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August 25, 2006, Issue No. 208
AHRQ News and Numbers
The percentage of employees at large companies who were eligible for health insurance and who enrolled in plans fell from 87 percent in 1996 to 80 percent in 2004. The steepest decline occurred among employees of large retail firms—from 81.5 percent to 69 percent. Enrollment of eligible workers in other types of large, private-sector firms also declined, but more modestly. [Source: Agency for Healthcare Research and Quality, MEPS, Establishment Survey of Employer-Based Health Insurance.]
- President Bush Issues Executive Order on Health Care Transparency
- Latest Issue of AHRQ WebM&M Available Online
- AHRQ Releases New Issue Brief on Mass Prophylaxis
- Special AHRQ-Funded Journal Issue Highlights Lessons From High-Reliability Organizations
- AHRQ's HCUP 2004 Nationwide Inpatient Sample Is Now Available
- AHRQ's HCUP/MEPS Data Users' Workshop Set for September 6-8
- AHRQ's Healthcare Cost and Utilization Project and the American Public Health Association Continuing Education Institute Seminar Set for November 4
- AHRQ in the Professional Literature
1. President Bush Issues Executive Order on Health Care Transparency
On August 22, President Bush signed an Executive Order to promote federally led efforts to implement more transparent and high-quality health care. The purpose of this Executive Order is to ensure that health care programs administered or sponsored by the Federal Government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health care quality and price, and better incentives for program beneficiaries, enrollees, and providers.
This Executive Order also makes relevant information available to beneficiaries, enrollees, and providers in a readily useable manner and in collaboration with similar initiatives in the private sector and non-Federal public sector. Measures of quality at the provider and health plan level will be developed from private and government sources and will not involve developing or releasing data at the individual patient level. Consumers will be able to access information from a variety of potential sources, including insurance companies, employers, and Medicare-sponsored Web sites. Select to access the Executive Order.
2. Latest Issue of AHRQ WebM&M Available Online
The August 2006 issue of AHRQ WebM&M is now available online. This month, the Perspectives on Safety section offers reflections on the history of the patient safety movement from two of its pioneers: Lucian Leape, M.D., of Harvard University, and Jeff Cooper, Ph.D., an expert in biomedical engineering, anesthesia, and safety at Harvard.
In the first Spotlight Case, an admitting physician, a night float resident, and the daytime team all fail to provide a genitourinary exam on a patient with paraplegia. The attending physician later examines him and discovers that the patient has a life-threatening necrotizing fasciitis. The commentary discusses the decline in proficiency of and reliance on physical examination skills among health care providers. The authors are George Thompson III, M.D., and Abraham Verghese, M.D., from the University of Texas Health Sciences Center, San Antonio. In the second case, an ambulatory patient with diabetes presents with high blood sugar, and the nurse practitioner orders insulin. After administration, she discovers that she injected the insulin with a tuberculin rather than an insulin syringe, resulting in a 10-fold overdose. In the third case, in anticipation of discharge, a patient's opiate medication is changed from an immediate-release to a long-acting form—but the dose is incorrectly converted, resulting in an overdose. The patient develops respiratory distress and requires a 2-week stay in the ICU. Commentary authors are Saul Weingart, M.D., Ph.D., of Dana Farber Cancer Institute and Scott Strassels, Pharm.D., Ph.D., of University of Texas at Austin.
A Spotlight slide presentation is available for download, as always, and you can receive CME, CEU, or trainee certification by taking the Spotlight Quiz. All previously published commentaries are available under "Case Archive." Please submit cases to AHRQ WebM&M via the "Submit Case" button.
3. AHRQ Releases New Issue Brief on Mass Prophylaxis
AHRQ released Bioterrorism and Health System Preparedness Issue Brief No. 10 entitled, Mass Prophylaxis: Building Blocks for Community Preparedness. This issue brief examines the health care system's ability to administer mass prophylaxis and explains elements typically found within local mass prophylaxis plans. The goal of this information is to give local communities the information and capability to respond to public health emergencies in real time. Developing the capability to respond effectively is a challenge for local health systems and for the communities they serve.
4. Special AHRQ-Funded Journal Issue Highlights Lessons From High-Reliability Organizations
The August special issue of Health Services Research, funded by AHRQ, features 11 articles on lessons from high-reliability organizations (HROs)—those that experience fewer-than-expected medical errors. The special issue includes a foreword by AHRQ Director Carolyn M. Clancy, M.D., and five articles by AHRQ researchers.
"Keeping our Promises: Research, Practice, and Policy Issues in Health Care Reliability," A Special Issue of Health Services Research, is the result of a February 2004 meeting that AHRQ co-sponsored with the American Hospital Association's Health, Research and Educational Trust, and the Hospital and Healthsystem Association of Pennsylvania. The meeting also resulted in the development and support of an AHRQ HRO Learning Network, which is comprised of 19 health care systems from across the United States.
The articles in the special issue address several important research and policy issues, including principles of reliability, patterns of behavior that constitute an organization's culture, and, the translation of reliability theory to practice. Following are links to abstracts of several key articles featured in the issue:
- Organizational Silence and Hidden Threats to Patient Safety, by Kerm Henriksen and Elizabeth Dayton. Select to access the abstract in PubMed®.
- Sensemaking of Patient Safety Risks and Hazards, by James B. Battles, Nancy M. Dixon, Robert J. Borotkanics, Barbara Rabin-Fastmen, and Harold S. Kaplan. Select to access the abstract in PubMed®.
- Struggling to Invent High-Reliability Organizations in Health Care Settings: Insights from the Field, by Nancy M. Dixon and Marjorie Shofer. Select to access the abstract in PubMed®.
- Improving Patient Safety in Hospitals: Contributions of High-Reliability Theory and Normal Accident Theory, by Michal Tamuz and Michael I. Harrison. Select to access the abstract in PubMed®.
Limited copies of the above articles are available by sending an E-mail to firstname.lastname@example.org.
5. AHRQ's HCUP 2004 Nationwide Inpatient Sample Is Now Available
AHRQ's Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) featuring 2004 data has been released. This inpatient care database includes all patients, regardless of payer—including people covered by Medicare, Medicaid, private insurance, and the uninsured. The data can be weighted to produce national estimates, allowing researchers and policymakers to use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.
As part of the HCUP database family, the NIS is considered by health services researchers to be one of the most reliable and affordable databases for studying important health care topics. Select for additional information on the HCUP NIS, including how to purchase the data.
6. AHRQ's HCUP/MEPS Data Users' Workshop Set for September 6-8
AHRQ is conducting a 3-day workshop to facilitate the health services research community in using data from two AHRQ databases: the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project. The workshop will provide researchers with information on the components and capabilities of the two databases and will teach participants how to extract data for research projects. The workshop will be held at AHRQ's Eisenberg Building, 540 Gaither Road, Rockville, MD. Participants will have the opportunity to bring up specific research questions. This workshop combines lecture (1st day) and hands-on components (2nd and 3rd days). Select for registration and more information.
7. AHRQ's Healthcare Cost and Utilization Project and the American Public Health Association Continuing Education Institute Seminar Set for November 4
The American Publican Health Association and AHRQ are sponsoring a half-day workshop on November 4 in Boston, MA, on the Healthcare Cost and Utilization Project (HCUP). The purpose of this workshop is to introduce health services and policy researchers to HCUP and provide them with the foundational resources to apply HCUP data to their research interests.
Sponsored by AHRQ, HCUP captures information on 90 percent of all hospital stays in the U.S., and is the largest collection of longitudinal, all-payer, encounter-level data available to researchers. It is a family of databases, software tools, and products that enable health services research and policy analysis focusing on hospital, ambulatory surgery, and emergency department encounters.
8. AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.
Sedrakyan A, Zhang H, Treasure T, et al. Recursive partitioning-based preoperative risk stratification for atrial fibrillation after coronary artery bypass surgery. Am Heart J 2006 Mar;151(3):720-5. Select to access the abstract in PubMed®.
Baker DW, Sudano JJ, Durazo-Arvizu R, et al. Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992-2002. Med Care 2006 Mar;44(3):277-82. Select to access the abstract in PubMed®.
Feifer C, Ornstein SM, Jenkins RG, et al. The logic behind a multimethod intervention to improve adherence to clinical practice guidelines in a nationwide network of primary care practices. Eval Health Prof 2006 Mar;29(1):65-88. Select to access the abstract in PubMed®.
Rogers MA, Langa KM, Kim C, et al. Contribution of infection to increased mortality in women after cardiac surgery. Arch Intern Med 2006 Feb 27;166(4):437-43. Select to access the abstract in PubMed®.
Scott LD, Hwang WT, Rogers AE. The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses. J Nurs Admin 2006 Feb;36(2):86-95. Select to access the abstract in PubMed®.
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Current as of August 2006