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Research Briefs

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Barkin, S.L., Scheindlin, B., Brown, C., and others (2005, November-December). "Anticipatory guidance topics: Are more better?" (AHRQ grant HS10913). Ambulatory Pediatrics 5(6), pp. 372-376.

According to this study, pediatricians may need to limit the total number of topics discussed in a single visit so as not to overload parents with information. Researchers examined anticipatory guidance discussions between physicians of 26 practices and 861 parents of children age 2 to 11 years who were seen for a well-child visit. Immediately after the visit, parents and providers completed surveys to record what anticipatory guidance topics were discussed. The parents were asked by telephone 1 month later what they recalled discussing during the well-child visit.

Providers reported discussing the topics of nutrition, use of car restraints, dental care, and reading aloud to children most often (72 to 93 percent). They discussed regular exercise, firearms, and media use at least half of the time. About 20 percent of providers discussed four or fewer topics, 53 percent addressed between five and eight topics, and 29 percent discussed nine or more topics. Parents agreed with providers 72 to 90 percent of the time on topics discussed during the visit. However, parental recall decreased significantly when nine or more topics were discussed. The same trend existed 1 month later.

Freed, J.R., Marcus, M., Freed, B.A., and others (2005, October). "Oral health findings for HIV-infected adult medical patients from the HIV cost and services utilization study." (AHRQ Grant HS08578). Journal of the American Dental Association 136, pp. 1396-1405.

A new study from the HIV Cost and Services Utilization Study (HCSUS), found that most adult patients with HIV rated their oral health as at least "good," but 12 percent rated it as "poor." Dry mouth, often caused by HIV-related conditions and medications, was the most commonly reported symptom (37 percent of patients). Two-thirds (65 percent) of those who were receiving medical care at the time of the study reported having a usual source of dental care. About half (52 percent) had dental insurance; 29 percent had dental coverage under Medicaid; and 23 percent had coverage from private insurance. About 18 percent of patients with HIV had not revealed their HIV status to the dentist they usually saw. More than 60 percent of those with HIV had visited a dentist in the preceding 12 months. However, 13 percent had not visited a dentist in 2 to 5 years, and 9 percent had not seen a dentist in more than 5 years.

One-fourth of patients with HIV said they needed dental care, but had not received it. The majority were satisfied with the dental care they received. Although 84 percent felt they could trust their own dentists to keep their HIV status confidential, 8 percent did not trust their dentist to do so and 8 percent were unsure.

Lambert, B.L., Lin, S-J., and Tan, H.K. (2005). "Designing safe drug names." (AHRQ grant HS11609). Drug Safety 28(6), pp. 495-512.

Confusion among drug names that look and sound alike contributes to medication errors in community pharmacies. The authors of this paper outline a systematic approach to the design of safe drug names that will not be confused with existing names. They identify and define the most important constraints (both technical and legal/regulatory) and objectives (such as meaning, memorability, and pronounceability) that a drug name must satisfy. They also critique methods for evaluating a given name with respect to each safety objective and constraint.

Marcus, M., Yamamota, J.M., Der-Martirosian, C., and others (2005, October). "National estimates of out-of-pocket dental costs for HIV-infected users of medical care." (AHRQ Grant HS08578). Journal of the American Dental Association 136, pp. 1406-1414.

A new study from the HIV Cost and Services Utilization Study (HCSUS), found that the out-of-pocket costs for U.S. dental care in 1996 were $157 per person at the poverty level and $229 for people with higher incomes. Patients with HIV averaged $152 in out-of-pocket costs for dental care in 1996, with 135,000 patients spending a total of $20.5 million on dental care. White patients with HIV spent an average of $220, Hispanics $101, and blacks $55. Those who received dental care from private dentists spent $232 compared with $7 spent by those who received care in AIDS clinics.

Patients with HIV who had private dental insurance spent $213 annually, while those without insurance and not eligible for Medicaid spent $246. People living in States with adult Medicaid dental benefits spent an average of $47 out of pocket compared to $84 spent by those living in States without such benefits.

McNamara, P. (2006, February). "Foreword: Payment matters? The next chapter." Medical Care Research and Review 63(1S), pp. 5S-10S.

The Agency for Healthcare Research and Quality joined with the journal Medical Care Research and Review and a team of guest editors in an experiment to expedite the transfer of research on quality-based payment to public and private purchasers. The effort involved aggressive, systematic outreach to research teams across the country in an attempt to identify early findings, some based on partial data, appropriate for peer review and translation. This paper is the foreword to the journal supplement featuring the findings contributed by five research teams. The supplement also includes commentaries from employers, providers, and policy makers. The commentators were asked to interpret the new findings from their particular perspective and, more broadly, share their views on the advantages and disadvantages of this particular research-to-practice experiment of identifying, distilling, and packaging early findings. Reprints (AHRQ Publication No. 06-R050) are available from AHRQ Publications Clearinghouse.

McNamara, P. (2006, June). "Purchaser strategies to influence quality of care: From rhetoric to global applications." Quality and Safety in Health Care 15, pp. 171-173.

The global purchaser community knows little about the quality of health goods and services it buys. However, this is slowly starting to change. This paper describes and gives examples of three types of purchasers' strategies to influence the quality and safety of care. These include selective contracting based on quality, payment differentials based on quality, and sponsorship of comparative provider report cards. The ultimate goal of the authors is to encourage thoughtful discussion about whether or not one or more purchaser strategies might support a particular country's goals to improve care. They include experiences from both developed and developing countries to provide a broad perspective and facilitate the discussion. Reprints (AHRQ Publication No. 06-R051) are available from AHRQ Publications Clearinghouse.

Rogers, G., Alper, E., Brunelle, D., and others (2006, January). "Reconciling medications at admission: Safe practice recommendations and implementation strategies." (AHRQ Grant HS11928). Journal on Quality and Patient Safety 32(1), pp. 37-50.

This article describes how several groups in the State of Massachusetts adopted a set of safe practices for reconciling medications during hospital admission. Reconciling medication is a formal process for creating a complete and accurate list of all pre-admission medications for each patient and comparing the physician's admission, transfer, and/or discharge medication orders against that list. Medication discrepancies are brought to the attention of the physician and, if appropriate, changes are made to the orders and are documented.

The reconciling process was tested at 50 Massachusetts acute care hospitals. The 20 hospitals submitting baseline data had an average of 59 percent of medications unreconciled prior to implementing this safe practice recommendation. About 20 percent of the hospitals demonstrated success in spreading the practice throughout most of their organization within the 18-month time period, and 64 percent reported on the survey that they had a standardized reconciling form in use. Three hospitals that consistently followed the protocol averaged an 85 percent reduction in unreconciled medications over a 10-month period.

Sexton, J.B., Helmreich, R.L., Neilands, T.B., and others (2006). "The safety attitudes questionnaire: Psychometric properties, benchmarking data, and emerging research." (AHRQ grant HS11544).BMC Health Services Research 6. (www.biomedcentral.com/1472-6963/6/44)

The authors of this study analyzed the reliability of the Texas Safety Attitudes Questionnaire (SAQ) to assess providers' perceptions of six patient safety-related areas. These included teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. The researchers analyzed questionnaire responses by 10,843 health care providers from 3 countries in numerous clinical areas (including critical care units, operating rooms, inpatient setting, and ambulatory clinics). The SAQ demonstrated good psychometric properties. The researchers conclude that health care organizations can use the survey to measure caregiver attitudes about certain patient safety-related domains. They can also use the SAQ to compare themselves with other organizations, to prompt interventions to improve safety attitudes, and to measure the effectiveness of these interventions.

Singh, H., Petersen, L.A., and Thomas, E.J. (2006, June). "Understanding diagnostic errors in medicine: A lesson from aviation." (AHRQ grant HS11544). Quality and Safety in Health Care 15, pp. 159-164.

Diagnostic errors in medicine are common, harmful to patients, and costly. Preliminary research suggests that diagnostic errors have both cognitive and systems origins. Situational awareness, a model that is primarily used in aviation human factors research, can encompass both the cognitive and the systems roots of such errors, assert the authors of this paper. They illustrate the applicability of this model through analysis of a patient whose diagnosis of spinal cord compression was substantially delayed. They suggest that it is possible that use of such a model in medicine could help reduce errors in diagnosis and lead to significant improvements in patient care. They suggest more research, including the measurement of situational awareness and correlation with health outcomes.

Thomas, E.J., Sexton, J.B., Lasky, R.E., and others (2006, March). "Teamwork and quality during neonatal care in the delivery room." (AHRQ Grant HS11164). Journal of Perinatology 26, pp. 163-169.

The authors of this article indicate that certain teamwork behaviors (communication, management, and leadership) correlate with the quality of neonatal resuscitation in the delivery room. Although these correlations do not confirm a causal relationship, the teamwork behaviors may be used to train providers on how to prevent and manage neonatal resuscitation errors.

Researchers used independent observers to view recorded videos during the resuscitation of infants born by cesarean section and measure 10 teamwork behaviors and compliance with Neonatal Resuscitation Program (NRP) guidelines. All 132 clinical teams exhibited the behaviors of information sharing and inquiry and all but 1 team demonstrated vigilance and workload management. Factor analysis identified communication (information sharing and inquiry), management (workload management and vigilance), and leadership (assertion of opinion, sharing of intentions, assigning of tasks) as weakly but significantly correlated with independent assessments of NRP compliance and an overall rating of quality of neonatal resuscitation care.

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