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Electronic Newsletter

February 8, 2012

AHRQ News and Numbers

Only 10 percent of the U.S. population accounted for nearly two-thirds of all health care costs in 2008. The average annual cost for each of these individuals totaled almost $24,000, which includes costs covered by insurance and paid out of pocket. Approximately 45 percent of these individuals remained in this 10 percent of the population in 2009, based on their health expenses that year. [Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey (MEPS) Statistical Brief #354: The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009.]

Today's Headlines

New AHRQ toolkit supports hospital efforts to improve quality and safety.
AHRQ releases Web-based modules to help pharmacy faculty and pharmacists implement health literacy concepts.
New AHRQ report shows patient safety culture strengths and areas for improvement in hospitals.
Triage tool helps hospitals stratify emergency department patients according to needs.
Evidence lacking on benefits of screening or treating early stage chronic kidney disease.
Evidence lacking to support surgery for pelvic pain.
More research needed to evaluate self-measured blood pressure monitoring.
Call for abstracts to participate in an AHRQ research methods symposium on patient-centered outcomes.
Highlights from most recent monthly newsletter.
AHRQ in the professional literature.

1. New AHRQ Toolkit Supports Hospital Efforts To Improve Quality and Safety

AHRQ has released a free toolkit designed to guide hospitals that use its Inpatient Quality Indicators (IQIs) and Patient Safety Indicators (PSIs) to improve care. The AHRQ Quality Indicators™ Toolkit for Hospitals is designed and tested to meet the needs of a variety of hospital-based users, including senior leaders, quality staff, and improvement teams. AHRQ developed these research-based tools through a 2-year contract with RAND in collaboration with UHC. The toolkit's "Introduction and Roadmap" helps users identify the resources that are best suited to their specific needs at any given point in the improvement process. It is organized into seven sections:

Determining Readiness To Change.
Applying QIs to the Hospital Data.
Identifying Priorities for Quality Improvement.
Implementing Improvements.
Monitoring Progress for Sustainable Improvements.
Analyzing Return on Investment.
Using Other Resources.

Select to access the toolkit.

2. AHRQ Releases Web-based Modules To Help Pharmacy Faculty and Pharmacists Implement Health Literacy Concepts

AHRQ has released a set of Web-based modules to help pharmacy faculty integrate health literacy quality improvement into courses, experiential education, and for PharmD thesis or pharmacy residency projects. Advancing Pharmacy Health Literacy Practices through Quality Improvement: Curricular Modules for Faculty includes four PowerPoint® slide sets, more than a dozen guides to encourage active learning and resources to provide faculty and students with background and references for topics covered in the modules. Select to access the modules.

3. New AHRQ Report Shows Patient Safety Culture Strengths and Areas for Improvement in Hospitals

Eighty percent of hospital staff feel there is strong teamwork within units, but only 45 percent of hospital staff have positive perceptions of handoffs and transitions across hospital units, according to a new report from AHRQ. The sixth annual edition of the "Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report" provides results from 567,703 staff from 1,128 U.S. hospitals. The report enables hospitals to compare their patient safety culture scores with other U.S. hospitals. In addition, the 2012 report presents data from 650 hospitals on changes in patient safety culture perceptions over time. The full report contains detailed comparative data for various hospital characteristics (e.g., bed size, teaching status, ownership and control, region) and respondent characteristics (e.g., work areas, staff positions, and interaction with patients). The Hospital Survey on Patient Safety Culture can be used to assess the opinions of diverse hospital staff about patient safety issues, medical error, and event reporting. It measures 12 areas, or composites, of patient safety culture. Select to access the report. U.S. hospitals using the survey are encouraged to submit data to the database between May 15 and June 15; select for details.

4. Triage Tool Helps Hospitals Stratify Emergency Department Patients According to Needs

AHRQ's new edition of a handbook provides an updated guide to implementing the Emergency Severity Index (ESI), a five-level algorithm that helps clinicians stratify patients according to their needs. The updated edition of the Emergency Severity Index: A Triage Tool for Emergency Department Care, Version 4, includes a new chapter on using the ESI with pediatric populations. A well-implemented ESI program can help hospital EDs rapidly identify patients in need of immediate attention, better identify patients who could safely and more efficiently be seen in a fast-track or urgent care center rather than the main ED, and more accurately determine thresholds for diversion of ambulance patients from the ED. First implemented in 1999, the ESI has been continuously tested and updated to provide EDs with a standardized approach to stratifying patients. The new edition also includes a summary of ESI research, an overview of triage acuity systems in the U.S. and research reports using ESI, an overview chapter describing the ESI in detail, and chapters on ESI implementation and quality monitoring. Select to access the updated edition of the ESI handbook.

5. Evidence Lacking on Benefits of Screening or Treating Early Stage Chronic Kidney Disease

A new AHRQ research review evaluates the evidence regarding the potential benefits and harms of screening, monitoring, and treating adults for early stage chronic kidney disease. The condition affects more than 44 percent of U.S. adults over the age of 70. The review examined screening, monitoring, and treatment of adults in stage 1, 2, or 3 of the five stages of chronic kidney disease. It found no or limited evidence that these interventions are beneficial to patients in the early stages of the disease. Select to access the review, Chronic Kidney Disease Stages 1-3: Screening, Monitoring, and Treatment.

6. Evidence Lacking to Support Surgery for Pelvic Pain

Despite the frequent use of invasive surgical procedures to treat women with noncyclic chronic pelvic pain, little evidence supports a surgical approach, a new review from AHRQ's Effective Health Care Program has found. In general, a lack of high quality research is available to evaluate the comparative effectiveness of both surgical and nonsurgical treatment options for noncyclic (not occurring during menstruation) chronic pelvic pain. Select these findings and future research needs summarized in the review, Comparative Effectiveness of Therapies for Women with Noncyclic Chronic Pelvic Pain.

7. More Research Needed to Evaluate Self-Measured Blood Pressure Monitoring

A new research review from AHRQ's Effective Health Care Program has found that there may be a small benefit to self-measured blood pressure monitoring for patients with hypertension, but there is limited evidence on its long-term effects and sustainability. Hypertension affects more than 76 million Americans and results in seven million annual deaths. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, adds to AHRQ's growing collection of resources on cardiovascular health, one of AHRQ's priority topics.

8. Call for Abstracts to Participate in an AHRQ Research Methods Symposium on Patient-Centered Outcomes

AHRQ's Effective Health Care Program is accepting abstract submissions for poster presentation at the symposium on research methods for comparative effectiveness and patient-centered outcomes research. The theme of the 2012 conference is "From Efficacy to Effectiveness." Authors of abstracts selected for the symposium will be invited to present their work as a poster. At least one author of a poster presentation will be invited to submit a complete manuscript for peer-review and publication in a special journal supplement. Submissions are due by March 1. The symposium is a follow-up to the 2006, 2009, and 2010 AHRQ conferences on Methods in Comparative Effectiveness Research. Papers presented at 2006 and 2009 conferences were published in the journal Medical Care and can be accessed at no cost. Select for more information and the submission form.

9. Highlights from Most Recent Monthly Newsletter

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

Increasing body mass index lowers quality of life in obese individuals.
As the rate of obesity increases in the United States, so too does its impact on a person's health-related quality-of-life (HRQoL), suggests a new study. Although some past studies have explored the impact of obesity on two to three measures of HRQoL, this was the first study to investigate nine HRQoL measures. It assessed how HRQoL varied by body mass index (BMI) in gender and racial subgroups. It found that six HRQoL indexes and two of three health status summary measures detected significantly worse quality of life in obese individuals compared to those with normal BMIs. Select to access this article.