Major Study Shows Significant Drop in In-Hospital Adverse Event Rates Pre-COVID

AHRQ Stats: Expected Payer for Maternal Emergency Department Visits

In 2019, Medicaid was the primary expected payer for 54.3 percent of treat-and-release emergency department visits and 51.3 percent of emergency department costs for pregnant women. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #296, Expected Payers and Patient Characteristics of Maternal Emergency Department Care, 2019.)

Today's Headlines:

• Major Study Shows Significant Drop in In-Hospital Adverse Event Rates Pre-COVID.
• AHRQ Seeks New Director of Patient Safety.
• Ambulatory Care Clinics Participating in AHRQ-Funded Program Reduced Antibiotic Use.
• Novel Market Share Approach More Accurately Identifies Hospital Capacity.
• AHRQ Releases COVID-19 Post-Vaccination Practices Learning Module Series for Nursing Homes.
• Primary Care Physicians in Medicaid Expansion States See Boost in Starting Salaries.
• Highlights From AHRQ’s Patient Safety Network.
• New Research and Evidence From AHRQ.
• AHRQ in the Professional Literature.

Major Study Shows Significant Drop in In-Hospital Adverse Event Rates Pre-COVID

The rates of in-hospital adverse events for healthcare-related patient harm fell significantly in the United States in the decade prior to the onset of the COVID-19 pandemic, according to a new study funded and carried out by AHRQ. The authors of the study, published in JAMA, tracked 21 adverse events of nearly 245,000 patients in more than 3,100 hospitals between 2010 and 2019. Examples of the events included adverse medication events such as those associated with the use of insulin or anticoagulants, infections such as central line-associated bloodstream infections and catheter-associated urinary tract infections, and post-procedure events such as those associated with hip joint or knee joint replacement surgeries or postoperative cardiac events. The authors conclude that pre-COVID hospital care was getting safer. Access the article and the AHRQ press release. Learn about AHRQ patient safety programs.

AHRQ Seeks New Director of Patient Safety

AHRQ is seeking applicants to serve as director of the agency’s Center for Quality Improvement and Patient Safety (CQuIPS). The CQuIPS director serves as a key advisor to the AHRQ director and functions as a member of the AHRQ’s Senior Leadership Team. The CQuIPS director will plan and direct a comprehensive research agenda to evaluate the nation’s healthcare quality and safety. Other responsibilities include overseeing research to assess consumer and provider perceptions of healthcare culture, services and systems, and developing and testing measures, tools and methods to evaluate and improve safety and quality. The CQUiPS director also serves as the agency’s patient safety spokesperson. A clinical background is preferred.  Applications will be accepted through July 30. Access the USAJobs posting to learn more.

Ambulatory Care Clinics Participating in AHRQ-Funded Program Reduced Antibiotic Use

Antibiotic prescribing at ambulatory care clinics was cut almost in half at clinics that participated in an AHRQ-funded safety program. Research findings published in JAMA Network Open represent the latest demonstration that AHRQ’s efforts to help healthcare providers manage prescribing practices more appropriately can significantly improve antibiotic prescribing. The study analyzed the results of the AHRQ Safety Program for Improving Antibiotic Use, which assisted 389 ambulatory clinics in establishing or improving antibiotic stewardship programs. Antibiotic prescribing at participating clinics decreased overall by nearly 48 percent, while antibiotic prescribing for acute respiratory infection diagnoses decreased by 37 percent. While antibiotic medications have drastically reduced illness and death, up to half of all prescriptions are medically inappropriate and may increase the risk of antibiotic resistance. At least 2.8 million illnesses and 35,000 deaths in the United States each year are caused by antibiotic-resistant bacteria, according to estimates. Access the new study and the AHRQ press release.

Novel Market Share Approach More Accurately Identifies Hospital Capacity

Combining data from AHRQ’s Healthcare Cost and Utilization Project with data from several other sources, AHRQ researchers designed a more accurate method of measuring hospital capacity. The method, outlined in Health Services Research, uses market share and discharge data to identify which hospitals are most commonly used by residents in different ZIP codes, even when facilities are not located within the same region as the patient. By using a near-census of discharges, this approach offers a more flexible and realistic view of hospital capacity than traditional means. In practice, it identified a nearly 4 percent reduction in average bed capacity in non-Hispanic Black population regions compared with methods using Health Service Areas and an over 10 percent reduction compared to those using counties. Access the abstract.

AHRQ Releases COVID-19 Post-Vaccination Practices Learning Module Series for Nursing Homes

AHRQ has released a series of two self-paced video modules for frontline nursing home staff designed to minimize infection risk during COVID-19. These modules illustrate how staff can protect themselves, other staff and residents from infection, as well as strategies to prevent infection. The five-minute modules are available online through the COVID-19 Resources Catalog for Nursing Homes. Access the modules. 

Primary Care Physicians in Medicaid Expansion States See Boost in Starting Salaries

Starting salaries for new primary care physicians (PCPs), especially new general internists and family physicians, grew faster in states that expanded Medicaid under the Affordable Care Act (13.8 percent) compared with those in non-expansion states (6.1 percent), concluded an AHRQ-funded study in Medical Care. Researchers assessed changes in PCP compensation using 2009–2018 data from the annual survey of nearly 2,000 medical residents who completed training in New York; the study period covered the five-year period before and after Medicaid expansion. In addition to higher increases in starting salaries, Medicaid expansion was associated with a significant increase in additional income as part of the total compensation for new PCPs practicing in rural areas. 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:

• Does racism impact healthcare quality? Perspectives of Black and Hispanic/Latino patients.
• Monitoring preventable adverse events and near misses: number and type identified differ depending on method used.
• Diagnostic challenges in primary care: identifying and avoiding cognitive bias.

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).

New Research and Evidence From AHRQ

• Systematic Review: Schedule of Visits and Televisits for Routine Antenatal Care.
• Systematic Review (draft open for comment): Partial Breast Irradiation for Breast Cancer.

AHRQ in the Professional Literature

Management of primary headaches during pregnancy, postpartum, and breastfeeding: a systematic review. Saldanha IJ, Cao W, Bhuma MR, et al. Headache 2021 Jan;61(1):11-43. Epub 2021 Jan 12. Access the abstract on PubMed®.

Feasibility and acceptability of a Neonatal Project ECHO (NeoECHO) as a dissemination and implementation strategy to prevent necrotizing enterocolitis. Gephart SM, Newnam K, Weiss A, et al. Worldviews Evid Based Nurs 2021 Dec;18(6):361-70. Epub 2021 Jul 23. Access the abstract on PubMed®.

Applying a biopsychosocial framework to achieve durable behavior change in kidney disease. Nair D, Cukor D, Taylor WD, et al. Semin Nephrol 2021 Nov;41(6):487-504. Access the abstract on PubMed®.

Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system. Cifra CL, Tigges CR, Miller SL, et al. Appl Clin Inform 2022 Mar;13(2):495-503. Epub 2022 May 11. Access the abstract on PubMed®.

Eating disorders in the U.S. Medicare population. Presskreischer R, Steinglass JE, Anderson KE. Int J Eat Disord 2022 Mar;55(3):362-71. Epub 2022 Jan 13. Access the abstract on PubMed®.

Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis. Reid LD, Weiss AJ, Fingar KR. J Hosp Med 2022 Feb;17(2):77-87. Epub 2021 Jan 27. Access the abstract on PubMed®.

Mitigating racial bias in machine learning. Kostick-Quenet KM, Cohen IG, Gerke S, et al. J Law Med Ethics 2022;50(1):92-100. Access the abstract on PubMed®.

Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Topham EW, Bristol A, Luther B, et al. Prof Case Manag 2022 Jul-Aug;27(4):181-93. Access the abstract on PubMed®.