AHRQ National Reports Indicate That Hospital Care Is Improving
Medicare patients with three conditions had the largest number of all-cause 30-day readmissions in 2011: congestive heart failure (134,500 readmissions), septicemia (92,900 readmissions) and pneumonia (88,800 readmissions). These readmissions resulted in $4.3 billion in hospital costs. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #172: Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011.)
- AHRQ National Reports Indicate That Hospital Care Is Improving.
- AHRQ Publishes New Infection Control Toolkit on KPC.
- AHRQ Research Review Finds Medications Acamprosate and Oral Naltrexone Have Best Evidence for Decreasing Alcohol Use.
- AHRQ Study Examines Effectiveness of Automated Approaches for Receiving Patient Feedback .
- New AHRQ Video Series Highlights Innovations on Patient- and Family-Centered Care.
- Innovative Diabetes Self-Management Programs Identified for Urban Patients Who Speak Various Languages.
- Register Now for AHRQ Webinar on Public Reporting of Patients' Comments With Quality Measures.
- AHRQ in the professional literature.
Hospitals are leading the movement to improve the quality of care delivered to U.S. patients, outpacing improvements in other settings, according to two national reports issued by AHRQ on May 15. Three-quarters of hospital quality measures showed significant improvement, compared with 60 percent for home health and nursing home care, and about half for ambulatory settings, according to AHRQ's 2013 National Healthcare Quality Report and National Healthcare Disparities Report. The U.S. Department of Health and Human Services (HHS) Partnership for Patients initiative, HHS' Centers for Medicare & Medicaid Services (CMS) quality reporting programs, such as the Hospital Inpatient Quality Reporting Program and Hospital Outpatient Quality Reporting Program, and private-sector initiatives such as those sponsored by the Institute for Healthcare Improvement have been catalysts for the current quality improvement effort in hospitals. "Hospitals are clearly engaged in efforts to improve health care quality in the United States," said AHRQ Director Richard Kronick, Ph.D. "The intense national focus on quality improvement in hospitals is starting to pay off, but much work remains to make sure that all Americans have access to high-quality care in every setting." The reports include trend data for most measures of quality and disparities from 2000-2002 to 2010-2011, which predate implementation of most of the Medicaid expansions and health insurance exchanges under the Affordable Care Act. The reports provide a baseline for tracking progress under the Affordable Care Act in upcoming years.
The quality and disparities reports also are available online at NHQRnet, a Web site that has been redesigned to facilitate benchmarking and trending capabilities. It includes a data query tool to compare national- and state-level data. Printed copies of the reports can be obtained by calling 1-800-358-9295 or by sending an email to firstname.lastname@example.org.
AHRQ has published a toolkit to help hospitals control and prevent Klebsiella pneumoniae carbapenemase (KPC), a highly dangerous, antibiotic-resistant germ. KPC is sometimes referred to as a "superbug" because it is hard to kill and resists most antibiotics. KPC is a type of carbapenem-resistant Enterobacteriaceae, or CRE, a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. AHRQ funded leading KPC researchers to develop the toolkit, which hospitals can use to control and prevent KPC outbreaks in their facilities. AHRQ's toolkit, Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit, helps organizations implement guidelines from the HHS' Centers for Disease Control and Prevention, which define what health care organizations should do to prevent KPC.
A new research review from AHRQ finds the use of psychosocial co-interventions, such as counseling and the addition of several medications, can decrease alcohol consumption in patients with alcohol-use disorders. The medications acamprosate and oral naltrexone have the best evidence for decreasing alcohol consumption in patients with alcohol-use disorders. Since research has not consistently recognized the superiority of either medication, other factors may impact the choice of medications, including how often a medication is taken, potential adverse reactions and the availability of treatments. These findings are available in the research review, Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings and were published in an abstract and study online in the May 13 issue of the Journal of the American Medical Association (JAMA).
A new AHRQ-supported study suggests that many patients who do not improve as expected after a medical appointment don't take further action to address unresolved problems. The study found that systematic follow-up, including a live follow-up call and those made by an interactive voice response system, can potentially identify patients needing care and connect them to it. The study and abstract, titled "Exploration of an Automated Approach for Receiving Patient Feedback After Outpatient Acute Care Visits," appeared online March 8 in the Journal of General Internal Medicine. Researchers evaluated patients seen in outpatient settings for diagnosis and treatment of a new health problem. The patients received a live follow-up call one week after their visit and a call from an interactive voice response system three weeks after their visit to determine their satisfaction with the diagnosis and treatment provided. The study showed that automated telephone feedback systems can feasibly be used to follow up on patient outcomes in outpatient settings. Further research on the effectiveness of this technology is needed to determine the role of automated telephone feedback systems in ambulatory care settings.
AHRQ has released a new video series featuring three profiles of health care professionals sharing stories about how they are working in partnership with patients and families to improve the quality of health care services delivered at their facilities. The series, "Frontline Innovators on Providing Patient- and Family-Centered Care," was developed as part of the AHRQ Health Care Innovations Exchange, an online repository of information where health professionals and researchers can share and learn about evidence-based practices and tools that can be adopted for use within an array of health care settings and populations. Stories highlighted in the videos explain how current and former patients and families advise a hospital on care improvement; how a day-treatment program partners with parents to support and stabilize children with dual psychiatric and chronic disease diagnoses; and how a hospital brings together the expertise of families and geriatric-trained staff to improve outcomes in a separate, seniors-only emergency department setting.
Research supported by AHRQ identified innovative diabetes self-management programs for patients who speak various languages. The study and abstract, "Diabetes Health Information Technology Innovation to Improve Quality of Life for Health Plan Members in Urban Safety Net," appeared in the April–June issue of Journal of Ambulatory Care Management. Through an automated telephone system, the program provided 27 weeks of support in English, Spanish and Cantonese. Participants showed improvements in diabetes self-care behaviors, suggesting that automated telephone support can play an important role in improving patient-centered diabetes care.
AHRQ is hosting a free 1-hour webinar on June 3 at 1 p.m. ET on the use of patient comments in public reports that are designed to inform consumers about health care providers. Researchers will discuss an ongoing AHRQ study of methods for eliciting representative patient comments and reporting those comments in a coherent manner with standardized measures of physician quality, including CAHPS® (Consumer Assessment of Healthcare Providers and Systems) measures of patient experience and clinical measures of patient treatment. Speakers are Steven Martino, Ph.D., behavioral scientist, RAND, Pittsburgh, Pennsylvania; Rachel Grob, Ph.D., director of national initiatives, University of Wisconsin, Madison; and Mark Schlesinger, Ph.D., professor of health policy, Yale School of Public Health, New Haven, Connecticut. The moderator is Dale Shaller, managing director, CAHPS database, Shaller Consulting Group, Stillwater, Minnesota.
Registration is open.
Hays RD, Martino S, Brown JA, et al. Evaluation of a care coordination measure for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey. Med Care Res Rev. 2014 Apr;71(2):192-202. Epub 2013 Nov 13. Select to access the abstract on PubMed®.
Dahlke AR, Chung JW, Holl JL, et al. Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare Web site. J Am Coll Surg. 2014 Mar;218(3):374-80. Epub 2013 Nov 27. Select to access the abstract on PubMed®.
Rust G, Zhang S, Reynolds J. Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma. J Asthma. 2013 Sep;50(7):769-75. Epub 2013 Jun 20. Select to access the abstract on PubMed®.
Peterson PN, Chan PS, Spertus JA, et al. Practice-level variation in use of recommended medications among outpatients with heart failure: insights from the NCDR PINNACLE program. Circ Heart Fail. 2013 Nov;6 (6):1132-8. Epub 2013 Oct 15. Select to access the abstract on PubMed®.
Everett C, Thorpe C, Palta M, et al. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes. Health Aff. 2013 Nov;32(11):1942-8. Select to access the abstract on PubMed®.
Utter GH, Zrelak PA, Baron R, et al. Detecting postoperative hemorrhage or hematoma from administrative data: the performance of the AHRQ Patient Safety Indicator. Surgery. 2013 Nov;154(5):1117-25. Epub 2013 Sep 26. Select to access the abstract on PubMed®.
Aparasu RR, Chatterjee S, Chen H. Risk of pneumonia in elderly nursing home residents using typical versus atypical antipsychotics. Ann Pharmacother. 2013 Apr;47(4):464-74. Epub 2013 Apr 2. Select to access the abstract on PubMed®.
Sylvia LG, Friedman ES, Kocsis JH, et al. Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder. J Affect Disord. 2013 Nov;151(2):722-7. Epub 2013 Aug 16. Select to access the abstract on PubMed®.
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