January 25, 2013
Hospital stays increased by 12 percent between 1997 and 2010, but their cost jumped 62 percent — from $232 billion to $376 billion. (Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #144: Overview of Hospital Stays in the United States, 2010).
- Intensive Care Units for Newborns See Sharp Drop in Bloodstream Infections.
- Study Finds 6.5 Percent of Patients Readmitted to Pediatric Hospitals Within 30 Days.
- Treatments for Chronic Hepatitis C Reviewed for Effectiveness.
- EHR-Generated Clinical Measures Useful in Estimating Quality of Care.
- AHRQ Offers New Report Summary on Quality Gaps Across Health Care.
- AHRQ To Host January 29 Web Conference on Using ACO Principles and Financial Incentives to Improve Health Outcomes.
- AHRQ in the professional literature.
1. Intensive Care Units for Newborns See Sharp Drop in Bloodstream Infections
Central line-associated bloodstream infections (CLABSIs) in newborns were reduced by 58 percent in less than a year in hospital neonatal intensive care units (NICUs) participating in an AHRQ patient safety program. Frontline caregivers in 100 NICUs in nine states relied on the program's prevention practice checklists and better communication to prevent an estimated 131 infections and up to 41 deaths and to avoid more than $2 million in health care costs, according to a new AHRQ report.
CLABSIs are healthcare-associated infections (HAIs) that cause serious illness and death in infants as well as adults. In newborns, especially premature infants, central lines can remain in place for weeks or months to provide nutrients and medications, creating opportunities for infections. Health care teams in the project states, caring for 8,400 newborns, used AHRQ's Comprehensive Unit-based Safety Program (CUSP) to improve safety culture and consistently implement catheter insertion and maintenance guidelines. CUSP helps hospitals understand and apply the science of safety and take actions to improve teamwork and communications. A nationwide project to reduce CLABSIs in all ICUs that ended in September 2012 led to a 41 percent overall reduction, according to new details in a separate final report from that project. Select to see details from both projects in a January 24 AHRQ press release.
2. Study Finds 6.5 Percent of Patients Readmitted to Pediatric Hospitals Within 30 Days
More than 6 percent of infants and youth hospitalized over a 1-year period had unplanned readmissions within 30 days of discharge, a new study from AHRQ and CMS has found. The three health conditions with the highest readmission rates were anemia or neutropenia (23 percent); ventricular shunt procedures (18 percent); and sickle cell anemia crisis (17 percent). The majority of readmissions (9 of the top 10 diagnoses) were related to the initial cause of hospitalization. Two-thirds of the children included in this analysis of nearly 569,000 admissions to 72 children's hospitals had at least one chronic health condition. The study also found that children with a higher number of chronic conditions had a higher likelihood of an unplanned readmission as well as significant variation in readmission rates across conditions and hospitals. The study, "Pediatric Readmission Prevalence and Variability Across Hospitals," was published in the January 23 issue of JAMA. Select to access the abstract on PubMed®.
3. Treatments for Chronic Hepatitis C Reviewed for Effectiveness
Patients with hepatitis C virus (HCV) who achieved a sustained virologic response (SVR), or undetectable levels of the virus 6 months after completing treatment, have a decreased risk of death compared with those who do not achieve that response, a new research review from the AHRQ's Effective Health Care Program finds. HCV is the most common chronic bloodborne pathogen and is associated with an estimated 15,000 U.S. deaths each year. The review compared the effectiveness of dual- and triple-drug combinations in achieving SVR. For the summary of findings and future research needs, select to access the publication, Treatment of Hepatitis C Virus Infection in Adults: A Comparative Effectiveness Review.
4. EHR-Generated Clinical Measures Useful in Estimating Quality of Care
Nine of 12 clinical quality measures generated by interoperable electronic health records showed good consistency in estimating quality of care, a recent AHRQ-supported study concludes. The study, "Accuracy of Electronically Reported 'Meaningful Use' Clinical Quality Measures: A Cross-Sectional Study," which appeared in the January 15 issue of the Annals of Internal Medicine, suggests that electronic quality measurement can identify areas in need of improvement and quantify the impact of changes that have been made. This study was a part of AHRQ's research into how to improve electronically enabled quality measurement. Select to access a short video about this project. Select to access the abstract on PubMed®.
5. AHRQ Offers New Report Summary on Quality Gaps Across Health Care
A new summary of evidence reports from AHRQ on opportunities to improve health care quality is now available. Beginning in 2004, the eight "Closing the Quality Gap" reports assessed evidence for improvement for selected settings, interventions and clinical conditions. Individual reports examined the effectiveness of bundled payment programs, effectiveness of the patient-centered medical home, strategies to address health disparities, effectiveness of medication adherence interventions, effectiveness of public reporting, prevention of healthcare-associated infections, measurement of outcomes for people with disabilities, and health care and palliative care for patients with advanced and serious illness. The summary, Closing the Quality Gap: Revisiting the State of the Science, is designed to provide a deeper understanding of the nature and extent of quality gaps across health care, as well as the systemic changes necessary to close them. Select to access the AHRQ report.
6. AHRQ To Host January 29 Web Conference on Using ACO Principles and Financial Incentives to Improve Health Outcomes
AHRQ's Health Care Innovations Exchange is sponsoring a free 90-minute Web conference on January 29 from 1:00 p.m.—2:30 p.m. EST that focuses on how to use Accountable Care Organization (ACO) principles and financial incentives to improve health outcomes. The Web conference will feature innovative practices from Montefiore Medical Center in New York and Blue Cross Blue Shield of Michigan. Leaders at Montefiore Medical Center established an infrastructure based on ACO principles and improved the management of diabetes, asthma and congestive heart failure. As a result, it reduced hospital admissions, readmissions and medical expenses among several key populations. Select to access the innovation profile.
Blue Cross Blue Shield of Michigan provided financial incentives and supported provider-led quality improvement collaboratives, significantly improving quality, reducing costs and generating a positive return on investment. Select to access the innovation profile and select to register for the Web conference.
7. AHRQ in the Professional Literature
Kwon S, Thompson R, Florence M, et al. B-Blocker continuation after noncardiac surgery: a report from the Surgical Care and Outcomes Assessment Program. Arch Surg 2012 May; 147(5):467-73. Select to access the abstract on PubMed®.
Kesselheim AS, Robertson CT, Myers JA, et al. A randomized study of how physicians interpret research funding disclosures. N Engl J Med 2012 Sep 20; 367(12):1119-27. Select to access the abstract on PubMed®.
Gierisch JM, Straits-Troster K, Calhoun PS, et al. Tobacco use among Iraq- and Afghanistan-era veterans: a qualitative study of barriers, facilitators, and treatment preferences. Prev Chron Dis 2012 Feb; 9:E58. Select to access the abstract on PubMed®.
Leeman J, Sandelowski M. Practice-based evidence and qualitative inquiry. J Nurs Scholarsh 2012 Jun; 44(2):171-9. Select to access the abstract on PubMed®.
Churpek MM, Yuen TC, Park SY, Meltzer DO, et al. Derivation of a cardiac arrest prediction model using ward vital signs. Crit Care Med 2012 Jul; 40(4):2102-8. Select to access the abstract on PubMed®.
Anderson JE, Lassiter R, Bickler SW, Talamini MA, Chang DC. Brief tool to measure risk-adjusted surgical outcomes in resource-limited hospitals. Arch Surg 2012 Sep; 147(9):798-803. Select to access the abstract on PubMed®.
Bhavsar NA, Kottgen A, Coresh J, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) as predictors of incident CKD Stage 3; the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2012 Aug; 60(2):233-40. Select to access the abstract on PubMed®.
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Current as of January 2013
AHRQ Electronic Newsletter, January 25, 2013, Issue 365. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews365.htm