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January 17, 2003, Issue No. 84
AHRQ News and Numbers
Three ambulatory care sensitive conditions—diabetes with complications, asthma, and urinary tract infection—are among the top 10 common reasons for hospitalization among nonobstetric female patients who are uninsured or covered by Medicaid. These are conditions for which good outpatient care might prevent hospitalization. [Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, HCUP Fact Book #3, 2002.]
- AHRQ-funded study examines risk factors for retained instruments and sponges after surgery
- Study finds patients with hip fracture who leave the hospital too soon are at risk for worse outcomes
- Cultural competence guides for managed care plans available
- AHRQ releases new evidence report on autopsy
- New information in Spanish available
- National Conference on Asthma set for June 2003
- AHRQ in the professional literature
1. AHRQ-funded Study Examines Risk Factors For Retained Instruments and Sponges After Surgery
An AHRQ-funded study in the January 16 issue of the New England Journal of Medicine estimates that a surgical instrument or sponge is left in more than 1,500 patients during surgery each year. Researchers, led by Atul Gawande, M.D., M.P.H., of Brigham and Women's Hospital and Harvard University in Boston, studied 54 patients who had a total of 61 foreign bodies left inside them after surgery. Of the 61 foreign bodies, 69 percent were sponges and 31 percent were surgical instruments. The study found that patients who had emergency surgery were nine times more likely to have a sponge or surgical instrument left in their body; the risk increased by four times for patients who had unplanned changes in their procedure. Patients who had a higher body mass index were found to be more likely to have a foreign body left after surgery. Researchers conclude that a number of techniques are available to reduce the incidence of foreign bodies left in patients after surgery, including counting instruments and sponges before and after procedures and x-raying patients for instruments that may have inadvertently been left behind. Select to access the abstract.
2. Study Finds Patients With Hip Fracture Who Leave the Hospital Too Soon Are At Risk For Worse Outcomes
A new AHRQ-funded study indicates that patients recovering from a hip fracture who had one or more abnormal vital signs, mental confusion, heart or lung problems, or couldn't eat when they were discharged from the hospital had a 360 percent greater chance of dying and a 60 percent greater chance of readmission within 60 days. The study, "Frequency and Impact of Active Clinical Issues and New Impairments on Hospital Discharge in Patients with Hip Fracture," led by Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine in New York, is published in the January 13 issue of the Archives of Internal Medicine. Select to access the press release.
3. Cultural Competence Guides for Managed Care Plans Available
New guides, Providing Oral Linguistic Services and Planning Culturally and Linguistically Appropriate Services, have been developed to assist managed care organizations that choose to address culturally and linguistically appropriate services. The guides were commissioned by CMS and produced by AHRQ's Integrated Delivery Systems Research Network. Select to access a summary of the guides. Print copies are available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
4. AHRQ Releases New Evidence Report on Autopsy
Autopsies continue to detect clinically important diagnostic discrepancies, according to a new evidence report from AHRQ's Evidence-based Practice Center at the University of California at San Francisco-Stanford University. Baed on an analysis of more than 50 studies spanning 40 years, researchers estimate that, in U.S. hospitals in the year 2000, the correct cause of death escaped clinical detection in between 8 percent and 23 percent of cases, with as many as 4 percent to 8 percent of all deaths having a diagnostic discrepancy that may have harmed the patient. In addition to clinically missed diagnoses, up to 5 percent of autopsies disclosed clinically unsuspected complications of care. Select to access the press release and the summary. Print copies of the summary and the full report, The Autopsy as an Outcome and Performance Measure, are available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
5. New Information in Spanish Available
AHRQ has new information and publications available in Spanish. Print copies are available by sending an E-mail to AHRQPubs@ahrq.hhs.gov. Select to access other information available in Spanish.
- Consejos para cuando necesite operarse (Quick Tips—When Planning for Surgery).
- Consejos para cuando necesite pruebas médicas (Quick Tips—Getting Medical Tests).
- Consejos para cuando necesite una receta médica (Quick Tips—Getting a Prescription).
- Consejos—cuando visite a su médico (Quick Tips—Talking with Your Doctor).
- Grupo especial recomienda asesoría dietética para adultos con colesterol alto y otros factores de riesgo de enfermedades crónicas (Task Force Recommends Dietary Counseling for Adults with High Cholesterol and Other Risk Factors for Chronic Disease).
6. National Conference on Asthma Set for June 2003
The National Conference on Asthma will be held June 19-21, 2003, in Washington, DC. The conference, "Meeting the Challenge of Healthy People 2010: Preventing and Controlling Asthma," is sponsored by the National Asthma Education and Prevention Program and coordinated by the National Heart, Lung, and Blood Institute. It will address the asthma and asthma-related objectives of Healthy People 2010, as well as overarching goals to increase years of healthy life and eliminate health disparities. Asthma 2003 will examine a number of topics, including recent trends in asthma management, cutting-edge basic and clinical research, new therapies and medications, the hope of genetics research, patient education and skill building, community-based interventions, the demographics of asthma, and emergency department clinical recommendations. Select to access registration and more information about the conference.
7. 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.
Gidwani PP, Sobol A, DeJong W, et al. Television viewing and initiation of smoking among youth. Pediatrics 2002 Sep;110(3):505-8. Select to access the abstract on PubMed®.
Sarver JH, Cydulka RK, Baker DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med 2002 Sep;9(9):916-23. Select to access the abstract on PubMed®.
Koike AK, Unutzer J, Wells KB. Improving the care for depression in patients with comorbid medical illness. Am J Psychiatry 2002 Oct;159(10):1738-45. Select to access the abstract on PubMed®.
Vitullo MW, Taylor AK. Latino adults' health insurance coverage: an examination of Mexican and Puerto Rican subgroup differences. J Health Care Poor Underserved 2002 Nov;13(4):504-25. Select to access the abstract on PubMed®.
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Current as of January 2003