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Braithwaite, R.S., Fridsma, D., and Roberts, M.S. (2006, March). "The cost-effectiveness of strategies to reduce mortality from an intentional release of aerosolized anthrax spores." (AHRQ Contract No. 290-00-0009). Medical Decision Making 26, pp. 182-193.
Strategies to reduce deaths from anthrax attacks are cost-effective only if large exposures are certain. Also, a faster response is more beneficial than enhanced surveillance. The investigators used computer simulation of a 100,000-person single-site exposure (worst case scenario) and a 100-person multiple-site exposure (resembling a recent U.S. attack). For each scenario, they compared universal vaccination and an emergency surveillance and response (ESR) system with a default strategy that assumed eventual discovery of the exposure to aerosolized anthrax spores. They concluded that, if an exposure was unlikely to occur or was small in scale, neither vaccination nor an ESR system was cost-effective. If an exposure was certain and large in scale, an ESR system was more cost-effective than vaccination ($73 vs. $29,600 per life-year saved), and that a rapid response saved more lives than improved surveillance.
Darby, C., Crofton, C., and Clancy, C.M. (2006, March/April). "Consumer assessment of health providers and systems (CAHPS®): Evolving to meet stakeholder needs." American Journal of Medical Quality 21(2), pp. 144-147.
This paper describes how the Consumer Assessment of Health Providers and Systems (CAHPS®) surveys have evolved over time to meet stakeholder needs. The first survey assessed how members of health plans evaluated their quality of care and their health plans. The surveys were eventually expanded to include other stakeholders beyond health care consumers. The 30 surveys developed or in development target stakeholders including health care accrediting organizations, individual providers, providers in group practice, and different patient groups, such as children with special health care needs or people with mobility impairments.
CAHPS® II provides reporting guidance to stakeholders through its TalkingQuality Web site (https://www.talkingquality.ahrq.gov). It offers research findings, real-world examples, and innovative strategies for communicating complex health quality information to consumers. Reprints (AHRQ Publication No. 06-R047) are available from the AHRQ Publication Clearinghouse.
Feifer, C., Ornstein, S.M., Jenkins, R.G., and others (2006, March). "The logic behind a multimethod intervention to improve adherence to clinical practice guidelines in a nationwide network of primary care practices." (AHRQ grants HS11132 and HS13716). Evaluation & The Health Professions 29(1), pp. 65-88.
Guidelines are more likely to be implemented if interventions address clinical practice motivations and clinicians' abilities to focus on new tasks in an already busy workday, note the authors of this paper. They describe the logic behind a multimethod intervention to increase adherence to clinical guidelines among practices in a nationwide network of primary care practices. The network specializes in quality improvement research and uses a common electronic medical record. Practice performance reports, site visits, and network meetings are a few intervention methods designed to stimulate improvement in practices by addressing personal and organizational factors. The researchers describe theories and evidence supporting these interventions, which they believe could prove useful to others trying to translate medical research into practice.
Fischer, I.D., Krauss, M.J., Dunagan, W.C., and others (2005, October). "Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital." (AHRQ Grant HS11898). Infection Control and Hospital Epidemiology 26, pp. 822-827, 2005.
Fall frequency and rates of fall-related injury vary substantially by hospital department. Researchers found that the median age of patients who fell at an urban hospital was 62 years and half of those who fell were women and 20 percent were confused. The overall hospital fall rate was 3.1 falls per 1,000 patient days, which varied by service from 0.86 (women and infants) to 6.36 (oncology) per 1,000 patient days. About 6 percent of the falls resulted in serious injury, ranging by service from 3.1 percent (women and infants) to 10.9 percent (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6 percent), fracture or dislocation (15.9 percent), and hematoma or contusion (13 percent).
After adjusting for other factors that might affect falls, patients 75 years or older were over 3 times more likely to sustain serious fall-related injuries than other patients and those on the geriatric psychiatry floor were nearly 3 times more likely. Advanced age may serve as a marker for conditions that increase the risk of falls and related injuries. Also, health conditions common to geriatric psychiatry patients, such as Parkinson's disease and Alzheimer's disease, may contribute to falls. The findings were based on a retrospective analysis of 1,235 inpatient falls, which were documented in an online adverse event reporting database at an urban hospital in 2001 and 2002.
Gross, R., and Harrison, M.I. (2006). "Responses of Israeli HMOs to environmental change following the national health insurance law: Opening the black box." Health Policy 76, pp. 213-232.
The National Health Insurance (NHI) Law of 1995 introduced managed competition into the Israeli health care system by radically transforming HMO regulatory and competitive environments. This study analyzed the strategies developed by two Israeli HMOs in response to this change. The two HMOs developed comparable strategies, but diverged from one another in important ways, which the authors describe. Their analysis highlights how the interaction among organizational history, managerial choice, and environmental constraints created divergence in organizational responses to national policy initiatives. They suggest involving provider organizations in structuring of reform or simulating their response in advance, based on expert knowledge of their strategic repertoires. They also recommend including mechanisms for obtaining feedback on organizational responses when implementing reforms. Reprints (AHRQ Publication No. 06-R041) are available from the AHRQ Publication Clearinghouse.
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 policymakers. 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 the AHRQ Publication Clearinghouse.
McNeill, D., Moy, E., and Clancy, C.M. (2006, May). "The Agency for Healthcare Research and Quality's National Healthcare Quality and Disparities Reports: Action agendas for the nation." American Journal of Medical Quality 21(3), pp. 206-209.
This paper highlights trends documented in the 2005 National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The NHQR reveals that care quality continues to improve at a modest pace of 2.8 percent. Care quality is most improved (median of 10 percent) for diabetes, heart disease, respiratory conditions, nursing home care, and maternal and child health care. It is least improved for HIV/AIDS, cancer, end-stage renal disease, mental health, substance abuse, and home health care (median 0.3 percent). According to the NHDR, health care disparities related to race, ethnicity, and socioeconomic status still pervade the American health care system. For example, blacks received poorer quality of care than whites did in 43 percent of core measures and American Indians and Alaska Natives received poorer quality care than whites did in 38 percent of measures. While these disparities are narrowing for many minority Americans, they are widening for Hispanics and care access disparities are growing as well. Reprints (AHRQ Publication No. 06-R048) are available from the AHRQ Publication Clearinghouse.
Nast, P.A., Avidan, M., Harris, C.B., and others (2005, October). "Reporting and classification of patient safety events in a cardiothoracic intensive care unit and cardiothoracic postoperative care unit." (AHRQ grant 11898). Journal of Thoracic and Cardiovascular Surgery 130(4), pp. 1137-1143.
A study of the Intensive Care Unit Safety Reporting System (ICUSRS) at a cardiothoracic intensive care unit (ICU) and postoperative care unit in 1 hospital resulted in a total of 163 reports describing 157 patient safety events over a 6-month period. This included 121 events reported from the ICU (25.3 reported events per 1,000 patient-days)—a 3-fold increase in reported safety events over the hospital's preexisting online safety reporting system. A total of 113 reports (69 percent) came from nurses, 31 from physicians (19 percent), and 10 from other staff (6 percent). A majority of events (54 percent) reached the patient, but caused no harm. Health care workers identified multiple causes for the majority of events. The most frequent causes were related to human factors (48 percent) and organizational factors (34 percent).
The ICUSRS differed from the hospital's preexisting Risk Management Online Event/Incident Entry system in several ways. All health care workers had easy access to the ICUSRS, reporting forms could be carried easily and completed quickly in any location, reporting was completely voluntary, and reports could be submitted anonymously.
Weiner, R.J., Alexander, J.A., Baker, L.C., and others (2006, February). "Quality improvement implementation and hospital performance on patient safety indicators." (AHRQ grant HS11317). Medical Care Research and Review 63(1), pp. 29-57.
This study assessed the association between the scope of hospital involvement in hospital quality improvement (QI) activity and four hospital-level indicators of patient safety (postoperative complications, technical adverse events, technical difficulty with procedures, and failure to rescue). Involvement by multiple hospital units in the QI effort was associated with lower values on all four patient safety indicators. Percentages of hospital staff and senior managers participating in QI teams showed no significant association with any patient safety indicators. However, the percentage of physicians participating in QI teams was associated with higher values on two patient safety indicators. These findings were based on a 1997 quality improvement survey of 1,784 community hospitals, as well as other surveys and databases.
Zinn, J., Spector, W., Hsieh, L., and Mukamel, D. (2005, December). "Do trends in the reporting of quality measures on the Nursing Home Compare web site differ by nursing home characteristics?" Gerontologist 45(6), pp. 720-730.
A new study by William Spector, Ph.D., of the Agency for Healthcare Research and Quality, and colleagues found a clear downward trend of quality measures in nursing homes for pain, physical restraints, and delirium. The researchers used information obtained from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Web site (http://www.medicare.gov/NHCompare). The site includes quality-deficiency citations issued by State inspectors, staffing levels, a set of care quality measures (QM), and basic facility characteristics. Researchers compared the relationship between an initial set of 10 QMs for both post-acute, short-stay residents and long-term care residents and for 5 nursing home structural characteristics: ownership, chain affiliation, size, occupancy, and hospital-based versus freestanding status.
Declines between the first QM reporting period (April to June 2002) and the fifth period (April to June 2003) ranged from 12.7 percent to 46 percent. For-profit and chain-affiliated facilities appeared to do better on QMs for short-stay postacute residents. Small, independent, nonprofit, high-occupancy facilities performed better on QMs for long-term residents. Reprints (AHRQ Publication No. 06-R019) are available from the AHRQ Publication Clearinghouse.
Current as of July 2006
AHRQ Publication No. 06-0066