AHRQ Study: Rising Local Unemployment No Longer Linked to Declining Heart Attack Hospitalizations

Editor's Note: The next issue of the AHRQ Electronic Newsletter will be published May 12.

AHRQ Stats

Mental Health Care Costs

Mental health care costs for individuals ages 18 to 64 averaged more than $48 billion annually from 2009 to 2011, with 45 percent of the cost (about $22 billion) spent on prescription medicines. On average during that period, 28 million adults per year had health care expenses related to mental health diagnoses. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #454: Expenditures for Mental Health among Adults, Ages 18-64, 2009-2011: Estimates for the U.S. Civilian Noninstitutionalized Population.)

Today's Headlines

1. AHRQ Study: Rising Local Unemployment No Longer Linked to Declining Heart Attack Hospitalizations.
2. Blacks Had Lower Inpatient Mortality Rates Than Whites When Hospitalized for Common Medical Conditions, AHRQ Study Finds.
3. Letters of Intent Due May 4 for Funding Opportunity Announcement on Electronic Health Data Projects.
4. AHRQ Continuing-Education Video Explores Medication Adherence Intervention Programs.
5. AHRQ Continuing-Education Resource Describes How PCMH Model Improves Care.
6. Register Now: May 11 Webinar on How AHRQ's 2014 National Healthcare Quality and Disparities Report and the National Quality Strategy Work Together To Improve Health Care.
7. Save the Date: May 12 AHRQ Care Coordination Quality Webinar.
8. AHRQ in the Professional Literature.

1. AHRQ Study: Rising Local Unemployment No Longer Linked to Declining Heart Attack Hospitalizations

An AHRQ study found new evidence that the overall relationship between health and the economy may have shifted over time for cardiovascular events. The study, which used AHRQ’s Healthcare Cost and Utilization Project State Inpatient Databases and Bureau of Labor Statistics data from 1995 to 2011, found that a one percentage point increase in the unemployment rate during that period was associated with a statistically significant 0.80 percent decline in heart attack hospitalizations for adults ages 20 to 64 and a 0.96 percent decline for those ages 65 and older from 1995 to 2003, but not for the second half of the study. Researchers speculated that this shift could be the result of many factors, including structural changes to the health care system, workplaces that seek to enhance the well-being of employees and increased housing costs that add to the burden of the unemployed. The study, “The Relationship between Local Economic Conditions and Acute Myocardial Infarction Hospital Utilization by Adults and Seniors in the United States 1995–2011,” and abstract were published online March 15 in the journal Health Services Research.

2. Blacks Had Lower Inpatient Mortality Rates Than Whites When Hospitalized for Common Medical Conditions, AHRQ Study Finds

Black hospital patients had lower mortality rates than white hospital patients for six common medical conditions, according to a new AHRQ study. Researchers compared data from 2009 on outcomes for heart attack, congestive heart failure, gastrointestinal hemorrhage, hip fracture, pneumonia and stroke. The biggest difference shown, after adjustment for risk factors, was that the black mortality rate for congestive heart failure was about 38 percent less than the white mortality rate (16.6 versus 26.6 deaths per 1,000 hospital stays) and the smallest difference in black and white mortality rates was shown for pneumonia at 5 percent (29.6 versus 31.1 deaths per 1,000 stays). Blacks experienced higher mortality rates, however, for two common surgical procedures, coronary artery bypass graft (13 percent higher) and craniotomy (10 percent higher). Mortality rates were 20 percent lower among blacks for abdominal aortic aneurysm repair, but were similar to whites for percutaneous transluminal coronary angioplasty. The study authors, Roxanne M. Andrews, Ph.D., and Ernest Moy, M.D., used AHRQ’s Inpatient Quality Indicators software to measure risk-adjusted hospital mortality rates. The study, “Racial Differences in Hospital Mortality for Medical and Surgical Admissions: Variations by Patient and Hospital Characteristics,” and abstract were published in the winter 2015 issue of the journal Ethnicity & Disease.

3. Letters of Intent Due May 4 for Funding Opportunity Announcement on Electronic Health Data Projects

The Electronic Data Methods (EDM) Forum, funded by AHRQ, is seeking proposals for research projects that provide novel, collaborative approaches to address the analytic, technological and governance challenges of using electronic health data in learning health systems. A priority will be given to projects that develop approaches, methods or tools to facilitate collaborative science and promote more open and rapid translation and dissemination of patient-centered outcomes research; improve knowledge management of the EDM Forum repository; or improve ability to show and share patient-level data. All proposals must be collaboratively designed and executed, drawing on the perspectives of multiple initiatives and stakeholder groups. Letters of intent are due May 4.

4. AHRQ Continuing-Education Video Explores Medication Adherence Intervention Programs

A new AHRQ continuing-education video explores how interventions can encourage medication adherence. On average, 50 percent of medications for chronic disease aren’t taken as prescribed. Nonadherence has been estimated to cost the U.S. health care system between $100 billion and $289 billion annually in direct costs. Strong evidence suggests that improved self-management of chronic diseases could result in a cost-to-savings ratio of approximately 1:10 and improve patient health outcomes. The video features findings from Medication Adherence Interventions: Comparative Effectiveness, a report from AHRQ’s Closing the Quality Gap Series that sheds light on the potential for multiple interventions, such as reducing copayments or improving coverage for prescription drugs, offering case management services and providing patients education and behavioral support to improve medication adherence.

5. AHRQ Continuing-Education Resource Describes How PCMH Model Improves Care

A new AHRQ continuing-education resource identifies efforts to evaluate the comprehensive patient-centered medical home (PCMH) model, summarizes current evidence for the model and identifies gaps in the evidence. The PCMH is a model of primary care transformation that seeks to meet the variety of health care needs of patients and improve patient and staff experiences, outcomes, safety and system efficiency. More information about PCMH interventions can be found in an AHRQ evidence report titled Closing the Quality Gap Series: The Patient-Centered Medical Home.

6. Register Now: May 11 Webinar on How AHRQ's 2014 National Healthcare Quality and Disparities Report and the National Quality Strategy Work Together To Improve Health Care

Each year, the AHRQ National Healthcare Quality and Disparities Report provides a comprehensive view of the quality of health care received by the U.S. population and disparities in care experienced by different racial, ethnic and socioeconomic groups. Register now for the one-hour webinar from 2 to 3 p.m. ET on May 11. The webinar will present information on how the report’s findings support the National Quality Strategy’s six priorities. The webinar also will highlight challenges and opportunities for improving health care quality and reducing health disparities in the future. Presenters are AHRQ’s Nancy J. Wilson, M.D., B.S.N., Executive Lead for the National Quality Strategy; and Ernest Moy, M.D., Medical Officer in AHRQ’s Center for Quality Improvement and Patient Safety.

7. Save the Date: May 12 AHRQ Care Coordination Quality Webinar

AHRQ will host a webinar May 12 from 1:30 to 3 p.m. ET to discuss a new set of measures of care coordination for children with complex medical conditions. The webinar will feature a presentation by Rita Mangione-Smith, M.D., of Seattle Children’s Research Institute. Dr. Mangione-Smith developed the measure set through an award from the Pediatric Quality Measures Program, funded and operated by AHRQ and the Centers for Medicare & Medicaid Services through the Children’s Health Insurance Program Reauthorization Act. In addition to Dr. Mangione-Smith, the webinar will include presentations from two users of the measures: David Bergman, M.D., of Stanford University and Valerie Harder, M.D., of the National Improvement Partnership Network. Registration details and information will be available soon.

8. AHRQ in the Professional Literature

Barocas DA, Alvarez J, Koyama T, et al. Racial variation in the quality of surgical care for bladder cancer. Cancer. 2014 Apr 1;120(7):1018-25. Epub 2013 Dec 11. Select to access the abstract on PubMed®. 

Grinspan ZM, Abramson EL, Banerjee S, et al. People with epilepsy who use multiple hospitals; prevalence and associated factors assessed via a health information exchange. Epilepsia. 2014 May;55(5):734-45. Epub 2014 Mar 5. Select to access the abstract on PubMed®.

Miller SC, Looze J, Shield R, et al. Culture change practice in U.S. nursing homes: prevalence and variation by state Medicaid reimbursement policies. Gerontologist. 2014 Jun;54(3):434-45. Epub 2013 Mar 20. Select to access the abstract on PubMed®.

Baker DW, Brown T, Buchanan DR, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med. 2014 Aug;174(8):1235-41. Select to access the abstract on PubMed®.

Fulford D, Peckham AD, Johnson K, et al. Emotion perception and quality of life in bipolar I disorder. J Affect Disord. 2014 Jan;152-154:491-7. Epub 2013 Sep 7. Select to access the abstract on PubMed®.

Mularski RA, McBurnie MA, Lindenauer PK, et al. Comparative effectiveness research in chronic obstructive pulmonary disease. J Comp Eff Res. 2012 Jan;1(1):71-82. Select to access the abstract on PubMed®. 

Ancker JS, Silver M, Kaushal R. Rapid growth in use of personal health records in New York, 2012-2013. J Gen Intern Med. 2014 Jun;29(6):850-4. Epub 2014 Feb 12. Select to access the abstract on PubMed®.

Correa A, Bardenheier B, Elixhauser A, et al. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J. 2015 Mar;19(3):635-42. Select to access the abstract on PubMed®.