domingo, 30 de septiembre de 2012

AHRQ Innovations Exchange | Recent Events | Vermont Blueprint for Health: Working Together for Better Care

AHRQ Innovations Exchange | Recent Events | Vermont Blueprint for Health: Working Together for Better Care



Vermont Blueprint for Health: Working Together for Better Care
AHRQ's Health Care Innovations Exchange held a Webcast titled Vermont Blueprint for Health: Working Together for Better Care on September 25, 2012.

This event featured a video presentation about successful linkages among primary care, public health, and clinical community resources in the state of Vermont. Vermont's Blueprint for Health program provides comprehensive, coordinated care while improving health outcomes and reducing costs.

The video presentation was followed by a panel discussion during which Vermont program staff discussed implementation challenges and potential solutions related to linking clinical care and community resources. The replay of the Webcast, including the panel discussion, will be available shortly.

AHRQ Innovations Exchange | Expert Commentary: State-Mandated Tracking and Public Reporting Reduce Incidence and Costs of Common Hospital-Acquired Infections

AHRQ Innovations Exchange | Expert Commentary: State-Mandated Tracking and Public Reporting Reduce Incidence and Costs of Common Hospital-Acquired Infections



Lessons Learned From the New York Law Mandating Hospitals to Report on Infections
By Sharon Moffatt, RN, BSN, MSN
Chief of Health Promotion and Disease Prevention
Association of State and Territorial Health Officials

As a significant cause of death, health care–associated infections (HAIs) are a critical challenge to public health in the United States. About 1 in 20 patients develops an infection while receiving care in U.S. hospitals. These infections result in up to $33 billion in excess medical costs every year.1 Despite these staggering statistics, HAIs are preventable through comprehensive strategies that involve public reporting, education, and prevention. Policies that support comprehensive programs are needed to reduce and eventually eliminate HAIs.

State health agencies play a central role in HAI prevention because they are responsible for protecting patients across the health care system and serve as a bridge between health care and the community. State health agencies may have authority to regulate and inspect facilities, collect and validate data on infections, and implement improvement programs, while protecting patients’ rights by maintaining the requisite level of privacy and confidentiality.

At least 28 states have enacted laws in the past decade to require that hospitals report infection data regularly to their State health agencies or other designated organizations.2 The most common HAIs addressed by these laws are central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections, and surgical site infections. These are the leading cost drivers, based on the severity of the infection and the intervention required to treat the infection. For example, CLABSIs are life threatening and may result in long stays in intensive care units.

New York was one of the first states to enact a comprehensive reporting law in 2005. The State health agency partnered with hospital representatives, consumer advocates, and State legislators, who recognized that HAIs were a problem both nationally and in New York. They drafted legislation to provide New Yorkers and other stakeholders with fair, accurate, and reliable data to guide decisions on where to receive care.3

However, public reporting alone is insufficient to sustain a decrease in HAI rates. The New York law authorized funds for the State health agency to support quality improvement projects at selected hospitals to improve their infection control programs. The agency also provided technical assistance to the hospitals, such as root cause analysis to facilitate HAI data reporting, and audited the accuracy of information submitted by the hospitals. Given the constantly changing hospital environment, the State health agency could also address the need to develop protocols for quality improvement and for ongoing review and reporting, to ensure sustained progress in reducing HAI rates.

Partnerships played an important role in the success of the legislation in reducing HAI rates and associated health care costs. For example, the State health agency collaborated with several hospitals on the quality improvement projects that it funded.

The comprehensive program increased staff adherence to hospital infection prevention and control programs, leading to significant reductions in targeted infections and cost savings. Since 2007, adult and pediatric CLABSI rates have decreased by 18 percent in New York after adjusting for type of intensive care unit. The State health agency estimated that the decline in surgical site infections between 2007 and 2010 generated between $7.9 million and $23.1 million in cost savings, while the decline in CLABSIs in adult, pediatric, and neonatal intensive care units has generated an additional $7.3 million to $29.4 million in savings.3

In interviews for a State policy report on HAIs1 issued by the Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention (CDC), stakeholders from New York attributed the success of the public reporting policies to the auditing of reported data and the initial pilot reporting program that allowed the state to refine the requirements and educate facilities on reporting. By raising awareness among hospital leadership and health care providers, the policies were also the catalyst for institutional and cultural change in facilities. This created the impetus for increasing dedicated infection control resources at the facility level.

States with dedicated financial support are better positioned to provide the technical assistance and oversight necessary to implement a comprehensive, well-staffed HAI prevention program. State health officials interviewed for the State policy report said that their HAI prevention efforts benefited from national funding provided by the American Recovery and Reinvestment Act of 2009. Yet the stakeholders expressed concern about the long-term sustainability of surveillance, reporting, and technical assistance. One way to address that challenge is to invest the money saved from reductions in HAI rates back into the State health programs that support efforts to prevent HAIs.

The experience with New York’s HAI public reporting law offers some important lessons. Public health officials and the health care community have a responsibility to inform policymakers about the benefits of such laws, especially as states face budget cuts and assess the value of public health programs. After seeing the associated cost savings and the improved quality of life of patients treated in hospitals with reduced HAI rates, policymakers may consider that information when deciding whether to implement similar laws in their own states or territories.

About the Author: Sharon Moffatt, RN, BSN, MSN, is the Chief of Health Promotion and Disease Prevention at the Association of State and Territorial Health Officials (ASTHO). ASTHO is the national nonprofit organization representing the public health agencies in U.S. states, territories, and the District of Columbia. ASTHO's members, the chief health officials of these jurisdictions, are dedicated to developing sound public health policy and ensuring excellence in State-based public health practice.

Disclosure Statement: Ms. Moffatt reported that ASTHO received a CDC grant for HAI and Winnable Battles. She reported no other financial or business/professional affiliations that are relevant to the work described in this commentary.

References:


1Policies for Eliminating Healthcare-Associated Infections: Lessons from State Stakeholder Engagement, January 2012. Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention. Available at: http://www.astho.org/Display/AssetDisplay.aspx?id=6786External Link.

2Healthcare Associated Infection Reporting Laws. December 2008. Association of State and Territorial Health Officials. Available at: http://www.astho.org/uploadedFiles/Programs/Infectious_Disease/Healthcare-Associated_Infections/State%20HAI%20Reporting%20Laws%20122208.pdfExternal Link (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software External Web Site Policy.).

3State-Mandated Tracking and Public Reporting Reduce Incidence and Costs of Common Hospital-Acquired Infections, Sept. 26, 2012. AHRQ Health Care Innovations Exchange. Available at: http://www.innovations.ahrq.gov/content.aspx?id=3686.
Original publication: September 26, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: September 26, 2012.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

AHRQ Innovations Exchange: State Health Care Legislation and Statewide Initiatives

AHRQ Innovations Exchange



September 26, 2012 Issue 
State Health Care Legislation and Statewide Initiatives
State Health Care Legislation and Statewide Initiatives
This issue includes
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Next issue: Increasing Patient Involvement in Health Care

RFA-HS-13-002: AHRQ Patient Centered Outcomes Research (PCOR) Pathway to Independence Award (K99/R00)

RFA-HS-13-002: AHRQ Patient Centered Outcomes Research (PCOR) Pathway to Independence Award (K99/R00)



AHRQ Announces New Patient-Centered Outcomes Research Pathway to Independence Award

AHRQ is seeking applications for the new Patient-Centered Outcomes Research (PCOR) Pathway to Independence Award programThe primary purpose of this program is to increase and maintain a strong cohort of new and talented AHRQ-supported independent investigators trained in comparative effectiveness methods to conduct patient care outcomes research. The program is designed to facilitate a timely transition from a junior non-tenure track faculty or a postdoctoral research position (or their equivalents) to a stable independent research career. It targets investigators early in their careers to support their development in new sophisticated methodological comparative effectiveness research skills, interdisciplinary perspectives, and capabilities in PCOR. Deadline to submit an application is December 17. Select to access the announcement.

AHRQ Centers for Primary Care Practice-Based Research and Learning

AHRQ Centers for Primary Care Practice-Based Research and Learning



AHRQ Awards Eight Institutions to Support Collaborative Centers for Primary Care Practice-Based Research

AHRQ has announced grant awards to eight institutions to support collaborative centers for primary care practice-based research. For over a decade, AHRQ has invested in primary care practice-based research networks (PBRNs) - groups of ambulatory medical practices devoted principally to the primary care of patients that join to conduct and disseminate research to improve the practice of primary care. While AHRQ has supported PBRNs with as few as 15 primary care practices, each Center created through this program has a minimum of 120 member practices and several have more than 500. Many of the Centers are collaborations between smaller well-established PBRNs. By leveraging common resources, these Centers are expected to improve productivity and to develop the ability to plan and conduct independent research projects more quickly and produce results that are more generalizable than they would as separate PBRNs. Select to read more about the new Centers.

AHRQ Innovations Exchange | Innovations & QualityTools

AHRQ Innovations Exchange | Innovations & QualityTools



AHRQ’s Health Care Innovations Exchange Focuses on Workforce Development and the Role of Community Health Workers

The September 12 issue of AHRQ’s Health Care Innovations Exchange features two profiles related to policies that support the development and expansion of the health care workforce to leverage community members and health workers. One of the policies created a new staff position within primary care clinics and hospitals that was filled by community members with experience as caregivers. Known as “Grand-Aides,” these new members of the health care team completed a rigorous training and certification process before performing a variety of tasks intended to streamline and reduce the costs of patient care, and assist health care teams in providing appropriate care to patients. Though their work varied depending on the setting (primary care or transitional care after discharge), Grand-Aides typically had face-to-face interactions and/or telephone conversations with patients, focusing on assessment of needs, education on preventive and self-care, ongoing monitoring, and followup in two pilot sites, Grand-Aides reduced unnecessary physician visits and demonstrated the potential to generate significant cost savings. This new health workforce role is currently being tested and spread to sites in California, Pennsylvania, Virginia, and Texas. Select to read more innovation profile related to community health workers on the Health Care Innovations Exchange Web site, which contains more than 725 searchable innovations and 1,500 QualityTools.

Medicaid Providers Face Common Barriers to Meaningful Use



Medicaid Providers Face Common Barriers to Meaningful Use

A new AHRQ report examines challenges Medicaid providers face in achieving Meaningful Use (MU) of health information technologies. The report finds barriers to adoption and MU of Electronic Health Records (EHRs) were not associated with serving a predominantly Medicaid-insured population. However, providers such as dentists, pediatricians, and nurse midwives who were only eligible under the Medicaid program reported some difficulty finding a certified EHR appropriate for their specialty, and that some required measures, such as blood pressure, were irrelevant due to the age of the patient groups they serve. The reported barriers to adoption and achievement of MU were consistent with those cited in past studies, including limited awareness of the Medicaid EHR Incentive program, difficulty in selecting and functionality of EHRs and limited ability to implement core measures of Stage 1 MU. The report recommended greater collaboration between all stakeholders to provide more targeted technical assistance tools and development of a body of knowledge to address the socio-cultural, technical, and training needs of Medicaid providers. Select to access the full report.

Closing the Quality Gap Series: Quality Improvement Interventions To Address Health Disparities - Research Review - Final | AHRQ Effective Health Care Program

Closing the Quality Gap Series: Quality Improvement Interventions To Address Health Disparities - Research Review - Final | AHRQ Effective Health Care Program



Research Review - Final – Aug. 27, 2012

Closing the Quality Gap Series: Quality Improvement Interventions To Address Health Disparities

Formats

  • View PDF (PDF) 2.6 MB
  • Two New Quality Reports: Impact of Bundled Payments and Interventions to Reduce Disparities

    AHRQ has released two reports that are part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, and build on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. One report prepared by AHRQ’s RAND Evidence-based Practice Center found that the introduction of bundled payments to reimburse providers for the expected cost of related health care services reduced health care spending and use. But the evidence for the effect of bundled payments on quality measures was inconsistent and generally had small effects. The researchers found the overall evidence to be low because most of the studies examined bundled payment for single institutions and many had quality concerns. The lead researcher Peter S. Hussey, Ph.D., says the report provides policymakers some support that bundling payment is likely to be an effective strategy, and while the method’s effects on quality are less certain, the evidence does not support the worst concerns about potentially adverse effects. Select to access the report, “Bundled Payment: Effects on Health Care Spending and Quality.” The other report in this series, AHRQ’s Vanderbilt University Evidence-based Practice Center researchers led by Melissa L. McPheeters, Ph.D., found that, as a whole, quality interventions to reduce health care disparities have not been shown to be effective, although they did find a few studies showing that quality improvement interventions affected health care disparities in certain disadvantaged populations. Select to access the report, “Quality Improvement Interventions to Address Health Care Disparities.”             

Closing the Quality Gap Series: Bundled Payment: Effects on Health Care Spending and Quality - Research Review - Final | AHRQ Effective Health Care Program

Closing the Quality Gap Series: Bundled Payment: Effects on Health Care Spending and Quality - Research Review - Final | AHRQ Effective Health Care Program

Two New Quality Reports: Impact of Bundled Payments and Interventions to Reduce Disparities

AHRQ has released two reports that are part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, and build on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. One report prepared by AHRQ’s RAND Evidence-based Practice Center found that the introduction of bundled payments to reimburse providers for the expected cost of related health care services reduced health care spending and use. But the evidence for the effect of bundled payments on quality measures was inconsistent and generally had small effects. The researchers found the overall evidence to be low because most of the studies examined bundled payment for single institutions and many had quality concerns. The lead researcher Peter S. Hussey, Ph.D., says the report provides policymakers some support that bundling payment is likely to be an effective strategy, and while the method’s effects on quality are less certain, the evidence does not support the worst concerns about potentially adverse effects. Select to access the report, “Bundled Payment: Effects on Health Care Spending and Quality.” The other report in this series, AHRQ’s Vanderbilt University Evidence-based Practice Center researchers led by Melissa L. McPheeters, Ph.D., found that, as a whole, quality interventions to reduce health care disparities have not been shown to be effective, although they did find a few studies showing that quality improvement interventions affected health care disparities in certain disadvantaged populations. Select to access the report, “Quality Improvement Interventions to Address Health Care Disparities.”


Research Review - Final – Aug. 24, 2012

Closing the Quality Gap Series: Bundled Payment: Effects on Health Care Spending and Quality

Interventions to Improve Adherence to Self-ad... [Ann Intern Med. 2012] - PubMed - NCBI

Interventions to Improve Adherence to Self-ad... [Ann Intern Med. 2012] - PubMed - NCBI

2012 Sep 11. doi: 10.7326/0003-4819-157-11-201212040-00538. [Epub ahead of print]

Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A Systematic Review.

Abstract

BACKGROUND:

Suboptimum medication adherence is common in the United States and leads to serious negative health consequences but may respond to intervention.

PURPOSE:

To assess the comparative effectiveness of patient, provider, systems, and policy interventions that aim to improve medication adherence for chronic health conditions in the United States.

DATA SOURCES:

Eligible peer-reviewed publications from MEDLINE and the Cochrane Library indexed through 4 June 2012 and additional studies from reference lists and technical experts.

STUDY SELECTION:

Randomized, controlled trials of patient, provider, or systems interventions to improve adherence to long-term medications and nonrandomized studies of policy interventions to improve medication adherence.

DATA EXTRACTION:

Two investigators independently selected, extracted data from, and rated the risk of bias of relevant studies.

DATA SYNTHESIS:

The evidence was synthesized separately for each clinical condition; within each condition, the type of intervention was synthesized. Two reviewers graded the strength of evidence by using established criteria. From 4124 eligible abstracts, 62 trials of patient-, provider-, or systems-level interventions evaluated 18 types of interventions; another 4 observational studies and 1 trial of policy interventions evaluated the effect of reduced medication copayments or improved prescription drug coverage. Clinical conditions amenable to multiple approaches to improving adherence include hypertension, heart failure, depression, and asthma. Interventions that improve adherence across multiple clinical conditions include policy interventions to reduce copayments or improve prescription drug coverage, systems interventions to offer case management, and patient-level educational interventions with behavioral support.

LIMITATIONS:

Studies were limited to adults with chronic conditions (excluding HIV, AIDS, severe mental illness, and substance abuse) in the United States. Clinical and methodological heterogeneity hindered quantitative data pooling.

CONCLUSION:

Reduced out-of-pocket expenses, case management, and patient education with behavioral support all improved medication adherence for more than 1 condition. Evidence is limited on whether these approaches are broadly applicable or affect long-term medication adherence and health outcomes.

PRIMARY FUNDING SOURCE:

Agency for Healthcare Research and Quality.

PMID:
22964778
[PubMed - as supplied by publisher]

Closing the Quality Gap Series: Medication Adherence Interventions: Comparative Effectiveness - Executive Summary | AHRQ Effective Health Care Program

Closing the Quality Gap Series: Medication Adherence Interventions: Comparative Effectiveness - Executive Summary | AHRQ Effective Health Care Program

Executive Summary – Sept. 11, 2012

Closing the Quality Gap Series: Medication Adherence Interventions: Comparative Effectiveness

Formats

Table of Contents

Background

Achieving the goal of quantitatively improving the quality and effectiveness of health care for all Americans requires both knowledge and tools. Although medical researchers have demonstrated many efficacious medical treatments to improve health outcomes, a recent Institute of Medicine report identified a disquieting discrepancy between present treatment success rates and those thought to be achievable.1 This gap has been attributed partly to barriers that providers face in implementing best practice guidelines.1,2 Patients’ adherence to treatment, however, provides an additional explanation for the incongruity between recommended treatment and actual treatment outcomes.
Poor medication adherence is relatively common.3,4 Studies have shown consistently that 20 to 30 percent of medication prescriptions are never filled and that, on average, 50 percent of medications for chronic disease are not taken as prescribed.5,6
This lack of adherence to medications is not only prevalent, but also has dramatic effects on individual and population-level health.5,7-16 Nonadherence has been estimated to cost the U.S. health care system between $100 billion and $289 billion annually in direct costs.3,5,17-20 Strong evidence suggests that benefits attributable to improved self-management of chronic diseases could result in a cost-to-savings ratio of approximately 1:10.21-27

National Health IT Week

National Health IT Week

National Health IT Week 2012 has been scheduled for September 10-14, 2012. Start planning your organization's participation today! Click on the "Toolkit" tab above for activity ideas.

One Voice, One Vision: Entering the 7th Year of Transforming Health and Care

Last year, 200 organizations participated in National Health IT Week 2011, which was also recognized by President Obama—who issued an official Proclamation of National Health IT Week —and by the U.S. Senate, which passed a Resolution declaring National Health IT Week. We’d be happy to have your organization join this year’s celebrations! Contact NHITweek@gmail.com for more information.
The Seventh Annual National Health IT Week is being held September 10-14, 2012. Join us for this collaborative forum where public and private healthcare constituents will work in partnership to educate industry and policy stakeholders on the value of health IT for the US healthcare system. There is no better time for the health IT community to come together under one umbrella to raise national awareness!
Comprehensive health care reform is not possible without system-wide adoption of health information technology, which improves the quality of healthcare delivery, increases patient safety, decreases medical errors, and strengthens the interaction between patients and healthcare providers.
With Meaningful Use now providing the way forward, eligible providers across the country increasingly understand the benefits for themselves and their patients, and are adopting Meaningful Use compliant electronic health records.
It’s easy to become a Partner in National Health IT Week 2012:
  • We need only a logo + a brief (50 words + company URL) company overview to get started
  • Email these materials to NHITweek@gmail.com – or let us know if you have further inquiries
  • Your information will be posted at www.HealthITWeek.org
There is no cost for National Health IT Week 2012 Partnership (certain criteria apply) – we will keep you up to date on events during the Week, and your participation will be highlighted in our promotions across the industry.
To learn more about how your organization can become involved in National Health IT Week 2012 by sponsoring or participating in a Partner event, please contact us at NHITweek@gmail.com for more information.

National Health IT Week: Celebrating HIT as an essential tool | Government Health IT

National Health IT Week: Celebrating HIT as an essential tool | Government Health IT


National Health IT Week: Celebrating HIT as an essential tool

September 10, 2012 | Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and Quality (AHRQ)
Just as a carpenter finishes his work by making sure that his hammers, chisels and saws are clean, sharp and ready for the next project, so should we take pride in and look after our health IT tools and systems. In essence, that’s what we’re doing at this moment, as the health IT community convenes in Washington, DC, for National Health IT Week.
The purpose of National Health IT Week is to raise awareness of the importance of health information technology. We are grateful to HIMSS and the week’s other co-sponsors, the Institute for e-Health Policy and the College of Healthcare Information Management Executives (CHIME), for leading the activities. This is an important annual event, demonstrating for Federal policymakers that health IT is neither an abstract nor experimental activity.
Instead, health IT is embedded in everything we do.
It has become fundamental to the provision of high-quality, patient-centered health care. IT-enabled innovations including (but not limited to) electronic health records (EHRs), clinical decision support systems, mobile health applications, and e-prescribing have become necessary tools in how we take care of patients each day. Endeavors such as patient-centered outcomes research, healthcare-associated infection (HAI) surveillance, disease and care management, and cutting-edge treatments and lab tests all feature IT-enabled applications as core components. In many instances, the practice of modern medicine could not exist without them.
The best part is, this is hardly news. Health IT is an essential part of how we diagnose, provide, monitor and improve health care services.
The Agency for Healthcare Research and Quality (AHRQ) considers this especially gratifying, because for years AHRQ has supported the evidence base behind health IT. Since its inception in 2004, AHRQ’s Health IT Portfolio has funded projects that show health IT’s impact on improving health care decision-making, supporting patient-centered care, coordinating care across transitions, and using electronic exchange of health information.
AHRQ asserted its belief in the relationship between health IT and quality through the creation of its Health IT Portfolio, which embarked on a series of grants and contracts. To date, more than 300 projects have been supported by the Portfolio and have produced important findings, practical tools, individual and organizational talent, and substantively moved the field forward.
In one project, Emergency Medical Service agencies used a web-based quality reporting system and clinical decision support technology to improve the timeliness of care provided to heart attack patients. Other projects included one in which nursing homes used health IT to improve quality; another featured a network of rural hospitals that implemented an EHR system and simultaneously redesigned many aspects of care delivery to improve patient safety.
Where We’re Going: A Focus on the Patient
Today, much of the health IT community’s attention is appropriately directed to meeting Meaningful Use standards in the adoption of EHRs. AHRQ supports its Federal partners in promoting Meaningful Use and overcoming barriers to EHR adoption.
As this transformation takes place, AHRQ remains focused primarily on identifying and filling gaps in knowledge about health IT to help prepare the field for future innovations. With this in mind, projects funded by AHRQ suggest where the field is headed. Examples of innovative AHRQ-funded work include:
Project ECHO. Clinicians at the University of New Mexico Health Sciences Center are bringing sophisticated treatment for Hepatitis C to patients in rural New Mexico and across the Nation. ECHO (which stands for Extension for Community Healthcare Outcomes) is wisely using available technology, expert training, and real-time feedback to bring state-of-the-art medical knowledge to primary care providers and nurses. Building on this experience, the project has also initiated telemedicine clinics for other complex conditions.
Project RED. Project RED (Re-Engineered Discharge) at Boston University Medical Center seeks to correct patient safety problems at one of the most vulnerable points of care—discharge from the hospital. Project RED offers tools to improve the discharge process by preparing patients for discharge from the moment they arrive in the hospital. Elements include a “virtual nurse” who simulates face-to-face interaction between a patient and a nurse, based on the patient’s individual medical data.
Active Aging Research Center. This center in Madison, Wisconsin aims to keep older adults safe and healthy in their homes and communities by developing an integrated system of health IT for seniors and their caregivers. These tools extend the independence and functioning of older adults, keeping them connected with family and friends and reducing unnecessary hospital visits, while ensuring that patients get timely access to the care they need.
What do these projects have in common?
It isn’t the IT itself. Some projects use very sophisticated, newly developed technologies; others rely on technologies that have been around for years. Instead, these projects leverage technology as a means to achieve patient-centered care—tracking and reducing medical errors, bringing care to vulnerable and complex patient groups, and ensuring that every patient gets care according to his or her wishes.
It is true, of course, that health care stakeholders — including providers, plans, purchasers, and government agencies — have been working toward this goal for years, even decades. Today, we believe that goal is within reach, because stakeholders have greater resources to enhance their efforts. AHRQ supports this goal through patient-centered outcomes research, the identification of health care quality deficiencies and disparities, and the development of performance measures to make sure health care providers deliver the highest quality care possible.
Consistent with that latter goal are three recently released AHRQ products that are of special interest to readers of Government Health IT.
One is the Workflow Assessment for Health IT Toolkit, an AHRQ-developed tool that helps health care providers reorganize and improve workflow, recognizing health IT’s likely impact on both clinical and administrative processes. This toolkit is designed for people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care.
A second is a Toolset for E-Prescribing Implementation in Physician Offices, the purpose of which is to provide physician practices with the knowledge and resources to implement e-prescribing successfully. The toolset includes specific tools to support planning and decision-making, such as surveys to determine whether an organization is ready for e-prescribing, worksheets for planning the implementation and monitoring progress, and templates for communicating the launch to patients.
The third tool, An Interactive Preventive Care Record (IPHR): A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention, offers practical steps for health care professionals to follow when deploying IPHRS as components of EHRs. Sections are targeted for use by practice leaders, informatics staff and practice personnel and provide advice for each team member on selection, implementation and maintenance.
These and other AHRQ health IT products are available for free on our web site, www.ahrq.gov.
A Vision for the Future
HIMSS, CHIME, and the Institute for e-Health Policy all deserve recognition for their leadership in co-sponsoring National Health IT Week. If you are in Washington during the week, we hope that you will join with your colleagues from both the public and private sectors to promote health IT. If policymakers from your area express interest, we hope you will consider inviting them to tour your facility to demonstrate the practical applications of sophisticated technology.
Looking ahead, it’s reasonable to predict that innovation will continue to play a central role in adoption and use of health IT. The private sector will continue to take the lead in searching for ways to use technology to increase quality and lower costs, and AHRQ will continue to support projects that show promise.
Will all of them work? Of course not. The “error” part of trial-and-error is an important part of basic research, and it’s important to learn what doesn’t work on a small scale before implementing new applications on a large scale. But we remain confident that overall, health IT will remain a critically important, and increasingly essential, tool for delivering high-quality health care to individuals and to populations.
Carolyn M. Clancy, MD, is Director of the Agency for Healthcare Research and Quality, Rockville, MD.

Changing BMI categories and healthca... [Obesity (Silver Spring). 2012] - PubMed - NCBI

Changing BMI categories and healthca... [Obesity (Silver Spring). 2012] - PubMed - NCBI

2012 Jun;20(6):1240-8. doi: 10.1038/oby.2011.86. Epub 2011 Apr 28.

Changing BMI categories and healthcare expenditures among elderly Medicare beneficiaries.

Source

West Virginia University School of Pharmacy, Department of Pharmaceutical Systems and Policy, Morgantown, West Virginia, USA. twilkins@hsc.wvu.edu

Abstract

To examine the association between changes in BMI categories and health-care expenditures among elderly Medicare beneficiaries using longitudinal data of the Medicare Current Beneficiary Survey (MCBS) 2000-2005. Changes in BMI were (i) Stayed Normal: individuals with a normal BMI at baseline and follow-up; (ii) Stayed Overweight individuals with overweight BMI at baseline and follow-up; (iii) Stayed Obese individuals with obese BMI at baseline and follow-up; (iv) Normal-Overweight: individuals with normal BMI at baseline and overweight BMI at follow-up; (v) Overweight-Obese: individuals with overweight BMI at baseline and obese BMI at follow-up; (vi) Overweight-Normal: individuals with overweight BMI at baseline and normal BMI at follow-up; (vii) Obese-Overweight: individuals with obese BMI at baseline and overweight BMI at follow-up. Ordinary Least Squares (OLS) models on logged Year 3 expenditures were used to analyze changes in expenditures between BMI categories. Overall, 35% Stayed Normal, 34% Stayed Overweight, 18% Stayed Obese, 4% gained weight from Normal-Overweight BMI, 3% gained weight from Overweight-Obese BMI, 5% lost weight from Overweight-Normal BMI, and 3% lost weight from Obese-Overweight BMI. Adjusted models revealed those who Stayed Obese had increased total and multiple expenditure types that were significantly higher than Stayed Normal including total (11%), outpatient (25%), prescription (9%), and medical provider (4%). Compared to Stayed Normal, total expenditures were both 26% higher for Obese-Overweight and Overweight-Obese. The current findings highlight the importance of maintaining a normal BMI in the elderly.

PMID:
21527898
[PubMed - indexed for MEDLINE]

Impact of FDA drug risk communications on health ca... [Med Care. 2012] - PubMed - NCBI

Impact of FDA drug risk communications on health ca... [Med Care. 2012] - PubMed - NCBI

2012 Jun;50(6):466-78.

Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review.

Source

Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.

Abstract

OBJECTIVE:

To review literature on the impact of The Food and Drug Administration (FDA) drug risk communications on medication utilization, health care services use, and health outcomes.

DATA SOURCES:

The authors searched MEDLINE and the Web of Science for manuscripts published between January 1990 and November 2010 that included terms related to drug utilization, the FDA, and advisories or warnings. We manually searched bibliographies and works citing selected articles and consulted with experts to guide study selection.

STUDY SELECTION:

Studies were included if they involved an empirical analysis evaluating the impact of an FDA risk communication.

DATA EXTRACTION:

We extracted the drug(s) analyzed, relevant FDA communication(s), data source, analytical method, and main outcome(s) assessed.

RESULTS:

Of the 1432 records screened, 49 studies were included. These studies covered 16 medicines or therapeutic classes; one third examined communications regarding antidepressants. Most used medical or pharmacy claims and a few rigorously examined patient-provider communication, decision making, or risk perceptions. Advisories recommending increased clinical or laboratory monitoring generally led to decreased drug use, but only modest, short-term increases in monitoring. Communications targeting specific subpopulations often spilled over to other groups. Repeated or sequential advisories tended to have larger but delayed effects and decreased incident more than prevalent use. Drug-specific warnings were associated with particularly large decreases in utilization, although the magnitude of substitution within therapeutic classes varied across clinical contexts.

CONCLUSIONS:

Although some FDA drug risk communications had immediate and strong impacts, many had either delayed or had no impact on health care utilization or health behaviors. These data demonstrate the complexity of using risk communication to improve the quality and safety of prescription drug use, and suggest the importance of continued assessments of the effect of future advisories and label changes. Identifying factors that are associated with rapid and sustained responses to risk communications will be important for informing future risk communication efforts.

PMID:
22266704
[PubMed - indexed for MEDLINE]
PMCID:
PMC3342472
[Available on 2013/6/1]

An evaluation of stroke education in AVAIL r... [J Neurosci Nurs. 2012] - PubMed - NCBI

An evaluation of stroke education in AVAIL r... [J Neurosci Nurs. 2012] - PubMed - NCBI

2012 Jun;44(3):115-23.

An evaluation of stroke education in AVAIL registry hospitals.

Source

Neuroscience/Stroke, at Long Beach Memorial Medical Center, Long Beach, CA, USA.

Abstract

The purpose of this study is to explore factors associated with recall of medication education and satisfaction with healthcare provider communication in patients with acute stroke or transient ischemic attack. This is an analysis of data from the AVAIL (Adherence Evaluation of Acute Ischemic Stroke Longitudinal) study. At 3 months after discharge, 2,219 stroke patients from 99 sites were interviewed and asked about their perceptions of education and communication with their healthcare providers as well as their current medication use and knowledge. Results show that less than 2% of the respondents reported not understanding how to take their medications, 4% did not know how to refill their medications, and 5% did not know the reason they were taking them. A vast majority (92%) of participants reported high levels of satisfaction in their communications with healthcare providers after discharge. Although overall understanding and satisfaction was high, older subjects were less likely to recall receiving medication information at discharge or to understand their medications. Similarly, African Americans and patients discharged from an academic hospital were less likely to report receiving a written medication list. This report highlights the success of education efforts and potential areas for additional improvement.

PMID:
22555348
[PubMed - indexed for MEDLINE]

New paradigms for measuring clinical ... [Int J Qual Health Care. 2012] - PubMed - NCBI

New paradigms for measuring clinical ... [Int J Qual Health Care. 2012] - PubMed - NCBI

2012 Jun;24(3):200-5. Epub 2012 Apr 6.

New paradigms for measuring clinical performance using electronic health records.

Source

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jweiner@jhsph.edu

Abstract

Measures of provider success are the centerpiece of quality improvement and pay-for-performance programs around the globe. In most nations, these measures are derived from administrative records, paper charts and consumer surveys; increasingly, electronic patient record systems are also being used. We use the term 'e-QMs' to describe quality measures that are based on data found within electronic health records and other related health information technology (HIT). We offer a framework or typology for e-QMs and describe opportunities and impediments associated with the transition from old to new DATA SOURCES: If public and private systems of care are to effectively use HIT to support and evaluate health-care system quality and safety, the quality measurement field must embrace new paradigms and strategically address a series of technical, conceptual and practical challenges.

PMID:
22490301
[PubMed - indexed for MEDLINE]

Linking health information technology... [Inform Health Soc Care. 2012] - PubMed - NCBI

Linking health information technology... [Inform Health Soc Care. 2012] - PubMed - NCBI

2012 Jun 1. [Epub ahead of print]

Linking health information technology to patient safety and quality outcomes: a bibliometric analysis and review.

Source

Department of Knowledge Informatics and Translation , Indiana University School of Medicine , IN , USA.

Abstract

Objective. To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that published knowledge relevant to the impact of health information technologies on patient safety and quality of care outcomes. Study design We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In addition, we performed a qualitative review of the full-text articles and grant documents. Data collection/extraction methods Papers published by AHRQ-funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson Reuters Journal Citation Report, citations were retrieved from ISI's Web of Knowledge and Google Scholar. Principal findings. Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQ's outcome goals and focus priorities. The average impact factor for the journals was 4.005 (range: 0.654-28.899). The articles, and their respective grants, represented a broad range of health information technologies. Conclusions. This set of AHRQ-funded research projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge base on the impact of information system use in healthcare.

PMID:
22657387
[PubMed - as supplied by publisher]

Healthcare-associated infectio... [Infect Control Hosp Epidemiol. 2012] - PubMed - NCBI

Healthcare-associated infectio... [Infect Control Hosp Epidemiol. 2012] - PubMed - NCBI

2012 Jun;33(6):539-44. Epub 2012 Apr 16.

Healthcare-associated infection and hospital readmission.

Source

Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Abstract

OBJECTIVE:

Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.

DESIGN:

Retrospective cohort study.

PATIENTS AND SETTING:

Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008.

METHODS:

The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS:

Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33-1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.

CONCLUSIONS:

Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.

PMID:
22561707
[PubMed - indexed for MEDLINE]

SALUD EQUITATIVA: DIRECTORIO DE DOCUMENTOS EDITADOS EN SEPTIEMBRE 2012 [*]

Domingo 30 de SEPTIEMBRE de 2012
SALUD EQUITATIVA: DIRECTORIO DE DOCUMENTOS EDITADOS EN SEPTIEMBRE 2012 [*]

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