AHRQ Views Blog: Unveiling a Research Agenda To Transform Care for People With Multiple Chronic Conditions

AHRQ Stats: Adult Hospitalizations and In-Hospital Deaths During the Onset of the COVID-19 Pandemic

Across 13 states, from April through June 2020, the average number of hospitalizations for adults 18 to 64 years old fell 19 percent, to about 68,000, while the average number of in-hospital deaths among patients in this age group rose 44 percent, to about 1,300, compared with the same months in previous years. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #284, Changes in Hospitalizations and In-Hospital Deaths for Adults Aged 18-64 Years in the Initial Period of the COVID-19 Pandemic [April-September 2020], 13 States.)

Today's Headlines:

• AHRQ Views Blog: Unveiling a Research Agenda To Transform Care for People With Multiple Chronic Conditions.
• Rural Hospital Mergers Shown To Reduce Services, but Improve Care Quality.
• Before American Rescue Plan, ACA Marketplace Plans Became Less Affordable for Many Middle-Class Families, AHRQ Study Finds.
• VA Hospitals Step Up Antibiotic Care for Veterans With Sepsis.
• Highlights From AHRQ’s Patient Safety Network.
• AHRQ in the Professional Literature.

AHRQ Views Blog: Unveiling a Research Agenda To Transform Care for People With Multiple Chronic Conditions

AHRQ’s lead role in establishing a research agenda to improve care for Americans living with multiple chronic conditions (MCC) is the subject of a new blog post by Arlene S. Bierman, M.D., M.S., director of AHRQ’s Center for Evidence and Practice Improvement. The agency has worked to develop a research agenda to guide future investments in improving MCC care. These efforts culminated with the AHRQ Summit on Transforming Care for People Living with Chronic Conditions, attended by over 100 researchers, clinicians, patients, health system leaders and others. Participants identified and prioritized key areas for investigation and innovation. In a recent article in a special issue of Health Services Research (HSR) devoted to The Science of Care for People with Multiple Chronic Conditions, Dr. Bierman and co-authors presented an AHRQ research agenda aimed at providing the needed evidence to transform MCC care. Access the blog post. Watch for details about a forthcoming webinar Nov. 18, from 11 a.m. to noon, about the HSR special issue.

Rural Hospital Mergers Shown To Reduce Services, but Improve Care Quality

A pair of studies from an AHRQ-funded research team examining access to and quality of care after rural hospital mergers provides mixed news on the impact of mergers. The first article, published in Health Affairs, found that rural hospitals that merged were more likely to eliminate maternal/neonatal and surgical services to stay in business compared with independent hospitals.  A second study published in JAMA Network Open found significantly greater reduction in inpatient deaths for several common conditions (e.g., heart attack, heart failure, acute stroke and pneumonia) among patients admitted to rural hospitals that merged. Researchers conclude in this study that mergers result in greater improvements in healthcare, however more research is needed to assess the impact of mergers on the healthcare of rural communities.  

Before American Rescue Plan, ACA Marketplace Plans Became Less Affordable for Many Middle-Class Families, AHRQ Study Finds

The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the poverty line did not qualify for tax credits and could face substantial financial burdens when purchasing coverage, concludes a new study by AHRQ authors published in Health Affairs. As part of COVID-19 relief, the Administration and Congress expanded subsidies. This research, based on an analysis of data from 2015-2019, concludes that families making more than 400 percent of poverty may have challenges purchasing insurance if and when these subsidies end. Access the abstract.

VA Hospitals Step Up Antibiotic Care for Veterans With Sepsis

Antibiotics are being administered more quickly to veterans who are hospitalized with sepsis, a life-threatening complication caused by infection, according to an AHRQ-funded study published in JAMA Network Open. The nationwide study of more than 111,000 patients at 130 Veterans Affairs hospitals showed that, on average, hospitals started antibiotics to treat sepsis nine minutes faster each year from 2013 to 2018. However, the average antibiotic start time at a given hospital varied significantly, ranging from 3.1 to 6.7 hours. For most patients with sepsis, guidelines recommend starting antibiotics within three hours of diagnosis or sooner. Researchers said this significant variation between hospitals suggests the potential for further improvement but added that the benefits of earlier antibiotics must be weighed against the risks of overtreatment. Access the abstract. 

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:

• Systematic review: nurses' safety attitudes and their impact on patient outcomes in acute-care hospitals.
• Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care.
• EMS non-conveyance: a safe practice to decrease ED crowding or a threat to patient safety.

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

A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization. Austin EJ, LeRouge C, Lee JR, et al. Learn Health Syst 2021 Oct;5(4):e10263. Access the abstract on PubMed®.

Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review. Fishbein AB, Hamideh N, Lor J, et al. J Pediatr 2020 Jun;221:138-44.e3. Epub 2020 Mar 11. Access the abstract on PubMed®.

Associations of flavored e-cigarette uptake with subsequent smoking initiation and cessation. Friedman AS, Xu S. JAMA Netw Open 2020 Jun;3(6):e203826. Access the abstract on PubMed®.

CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting. Watterson TL, Stone JA, Brown R, et al. J Am Med Inform Assoc 2021 Jul 14;28(7):1526-33. Access the abstract on PubMed®.

Health data sharing in US nursing homes: a mixed methods study. Powell KR, Deroche CB, Alexander GL. J Am Med Dir Assoc 2021 May;22(5):1052-9. Epub 2020 Mar 27. Access the abstract on PubMed®.

Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. Sorra J, Zebrak K, Yount N, et al. BMJ Qual Saf 2021 Aug 20. [Epub ahead of print.] Access the abstract on PubMed®.

Quality of care before and after mergers and acquisitions of rural hospitals. Jiang HJ, Fingar KR, Liang L, et al. JAMA Netw Open 2021 Sep;4(9):e2124662. Access the abstract on PubMed®.

Estimating the marginal hazard ratio by simultaneously using a set of propensity score models: a multiply robust approach. Shu D, Han P, Wang R, et al. Stat Med 2021 Feb;40(5):1224-42. Epub 2021 Jan 6. Access the abstract on PubMed®.