New AHRQ Study Shows Low Rates of Serious Infections Following Ambulatory Surgery

Electronic Newsletter, Issue 414

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

February 25, 2014


AHRQ Stats

Compared with the United States as a whole, the percentage of people with dental expenses in 2010 was lower in California and Texas, and higher in Illinois and Michigan. Overall, dental care represented 6.6 percent of all medical expenditures in 2010. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #415: Dental Expenditures in the 10 Largest States, 2010.)

Today's Headlines

  1. New AHRQ Study Shows Low Rates of Serious Infections Following Ambulatory Surgery.
  2. Use of Contact Precautions in Emergency Departments Varies, AHRQ Study Finds.
  3. Article Describes How AHRQ's Medical Expenditure Panel Survey Informs Affordable Care Act.
  4. AHRQ Study Examines Quality of Bladder Cancer Surgery for Black and White Patients.
  5. AHRQ Offers New Guide for Implementing Single-Patient Trials.
  6. Register Now: February 28 Webinar on Electronic Health Record Functionality To Support Primary Care .
  7. Register Now: AHRQ Long-Term Care Patient Safety Training Models Are Topic of March 12 Webinar.
  8. AHRQ in the professional literature.

1. New AHRQ Study Shows Low Rates of Serious Infections Following Ambulatory Surgery

Although the rates of serious surgical site infections (SSIs) following outpatient surgery are low, the number of patients who develop these serious infections is substantial and warrants continued quality improvement efforts because outpatient surgery is so common, according to a new AHRQ-funded study published in the February 19 issue of the Journal of the American Medical Association (JAMA). The study, "Surgical Site Infections Following Ambulatory Procedures," [abstract] used AHRQ's Healthcare Cost and Utilization Project databases to analyze SSI rates following surgery in hospital-owned ambulatory (outpatient) settings in eight states. SSIs are among the most common type of healthcare-associated infection (HAI). Researchers, led by Pamela L. Owens, Ph.D., and Claudia A. Steiner, M.D., M.P.H., both of AHRQ, found that 877 patients in the eight states, or a rate of just over 3 (3.09) of every 1,000 patients, who had ambulatory surgery were treated within 14 days for a SSI that required hospitalization. At 30 days, the rate increased to nearly 5 (4.84) of every 1,000 patients. Because the study found that most of the serious SSIs occur within 14 days, the study's authors recommend that more attention be paid to preventing and reducing infections in the early window following an ambulatory surgery. Select to access the AHRQ press release. AHRQ and other federal agencies are tackling HAIs under the umbrella of HHS's National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination. AHRQ has undertaken a Safety Program for Ambulatory Surgery, which is promoting the use of the Comprehensive Unit-based Safety Program (CUSP), a proven method for preventing HAIs, to reduce SSIs and other complications from surgery in ambulatory surgery centers and hospital outpatient departments.

2. Use of Contact Precautions in Emergency Departments Varies, AHRQ Study Finds

In a survey of 301 emergency departments (EDs) in 49 states, AHRQ-funded researchers found that policies on the use of contact precautions to prevent the spread of antimicrobial resistant organisms and Clostridium difficile varied greatly, according to a study published online February 3 in Infection Control and Hospital Epidemiology. The researchers found that, while most EDs require their staff to use contact precautions (wearing a gown and gloves) when treating patients suspected of having an infection caused by a specific organism, less than half of EDs require such contact precautions when treating patients with symptoms often caused by those organisms. For example, 79 percent of EDs required isolation (including contact precautions) when treating patients with suspected methicillin-resistant Staphylococcus aureus (MRSA), but only 49 percent required contact precautions for all patients with purulent skin infections, which are predominantly caused by community-acquired MRSA. The authors also found that most EDs had not participated in quality improvement projects related to decreasing the spread of these organisms. The authors suggest, based on the variations they observed, that ED organizations and leaders enact policies on the use of contact precautions in the ED. Select to access an abstract of the study's findings.

3. Article Describes How AHRQ's Medical Expenditure Panel Survey Informs Affordable Care Act

In a new AHRQ article published in Inquiry: The Journal of Health Care Organization, Provision, and Financing, authors Steven B. Cohen and Joel W. Cohen of AHRQ describe how the Medical Expenditure Panel Survey (MEPS) was one of the core data sources used to inform several provisions of the Affordable Care Act. MEPS, a set of large-scale nationally representative surveys AHRQ has conducted since 1996, represents the most complete source of data on the cost and use of U.S. health care and health insurance coverage for the noninstitutionalized population. MEPS data are being used to inform the planning, implementation, and performance evaluation of Affordable Care Act provisions, such as determining the amount of the small employer health insurance tax credits and informing projections of the Federal Government's matching funds for state Medicaid programs. The authors said MEPS also provides a solid framework for evaluating the effects of the Affordable Care Act on the Nation's health care system. The study is titled "The Capacity of the Medical Expenditure Panel Survey to Inform the Affordable Care Act."

4. AHRQ Study Examines Quality of Bladder Cancer Surgery for Black and White Patients

A recent study published in the journal Cancer showed that, among nearly 17,000 patients undergoing cystectomy (bladder removal) for bladder cancer from 1996 through 2009, black patients received lower quality of care by some metrics than did white patients. The researchers found that blacks were treated more often by surgeons and hospitals that had performed fewer cystectomies, received fewer recommended related surgical procedures for their condition, and experienced more adverse outcomes than did whites. Even when black patients were treated by high-volume surgeons and hospitals, the researchers found that they still received fewer recommended related surgical procedures and had more adverse outcomes than did white patients. Findings were based on AHRQ Healthcare Cost and Utilization Project data, and the study was restricted to discharges from Florida, Maryland, and New York hospitals meeting specific AHRQ criteria for anticipated accuracy in coding of race/ethnicity. The study, titled "Racial Variation in the Quality of Surgical Care for Bladder Cancer," was published online on December 11, 2013, and coauthors included AHRQ's Darryl T. Gray, M.D.

5. AHRQ Offers New Guide for Implementing Single-Patient Trials

AHRQ's Effective Health Care Program offers a new guide, "Design and Implementation of N-of-1 Trials: A User's Guide," that provides information on the design and implementation of N-of-1 trials (a.k.a. single-patient trials), a form of prospective research in which different treatments are evaluated in an individual patient over time. The guide explains how to design and use N-of-1 trials in a sustainable way by outlining potential benefits and barriers, human subject issues, financial considerations, statistical design and analysis factors, required information technology infrastructure for implementation, and training and engagement of providers and patients. Each chapter also includes a checklist to help clinicians and investigators determine if key considerations are met. Each of the six chapters can be downloaded for free by visiting the Effective Health Care Program Web site.

6. Register Now: February 28 Webinar on Electronic Health Record Functionality To Support Primary Care

AHRQ is hosting a Webinar on February 28 from 2:30 p.m. to 4:00 p.m. ET, on electronic health record (EHR) functionality needed to support primary care delivery. The expert panel will discuss the need for EHRs to move beyond documentation to interpreting and tracking information over time, supporting patient partnering activities, enabling team-based care, and allowing providers to use population-management tools to facilitate care delivery.

Select to register.

7. Register Now: AHRQ Long-Term Care Patient Safety Training Models Are Topic of March 12 Webinar

AHRQ is hosting a Webinar on March 12 from 1:00 p.m. to 2:00 p.m. ET on the use of AHRQ's "Improving Patient Safety in Long-Term Care (LTC) Facilities: Training Modules." The Webinar, designed for nurses and staff educators who work in long-term care settings, will provide an overview on using the materials to train staff on how to effectively detect and communicate changes in a resident's condition, with a special focus on falls prevention.

Select to register.

8. AHRQ in the Professional Literature

Bradley EH, Yakusheva O, Horwitz LI, et al. Identifying patients at increased risk for unplanned readmission. Med Care. 2013 Sep;51(9):761-6. Select to access the abstract on PubMed®.

Krupat E, Pololi L, Schnell ER, et al. Changing the culture of academic medicine: the C-Change learning action network and its impact at participating medical schools. Acad Med. 2013 Sep;88(9):1252-8. Select to access the abstract on PubMed®.

Wherry LR. Medicaid family planning expansions and related preventive care. Am J Public Health. 2013 Sep;103(9):1577-82. Epub 2013 Jul 18. Select to access the abstract on PubMed®.

Talbert-Slagle K, Berg D, Bradley EH. Innovation spread: lessons from HIV. Int J Qual Health Care. 2013 Sep;25(4):352-6. Epub 2013 May 21. Select to access the abstract on PubMed®.

Almasalha F, Xu D, Keenan GM, et al. Data mining nursing care plans of end-of-life patients: a study to improve healthcare decision making. Int J Nurs Knowl. 2013 Feb;24(1):15-24. Epub 2012 Aug 17. Select to access the abstract on PubMed®.

Cronholm PF, Shea JA, Werner RM, et al. The patient centered medical home: mental models and practice culture driving the transformation process. J Gen Intern Med. 2013 Sep;28(9):1195-1201. Epub 2013 Mar 29. Select to access the abstract on PubMed®.

Meyer AM, Reeder-Hayes KE, Liu H, et al. Differential receipt of sentinel lymph node biopsy within practice-based research networks. Med Care. 2013 Sep;51(9):812-18. Select to access the abstract on PubMed®.

Chen LM, Staiger DO, Birkmeyer JD, et al. Composite quality measures for common inpatient medical conditions. Med Care. 2013 Sep;51(9):832-7. Select to access the abstract on PubMed®.


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Current as of February 2014
Internet Citation: New AHRQ Study Shows Low Rates of Serious Infections Following Ambulatory Surgery: Electronic Newsletter, Issue 414. February 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/414.html