Research Activities, September 2012, No. 385
Anesetti-Rothermel, A., and Sambamoorthi, U. (2011). "Physical and mental illness burden: Disability days among working adults." (AHRQ grant HS15390). Population Health Management 14(5), pp. 223-230.
Researchers measuring the impact of 25 specific conditions on disability days among working adults found that the average number of disability days varied from 4 days for impulse-control disorders to a maximum of 18 days for stroke. The contribution of coexisting conditions to disability days varied from 0 percent for stroke and 14 percent for cancer to 72 percent for diabetes and 77 percent for asthma.
Chen, A., Schrager, S.M., and Mangione-Smith, R. (2012). "Quality measures for primary care of complex pediatric patients." (AHRQ grant HS18087). Pediatrics 129(3), pp. 433-445.
The goal of this study was to assess through expert consensus recommended primary care processes for complex pediatric patients by using the patient-centered medical home approach as a first step toward establishing a candidate set of quality measures. By using a systematic literature review and the RAND/University of California, Los Angeles appropriateness method, a national expert panel was able to select 35 primary care quality measures for complex pediatric patients.
Chen, P.G., Curry, L.A., Nunez-Smith, M., and others (2012, February). "Career satisfaction in primary care: A comparison of international and U.S. Medical graduates." (AHRQ grant T32 HS17589). Journal for General Internal Medicine 27(2), pp. 147-152.
The researchers found that among 1,890 primary care physicians who reported at least 20 hours per week of direct patient care, international medical graduates (IMGs) were significantly less satisfied than U.S. medical graduates (USMGs). Seventy-six percent of IMGs reported satisfaction versus 82 percent of USMGs. Lower satisfaction was noted for IMGs who were solo practitioners (44 percent lower) and those not in a practice that allowed the provision of high-quality care (56 percent lower).
Chin, C.T., Wang, T.Y., Shuang, L., and others (2012). "Comparison of the prognostic value of peak creatine kinase-MB and troponin levels among patients with acute myocardial infarction: A report from the Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With The Guidelines." (AHRQ grant HS16964). Clinical Cardiology 35(7), pp. 424-429.
In patients with acute myocardial infarction (AMI), serial measurements of both cardiac troponin and creatine kinase MB isoenzyme (CK-MB) levels are commonly performed. Yet the independent prognostic implications of these markers have not been previously compared by AMI classification. The results of this study indicate that both peak CK-MB and peak troponin have independent incremental or additive prognostic value among patients treated for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction.
Clancy, C.M. (2012). "Progress on a national patient safety imperative to eliminate CLABSI." American Journal of Medical Quality 27(2), pp. 170-171. Reprints (AHRQ Publication No. 12-R068) are available from the AHRQ Publications Clearinghouse.
The author, director of the Agency for Healthcare Research and Quality, discusses a program to eliminate central line-associated bloodstream infections (CLABSIs). The Comprehensive Unit-based Safety Program, originally started in Michigan intensive care units (ICUs), was extended to hospitals in 10 States. It has since been expanded to hospitals nationwide, and to settings other than ICUs. Other types of healthcare-associated infections, besides CLABSIs, are also included. Reports thus far have found considerable success in the reduction of infections.
Crews, K.R., Gaedigk, A., Dunnenberger, H.M., and others (2012, February). "Clinical pharmacogenetics implementation consortium (CPPIC) guidelines for codeine therapy in the context of cytochrome P4502D6 (CYP2D6) genotype." (AHRQ grant HS19818). Clinical Pharmacology & Therapeutics 91(2), pp. 321-326.
The efficacy and safety of codeine as an analgesic are governed by CYP2D6 polymorphisms. In order to develop a guideline in this area, the authors conducted a systematic literature review focusing on CYP2D6 and its relevance in codeine use. The guideline provides information relating to the interpretation of CYP2D6 genotype test results to guide the dosing of codeine.
Dorn, S.D., Morris, C.B., Schneck, S.E., and others (2011). "Development and validation of the irritable bowel syndrome satisfaction with care scale." (AHRQ grant HS19468). Clinical Gastroenterology and Hepatology 9, pp. 1065-1071.
The authors used standard scale development methods to develop the Irritable Bowel Syndrome Satisfaction with Care Scale (IBS-SAT). They report the results of a study to develop and assess the psychometric properties of the IBS-SAT, including a conceptual and measurement model (subscale structure), reliability (internal consistency), and validity (content, convergent and discriminant construct validity, and known-groups validity).
Elbardissi, A.W., and Sundt, T.M. (2012). "Human factors and operating room safety." (AHRQ grant HS19190). Surgical Clinics of North America 92, pp. 21-35.
This article reviews previous research on the impact of work system factors on surgical care. Specifically, the discussion highlights research pertaining to the following components of surgical care: (1) the physical operating room environment, (2) teamwork and communication, (3) tools and technology, (4) tasks and workload, and (5) organizational processes.
Gartlehner, G., Poole, C., West, S.L., and others (2012). "Clinical heterogeneity in systematic reviews and health technology assessments: Synthesis of guidance documents and the literature." (AHRQ Contract No. 290-02-0016). International Journal of Technology Assessments in Health Care 28(1), pp. 36-43.
This study summarizes a project to identify, discuss, and synthesize best practices for addressing clinical heterogeneity in systematic reviews and health technology assessments. Recognizing clinical heterogeneity and clarifying its implications helps decisionmakers to identify patients who benefit from an intervention or are at greatest risk of an adverse outcome from that intervention.
Gellad, W.F., Grenard, J.L., and Marcum, Z.A. (2011). "A systematic review of barriers to medication adherence in the elderly: Looking beyond cost and regimen complexity." (AHRQ grant T32 HS00046). American Journal of Geriatric Pharmacotherapy 9(1), pp. 11-23.
The authors conducted a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. They found that the topic is not well described in the literature, despite being a major cause of morbidity. Thus, it is difficult to draw a systematic conclusion on potential barriers to medication adherence among the elderly.
Glascock, J.J., Shababi, M., Wetz, M.J., and others (2012). "Direct central nervous system delivery provides enhanced protection following vector-mediated gene replacement in a severe model of spinal muscular atrophy." (AHRQ grant HS41584). Biochemical and Biophysical Research Communications 417, pp. 376-381.
This study was performed on mice to directly compare the influence of the injection route on the spinal muscular atrophy (SMA) phenotype. The researchers compared the two injection techniques that have been used in viral gene therapy of SMA: intracerebroventricular and intravenous injections. Both routes resulted in a significant increase in lifespan and weight compared to untreated mice.
Halpern, S.D. (2011). "ICU capacity strain and the quality and allocation of critical care." (AHRQ grant HS18406). Current Opinions on Critical Care 17, pp. 648-657.
The author presents a conceptual framework for intensive care unit capacity strain, considers what data elements may contribute to it, and suggests methods for determining the optimal metric. He also outlines the range of potential consequences of increased capacity strain, in terms of both the quality and ethics of care delivered.
Haukoos, J.S. (2012, January). "The impact of nontargeted HIV screening in emergency departments and the ongoing need for targeted strategies." (AHRQ grant HS17526). Archives of Internal Medicine 172(1), pp. 20-22.
The author examines this question by analyzing 11 studies that have systematically evaluated nontargeted HIV screening in an emergency department (ED) setting. He also discusses the debate over targeted versus nontargeted HIV screening in the ED. He argues that targeted HIV screening most likely fails because of poor implementation, not because targeting does not work.
Kramer, D.B., Xu, S., and Kesselheim, A.S. (2012, March). "Regulation of medical devices in the United States and European Union." (AHRQ grant HS18465). New England Journal of Medicine 366(9), pp. 848-855.
Some policymakers and device manufacturers have characterized U.S. device regulation as slow, risk-averse, and expensive, while others have suggested that current procedures may not be comprehensive enough. The authors compare the European Union and U.S. systems and consider what evidence exists on the performance of each device-approval system.
Kwon, S., Florence, M., Grigas, P, and others (2012). "Creating a learning healthcare system in surgery: Washington State's Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years." (AHRQ grant HS20025). Surgery 151(2), pp. 146-151.
SCOAP is a peer-to-peer collaborative that engages surgeons to determine the many process-of-care metrics that go into a "perfect" operation, track risk-adjusted outcomes that are specific in a given operation, and create interventions to correct underperformance in both the use of process measures and outcomes. The authors discuss the progress of the SCOAP initiative and highlight its achievements and challenges.
Luft, H.S. (2012). "Advancing public reporting through a new ‘aggregator' to standardize data collection on providers' cost and quality." (AHRQ Contract No. 290-07-10022). Health Affairs 31(3), pp. 619-626.
The author proposes creating a public-private data aggregator that would receive patient and provider data from payers that are deidentified in such a way as to remain useful for consumer reporting and research purposes. It could be funded through fees charged to commercial users while registered researchers could access the data aggregator for free. Such an approach could allay privacy considerations as well as concerns about how such an effort would be funded.
Meyers, D. (2012, March). "Introduction from the Agency for Healthcare Research and Quality." Journal of the American Board of Family Medicine 25 Suppl 1, p. S1. Reprints (AHRQ Publication No. 12-R070) are available from the AHRQ Publications Clearinghouse.
This article introduces a series of reports from an international conference on primary care. Health policy, health system researchers, and primary care leaders from seven countries, including the United States, participated. Topics included payment reform, team-based care, and the use of health information technology to support population management.
Needleman, J., Buerhaus, P., Pankratz, S., and others (2011). "Nurse staffing and inpatient hospital mortality." AHRQ grant HS15508. The New England Journal of Medicine 364(11), pp. 1037-1045.
Patients cared for by understaffed shifts of registered nurses are slightly, but significantly, more likely to die while in the hospital than patients on fully staffed shifts, found this study. Specifically, patients on understaffed shifts were 2 percent more likely and patients on high-turnover shifts were 4 percent more likely to die during their hospital stay; both findings were significant.
Neily, J., Mills, P.D., Eldridge, N., and others (2011). "Incorrect surgical procedures within and outside of the operating room," Archives of Surgery [Epub ahead of print]. Reprints (AHRQ Publication No. 11-R076) are available from the AHRQ Publications Clearinghouse.
To improve communication and patient safety and reduce adverse events in the operating room, the Veterans Health Administration implemented a mandatory medical team training program between 2006 and 2009. This training includes preoperative briefings and postoperative debriefings, both guided by a checklist. Researchers found the rate of reported adverse events declined from 3.21 per month from 2001 to mid-2006 to 2.4 per month from mid-2006 to 2009.
Noël, P.H., Lanham, H.J., Parchman, M.L., and others (2012, March). "The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams." Health Care Management Review [Epub ahead of print]. Reprints (AHRQ Publication No. 12-R053) are available from the AHRQ Publications Clearinghouse.
Researchers recently explored how primary care team members perceive their relationships and learning as they relate to Chronic Care Model (CCM) success. They found that high levels of relational coordination were significantly and positively associated with the delivery of care as described by the CCM model. Reciprocal learning was also found to be independently and significantly associated with fulfilling all six elements of the CCM.
Nuckols, T.K., Aledort, J.E., Adams, J., and others (2011). "Cost implications of improving blood pressure management among U.S. adults." (AHRQ grant HS17954.) HSR: Health Services Research 46(4), pp. 1124-1157.
Improved hypertension care, that is, consistently providing the basic elements of blood pressure management to U.S. adults, would cost $170 more per person with hypertension each year, estimates this study. These costs are affected by the cost of medication per day, the optimal number of visits for recommended care, the blood pressure elevation, and the complexity of the hypertension care.
Nuckols, T.K., McGlynn, E.A., Adams, J., and others (2011). "Cost implications to health care payers of improving glucose management among adults with type 2 diabetes" (AHRQ grant HS17954). HSR: Health Services Research 46(4), pp. 1158-1179.
This study reveals that the cost of providing improved glucose management, relative to current care, would be $327 per person annually, with the increased cost largely due to antihyperglycemic medication. Researchers found that the cost-effectiveness to payers, defined as the incremental annual costs per patient newly attaining any one of three care goals, would be $1,128; including glycemic crises reduced this to $555.
Nunez-Smith, M., Bradley, E.H., Herrin, J., and others (2011). "Quality of care in U.S. Territories." Archives of Internal Medicine, pp. E1-E13. [Epub ahead of print].
A comparison of hospitals in U.S. Territories to hospitals in U.S. States finds that patients in territorial hospitals experience significantly higher 30-day readmission rates and higher mortality rates for acute myocardial infarction, heart failure, and pneumonia. The study compared the experience of Medicare fee-for-service patients in 57 territorial hospitals and 4,799 stateside hospitals.
Olfson, M., Crystal, S., Gerhard, T., and others (2011). "Patterns and correlates of tic disorder diagnoses in privately and publicly insured youth." (AHRQ grant HS16097). Journal of the American Academy of Child and Adolescent Psychiatry 50(2), pp. 119-131.
Medicaid-insured children diagnosed with Tourette disorder (often characterized by severe vocal and physical tics) tend to have more psychiatric and behavioral problems than similar children with private insurance. This study finds that they also appear to be diagnosed at a later stage and receive more antipsychotic medications and less mental health assessments or psychotherapy than their privately insured counterparts.
Pakyz, A., Carroll, N.V., Harpe, S.E., and others (2011). "Economic impact of Clostridium difficile infection in a multihospital cohort of academic health centers." (AHRQ grant HS18578). Pharmacotherapy 31(6), pp. 546-551.
Patients with healthcare-associated Clostridium difficile infections (CDIs) have an adjusted mean cost of hospital care nearly double that for matched patients without CDI ($55,769 vs. $28,609), found this study of administrative data. The researchers also found in their case–control study that the adjusted mean length of hospital stay was more than twice as long (21.1 days) for patients with healthcare-associated CDI than for those without the infection (10.0 days).
Peron, E.P., Marcum, Z.A., Boyce, R., and others (2012, February). "Year in review: Medication mishaps in the elderly." (AHRQ grants HS17695, HS18271, HS19461). American Journal of Geriatric Pharmacotherapy 9(1), pp. 1-10.
This paper reviewed 5 articles from 2010 that examined medication mishaps in the elderly. Three studies focused on types of medication errors, including underuse due to prescribing and potentially inappropriate prescribing. The other studies focused on medication-related adverse patient events related to the use of skeletal muscle relaxants and high-risk medications.
Phillips, R.L. (2012). "International learning on increasing the value and effectiveness of primary care (I LIVE PC)." (AHRQ Contract No. 290-07-10008). Journal of the American Board of Family Medicine 25 Suppl 1, pp. S2-S5.
This article provides a brief introduction to eight papers from an international conference on primary care funded in part by the Agency for Healthcare Research and Quality. The countries represented were Australia, Canada, Denmark, The Netherlands, New Zealand, the United Kingdom, and the United States. Topics discussed include new models of care, accountability and population health, practice support and change facilitation, and care quality and safety.
Pitzer, V.E., Burgner, D., Viboud, and others (2012, March). "Modeling seasonal variations in the age and incidence of Kawasaki disease to explore possible infectious etiologies." Proceedings of the Royal Society of Biological Sciences [Epub ahead of print]. Reprints (AHRQ Publication No. 12-R071) are available from the AHRQ Publications Clearinghouse.
The average age of Kawasaki disease infection is expected to vary during seasonal epidemics in a way that is predictable from the epidemiological features. To determine whether examining the relationship between seasonal variation in the number and average age of cases can lend insight into the number of infectious triggers, the researchers sought to extend and validate previous work on age-incidence patterns, then apply this theory to Kawasaki disease.
Quattromani, E., Powell, E.S., Khare, R.K., and others (2011). "Hospital-reported data on the pneumonia quality measure ‘time to first antibiotic dose' are not associated with inpatient mortality: Results of a nationwide cross-sectional analysis." (AHRQ grant T32 HS00078). Academic Emergency Medicine 18(5), pp. 496-503.
Hospitals are required to publicly report on their quality measures for treating pneumonia, including the time to first antibiotic dose (TFAD). This means that hospitals must give the first antibiotic dose within 6 hours after a patient arrives at the hospital. In fact, a new study finds no association between this TFAD quality measure and inpatient mortality for these patients.
Rosolowsky, E.T., Skupien, J., Smiles, A.M., and others (2011). "Risk for ESRD in Type 1 diabetes remains high despite renoprotection." (AHRQ grant T32 HS00063) Journal of the American Society of Nephrology 22(3), pp. 545-553.
Treating patients who have type-1 diabetes and high urine albumin levels with kidney-protective medications and blood-pressure lowering medications does not reduce the risk of their developing end-stage renal disease (ESRD), concludes a new study. Despite treatments meant to prevent the condition's development, 172 of 423 study patients developed ESRD, 62 of whom died during dialysis.
Ruhnke, G.W., Coca-Perraillon, M., Kitch, B.T., and Cutler, D.M. (2011) "Marked reduction in 30-day mortality among elderly patients with community-acquired pneumonia," (AHRQ grant HS16948). American Journal of Medicine 124, pp. 171-178.
Deaths from community-acquired pneumonia, the most common infectious cause of death in the United States, dropped 28 percent from 1987 to 2005, according to this study. It found that 30-day mortality from this condition dropped from 13.5 percent to 9.7 percent. The researchers believe that increased pneumococcal and influenza vaccination rates, as well as a wider use of antibiotics, may explain a large portion of the downward trend in mortality.
Sarkar, U., Karter, A.J., Lieu, J.Y., and others (2011). "Social disparities in internet patient portal use in diabetes: Evidence that the digital divide extends beyond access." (AHRQ grants HS17594 and HS17261). Journal of the American Medical Informatics Association 18, pp. 318-321.
Internet portals allow patients to conduct a variety of tasks normally associated with an office visit, such as refilling prescriptions and communicating with providers. Studies have shown poor outcomes among minority and less educated patients. This study finds that these groups also experience a "digital divide," making them less likely to have access to these Web portals and their disease-management benefits.
Spindler, K.P., Huston, L.J., Wright, R.W., and others (2011). "The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction. A population cohort study." (AHRQ grant HS16075).American Journal of Sports Medicine 39(2), pp. 348-359.
Tears in the ACL (anterior cruciate ligament), a major ligament of the knee, are common, especially among athletes. This study identifies factors that help predict better or worse functional outcomes following ACL reconstruction. Use of the patient's own tissue (autograft) rather than tissue from another person (allograft), not smoking, and having normal body mass index were correlated with better long-term outcomes.
Steinman, M.A., Hanlon, J.T., Sloane, R.J., and others (2011). "Do geriatric conditions increase risk of adverse drug reactions in ambulatory elders? Results from the VA GEM Drug Study." (AHRQ grant HS17695 and HS18721). Journal of Gerontology. Series A. Biological Sciences and Medical Sciences 66A(4), pp. 444-451.
Common geriatric conditions do not significantly increase the risk of adverse drug reactions (ADRs), according to a new study by researchers at three Veterans Affairs (VA) medical centers. Using data from an ongoing VA study, the researchers found only weak associations between either mobility impairment or dependency in activities of daily living and ADRs.