AHRQ Findings Show Modest Improvements in Patient-Provider Communication

Editor's Note: This week's newsletter introduces a new series, the Featured Impact Case Study, highlighting real-life examples of how AHRQ materials are used to improve health care.

AHRQ Stats: Outpatient Drug Expenses

Prescription drug expenses for adults totaled $267 billion nationwide in 2012. Of the leading classes of outpatient prescription drugs based on total expenses that year, metabolic drugs (used for conditions such as high cholesterol, diabetes and weight control) were purchased by nearly one in four adults age 18 and older at an average of $104 per prescription. Meanwhile, cardiovascular drugs (used for conditions such as heart disease, blood clots and other circulatory disorders) were purchased by seven in 10 Medicare patients age 65 and older at an average of $28 per prescription. (Source: AHRQ Medical Expenditure Panel Survey Statistical Brief #468, Expenditures for the Top Five Therapeutic Classes of Outpatient Prescription Drugs, Adults Age 18 and Older, U.S. Civilian Noninstitutionalized Population, 2012 and Statistical Brief #469, Expenditures for the Top Five Therapeutic Classes of Outpatient Prescription Drugs, Medicare Beneficiaries, Age 65 and Older, U.S. Civilian Noninstitutionalized Population, 2012.)

Today's Headlines

1. AHRQ Findings Show Modest Improvements in Patient-Provider Communication.
2. Pediatric Electronic Health Records Need Features Different From Adult Records, Experts Say in AHRQ Report.
3. AHRQ Report Assesses Interventions for Postpartum Hemorrhage.
4. CHIPRA Evaluation Highlight Reveals How Two-State Collaboration Helped Transform Perinatal Care Quality.
5. AHRQ Web M&M Examines Errors in Sepsis Management.
6. Featured Impact Case Study: Pennsylvania Hospital Uses AHRQ Toolkit To Reduce Readmissions by 50 Percent.
7. AHRQ in the Professional Literature.

1. AHRQ Findings Show Modest Improvements in Patient-Provider Communication

Health providers are paying more attention to communicating more effectively with patients and their families about their care, although progress is occurring at a modest pace, according to findings from AHRQ's newly released Chartbook on Patient- and Family-Centered Care. Of the 20 measures of patient-centered care collected in the report, 17 showed improvement and three showed no change. While none of the measures improved quickly, none showed worsening quality. One measure, communication between patients and hospital staff about getting discharged from the hospital, improved each year between 2009 and 2013. But certain groups reported worse quality of patient-centered care, including poor patients compared with high-income patients, blacks compared with whites and Hispanics compared with whites. AHRQ offers a variety of resources to improve engagement between clinicians and patients.

2. Pediatric Electronic Health Records Need Features Different From Adult Records, Experts Say in AHRQ Report

A new report from AHRQ examines features needed in pediatric electronic health records (EHRs) to ensure quality care for children. The report scanned scientific literature and gathered expert consensus on EHRs used in the care of children. Child health care providers stated that they need access to EHRs with special features to assure the delivery of quality care to pediatric patients. These features relate to a child's evolving physiology, maturity and associated conditions not found in EHRs used for adult patients. Key EHR functionalities for consideration include the ability to build and maintain vaccination records, record growth and development data, calculate weight and age-based medication dosing, manage pediatric diseases, identify pediatric norms such as developmental milestones and document the relationship between pediatric patients and their parents and caregivers.

3. AHRQ Report Assesses Interventions for Postpartum Hemorrhage

A new AHRQ report that identifies interventions for management of postpartum hemorrhage (PPH) found that standards of care for treating the condition vary among health care professionals, particularly in emergency situations. PPH accounts for nearly one-quarter of all maternal pregnancy-related deaths. Many studies have suggested that deaths associated with PPH could be prevented with prompt recognition and more timely and aggressive treatment by health care professionals. The report says further research is needed to examine all interventions for PPH management, especially treatment with interventions using drugs, which as first-line therapies are the most frequently used.

4. CHIPRA Evaluation Highlight Reveals How Two-State Collaboration Helped Transform Perinatal Care Quality

AHRQ has issued the 12th Evaluation Highlight from the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program, now available on the national evaluation Web site. This Highlight focuses on how demonstration partners Florida and Illinois worked together to transform the quality of perinatal care in their respective states. CHIPRA grant funding helped establish or expand perinatal quality collaboratives, which engage hospitals in evidence-based and data-driven quality improvement projects aimed at improving perinatal care and outcomes for pregnant women and newborns. Both states implemented systems-level changes and reported improved outcomes for several quality measures. AHRQ is leading the national evaluation of the CHIPRA Quality Demonstration Program. The Centers for Medicare & Medicaid Services funds the evaluation. Contact the national evaluation team via email with questions or comments.

5. AHRQ Web M&M Examines Errors in Sepsis Management

The latest issue of AHRQ Web M&M includes the case of a 72-year-old woman with pulmonary hypertension, chronic obstructive pulmonary disease on home oxygen and coronary artery disease who came to the hospital experiencing abdominal pain on her left side and shortness of breath. Upon being admitted, she was also diagnosed with pneumonia. The patient was treated with normal saline in the emergency department, but was not given additional intravenous fluids because of her history of pulmonary hypertension and coronary artery disease. Twenty-four hours after admission her blood cultures were growing methicillin-resistant Staphylococcus aureus. Her condition worsened to the point that she required mechanical ventilation. Following a decision by her family to withdraw life-sustaining therapies, she died during her fourth day in the hospital. In the Perspectives on Safety feature, John Birkmeyer, M.D., chief academic officer and executive vice president at Dartmouth-Hitchcock Medical Center, talks about his video study, which found a link between practicing surgeons' directly observed technical skills and surgical outcomes. An accompanying perspective explores the advantages of using video in clinical practice and health care education.

6. Featured Impact Case Study: Pennsylvania Hospital Uses AHRQ Toolkit To Reduce Readmissions by 50 Percent

Penn Medicine Chester County Hospital, a 257-bed complex in West Chester, Pennsylvania, part of the University of Pennsylvania Health System, has used AHRQ's Re-Engineered Discharge (RED) toolkit to reduce preventable readmissions. Initially implemented in one unit, the program is now used hospital-wide with notable improvements in readmission rates and the patient experience.

7. AHRQ in the Professional Literature

Prey JE, Woollen J, Wilcox L, et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014 Jul-Aug;21(4):742-50. Epub 2013 Nov 22. Select to access the abstract on PubMed®.

Chrischilles EA, Hourcade JP, Doucette W, et al. Personal health records: a randomized trial of effects on elder medication safety. J Am Med Inform Assoc 2014 Jul-Aug;21(4):679-86. Epub 2013 Dec 10. Select to access the abstract on PubMed®.

Schumacher JR, Palta M, Loconte NK, et al. Characterizing the psychological distress response before and after a cancer diagnosis. J Behav Med 2013 Dec;36(6):591-600. Epub 2012 Aug 28. Select to access the abstract on PubMed®.

Ohno-Machado L, Agha Z, Bell DS, et al. pSCANNER: patient-centered Scalable National Network for Effectiveness Research. J Am Med Inform Assoc 2014 Jul-Aug;21(4):621-6. Epub 2014 Apr 29. Select to access the abstract on PubMed®.

Camelo Castillo W, Boggess K, Stürmer T, et al. Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011. Obstet Gynecol 2014 Jun;123(6):1177-84. Select to access the abstract on PubMed®.

Hellinger FJ. Assessing the cost effectiveness of pre-exposure prophylaxis for HIV prevention in the US. Pharmacoeconomics 2013 Dec;31(12):1091-104. Select to access the abstract on PubMed®.

Hanlon JT, Schmader KE. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging 2013 Nov;30(11):893-900. Select to access the abstract on PubMed®.

Navarro-Millán I, Sattui SE, Curtis JR. Systematic review of tumor necrosis factor inhibitor discontinuation studies in rheumatoid arthritis. Clin Ther 2013 Nov;35(11):1850-61.e1. Epub 2013 Oct 22. Select to access the abstract on PubMed®.