HHS Announces $112 million in AHRQ Awards To Help 5,000 Primary Care Professionals Advance Heart Health

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: The Long-Term Uninsured

Hispanics were disproportionately represented from 2009 to 2012 among the "long-term uninsured"—those without insurance during the entire four-year period. They comprised 19 percent of the population under age 65 but accounted for 42 percent of the long-term uninsured. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #464: The Long-Term Uninsured in America, 2009-2012 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65.)

Today's Headlines

1. HHS Announces $112 million in AHRQ Awards To Help 5,000 Primary Care Professionals Advance Heart Health.
2. AHRQ-Funded Study Finds Lower Readmission Rates in Low-Volume Hospitals.
3. New AHRQ Patient Safety Primer on Alert Fatigue Asserts Increase in Electronic Alarms Might Harm Patients.
4. National Quality Strategy Priorities in Action Recognizes Children's Hospital for Reducing Harm in Care Delivery.
5. AHRQ Offers On-Demand Continuing Education Webinars for Nurses, Nurse Practitioners and Nurse Educators.
6. AHRQ's Health Care Innovations Exchange Focuses on Primary Care Innovations To Improve Cardiovascular Health.
7. Featured Impact Case Study: Florida Hospital Uses HCAHPS® To Help Improve Patient Care Experiences.
8. AHRQ in the Professional Literature.

1. HHS Announces $112 million in AHRQ Awards To Help 5,000 Primary Care Professionals Advance Heart Health

HHS Secretary Sylvia M. Burwell has announced awards of $112 million to regional cooperatives to work with about 5,000 primary care professionals in 12 states to improve the heart health of nearly 8 million patients. The grants represent one of the largest research investments to date by AHRQ. The initiative, EvidenceNOW: Advancing Heart Health in Primary Care, establishes seven regional cooperatives composed of multidisciplinary teams of experts that will provide quality improvement services to up to 300 small primary care practices. An eighth awardee will receive a grant to conduct an independent external evaluation of the initiative. The awards are aligned with the Department's Million Hearts® national initiative to prevent heart attacks and stroke and will incorporate the most recent evidence on how best to deliver the ABCS of cardiovascular prevention into their patients' care - aspirin use by high-risk individuals, blood pressure control, cholesterol management and smoking cessation. Services provided as part of the EvidenceNOW initiative include onsite coaching, consultation from experts in health care delivery improvement, sharing best practices, and electronic health record support.

2. AHRQ-Funded Study Finds Lower Readmission Rates in Low-Volume Hospitals

A typical marker of high-quality hospital care is higher volume, especially for surgical care. However, an AHRQ-funded study has found that 30-day readmission rates are lowest among low-volume hospitals, suggesting that readmissions are associated with aspects of care other than mortality or complications. Using Medicare inpatient data of nearly 7 million adult discharges over a one-year period (2011-2012), researchers found the average risk-standardized 30-day readmission rate for hospitals in the group with the lowest volume was 14.7 percent, compared with 15.9 percent for hospitals in the group with the highest volume. The same pattern of significantly lower standardized readmission rates among the lowest volume hospitals was observed following medicine, cardio-respiratory and neurology admissions, but not following cardiovascular and surgery admissions. The study, titled "Association of Hospital Volume With Readmission Rates: a Retrospective Cross-Sectional Study," and abstract were published online February 9 in the journal BMJ.

3. New AHRQ Patient Safety Primer on Alert Fatigue Asserts Increase in Electronic Alarms Might Harm Patients

The rapidly increasing computerization of health care has produced benefits for clinicians and patients, yet the integration of technology into medicine has been anything but smooth, according to a new primer on alert fatigue posted on AHRQ's Patient Safety Network. For instance, computerized provider order entry systems, smart intravenous infusion pumps and cardiac monitoring devices provide auditory or visual warnings to clinicians to prevent or act on unsafe situations. In the highly computerized clinical environment, clinicians may experience dozens of warnings and alerts a day. The term "alert fatigue" describes how clinicians become desensitized to safety alerts, and as a result, ignore or fail to respond appropriately to such warnings. The phenomenon occurs because of the number of alerts. Most alerts are clinically inconsequential, and in most cases clinicians should ignore them. However, clinicians also ignore both clinically meaningless alarms and critical alerts that warn of impending serious patient harm. In essence, the primer stated, the proliferation of alerts intended to improve safety paradoxically increases the chance that patients will be harmed.

4. National Quality Strategy Priorities in Action Recognizes Children's Hospital for Reducing Harm in Care Delivery

The latest edition of the National Quality Strategy's Priorities in Action features the work of Children's Hospital of Pittsburgh to improve outcomes for pediatric patients. The hospital uses an innovative health information technology system based on the knowledge that pediatric patients are at a uniquely high risk for preventable medication errors. As a result of this work, the hospital experienced a 60 percent decrease in medication safety events and a 92 percent decrease in serious medication errors. The facility reduces harm caused in the delivery of care through the National Quality Strategy levers of Health Information Technology, Innovation and Diffusion, and Learning and Technical Assistance.

5. AHRQ Offers On-Demand Continuing Education Webinars for Nurses, Nurse Practitioners and Nurse Educators

AHRQ offers free web-based continuing education for nurses, nurse practitioners, case managers, staff educators and nurse practitioner faculty. The recorded webinars highlight resources such as the National Guidelines Clearinghouse, the Electronic Preventive Services Selector and the Improving Patient Safety in Long-Term Care Facilities training modules. The webinars offer practical insights on how these resources can be integrated into education and practice.

6. AHRQ's Health Care Innovations Exchange Focuses on Primary Care Innovations To Improve Cardiovascular Health

The current issue of AHRQ's Health Care Innovations Exchange features three programs that used innovative approaches to reduce the risk of cardiovascular disease and improve patient outcomes. One profile describes a program by NorthShore University HealthSystem in Chicago's northern suburbs that provides clinicians in 40 primary care practices a monthly list of patients at risk of undiagnosed hypertension. Practice staff contact patients to schedule standardized visits for blood pressure measurement and primary care evaluation. In this program, electronic health records also generate automatic alerts whenever an at-risk patient visits the office regardless of the reason for the visit. Once patients arrive at the office, a blood pressure measurement is determined by using an automated device that averages five blood pressure readings taken while the patient sits alone in the examination room. The program has been effective, reducing the percentage of at-risk patients remaining undiagnosed for hypertension by approximately 70 percent.

7. Featured Impact Case Study: Florida Hospital Uses HCAHPS® To Help Improve Patient Care Experiences

AHRQ's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) survey results have helped Gulf Breeze Hospital near Pensacola, Florida, address four quality measures of the patient experience. The hospital showed the most improvement in the measure of pain control, which moved from 76 percent in 2012 to 93 percent in 2014.

8. AHRQ in the Professional Literature

Gonzalez AA, Girotti ME, Shih T, et al. Reliability of hospital readmission rates in vascular surgery. J Vasc Surg 2014 Jun;59(6):1638-43. Epub 2014 Mar 12. Select to access the abstract on PubMed®.

Heintzman J, Bailey SR, Hoopes MJ, et al. Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults. J Am Med Inform Assoc 2014 Jul-Aug;21(4):720-4. Epub 2014 Feb 7. Select to access the abstract on PubMed®.

Holmes JH, Elliott TE, Brown JS, et al. Clinical research data warehouse governance for distributed research networks in the USA: a systematic review of the literature.J Am Med Inform Assoc 2014 Jul-Aug;21(4):730-6. Epub 2014 Mar 28. Select to access the abstract on PubMed®.

Weidmer BA, Cleary PD, Keller S, et al. Development and evaluation of the CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey for in-center hemodialysis patients. Am J Kidney Dis 2014 Nov;64(5):753-60. Epub 2014 Jul 3. Select to access the abstract on PubMed®.

Masnick M, Morgan DJ, Wright MO, et al. Survey of infection prevention informatics use and practitioner satisfaction in US hospitals. Infect Control Hosp Epidemiol 2014 Jul;35(7):891-3. Epub 2014 May 15. Select to access the abstract on PubMed®.

Gadzinski AJ, Dimick JB, Ye Z, et al. Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals. JAMA Surg 2014 Jul;149(7):671-7. Select to access the abstract on PubMed®.

Vouri SM, Marcum ZA. Use of a medication reconciliation tool in an outpatient geriatric clinic. J Am Pharm Assoc 2013 Nov-Dec;53(6):652-8. Select to access the abstract on PubMed®.

Derose SF, Gabayan GZ, Chiu VY, et al. Emergency department crowding predicts admission length-of-stay but not mortality in a large health system. Med Care 2014 Jul;52(7):602-11. Select to access the abstract on PubMed®.