Data from EHRs May Provide Insights into Quality of Children's Care

Electronic Newsletter, Issue 358

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

November 8, 2012

AHRQ Stats

A new AHRQ data analysis shows that hospitals stays among obese patients jumped from 6 percent to 9 percent between 2004 and 2009; another analysis found that stays by obese children doubled between 2000 and 2009. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #137: Obesity-Related Hospitalizations, 2004 vs. 2009 and Statistical Brief #138: Obesity in Children: Hospitalizations from 2000 to 2009.]

Today's Headlines

  1. Data from EHRs may provide insights into quality of children's care.
  2. Little evidence exists on how to measure quality improvement in people with disabilities.
  3. Better neonatal outcomes seen for premature babies at hospitals with NICUs.
  4. Care processes may reduce agitation in people with dementia.
  5. New online toolkit helps hospitals reduce C. difficile.
  6. Insufficient evidence exists on biomarkers to detect iron deficiency anemia in patients with kidney disease.
  7. Some noninvasive tests found to excel at detecting coronary artery disease in women.
  8. AHRQ's Health Care Innovations Exchange focuses on underserved populations.
  9. AHRQ in the professional literature.

Data from EHRs May Provide Insights into Quality of Children's Care

Overly strict adherence to measures that define the quality of health care that children receive under the Children's Health Insurance Program may overlook the true quality of care provided, especially among children who use health services sporadically, a new AHRQ-funded study finds. Quality measures developed as a result of Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 calculate care quality based on health insurance claims data. However, claims data may not capture as many facets of patient care as electronic health records (EHRs), according to the study authors. While claims data capture information generated during the period a patient is insured through a health plan, EHRs can capture information about patient care regardless of health insurance status. The article, "Are Pediatric Quality Measures Too Stringent?" appeared in the October issue of the Journal of the American Board of Family Medicine. Select to access the abstract on PubMed®. 

Little Evidence Exists on How to Measure Quality Improvement in People with Disabilities

Little evidence is available to adequately assess measures for evaluating quality improvement outcomes among disabled people, according to a new AHRQ-funded report. Quality of life, social functioning, and other outcomes measures are essential to help assess the quality of care for people with physical, intellectual, or developmental disabilities. Such measures are important because they can provide insight into how disabilities can influence ongoing medical conditions, treatment, and follow-up care. But no studies include disability as an underlying condition and also assess the outcomes of medical care for basic medical needs or secondary conditions in mixed populations of disabled and non-disabled participants. Research on disability as a comorbidity is at an early stage and could benefit from organized databases of critically assessed outcome measures, according to the lead author, Mary Butler, Ph.D., of the Minnesota Evidence-based Practice Center. The report 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. The initiative was developed by AHRQ's Effective Health Care Program. Select to read Quality Improvement Measurement of Outcomes for People with Disabilities. 

Better Neonatal Outcomes Seen for Premature Babies at Hospitals with NICUs

Mortality rates and other complications of premature deliveries are between 100 percent and 300 percent higher at hospitals lacking high-level neonatal intensive care units (NICUs) compared with hospitals with NICUs, an AHRQ-funded study finds. Previous studies of preterm birth outcomes at NICUs showed survival rates between 30 percent and 50 percent, the authors said. The new study is based on more than 1.3 million deliveries of babies with a gestational age of 23 to 37 weeks at hospitals in Pennsylvania, California, and Missouri over a multi-year period. Rather than suggesting that every hospital should build its own high-level NICU, the authors said their findings can assist policymakers in organizing regional and statewide care systems to more efficiently provide care for premature infants within a geographical area. The study, "The Differential Impact of Delivery Hospital on the Outcomes of Premature Infants," was published online July 9 in Pediatrics. Select to access the abstract on PubMed®. 

Care Processes May Reduce Agitation in People with Dementia

Providing pleasant sensory stimulation, such as calm music, may reduce agitation in patients with dementia, according to a new research review from AHRQ's Effective Health Care Program. The report compared characteristics and outcomes of patients in nursing homes and other residential long-term care settings. Individualized care and skill training may also reduce pain and agitation and improve function. Overall, outcomes for people with dementia do not differ between nursing homes and residential care/assisted living settings, except for those who need medical care and may benefit from a nursing home setting. As many as one in eight individuals ages 65 years or older, or an estimated 5 million people, has dementia. These findings and future research needs are summarized in Comparison of Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People With Dementia. 

New Online Toolkit Helps Hospitals Reduce C. difficile

A new toolkit from AHRQ can help facilities implement an antimicrobial stewardship program that specifically targets C. difficile. The online toolkit includes an extensive list of user-ready resources and real-world examples of their implementation. It addresses detailed questions that hospitals commonly have when considering how to set up a program, such as organizational readiness and how to select the right intervention. Select to access the toolkit. 

Insufficient Evidence Exists on Biomarkers to Detect Iron Deficiency Anemia in Patients with Kidney Disease

A new research review from AHRQ evaluates the evidence on the comparative effectiveness and accuracy of using biomarkers to identify iron deficiency anemia in patients with kidney disease. No single laboratory test that examines biomarkers of iron status can determine iron deficiency, and more evidence is needed to determine the comparative accuracy of various biomarker combinations for diagnosing iron deficiency, the review found. Overall, the strength of evidence supporting these conclusions is low, particularly related to children and non-hemodialysis patients. Clinical uncertainty also remains about the use of newer biomarkers in the assessment of iron status and management of iron deficiency in patients with stages 3 – 5 chronic kidney disease. Select to access Biomarkers for Assessing and Managing Iron Deficiency Anemia in Late Stage Chronic Kidney Disease. 

Some Noninvasive Tests Found to Excel at Detecting Coronary Artery Disease in Women

Noninvasive tests that produce images of how well the heart is functioning, such as echocardiography and single proton emission computed tomography, can accurately diagnose coronary artery disease (CAD) in women with symptoms, according to a new research review from AHRQ's Effective Health Care Program. These tests were more accurate than electrocardiography, which monitors heartbeats to detect restricted blood flow. The new research review, Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women, found there is insufficient evidence from studies to determine which clinical or demographic factors may influence the diagnostic accuracy, risk determinations, prognostic value, treatment decisions, clinical outcomes, or harms associated with these tests. 

AHRQ's Health Care Innovations Exchange Focuses on Underserved Populations

The November 7 issue of AHRQ's Health Care Innovations Exchange features three profiles of programs that provided medical care and patient education to persons with limited means of accessing such services, improving their health status and facilitating access to follow-up care. One program, the Rural Health Initiative , sent registered nurses with farming backgrounds to three Wisconsin counties to provide free preventive health and occupational safety screenings and health education to farmers and their adult family members and employees. Nurses returned to review test results and, if necessary, make referrals for appropriate follow-up care. The program enhanced access to routine medical care and safety screenings, improved eating habits and cholesterol levels, and generated high attendance at follow-up appointments and high levels of satisfaction. Select to read more innovation profiles related to underserved populations on the Health Care Innovations Exchange Web site, which contains more than 750 searchable innovations and 1,500 QualityTools. 

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.

Goldman LE, Chu PW, Tran H, et al. Federally qualified health centers and private practice performance on ambulatory care measures. Am J Prev Med 2012 Aug; 43(2):142-9. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22813678 on PubMed®.

Memtsoudis SG, Sun X, Chiu YL, Nurok M, et al. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: epidemiology and risk factors. Anesthesiology 2012 Jul; 117(1):107-16. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22634871 on PubMed®.

Zhang Y, Baik SH, Zhou L, et al. Effects of Medicare Part D coverage gap on medication and medical treatment among elderly beneficiaries with depression. Arch Gen Psychiatry 2012 Jul; 69(7):672-9. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22752233 on PubMed®.

Li P, To T, Parkin PC, et al. Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes: a Canadian population-based study. Arch Pediatr Adolesc Med 2012 Jul. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22776991 on PubMed®.

Schaefer GR, Matus H, Schumann JH, et al. Financial responsibility of hospitalized patients who left against medical advice: medical urban legend? J Gen Intern Med 2012 Jul; 27(7):825-30. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22331399 on PubMed®.

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Current as of November 2012
Internet Citation: Data from EHRs May Provide Insights into Quality of Children's Care: Electronic Newsletter, Issue 358. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/358.html