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Ahn, A.C., Ngo-Metzger, Q., Legedza, A.T., and others (2006, February). "Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: Prevalence, associated factors, and effect of patient-clinician communication." (AHRQ grant HS10316). American Journal of Public Health 96(2), pp. 647-653.

In the first national survey of complementary and alternative medicine (CAM) use among Chinese and Vietnamese Americans, researchers surveyed 3,258 patients who visited 11 community health centers in 8 major cities throughout the United States. Nearly 90 percent of those surveyed spoke little or no English. Two-thirds of the survey respondents reported that they had used some form of CAM therapy at some time. Overall, 55 to 72 percent had used CAM therapy in the past, and 10 to 18 percent had used CAM therapy in the week before their most recent health center visit. Vietnamese Americans and Cantonese-speaking Chinese Americans tended to use CAM therapies more often than Mandarin-speaking Chinese Americans. Chinese Americans most commonly used herbal medicine and acupuncture. The Vietnamese group most often used coining (rubbing a coin and menthol oil on a patient's spine and ribs), massage, and cupping (use of cups to apply suction to the skin by means of heat).

Alexander, J.A., Weiner, B.J., Baker, L.C., and others (2006, June). "Care management implementation and patient safety." (AHRQ grant HS11317). Journal of Patient Safety 2(2), pp. 83-96.

Care management (CM) is a team effort using resources such as case managers and health educators across the continuum of care, and tools for managing patient care, such as general practice guidelines and prescribed patterns of care (critical pathways). Researchers surveyed 1,784 community hospitals about their quality improvement practices in 1997, and analyzed Medicare inpatient data, hospital survey data, and data on market variables. They assessed the relationship between CM implementation intensity and four hospital-level patient safety indicators: postoperative complications, technical adverse events, technical difficulty with procedures, and failure to rescue (from complications of care, such as blood infection).

Greater implementation of CM appeared to improve patient safety. For example, more extensive use of statistical and process management tools was positively associated with three of the four patient safety indicators: postoperative complications, technical difficulty with procedures, and failure to rescue. Hospital intensity of CM led to better patient safety results as the financial position of the hospital improved (presumably with enough resources to devote to CM efforts) and in markets with high managed care penetration.

Beal, A.C., Chou, S-C., Palmer, R.H., and others (2006, May 2006). "The changing face of race: Risk factors for neonatal hyperbilirubinemia." (AHRQ grant HS09782). Pediatrics 117(5), pp. 1618-1625.

Black newborns are at the lowest risk for neonatal jaundice (hyperbilirubinemia). However, mothers often mark the baby's race on the medical record as black when the baby is multiracial. If the baby's second race is American Indian or Asian, who have the highest risk for neonatal jaundice, it may lead the doctor to underestimate that baby's risk of developing jaundice. Researchers studied the racial classification of 3,012 babies born at least at 35 weeks gestation who were discharged from a hospital nursery between January 2001 and October 2002. They examined the classification of the infantŐs race entered into the medical record and surveyed the mothers by phone 6 months after birth. They found that when given one choice in medical record forms, mothers of multiracial infants overselected black as their newborn's ancestry. Yet only 70 percent of mothers who had recorded their race as black said they were black during the phone survey. Mothers identified 93 newborns as having 2 or more races with the primary race matching both parents for 41 percent, father for 25 percent, mother for 23 percent, and neither parent for 11 percent. Of 70 newborns whose parents were not the same race, mothers identified 64 percent as having 2 or more races.

Bergman, D.A., Mayer, M.L., Pantell, R.H., and others (2006, March). "Does clinical presentation explain practice variability in the treatment of febrile infants?" (AHRQ grant HS06485). Pediatrics 117(3), pp. 787-795.

This study revealed that pediatricians hospitalized only 61.3 percent of febrile infants under 28 days of age, and that they varied considerably in how they evaluated and treated febrile infants. The intensity of their clinical approach primarily depended on how sick the infant appeared. Infants who had appeared very ill and moderately ill had expected evaluation and treatment intensity scores 0.92 points and 0.69 points higher, respectively, than those whom pediatricians characterized as appearing minimally ill.

A summary score was developed by a research team that analyzed data from the Pediatric Research in Office Settings network on the treatment of 2,712 febrile infants. A model that included the infant's clinical presentation, demographic, provider, and practice characteristics, and regional variables explained nearly half (46.5 percent) of the variation in treatment of febrile infants. Infant clinical characteristics explained nearly 30 percent and practice site factors explained nearly 15 percent of the overall treatment variation. Provider and practitioner characteristics and geographic region explained little of the variation.

Fung, V., Ortiz, E., Huang, J., and others (2006, May). "Early experiences with e-health services (1999-2002): Promise, reality, and implications." (Contract 290-00-0015). Medical Care 44, pp. 491-496.

This study details variations in the specific types of electronic healthcare (e-health) use, such as online drug refill requests or appointment scheduling, and the characteristics of the users. Researchers calculated the amount and frequency of e-health use over time and characteristics of 3.3 million members of a large, prepaid integrated delivery system. The number of members registered for access to e-health jumped from 0.7 percent of all members in 1999 to 8.6 percent in 2002. During that period, 1.3 percent of members used the drug refill service and 1.7 percent used the appointment scheduling service, compared with 0.3 percent who used the medical advice service and 0.1 percent who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses per user versus 1.6 uses per user among care-related service users. Those most likely to use e-health services of all types had a high level of clinical need and a regular primary care provider, and were 30 to 64 years old, female, white, and lived in a neighborhood that did not have a low socioeconomic status.

Hand, M.M., Chesley, F.D., Ho, K.K., and Clancy, C. (2006, August). "The third national reports on healthcare quality and disparities in the United States: National data for targeting improvements." Journal of Nursing Care Quality 21(4), pp. 283-289.

Nurses are needed to participate in initiatives that can close gaps in care quality and disparities. They can use the Agency for Healthcare Research and Quality's 2005 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) as resources to accomplish this, suggest Agency Director Carolyn M. Clancy, M.D., and AHRQ colleagues in a recent paper. Using national data from these reports, nurses can find health care quality and disparities information for their clinical setting or population of interest. They can also find trend data to drive quality improvement efforts for relevant clinical conditions and in diverse patient care settings such as hospitals or nursing homes. Facilities and networks, in turn, can compare their performance with their State and the nation. Nurses can address disparities through community-based projects and use the NHDR findings as benchmarks against which to compare their progress. State health departments can do regional and national comparisons using the new State Snapshot Web tool, which was released in January 2006 and is based on the 2005 NHQR and NHDR.

Reprints (AHRQ Publication No. 07-R002) are available from the AHRQ Publications Clearinghouse.

Kalus, R.M., Shojania, K.G., Amory, J.K., and Saint, S. (2006, October). "Lost in transcription." (AHRQ grant HS11540). New England Journal of Medicine 355(14), pp. 1487-1491.

This report describes how a medication transcription error was the source of life-threatening acute bone marrow failure in a 55-year-old bedridden woman who had been transferred from an assisted living facility to a skilled nursing facility due to progressive disability. She suffered from multiple sclerosis, had a fever, urinary problems, and a history of urinary tract infections (UTIs). The woman initially was given an oral antibiotic to treat a presumed UTI. However, further blood test results revealed acute bone marrow failure and prompted transfer to a hospital. The clinical team suspected methotrexate toxicity and examined her clinical records. The physicians found that the woman had been mistakenly prescribed methotrexate on a daily rather than weekly basis for 3 years prior to this hospital admission. The woman's initial methotrexate dose was erroneously recorded, 3 years before, as 10 mg per day instead of per week. When the patient was transferred to the skilled nursing facility, her primary care doctor transcribed the incorrect dose of 10 mg per day directly from the electronic record. Thus, she continued to receive the incorrect daily dose at that facility. Once the mistake was identified at the hospital and the methotrexate was cleared from her system, her bone marrow normalized and many of her symptoms resolved.

Kirby, J.B. and Kaneda, T. (2006, June). "Access to health care: Does neighborhood residential instability matter?" Journal of Health and Social Behavior 47, pp. 142-155.

In order to obtain needed health care, individuals need information about the availability of health care resources in their communities. Moreover, much of this information is specific to a given area and therefore is most readily available through informal social contacts. Residential instability may disrupt the development and functioning of social networks that help people find and obtain health care. Researchers linked individual-level data from the 2000 Medical Expenditure Panel Survey (MEPS) of U.S. households to data on area supply of health care providers and to neighborhood-level characteristics of the MEPS sample from 2000 block-level census data. They used responses to the MEPS questionnaire to construct whether individuals had poor access to health care (did not have a usual source of care, their usual source of care was a hospital emergency room, or they reported unmet medical need). A 10-percent increase in the number of residents in a neighborhood who had lived in their current homes for 1 year or less was associated with a significant 23-percent increase in the likelihood of having poor access to health care. Consideration of neighborhood poverty prevalence and supply of doctors and hospital beds per 1,000 residents reduced this to a 15 percent increased likelihood of poor care access.

Reprints (AHRQ Publication No. 06-R072) are available from the AHRQ Publications Clearinghouse.

Lin, W-C., Kane, R.L., Mehr, D.R., and others (2006, August). "Changes in the use of postacute care during the initial Medicare payment reforms." (AHRQ grant HS13422). HSR: Health Services Research 41(4), pp. 1338-1356.

This study used Medicare data to examine changes in postacute care use for six major illnesses or procedures during the 1996-2000 period of Medicare payment reforms. During the first Interim Payment System (IPS) reform, which reduced reimbursement to home health (HH) agencies, HH use decreased consistently across disease groups. This decrease was accompanied by increased use of skilled nursing facilities (SNFs). Following the implementation of the Prospective Payment System (PPS) for SNFs, the use of inpatient rehabilitation facilities (IRFs) increased.

When comparing 2000 with 1996, SNF use did not change significantly for rehabilitative conditions, but it increased 15 to 20 percent for medical conditions. In contrast, IRF use did not increase until the PPS was implemented in SNFs between 1998 and 2000, most noticeably for hip and knee procedures. The number of IRFs also increased by 4 percent between 1997 and 1999. The increase in IRF supply and use may be attributable to the cost-based reimbursement for IRFs during the study period.

Owens, P.L., Kerker, B.D., Zigler, E., and Horwitz, S.M. (2006). "Vision and oral health needs of individuals with intellectual disability." Mental Retardation and Developmental Disabilities Research Reviews 12(1), pp. 28-40.

People with Down Syndrome and other types of intellectual disability (ID) suffer from more vision problems and oral health problems than the general population. People with ID are less likely than those without ID to receive preventive and early treatment of these conditions. Researchers reviewed research studies on vision and oral health related to individuals with ID, as well as those specific to individuals with Down Syndrome, and estimated the prevalence of specific vision problems and oral health conditions among individuals with ID. The greater needs of individuals with ID for visual and oral health care may be related to etiology, health behaviors, or lack of access to appropriate treatment.

Reprints (AHRQ Publication No. 06-R035) are available from the AHRQ Publications Clearinghouse.

Ozdas, A., Speroff, T., Waitman, L.R., and others (2006, March/April). "Integrating 'best of care' protocols into clinicians' workflow via care provider order entry: Impact on quality-of-care indicators for acute myocardial infarction." (AHRQ grant HS10384). Journal of the American Medical Informatics Association 13, pp. 188-196.

This study was conducted by investigators at the Vanderbilt University Center for Education and Research in Therapeutics. Researchers examined the use of an ACS (acute coronary syndrome) order set or protocol that included diagnosis/procedure-specific guidelines relevant to the care of patients with ACS or acute myocardial infarction (AMI), including the early use of aspirin and/or beta-blockers. American Heart Association guidelines recommend that doctors prescribe aspirin and/or beta-blockers within the first 24 hours of hospital admission for unless there are contradictions such as an aspirin allergy.

Use of a care provider order entry system by hospital physicians markedly improved drug prescribing for heart attack victims. Among suspected AMI admissions at one medical center, implementation of an Admission Advisor support tool significantly increased use of the ACS order set from 60 to 70 percent. The trend was similar, but not significant, for confirmed AMI cases. Use of the ACS order set tripled the increase in the number of patients who received aspirin within the first 24 hours of hospitalization, and showed an increase in the trend toward significant ordering of beta-blockers.

Washington, E.L., Shen, J.J., Kocher, J., and Moseley, C.B. (2006, Summer). "Care patterns for affective psychosis across diverse ethnicities: Exploring potential contributors to complications and emergency room use." (AHRQ grant HS13056). Ethnicity & Disease 16, pp. 712-717.

The proportion of emergency room (ER) admissions for affective psychosis decreased from 1995 through 1999. However, they increased in proportion to all ER admissions in 2001. This jump in ER admissions for affective psychosis may have been related to the stress of high unemployment that year compared to previous years and the September 11, 2001 tragedy, suggests a new study. Researchers linked hospital data on people diagnosed with affective psychosis from the National Inpatient Sample of the Healthcare Cost and Utilization Project with hospital survey data on ER use and county-based data on care provider to population ratios for the years 1995-2001. From 1995 to 1999, the proportion of patients diagnosed with affective psychosis who were admitted to the hospital through the ER remained stable or decreased slightly—42.5 percent in 1995, 41.7 percent in 1997, and 40.1 percent in 1999—but increased to 44.7 percent in 2001. Blacks were more likely than whites to be admitted to the hospital through the ER for the first 3 years studied, but there was no difference between them in 2001.

AHRQ Publication No. 07-0014
Current as of January 2007


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