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December 22, 2006, Issue No. 216
AHRQ News and Numbers
The first Federal analysis in a decade of sickle cell disease hospitalizations shows that admissions of adults remained stable from 1997 to 2004. In 2004, roughly 83,000 hospital stays were for adults and 30,000 were for children. Of the latter, 2,000 stays were for infants. Patients spent about 5 days in the hospital, which cost an average of $6,223 per stay. Total hospital costs were nearly $500 million overall in 2004. [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief No. 21: Sickle Cell Disease Patients in U.S. Hospitals, 2004].
- City Versus City: When It Comes to Health Insurance Costs, Geography Matters
- Physicians' Extended Work Shifts Associated With Increased Risk of Medical Errors That Harm Patients
- Latest Issue of AHRQ WebM&M Available Online
- AHRQ's Healthcare 411 Audio Program Highlights Research on Extended Work Shifts for Interns and Risk of Medical Errors
- New Evidence Report on Methods for Toilet Training Is Available
- New Evidence Report on Heparin Is Available
- Do You Know How AHRQ's Research Is Being Used?
- Calling All AHRQ Researchers! "Help Us to Help You."
- AHRQ in the Professional Literature
1. City Versus City: When It Comes to Health Insurance Costs, Geography Matters
AHRQ has developed a database that for the first time allows companies, consumers, health care analysts and others to compare health insurance costs between the nation's largest cities and other geographical areas. This new metropolitan area data table provides comparable statistics on average annual costs for companies and workers contributing to private-sector health insurance.
The estimates, which are from AHRQ's Medical Expenditure Panel Survey for 2004—the most current data—show large geographical variations in how much Americans pay for family coverage and individual coverage as well as how much employers contribute to workers' health insurance premiums.
The data include statistical averages from the following cities and surrounding areas: New York; Los Angeles; Chicago; Philadelphia; Dallas-Fort Worth; Miami; Houston; Washington, DC; Atlanta; Detroit; Boston; San Francisco; Riverside; Phoenix; Seattle; Minneapolis; San Diego; St. Louis; Baltimore; and Tampa. Select to access our press release and to access the data.
2. Physicians' Extended Work Shifts Associated With Increased Risk of Medical Errors That Harm Patients
First-year doctors-in-training reported that working five extra-long shifts—of 24 hours or more at a time without rest—per month led to a 300 percent increase in their chances of making a fatigue-related, preventable adverse event that contributed to the death of a patient. Preventable adverse events are defined as medical errors that cause harm to a patient. Interns were three times more likely to report at least one fatigue-related preventable adverse event during months in which they worked between one and four extended-duration shifts.
In months in which they worked more than five extended-duration shifts, the doctors were seven times more likely to report at least one fatigue-related, preventable adverse event and were also more likely to fall asleep during lectures, rounds, and clinical activities, including surgery. The study, funded by AHRQ and CDC's National Institute for Occupational Safety and Health, was published on December 12 in the online journal PLoS Medicine. Select to access our press release.
3. Latest Issue of AHRQ WebM&M Available Online
The December issue of AHRQ WebM&M is available online. This month, the Perspectives on Safety section looks at the culture of safety. Timothy J. Hoff, Ph.D., an organizational management expert at the State University of New York at Albany, offers his perspective on establishing a safety culture, particularly in teaching settings. An interview with J. Bryan Sexton, Ph.D., Johns Hopkins in Baltimore is on efforts to measure and improve safety culture.
In the Spotlight Case, a woman with multiple medical problems is diagnosed with heparin-induced thrombocytopenia, but is mistakenly exposed to heparin flushes during dialysis. The commentary, authored by Patrick F. Fogarty, M.D., of the University of California, San Francisco, discusses the HIT strategies to prevent the risks of morbidity and mortality in patients with HIV. It also highlights the point that not all dangerous medications are found only in the pharmacy.
In the second case, a young woman with borderline personality disorder hospitalized following a suicide attempt is allowed to leave the hospital and attempts suicide again. In the third case, a man admitted to the hospital for elective surgery has blood drawn. Despite a policy for proper identification, the blood samples were mislabeled with another patient's name.
Commentary authors are John M. Oldham, M.D., of Medical University of South Carolina and Michael Astion, M.D., Ph.D. of the University of Washington in Seattle. 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.
4. AHRQ's Healthcare 411 Audio Program Highlights Research on Extended Work Shifts for Interns and Risk of Medical Errors
This week's program features Charles Czeisler, M.D. and Laura Barger, Ph.D., explaining their PLoS Medicine study findings that interns who work five or more extra-long hospital shifts in a month are prone to making serious medical errors. The story also includes comments from AHRQ Director Carolyn M. Clancy, M.D. The newscast also announces that R01 grant applications now require electronic submission. And data from MEPS are about the cost of treating adults with diabetes. Select to access this 9-minute audio program.
You can listen to these audio programs directly through your computer—if it has a sound card and speakers and can play MP3 audio files—or you can download it to a portable audio device. In any case, you will be able to listen at your convenience. To access any of AHRQ's newscasts and special reports or to sign up for a free subscription to the series to receive notice of all future AHRQ podcasts, visit our Healthcare 411 series main page.
5. New Evidence Report on Methods for Toilet Training Is Available
AHRQ released a new evidence report that finds there is little research evaluating the effectiveness of toilet training approaches. Most research has studied two methods: the child-oriented or child-readiness (Brazelton) approach, which is based on building an environment that facilitates a child's tendency to become toilet-trained, and the parent-oriented (Azrin and Foxx) approach, which uses training and reinforcement of specific skills.
Most studies compared variations of the same approach rather than directly comparing the two approaches. Both the Brazelton and Azrin and Foxx approaches appear to work well in healthy children. Limited evidence supports that the Azrin and Foxx approach or other programs modified to meet the individual needs of children with behavioral or developmental disabilities are at least partially effective.
Select to review the report. The report was prepared by AHRQ's University of Alberta Evidence-based Practice Center in Edmonton, Canada. A print copy is available by sending an E-mail to email@example.com.
6. New Evidence Report on Heparin Is Available
AHRQ released a new evidence report that finds no strong evidence that the use of heparin to treat burns based on its properties that affect wound healing lead to better clinical outcomes in burn care than other treatments. The absence of strong evidence to support the use of heparin to improve wound healing or decrease pain reflects the poor design and quality of the available studies. Additional well-designed research into heparin use in burn care is necessary.
Select to review the report. The report was prepared by AHRQ's McMaster University Evidence-based Practice Center, Hamilton, Ontario, Canada. A print copy is available by sending an E-mail to firstname.lastname@example.org.
7. Do You Know How AHRQ's Research Is Being Used?
We are always looking for ways in which AHRQ-funded research, products, and tools have changed people's lives, influenced clinical practice, improved policies, and affected patient outcomes. These impact case studies describe AHRQ research findings in action. These case studies are used in testimony, budget documents, and speeches.
We would like to know if you are aware of any impact your AHRQ-funded research has had on health care policy, clinical practice, or patient outcomes. Contact AHRQ's Impact Case Studies Program at Jane.Steele@ahrq.hhs.gov or (301) 427-1244 with your impact stories.
8. Calling All AHRQ Researchers! "Help Us to Help You."
As you may know, AHRQ can help you promote the findings of your research, but we can't do it without you. AHRQ has been successful in working with our grantees and contractors to promote findings to the media and to transfer knowledge based on the research to appropriate audiences in the health care community. However, we know that we can do better.
We need you to notify us when you have an article accepted for publication. Please send a copy of the manuscript, anticipated publication date, and contact information for the journal and your institution's PR office to your AHRQ project officer and to AHRQ Public Affairs at email@example.com. Your manuscript will be reviewed to determine what level of marketing we will pursue. Please be assured that AHRQ always honors the journal embargo. Thank you for your cooperation.
9. 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.
Lockley SW, Landrigan CP, Barger LK, et al. When policy meets physiology: the challenge of reducing resident work hours. Clin Orthop Relat Res 2006 Aug;449:116-27. Select to access the abstract in PubMed®.
Corriveau C, Slonim AD. Improving access to intensive care: is insurance the problem? Crit Care Med 2006 Aug;34(8):2235-6. Select to access the abstract in PubMed®.
Marso SP, Safley DM, House JA, et al. Suspected acute coronary syndrome patients with diabetes and normal troponin-1 levels are at risk for early and late death: identification of a new high-risk acute coronary syndrome population. Diabetes Care 2006 Aug;29(8):1931-2. Select to access the abstract in PubMed®.
Gessert CE, Haller IV, Kane RL, et al. Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life. J Am Geriatr Soc 2006 Aug;54(8):1199-1205. Select to access the abstract in PubMed®.
Conway PH, Edwards S, Stucky ER, et al. Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians. Pediatrics 2006 Aug;118():441-7. Select to access the abstract in PubMed®.
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Current as of December 2006