Research Briefs

Bhutani, V.K., Johnson, L.H., Maisels, M.J., and others (2004, October). "Kernicterus: Epidemiological strategies for its prevention through systems-based approaches," (AHRQ grant HD/HS36914). Journal of Perinatology 24(10), pp. 650-662.

In newborn infants with jaundice, blood levels of bilirubin can become high enough to result in neurotoxicity, a condition of severe jaundice called kernicterus, which if untreated, can result in cerebral palsy, mental retardation, hearing loss, and difficulty moving the eyes. Rates of hospital readmission for jaundice among newborns ranged from 1.7 to 30.2 per live births reported from 1988 to 1998, with near-term infants being readmitted two to three times as often as term infants. Attendees at a recent conference noted that early identification, prevention, and treatment of severe jaundice should make kernicterus a preventable disease. Their recommendations include: using standardized definitions to obtain prospective data on the prevalence and incidence of severe jaundice and its sequelae, exploring the clinical characteristics and root cause of kernicterus in children identified in the Kernicterus Pilot Registry, identifying and testing an indicator for population surveillance, validating systems-based approaches to the management of newborn jaundice, and exploring the feasibility of using biologic or genetic markers to identify infants at risk for hyperbilirubinemia.

Morimoto, T., Gandhi, T.K., Seger, A.C., and others (2004). "Adverse drug events and medication errors: Detection and classification methods." (AHRQ grant HS11169). Quality and Safety in Health Care 13, pp. 306-314.

These authors describe a method of adverse drug event (ADE) and medication error detection and classification that is feasible, reliable, and appropriate for use in various clinical settings to measure and improve medication safety. ADEs, potential ADEs, and medication errors are collected by identifying signals from practice data (medical charts, laboratory data, prescription data, and administrative databases). Research nurses, pharmacists, or research assistants review these signals and present those likely to represent an ADE or medication error to reviewers who independently categorize them into ADEs, potential ADEs, medication errors, or exclusions. They also classify the incidents according to preventability, ameliorability, disability, severity, stage, and responsible person.

Richman, D.D., Morton, S.C., Wrin, T., and others (2004). "The prevalence of antiretroviral drug resistance in the United States." (AHRQ grant HS08578). AIDS 18, pp. 1393-1401.

Antiretroviral therapy has dramatically reduced the morbidity and mortality associated with HIV, but the emergence of drug-resistant virus has limited the usefulness of many drugs. To assess the extent of drug-resistant virus, the researchers examined viral load and drug resistance (using HIV drug susceptibility assays on plasma virus) among 1,797 U.S. adults receiving HIV care in early 1996 who survived to late 1998. Three-fourths (76 percent) of viremic patients had resistance to one or more antiretroviral drugs, and nearly half of people in this group were resistant to more than one drug. The researchers note that these findings have significant implications for HIV treatment and transmission.

Zivin, J.G., and Pfaff, A.S. (2004). "To err on humans is not benign: Incentives for adoption of medical error-reporting systems." (AHRQ grant HS11905). Journal of Health Economics 23, pp. 935-949.

Concerns about frequent and harmful medical errors have led policymakers to advocate the creation of a system for medical error reporting. Health providers, fearing that reported information about errors might be used against them under the current medical malpractice system, have been reluctant to participate in such reporting systems. The authors propose a redesign of the malpractice system to overcome this incentive problem. The authors also consider some alternatives to this approach, since physicians' reporting efforts may not always be observable. For example, hospitals may have interests distinct from individual physicians and may not be able to observe their reporting efforts. Second, a regulatory agency or a court may not be able to adequately observe reporting efforts by a provider.

AHRQ Publication No. 05-0018
Current as of November 2004

Internet Citation:

Research Activities Newsletter. November 2004, No. 291. AHRQ Publication No. 05-0018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/nov04/