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Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths among Medicare Patients in Michigan Intensive Care Units

Electronic Newsletter, Issue 306

February 10, 2011

AHRQ News and Numbers

Roughly 3.4 million emergency department visits—an average of 9,400 a day—were specifically for back problems at U.S. hospitals in 2008. In the same year, there were over 663,000 inpatient stays—a daily average of nearly 1,820—principally for back surgery or other back disorder treatments. The overall costs for inpatient stays principally for back problems was over $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals. [Source: Agency for Healthcare Research and Quality (AHRQ), HCUP Statistical Brief #105: Emergency Department Visits and Inpatient Stays Related to Back Problems, 2008.]

Today's Headlines

  1. Landmark initiative to reduce healthcare-associated infections cuts deaths among Medicare patients in Michigan intensive care units
  2. New AHRQ resource helps to improve nursing home care
  3. AHRQ releases report on checklists for chronic risk factors
  4. CME offered on in-hospital off-label uses of recombinant factor VIIa
  5. AHRQ women's health updates are available
  6. Vision screening in children ages 1-5
  7. AHRQ's Health Care Innovations Exchange focuses on mental illness and care coordination
  8. New AHRQ evidence report on value of pretesting autoimmune disorder patients before prescribing thiopurine drugs unclear is available
  9. Highlights from our most recent monthly newsletter
  10. AHRQ director helps consumers navigate the health care system in a new advice column on the Web
  11. AHRQ in the professional literature

1. Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths among Medicare Patients in Michigan Intensive Care Units

Older Americans who were treated in Michigan intensive care units (ICUs) saw larger decreases in their likelihood of dying while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new AHRQ-funded study evaluating an innovative quality improvement initiative. The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce (HAIs). This study, "Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis," published in British Medical Journal, is the first to link these programs to reduced death rates. Researcher led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern States. Select to read our press release.

2. New AHRQ Resource Helps to Improve Nursing Home Care

A new AHRQ resource could help nursing homes improve the services they provide to their residents. The On-Time Quality Improvement Program Manual presents a practical approach to establish and maintain quality improvement. The manual provides an overview of the tools, key action steps, implementation tips, and firsthand knowledge from current program users about what works best. It targets State health departments, Quality Improvement Organizations or QIOs, nursing home decisionmakers addressing quality improvement priorities and the frontline staff providing the care. Another key component is the effective use of health information technology for clinical decisionmaking to identify and treat high-risk residents much earlier. The manual helps to reorganized nursing home operations and identify essential quality improvement elements needed in coordinating members of a multidisciplinary team with clear performance roles to improve efficiency and promote better clinical outcomes. 

3. AHRQ Releases Report on Quality Criteria for Evaluating Incidence, Prevalence or Risk Factor Studies

AHRQ's Effective Health Care Program has released a new report titled, Development of Quality Criteria To Evaluate Nontherapeutic Studies of Incidence, Prevalence, or Risk Factors of Chronic Diseases: Pilot Study of New Checklists. The project's objective was development of two checklists for the quality of observational studies of incidence or risk factors of diseases. Authors proposed transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence. Select to access the report.

4. CME Offered on In-Hospital Off-Label Uses of Recombinant Factor VIIa

A continuing medical education (CME) module offered by AHRQ's Effective Health Care (EHC) Program, Comparative Effectiveness of In-Hospital Off-Label Use of Recombinant Factor VIIa vs. Usual Care, offers an AMA PRA Category 1 Credit™ based on a comparative study of the utilization and effectiveness of the use of rFVIIa. The study found that current evidence does not show that off-label use of rFVIIa reduces mortality or improves other direct outcomes. Thromboembolic events are increased by use of rFVIIa to threat spontaneous intracranial hemorrhage and in adult cardiac surgery. The EHC program also offers a guide for clinicians, Utilization and Clinical Data on In-Hospital Off-Label Uses of Recombinant Factor VIIa.

5. AHRQ Women's Health Updates Are Available

AHRQ has issued three program briefs.

6. Vision Screening in Children Ages 1-5

In an update to its 2004 recommendation, the U.S. Preventive Services Task Force now recommends vision screening in all children at least once during the ages of 3 to 5 years to detect the presence of amblyopia or its risk factors. The Task Force found that the current evidence is insufficient to assess the balance of benefits and harms of vision screening in children younger than 3 years of age. The recommendation was published in the February issue of Pediatrics. Select to access the recommendation

7. AHRQ's Health Care Innovations Exchange Focuses on Mental Illness and Care Coordination

In this week's issue, AHRQ's Health Care Innovations Exchange Web site focuses on care coordination for people with mental illness. The featured Innovations describe three programs that used care coordinators to assess, monitor, and connect individuals with mental illness to needed services. The featured Quality Tools help providers improve communication and care coordination for individuals with mental illness. Select to read this issue and more on the AHRQ Health Care Innovations Exchange Web site.

8. New AHRQ Evidence Report on Value of Pretesting Autoimmune Disorder Patients before Prescribing Thiopurine Drugs Unclear Is Available

According to the authors of a new AHRQ evidence report, there is insufficient evidence to determine whether patients with autoimmune diseases such as Crohn's Disease have better outcomes if they are pretested for levels of the TPMT enzyme prior to clinicians prescribing a dosage for thiopurine-based medication. The report sought to determine if TPMT pretesting reduces drug-related adverse effects. Experts have proposed that patients with either intermediate, low, or absent TPMT enzyme activity (reduced detoxifying metabolism) may benefit from lower initial doses of thiopurine drugs because higher doses may cause toxic reactions such as the reduction of white blood cell and platelet count in the bone marrow. Testing patients' TPMT status prior to starting thiopurine drugs, such as Azasan® and Imuran®, has been recommended. The authors, led by Ronald A. Booth, Ph.D., of AHRQ's University of Ottawa Evidence-based Practice Centre in Ottawa, Ontario, said that it is unclear whether pretesting guides appropriate prescribing. Select to access the report, .

9. Highlights from Our Most Recent Monthly Newsletter

The February issue of Research Activities is available online. Key articles include:

  • Emergency departments have increasingly become the health care safety net for adults insured by Medicaid.

    Emergency departments must provide care to all regardless of the ability to pay or insurance coverage. Part of the national medical safety net, emergency departments are often the last resort for the underinsured and uninsured. A new study of emergency departments visits found that visits to emergency departments have increased significantly since the 1990s, yet the number of emergency departments has actually declined. In addition, emergency departments have increasingly become the health care safety net for adults insured by Medicaid. Emergency departments visit rates did not increase for the privately insured, uninsured, and adults covered by Medicare. Select to read this article.

Other articles include:

  • Trauma care costs less at hospitals with lower mortality rates.
  • Pilot study finds a low level of medication errors for look-alike, sound-alike drugs prescribed for children.
  • Primary care physicians' performance ratings depend on the makeup of their patient population.

Select to read these articles and others.

10. AHRQ Director Helps Consumers Navigate the Health Care System in a New Advice Column on the Web

AHRQ Director Carolyn M. Clancy, M.D., offers advice to consumers in new, brief, easy-to-understand columns. The columns will help consumers better navigate the health care system. Select to read Dr. Clancy's advice column on heart health.

11. 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.

Haukoos JS, Witt MD, Lewis RJ. Derivation and reliability of an instrument to estimate medical benefit of emergency treatment. Am J Emerg Med 2010 May; 28(4):404-11. Select to access the abstract on PubMed®.

Kesselheim AS, Stedman MR, Bubrick EJ, et al. Seizure outcomes following the use of generic versus brand-name antiepileptic drugs: a systematic review and meta-analysis. Drugs 2010 Mar 26; 70(5):605-21. Select to access the abstract on PubMed®.

Stenger RJ, Devoe JE. Policy challenges in building the medical home: do we have a shared blueprint? J Am Board Fam Med 2010 May-Jun; 23(3):384-92. Select to access the abstract on PubMed®.

Sarkar U, Karter AJ, Liu JY, Moffet HH, Adler NE, Schillinger D. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 2010 May 18; Epub. Select to access the abstract on PubMed®.

Lakshminarayan K, Borbas C, McLaughlin B, et al. A cluster-randomized trial to improve stroke care in hospitals. Neurology 2010 May 18; 74(20):1634-42. Select to access the abstract on PubMed®.

Nguyen-Oghalai TU, Kuo YF, Wu H, et al. The impact of race/ethnicity on preoperative time to hip stabilization procedure after hip fracture. South Med J 2010 May; 103(5):414-18. Select to access the abstract on PubMed®.

Contact Information

Please address comments and questions regarding the AHRQ Electronic Newsletter to Nancy Comfort at or (301) 427-1866.

This service is provided to you at no charge by the Agency for Healthcare Research and Quality AHRQ).

Page last reviewed February 2011
Internet Citation: Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths among Medicare Patients in Michigan Intensive Care Units. February 2011. Agency for Healthcare Research and Quality, Rockville, MD.


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