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AHRQ Releases Training Modules to Help Improve Safety in Nursing Homes

Electronic Newsletter, Issue 351

The AHRQ Electronic Newsletter is issued periodically and summarizes Agency research and programmatic activities.

August 10, 2012

AHRQ Stats

In 2008, elderly veterans were in better health and had lower rates of activity limitation than elderly non-veterans. [Source: Agency for Health Care Research and Quality, MEPS Statistical Brief #370: Health and Insurance Status, Health Care Use, and Expenditures for Male Veterans, 2008: Estimates for the U.S. Civilian Noninstitutionalized Population.]

Today's Headlines

  1. AHRQ releases training modules to help improve safety in nursing homes.
  2. Increased fluid and supplemental treatments may reduce recurrence of kidney stones.
  3. Study profiles patients likely to be readmitted to the hospital for congestive heart failure.
  4. New Closing the Quality Gap evidence reports are available.
  5. AHRQ's Health Care Innovations Exchange focuses on sepsis management.
  6. August issue of AHRQ Web M&M discusses lapses in lab test result follow-up.
  7. Register for AHRQ's MEPS Data Users' Workshop set for September 24-25.
  8. Highlights from the EHC Inside Track newsletter.
  9. Highlights from AHRQ's Research Activities monthly newsletter.
  10. AHRQ in the professional literature.


1. AHRQ Releases Training Modules to Help Improve Safety in Nursing Homes

AHRQ has released a set of training modules to help educate nursing home staff on key patient safety concepts to improve the safety of nursing home residents. The modules, Improving Patient Safety in Long-Term Care Facilities, include:

  • Detecting Change in a Resident's Condition.
  • Communicating Change in a Resident's Condition.
  • Falls Prevention and Management.

Each module features an instructor's guide and a student workbook. Training of nursing home staff, including support for teamwork across specialties, is likely to be effective in reducing medical errors and improving patient safety and can help reduce the number of falls and fall-related injuries. Select to access the modules.


2. Increased Fluid and Supplemental Treatments May Reduce Recurrence of Kidney Stones

Increased fluid intake, reduced soft drink consumption, thiazide diuretics (which lower urinary calcium excretion and prevent calcium-containing kidney stones), citrate pharmacotherapy (citrate naturally prevents kidney stone formation), and allopurinol (used to treat excess uric acid in blood plasma) each decreased the risk of recurrent calcium kidney stones, according to a new research review by AHRQ's Effective Health Care Program. Nephrolithiasis is the clinical term for the formation of hard masses, usually made of calcium crystals, in the kidneys. The research review, Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies, summarizes evidence on the effectiveness and risks of dietary and pharmacological preventive treatments for patients with nephrolithiasis.


3. Study Profiles Patients Likely To Be Readmitted to the Hospital for Congestive Heart Failure

A new AHRQ-funded study suggests characteristics of patients likely to be readmitted to the hospital after an admission for congestive heart failure. Analyzing data from 14 States that participate in AHRQ's Healthcare Cost and Utilization Project (HCUP), researchers determined that congestive heart failure patients with the strongest likelihood of readmission were: discharged against medical advice; covered by Medicaid; and had more severe loss of function and certain comorbidities such as drug abuse, renal failure, or psychoses. High readmission rates for Medicaid patients suggest that State and Federal governments should target these populations for better care coordination to reduce readmissions and health care costs, according to study authors. The study, "Congestive Heart Failure: Who Is Likely to be Readmitted?" was published in the May 31 online issue of Medical Care Research and Review. Select to access the abstract on PubMed.®


4. New Closing the Quality Gap Evidence Reports Are Available

AHRQ released the first two of eight evidence reports in its new series, Closing the Quality Gap: Revisiting the State of the Science. The series is a follow-up to , a collection of seven evidence reports published between 2004 and 2007. The new Closing the Quality Gap series broadens the areas of investigation of the series with regard to settings, interventions, and clinical conditions, while continuing the focus on improving the quality of health care through critical assessment of relevant evidence. Targeting multiple audiences and uses, the new series assembles evidence about strategies aimed at closing the difference between what is expected to work well for patients based on known evidence and what actually happens in day-to-day clinical practice across populations of patients. The first two reports in this new series are:

  • The Patient-Centered Medical Home: Duke University Evidence-based Practice Center researchers found that studies of the Patient-Centered Medical Home (PCMH) often had similar elements, but the precise components of care varied widely. While the studies suggest that the PCMH is promising for improving the experiences of patients and staff, there is insufficient evidence to date that shows these interventions improve patient clinical outcomes or reduce total costs. Studies now taking place have the potential to greatly expand our knowledge of the PCMH.
  • Public Reporting as a Quality Improvement Strategy Public Reporting as a Quality Improvement Strategy: Oregon Evidence-based Practice Center researchers found that public reporting of health care quality information is more likely to change behaviors in health care providers than it does consumers' choice of providers. The researchers also found that quality measures that are publicly reported tend to improve over time. In addition, the number of studies on potential harms from public reporting was limited and those that did examine the issue do not confirm potential harms.


5. AHRQ's Health Care Innovations Exchange Focuses on Sepsis Management

The August 1 issue of AHRQ's Health Care Innovations Exchange features profiles of programs in California and Delaware that achieved significant reductions in sepsis mortality by supporting timely identification and treatment. One program, a collaborative run by the Integrated Nurse Leadership Program at the University of San Francisco, focused on reducing deaths from sepsis at nine hospitals. Participating clinicians generally adopted four approaches: screening of all patients for sepsis, rapid workup to confirm the diagnosis, prompt initiation of appropriate treatment, and ongoing monitoring. The program resulted in significant reductions in mortality and a positive return on investment. Select to read more innovation profiles related to sepsis management on AHRQ's Innovations Exchange Web site, which contains more than 700 searchable innovations and 1,500 QualityTools.


6. August Issue of AHRQ Web M&M Discusses Lapses in Lab Test Result Follow-up

The August issue of AHRQ Web M&M features a Spotlight Case on a 10-year-old patient who underwent lab tests to determine the cause of an unexplained weight loss. Although the lab tests revealed an abnormally high blood glucose level, neither the child's pediatrician nor the covering physician saw the results until the child and her mother returned to the clinic four days later. By that time, the child's glucose levels were dangerously high and urinalysis showed early signs of diabetic ketoacidosis. A commentary on the case is provided by Carlton Moore, M.D., of the University of North Carolina, Chapel Hill. The Perspectives on Safety section features an interview with Nicholas Castle, Ph.D., an expert on patient safety in long-term care facilities at the University of Pittsburgh Department of Health Policy and Management. Physicians and nurses can receive free CME, CEU, or training certification by taking the Spotlight Quiz. Select to access AHRQ's Web M&M site.


7. Register for AHRQ's MEPS Data Users' Workshop Set for September 24-25

Registration is now open for the two-day hands-on MEPS Data Users' Workshop in Rockville, MD, on September 24-25. Select for more information and to register.


8. Highlights from the EHC Inside Track Newsletter

EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program. Key articles include:

  • From Florida to Alaska: Partners Highlighting Effective Health Care Program Resources.
  • EHC Program Adds 10 New Spanish-language Consumer Publications.
  • New Resources Compare ADHD Treatments.
  • More New Effective Health Care Program Resources for Clinicians and Patients.

Select to read the July issue of EHC Inside Track.


9. Highlights from AHRQ's Research Activities Monthly Newsletter

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

  • Outcomes of trauma patients depend heavily on whether recommended practices are followed.

    Traumatic injuries place patients at increased risk for death and disability, as well as high costs associated with the high-tech care these individuals receive. Traumatic injuries are the fifth most-common cause of death overall in the United States and the leading cause of death in those younger than 45 years old. A set of quality indicators for trauma care has been developed by the American College of Surgeons. In a recent study, researchers found a direct correlation between these best practices of care and patient outcomes. Better performance on six quality indicators was associated with lower rates of mortality or major complications. Select to read this article.

Other articles include:

  • Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life.
  • Effects of antidepressants on suicidal thoughts and behavior differ by age group.
  • Provider-patient dialogue could be improved to foster medication adherence in HIV care.
  • Certain medications are associated with functional decline in the elderly.
  • Treatment guideline reduces hypoglycemic events in critically ill children.

Select to read these articles and others.


10. AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Access to the abstracts may be blocked because of firewalls or specific settings on individual computer systems. If you are having problems, ask your technical support staff for possible remedies.

Mukamel DB, Weimer DL, Li Y, et al. Nursing home appeals of deficiencies: the informal dispute resolution process. J Am Med Dir Assoc 2012 Jul; 13(6):512-6. [Epub ahead of print.] Select to access the abstract on PubMed.®

Haukoos JS, Lyons MS, Lindsell CJ, et al. Derivation and validation of the Denver Human Immunodeficiency Virus (HIV) risk score for targeted HIV screening. Am J Epidemiol 2012 Apr 15; 175(8):838-46. Select to access the abstract on PubMed.®

Woz S, Mitchell S, Hesko C, et al. Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis. BMJ Open 2012 Apr 18; 2(2):e000428. Select to access the abstract on PubMed.®

Galvagno SM Jr, Haut ER, Zafar SN, et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA 2012 Apr 18; 307(15):1602-10. Select to access the abstract on PubMed.®

Sarpong EM, Bernard DM, Miller GE. Changes in pharmaceutical treatment of diabetes and family financial burdens. Med Care Res Rev 2012 Aug; 69(4):474-91. [Epub ahead of print.] 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.

If you have questions about AHRQ's activities, please try to find the answers by checking our Home Page, where we have established links to various topical areas. Also check the News & Information section and Frequently Asked Questions. You may also Browse the Web Site. These features are designed to assist you in obtaining the information you are seeking.

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

Page last reviewed August 2012
Internet Citation: AHRQ Releases Training Modules to Help Improve Safety in Nursing Homes: Electronic Newsletter, Issue 351. August 2012. Agency for Healthcare Research and Quality, Rockville, MD.


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