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AHRQ Annual Highlights, 2011 |
The Agency for Healthcare Research and Quality (AHRQ) is committed to helping the Nation improve our health care system. To fulfill its mission, AHRQ conducts and supports a wide range of health services research. This report presents key findings from AHRQ's research portfolio during Fiscal Year 2011.
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Contents
Mission
Reducing the Risk of Harm
Transforming the Practice of Health Care
Improving Health Care Outcomes
Mission
As 1 of 12 agencies within the Department of Health and Human Services
(HHS), the mission of AHRQ is to improve the quality, safety, efficiency, and
effectiveness of health care for all Americans. The Agency fulfills this mission
by producing information that:
- Reduces the risk of harm from health care services by using evidence-based
research and technology to promote the delivery of the best possible
care.
- Transforms the practice of health care to achieve wider access to effective
services and reduce unnecessary health care costs.
- Improves health care outcomes by encouraging providers, consumers, and
patients to use evidence-based information to make informed treatment
decisions.
Ultimately, the Agency achieves its goals through translating research into
improved health care practice and policy. Health care providers, patients,
policymakers, payers, administrators, and others use AHRQ research findings
to improve health care quality, accessibility, and outcomes of care.
Disseminating AHRQ's research findings helps support a Nation of healthier,
more productive people and results in an enhanced return on the Nation's
substantial investment in health care. This report highlights some of the
Agency's key accomplishments, initiatives, and research findings during fiscal
year 2011 (FY11). Return to Contents
Reducing the Risk of Harm
Through its research on quality and patient safety, in FY11 AHRQ developed
tools, resources, and research that show how health care professionals can
improve the quality and safety of the health care services they provide and
reduce medical errors.
Tools and Resources
- A new guide—Training Guide: Using Simulation in TeamSTEPPS®
Training (http://www.ahrq.gov/teamsteppstools)—integrates teamwork,
interpersonal, and communication skills into simulation-based training. It
offers strategies and tools that can improve team
performance and enhance patient safety.
- AHRQ's first report on nursing home safety
culture—Nursing Home Survey on Patient
Safety Culture: 2011 User Comparative
Database Report—(http://www.ahrq.gov/qual/nhsurvey11) offers a comparative
assessment of 16,155 staff responses from 226
U.S. nursing homes to AHRQ's Nursing Home
Survey on Patient Safety Culture
(http://www.ahrq.gov/qual/patientsafetyculture/nhsurvindex.htm).
- New Common Formats (http://www.pso.ahrq.gov) for patient safety
reporting in skilled nursing facilities complement an existing set of
Common Formats, Version 1.1, which are designed to help health care
providers collect both generic and event-specific information about
incidents, near misses or close calls, and unsafe conditions in hospital
settings.
- AHRQ and the National Council on Patient Information
and Education released Your Medicines: Be Smart. Be Safe
(http://www.ahrq.gov/consumer/safemeds/yourmeds.htm),
a guide to help patients learn more about how to take
medicines safely. The guide includes a
detachable, wallet-sized card that can be
personalized to help patients keep track of
all medicines they are taking, including
vitamins and herbal and other dietary
supplements.
Public reports on provider performance
AHRQ released the Public Reporting Web Page
(http://www.ahrq.gov/path/publicreporting.htm) featuring resources on
public reporting of provider performance information for consumers. The
resources include:
- MONAHRQ®, innovative software for creating a public report
developed by AHRQ.
- A sampler of model public report elements.
- A comprehensive guide for public report card sponsors.
- And a decision guide for report card developers about selecting quality
of care and resource use measures, as well as other tools and reports on
public reporting.
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Eliminating central line-associated bloodstream infections
Intensive care units (ICUs) in both large and small hospitals eliminated
central line-associated bloodstream infections for up to 2 years after using a
targeted quality improvement initiative funded in part by AHRQ. The
initiative, known as the Comprehensive Unit-based Safety Program, or CUSP
(http://www.ahrq.gov/qual/cusp.htm), was implemented through the Keystone
Intensive Care Unit Project in Michigan hospitals. (Go to "The Ability of
Intensive Care Units to Maintain Zero Central Line-Associated Bloodstream
Infections" by Allison Lipitz-Snyderman, Ph.D., Dale M. Needham, F.C.A.,
M.D., Ph.D., Elizabeth Colantuoni, Ph.D., and others, in the May 9, 2011,
Archives of Internal Medicine 171(9), pp. 856-858.)
Healthcare 411
Healthcare 411 (http://healthcare411.ahrq.gov/) is an audio podcast series
produced by AHRQ. Using the latest technology, AHRQ shares news and
information in the form of concise 60-second audio news programs that
feature current research on important health care topics. Healthcare 411 gives
consumers information they can use in their health care decision making.
50+: New and Improved—Two updated checklists are designed to help
men and women over 50 stay healthy.
Treating High Cholesterol—Managing high cholesterol with diet,
exercise, and medicine helps lower cholesterol levels.
Questions are the Answer—When patients and their caregivers
communicate well, care is better.
AHRQ's Spanish-language Materials—In addition to tools about
preventive care, a growing array of videos, guides and pamphlets address
specific health conditions.
Why You Need to Explore Your Treatment Options—Finding the
best treatment option can make a major difference in your health and well-being. |
Identifying medical errors
Researchers looked at 6,749 medication error reports from neonatal intensive
care units in 163 health care facilities and found:
- 72 percent of errors that reached the patient did not result in harm.
- 4 percent of actual errors resulted in permanent harm or death.
- 48.2 percent of all reported medication errors occurred during the drug
administering phase, followed by drug transcribing/documenting,
prescribing, and dispensing.
- 26.9 percent of all error types cited involved improper dose or quantity,
18.6 percent were omission errors, and 17.6 percent were wrong timing.
(Go to "NICU medication errors: Identifying a risk profile for medication errors
in the neonatal intensive care unit," by Theodora A. Stavroudis, M.D., Andrew
D. Shore, Ph.D., Laura Morlock, Ph.D., and others in the Journal of
Perinatology 30, pp. 459-468, 2010.)
TeamSTEPPS improves teamwork, communication, and attitudes
IFMC, the Medicare Quality Improvement Organization (QIO) for Iowa, uses
"Team Strategies and Tools to Enhance Performance and Patient Safety"
(TeamSTEPPS®), with Covenant Medical Center and Sartori Memorial
Hospital to improve patient safety by enhancing teamwork and
communication.
Kelli Vellinga, RN, BSN,
A Collaboration Specialist with IFMC and a TeamSTEPPS master team
trainer, Vellinga uses the TeamSTEPPS tools to assist hospitals working on
surgical care improvement to reduce surgical infections and complications.
"TeamSTEPPS has a lot of tools, and we try to customize the approach based
on the providers' needs. After conducting my assessment and on-site
observation, I assist teams in developing a customized plan to improve the
quality and safety of care. As an outsider, I can be a change catalyst," says
Vellinga.
Kathy Eisenman, RN,
Covenant Medical Center and Sartori Memorial Hospital,
As the Surgical Services Manager at Sartori Memorial Hospital, Eisenman
works with Vellinga to implement TeamSTEPPS. "We learned the effect
TeamSTEPPS can have on patient safety, and we talked about debriefs,
huddles, and trying to communicate better," she says. "We took baby steps
at first trying to get it going—we picked out a few tools from the program
like CUS (‘I'm concerned, uncomfortable, this is a safety issue'), handoffs,
briefing, and debriefing. We also tried to stress the environment of
collaboration, and that it's okay to speak up in order to change the culture of
safety."
Marcia Dlouhy, RN, BS,
Dlouhy is the Director of Surgical Services for Covenant Medical Center and
Sartori Memorial Hospital. Dlouhy says the hospitals' national surgical care
infection prevention measures have significantly improved. "Our data show
we are ranking much better now than before we introduced TeamSTEPPS.
We're spreading this to the other departments, too. It isn't just happening
with the surgical teams."
Eisenman agrees that the results of the improved communications
TeamSTEPPS creates are far-reaching. Improvements in the hospital's scores
on national surgical care safety measures that reduce the incidence of
surgical complications are being attributed directly to TeamSTEPPS tools.
In addition, Eisenman says that her teams' attitudes about patient safety have
changed because of the TeamSTEPPS program. "At first it was to meet the
mark; now it is because we want zero complications and infections. All the
units are committed to the TeamSTEPPS process." |
Improving pregnancy warnings
Researchers interviewed 132 women at outpatient care clinics and found that
94 percent of the women were able to understand the message of the enhanced
text—"Do not use if you are pregnant, think you are pregnant, or breast
feeding"—when it accompanied an icon that was a silhouette of a pregnant
woman with a slash through it. In contrast, just 76 percent of women
comprehended the standard label and 79 percent understood the enhanced text
alone. (See "Improving pregnancy drug warnings to promote patient
comprehension," by Whitney B. You, M.D., William Grobman, M.D., M.B.A.,
Terry Davis, Ph.D., and others in the April 2011 American Journal of
Obstetrics and Gynecology, 204(4), pp. 318.e1-318.e5.)
AHRQ Quality Indicators
AHRQ has developed an array of health care decision making and research
tools that can be used by program managers, researchers, and others at the
Federal, State and local levels. The Quality Indicators (QIs)
(http://www.qualityindicators.ahrq.gov/) are measures of health care
quality that make use of readily available hospital inpatient administrative
data. The QIs can be used to highlight potential quality concerns, identify
areas that need further study and investigation, and track changes over time.
The current AHRQ QI modules represent various aspects of quality:
- Prevention Quality Indicators identify hospital admissions in geographic
areas that evidence suggests may have been avoided through access to
high-quality outpatient care.
- Inpatient Quality Indicators reflect quality of care inside hospitals, as well
as across geographic areas, including inpatient mortality for medical
conditions and surgical procedures.
- Patient Safety Indicators reflect quality of care inside hospitals, as well as
geographic areas, to focus on potentially avoidable complications and
iatrogenic events.
- Pediatric Quality Indicators use indicators from the other three modules
with adaptations for use among children and neonates to reflect quality
of care inside hospitals, as well as geographic areas, and identify
potentially avoidable hospitalizations.
The AHRQ QIs are used in free software distributed by AHRQ. The software
can be used to help hospitals identify quality of care events that might need
further study. The software programs can be applied to any hospital inpatient
administrative data. These data are readily available and relatively
inexpensive to use. |
Return to Contents
Transforming the Practice of Health Care
AHRQ evaluates the benefits and harms of different health care interventions
and ways to deliver health care that provides the most appropriate treatment
for an illness or condition. The Agency collects data and provides tools and
resources to help measure and assess the Nation's health, health care services,
and the costs of those services. These efforts help to inform both clinicians
and consumers to make the best decisions they can about health care.
Tools and Resources
Effective Health Care Program
In FY11, the Effective Health Care Program
(http://effectivehealthcare.ahrq.gov/) released comparative effectiveness
research reviews, original research findings, and summary guides for
clinicians and patients. Topics included osteoarthritis, antipsychotic drugs,
depression, sleep apnea, hypertension, pain management, health literacy, fetal
surgery, autism, and diabetes. For example:
- Treatment for autism spectrum disorders—two commonly used
medications—risperidone and aripiprazole—show benefit in reducing
emotional distress, aggression, hyperactivity, and self-injury. However,
these medicines are associated with significant side effects, such as rapid
weight gain and drowsiness.
- Off-label use of antipsychotic drugs—some evidence supports the off-label
use of atypical antipsychotic medications such as the use of risperidone,
olanzapine, and aripiprazole to treat symptoms of dementia; quetiapine to
treat generalized anxiety disorder; and risperidone to treat obsessive-compulsive
disorder. However, evidence was lacking to justify the use of
these and other atypical antipsychotic drugs to treat substance abuse
problems, eating disorders, or insomnia.
- Options to treat sleep apnea—continuous positive airway pressure machine
is highly effective in improving sleep and related symptoms of obstructive
sleep apnea by improving airflow. Another treatment, a mouthpiece called a
mandibular advancement device, can also be very effective.
Consumer resources
- Guía para pacientes que están en tratamiento de
una cardiopatía coronaria estable ("ACE
Inhibitors" and "ARBs" to Protect Your Heart?—A Guide for Patients Being Treated for Stable
Coronary Heart Disease)
(http://effectivehealthcare.ahrq.gov/index.cfm/informacion-en-espanol/), is a free, illustrated
easy-to-read pamphlet that compares drugs for
preventing heart attacks, heart failure or
strokes in people with stable coronary heart disease. The guide summarizes the benefits and risks of medications that
help reduce blood pressure in patients who often take other heart-related
medications such as aspirin, blood thinners, or cholesterol-lowering drugs.
This new Spanish-language guide on heart medications is part of AHRQ's
ongoing effort to give Hispanics the knowledge they need to take a greater
role in their health care.
- Conozca las preguntas, (Know the Questions) a new, multimedia Spanish-language
campaign by AHRQ and the Ad Council, encourages Hispanics to
get more involved in their health care and to talk with their doctors about
their medical concerns.The national public service advertising campaign,
which features television, radio, print and Web ads, offers tips to help
Hispanics prepare for medical appointments by thinking ahead of time
about questions to ask their doctors during medical appointments.
Data and Surveys
MONAHRQ 2.0
(http://www.monahrq.ahrq.gov) is a unique,
desktop, Windows®-based software application
for developing Web sites for hospital quality
public reporting or research use. MONAHRQ
gives users the ability to report the Centers for Medicare & Medicaid
Services' (CMS) Hospital Compare measure results along with, or instead of,
their own inpatient discharge data. Web sites created with MONAHRQ 2.0
provide information in four areas: quality of care for specific hospitals;
provision of services by hospitals for health conditions and procedures;
potentially avoidable hospitalizations; and rates of health conditions and
procedures. |
AHRQ's Healthcare Cost and Utilization Project (HCUP)
(http://www.ahrq.gov/data/hcup/) collects data that allows us to conduct
research on a broad range of health policy issues, including cost and quality of
health services, medical practice patterns, access to health care programs, and
outcomes of treatments at the national, State, and local market levels. In FY11,
AHRQ released the following updates to HCUP databases:
- The Kid's Inpatient Database (KID) featuring 2009 data, which is the only
national dataset on hospital use, outcomes, and charges designed to study
children. Data elements include diagnoses and procedures, patient
characteristics, hospital characteristics, source of admission, charges, and
expected payer.
- The Nationwide Inpatient Sample (NIS) featuring 2009 data, which is the
largest all-payer inpatient care database in the United States and is updated
annually. The data can be weighted to produce national estimates, allowing
researchers and policymakers to use it to identify, track, and analyze
national trends in health care use, access, charges, quality, and outcomes.
Data from the Kids' Inpatient Database and Nationwide Inpatient Sample show
that influenza increased dramatically as a major cause of hospitalizations for
children age 17 and under, climbing from 65th in 2000 in the ranking of
reasons why children go to the hospital to 10th in 2009. Pneumonia, asthma,
and acute bronchitis were the most common conditions that required hospital
care in 2009, followed by mood disorders (depression and bipolar disorder).
Children represented one out of every six hospital stays, and total hospital
charges for children were $33.6 billion, or 9 percent of total hospital costs in
2009. (Go to Statistical Brief #118: Hospital Stays for Children, 2009 at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb118.jsp)
Data from the 2008 Nationwide Inpatient Sample show that U.S. community
hospitals billed insurance companies and Federal and State programs $1.2
trillion in 2008 for inpatient care. This represents a 28 percent increase over
the $900 billion, adjusted for inflation, billed in 2004. Total charges billed to
Medicare ($534 billion) and Medicaid ($159 billion) accounted for about 60
percent of all charges in 2008. Private insurers were charged $373 billion, or
32 percent of the total. The uninsured accounted for $48 billion, or 5 percent
of the national bill. (Go to The National Bill: The Most Expensive Conditions by
Payer, 2008 at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb107.jsp).
AHRQ's Medical Expenditure Panel Survey (MEPS)
(http://www.meps.ahrq.gov/mepsweb/) is a detailed source of information on
the health services used by Americans, the frequency with which they are
used, the cost of those services, and how they are paid for.
- In FY11, MEPS released data files for 2009 population characteristics,
jobs, health insurance, medical visits, dental visits, expenses, medical
conditions, and prescribed medicines.
- MEPS is an important data source to inform health care policy
decisionmaking at the State and national levels. In FY11, congressional
and Executive Branch analysts requested MEPS data on health insurance,
costs of coverage, expenditures, preventive care, mental illness, and the
uninsured (http://www.ahrq.gov/data/mreqahi.htm). Table 1 provides a
sample of the responses provided to specific requests in FY11.
- An analysis of MEPS data showed that insurers and consumers spent $52.2
billion on prescription drugs in 2008 for outpatient treatment of metabolic
conditions such as diabetes and elevated cholesterol. Purchases of
metabolic drugs by adults aged 18 and older accounted for 22 percent of
the nearly $233 billion spent overall to buy prescription medicines that
year. Central nervous system drugs, used to relieve chronic pain and
control epileptic seizures and Parkinson's Disease tremors cost $35 billion
while cardiovascular drugs, including calcium channel blockers and
diuretics cost $29 billion. (Go to Statistical Brief #313, Expenditures for the
Top Five Classes of Outpatient Prescription Drugs, Adults Ages 18 and
Older, 2008 at http://meps.ahrq.gov/mepsweb/data_files/publications/st313/stat313.shtml.)
Table 1—MEPS responses to request for assistance on health initiatives for FY11
Source of Request |
Assistance Provided |
Congressional Budget Office |
National estimates of private and government sector health insurance enrollment, eligibility,
and other measures, by industry. |
Assistant Secretary for Planning and Evaluation, HHS |
Estimates for coverage, expenditures, and preventive care utilization for use on a paper that would be published on the second
anniversary of the CHIPRA reauthorization.
"Rush" assistance with estimates on how many
individuals: (a) have a mental illness; (b) do not
speak English as a first language; or (c) are not
citizens.
Technical assistance and estimates for the
Health System Tracking Project. |
Office of Health Reform, HHS |
Technical assistance on the use of preventive care by the uninsured. |
Council of Economic Advisors |
Data covering topics such as the capacity for large-scale surveys to collect the data that will be needed to evaluate key provisions of health reform, and changes that could be made now that would improve evaluation capacity. |
Office of Management and Budget (OMB) |
A seminar for OMB colleagues to enable them to better understand AHRQ simulation models and related research on projecting
expenditures. The purpose of the seminar was to help OMB develop its own microsimulation capacity. |
Office of Health Reform, HHS |
Estimates for medical expenditures and out-of-pocket costs for the uninsured. |
Health IT
Workflow Assessment for Health IT is a new toolkit that assists small- and
medium-sized practices in workflow analysis and redesign before, during, and
after health information technology (IT) implementation. The toolkit includes
tools to analyze workflow, examples of workflow analysis and redesign, and
others' experiences with health IT and workflow.
New resource identifies care coordination
measures
AHRQ released a new resource for researchers
interested in measuring care coordination, an
emerging field of quality measurement. The Care
Coordination Measures Atlas
(http://www.ahrq.gov/qual/careatlas) identifies
more than 60 measures for assessing care
coordination that include the perspectives of
patients and caregivers, health care
professionals, and health system managers. To
help users easily identify measures that are
relevant to their awork, the measures are mapped to a conceptual
framework for understanding care coordination measurement. Researchers,
measure developers, accountable care organizations, and others responsible
for measuring care coordination will find the atlas useful in identifying
currently available measures to assess care coordination activities, as well as
gaps in existing measures that can be addressed in future work. |
Using antibiotics more effectively
Researchers at the University of Pennsylvania School of Medicine's Center for
Education and Research on Therapeutics found that implementing electronic
order sets that adhere to the Centers for Disease Control and Prevention
guidelines for antibiotic use after surgery was effective in raising the
percentage of patients whose antibiotics were stopped appropriately after
surgery. The hospital that integrated the electronic order set in its computerized
provider order entry system saw timely discontinuation of antibiotics rise from
36.8 percent of patients to 55.7 percent. (Go to "Effectiveness of an information
technology intervention to improve prophylactic antibacterial use in the
postoperative period," by Kevin Haynes, Pharm.D., M.S.C.E., Darren R.
Linkin, M.D., M.S.C.E., Neil O. Fishman, M.D., and others in the March 2011
Journal of the American Medical Informatics Association 18(2), pp. 164-168.)
Enabling Medication Management Through Health
Information Technology
This new evidence report, available at (http://www.ahrq.gov/clinic/tp/medmgttp.htm), examines the impact—clinical, economic, and effectiveness—
of health IT applications on medication management. The review found that
health IT-enabled applications, especially clinical decision support and
computerized physician order entry systems, showed evidence of improved care processes. The real-life cost of implementing electronic health records
(EHRs) in an average five-physician primary care practice, operating within a
large physician network committed to network-wide implementation of
electronic health records, is about $162,000 with an additional $85,500 in
maintenance expenses during the first year. (Go to "The financial and
nonfinancial costs of implementing electronic health records in primary care
practices," by Neil S. Fleming, Ph.D., Steven D. Culler, Ph.D., Russell
McCorkle, M.B.A., and others in the March 2011 Health Affairs 30(3),
pp. 481-489.)
Helping consumers choose health care plans
The Hawaii Department of Human Services uses the Consumer Assessment of
Healthcare Providers and Systems (CAHPS®, https://cahps.ahrq.gov)
to collect and report patients' experience with their managed health care
plans.
Anthea Wang, MD, MPH, Medical Director for the Med-Quest Division of
the Hawaii Department of Human Services, is a member of the AHRQsponsored
Medicaid Medical Directors' Learning Network, an AHRQ
Knowledge Transfer Project. Though the CAHPS survey had been used since
2007 to better understand patient care experiences, she decided to use the
survey findings for public reporting and pay-for-performance initiatives. She
finds that the CAHPS Health Plan Survey's prescriptive instructions reduce the
likelihood of bias and error.
Wang reports that a consumer guide—based on the adult CAHPS Health
Plan Survey results, along with selected National Committee for Quality
Assurance's Healthcare Effectiveness Data and Information Set measures—was developed and published on the Hawaii Department of Human Services
Web site. The guide presents a side-by-side comparison of the performance
of the various health plans in a way that is transparent and easily
understood by users. Health plan members can use this information to
choose plans that provide high quality care for themselves and their families.
The consumer guide was sent to patients for open enrollment and is posted
at http://www.med-quest.us/ManagedCare/consumerguides.html . |
Return to Contents
Improving Health Care Outcomes
Improvements in health care quality continue to progress at a slow rate—about
2.3 percent a year; however, disparities based on race and ethnicity,
socioeconomic status and other factors persist at unacceptably high levels. To
help the nation address these disparities, AHRQ collects data and reports on its
findings through the National Healthcare Quality Report and National
Healthcare Disparities Report. Through its research projects, the Agency also
develops tools and resources that health care providers can use in order to
improve outcomes in the health care they provide.
Tools and Resources
- The National Healthcare Quality and Disparities Reports
(http://www.ahrq.gov/qual/qrdr10.htm) show trends by measuring health
care quality for the Nation using a group of measures such as effectiveness,
patient safety, timeliness, patient-centeredness, care coordination,
efficiency, health system infrastructure, and access. The 2010 reports show:
- Gains in health care quality were seen in a number of areas, with the
highest rates of improvement in measures related to treatment of acute
illnesses or injuries. For example, the proportion of heart attack patients
who underwent procedures to unblock heart arteries within 90 minutes
improved from 42 percent in 2005 to 81 percent in 2008.
- Blacks, American Indians, and Alaska Natives received worse care than
whites for about 40 percent of core measures. Asians received worse
care than whites for about 20 percent of core measures. Hispanics
received worse care than whites for about 60 percent of core measures.
Poor people received worse care than high-income people for about 80
percent of core measures.
- On average, Americans report barriers to care one-fifth of the time,
ranging from 3 percent of people saying they were unable to get or had
to delay getting prescription medications to 60 percent of people saying
their usual provider did not have office hours on weekends or nights.
- The report, Promoting Safety and Quality Through Human Resources
Practices (http://www.ahrq.gov/qual/prosafetysum.htm), examines the
growing support for a link between innovative human resources staffing
patterns and improvements in safety and quality in health care settings. Key
findings included:
- The importance of engaging staff with an organization's mission, vision,
goals, and objectives.
- Empowering frontline staff.
- hiring and placing staff based on competencies and organizational fit,
rather than just on formal training.
- Holding leaders accountable for organizational objectives.
- And using a high-performance organizing framework, such as Six Sigma
or Lean production to clarify the link with quality and safety outcomes.
A tool derived from this project, Using Workforce Practices to Guide
Quality Improvement: A Guide for Hospitals, is available at
http://www.ahrq.gov/qual/workforceguide.htm.
Preventing Pressure Ulcers in Hospitals: A Toolkit
for Improving Quality of Care
(http://www.ahrq.gov/research/ltc/pressureulcertoolkit) is a Web-based resource
that can assist hospital staff in implementing
effective pressure-ulcer prevention practices
through an interdisciplinary approach to care.
The tools outline a step-by-step hospital-based
initiative to target interventions in those areas
where patient care processes have shown the
most risks to patient skin integrity. |
Collaboration to improve care in underserved areas
To bring effective treatment to persons with the Hepatitis C virus (HCV)
infection in underserved areas, researchers at the University of New Mexico
Health Sciences Center developed a model called Extension for Community
Healthcare Outcomes, or ECHO, that brings state-of-the-art medical
knowledge to primary care providers and nurses. Using videoconference or
teleconference lines, community-based medical teams, including physicians
and nurses, take part in weekly clinics with specialists. Together, they discuss
patients' medical history, review lab results and other key findings and
collaborate on treatment plans using evidence-based treatment approaches.
They found that the HCV infection was cured at a similar rate for patients who
were treated at these community-based settings as patients who were treated at
the university clinic (58.2 percent vs. 57.5 percent).(Go to "Outcomes of
treatment for hepatitis C virus infection by primary care providers," by Sanjeev
Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., and others in the June
9, 2011, New England Journal of Medicine, 364(23):2199-207.)
Empowering patients with self-management of
diabetes
Delivery of effective self-management education and support can be difficult
in traditional primary care, but a new study shows that structured goal-setting
approaches to diabetes self-management can significantly reduce hemoglobin
A1 (HbA1c, an indicator of blood-glucose levels). The researchers tested two
alternative diabetes clinic approaches in 87 older veterans with treated, but
uncontrolled, diabetes (HbA1c of 7 percent or higher). Patients who
participated in the structured goal-setting approach known as "Empowering
Patients in Care" (EPIC), had significantly greater improvements in HbA1c
immediately following the active intervention compared to the education-usual
care group. These differences persisted at the 1 year follow-up. The EPIC
approach trained patients to integrate their health care providers' treatment
plans into collaborative self-management goals and action plans. (Go to
"Comparative effectiveness of goal setting in diabetes mellitus group clinics,"
by Aanand D. Naik, M.D., Nynikka Palmer, Dr.P.H., Nancy J. Petersen, Ph.D.,
and others in the March 14, 2011, Archives of Internal Medicine 171(5),
pp. 453-459.)
Educating patients on the use of blood
thinners
Fletcher Allen Health Care, the academic medical
center affiliated with the University of Vermont,
has incorporated AHRQ's DVD, Staying Healthy
and Active With Blood Thinners, and its
companion booklet, Blood Thinner Pills: Your
Guide to Using Them Safely,
(http://www.ahrq.gov/consumer/btpills.htm)
into its television system and hospital patient
education.
Kelli L. Rothenberger, PharmD, at Fletcher Allen
Health Care in Burlington, Vermont, is a clinical pharmacist delivering
the anticoagulation therapy education to new patients. She says, "I find the
DVD and especially the booklet to be quite complete. The response from
patients has been good; they find it comforting that the information from both
the DVD and our counseling sessions can be found in these resources."
Available in both English and Spanish, AHRQ's DVD and booklet are
designed to complement education that patients receive in their doctor's
office, clinic, pharmacy, or hospital.
Fletcher Allen Health Care offers 30 educational videos on its inpatient
system. As of August 2011, Blood Thinner Pills: Your Guide to Using Them
Safely had the highest number of patient views on the educational listing. |
Return to Contents
AHRQ Publication No. 11(12)-0008
Current as of December 2011
Internet Citation:
AHRQ Annual Highlights 2011. AHRQ Publication No. 11(12)-0008, December 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/highlt11.htm
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