AHRQ Studies Suggest Integrated Health Systems Have Not Improved Patient Care

AHRQ Stats: Average Cost of a Medicare Advantage and Traditional Medicare Hospital Stay

The average cost of a hospital stay among patients at least 65 years old with Medicare Advantage as the expected primary payer rose 16 percent from 2009 to 2017. The average cost of a stay expected to be paid for by traditional Medicare, meanwhile, grew by 11 percent. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #262: Medicare Advantage Versus the Traditional Medicare Program: Costs of Inpatient Stays, 2009-2017.)

Today's Headlines:

• AHRQ Studies Suggest Integrated Health Systems Have Not Improved Patient Care.
• Now Available From AHRQ: 2020 Data on Hospital Utilization.
• JAMA Series Commemorates 20th Anniversary of Crossing the Quality Chasm Report.
• Applications Due by Jan. 7 for AHRQ Summer Fellowships.
• Highlights From AHRQ’s Patient Safety Network.
• AHRQ in the Professional Literature.

AHRQ Studies Suggest Integrated Health Systems Have Not Improved Patient Care

The impact of integrated health systems on the quality, cost and equity of patient care is examined in a recent AHRQ-funded special issue of the journal Health Services Research. Integrated health systems, often including hospitals, physician practices and other settings of care, have grown significantly in recent years. While these systems offer the potential to improve quality of care while reducing costs and administrative burdens, evidence has been limited on impact. In one expert commentary, Commonwealth Fund President David Blumenthal, M.D., Ph.D., asserts that current payment models have led health systems to focus more on financial performance than patient outcomes. In another, former AHRQ Director and current University of California, San Diego, professor Richard Kronick, Ph.D., suggests the potential benefits of integrated systems are unlikely to occur without effective policy and regulatory oversight. Among the articles in the special issue:

• Organizational Integration, Practice Capabilities, and Outcomes in Clinically Complex Medicare Beneficiaries.
• Primary Care Quality and Cost for Privately Insured Patients in and out of U.S. Health Systems: Evidence From Four States.
• Racial and Ethnic Disparities in Care for Health System‐Affiliated Physician Organizations and Non‐Affiliated Physician Organizations.

AHRQ supported this research via the agency’s Comparative Health System Performance (CHSP) Initiative, which studies the landscape, impact and trends in health systems. Access the special issue.

Now Available From AHRQ: 2020 Data on Hospital Utilization

A new data product that provides downloadable, state-specific trend tables on monthly hospital utilization from 2017 through 2020 is now available from AHRQ’s Healthcare Cost and Utilization Project (HCUP). The information, derived from the HCUP State Inpatient Databases, is provided by HCUP partner organizations. The data include monthly trends in hospital utilization overall as well as by three key reporting categories: inpatient stays by select priority conditions; inpatient encounter type (including newborns, deliveries, nonelective and elective stays); and inpatient service line (including neonatal/maternal; mental health/substance use, injury, surgical, other medical). AHRQ has also released a report (PDF) with graphs derived from the tables that display trends in the monthly rate of in-hospital mortality from January 2019 through June 2020 for nine states. 

JAMA Series Commemorates 20th Anniversary of Crossing the Quality Chasm Report

JAMA has published a series of articles commemorating the 20th anniversary of a sentinel patient safety report called Crossing the Quality Chasm that has helped to guide AHRQ’s patient safety work over the past two decades. The issue’s contributing authors include former AHRQ Director Carolyn Clancy, M.D., and former Centers for Medicare & Medicaid Services Administrator Don Berwick, M.D., as well as a companion Viewpoint by AHRQ grantee Hardeep Singh, M.D., that offers a roadmap to help advance safety in ambulatory care.

Applications Due by Jan. 7 for AHRQ Summer Fellowships

Individuals with advanced degrees concentrated in health services research or a related field are encouraged to apply by Jan. 7, 2021, to be selected for AHRQ’s Intramural Fellowship Program. Junior-level fellows will work with agency health services researchers during summer 2021 on issues that support AHRQ’s mission, including work focused on:

• Analysis of health policy priorities and design of a health policy education strategy.
• Development of an electronic care plan for people living with multiple chronic conditions and disability.
• Review of race-based clinical algorithms used in standard medical practice.
• Analysis of information data models related to shared decision-making.
• Synthesis of data to inform future substance use disorder initiatives.
• Assessment of content on AHRQ’s Health Care Innovations Exchange.

Applicants should demonstrate a fundamental understanding of research, statistics and scientific terminology and should be able communicate orally and in writing. Only U.S. citizens or citizens who have gained U.S. citizenship through naturalization may be considered. Access information about the fellowship program and how to apply.

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:

• Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review.
• Transforming the medication regimen review process using telemedicine to prevent adverse events.
• Alternatives to opioid education and a prescription drug monitoring program cumulatively decreased outpatient opioid prescriptions.

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).

AHRQ in the Professional Literature

Is treatment working? Detecting real change in the treatment of child and adolescent depression. Liu FF, Adrian MC. J Am Acad Child Adolesc Psychiatry 2019 Dec;58(12):1157-64. Epub 2019 Feb 27. Access the abstract on PubMed®.

Screening performance of digital breast tomosynthesis vs digital mammography in community practice by patient age, screening round, and breast density. Lowry KP, Coley RY, Miglioretti DL, et al. JAMA Netw Open 2020 Jul;3(7):e2011792. Access the abstract on PubMed®.

Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model? Machta RM, Reschovsky J, Jones DJ, et al. Health Serv Res 2020 Aug;55(4):541-7. Access the abstract on PubMed®.

Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC). Kocher KE, Arora R, Bassin BS, et al. Ann Emerg Med 2020 Feb;75(2):192-205. Epub 2019 Jun 27. Access the abstract on PubMed®.

Risk of gastrointestinal bleeding increases with combinations of antithrombotic agents and patient age. Abraham NS, Noseworthy PA, Inselman J, et al. Clin Gastroenterol Hepatol 2020 Feb;18(2):337-46.e19. Epub 2019 May 18. Access the abstract on PubMed®.

Trends in hospitals and skilled nursing facilities sharing medical providers, 2008-16. White EM, Kosar CM, Rahman M, et al. Health Aff 2020 Aug;39(8):1312-20. Access the abstract on PubMed®.

Association of infectious disease physician approval of peripherally inserted central catheter with appropriateness and complications. Vaughn VM, O'Malley M, Flanders SA, et al. JAMA Netw Open 2020 Oct;3(10):e2017659. Access the abstract on PubMed®.

Medicaid Accountable Care Organizations and childbirth outcomes. Henke RM, Karaca Z, Gibson TB, et al. Med Care Res Rev 2020 Dec;77(6):559-73. Epub 2019 Jan 7. Access the abstract on PubMed®.