AHRQ Reports Find Cardiac Care Is Improving But Quality and Access Still Lag for Many Americans

Electronic Newsletter, Issue 341

The AHRQ Electronic Newsletter is issued periodically and summarizes Agency research and programmatic activities.

April 25, 2012

Today's Headlines

  1. AHRQ report find cardiac care is improving but quality and access still lag for many Americans
  2. Men more likely to be readmitted to hospital after discharge
  3. Hospital Common Formats Version 1.2 available from AHRQ
  4. AHRQ review finds glaucoma treatments can lower eye pressure
  5. Risks high for elderly patients receiving treatment to fix narrowed heart artery
  6. AHRQ's Innovations Exchange profiles patient-centered care programs for vulnerable populations
  7. Symposium on patient-centered outcomes research methods to be Web broadcast June 12-13
  8. AHRQ in the professional literature

1. AHRQ Reports Find Cardiac Care Is Improving But Quality and Access Still Lag for Many Americans

Cardiac care is showing significant improvement in the United States, according to AHRQ's 2011 National Healthcare Quality Report and National Healthcare Disparities Report. Gains were seen in reduced hospital admissions for congestive heart failure, fewer hospital deaths due to heart attack, and improved timeliness by hospitals to provide angioplasty to heart attack patients. The reports, mandated by Congress since 2003, show that racial and ethnic disparities in cardiovascular care were less common than disparities in care for other conditions. However, overall health care quality continues to improve at a slow rate (2.5 percent), and quality and access to care are lacking for many Americans because of disparities based on race and ethnicity, socioeconomic status and other factors. New features in the 2011 reports include data on the adoption of electronic health record systems in hospitals as well as home health and hospice agencies. The reports show that only 12 percent of hospitals had fully implemented an electronic system that supports clinical documentation including patient demographics, physician and nursing notes, medication and problem lists, advance directives and discharge summaries. Select to access the reports. AHRQ also offers an online query system that allows access to national and state data on health care quality.

2. Men More Likely To Be Readmitted to Hospital after Discharge

Men are more likely than women to be readmitted to the hospital within a month after being discharged, according to a new AHRQ-funded study. The risk for returning to the hospital within 30 days is higher among men who are retired, unmarried, screen positive for depression or don't visit a primary care physician for follow-up after their hospitalization, according to the study from researchers at Boston University School of Medicine. The article was published online in BMJ Open. Returning to the hospital within 30 days following discharge occurs frequently and is often linked to complications and longer recovery times. Nearly one in five Medicare patients returned to the hospital within 30 days after discharge from 2003 to 2004 at an estimated yearly cost of $17.4 billion. Previous research by the Boston University School of Medicine team found that hospital staff could lower the incidence of hospital readmission by 30 percent through specific, coordinated efforts, including providing clear instructions to patients about what they need to do once they leave the hospital and following up with patients after discharge. In the new study, the only risk factor that predicted whether men and women were likely to be readmitted to the hospital within 30 days was whether they had been hospitalized in the previous 6 months. Select to access AHRQ information to help improve the hospital discharge process

3. Hospital Common Formats Version 1.2 Available from AHRQ

AHRQ developed Common Formats—Hospital Version 1.2 which incorporates the event-specific formats entitled Venous Thromboembolism (VTE) and Device or Medical/Surgical Supply including Health Information Technology (Health IT) Device.  Common Formats—Hospital Version 1.2 also includes minor changes to existing modules and technical specifications and is available for public review and comment. The Common Formats, which are authorized by the Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), establish a standard language, definitions, technical requirements, and reporting specifications that patient safety, quality, and risk managers, clinicians, and others can use to collect patient safety event information. Patient Safety Organizations (PSOs) use Common Formats to ensure consistency in reporting patient safety event information and allow aggregation and analysis of comparable, interoperable data at provider, PSO, and national levels. Select to access the most current versions of the Common Formats on the PSO Privacy Protection Center Web site.

4. AHRQ Review Finds Glaucoma Treatments Can Lower Eye Pressure

Glaucoma treatments can lower eye pressure, and a common surgery for this condition offers better outcomes than other approaches, according to two new research reviews from AHRQ's Effective Health Care Program. Treatment for Glaucoma: Comparative Effectiveness shows that glaucoma treatments, including medication, laser treatment, and surgery, can lower eye pressure. Trabeculectomy, a common surgery, appears to be superior to other approaches, such as laser trabeculoplasty and medications to decrease eye pressure. Screening for Glaucoma: Comparative Effectiveness summarizes evidence linking glaucoma screening to health outcomes. It found insufficient evidence to address whether glaucoma screening is effective in improving vision-related outcomes and concluded that more research is needed to address the association between screening and quality of life outcomes. Glaucoma is a leading cause of blindness, affecting over 60 million people worldwide. Open-angle glaucoma, the most common subtype of the disease, affects over 2.5 million people in the United States.

5. Risks High for Elderly Patients Receiving Treatment to Fix Narrowed Heart Artery

Adverse events are common in patients 65 and older who undergo percutaneous coronary intervention (PCI), or angioplasty, to treat the narrowed unprotected left main coronary artery, according to AHRQ's Effective Health Care Program. PCI is used to treat less than 5 percent of patients with unprotected left main coronary artery stenosis and is generally reserved for patients at high surgical risk.  Negative effects in elderly patients are common and are likely influenced by both patient and procedural factors, including the type of stent used. The study, "Characteristics and Long-Term Outcomes of Percutaneous Revascularization of Unprotected Left Main Coronary Artery Stenosis in the United States," published in the Journal of the American College of Cardiology, showed 40 percent of elderly patients die within the first three years of follow-up after the procedure. Select to access the abstract on PubMed®.

6. AHRQ's Innovations Exchange Profiles Patient-Centered Care Programs for Vulnerable Populations

The April 11 issue of AHRQ's Health Care Innovations Exchange profiles two programs that deliver patient-centered care to vulnerable populations, improve the patient experience and enhance access to appropriate care. Penn Asian Senior Services, based in Philadelphia, trains and places culturally competent certified nurse aides and home health aides for home health care services. The program has enhanced culturally sensitive care to the underserved Asian population, particularly those who are frail, elderly, and speak limited English. Practice Without Pressure, helps people with disabilities access medical, dental, and personal care by training them to overcome their fear of routine procedures. The Delaware-based program has enhanced access to services for numerous individuals, many of whom now receive care without sedation or restraints. Select to read more profiles of innovations related to patient-centered care on the Innovations Exchange Web Site, which contains more than 700 searchable innovations and 1,550 QualityTools.

7. Symposium on Patient-Centered Outcomes Research Methods to be Web Broadcast June 12-13

An invitational symposium on research methods, "Efficacy to Effectiveness," will be held June 12-13 at the AHRQ Conference Center in Rockville, MD. AHRQ will provide a live, online broadcast of scientists' slides and audio presentations, which will highlight factors that result in differences between results from randomized clinical trials of treatments (efficacy) and observational studies of treatments outside of controlled research environments (effectiveness). The symposium—the 4th sponsored by AHRQ's DEcIDE Research Network—also will provide a forum for scholarly deliberation of new and emerging research methods in different disciplines and across settings. Sherine E. Gabriel, M.D., professor of medicine and epidemiology at the Mayo Clinic and methodology committee chair at the Patient-Centered Outcomes Research Institute (PCORI), will provide the keynote speech. Select to register, review the agenda, or get more information. Papers presented at 2006 and 2009 symposia and published in the journal Medical Care are available on AHRQ's Effective Health Care Web site. For free reprints, Email AHRQpubs@ahrq.hhs.gov, Publication Nos. OM07-0085 and OM10-0067. Papers presented at the 2011 conference will be available soon on the AHRQ Web site or may be pre-ordered through the AHRQ Clearinghouse (Publication No. OM12-0043).

8. 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.

Shaikh U, Nettiksimmons J, Bell RA, et al. Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling. Acad Pediatr 2012 Mar; 12(2):81-7. Select to access the abstract on PubMed®.

Carroll NW, Dorsch MP. Costs of providing antiplatelet medication for percutaneous coronary intervention patients. Am J Manag Care 2011 Dec; 17(12):803-10. Select to access the abstract on PubMed®.

O'Neill SM, Hempel S, Lim YW, et al. Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'? BMJ Qual Saf 2011 Dec; 20(12):1011-19. Select to access the abstract on PubMed®.

Kesselheim AS, Cresswell K, Phansalkar S, et al. Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation. Health Aff 2011 Dec; 30(12):2310-17. Select to access the abstract on PubMed®.

Shiffman RN, Michel G, Rosenfeld RM, et al. Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc 2012 Jan 1;19(1):94-101. Select to access the abstract on PubMed®.

Binswanger IA, Mueller S, Clark CB, et al. Risk factors for cervical cancer in criminal justice settings. J Womens Health 2011 Dec; 20(12):1839-45. Select to access the abstract on PubMed®..

Routh JC, Pennison M, Rosoklija I, et al. Racial variation in timing of pyeloplasty: prenatal versus postnatal diagnosis. J Urol 2011 Dec; 186(6):2386-91. Select to access the abstract on PubMed®.

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Current as of April 2012
Internet Citation: AHRQ Reports Find Cardiac Care Is Improving But Quality and Access Still Lag for Many Americans: Electronic Newsletter, Issue 341. April 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/341.html