Clinicians Perform "Chart Biopsies" to Prepare for Patient Handoffs

Enewsletter, Issue 366

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

February 1, 2013

AHRQ Stats

Hospital admissions of patients needing hip replacement for the first time were projected to reach 440,000 by the end of 2012, at a cost of $19,000 per patient. Two-thirds of the hip replacement admissions were due to osteoarthritis. (Source: Agency for Healthcare Research and Quality, HCUP Projections: Mobility/Orthopedic Procedures 2011 to 2012).

Today's Headlines

  1. Clinicians Perform "Chart Biopsies" to Prepare for Patient Handoffs.
  2. Clinical Decision Support Tools to Prevent VTE Increase Correct Therapy Choices.
  3. Launch of Open Access Journal on Electronic Clinical Data.
  4. AHRQ’s Health Care Innovations Exchange Focuses on Medical Home Models for Specialty Care.
  5. New AHRQ Resources on Rheumatoid and Psoriatic Arthritis Treatment Options Now Available.
  6. AHRQ in the professional literature. 

1. Clinicians Perform "Chart Biopsies" to Prepare for Patient Handoffs

A new AHRQ-funded study examines the practice of chart biopsies, a process that allows clinicians to understand the services that patients have received before they are transferred to another care setting. The term "chart biopsy" refers to the activity of examining portions of a patient's electronic health record (EHR) to gather specific information about that patient or to develop a broader understanding of the patient's care, according to the study. With many hospitals moving to EHRs, practitioners can now view patient records before patients are transferred. Chart biopsies enable receiving clinicians to gain a stronger understanding of the patient's condition, allow receiving practitioners to better prepare for handoff and subsequent care, and guard against possible bias in verbal reports. Proponents point out that chart biopsy provides a tool to enrich coordination and collaboration, which may enable safety, efficiency and effectiveness of medical care. The study, "Chart Biopsy: An Emerging Medical Practice Enabled By Electronic Health Records and Its Impacts on Emergency Department-inpatient Admission Handoffs," was published in the September 2012 issue of the Journal of the American Medical Informatics Association. Select to access the abstract on PubMed®. 

2. Clinical Decision Support Tools to Prevent VTE Increase Correct Therapy Choices

Adult trauma patients whose care included the use of mandatory clinical decision support (CDS) tools to prevent venous thromboembolism (VTE) received a greater amount of appropriate preventive therapies, a recent AHRQ-funded study has found. To improve best practices in VTE prevention, researchers implemented a mandatory computerized provider order entry tool and evaluated a checklist of VTE prevention best practices against each patient's pharmacological and risk profile. Providers were prompted to order VTE prevention measures based on each patient's level of risk. The study, "Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma," appeared in the October issue of Archives of Surgery. Select to access the abstract on PubMed®. 

3. Launch of Open Access Journal on Electronic Clinical Data

AHRQ and the Electronic Data Methods Forum have announced the official launch of an open access journal focused on using electronic clinical data to advance research and quality improvement. Called eGEMs (Generating Evidence and Methods to improve patient outcomes), the journal seeks research contributions that aim to improve patient and community outcomes. Authors can submit papers, images or other media focused on data methods, informatics, governance and the learning health system. Select to access the eGEMs system.  

4. AHRQ’s Health Care Innovations Exchange Focuses on Medical Home Models for Specialty Care

The January 30 issue of AHRQ's Health Care Innovations Exchange highlights efforts to adapt patient-centered medical home models for use in specialty practices. Profiles include a community-based oncology practice in Pennsylvania that redesigned its care delivery processes and a pediatric center in Virginia serving children with special health care needs. In the policy area, Community Care of North Carolina, a statewide public–private partnership, adapted its successful primary care medical home model to serve pregnant Medicaid beneficiaries. The initiative has enhanced access to comprehensive prenatal care, including access to care coordination for women with high-risk pregnancies. Preliminary data suggest this initiative has also increased provider adherence to evidence-based care standards and has reduced the incidence of low birth-weight infants and the rate of primary cesarean sections. Read about more innovation profiles and tools related to medical homes on the Innovations Exchange Web site, which contains more than 750 searchable innovations and 1,500 quality tools. 

5. New AHRQ Resources on Rheumatoid and Psoriatic Arthritis Treatment Options Now Available

Two updated research reviews from AHRQ's Effective Health Care Program reinforce the current standards of care for drug therapies used to treat rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Limited evidence on oral and biologic disease-modifying antirheumatic drug (DMARD) therapies prevents firm conclusions on their effectiveness and risks for treating RA and on the superiority of one oral DMARD over another. For PsA, the new review found limited evidence supporting the efficacy of biologic DMARDs; however, evidence is insufficient to draw firm conclusions about the effectiveness, or impact on functional status, health-related quality of life, or tolerability. The new clinician and patient resources compare the latest research on RA and PsA treatments. The summaries reinforce the current standards of care for drug therapies for both conditions. Findings indicate that oral DMARDs remain effective first-line treatments for RA, but biologic DMARDs are more effective in treating RA symptoms. For the treatment of PsA, evidence supports the general efficacy of both oral and biologic DMARDs. No conclusions can be reached about whether some DMARDs and treatment strategies are better than others for minimizing PsA joint damage and improving quality of life. New RA resources include a patient summary, clinician summary, CME/CE activity, and faculty slide set, based on the review Drug Therapy for Rheumatoid Arthritis in Adults: An Update. New PsA resources include a patient summary and clinician summary based on the review Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report. 

6. AHRQ in the Professional Literature

Campbell NL, Boustani MA, Skopelja EN, et al. Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. Am J Geriatr Pharmacother 2012 Jun; 10(3):165-77. Select to access the abstract on PubMed®.

Zhang Y, Steinman MA, Kaplan CM. Geographic variation in outpatient antibiotic prescribing among older adults. Arch Intern Med 2012 Sep 24. Select to access the abstract on PubMed®.

Lichtman JH, Naert L, Allen NB, et al. Use of antithrombotic medications among elderly ischemic stroke patients. Circ Cardiovasc Qual Outcomes 2011 Jan 1; 4(1):30-8. Select to access the abstract on PubMed®.

Pylypchuk Y, Sarpong EM. Comparison of health care utilization: United States versus Canada. Health Serv Res 2012 Sep 25. Select to access the abstract on PubMed®.

Yabroff KR, Dowling E, Rodriguez J, Ekwueme DU, Meissner H, Soni A, et al. The Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement. J Cancer Surviv 2012 Jul 19. Select to access the abstract on PubMed®.

Widmer K, Zhu Y, Williams JV, et al. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis 2012 Jul 1; 206(1):56-62. Select to access the abstract on PubMed®.

Angier H, DeVoe JE, Tillotson C, et al. Trends in health insurance status of US children and their parents, 1998-2008. Matern Child Health J 2012 Sep 27. Select to access the abstract on PubMed®.

Burke JF, Lisabeth LD, Brown DL, reeves MJ, Morgenstern LB. Determining stroke's rank as a cause of death using multicause mortality data. Stroke 2012 Aug; 43(8):2207-11. Select to access the abstract on PubMed®.

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Current as of February 2013
Internet Citation: Clinicians Perform "Chart Biopsies" to Prepare for Patient Handoffs: Enewsletter, Issue 366. February 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/366.html