The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2011-2012 – AHRQ – September 2015

Posted on February 18, 2015. Filed under: Health Economics | Tags: |

The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2011-2012 – AHRQ – September 2015

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Improving the Emergency Department Discharge Process: Environmental Scan Report – AHRQ – December 2014

Posted on December 10, 2014. Filed under: Emergency Medicine | Tags: , |

Improving the Emergency Department Discharge Process: Environmental Scan Report – AHRQ – December 2014

Prepared by: Johns Hopkins University, Armstrong Institute for Patient Safety and Quality

“Millions of patients visit hospital emergency departments (EDs) each year for a variety of injuries and ailments. It is crucial for these patients to receive appropriate preparation for their return home so that they can properly manage their recovery. ED discharge failure, such as ED return within 72 hours or more, carries significant clinical implications for patients, including unfinished treatments and progression of illness. But there is only limited understanding of such risk factors currently. This report presents the purpose, methods, and results of an environmental scan on existing literature in this area.”

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AHRQ Quality Indicators™ Toolkit for Hospitals: Improving Performance on the AHRQ Quality Indicators. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

Posted on October 27, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

AHRQ Quality Indicators™ Toolkit for Hospitals: Improving Performance on the AHRQ Quality Indicators. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

“The QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”

… continues on the site

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Center for Evidence and Practice Improvement (CEPI) – AHRQ – [AHRQ = US Agency for Healthcare Research and Quality]

Posted on July 23, 2014. Filed under: Evidence Based Practice, Health Informatics, Preventive Healthcare, Primary Hlth Care | Tags: |

Center for Evidence and Practice Improvement (CEPI) – AHRQ – [AHRQ = US Agency for Healthcare Research and Quality]

CEPI consists of five divisions:

Evidence-Based Practice Center Program
U.S. Preventive Services Task Force Program
Division of Decision Science and Patient Engagement
Division of Health Information Technology
Division of Practice Improvement

CEPI is also home to AHRQ’s National Center for Excellence in Primary Care Research (NCEPCR)

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AHRQ and Joint Commission Launch E-Learning Module To Reduce Long Term Care Infections – [AHRQ = US Agency for Healthcare Research and Quality]

Posted on July 23, 2014. Filed under: Infection Control | Tags: , |

AHRQ and Joint Commission Launch E-Learning Module To Reduce Long Term Care Infections – [AHRQ = US Agency for Healthcare Research and Quality]

“Assisted living and nursing home staff at all levels can help prevent healthcare-associated infections by using a 50-minute e-learning tool based on high reliability principles. The online module teaches long-term care facilities to apply these principles, which can help them achieve safety, quality and efficiency goals, to prevent infections and achieve high safety performance over extended periods. The Joint Commission developed the e-learning module with partial funding from AHRQ. It features quizzes and a searchable database of practical resources. The free CDs and online format are available to all facilities, not only Joint Commission customers.”

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Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition – AHRQ [AHRQ = US Agency for Healthcare Research and Quality] – April 2014 – now available in ebook format

Posted on July 23, 2014. Filed under: Evidence Based Practice | Tags: |

Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition – AHRQ [AHRQ = US Agency for Healthcare Research and Quality] – April 2014 – now available in ebook format

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Guide to Clinical Preventive Services, 2014: Recommendations of the U.S. Preventive Services Task Force – AHRQ

Posted on July 17, 2014. Filed under: Preventive Healthcare | Tags: , |

Guide to Clinical Preventive Services, 2014: Recommendations of the U.S. Preventive Services Task Force – AHRQ

 

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Registries for Evaluating Patient Outcomes: A User’s Guide 3rd edition – AHRQ – April 2014

Posted on June 19, 2014. Filed under: Patient Participation, Patient Safety, Research | Tags: |

Registries for Evaluating Patient Outcomes: A User’s Guide 3rd edition – AHRQ – April 2014

Agency for Healthcare Research and Quality (US)

“Excerpt

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care.

Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure.”

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Hospital Survey on Patient Safety Culture. 2014 User Comparative Database Report – Agency for Healthcare Research and Quality (AHRQ) [US] – March 2014

Posted on May 14, 2014. Filed under: Patient Safety | Tags: |

Hospital Survey on Patient Safety Culture. 2014 User Comparative Database Report – Agency for Healthcare Research and Quality (AHRQ) [US] – March 2014

“Based on data from 653 U.S. hospitals, the 2014 user comparative database report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2014 report presents results showing change over time for 359 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 359 trending hospitals.”

 

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Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition – AHRQ – 30 April 2014

Posted on May 7, 2014. Filed under: Research | Tags: |

Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition – AHRQ – 30 April 2014

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Observational Evidence and Strength of Evidence Domains: Case Examples. Research White Paper – AHRQ – April 2014

Posted on May 6, 2014. Filed under: Evidence Based Practice, Research | Tags: |

Observational Evidence and Strength of Evidence Domains: Case Examples. Research White Paper – AHRQ – April 2014

O’Neil M, Berkman N, Hartling L, Chang S, Anderson J, Motu’apuaka M, Guise JM, McDonagh M. Observational Evidence and Strength of Evidence Domains: Case Examples. Research White Paper. (Prepared by the AHRQ Scientific Resource Center under Contract No. 290-2012-00004-C). AHRQ Publication No. 14-EHC001-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2014.

“Structured Abstract

Background. Systematic reviews of health care interventions most often focus on randomized controlled trials. However, certain circumstances warrant consideration of observational evidence, and such studies are increasingly being included as evidence in systematic reviews.

Methods. To illustrate the use of observational evidence, we present case examples of systematic reviews in which observational evidence was considered as well as case examples of individual observational studies and how they demonstrate various strength of evidence domains in accordance with current AHRQ Evidence-based Practice Center methods guidance.

Results. In the presented examples, observational evidence is used when randomized controlled trials are infeasible or raise ethical concerns, lack generalizability, or provide insufficient data. Individual study case examples highlight how observational evidence may fulfill required strength of evidence domains, such as study limitations (reduced risk of selection, detection, performance, and attrition); directness; consistency; precision; and reporting bias (publication, selective outcome reporting, and selective analysis reporting), as well as additional domains of dose-response association, plausible confounding that would decrease the observed effect, and strength of association (magnitude of effect).

Conclusions. The cases highlighted in this paper demonstrate how observational studies may provide moderate-to (rarely) high-strength evidence in systematic reviews.”

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A Robust Health Data Infrastructure – Prepared for: Agency for Healthcare Research and Quality – April 2014

Posted on April 17, 2014. Filed under: Health Informatics | Tags: |

A Robust Health Data Infrastructure – Prepared for: Agency for Healthcare Research and Quality – April 2014

Prepared by: JASON, The MITRE Corporation

Extract:

“The body of this report provides the details of an example software architecture that breaks the stranglehold of current stovepipe systems and facilitates migration to a software ecosystem, with a diversity of products and apps, that fosters innovation and entrepreneurship. JASON believes that now is time to define such an architecture, leveraging the opportunity to specify CMS Stage 3 Meaningful Use requirements to drive implementation. A fundamental precept of medicine is: “Above all, do no harm.” A software architecture that is broadly tolerant of different scales, input types, and sites for data storage and processing offers a sure pathway, and one that will be open to future innovation. Patients and health care providers will be in a position to choose which particular implementations within the architecture have the most utility for their needs.”

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Design and Implementation of N-of-1 Trials: A User’s Guide – AHRQ – 12 February 2014

Posted on February 26, 2014. Filed under: Comparative Effectiveness Research, Research | Tags: |

Design and Implementation of N-of-1 Trials: A User’s Guide – AHRQ – 12 February 2014

AHRQ = US Agency for Healthcare Research and Quality

“Design and Implementation of N-of-1 Trials: A User’s Guide provides information on the design and implementation of n-of-1 trials (a.k.a. single-patient trials), a form of prospective research in which different treatments are evaluated in an individual patient over time. The apparent simplicity of this study design has caused it to be enthusiastically touted in some research fields and yet overlooked, underutilized, misunderstood, or erroneously implemented in other fields. With the advent of comparative effectiveness research and patient-centered outcomes research, there is a renewed interest in n-of-1 trials as an important research method for generating unique scientific evidence on patient health outcomes. A core aspect of this interest is that the n-of-1 approach may overcome some important limitations of other methodologies that involve larger samples of subjects. As a result, findings from n-of-1 trials may be especially useful in informing key health care decisions by patients and providers, particularly when combined with other scientific evidence. Likewise, the expansion of electronic health information technology into all areas of clinical care and the increasing recognition that new systems may also be deployed for research and quality improvement have further driven interest in conducting more n-of-1 trials as part of a learning health care system.

AHRQ commissioned this User’s Guide as an informational resource to researchers, health care providers, patients, and other stakeholders to improve general understanding of n-of-1 trials and strengthen the quality of evidence that is generated when an n-of-1 trial is conducted. The overarching aim of this User’s Guide is to guide readers by identifying key decisions and tradeoffs in the design and implementation of n-of-1 trials, particularly when used for patient-centered outcomes research. Patient-centered outcomes research includes investigations of a wide range of research problems, particularly studying the outcomes, effectiveness, benefits, and harms of diagnostic tests, treatments, procedures, or health care services. This User’s Guide identifies key elements to consider in applying the n-of-1 trial methodology to patient-centered outcomes research, describes some of the important complexities of the method, and provides readers with checklists to summarize the main points.”

… continues on the site

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Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Posted on February 5, 2014. Filed under: Anaesthesiology, Comparative Effectiveness Research, Surgery | Tags: |

Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Balk EM, Earley A, Hadar N, Shah N, Trikalinos TA. Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness. Comparative Effectiveness Review No. 130. (Prepared by Brown Evidence-based Practice Center under Contract No. 290-2012-0012-I.) AHRQ Publication No. 14-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014.

“Structured Abstract

Objectives. Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications.There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results.

Data sources. We searched MEDLINE® and Ovid Healthstar® (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews.

Review methods. We included comparative and cohortstudies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis(in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing.

Results. Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing.

Conclusions. There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia.”

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Transitioning Newborns from NICU to Home: A Resource Toolkit – AHRQ – December 2013

Posted on January 8, 2014. Filed under: Obstetrics | Tags: |

Transitioning Newborns from NICU to Home: A Resource Toolkit – AHRQ – December 2013

“This toolkit includes resources for hospitals that wish to improve safety when newborns transition home from their neonatal intensive care unit (NICU) by creating a Health Coach Program, tools for coaches, and information for parents and families of newborns who have spent time in the NICU.

Infants born preterm or with complex congenital conditions are surviving to discharge in growing numbers and often require significant monitoring and coordination of care in the ambulatory setting.

This manual is designed to be adapted for any institution that cares for fragile newborn infants.

Health Coaches who want to print materials to create customized Family Information Packets should select PDF files for the Cover Page and each relevant topic. These fact sheets can then be assembled into a packet for each family.”

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Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program – Agency for Healthcare Research and Quality (ACHS) – August 2013

Posted on December 11, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program – Agency for Healthcare Research and Quality (ACHS) – August 2013

Extract from the executive summary

“A large and growing number of clinical services are delivered in ambulatory care settings such as physician offices, hospital-based outpatient clinics, and public health and other types of clinics. Patients seen in ambulatory settings vary widely in terms of health status and the types and severity of illnesses. Ambulatory care is often logistically complex, depending upon coordination and exchange of information both within and across organizations to address patients’ interrelated medical care and social support needs. Ambulatory care providers must also help patients navigate effectively and efficiently through the health care system to achieve optimal outcomes, in accordance with patient preferences. Appropriate implementation and use of health information technology (IT) systems such as electronic health records (EHRs), personal health records (PHRs), and health information exchange (HIE) systems can support the delivery of ambulatory care. These systems can provide clinicians with information and decision support, engage patients and support self-management, and facilitate communication among clinicians and between clinicians and patients.

In 2007, the Agency for Healthcare Research and Quality (AHRQ) launched the Ambulatory Safety and Quality (ASQ) program to foster research on how to improve the safety and quality of ambulatory health care in the United States. This report is the fifth in a series of reports highlighting findings and lessons from the health IT-focused ASQ program initiatives. It summarizes the experiences and findings from those initiatives, organized according to key aspects of ambulatory care that can be supported and improved through the use of health IT.”

… continues

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The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide – AHRQ – October 2013

Posted on December 4, 2013. Filed under: Patient Participation | Tags: , |

The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide – AHRQ – October 2013

“An Instrument To Assess the Understandability and Actionability of Print and Audiovisual Patient Education Materials

The Patient Education Materials Assessment Tool (PEMAT) is a systematic method to evaluate and compare the understandability and actionability of patient education materials. It is designed as a guide to help determine whether patients will be able to understand and act on information. Separate tools are available for use with print and audiovisual materials.”

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Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update – November 2013

Posted on December 3, 2013. Filed under: Evidence Based Practice | Tags: |

Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update – November 2013

Berkman ND, Lohr KN, Ansari M, McDonagh M, Balk E, Whitlock E, Reston J, Bass E, Butler M, Gartlehner G, Hartling L, Kane R, McPheeters M, Morgan L, Morton SC, Viswanathan M, Sista P, Chang S. Grading the Strength of a Body of Evidence When Assessing Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare Research and Quality: An Update. Methods Guide for Comparative Effectiveness Reviews(Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2007-10056-I). AHRQ Publication No. 13(14)-EHC130-EF. Rockville, MD: Agency for Healthcare Research and Quality. November 2013.

“We briefly explore the rationale for grading strength of evidence, define domains of concern, and describe our recommended grading system for systematic reviews. The aims of this guidance are twofold: (1)to foster appropriate consistency and transparency in the methods that different EPCs use to grade strength of evidence and (2)to facilitate users’ interpretations of those grades for guideline development or other decisionmaking tasks. Because this field is rapidly evolving, future revisions are anticipated; they will reflect our increasing understanding and experience with the methodology.”

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Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence – AHRQ – November 2013

Posted on December 3, 2013. Filed under: Evidence Based Practice | Tags: , |

Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence – AHRQ – November 2013

McCormack L, Sheridan S, Lewis M, Boudewyns V, Melvin CL, KistlerC, Lux LJ, Cullen K, Lohr KN. Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence. Evidence Report/Technology Assessment No. 213. (Prepared by the RTIInternational–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 13(14)-E003-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2013.

“Structured Abstract

Objectives. This review examined how to best communicate and disseminate evidence, including uncertain evidence, to inform health care decisions. The review focused on three primary objectives—comparing the effectiveness of: (1) communicating evidence in various contents and formats that increase the likelihood that target audiences will both understand and use the information (KQ 1); (2) a variety of approaches for disseminating evidence from those who develop it to those who are expected to use it (KQ 2); and (3) various ways of communicating uncertainty-associated health-related evidence to different target audiences (KQ 3). A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians.

Data sources. We searched MEDLINE®, the Cochrane Library, Cochrane Central Trials Registry, PsycINFO®, and the Web of Science. We used a variety of medical subject headings (MeSH terms) and major headings, and used free-text and title and abstract text-word searches. The search waslimited to studies on humans published from 2000 to March 15, 2013, for communication and dissemination, given the prior systematic reviews, and from 1966 to March 15, 2013, for communicating uncertainty.

Review methods. We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, and abstractions, and quality ratings and group consensus to resolve disagreements. We used group consensus to grade strength of evidence.

Results. The search identified 4,152 articles (after removing duplicates) for all three KQs. After dual review at the title/abstract stage and full-text review stage, we retained 61 articles that directly (i.e., head to head) compared strategies to communicate and disseminate evidence.Across the KQs, many of the comparisons yielded insufficient evidence to draw firm conclusions. For KQ 1, we found that investigators frequently blend more than one communication strategy in interventions. For KQ 2, we found that, compared with single dissemination strategies, multicomponent dissemination strategies are more effective at enhancing clinician behavior, particularly for guideline adherence. Key findings for KQ 3 indicate that evidence on communicating overall strength of recommendation and precision was insufficient, but certain ways of communicating directness and net benefit may be helpful in reducing uncertainty.

Conclusions. The lack of comparative research evidence to inform communication and dissemination of evidence, including uncertain evidence, impedes timely clinician, patient, and policymaker awareness, uptake, and use of evidence to improve the quality of care. Expanding investment in communication, dissemination, and implementation research is critical to the identification of strategies to accelerate the translation of comparative effectiveness research into community and clinical practice and the direct benefit of patient care.”

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AHRQ’s New CUSP Module Helps Hospitals Engage Patients and Families in Their Care

Posted on November 6, 2013. Filed under: Patient Participation | Tags: |

AHRQ’s New CUSP Module Helps Hospitals Engage Patients and Families in Their Care

“AHRQ has released a new module for its Comprehensive Unit-based Safety Program (CUSP) to help clinical teams learn how to engage patients and families in their care. Based on a field-tested guide for engaging patients and families, the CUSP Patient and Family Engagement Module includes PowerPoint slides, speaker notes, demonstration videos, and tools to improve communication and patient safety in the hospital setting. The module helps clinicians:

Explore the roles and characteristics of patient and family advisors
Understand the relationship between communication and patient safety
Apply IDEAL Discharge Planning
Communicate adverse events to patients and family members

Clinical teams can use this module to foster an environment where patients, family members, and hospital staff are working together as partners to improve the quality and safety of care.”

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Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses – AHRQ – September 2013

Posted on October 23, 2013. Filed under: Research | Tags: , , |

Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses – AHRQ – September 2013

Trikalinos TA, Dahabreh IJ, Wallace BC, Schmid CH, Lau J. Towards a Framework for Communicating Confidence in Methodological Recommendations for Systematic Reviews and Meta-Analyses. Methods Research Report. (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I). AHRQ Publication No. 13-EHC119-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2013

“Abstract

We propose a framework for organizing and describing the rationale behind methodological recommendations, and for communicating one’s confidence in them. We start by defining the background context in which the recommendations are made. We distinguish recommendations that are testable (in that their likelihood to hold can be informed by theoretical arguments or empirical data) from nontestable ones, which represent beliefs or assumptions that are not verifiable. Nontestable statements can be justified, but their validity cannot be demonstrated. Testable statements can be assessed in terms of the adequacy of their evidentiary basis.

Both testable and nontestable statements can be evaluated regarding their feasibility of implementation, the expected impact of following them versus not, and their congruence with the desired characteristics of the background context. Considering these four dimensions, one can indicate one’s confidence (along a continuum) about how closely a methods recommendation should be followed: some recommendations may be perceived and communicated as mandatory items (minimum standards), while others as highly desirable but not mandatory items. Finally, giving specific methods guidance for addressing difficult or ill-defined problems can be premature pending more research or clearer problem specification. In such cases, describing the problem and laying out attributes of a satisfactory resolution can serve until actionable guidance can be offered.

We view the proposed framework strictly as a communication tool to describe rationale for the recommendations to the intended audience and not as a device to deduce the “correctness” of a recommendation. Nonetheless, application of the framework can facilitate the latter, because methodologists can most effectively and honestly critique recommendations whose rationale is transparent. We anticipate that this initial instantiation of the framework for making methods recommendations will evolve.”

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Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance – AHRQ – September 2013

Posted on October 1, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: |

Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance – AHRQ – September 2013

Roper RA, Anderson KM, Marsh CA, Flemming AC. Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance. (Prepared by Booz Allen Hamilton, under Contract No. HHSA290200900024I.) AHRQ Publication No. 13-0059-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2013.

“This report examines the intersection of health IT and quality measurement, reflecting the expectation that health IT-enabled quality measurement can make quality improvement possible. It is presented to share information, stimulate discussion, assist communication among stakeholders, facilitate understanding, and to provide guidance on potential infrastructure enhancements that could be pursued, individually or collectively. Five appendixes to this report summarize the input received as well as catalog the efforts of many organizations who are engaged in efforts to improve quality through health IT.”

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Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

Posted on August 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

“This report summarizes the extent to which the projects addressed the areas of interest of the IQHIT initiative and identifies practical insights regarding the use of health IT to improve clinical decisionmaking and care coordination in the ambulatory setting. It presents illustrative project findings in an effort to inform research discussion and provide guidance to other entities implementing health IT systems that help clinicians improve the quality of patient care. As the researchers continue to disseminate findings from these projects, additional lessons may become evident.”

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Inclusion Criteria [for clinical practice guidelines to be included in the US National Guideline Clearinghouse] – June 2013 Agency for Healthcare Research and Qualit

Posted on June 11, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , , , |

Inclusion Criteria [for clinical practice guidelines to be included in the US National Guideline Clearinghouse] – June 2013  Agency for Healthcare Research and Quality

“Effective June 2014, NGC will employ the 2011 definition of clinical practice guideline developed by the Institute of Medicine (IOM).1

Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.

For more information, please refer to the Frequently Asked Questions. We invite you to send your comments to info@guideline.gov.

Revised Criteria for Inclusion of Clinical Practice Guidelines in NGC

Effective June 2014: In order for NGC to accept a submitted clinical practice guideline, the guideline must meet all the criteria below. In addition to the guideline, developers must provide NGC with documentation of the underlying systematic review*.”

… continues on the site

 

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Re-Engineered Discharge (RED) Toolkit – Agency for Healthcare Research and Quality – March 2013

Posted on April 2, 2013. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , |

Re-Engineered Discharge (RED) Toolkit – Agency for Healthcare Research and Quality – March 2013

Prepared by: Boston University for AHRQ – Agency for Healthcare Research and Quality

“A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.”

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Through the Quality Kaleidoscope: Reflections on the Science and Practice of Improving Health Care Quality – Agency for Healthcare Research and Quality [US] – February 2013

Posted on March 15, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Research | Tags: |

Through the Quality Kaleidoscope: Reflections on the Science and Practice of Improving Health Care Quality – Agency for Healthcare Research and Quality [US] – February 2013

Closing the Quality Gap: Revisiting the State of the Science

Methods Research Reports

Investigators: Kathryn M McDonald, MM, Christine Chang, MD, MPH, and Ellen Schultz, MS.

Rockville (MD): Agency for Healthcare Research and Quality (US); February 2013.
Report No.: 13-EHC041-EF

“Structured Abstract

Background:
The United States devotes significant resources to health care, yet quality is often lacking. In 2004, the Agency for Healthcare Research and Quality launched a collection of evidence reports on quality improvement (QI) opportunities and strategies related to chronic conditions, practice areas, and cross-cutting priorities. This new Closing the Quality Gap series expands the topics examined and marshals the knowledge of eight Evidence-based Practice Centers (EPCs) to synthesize lessons learned and to advance the state of QI science.”

… continues on the site

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Framework for Determining Research Gaps During Systematic Review: Evaluation – Agency for Healthcare Research and Quality [US] – February 2013

Posted on March 15, 2013. Filed under: Research | Tags: , |

Framework for Determining Research Gaps During Systematic Review: Evaluation – Agency for Healthcare Research and Quality [US] – February 2013

Methods Research Reports

Investigators: Karen A Robinson, PhD, Oluwaseun Akinyede, MPH, Tania Dutta, MS, MPP, Veronica Ivey Sawin, BA, Tianjing Li, MD, PhD, Merianne Rose Spencer, BS, Charles M Turkelson, PhD, and Christine Weston, PhD.

Johns Hopkins University Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); February 2013.
Report No.: 13-EHC019-EF

“Structured Abstract

Background:
Research gaps prevent systematic reviewers from making conclusions and, ultimately, limit our ability to make informed health care decisions. While there are well-defined methods for conducting a systematic review, there has been no explicit process for the identification of research gaps from systematic reviews. In a prior project we developed a framework to facilitate the systematic identification and characterization of research gaps from systematic reviews. This framework uses elements of PICOS (Population, Intervention, Comparison, Outcomes, Setting) to describe the gaps and categorizes the reasons for the gaps as (A) insufficient or imprecise information, (B) biased information, (C) inconsistent or unknown consistency results, and/or (D) not the right information.”

continues

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Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices – Agency for Healthcare Research and Quality, Rockville, MD – March 2013

Posted on March 13, 2013. Filed under: Patient Safety | Tags: , |

Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices – Agency for Healthcare Research and Quality, Rockville, MD – March 2013

This evidence report updates the 2001 report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices.

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Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – January 2013

Posted on March 11, 2013. Filed under: Research | Tags: , |

Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – January 2013

Edited by Priscilla Velentgas, PhD, Nancy A Dreyer, MPH, PhD, Parivash Nourjah, PhD, Scott R Smith, PhD, and Marion M Torchia, PhD.

Rockville (MD): Agency for Healthcare Research and Quality (US)
Publication No.: 12(13)-EHC099

“The Observational CER User’s Guide serves as a resource for investigators and stakeholders when designing observational comparative effectiveness research (CER) studies, particularly those with findings that are intended to translate into decisions or actions. The User’s Guide provides principles for designing research that will inform health care decisions of patients and other stakeholders. Furthermore, it serves as a reference for increasing the transparency of the methods used in a study and standardizing the review of protocols through checklists provided in every chapter.”

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Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – 12 February 2013

Posted on February 26, 2013. Filed under: Research | Tags: , , |

Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide – Agency for Healthcare Research and Quality – 12 February 2013

“Researchers from the Effective Health Care Program’s DEcIDE Network authored this 11-chapter guide that aims to serve as a resource for researchers when developing observational comparative effectiveness research (CER) studies. The user’s guide identifies best practices for designing observational CER studies and standardizes the review of study protocols with checklists in each chapter. Topics in this user’s guide include developing study objectives and questions, study design, data sources, and analysis.

The educator resources, 12 presentations in PowerPoint format, are aligned with each chapter to expand training in these best practices.”

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Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs – AHRQ – January 2013

Posted on January 29, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality | Tags: |

Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs – AHRQ – January 2013

Totten AM, Wagner J, Motu’apuaka M, Hickam DH, Guise JM. Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs. Future Research Needs Paper No. 30. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC035-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2013.

“Background

In 2010, the Agency for Healthcare Research and Quality (AHRQ) charged the Oregon Evidence-based Practice Center with conducting a Comparative Effectiveness Review (CER)1 to assess the effectiveness of outpatient case management as an intervention strategy for chronic illness management.
The Key Questions the review addressed were:
Key Question 1. In adults with chronic medical illness and complex care needs, is case management effective in improving:
1a. Patient-centered outcomes, including mortality, quality of life, disease-specific health outcomes, avoidance of nursing home placement, and patient satisfaction with care?
1b. Quality of care, as indicated by disease-specific process measures, receipt of recommended health care services, adherence to therapy, missed appointments, patient self-management, and changes in health behavior?
1c. Resource utilization, including overall financial cost, hospitalization rates, days in the hospital, emergency department use, and number of clinic visits (including primary care and other provider visits)?
Key Question 2. Does the effectiveness of case management differ according to patient characteristics, including but not limited to: particular medical conditions, number or type of comorbidities, patient age and socioeconomic status, social support, and/or level of formally assessed health risk?
Key Question 3. Does the effectiveness of case management differ according to intervention characteristics, including but not limited to: practice or health care system setting; case manager experience, training, or skills; case management intensity, duration, and integration with other care providers; and the specific functions performed by case managers?
The analytic framework (Figure A) outlines the targeted population, interventions, and outcomes for the review.”

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Closing the Quality Gap: Revisiting the State of the Science – AHRQ – January 2013

Posted on January 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Closing the Quality Gap: Revisiting the State of the Science – AHRQ – January 2013
 
McDonald KM, Chang C, Schultz E. Closing the Quality Gap: Revisiting the State of the Science. Summary Report. (Prepared by Stanford-UCSF Evidence-based Practice Center under Contract No. 290-2007-10062-I.) AHRQ Publication No. 12(13)-E017. Rockville, MD: Agency for Healthcare Research and Quality. January 2013.
 
“Structured Abstract
 
Background. The United States devotes significant resources for the provision of health care, yet quality is often elusive or lacking. In 2004, the Agency for Healthcare Research and Quality launched a collection of evidence reports to bring data to bear on quality improvement (QI) opportunities. This new series, Closing the Quality Gap: Revisiting the State of the Science, consists of eight reports that continue the focus on improving the quality of health care through critical assessment of relevant evidence for selected settings, interventions, and clinical conditions. This report is an introduction to the Executive Summaries of the eight reports in the series and summarizes elements across the series for readers.
 
Overview. The topics are: 
effectiveness of bundled payment programs,
effectiveness of the patient-centered medical home,
QI strategies to address health disparities,
effectiveness of medication adherence interventions,
effectiveness of public reporting, prevention of healthcare associated infections,
QI measurement of outcomes for people with disabilities,
and health care and palliative care for patients with advanced and serious illness.

The overview describes the scope of the eight reports; describes the scope of the series by summarizing the quality levers, populations, interventions, outcomes, and other features across the reports; and discusses key messages by audience (patient/consumer/caregiver, health care professional, health care delivery organization, policymaker, and research community).
 
Conclusions. The series covers many important aspects of quality improvement in health care. This Summary is intended to show how topics relate and complement each other, and how together they provide a picture of the state of the science. It will help readers, as they read the Executive Summaries for the individual topics, to gain a deeper  understanding of the nature and extent of quality gaps across health care, as well as the systemic changes necessary to close them.”

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Sustainability, Partnerships, and Teamwork in Health IT Implementation: Essential Findings From the Transforming Healthcare Quality Through IT Grants – AHRQ – December 2012

Posted on January 4, 2013. Filed under: Health Informatics | Tags: , |

Sustainability, Partnerships, and Teamwork in Health IT Implementation: Essential Findings From the Transforming Healthcare Quality Through IT Grants – AHRQ – December 2012

“This report synthesizes findings across several sources, focusing specifically on sustainability, partnerships, and effective teamwork—which were recognized by THQIT grantees as critical aspects of successful health IT implementation. The goal is to provide relevant information to those currently working toward health IT implementation.”

Agency for Healthcare Research and Quality

Felt-Lisk S, Ferry G, Roper R, Au M, Walker J, Jones JB, Lerch S. Sustainability, Partnerships, and Teamwork in Health IT Implementation: Essential Findings From the Transforming Healthcare Quality Through IT Grant. (Prepared by Mathematica Policy Research and Geisinger Health System, under Contract No. HHSA 290200900019I). AHRQ  Publication No. 12-0075-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2012.

“This report focuses specifically on sustainability, partnerships, and effective teamwork—which were recognized by THQIT grantees as critical aspects of successful health IT implementation. The goal is to provide those currently working towards health IT implementations with information to support more effective implementation.

This report offers insights into four questions:
●● Sustainability: How likely was the projects’ purposeful use of health IT to be sustained and what factors influence the sustainability of health IT projects?
●● Vendors: How should patient care delivery organizations engage and work with health IT vendors?
●● Other Cross-Organization Partnerships: How can health care organizations work together to facilitate health IT implementation?
●● End Users: What methods of involving intended end users of grant-featured health IT did grantees find most valuable?”

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Development of Quality Indicators for the Home and Community-Based Services Population: Technical Report – AHRQ Quality Indicators – June 2012

Posted on January 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Community Services | Tags: , , |

Development of Quality Indicators for the Home and Community-Based Services Population: Technical Report – AHRQ Quality Indicators – June 2012

Prepared by: Ellen Schultz, Sheryl M. Davies, Kathryn M. McDonald, Center for Primary Care and Outcomes Research, Stanford University.  This project was funded by a contract from the Agency for Healthcare Research and Quality

“Purpose

These quality indicators (QIs) are intended to reflect the health and well-being of beneficiaries receiving home and community-based services (HCBS) through state Medicaid programs. The indicators focus on the well being of HCBS beneficiaries as reflected by potentially preventable hospitalizations. These include hospitalizations for specific conditions associated with chronic disease exacerbation and progression as well as poor access to care and support services.”

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Methods for Benefit and Harm Assessment in Systematic Reviews – AHRQ – November 2012

Posted on November 20, 2012. Filed under: Evidence Based Practice, Research | Tags: , |

Methods for Benefit and Harm Assessment in Systematic Reviews – AHRQ – November 2012

“Structured Abstract

Introduction. Systematic reviewers are challenged by how to report and synthesize information about benefits and harms of medical interventions so that decisionmakers with varying preferences can better assess the balance of benefit and harm. Quantitative approaches exist for assessing benefits and harms, but it is unclear whether they are applicable to systematic reviews.

Objectives. The objectives of this report are: (1) to describe the challenges of quantitative approaches for assessing benefits and harms, (2) to describe methodological characteristics of existing quantitative approaches for assessing benefits and harms, (3) to determine the role of values and preferences in assessing benefits and harms across each step of a systematic review and (4) to formulate principles for assessing benefits and harms in systematic reviews.

Process. We formed a multidisciplinary team with expertise in clinical medicine, systematic reviews, statistics, and epidemiology. The team reviewed the literature on quantitative approaches for assessing benefits and harms of medical interventions, and held 12 weekly meetings to establish consensus about: 1) the challenges in assessing benefits and harms; 2) the methodological characteristics of approaches that have been used; and 3) the role of values and preferences when assessing benefits and harms in systematic reviews.

The team used that information to formulate principles for analyzing benefits and harms in systematic reviews so that decisionmakers are able to weigh the benefits and harms for a given population. An external panel of experts provided input in this process.

Results. Our team identified numerous challenges for the assessment of benefits and harms. The main challenges relate to selection of health outcomes important to patients, information asymmetry (e.g., reliable and robust data on benefits with sparse data on harms), and calculation of statistical uncertainty if benefit and harm are put on the same scale using a benefit harm comparison metric, and consideration of patient preferences.

We identified 16 quantitative approaches for the assessment of benefits and harms. Twelve of the methods can be used in a systematic review because the methods can be applied with the types of summary data that are typically reported and do not require individual patient data. Simpler approaches, such as the ratio of the number needed to treat to the number needed to harm, may be suitable for relatively simple decisionmaking contexts where relevant benefit and harm outcomes are few in number and similar in importance. More complex approaches are needed for decisionmaking contexts having a large number of relevant benefits and harms.

For individual-level decisions, values and preferences are key for determining the balance of benefit and harm. Choices are made by decisionmakers that are informed by the preferences of patients and other considerations. These choices, and therefore preferences, have an important role in determining how benefits and harms are assessed in systematic reviews. These choices and preferences also affect how guideline developers frame recommendations, how regulatory bodies make decisions at the population level, and how clinicians, patients, and other end users make decisions at the individual level.
The team formulated principles to conduct comparative assessments of benefits and harms in the context of a systematic review. For example, we recommend that systematic reviews define the decisionmaking context, report the sources of evidence used (e.g., estimates of baseline risks or treatment effects), be explicit about if and how patient preferences are considered, and provide a rationale for choosing a particular quantitative approach for comparative assessment of benefits and harms.

Conclusion. Quantitative approaches for comparative assessment of benefits and harms have strengths and limitations. The choice of a particular approach depends on the decisionmaking context, the quality and quantity of available data, and the epidemiological-statistical expertise of the systematic review team. A quantitative approach may help to improve the transparency of a review, relative to a qualitative approach, by being explicit about how benefits and harms are estimated and compared. Such transparency may help decisionmakers give proper consideration to complex information about benefits and harms.”

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Designing Consumer Health IT: A Guide for Developers and Systems Designers – AHRQ – September 2012

Posted on November 20, 2012. Filed under: Health Informatics, Patient Participation | Tags: |

Designing Consumer Health IT: A Guide for Developers and Systems Designers – AHRQ – September 2012

“The Agency for Healthcare Research and Quality (AHRQ) is working to speed the development of effective consumer health information technology (IT) applications so people can better use their personal health information to manage their health. AHRQ sought to learn about methods and strategies that have been used to design and develop successful consumer IT products in industries other than health care. The research first identified successful products based on market penetration, sales, and customer adoption and enjoyment. Next, the research examined the design methods that were used to develop these successful products through: 1) an environmental scan and grey literature review, 2) in-depth interviews with expert developers, and 3) guidance from a technical expert panel (TEP).”

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Comparison of Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People With Dementia – AHRQ – October 2012

Posted on November 9, 2012. Filed under: Aged Care / Geriatrics | Tags: , |

Comparison of Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People With Dementia – AHRQ – October 2012

Agency for Healthcare Research and Quality [US]

“Structured Abstract

Objectives. To compare characteristics and related outcomes of nursing homes (NHs) and other residential long-term care settings for people with dementia so as to reduce uncertainty when choosing a setting of care for someone with dementia.

Data Sources. We searched MEDLINE®, Embase®, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), AgeLine®, and PsycINFO® from 1990 through March 23, 2012. We identified additional studies from reference lists and experts.

Review methods. Two people independently selected, abstracted data from, and rated the quality of relevant studies. Given that quantitative analyses were inappropriate because of clinical heterogeneity, insufficient numbers of similar studies, or insufficient or variation in outcome reporting, we synthesized the data qualitatively. Two reviewers graded the strength of evidence (SOE) using established criteria.

Results. We identified 14 studies meeting our inclusion criteria. Generally, studies examined characteristics, structures, and process of care for populations with mild to severe dementia. Ten studies addressed health outcomes (Key Question [KQ] 1), and 10 examined psychosocial outcomes (KQ 2) for people with dementia. No eligible studies examined health or psychosocial outcomes for informal caregivers (KQ 3 and KQ 4, respectively). The studies included four prospective cohort studies, nine randomized controlled trials (RCTs), and one non-RCT. Two studies showed that the use of pleasant sensory stimulation reduces agitation. We found limited evidence on a number of interventions, including protocols for individualized care to reduce pain/discomfort and agitation/aggression and functional skill training to improve function. We found largely no differences across outcomes including function, cognition, depressive symptoms, pain, morbidity, behavioral symptoms, engagement, and quality of life based on residence in an NH or residential care/assisted living (RC/AL), other than increased hospitalization for people with mild dementia in RC/AL compared with NHs and increased restraint use in NHs compared with RC/AL for imminently dying residents.

Conclusions. Overall, we found low or insufficient SOE regarding the effect of organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate SOE indicate that pleasant sensory stimulation reduces agitation. Also, although the SOE is low, protocols for individualized care and to improve function result in better outcomes. Finally, outcomes do not differ between NHs and RC/AL except when medical care is indicated. Additional research is needed to develop a sufficient evidence base to support decisionmaking.”

Zimmerman S, Anderson W, Brode S, Jonas D, Lux L, Beeber A, Watson L, Viswanathan M, Lohr K, Middleton JC, Jackson L, Sloane P. Comparison of Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People With Dementia. Comparative Effectiveness Review No. 79. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 12(13)-EHC127-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2012.

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Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship – AHRQ – September 2012

Posted on November 9, 2012. Filed under: Infection Control, Infectious Diseases | Tags: , |

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship – AHRQ – September 2012

AHRQ = Agency for Healthcare Research and Quality

The Evaluation and Research on Antimicrobial Stewardship’s Effect on Clostridium difficile (ERASE C. difficile) Project

“Clostridium difficile infection (C. difficile) is a serious public health problem that has recently increased in both incidence and severity. Taking steps to reduce C. difficile is a major health and public health imperative. Antimicrobial stewardship targeted to C. difficile reduction shows promise, because increased rates of C. difficile are associated with inappropriate antibiotic use. An antimicrobial stewardship program (ASP) is a systematic approach to developing coordinated interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal outcomes for patients in cost-efficient ways. This toolkit assists hospital staff and leadership in developing an effective ASP with the potential to reduce C. difficile.”

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship. (Prepared by the Boston University School of Public Health, under AHRQ ACTION Contract No. HHSA290200600012i TO10.) AHRQ Publication No. 12-0082-EF, September 2012. Agency for Healthcare Research and Quality, Rockville, MD.

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Procalcitonin-Guided Antibiotic Therapy – AHRQ [US] – 5 October 2012

Posted on November 2, 2012. Filed under: Infectious Diseases, Pharmacy | Tags: , , |

Procalcitonin-Guided Antibiotic Therapy – AHRQ [US] – 5 October 2012

Full text

Soni NJ, Samson DJ, Galaydick JL, Vats V, Pitrak DL, Aronson N. Procalcitonin-Guided Antibiotic Therapy. Comparative Effectiveness Review No. 78. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 12(13)-EHC124-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2012.

“Structured Abstract

Objectives. To systematically review comparative studies of the use of procalcitonin in the clinical management of adult and pediatric patients with suspected local or systemic infection.

Data sources. MEDLINE®, Embase®, the Cochrane Database of Systematic Reviews, National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1, 1990, to December 16, 2011; the MEDLINE, Embase, and Cochrane searches were updated in December 2011. A search of the gray literature included databases with regulatory information, clinical trial registries, abstracts and conference papers, grants and federally funded research, and information from manufacturers.

Review methods. We sought studies that compared procalcitonin-guided versus clinical-criteria-guided initiation, discontinuation, or change of antibiotic therapy. Outcomes were antibiotic use, mortality, morbidity, and adverse drug events of antibiotic therapy. Data were abstracted by a single reviewer and fact-checked by a second reviewer. Study quality was assessed using the U.S. Preventive Services Task Force framework. A meta-analysis on short-term mortality in intensive care unit (ICU) patients was performed using a random-effects model. Strength of the body of evidence was assessed according to the AHRQ Methods Guide.

Results. There were 18 randomized, controlled trials that addressed five patient populations. Procalcitonin guidance reduces antibiotic use when used to discontinue antibiotics in adult ICU patients and to initiate or discontinue antibiotics in patients with respiratory tract infections (high evidence), without increasing morbidity (moderate evidence) and mortality (low evidence). In contrast, procalcitonin-guided intensification of antibiotics in adult ICU patients increases morbidity (moderate evidence). There is moderate evidence from a single good quality study that procalcitonin guidance reduces antibiotic use for suspected early neonatal sepsis, but insufficient evidence on morbidity and mortality outcomes was found. Evidence is insufficient to draw conclusions on outcomes of procalcitonin guidance for: (1) fever of unknown source in children 1–36 months of age; and (2) preemptive antibiotics after surgery.
Immunocompromised hosts and other special populations were generally excluded from procalcitonin guidance studies. Thus, findings from this review should not be extrapolated to patients with the following conditions: pregnancy; absolute neutropenia; immunocompromised states; chronic infections, and infections for which prolonged antibiotic therapy is standard of care (e.g., infective endocarditis).

Conclusions. Procalcitonin guidance reduces antibiotic use when used to discontinue antibiotics in adult ICU patients and to initiate or discontinue antibiotics in patients with respiratory tract infections. Populations for future research include immunocompromised patients, patients with other conditions (e.g., pregnancy, cystic fibrosis), and pediatric patients. Future research should compare procalcitonin guidance with antibiotic stewardship programs and to implementation of guidelines. Outcomes of high interest for future research are the consequences of reduction in antibiotic use for antibiotic resistance and for adverse events of antibiotic therapy.”

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Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection – The Agency for Healthcare Research and Quality [US] – August 2012

Posted on October 22, 2012. Filed under: Infection Control, Surgery | Tags: |

Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection – The Agency for Healthcare Research and Quality [US] – August 2012

Final Contract Report

“The Agency for Healthcare Research and Quality, in cooperation with the United States Centers for Disease Control and Prevention, commissioned a study in 2009 with the objective of developing techniques to improve the identification and surveillance of likely cases of surgical site infection using data on four common procedures (hernia repair, coronary artery bypass grafts, and hip and knee arthroplasty). A major focus of the project was to test the usefulness of computer algorithms that could alert infection control specialists to patients likely to have surgical site infections on the basis of retrospective analysis of electronic medical records, laboratory test results, and patient demographics.

Prepared for the Agency for Healthcare Research and Quality under contract HHSA 290-2006-00-20.”

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AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent – 10 September 2012

Posted on September 11, 2012. Filed under: Infection Control, Intensive Care | Tags: , |

AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent – 10 September 2012

“A unique nationwide patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ) reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units by 40 percent, according to the agency’s preliminary findings of the largest national effort to combat CLABSIs to date. The project used the Comprehensive Unit-based Safety Program (CUSP) to achieve its landmark results that include preventing more than 2,000 CLABSIs, saving more than 500 lives and avoiding more than $34 million in health care costs.”

… continues

Details about AHRQ’s national CUSP project are available at http://www.ahrq.gov/qual/hais.htm. AHRQ’s CUSP toolkit is available at http://www.ahrq.gov/cusptoolkit/ .”

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Treatment Strategies for Women With Coronary Artery Disease – Agency for Healthcare Research and Quality [US] – August 2012

Posted on August 30, 2012. Filed under: Cardiol / Cardiothor Surg, Comparative Effectiveness Research | Tags: |

Treatment Strategies for Women With Coronary Artery Disease – Agency for Healthcare Research and Quality [US] – August 2012

Dolor RJ, Melloni C, Chatterjee R, Allen LaPointe NM, Williams JB Jr., Coeytaux RR, McBroom AJ, Musty MD, Wing L, Samsa GP, Patel MR.
Treatment Strategies for Women With Coronary Artery Disease. Comparative Effectiveness Review No. 66.
(Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 12-EHC070-EF Rockville, MD. Agency for Healthcare Research and Quality. August 2012

“Structured Abstract

Objectives. Although coronary artery disease (CAD) is the leading cause of death for women in the United States, treatment studies to date have primarily enrolled men and may not reflect the benefits and risks that women experience. Our systematic review of the medical literature assessed the comparative effectiveness of major treatment options for CAD specifically in women. The comparisons were (1) percutaneous coronary intervention (PCI) versus fibrinolysis/supportive pharmacologic therapy in ST elevation myocardial infarction (STEMI), (2) early invasive versus initial conservative management in non-ST elevation myocardial infarction (NSTEMI) or unstable angina, and (3) PCI versus coronary artery bypass surgery (CABG) versus optimal medical therapy in stable or unstable angina. The endpoints assessed were clinical outcomes, modifiers of effectiveness by demographic and clinical factors, and safety outcomes.”

… continues on the site

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Quality Measurement Enabled by Health IT: Overview, Challenges, and Possibilities: an environmental snapshot – Agency for Healthcare Research and Quality [US] – July 2012

Posted on July 24, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: |

Quality Measurement Enabled by Health IT: Overview, Challenges, and Possibilities: an environmental snapshot – Agency for Healthcare Research and Quality [US] – July 2012

Prepared by: Booz Allen Hamilton

“Pathways to Quality Measurement Through Health IT is a 2-year, AHRQ-sponsored initiative that enables advancements in health IT-enabled quality measurement and reporting by identifying strategies, a health services infrastructure, and research issues related to health IT-enabled quality measures. Reports and other materials emanating from this initiative will culminate in the development of a strategic plan to improve health care quality enabled by health IT.

Provides an overview of health IT-enabled quality measurement;
Discusses possibilities for the next generation of health IT-enabled quality measurement;
Illustrates challenges to achieving the next generation of health IT-enabled quality measurement; and
Describes over 80 Federal, State, regional, and private activities seeking to improve health-IT enabled quality measurement.”

Anderson KM, Marsh CA, Flemming AC, Isenstein H, Reynolds J. Quality Measurement Enabled by Health IT: Overview, Possibilities, and Challenges (Prepared by Booz Allen Hamilton, under Contract No. HHSA290200900024I.) AHRQ Publication No. 12-0061-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2012.

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An Interactive Preventive Care Record (IPHR): A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention – AHRQ – June 2012

Posted on July 20, 2012. Filed under: Chronic Disease Mgmt, Health Informatics, Medical Records, Preventive Healthcare | Tags: |

An Interactive Preventive Care Record (IPHR): A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention – AHRQ – June 2012

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

Krist A, Rothemich S, Kashiri P, et al. An Interactive Preventive Care Record: A Handbook for Using Patient-Centered Personal Health Records To Promote Prevention. (Prepared by Virginia Commonwealth University, Department of Family Medicine, Virginia Ambulatory Care Outcomes Research Network (ACORN), under Grant No. R18 HS 017046.) AHRQ Publication No. 12-0051-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2012.

Extract from the introduction:

“Purpose of This Handbook

This step-by-step guide introduces you to—
●● Using personal health records (PHRs) to promote prevention.
●● Preparing your practice to use a PHR for promoting prevention.
●● Implementing and sustaining the use of a PHR for prevention.

The intended audience for this guide includes primary care practice personnel (e.g., office managers, clinicians, and nurses), practice leaders responsible for selecting informatics systems and ensuring that they are implemented well, and practice informatics staff.

Although the content of this guide can apply to using any PHR to promote prevention, we have focused on a specific type of PHR called an Interactive Preventive Health Record (IPHR). An IPHR is a highly advanced, patient-centered, evidence-based, patient portal focused on prevention. As information systems continue to advance, we believe that more PHRs will have interactivity functionality in the future.

Given the similarities between preventive and chronic care, the steps in this guide can also apply to using an IPHR to promote chronic disease management.

We have used organizational change theory to help determine the steps in this guide. While some steps may be specific to large practices and health systems, the concepts apply equally well to smaller primary care practices.”

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Enabling Patient-Centered Care through Health Information Technology (Health IT) – AHRQ – June 2012

Posted on July 16, 2012. Filed under: Health Informatics | Tags: |

Enabling Patient-Centered Care through Health Information Technology (Health IT) – AHRQ – June 2012

Agency for Healthcare Research and Quality [US]

“Structured Abstract

Objectives: The main objective of the report is to review the evidence on the impact of health IT that supports patient-centered care (PCC) on:

Health care processes.
Clinical outcomes.
Intermediate outcomes (patient or provider satisfaction, health knowledge and behavior, and cost).
Responsiveness to needs and preferences of patients.
Shared decisionmaking and patient–clinician communication.
Access to information.

Additional objectives were to identify barriers and facilitators for using health IT to deliver PCC, and to identify gaps in evidence and information needed by patients, providers, payers, and policymakers.”

… continues on the site

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Healthcare Cost and Utilization Project Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012 – 10 July 2012

Posted on July 16, 2012. Filed under: Cardiol / Cardiothor Surg, Chronic Disease Mgmt, Health Economics, Neurology | Tags: , , |

Healthcare Cost and Utilization Project Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012 – 10 July 2012

U.S. Agency for Healthcare Research and Quality, HCUP
by Steiner C, Barrett M, Weiss A.

Extract from the introduction:

“40 percent of Americans. Heart disease and stroke are the first and fourth leading causes of death in the United States, and these diseases are among the most common and costly reasons for hospital admissions.2,3 The prevalence of cardiovascular and cerebrovascular diseases increases with age, with cardiovascular disease occurring in fewer than 20 percent of adults age 20-39 but more than 70 percent of adults age 60-79. Gender differences in these diseases also exist, with increasing rates by age of first major cardiovascular events for both men and women, but with a 10-year lag in the rates among women. The Affordable Care Act provides up to $100 million for community programs targeted at reducing chronic diseases, including heart disease and stroke, and another $40 million for statewide efforts focused on chronic diseases.

Timely information on trends for cardiovascular/cerebrovascular conditions and procedures provides analysts and policy makers baseline information and can be used to help evaluate the impact of health improvement efforts. A novel initiative from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) is used in this report to produce timely, current inpatient statistics on cardiovascular/cerebrovascular conditions and procedures.

The HCUP State Inpatient Databases (SID) from 2001 to 2010 include about 330 million inpatient discharges from 46 States. The list of statewide data organizations that contribute to HCUP is available in Appendix I. In this report we use the historical SID data with early 2011 data from 10 HCUP States to develop national quarterly projections of 2011 and 2012 inpatient statistics for:

  • cardiovascular/cerebrovascular system conditions, overall
  • five specific cardiovascular/cerebrovascular conditions
  • cardiovascular/cerebrovascular system procedures, overall
  • four specific cardiovascular/cerebrovascular procedures.”

… continues on the site

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Peer Review of Search Strategies – AHRQ – June 2012

Posted on June 19, 2012. Filed under: Research | Tags: , , |

Peer Review of Search Strategies – AHRQ – June 2012

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

“Structured Abstract

Background. Many steps in the preparation of effectiveness and comparative effectiveness reviews (CERs) by the Agency for Healthcare Research and Quality‘s Effective Health Care (EHC) Program involve outside review and input (e.g., by Key Informants, the Technical Expert Panel, Draft Report Peer Reviewers). However, development of bibliographic database search strategies is currently not consistently peer reviewed. An opportunity exists for the EHC Program to leverage its expert searchers across the 14 Evidence-based Practice Centers (EPCs) in the Program by implementing a process of peer review of search strategies.

Objective. Due to the number and frequency of observed errors in published search strategies uncovered in the research literature, an evaluation of the feasibility of instituting a peer review process is warranted.
Specific Aims:
1. Evaluate whether the PRESS instrument or no-instrument (‗free-form‘ evaluations) is preferred by Technical Expert Peer Reviewers (TEPRs) of search strategies.
2. Evaluate the usefulness of a peer review process for database search strategies, that is, do peer reviews change search strategies.
3. Evaluate the costs of implementing a formal peer review of search strategies program as a part of the review process.

Methods. We identified current research protocol phase CER search strategies to review, TEPRs from across the EHC Program, and the original expert searchers who worked on developing each of the search strategies. Each TEPR was assigned to either the control group who only wrote ―free-form‖ reviews or to the group who initially wrote a ―free-form‖ review, then trained using the PRESS Instrument, and finally completed the last review using the PRESS instrument. Original expert searchers were asked to comment on the reviews of their searches. One study researcher administered the peer review process and log time required to perform it, while the other, blinded study researcher analyzed qualitative and quantitative data derived from the reviews, as well as demographic information about the TEPR and original expert searchers.

Results. As a whole, the group of people available to conduct and review search strategies in the EHC Program is professionally educated and very experienced. Of the 24 respondents to the demographic survey, 20 (83%) have master‘s degrees in library science. Most have more than 10 years‘ experience as a librarian or other information professional. Sixty-seven percent of respondents have more than 5 years experience contributing to systematic reviews, with 63 percent having contributed to more than 10 systematic reviews. These experienced searchers have a variety of relationships with the EPCs for whom they do searches. Of the 25 peer reviewers invited to participate, 24 completed the initial free-form round of reviews, and 15 completed either the PRESS review or a second free-form review as part of our control group. For the most part peer reviewers were positive about the review process, although many hesitated to incorporate the review process into their current workflow. All of the reviewers found the background material (systematic review protocol) helpful to the review. Of those who used the PRESS instrument, 82 percent (9) indicated that the instrument was helpful, 18 percent (2) reported that it was neither helpful nor limiting, and none of the reviewers indicated that the PRESS instrument was limiting. The PRESS instrument reviews contained more recommendations on the whole and in particular had more comments that could be termed error detection—specific comments about spelling or syntax indicating that a mistake had been made. In 97 percent of cases, the original searcher indicated that the comments did not cause them to alter their search strategies.

Conclusions. While the results of this study suggest that if a formal peer review process is to be valuable then it would need to be both timely and timed for a window of opportunity immediately prior to the finalization of the protocol. Even if a formal peer review process is not implemented, the PRESS instrument could be useful in informal peer review or even self review. If review of search strategies is to take place, then these results suggest that the use of the PRESS instrument would cut down the time taken, increase the likelihood of response and be more effective in identifying actual errors in search strategies. Additionally, the content of the reviews indicates that there are several search tactics for which there is no consensus, and further research could help us to understand variation in practice around such issues as limits, searching for observational studies, and searching for outcomes and comparators. The process of reviewing other searchers‘ work can bring these issues to light, and a peer review-like process could be used to start investigations and discussions of what techniques work and why. Finally, many of the reviewers commented on the difficulty of reading the search strategies as currently presented. The EHC Program currently has no standards for reporting search strategies, and there is no recognized standard for reporting search strategies. Adopting standard of reporting designed to facilitate review may make it easier to review search strategies both internally and when reported to the public.”

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Health IT Hazard Manager Beta-Test. Final Report – Agency for Healthcare Research and Quality [US] – May 2012

Posted on June 18, 2012. Filed under: Health Informatics, Patient Safety | Tags: |

Health IT Hazard Manager Beta-Test. Final Report – Agency for Healthcare Research and Quality [US] – May 2012

Prepared for: Agency for Healthcare Research and Quality by: Abt Associates and Geisinger Health System

Contributing Authors: James M. Walker, M.D., Principal Investigator; Geisinger Health System Andrea Hassol, M.S.P.H., Project Director; Abt Associates Inc. Bethany Bradshaw, Associate Analyst; Abt Associates Inc. Michael E. Rezaee, M.P.H., Analyst; Abt Associates Inc.

Extract from the executive summary:

“Learning from adverse events is essential for improving patient safety. But, as DeRosier et al. note, the focus of most reporting systems on analyzing adverse events “means that injury has already occurred before any learning takes place.”  A specific health IT application (vendor product), An effective approach to health information technology (health IT) safety requires both retrospective analysis and proactive identification and remediation of hazards. (Throughout this report, the term “hazard” refers to any characteristic of a health IT application or of its interactions with another health care system that increases the risk that care processes will be compromised and patients harmed.) To develop and execute this approach, a learning community, comprised of health care organizations, health IT vendors, researchers, and regulators will be needed. This learning community will need a software tool with which to share information about health IT hazards—a tool that supports the characterization and communication of hazards and their potential and actual adverse effects. Such a tool would support the creation of consistent, comparable information and support shared learning about hazards associated with:

1. A specific health IT application (vendor product),
2. A type of application (e.g., all pharmacy order-management applications),
3. A specific combination of application types (e.g., pharmacy order-management and order entry).

The Health IT Hazard Manager (referred to here as the Hazard Manager) was designed, developed and tested to meet this need.”

… continues

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Guide to Patient and Family Engagement: Environmental Scan Report – Agency for Healthcare Research and Quality [US] – June 2012

Posted on June 18, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Participation, Patient Safety | Tags: |

Guide to Patient and Family Engagement: Environmental Scan Report – Agency for Healthcare Research and Quality [US] – June 2012

“This report was prepared for the Agency for Healthcare Research and Quality (AHRQ) by the American Institutes for Research (AIR) under contract HHSA 290-200-600019. It presents the results of an environmental scan conducted by AIR to serve as an evidence-based foundation for the development of the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care.”

Extract from the executive summary:

“This goal of this project is to promote patient and family engagement in hospital settings by developing, implementing, and evaluating the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care (hereafter referred to as the Guide). The Guide will comprise tools, materials, and/or training for patients, family members, health professionals (e.g., hospital clinicians, staff), hospital leaders, and those who will implement the materials in the Guide. Our preliminary vision of the Guide included four components, each with a series of “tools” (e.g., materials, resources, items for training): (1) Patient and Family Active Involvement Materials; (2) Patient and Family Organizational Partnership Materials; (3) Health Professional Materials; and (4) Leadership and Implementation Materials. The tools in the Guide are intended to:

Support the involvement of patients and family members in the safety and quality of their care.
Encourage the involvement of patients and family members in improving quality and safety within the hospital setting.
Facilitate the creation of partnerships between health professionals and patients/family members.
Outline the steps needed to implement changes.”

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Helping Hospitals Deliver Better Care: A New Toolkit for Quality Improvement – RAND – May 2012

Posted on May 28, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Helping Hospitals Deliver Better Care: A New Toolkit for Quality Improvement – RAND – May 2012

by   Donna O. Farley,  Robin M. Weinick,  Lindsay Mayer,  Julie Cerese,  Rachel M. Burns,  Peter S. Hussey

“A team from RAND and the University HealthSystem Consortium developed a toolkit to help hospitals enhance their quality  improvement efforts using quality indicators from the Agency for Healthcare Research and Quality.”

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Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management – AHRQ – April 2012

Posted on April 26, 2012. Filed under: Evidence Based Practice, Health Informatics, Knowledge Translation | Tags: , , |

Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management – AHRQ – April 2012

Evidence Report / Technology Assessment no 2-3
AHRQ = Agency for Healthcare Research and Quality [US], Prepared by: Duke Evidence-based Practice Center, Durham, North Carolina

“Structured Abstract

Objectives: To catalogue study designs used to assess the clinical effectiveness of clinical decision support systems (CDSSs) and knowledge management systems (KMSs), to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs.

Data Sources: MEDLINE®, CINAHL®, PsycINFO®, and Web of Science®.

Review Methods: We included studies published in English from January 1976 through December 2010. After screening titles and abstracts, full-text versions of articles were reviewed by two independent reviewers. Included articles were abstracted to evidence tables by two reviewers. Meta-analyses were performed for seven domains in which sufficient studies with common outcomes were included.

Results: We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion. RCTs comprised 47.5 percent of the comparative studies on CDSSs/KMSs. Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 to 1.58), ordering clinical studies (n = 20; OR 1.72, 95% CI 1.47 to 2.00), and prescribing therapies (n = 46; OR 1.57, 95% CI 1.35 to 1.82). Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints. Meta-analyses identified six new success features: integration with charting or order entry system, promotion of action rather than inaction, no need for additional clinician data entry, justification of decision support via research evidence, local user involvement, and provision of decision support results to patients as well as providers. Three previously identified success features were confirmed: automatic provision of decision support as part of clinician workflow, provision of decision support at time and location of decisionmaking, and provision of a recommendation, not just an assessment. Only 29 (19.6%) RCTs assessed the impact of CDSSs on clinical outcomes, 22 (14.9%) assessed costs, and 3 assessed KMSs on any outcomes. The primary source of knowledge used in CDSSs was derived from structured care protocols.

Conclusions: Strong evidence shows that CDSSs/KMSs are effective in improving health care process measures across diverse settings using both commercially and locally developed systems. Evidence for the effectiveness of CDSSs on clinical outcomes and costs and KMSs on any outcomes is minimal. Nine features of CDSSs/KMSs that correlate with a successful impact of clinical decision support have been newly identified or confirmed.”

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Venous Thromboembolism Prophylaxis in Orthopedic Surgery – Research Review – AHRQ – 13 March 2012

Posted on March 29, 2012. Filed under: Orthopaedics, Pharmacy | Tags: |

Venous Thromboembolism Prophylaxis in Orthopedic Surgery – Research Review – AHRQ – 13 March 2012

AHRQ = Agency for Healthcare Research and Quality, Effective Health Care Program, Comparative Effectiveness Review Number 49

“Objectives. This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).”

… continues

Sobieraj DM, Coleman CI, Tongbram V, Lee S, Colby J, Chen WT, Makanji SS, Ashaye A, Kluger J, White CM. Venous Thromboembolism in Orthopedic Surgery. Comparative Effectiveness Review No. 49. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) AHRQ Publication No. 12-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2012. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm.

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Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways – AHRQ – 29 February 2012

Posted on March 29, 2012. Filed under: Community Services, Preventive Healthcare, Primary Hlth Care | Tags: , , |

Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways – AHRQ – 29 February 2012

AHRQ = Agency for Healthcare Research and Quality

“Developed by: Community Care Coordination Learning Network

This quick start guide is a reference and resource for public and private stakeholders engaged in improving the system for identifying and connecting at-risk individuals within a community to appropriate health and social services. The target audience includes all those involved in the design, implementation, and financing of care coordination services. This Quick Start guide complements Connecting Those at Risk to Care: A Guide to Building a Community “HUB” To Promote a System of Collaboration, Accountability, and Improved Outcomes.

Contents:

Overview

Why Create a Community HUB and Pathways?
Reason #1: To Promote the Goals of Health Care Reform
Reason #2: To Close the Nation’s Cost and Quality Gap by Paying for Value, Not Volume

A Quick Guide to Creating and Using a Community HUB and Pathways
Key Elements of an Effective Community HUB
A Step-by-Step Process for Using a Pathway

Examples of Six Core Pathways
Core Pathway 1: Medical Home
Core Pathway 2: Medical Referral
Core Pathway 3: Social Service Referral
Core Pathway 4: Health Insurance
Core Pathway 5: Medication Assessment
Core Pathway 6: Pregnancy

Other Resources

Appendix A: Pathways Compendium

Exhibits
Exhibit A-1: Sample Demographic and Referral Form
Exhibit A-2: Sample Care Planning Checklists
Exhibit A-3: Followup Adult Checklist
Exhibit A-4: Examples of Reports for the Community HUB and Participating Agencies”

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AHRQ Quality Indicators™ Toolkit for Hospitals [US] – March 2012

Posted on March 22, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

AHRQ Quality Indicators™ Toolkit for Hospitals [US] – March 2012

“AHRQ QI Toolkit: How to Improve Hospital Quality and Safety.
Improving Performance on the AHRQ Quality Indicators

This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from the Agency for Healthcare Research and Quality (AHRQ), and support your use of them to successfully improve quality and patient safety in your hospital. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs. It focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”

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Early Evidence on Patient-Centered Medical Home – AHRQ – February 2012

Posted on March 14, 2012. Filed under: Primary Hlth Care | Tags: , |

Early Evidence on Patient-Centered Medical Home – AHRQ – February 2012

AHRQ = Agency for Healthcare Research and Quality [US]

“The patient-centered medical home (PCMH, or medical home) aims to reinvigorate primary care and achieve the triple aim of better quality, lower costs, and improved experience of care. This study systematically reviews the early evidence on effectiveness of the PCMH.”

Patient Centered Medical Home Resource Centre – Evidence and Evaluation

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Review of the Evidence on Falls Prevention in Hospitals. Task 4 Final Report – RAND – February 2012

Posted on March 13, 2012. Filed under: Patient Safety, Preventive Healthcare | Tags: , , |

Review of the Evidence on Falls Prevention in Hospitals. Task 4 Final Report – RAND – February 2012

by Susanne Hempel, Sydne Newberry, Zhen Wang, Paul G. Shekelle, Roberta M. Shanman, Breanne Johnsen, Tanja Perry, Debra Saliba, David A. Ganz

“To facilitate the development of a hospital falls prevention resource guide, the authors systematically reviewed and documented the existing evidence base for interventions to prevent falls in hospitals, provided an overview of the performance of existing tools with known measurement properties, and compiled available online resources. The search identified a large number of published fall prevention intervention evaluations. Almost all interventions were multi-component in nature and included fall risk assessments and education for staff and patients and/or families. Intervention complexity and organizational implications varied widely. The review also identified a wide variety of tools for the prevention of falls in hospitals; the majority of the documented tools were fall risk assessment scales. Very few tools, such as the Morse Fall Scale and the STRATIFY scale, have been applied in a number of studies and have generalizable reliability and validity estimates. The documented evidence-based interventions and tools may assist in the development of programs to prevent falls in hospitals. Which tools and interventions are suitable for use in individual hospitals must be evaluated in the context of existing approaches, resources, and individual needs. The identified material will be integrated into the AHRQ toolkit as resources to guide fall prevention approaches for hospitals.”

AHRQ = US Agency for Healthcare Research & Quality

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Promoting Your Public Report: A Hands-on Guide – Agency for Healthcare Research and Quality [US] – February 2012

Posted on March 6, 2012. Filed under: Health Mgmt Policy Planning, Patient Participation | Tags: , |

Promoting Your Public Report: A Hands-on Guide – Agency for Healthcare Research and Quality [US] – February 2012

“This toolkit is designed to help communities increase awareness and use of their public reports by consumers and other important audiences. The suggested approaches and template materials are intended for use with the media, both in traditional settings (e.g., printed newspapers, radio broadcasts) and online avenues (e.g., news Web sites, blogs). The materials have been compiled for modification and use by Chartered Value Exchanges and others who produce public reports comparing health care quality, cost, patient experience, and other aspects of value.

Purpose

The suggested approaches and template materials in this toolkit are intended for use with the media, both in traditional settings (printed newspapers, broadcasts on radio and television) and online avenues (news Web sites, bloggers and podcasters, social media). The materials have been compiled for modification and use by Chartered Value Exchanges and others who produce public reports comparing health care quality, cost, patient experience, and other aspects of value. The intent is to help communities increase awareness and use of their public reports by consumers and other important audiences in each local community.”

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Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment – Agency for Healthcare Research and Quality [US] – January 2012

Posted on February 9, 2012. Filed under: Chronic Disease Mgmt, Nephrology | Tags: |

Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment – Agency for Healthcare Research and Quality [US] – January 2012

“Structured Abstract

Objective. The objective was to systematically review and synthesize evidence regarding benefits and harms of screening for and monitoring and treatment of chronic kidney disease (CKD) stages 1–3.

Data Sources. The data sources were MEDLINE® and Cochrane Database of Systematic Reviews electronic databases, hand searches of references from relevant systematic reviews and eligible trials, and references from expert consultants.

Review Methods. We screened abstracts and full text articles of identified references for eligibility and reviewed randomized controlled trials (RCTs) for evidence on benefits and harms of CKD treatments. We reviewed RCTs and observational studies for evidence regarding possible benefits and harms of CKD screening or monitoring. For all included RCTs, data were extracted, quality was rated, and strength of evidence was graded. Evidence on the benefits and harms of CKD treatments was quantitatively synthesized when possible. Additional evidence on CKD screening and monitoring was qualitatively described.

Results. We found no RCTs of CKD screening or monitoring. In treatment RCTs, several interventions significantly reduced clinical events. In patients with proteinuria, nearly all with diabetes and hypertension, angiotensin converting enzyme inhibitors (ACEIs) (relative risk [RR], 0.60, 95 percent confidence interval [CI], 0.43 to 0.83) and angiotensin receptor blockers (ARBs) (RR 0.77, 95 percent CI, 0.66 to 0.90) significantly reduced risk of end-stage renal disease (ESRD) versus placebo. In patients with microalbuminuria who had cardiovascular disease or diabetes with other cardiovascular risk factors, ACEI treatment reduced mortality risk (RR 0.79, 95 percent CI, 0.66 to 0.96) versus placebo. In individuals with hyperlipidemia and impaired estimated glomerular filtration rate (eGFR) or creatinine clearance, HMG CoA-reductase inhibitors (statins) reduced risk of mortality (RR 0.80, 95 percent CI, 0.68 to 0.95), myocardial infarction (MI), and stroke compared with placebo. However, limited data addressed whether these effects differed between patients with and without CKD or as a function of CKD severity. In RCTs that directly compared different treatments, including high dose versus low dose, combination versus monotherapy, and strict versus standard control, it was unclear whether intensification of treatment improves clinical outcomes. Reporting of study withdrawals and adverse events was limited. Based on treatment RCT findings and additional indirect data, including high CKD prevalence, low CKD recognition and limited CKD monitoring in usual care, uncertain sensitivity of screening and monitoring measures for CKD, and insufficient evidence on CKD screening and monitoring harms, the overall benefits of CKD  screening and monitoring are unclear. The likelihood of benefit, if present, appears to be greater in specific subgroups. For example, individuals not being treated with ACEIs or ARBs who have cardiovascular disease or diabetes combined with other cardiovascular risk factors may benefit from screening for albuminuria. Individuals not being treated with a statin who have hyperlipidemia and no cardiovascular disease may benefit from screening for impaired eGFR. Younger patients, and those without diabetes, hypertension, cardiovascular disease, or obesity, are the least likely to benefit from CKD screening. Individuals with impaired eGFR and at high risk for cardiovascular complications who are not being treated with ACEIs or ARBs may benefit from monitoring for incident  albuminuria.

Conclusions. No trials directly show a benefit for CKD screening or monitoring. The likelihood of benefit, if present, appears to be greater in specific subgroups. Screening and monitoring harms are poorly described. In selected CKD patients, ACEI or ARB treatment reduces ESRD risk, ACEI treatment reduces mortality risk, and statin treatment reduces risk of mortality, MI, and stroke. Many of these patients may already warrant treatment with these therapies regardless of CKD status. Many knowledge gaps remain, and additional research should increase understanding regarding optimal approaches to CKD screening, monitoring, and treatment. ”

Citation:

Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald, R, Rossini D, Sadiq S, Lankireddy S, Kane RL, Wilt TJ. Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review No. 37. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. HHSA 290-2007-10064-I.) AHRQ Publication No. 11(12)-EHC075-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2012. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm

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Hospital Survey on Patient Safety Culture. 2012 User Comparative Database Report – Agency for Healthcare Research and Quality [US] – January 2012

Posted on February 9, 2012. Filed under: Patient Safety | Tags: |

Hospital Survey on Patient Safety Culture. 2012 User Comparative Database Report – Agency for Healthcare Research and Quality [US] – January 2012

“Based on data from 1,128 U.S. hospitals, the Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2012 report presents results showing change over time for 650 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 650 trending hospitals.”

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Emergency Severity Index, Version 4 – Agency for Healthcare Research and Quality [US] – December 2011

Posted on February 9, 2012. Filed under: Emergency Medicine | Tags: , |

Emergency Severity Index, Version 4 – Agency for Healthcare Research and Quality [US] – December 2011

“The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs. The Agency for Healthcare Research and Quality (AHRQ) funded initial work on the ESI.”

Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 12-0014, December 2011. Agency for Healthcare Research and Quality, Rockville, MD.

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Users of Public Reports of Hospital Quality: Who, What, Why, and How? – AHRQ – December 2011

Posted on February 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Participation | Tags: |

Users of Public Reports of Hospital Quality: Who, What, Why, and How? – AHRQ – December 2011

“An aggregate analysis of 16 online public reporting Web sites and users’ and experts’ suggestions for improvement
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
AHRQ Publication No. 12-0016-EF

Extract from the executive summary

“States, community quality collaboratives, and others are investing millions of dollars in the sponsorship and development of public reports on the quality of hospital care. The hope is that these reports will stimulate quality improvement, increase accountability, and improve consumer choices. Although the major method of distributing these reports is through Web sites, it is not known who visits these public reporting Web sites or how Web site visitors use the data presented. This evidence gap leaves report sponsors with minimal guidance on how to construct and implement a report that will successfully engage consumers and providers.

Two key indicators of success for a public reporting Web site are the number of people who access it and the experiences people have when using it. However, there is little publicly available information on these topics. In order to capture these two indicators, we worked with 16 hospital reporting sites affiliated with the AHRQ Chartered Value Exchange program over a 3-month period starting in February 2011. We used two tools: Web analytics to measure and analyze Web site usage patterns for all visitors to the 16 sites, and an online pop-up survey on each Web site to gather information through direct interaction with a subset of visitors. The resulting data were augmented with expert review of the Web sites.

From the survey responses, we focused on consumers (patients and friends or family members) and health care professional respondents (physicians, nurses, hospital executives, etc.) because they are important target audiences for the public report sponsors and also accounted for most of the survey respondents.

We identified 12 key takeaways.”

… continues on the site

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AHRQ Quality Indicators Toolkit for Hospitals – Agency for Healthcare Research and Quality [US] – January 2012

Posted on January 30, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: |

AHRQ Quality Indicators Toolkit for Hospitals – Agency for Healthcare Research and Quality [US] – January 2012

“This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from the Agency for Healthcare Research and Quality (AHRQ), and support your use of them to successfully improve quality and patient safety in your hospital. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs. It focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”

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Improving Patient Flow and Reducing Emergency Department Crowding. A Guide for Hospitals – AHRQ – October 2011

Posted on January 11, 2012. Filed under: Emergency Medicine | Tags: , |

Improving Patient Flow and Reducing Emergency Department Crowding. A Guide for Hospitals – AHRQ – October 2011

AHRQ = US Agency for Healthcare Research and Quality
 
“This guide presents step-by-step instructions that can be used by hospitals in planning and implementing patient flow improvement strategies to ease emergency department crowding.

Contents
Acknowledgments
Executive Summary
Section 1. The Need to Address Emergency Department Crowding
Section 2. Forming a Patient Flow Team
Section 3. Measuring Emergency Department Performance
Section 4. Identifying Strategies
Section 5. Preparing to Launch
Section 6. Facilitating Change and Anticipating Challenges
Section 7. Sharing Results
References
Appendix A: Guide to Online Resources Successfully Used by Hospitals to Improve Patient Flow
Appendix B: Implementation Plan Template
Appendix C: Example Implementation Plan
Appendix D: Additional Readings”

McHugh, M., Van Dyke, K., McClelland M., Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290-200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094, October 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/ptflow/

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Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection – AHRQ Research Review – 19 December 2011

Posted on January 11, 2012. Filed under: Infectious Diseases | Tags: , |

Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection – AHRQ Research Review – 19 December 2011
AHRQ = US Agency for Healthcare Research and Quality

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention. Clinician Summary – AHRQ – 19 December 2011

Treating and Preventing C-diff Infections: A Review of the Research for Adults and Their Caregivers. Consumer Summary – AHRQ – 19 December 2011

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention – CME Activity

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention – Slides

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An Evidence Review of Active Surveillance in Men with Localized Prostate Cancer – AHRQ – 6 December 2011

Posted on December 19, 2011. Filed under: Oncology | Tags: |

An Evidence Review of Active Surveillance in Men with Localized Prostate Cancer – AHRQ – 6 December 2011

“Active surveillance (AS) and watchful waiting (WW) are two observational followup strategies that forgo immediate therapy in patients with prostate cancer, with the goal of minimizing the morbidities and costs of immediate active treatment for men who may never develop cancer-related symptoms or who are interested in palliative treatments only. AS is curative in intent, and WW is palliative.”

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Guide to Reducing Unintended Consequences of Electronic Health Records – AHRQ – 14 December 2011

Posted on December 16, 2011. Filed under: Health Informatics, Medical Records | Tags: , |

Guide to Reducing Unintended Consequences of Electronic Health Records – AHRQ – 14 December 2011

“The Guide to Reducing Unintended Consequences of Electronic Health Records is an online resource designed to help you and your organization anticipate, avoid, and address problems that can occur when implementing and using an electronic health record (EHR). Our purpose in developing the Guide was to provide practical, troubleshooting knowledge and resources.

The Guide was developed with all types of health care organizations in mind — from large hospital systems to solo physician practices. We anticipate that the primary users will be EHR implementers such as Regional Extension Centers, chief information officers, directors of clinical informatics, EHR champions or “super users,” administrators, information technology specialists, and clinicians involved in the implementation of an EHR. Frontline EHR users (such as physicians and nurses) may also find the Guide useful.

The Guide is based on the research literature, other practice-oriented guides for EHR implementation and use, research by its authors, and interviews with organizations that have recently implemented EHR. The Guide represents a compilation of the known best practices for anticipating, avoiding, and addressing EHR-related unintended consequences. However, this area of research is still in its infancy. Therefore, the Guide is a work in progress. We invite you to revise its tools and recommendations in keeping with your own experience and in response to emerging research findings.”

The RAND Corporation prepared the Guide for the Agency for Healthcare Research and Quality

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Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation – AHRQ – December 2011

Posted on December 12, 2011. Filed under: Patient Safety, Pharmacy | Tags: |

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation – AHRQ – December 2011

AHRQ = Agency for Healthcare Research and Quality

“Medication reconciliation is a complex process that impacts all patients as they move through all health care settings. The process involves comparison of a patient’s current medication regimen against a physician’s admission, transfer, or discharge orders to identify discrepancies. Study data show that an effective process can detect and avert most medication discrepancies, potentially avoiding a large number of adverse drug events and related costs for care of affected patients.

This toolkit is based on the Medications at Transitions and Clinical Handoffs (MATCH) Web site. MATCH was developed by Gary Noskin, M.D., and Kristine Gleason, R.Ph., of Northwestern Memorial Hospital in Chicago, Illinois, through the support of Agency for Healthcare Research and Quality (AHRQ) Grant No. 5 U18 HS015886 and collaboration between Northwestern University Feinberg School of Medicine and The Joint Commission.

This toolkit incorporates the experiences and lessons learned by health care facilities that have implemented the MATCH strategies to improve their medication reconciliation processes.”

 

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An Organizational Guide to Building Health Services Research Capacity – AHRQ – October 2011

Posted on November 15, 2011. Filed under: Research | Tags: |

An Organizational Guide to Building Health Services Research Capacity – AHRQ – October 2011

Investigators: Jennifer Stevens, MPH, Roger Levine, PhD, Andrea S. Burling, PhD, and Darlene Russ-Eft, PhD.

“This guide provides a user-friendly, step-by-step approach to planning, implementing, and sustaining a health services research infrastructure. It provides background information, recommendations, and resources to help research organizations and institutions improve their health services research capacity and competitiveness for grant and contract funding.

Prepared for the Agency for Healthcare Research and Quality by the American Institutes for Research”

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Multidisciplinary Pain Programs for Chronic Noncancer Pain – AHRQ – 30 September 2011

Posted on November 11, 2011. Filed under: Chronic Disease Mgmt, Health Professions, Multidisciplinary Care | Tags: |

Multidisciplinary Pain Programs for Chronic Noncancer Pain – AHRQ – 30 September 2011

AHRQ = US Agency for Healthcare Research and Quality

Jeffery MM, Butler M, Stark A, Kane RL. Multidisciplinary Pain Programs for Chronic Noncancer Pain. Technical Brief No. 8. (Prepared by Minnesota Evidence-based Practice Center under Contract No. 290-07-10064-I.) AHRQ Publication No. 11-EHC064-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011.

“Abstract

Background. Chronic noncancer pain affects millions of Americans, seriously impacting their quality of life and costing billions of dollars every year in health care expenditures and lost productivity. There are currently no definitive cures for the most prevalent chronic pain syndromes. Multidisciplinary Pain Programs (MPPs) follow a model of care that emphasizes, when pain cannot be successfully eliminated, managing the pain to the extent that the patient’s independence is restored and overall quality of life improved.

Purpose. The purpose of this report is to describe the literature and identify important issues and gaps in the evidence base assessing MPPs for the treatment of chronic noncancer pain.

Methods. A review of the published literature and interviews with key informants were conducted

Findings. MPPs have been extensively documented in the standard medical literature. The 183 papers considered in this Technical Brief followed a biopsychosocial model of chronic pain, including treatment components in each of four areas: medical, behavioral, physical reconditioning, and education. Most of the studies were observational before-after designs. Although several different clinical conditions were studied, 90 percent of the studies included chronic back pain, the most frequent condition addressed in the literature. Differences were apparent between studies based in the United States and those in Europe; recent European studies were more likely than U.S. studies to include inpatient delivery of MPP treatment. Declining access to MPP treatment in the United States is highlighted as a key issue faced by those in the community of chronic pain sufferers and researchers.”

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Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

Posted on November 11, 2011. Filed under: Cardiol / Cardiothor Surg, Neurology, Preventive Healthcare, Rehabilitation | Tags: |

Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

AHRQ = US Agency for Healthcare Research and Quality

“Structured Abstract

Objectives: To review the available published literature to assess whether evidence supports a beneficial role for coordinated transition of care services for the postacute care of patients hospitalized with first or recurrent stroke or myocardial infarction (MI). This review was framed around five areas of investigation:

1.Key components of transition of care services.
2.Evidence for improvement in functional outcomes, morbidity, mortality, and quality of life.
3.Associated risks or potential harms.
4.Evidence for improvement in systems of care.
5.Evidence that benefits and harms vary by patient-based or system-based characteristics.

Data Sources: MEDLINE®, CINAHL®, Cochrane Database of Systematic Reviews, and Embase®.

Review Methods: We included studies published in English from 2000 to 2011 that specified postacute hospitalization transition of care services as well as prevention of recurrent stroke or MI.

Results: A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories:

1.Hospital-initiated support for discharge was the initial stage in the transition of care process.
2.Patient and family education interventions were started during hospitalization but were continued at the community level.
3.Community-based models of support followed hospital discharge.
4.Chronic disease management models of care assumed the responsibility for long-term care.

Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient- or system-based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was inconsistency in the definition of what constituted a component of transition of care compared to “standard care.” Standard care was poorly defined, and nearly all studies were underpowered to demonstrate a statistical benefit. The endpoints varied greatly from study to study. Nearly all the studies were single-site based, and most (26 of 44) were conducted in countries with national health care systems quite different from that of the U.S., therefore limiting their generalizability.

Conclusions: Although a basis for the definition of transition of care exists, more consensus is needed on the definition of the interventions and the outcomes appropriate to those interventions. There was limited evidence that two components of hospital-initiated support for discharge (early supported discharge after stroke and specialty care followup after MI) were associated with beneficial effects. No other interventions had sufficient evidence of benefit based on the findings of this systematic review. The adoption of a standard set of definitions, a refinement in the methodology used to study transition of care, and appropriate selection of patient-centered and policy-relevant outcomes should be employed to draw valid conclusions pertaining to specific components of transition of care.”

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Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review – Agency for Healthcare Research and Quality [US] – October 2011

Posted on October 31, 2011. Filed under: Orthopaedics | Tags: |

Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review – Agency for Healthcare Research and Quality [US] – October 2011

Chou R, McDonagh MS, Nakamoto E, Griffin J. Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review. Comparative Effectiveness Review No. 38. (Prepared by the Oregon Evidence-based Practice Center under Contract No. HHSA 290 2007 10057 I) AHRQ Publication No.  11(12)-EHC076-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2011

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Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long- Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment – AHRQ Effective Health Care Program – 21 October 2011

Posted on October 26, 2011. Filed under: Child Health / Paediatrics | Tags: , |

Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long- Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment – AHRQ Effective Health Care Program – 21 October 2011

Press release: Report Finds Parent Training Effective for Treating Young Children With ADHD 

“Formal training in parenting strategies is a low-risk, effective method for improving behavior in preschool-age children at risk for developing attention deficit hyperactivity disorder (ADHD), while there is less evidence supporting the use of medications for children younger than 6 years old, according to a new report from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

The report found that formal parenting interventions—known as parent behavior training or PBT—are supported by strong evidence for effectiveness for children younger than the age of 6, with no reports of complications or harms. However, one large barrier to the success of PBT is parents who drop out of therapy programs, the report found. For children older than age 6, the report found that methylphenidate (sold under the brand name Ritalin) and another drug used to treat ADHD symptoms, atomoxetine (sold as Strattera), are generally safe and effective for improving behavior, but their effects beyond 12 to 24 months have not been well studied. Little information is available about the long-term effects of other medications used to treat ADHD symptoms. ”  … continues on the site

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Noninvasive Diagnostic Techniques for the Detection of Skin Cancers – AHRQ – September 2011

Posted on October 24, 2011. Filed under: Dermatology, Health Technology Assessment, Oncology | Tags: |

Parsons SK et al   Noninvasive Diagnostic Techniques for the Detection of Skin Cancers. Technical Brief No. 11.  (Prepared by the Tufts University Evidence-based Practice Center under Contract No. 290-2007-1055-1.) AHRQ Publication No. 11-EHC085-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011.

Structured Abstract
Background. Cancers of the skin are the most common forms of cancer. Timely diagnosis and treatment are critical to reducing the rates of morbidity and mortality. Newer noninvasive imaging technologies may assist with earlier detection.
Objective. To provide an objective description of noninvasive imaging modalities in diagnosing cancerous tumors of the skin, to proffer an analytic framework for assessing the applications of the imaging modalities, to summarize the state of ongoing research, and to delineate future research needs.
Methods. We searched the MEDLINE® database for English-language literature published between 1990 and March 2011 for selected noninvasive imaging  technologies. We included all publications types and study designs. We extracted data solely from relevant abstracts. Our search also included grey literature  (manufacturers’ Web sites, Food and Drug Administration’s relevant databases, and ClinicalTrials.gov), and incorporated expert input from our key informants.  devices were classified as in general clinical use, limited clinical use, or investigational use, based on all available information.
Findings. We screened in 629 abstracts that were relevant to the noninvasive imaging technologies of interest. Only 11 abstracts were on randomized controlled trials. Of the devices in general clinical use, we found a total of 51 abstracts on photography and 433 on dermoscopy. Of note, only one abstract reported clinical outcomes. None of the abstracts reported adverse events. Photography is principally used in specialty and subspecialty settings (i.e., oncology) and while widely used by dermatologists, dermoscopy is still not used in primary care. We did not identify any consistent guidelines for the assessment of suspicious skin lesions. Devices in limited clinical use are principally used in research settings. Available literature was limited for these devices as well as those still considered investigational.
Summary. A review of the literature reveals predominant use of noninvasive devices by dermatologists with limited diffusion of this technology in primary care. When compared with the use of biopsy, future research is needed to evaluate the test accuracies, clinical impact, and the potential adverse events associated with the use of noninvasive imaging technologies.”

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Integrating Clinical Decision Support Into Workflow—Final Report – AHRQ – September 2011

Posted on October 4, 2011. Filed under: Evidence Based Practice, Health Informatics, Knowledge Translation | Tags: , |

Integrating Clinical Decision Support Into Workflow—Final Report – AHRQ – September 2011

Doebbeling BN, Saleem J, Haggstrom D, et al. Integrating Clinical Decision Support Into Workflow—Final Report. (Prepared by Indiana University, Regenstrief Institute under Contract No. HSA290200600013-3.) AHRQ Publication No. 11-0076-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011.

Agency for Healthcare Research and Quality – AHRQ Publication No. 11-0076-EF

“Structured Abstract

Purpose: The aims were to (1) identify barriers and facilitators related to integration of clinical decision support (CDS) into workflow and (2) develop and test CDS design alternatives.

Scope: To better understand CDS integration, we studied its use in practice, focusing on CDS for colorectal cancer (CRC) screening and followup. Phase 1 involved outpatient clinics of four different systems—120 clinic staff and providers and 118 patients were observed. In Phase 2, prototyped design enhancements to the Veterans Administration’s CRC screening reminder were compared against its current reminder in a simulation experiment. Twelve providers participated.

Methods: Phase 1 was a qualitative project, using key informant interviews, direct observation, opportunistic interviews, and focus groups. All data were analyzed using a coding template, based on the sociotechnical systems theory, which was modified as coding proceeded and themes emerged. Phase 2 consisted of rapid prototyping of CDS design alternatives based on Phase 1 findings and a simulation experiment to test these design changes in a within-subject comparison.

Results: Very different CDS types existed across sites, yet there are common barriers: (1) lack of coordination of “outside” results and between primary and specialty care; (2) suboptimal data organization and presentation; (3) needed provider and patient education; (4) needed interface flexibility; (5) needed technological enhancements; (6) unclear role assignments; (7) organizational issues; and (8) disconnect with quality reporting. Design enhancements positively
impacted usability and workflow integration but not workload.

Conclusions: Effective CDS design and integration requires: (1) organizational and workflow integration; (2) integrating outside results; (3) improving data organization and presentation in a flexible interface; and (4) providing just-in time education, cognitive support, and quality reporting.”

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Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting – AHRQ – September 2011

Posted on September 30, 2011. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting – AHRQ – September 2011
A Guide for Community Quality Collaboratives: White Paper

“This paper is intended for use by Chartered Value Exchanges (CVEs), community collaboratives, and other organizations interested in creating public reports on the performance of health care providers in their communities. It addresses the issue of inconsistent reports based on the same data and identifies the key methodological decision points that precede publication of a performance report. ”

Friedberg MW, Damberg CL. Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives. AHRQ Publication No. 11-0093, September 2011. Prepared by RAND Corporation under Contract No. HHSA290200810037C. Agency for Healthcare Research and Quality, Rockville, MD.

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Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives – AHRQ – September 2011

Posted on September 27, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning, Patient Participation | Tags: , , , |

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives – AHRQ – September 2011

“This [white] paper is intended for use by Chartered Value Exchanges (CVEs), community collaboratives, and other organizations interested in creating public reports on the performance of health care providers in their communities. It addresses the issue of inconsistent reports based on the same data and identifies the key methodological decision points that precede publication of a performance report.”

Friedberg MW, Damberg CL. Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives. AHRQ Publication No. 11-0093, September 2011. Prepared by RAND Corporation under Contract No. HHSA290200810037C. Agency for Healthcare Research and Quality, Rockville, MD.

Contents
Acknowledgments
Foreword
Executive Summary
Introduction
How This Paper Is Organized
Overarching Methodological Issue: Performance Misclassification
Decisions Encountered During Key Task Number 1: Negotiating Consensus on Goals and “Value Judgments” of Performance Reporting
Decisions Encountered During Key Task Number 2: Selecting the Measures That Will Be Used To Evaluate Provider Performance
Decisions Encountered During Key Task Number 3: Identifying Data Sources and Aggregating Performance Data
Decisions Encountered During Key Task Number 4: Checking Data Quality and Completeness
Decisions Encountered During Key Task Number 5: Computing Provider-Level Performance Scores
Decisions Encountered During Key Task Number 6: Creating Performance Reports
Summary of Methodological Decisions Made by a Sample of CVE Stakeholders
Appendix 1: Validity and Systematic Performance Misclassification
Appendix 2: Performance Misclassification Due to Chance
References

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AHRQ Initiative Encourages Better Two-way Communication between Clinicians and Patients – 20 September 2011

Posted on September 21, 2011. Filed under: Patient Participation | Tags: |

AHRQ Initiative Encourages Better Two-way Communication between Clinicians and Patients  – 20 September 2011
Agency for Healthcare Research and Quality [US]

“The U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) today launched an initiative with the Ad Council to encourage clinicians and patients to engage in effective two-way communication to ensure safer care and better health outcomes. For nearly a decade, AHRQ has encouraged patients to be more involved in their health care, and this new initiative builds on previous public education campaigns AHRQ has conducted under contract with the Ad Council around the theme “Questions are the Answer.”  ”

… continues on the site

 

 

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Guide to Reducing Unintended Consequences of Electronic Health Records – Agency for Healthcare Research and Quality [US] – August 2011

Posted on September 21, 2011. Filed under: Health Informatics, Medical Records | Tags: , |

Guide to Reducing Unintended Consequences of Electronic Health Records – Agency for Healthcare Research and Quality [US] – August 2011

S.S. Jones, R. Koppel, M.S. Ridgely, T.E. Palen, S. Wu, and M.I. Harrison. Guide to Reducing Unintended Consequences of Electronic Health Records Prepared by RAND Corporation under Contract No. HHSA290200600017I, Task Order #5. Agency for Healthcare Research and Quality (AHRQ). Rockville, MD. August, 2011.
 
“The Guide to Reducing Unintended Consequences of Electronic Health Records is an online resource designed to help you and your organization anticipate, avoid, and address problems that can occur when implementing and using an electronic health record (EHR). Our purpose in developing the Guide was to provide practical, troubleshooting knowledge and resources.

The Guide was developed with all types of health care organizations in mind — from large hospital systems to solo physician practices. We anticipate that the primary users will be EHR implementers such as Regional Extension Centers, chief information officers, directors of clinical informatics, EHR champions or “super users,” administrators, information technology specialists, and clinicians involved in the implementation of an EHR. Frontline EHR users (such as physicians and nurses) may also find the Guide useful.

The Guide is based on the research literature, other practice-oriented guides for EHR implementation and use, research by its authors, and interviews with organizations that have recently implemented EHR. The Guide represents a compilation of the known best practices for anticipating, avoiding, and addressing EHR-related unintended consequences. However, this area of research is still in its infancy. Therefore, the Guide is a work in progress. We invite you to revise its tools and recommendations in keeping with your own experience and in response to emerging research findings.”

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Eliminating CLABSI: A National Patient Safety Imperative – Agency for Healthcare Research and Quality [US] – September 2011

Posted on September 15, 2011. Filed under: Infection Control | Tags: |

Eliminating CLABSI: A National Patient Safety Imperative – Agency for Healthcare Research and Quality [US] – September 2011
Second Progress Report on the National On the CUSP: Stop BSI Project

The Agency for Healthcare Research and Quality (AHRQ) is funding a national effort to prevent central line-associated bloodstream infections (BSIs) in U.S. hospitals by implementing a Comprehensive Unit-based Safety Program (CUSP). The On the CUSP: Stop BSI project is a unique partnership with the Health Research & Educational Trust, the Johns Hopkins University Quality and Safety Research Group, and the Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality. This second report summarizes progress made in the first 2 years of the On the CUSP: Stop BSI project.

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Improving Consumer Health IT Application Development: Lessons from Other Industries: Background Report – Agency for Healthcare Research and Quality – May 2011 [US]

Posted on August 23, 2011. Filed under: Health Informatics, Patient Participation | Tags: |

Improving Consumer Health IT Application Development: Lessons from Other Industries:  Background Report – Agency for Healthcare Research and Quality – May 2011 [US]
Agarwal R, Anderson C, Crowley K, Kannan PK. Understanding Development Methods From Other Industries to Improve the Design of Consumer Health IT: Background Report. (Prepared by Westat, under Contract No. HHSA290200900023I.) AHRQ Publication No. 11-0065-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2011.

Extract from the report”

“Background

In Crossing the Quality Chasm, the Institute of Medicine outlines six aims critical to transforming health care delivery. One of those aims is the delivery of patient-centered care, “care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine 2001, p. 40). Central to the vision of a patient-centered health care system are information technologies and tools in the form of consumer health information technology (IT) applications that support a range of health management activities such as storing and retrieving health information, sharing health information with health care providers, and tracking health-related behaviors and actions. However, despite the acknowledged value potential of consumer health IT applications in regard to improving health management, growing market offerings of consumer health IT applications, and vocal advocates of the technology, at the present time there is insufficient adoption and diffusion among consumers.

To address the need for accelerating the development and diffusion of consumer health IT applications, The Agency for Healthcare Research and Quality (AHRQ) commissioned this report as a key deliverable for the task order entitled “Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT.” The task order’s findings will constitute a foundation of recommendations intended to guide the development of consumer health IT applications. This report summarizes and synthesizes findings related to design methods used for the development of successful consumer products in industries other than health care. It offers recommendations for developers of consumer health IT applications and provides directions for future research.”

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Promoting Safety and Quality Through Human Resource Practices: Executive Summary – Agency for Healthcare Research and Quality [US] – August 2011

Posted on August 23, 2011. Filed under: Patient Safety, Workforce | Tags: |

Promoting Safety and Quality Through Human Resource Practices: Executive Summary – Agency for Healthcare Research and Quality [US] – August 2011

“The purpose of this Executive Summary is to provide an introduction to the methodology and summary findings of an ACTION Task Order funded by the Agency for Healthcare Research and Quality (AHRQ), “Promoting Safety and Quality Through Human Resources Practices,” which began in late 2008. The purpose of this research, managed by the Health Research & Education Trust (an affiliate of the American Hospital Association), was to study how health care organizations can use innovative human resources practices (also called high-performance work practices, or HPWPs) to promote safety and quality in health care. Among the outcomes of the study is the AHRQ document, Using Workforce Practices to Guide Quality Improvement: A Guide for Hospitals. A key component of the study was development of a predictive model linking particular HPWPs and quality outcomes in health care.”

McAlearney AS, Song P, Garman A, et al. Promoting Safety and Quality Through Human Resource Practices: Executive Summary. Final Report. Prepared by Health Research & Education Trust under Contract No. 290-06-0022-5X. AHRQ Publication No. 11-0080-EF, August 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/prosafetysum.htm

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Designing Consumer Reporting Systems for Patient Safety Events: Contract Final Report – AHRQ – Juy 2011

Posted on August 23, 2011. Filed under: Patient Participation, Patient Safety | Tags: |

Designing Consumer Reporting Systems for Patient Safety Events: Contract Final Report – AHRQ – Juy 2011

“Based on a series of technical expert panel meetings, consumer focus groups, interviews with key stakeholders, and an environment scan and literature review, this project addressed a series of questions about the ideal characteristics of a consumer reporting system, and how such a system could be realistically implemented. (For a summary, select Project Overview.)

The technical expert panel was able to reach consensus on many aspects of consumer reporting systems. However, the panel suggested that there may be a number of types of organizational structures capable of supporting consumer reporting. The report ends with discussion of what is needed to make consumer reporting successful, and the limitations of the study.”

Agency for Healthcare Research and Quality

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The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care – AHRQ – July 2011

Posted on July 20, 2011. Filed under: Chronic Disease Mgmt, Community Services, Primary Hlth Care | Tags: |

The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care – AHRQ – July 2011

Highlights opportunities to improve patient engagement in primary care.  The brief focuses on involvement at three levels: the engagement of patients and families in their own care, in quality improvement activities in the primary care practice, and in the development and implementation of policy and research related to the patient-centered medical home (PCMH).

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Workflow Assessment for Health IT Toolkit – Agency for Healthcare Research and Quality – 2011

Posted on July 20, 2011. Filed under: Chronic Disease Mgmt, Health Informatics | Tags: |

Workflow Assessment for Health IT Toolkit – Agency for Healthcare Research and Quality – 2011

“A key to successful implementation of health information technology (health IT) is to recognize its impact on both clinical and administrative workflow. Once implemented, health IT can provide information to help you reorganize and improve your workflow. This toolkit is designed for people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care.”

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Health Care Comes Home: The Human Factors – National Research Council [US] – 2011

Posted on July 20, 2011. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt, Community Services, Health Informatics, Telehealth | Tags: |

Health Care Comes Home: The Human Factors – National Research Council [US] – 2011

“Description

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book’s recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.”

ISBN-10: 0-309-21236-7
ISBN-13: 978-0-309-21236-6

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New Ad Campaign Urges Patients To Consider Medical Treatment Options – AHRQ – 30 June 2011

Posted on July 1, 2011. Filed under: Patient Participation | Tags: |

New Ad Campaign Urges Patients To Consider Medical Treatment Options – AHRQ – 30 June 2011

Explore Your Treatment Options,” a new multimedia ad campaign announced today by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and the Ad Council, encourages patients to become more informed about their options before choosing a treatment for a health condition or illness.

The goal of this campaign is to increase consumers’ involvement in their care by providing easy access to unbiased information about treatment options and tools to encourage patients to work with their doctors, nurses, pharmacists and other clinicians to make health care decisions. It features television, radio, print, web and outdoor ads that encourage consumers to visit AHRQ’s Effective Health Care Program Web site to find plain-language guides that summarize the scientific evidence on treatments for numerous medical conditions, including diabetes, osteoarthritis, high blood pressure, high cholesterol and more.”  … continues on the site

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Home Health Patient Assessment Tools: Preparing for Emergency Triage – AHRQ – June 2011

Posted on June 13, 2011. Filed under: Chronic Disease Mgmt, Community Services, Disaster Management | Tags: |

Home Health Patient Assessment Tools:  Preparing for Emergency Triage – AHRQ – June 2011
AHRQ = Agency for Healthcare Research and Quality [US]

“Approximately 7.6 million individuals receive care in their home from 17,000 home care providers because of acute illness, long-term care conditions, permanent disability, or terminal illness. During a mass casualty event, these community-dwelling patients could experience disruption of needed support services. Depending on the level of their needs, a disruption of care/services could lead to patient decompensation and increased reliance on acute care services, including emergency medical systems and hospital emergency departments already stretched thin by the disaster situation.

The model Community-Living Patient Assessment Tool for Disaster Planning included in this report rates the risk status of community-based patients in the event of a disaster. The goal for the tool is for home health agencies and others to be able to identify and estimate the number of individuals/patients who would be most at risk for hospitalization if their home supports and services were disrupted during an emergency. With this information, emergency planners could begin to anticipate and prepare for this additional surge demand.”

Data Sources for the At-Risk Community-Dwelling Patient Population – AHRQ – June 2011

“Many patients who live in the community and need some degree of medical assistance may be unable to manage if their resources or services are depleted during a mass casualty event (MCE). Patients who are not directly affected by an MCE but who have daily medical needs, those who cannot manage their medical needs in a shelter, and those who do not have family caregivers are likely to seek care at hospitals that will already be burdened by caring for people directly affected by the MCE. This study investigates data sources to enumerate and estimate the number of people who, though not directly affected by an MCE, might seek hospital care during an MCE. The report summarizes findings about the availability of data to quantify the at-risk community population.”

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Pain Management Interventions for Elderly Patients With Hip Fracture – AHRQ – Clinician Guide, Research Review, Consumer Guide – 17 May 2011

Posted on May 30, 2011. Filed under: Orthopaedics | Tags: , |

Pain Management Interventions for Elderly Patients With Hip Fracture – Clinician Guide – 17 May 2011
Key Clinical Issue
What are the comparative effectiveness, benefits, and adverse events associated with interventions for acute-pain management, as compared to usual care, in elderly patients with hip fractures from low-impact injury?

Pain Management Interventions for Hip Fracture – Research Review – Final – 17 May 2011

Managing Pain From a Broken Hip: A Guide for Adults and Their Caregivers – Consumer Guide – 17 May 2011

all from AHRQ – Agency for Healthcare Research and Quality

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Stereotactic Body Radiation Therapy – AHRQ – May 2011

Posted on May 23, 2011. Filed under: Oncology, Radiology | Tags: |

Stereotactic Body Radiation Therapy – AHRQ – May 2011

Tipton KN, Sullivan N, Bruening W, Inamdar R, Launders J, Uhl S, Schoelles K.
Stereotactic Body Radiation Therapy.
Technical Brief No. 6. (Prepared by ECRI Institute Evidence-based Practice Center under Contract No. HHSA-290-02-0019.) AHRQ Publication No. 10 (11)-EHC058-EF.
Rockville, MD: Agency for Healthcare Research and Quality. May 2011.

“Objectives. Conduct a systematic literature scan for published data for the treatment of stereotactic body radiation therapy (SBRT) and provide a broad overview of the current state of SBRT for solid malignant tumors.”

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Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease – AHRQ – April 2011

Posted on May 13, 2011. Filed under: Dietetics | Tags: , |

Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease – AHRQ – April 2011

“Objectives: To catalog what is known about the safety of interventions containing Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus strains used as probiotic agents in research to reduce the risk of, prevent, or treat disease.”  Agency for Healthcare Research and Quality  [US]

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Medication Management & Health IT – AHRQ – April 2011

Posted on May 6, 2011. Filed under: Health Informatics, Medications, Pharmacy | Tags: , |

Medication Management & Health IT – AHRQ – April 2011

U.S. Agency for Healthcare Research and Quality

“Structured Abstract
Objective: The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research.

Data sources: We searched peer-reviewed electronic databases, grey literature, and performed hand searches. Databases searched included MEDLINE®, Embase, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Compendex, Inspec (which includes IEEE Xplore), Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete. Grey literature searching involved Internet searching, reviewing relevant Web sites, and searching electronic databases of grey literatures. AHRQ also provided all references in their e-Prescribing, bar coding, and CPOE knowledge libraries.

Methods: Paired reviewers looked at citations to identify studies on a range of health IT used to assist in the medication management process (MMIT) during multiple levels of screening (titles and abstracts, full text and final review for assignment of questions and data abstrction). Randomized controlled trials and cohort, case-control, and case series studies were independently assessed for quality. All data were abstracted by one reviewer and examined by one of two different reviewers with content and methods expertise.

Results: 40,582 articles were retrieved. After duplicates were removed, 32,785 articles were screened at the title and abstract phase. 4,578 full text articles were assessed and 789 articles were included in the final report. Of these, 361 met only content criteria and were listed without further abstraction. The final report included data from 428 articles across the seven key questions. Study quality varied according to phase of medication management. Substantially more studies, and studies with stronger comparative methods, evaluated prescribing and monitoring. Clinical decision support systems (CDSS) and computerized provider order entry (CPOE) systems were studied more than any other application of MMIT. Physicians were more often the subject of evaluation than other participants. Other health care professionals, patients, and families are important but not studied as thoroughly as physicians. These nonphysicians groups often value different aspects of MMIT, have diverse needs, and use systems differently. Hospitals and ambulatory clinics were well-represented in the literature with less emphasis placed on long-term care facilities, communities, homes, and nonhospital pharmacies. Most studies evaluated changes in process and outcomes of use, usability, and knowledge, skills, and attitudes. Most showed moderate to substantial improvement with implementation of MMIT. Economics studies and those with clinical outcomes were less frequently studied. Those articles that did address economics and clinical outcomes often showed equivocal findings on the effectiveness and cost-effectiveness of MMIT systems. Qualitative studies provided evidence of strong perceptions, both positive and negative, of the effects of MMIT and unintended consequences. We found little data on the effects of forms of medications, conformity, standards, and open source status. Much descriptive literature discusses implementation issues but little strong evidence exists. Interest is strong in MMIT and more groups and institutions will implement systems in the next decades, especially with the Federal Government’s push toward more health IT to support better and more cost-effective health care.

Conclusions: MMIT is well-studied, although on closer examination of the literature the evidence is not uniform across phases of medication management, groups of people involved, or types of MMIT. MMIT holds the promise of improved processes; clinical and economics studies and the understanding of sustainability issues are lacking.”

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Hospital Survey on Patient Safety Culture – The Agency for Healthcare Research and Quality (AHRQ) – April 2011

Posted on April 29, 2011. Filed under: Comparative Effectiveness Research, Patient Safety | Tags: |

Hospital Survey on Patient Safety Culture – The Agency for Healthcare Research and Quality (AHRQ) – April 2011
2011 User Comparative Database Report

“Based on data from 1,032 U.S. hospitals, the Hospital Survey on Patient Safety Culture: 2011 User Comparative Database Report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2011 report presents results showing change over time for 512 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 512 trending hospitals.”

… continues on the site

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Longitudinal Program Evaluation of HHS Healthcare Associated Infections (HAI) National Action Plan (NAP) – RAND – April 2011

Posted on April 27, 2011. Filed under: Infection Control | Tags: , |

Longitudinal Program Evaluation of HHS Healthcare Associated Infections (HAI) National Action Plan (NAP) – RAND – April 2011
Year 1 Report
by Peter Mendel, Daniel Weissbein, Daniel Weinberg, Rebecca Shaw, Donna O. Farley, David P. Baker, Katherine L. Kahn

“The widespread prevalence and enormous cost of healthcare-associated infections (HAIs) have been recognized as public and personal-level health problems. An estimated 1.7 million HAIs are diagnosed annually in hospitals and are associated with approximately 100,000 deaths. However, substantial opportunities exist for adopting evidence-based processes to reduce rates of HAIs. In June 2009 the Department of Health and Human Services (HHS) issued the Action Plan to Prevent Healthcare-Associated Infections, which established national goals for HAI prevention, including key actions for achieving identified short- and long-term objectives over the next five years. The National Evaluation of the HHS Action Plan to Prevent Healthcare-Associated Infections is a large-scale formative evaluation project conducted by IMPAQ International and the RAND Corporation. The evaluation seeks to establish baseline data and provide feedback on how to strengthen ongoing assessments of the scope of HAIs and interventions, how to reduce HAIs, and how to begin to understand the effectiveness of those interventions. This report presents the results of the first year of the team’s evaluation, which focused on a document and literature review and interviews with key stakeholders to gain information about the context in which the action plan was developed. Future years will assess processes associated with the action plan and resulting products. Recommendations include increasing the engagement of stakeholders both within and external to the federal government, acknowledging prevalent conceptual and implementation tensions between differing major perspectives on HAIs, and creating a supplementary document to outline the steps necessary to achieve each action plan goal.”

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Traumatic Brain Injury and Depression – Agency for Healthcare Research and Quality [US] – 13 April 2011

Posted on April 27, 2011. Filed under: Mental Health Psychi Psychol, Neurology | Tags: |

Traumatic Brain Injury and Depression – Agency for Healthcare Research and Quality [US] – 13 April 2011

AHRQ has released a new systematic review of 115 clinical studies involving depression after traumatic brain injury (TBI).  Comparative Effectiveness Review of Traumatic Brain Injury and Depression, prepared by researchers at the AHRQ’s Vanderbilt Evidence-based Practice Center addresses key questions on depression after traumatic brain injury and finds there are many research gaps.  However, there are treatments available for people with depression and people should understand their options.

Depression After Brain Injury: A Guide for Patients and Their Caregivers – 13 April 2011

Depression After Traumatic Brain Injury – Clinician Guide – 13 April 2011

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Staying Healthy Through Education and Prevention (STEP) – [US] Agency for Healthcare Research and Quality – February 2011

Posted on April 18, 2011. Filed under: Aged Care / Geriatrics, Preventive Healthcare, Public Hlth & Hlth Promotion | Tags: |

Staying Healthy Through Education and Prevention (STEP) – [US] Agency for Healthcare Research and Quality – February 2011

“This implementation guide is a tool for continuing care retirement community (CCRC) staff to implement the Staying Healthy Through Education and Prevention (STEP) program. The STEP program is an evidence-based exercise program focusing on walking and strength training for seniors. This guide provides the information, tools, curricular material, and other resources needed to successfully implement the STEP program in CCRCs. “

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AHRQ’s Effective Health Care Program Data Points Publication Series Available

Posted on April 5, 2011. Filed under: Comparative Effectiveness Research, Evidence Based Practice | Tags: |

AHRQ’s Effective Health Care Program Data Points Publication Series Available

Agency for Healthcare Research and Quality [US]

“The DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network announces a new publication series Data Points that will be available on AHRQ’s Effective Health Care Program Web site. This series will offer new information and insights on the use of health care services and interventions for the treatment, management, and diagnosis of diseases, as well as the variations and potential disparities across patient subpopulations.  Reports will provide brief descriptive statistics, background information, and analytic tables on a variety of specific, focused topics related to medical diagnoses, treatments, services, and patient populations.  Specific reports will present new statistics on topics such as disease incidence, prevalence, and burden of illness, as well as outcomes such as readmission, morbidity, and mortality.  The publication series will generally summarize the basic demographic and geographic breakdowns with additional details available in statistical tables that can be downloaded from the Effective Health Care Program Web site.  The first Data Points reports describe the incidence and prevalence of diabetic foot ulcers and some of its major complications in Medicare beneficiaries.  Three reports are now available on the Effective Health Care Program Web site. “

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Health Literacy Interventions and Outcomes: An Updated Systematic Review – AHRQ – 28 March 2011

Posted on March 29, 2011. Filed under: Health Status | Tags: , |

Health Literacy Interventions and Outcomes: An Updated Systematic Review – AHRQ – 28 March 2011

Agency for Healthcare Research and Quality

Press release:  Low Health Literacy Linked to Higher Risk of Death and More Emergency Room Visits and Hospitalizations 

“Low health literacy in older Americans is linked to poorer health status and a higher risk of death, according to a new evidence report by HHS’ Agency for Healthcare Research and Quality (AHRQ). More than 75 million English-speaking adults in the United States have limited health literacy, making it difficult for them to understand and use basic health information.

The report, an update of a 2004 literature review featuring findings from more than 100 new studies, also found an association between low health literacy in all adults, regardless of age, and more frequent use of hospital emergency rooms and inpatient care, compared with other adults.”  … continues on the press release site

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Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap – Centers for Disease Control and Prevention – 2011

Posted on March 25, 2011. Filed under: Aged Care / Geriatrics, Preventive Healthcare | Tags: , |

Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap – Centers for Disease Control and Prevention – 2011

Centers for Disease Control and Prevention, Administration on Aging, Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services. Enhancing Use of Clinical Preventive Services Among Older Adults. Washington, DC: AARP, 2011.

“This new report, Enhancing Use of Clinical Preventive Services Among Older Adults – Closing the Gap, calls attention to the use of potentially lifesaving preventive services by our nation’s growing population of adults aged 65 years and older. By presenting and interpreting available state and national self-reported survey data, the Report aims to raise awareness among public health and aging services professionals, policy makers, the media, and researchers of critical gaps and opportunities for increasing the use of clinical preventive services, particularly among those who are currently underserved.”

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New Resource Helps Hospitals Get Up To Speed on Safety Culture – US Agency for Healthcare Research and Quality

Posted on March 11, 2011. Filed under: Patient Safety | Tags: |

New Resource Helps Hospitals Get Up To Speed on Safety Culture  – US Agency for Healthcare Research and Quality
 
“Hospitals working to improve the safety culture of their organization have a new Web-based resource that provides practical information on the patient safety dimensions used in AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).  The resource is organized by the dimensions assessed in the HSOPS, such as teamwork within units, overall perceptions of safety, and feedback and communication about errors.  It contains links to useful tools and examples that organizations can use to help improve their safety culture.  A list of general resources from leading public and private groups involved in patient safety is also included.  Select to access the resource.

AHRQ’s Patient Safety Organization Web Site

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2010 National Healthcare Quality & Disparities Reports (US) – Agency for Healthcare Research & Quality – February 2011

Posted on March 1, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Status, Public Hlth & Hlth Promotion | Tags: , |

2010 National Healthcare Quality & Disparities Reports (US) – Agency for Healthcare Research & Quality – February 2011

“For the eighth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. New this year are chapters on care coordination, health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.

The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations. The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.”

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