Research Activities, March 2014
News and Notes
Implementing clinical decision support program reduces pressure ulcers in long-term care
New research supported by AHRQ found that implementing the On-Time Quality Improvement for Long-Term Care (On-Time) Program, a clinical decision support intervention, led to a significant reduction in pressure ulcers. "Evaluation of AHRQ's On-Time Pressure Ulcer Prevention Program: A Facilitator-Assisted Clinical Decision Support Intervention for Nursing Homes" appeared in the March 2014 issue of Medical Care. The program's components include information technology-enabled identification of high-risk residents, reports that profile residents with recent changes in risk, strategies to integrate reports into care planning, and guided facilitation to support adoption of tools and strategies. The program resulted in a large and statistically significant reduction in pressure ulcer incidence when implemented, suggesting that widespread adoption could increase patient safety. To access the abstract, select: http://www.ncbi.nlm.nih.gov/pubmed/24374408.
Evidence lacking on the value of preoperative testing
A new AHRQ research review finds that with the exception of cataract surgery, there is a lack of reliable evidence on the benefits, harms, and resource use associated with routine or per protocol preoperative testing for all tests used for all procedures. For patients scheduled for cataract surgery, routine preoperative testing including electrocardiography (ECG), basic metabolic panel (biochemistry), and complete blood count has no effect on important clinical outcomes, including total perioperative complications or procedure cancellations.
Preoperative testing, including a panel of blood tests, urine tests, chest radiography, and ECG, has been part of the preoperative care process to determine patient's fitness for anesthesia and identifying patients at high risk for perioperative complications. No conclusions could be drawn regarding preoperative testing's impact on quality of life, satisfaction, resource use, or harms of testing, and whether other factors may affect the balance of benefits and harms. Given the large number of patients undergoing elective surgery, there is a clear need to develop better evidence for when routine or per protocol testing improves patient outcomes and reduces potential harms. These findings are available in the research review, Benefits and Harms of Routine Preoperative Testing: A Comparative Effectiveness Review at www.effectivehealthcare.ahrq.gov.
Journal issues highlights integrating mixed methods in health services and delivery system research
A special issue of Health Services Research, sponsored by AHRQ, contains papers solicited and reviewed using the journal's standard procedures, along with an editorial overview. Benjamin Crabtree and William Miller were guest editors. Papers address: research designs for achieving mixed methods integration; processes in mixed method research teams; mixed methods analyses of care redesign; and care delivery in diverse settings. Included among the papers are reports funded under AHRQ's Delivery System Initiative. To access the issue go to http://onlinelibrary.wiley.com/doi/10.1111/hesr.2013.48.issue-6pt2/issuetoc. For further information on Advanced Methods in Delivery System Research and the Primary Care Medical Home Research Methods Series go to http://go.usa.gov/B6gw and http://go.usa.gov/B6ge.