Most Health Outcomes Following Surgery Are Worse For Low-Income Patients, New AHRQ Study Shows
Note to subscribers: This is our last issue of the AHRQ Electronic Newsletter for 2013. Our next issue will be published on January 7, 2014. Happy holidays!
Hispanics were disproportionately represented among the long-term uninsured in 2008–2011. While Hispanics represented 18.2 percent of the population under age 65, they comprised 41.5 percent of the long-term uninsured for the period. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #424: The Long-Term Uninsured in America, 2008–2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population Under Age 65).
- Most Health Outcomes Following Surgery Are Worse For Low-Income Patients, New AHRQ Study Shows.
- New AHRQ Study Examines Rehospitalizations for Childhood Asthma.
- Study Finds Emailing Providers Increases Awareness of Pending Test Results.
- Registration for AHRQ 2014 TeamSTEPPS® Trainings Open.
- Safety Risks of Newer Oral Anticoagulants Explored on AHRQ's Web M&M.
- Register Now: January 15 Demonstration of CAHPS Online Reporting System.
- Meaningful Use Portal Updates in USHIK.
- AHRQ in the professional literature.
A new AHRQ study of 12 measures of outcomes following surgical procedures found that outcomes for patients from both high- and low-income geographic areas improved between 2000 and 2009. In fact, survival following two surgical procedures—coronary angioplasty and carotid endarterectomy—improved for both high- and low-income patients, and the disparity between the two groups narrowed. However, in nine of the remaining 10 outcomes studied, patients from low-income areas fared worse than patients from high-income areas across both years. For example, low-income patients had significantly increased risks for postoperative complications involving respiratory failure and lower survival rates following abdominal aortic aneurysm repair and coronary artery bypass graft. Prior research has shown that low-income patients were more likely to be either uninsured or covered by Medicaid as well as belong to a racial or ethnic minority group, the study said, noting that those characteristics were associated with poorer surgical outcomes. The abstract and study, "Despite Overall Improvement in Surgical Outcomes Since 2000, Income-Related Disparities Persist," co-authored by AHRQ's Roxanne Andrews and Mehwish Qasim, a doctoral candidate at the University of Iowa, appeared in the October issue of Health Affairs.
A new study in the November 14 issue of the Journal of Pediatrics found that about one in six children hospitalized with asthma was rehospitalized for the same condition within a year. This retrospective cohort analysis involved more than 44,000 hospitalizations at 42 children's hospitals from 2008 to 2011. According to the study and abstract, titled "Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention," significant variation in asthma rehospitalizations was found at the 7-, 15-, 30-, 60-, 180-, and 365-day marks of an index admission, based on patient, physician, and facility characteristics. Researchers said racial/ethnic and economic disparities were evident at the 60-day mark. Children with higher odds of being readmitted at each time interval were between the ages of 12 and 18, diagnosed with a complex chronic condition, those who had an initial hospital stay longer than 1 day, those who had a prior-year asthma admission, or those who had public insurance.
Many patients have pending test results at the time of hospital discharge, and lack of appropriate follow-up on those results may pose a risk to a patient's safety, according to a new AHRQ-funded study. Hospitals that automatically emailed physicians test results when they became available increased provider awareness of actionable test results, according to AHRQ-supported research that appeared October 23 in the Journal of the American Medical Informatics Association. According to the journal article and abstract, titled "Impact of an Automated Email Notification System for Results of Tests Pending at Discharge: A Cluster Randomized Controlled Trial," providers who received the emails were significantly more likely to be aware of abnormal test results, suggesting that widespread use of such notifications could improve patient safety. The study examined the impact of automatically emailing test results that were pending at the time of discharge to both the hospital attending physician and the patient's primary care provider.
Registration is now open for in-person TeamSTEPPS trainings in 2014. A total of 24 two-day trainings will take place between January and September at the following locations:
- Duke Medical Center, Durham, NC.
- North Shore Long Island Jewish Health System, New Hyde Park, NY.
- Tulane University, New Orleans, LA.
- UCLA, Los Angeles, CA.
- University of Minnesota, Minneapolis, MN.
- University of Washington, Seattle, WA.
Registration for the training is available at no cost to participants on a first-come, first-served basis; teams of three from the same health facility are required. Participants cover the cost of their own travel and lodging. Please be prepared to sign up each member of your three-person team in order to finalize your registration.
The current issue of AHRQ Web M&M features a Spotlight Case describing knee replacement surgery for a patient who had a history of deep vein thrombosis and was receiving pain control via epidural catheter. Two days after the surgery, her outpatient dose of rivaroxaban was restarted. The pain service fellow scanned her medication list for traditional anticoagulants, but did not notice that she was taking rivaroxaban, a newer oral anticoagulant, before removing the epidural catheter, placing her at very high risk for bleeding. The Perspective on Safety section of the issue features an interview about becoming a patient safety researcher with Hardeep Singh, M.D., M.P.H., a nationally recognized expert in electronic health record-related patient safety issues and diagnostic errors. Patient safety research is also the topic of an article by three leaders in AHRQ's research portfolio: Jeff Brady, M.D., M.P.H., associate director of AHRQ's Center for Quality Improvement and Patient Safety; William Munier, M.D., M.B.A., director of the Center for Quality Improvement and Patient Safety; and Irim Azam, M.P.H.
AHRQ is hosting a free webinar on January 15 from 1:00 p.m. to 2:30 p.m. ET, about the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) database. The event will include an overview of the CAHPS database, a demonstration of the CAHPS online reporting system, and two examples of organizations that have been using the database and reporting system.
- Janice Ricketts, senior project director, CAHPS Database, Westat, Rockville, MD.
- Deborah Kilstein, B.S.N., M.B.A., vice president for quality management and operational support, Association for Community Affiliated Plans, Washington, DC.
- Francis Fullam, M.A., senior director of marketing research and the Patient Relations Department, Rush University Medical Center, Chicago, IL.
- Edward M. Karls, M.B.A., director of customer performance metrics and improvement, University of Michigan Health System, Ann Arbor, MI.
- Gladys Epting, Ph.D., director of research and evaluation, University Health System Consortium, Chicago, IL.
- Dale Shaller, managing director, CAHPS Database; Shaller Consulting Group, Stillwater, MN (Moderator).
AHRQ's CAHPS program supports the development and promotion of CAHPS surveys, toolkit materials, and comparative databases. The CAHPS database accepts CAHPS survey results voluntarily submitted by health plans and, more recently, physician practices. Hundreds of CAHPS survey users rely on the CAHPS database to assess their own results relative to key comparators, such as national and regional averages, in order to identify opportunities to improve patient experience with care.
Select to register.
The Meaningful Use Portal in the AHRQ-funded United States Health Information Knowledgebase (USHIK) has been updated with new functionality. The portal is a one-stop shop for Meaningful Use Stage 1 and Stage 2 Clinical Quality Measures, their computation logic, their data elements, and the vocabularies and codes the data elements may take on. New enhancements include:
- Updates to the Clinical Quality Measures (CQM) and Value Sets, including the release date package. Users can now sort and filter the measures by release package and can download current or historical packages detailing the state of the CQM and Value Sets at the time they were released.
- Inclusion of each Code System's object identifier in the Value Sets. This information has been added to the screens, the application program interface, and the exports containing Value Set information.
- Addition of the short name for each eligible hospital's CQM on the CQM list pages. Users can search or sort by this field.
USHIK is an online, publicly accessible registry and repository of health-care-related data, metadata, and standards. It is funded and directed by AHRQ with management support and partnership from the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention's National Center for Health Statistics.
Pesis-Katz I, Phelps CE, Temkin-Greener H, et al. Making difficult decisions: the role of quality of care in choosing a nursing home. Am J Public Health 2013 May;103(5):e31-e37. Epub 2013 Mar 14. Select to access the abstract on PubMed®.
Puskarich MA, Trzeciak S, Shapiro NI, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest 2013 Jun;143(6):1548-53. Select to access the abstract on PubMed®.
Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol 2013 Mar;11(3):208-16. Epub 2012 Oct 24. Select to access the abstract on PubMed®.
Venkatesan R, Chandakkar P, Li B, et al. Classification of diabetic retinopathy images using multi-class multiple-instance learning based on color correlogram features. Conf Proc IEEE Eng Med Biol Soc 2012;2012:1462-65. Select to access the abstract on PubMed®.
Paustian ML, Alexander JA, El Reda DK, et al. Partial and incremental PCMH practice transformation: implications for quality and costs. Health Serv Res 2013 Jul 5. Epub ahead of print. Select to access the abstract on PubMed®.
Suk Lee M, Walker V, Chen LF, et al. The epidemiology of ventilator-associated pneumonia in a network of community hospitals: a prospective multicenter study. Infect Control Hosp Epidemiol 2013 Jul;34(7):657-62. Epub 2013 May 22. Select to access the abstract on PubMed®.
Flickinger TE, Saha S, Moore RD, et al. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr 2013 Jul 1; 63(3):362-6. Select to access the abstract on PubMed®.
Li X, Shen C. Linkage of patient records from disparate sources. Stat Methods Med Res 2013 Feb; 22(1):31-8. Epub 2011 Jun 10. Select to access the abstract on PubMed®.
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