Existing Sepsis Policies May Harm Safety-Net Hospitals and Widen Health Disparities

AHRQ Stats: Hospital Stays for Sickle Cell Disease

Costs of hospital stays specifically for sickle cell disease totaled $811.4 million in 2016, with an average length of stay of five days. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #251, Characteristics of Inpatient Hospital Stays Involving Sickle Cell Disease, 2000-2016.)

Today's Headlines:

• Existing Sepsis Policies May Harm Safety-Net Hospitals and Widen Health Disparities.
• New AHRQ Views Blog Posts.
• Filling Opioid Prescriptions Linked to New Persistent Use Among Women Following Childbirth.
• New Research Focuses on Data’s Potential To Drive Health System Transformation.
• Highlights From AHRQ’s Patient Safety Network.
• Opioid Management Program Improves Clinicians’ Views of Daily Work: AHRQ Study.
• New Research and Evidence From AHRQ.
• AHRQ in the Professional Literature.

Existing Sepsis Policies May Harm Safety-Net Hospitals and Widen Health Disparities

Safety-net hospitals may not have adequate resources to comply with federal and state sepsis quality improvement standards required of acute care hospitals, according to an AHRQ-supported study in the Journal of Critical Care. Researchers analyzed data from 2,827 hospitals and found a small but statistically significant difference (almost 3 percent) between non–safety-net hospitals and safety-net hospitals on adherence to the Medicare severe sepsis and septic shock early management bundle, known as SEP-1. Responding to these policies requires considerable resources, including a financial investment that is beyond the reach of many hospitals and may disproportionately burden safety-net hospitals, authors noted. Initial data suggest that compliance with this measure is generally poor; on average, hospitals complete the bundle in only half of eligible patients. Researchers concluded this poor compliance exacerbates disparities in healthcare relating to infection control. They suggested potential strategies to improve sepsis care in safety-net hospitals, including promoting collaboration among hospitals. Access the abstract. 

New AHRQ Views Blog Posts

After 20 Years of Improving America’s Healthcare, AHRQ Makes Bold Plans for Future Successes. As AHRQ pursues exciting plans for future initiatives, Director Gopal Khanna, M.B.A., notes in a new blog post that two seminal events, both occurring 20 years ago, helped set the nation’s healthcare agenda and define the quality improvement and patient safety mission that drives AHRQ’s work today. Publication in 1999 of the then-Institute of Medicine’s To Err is Human, followed by legislation establishing AHRQ as the nation’s lead healthcare improvement agency, not only guided the agency through two decades of successes but helped AHRQ identify new areas of impact. AHRQ’s emerging plans are aimed at improving care for people with multiple chronic conditions, providing data and analytics to support informed policymaking, and reducing diagnostic errors. 

AHRQ Advances Pain Management Through Greater Use of Digital Technology. Factors to Consider in Managing Chronic Pain, a new interoperable digital tool for clinicians that consolidates pain-related information scattered throughout a patient’s electronic health record, is the subject of an additional blog post by Director Khanna. The free, open-source software package is accessible through AHRQ’s CDS Connect initiative, a platform for developing and sharing interoperable clinical decision support resources. The tool’s dashboard helps clinicians quickly access vital information, such as patients’ pertinent medical histories, pain assessments, historical treatments and potential risks. It is estimated that 50 million American adults experience chronic pain daily, with a financial cost of treating pain between $560 billion and $635 billion annually. To receive all blog posts, submit your email address and select “AHRQ Views Blog.”

Filling Opioid Prescriptions Linked to New Persistent Use Among Women Following Childbirth

Women who received opioid prescriptions immediately before or following childbirth and had a cesarean delivery had a 2.2 percent rate of new persistent opioid use, according to an AHRQ-funded study published in JAMA Network Open. Persistent opioid use is defined as filling one or more prescriptions up to one year after discharge. Women with opioid prescriptions who had a vaginal delivery had a 1.7 percent new opioid use rate. Both rates are significantly higher than those for women who were not prescribed opioids before or after childbirth (1 percent for cesarean deliveries, and 0.5 percent for vaginal deliveries), the study found. Researchers examined 2008–2016 data on the rates of new persistent opioid use among 308,000 women with no prior opioid use and who received a pregnancy-related opioid prescription immediately before, during or after delivery. Filling an opioid prescription before delivery was the strongest factor associated with new persistent opioid use. While opioid prescribing among this population has declined since 2008, careful prescribing and risk assessment could further reduce use after childbirth, according to researchers. Access the abstract. 

New Research Focuses on Data’s Potential To Drive Health System Transformation

An AHRQ-sponsored special issue of eGEMS highlights data insights and capabilities that can help researchers, clinicians, patients and policymakers use data to transform healthcare in an era of rapid change. The 11 articles in this collection explore various phases of effective analytics including data acquisition, ensuring or enhancing data access and usability, data analysis and dissemination. The issue’s theme aligns with AHRQ’s strategic initiative to increase healthcare value while building off the agency’s core competencies in data and analytics. Central to that initiative is establishment of an integrated data, analytics and information platform capable of providing a 360-degree view of the healthcare system. The issue includes an introductory commentary, “Innovative Data Science to Transform Healthcare: All the Pieces Matter,” by Andrew Masica, M.D., M.S.C.I., a member of AHRQ’s National Advisory Council, and José Escarce, M.D., Ph.D., a former council member. The new eGEMS issue, published by AcademyHealth, is open access.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours.
• Effectiveness of double checking to reduce medication administration errors: a systematic review.
• Untangling infusion confusion: a comparative evaluation of interventions in a simulated intensive care setting.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web). 

Opioid Management Program Improves Clinicians’ Views of Daily Work: AHRQ Study

Clinicians and staff across clinics enrolled in the Six Building Blocks Program, an AHRQ-funded initiative on improving opioid management in primary care, reported that program participation improved their work life experience and their ability to provide high- quality care, according to a study in the Journal of the American Board of Family Medicine. Researchers conducted semistructured interviews and focus groups among 20 clinic members within six rural-serving primary care organizations in the western United States. Findings showed increased clinician confidence and comfort in providing care, enhanced collaboration and teamwork, stronger ability to respond to administrative requests such as from insurers, and improved relationships with patients. The study’s findings were based on Six Building Blocks’ strategies such as focusing on team-based care, standardizing workflows and monitoring medications. Access the study abstract and get more information on the Six Building Blocks program. 

New Research and Evidence From AHRQ

• Comparative Effectiveness of Analgesics To Reduce Acute Pain in the Prehospital Setting.
• Antipsychotics for the Prevention and Treatment of Delirium.

AHRQ in the Professional Literature

Antimicrobial stewardship in the emergency department. Pulia M, Redwood R, May L. Emerg Med Clin North Am 2018 Nov;36(4):853-72. Epub 2018 Sep 6. Access the abstract on PubMed®.

Methods for evaluating natural experiments in obesity: a systematic review. Bennett WL, Wilson RF, Zhang A, et al. Ann Intern Med 2018 Jun 5;168(11):791-800. Epub 2018 May 1. Access the abstract on PubMed®.

Allergen-specific immunotherapy in the treatment of pediatric asthma: a systematic review. Rice JL, Diette GB, Suarez-Cuervo C, et al. Pediatrics 2018 May;141(5). Epub 2018 Mar 23. Access the abstract on PubMed®.

Study protocol for the Anesthesiology Control Tower-Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: a pilot randomized controlled trial in intraoperative telemedicine. Gregory S, Murray-Torres TM, Fritz BA, et al. F1000Res 2018 May 22 [revised 2018 Aug 24];7:623. eCollection 2018. Access the abstract on PubMed®.

Testing of a tool for prostate cancer screening discussions in primary care. Misra-Hebert AD, Hom G, Klein EA, et al. Front Oncol 2018 Jun 28;8:238. eCollection 2018. Access the abstract on PubMed®.

Technology solutions to support care continuity in home care: a focus group study. Dowding DW, Russell D, Onorato N, et al. J Healthc Qual 2018 Jul/Aug;40(4):236-46. Access the abstract on PubMed®.

PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Tricco AC, Lillie E, Zarin W, et al. Ann Intern Med 2018 Oct 2;169(7):467-73. Epub 2018 Sep 4. Access the abstract on PubMed®.

Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics. Denton CA, Soni HC, Kannampallil TG, et al. Appl Clin Inform 2018 Jul;9(3):725-33. Epub 2018 Sep 12. Access the abstract on PubMed®.