et al. The cultural complexity of medical groups. Health Care Manage Rev 2012 Jul-Sep; 37(3):2300-13. Select to access the abstract on PubMed®.
Tang JW, Kushner RF, Cameron KA, et al. Electronic tools to assist with identification and counseling for overweight patients: a randomized controlled trial. J Gen Intern Med 2012 Aug; 27(8):933-9. Select to access the abstract on PubMed®.
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Current as of December 2012
AHRQ Electronic Newsletter, December 14, 2012, Issue 361. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews361.htm