Infection Prevention "Bundle" Can Reduce Staph Surgical Site Infections, JAMA Article Says

AHRQ Stats: Children's Health Care Expenses

The highest total health care expense in 2012 for children age 17 and under was for mental health, with $13.9 billion spent on treatment of mental disorders. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #472: Top Five Most Costly Conditions among Children, Ages 0-17, 2012 Estimates for the U.S. Civilian Noninstitutionalized Population).

Today's Headlines

1. Infection Prevention "Bundle" Can Reduce Staph Surgical Site Infections, JAMA Article Says.
2. Children's Use of Psychiatric Services on the Rise, NEJM Article Finds.
3. AHRQ Case Study Analysis Pinpoints Success Factors for Reducing Central Line-Associated Bloodstream Infections.
4. Problematic Medication Use Still High Among Seniors, but Dropping.
5. Register Now: June 10 AHRQ Webinar Features Success Stories From Hospital Patient Safety Organization Members.
6. Register Now: June 24 AHRQ Webinar on Improving Informed Consent and End-of-Life Communication.
7. Featured Impact Case Study: Memorial Hospital Uses AHRQ Resources To Cut Readmissions, Promote Patient Self-Management.
8. AHRQ in the Professional Literature.

1. Infection Prevention "Bundle" Can Reduce Staph Surgical Site Infections, JAMA Article Says

Implementing a preoperative infection prevention "bundle" was associated with a reduction in serious Staphylococcus aureus surgical site infections (SSIs), according to an AHRQ-funded study and abstract published online in the June 2 issue of in the Journal of the American Medical Association. According to the article, "Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery," the bundle included screening for S. aureus, decolonizing patients who were positive for these bacteria and administering perioperative antibiotics according to an evidence-based protocol. Researchers looked at SSI rates for 42,534 operations involving cardiac surgery and hip or knee replacements performed in 20 Hospital Corporation of America-affiliated hospitals in nine states. Overall, they found that fully adhering to the bundle significantly reduced the risk of serious S. aureus SSIs in these operations.

2. Children's Use of Psychiatric Services on the Rise, NEJM Article Finds

A new study using data from AHRQ's Medical Expenditure Panel Survey (MEPS) found that the percentage of children 6 to 17 years old receiving outpatient mental health service increased from 9.2 percent in 1996–1998 to 13.3 percent in 2010–2012. Youths with less severe or no impairment accounted for a significant amount of the increase. Researchers calculated that 4.19 million youths with less severe or no mental health impairment used mental health services in 2010–2012, up from 2.74 million in 1996–1998. The number of youths with severe impairment who received services, meanwhile, increased from about 1.6 million to 2.34 million in the same time period. Fewer than half of youths with severe impairment, however, accessed mental care services in 2010–2012, researchers found. The study, led by Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the New York State Psychiatric Institute, used data from the 1996–1998, 2003–2005 and 2010–2012 MEPS to examine trends in outpatient use of mental health services among 53,622 children 6 to 17 years old. The study and abstract were published in the May 20 edition of the New England Journal of Medicine.

3. AHRQ Case Study Analysis Pinpoints Success Factors for Reducing Central Line-Associated Bloodstream Infections

An analysis of case studies of health care organizations that participated in AHRQ's Comprehensive Unit-based Safety Program (CUSP) national implementation project has identified management practices and "success factors" in reducing and eliminating central line-associated bloodstream infections (CLABSIs) in health care facilities. AHRQ has funded numerous projects to prevent and reduce healthcare-associated infections as part of its patient safety mission, including CUSP, which intensive care units across the country used to reduce CLABSIs by 41 percent. In this analysis, "High-Performance Work Practices in CLABSI Prevention Interventions," AHRQ-funded researchers conducted in-depth case studies of health care organizations and intensive care units that participated in a CUSP implementation project to study whether and how high-performance work practices facilitate successful reduction of healthcare-associated infections, focusing particularly on CLABSIs. Researchers concluded that the following management practices lead to the reduction of CLABSIs in health care settings: engaging staff, acquiring and developing talented employees, empowering frontline providers and aligning leaders. Researchers also identified six factors widely evident in health care facilities that reduce CLABSIs and missing or inconsistently applied in lower-performing facilities. Included were frontline accountability, strong leadership and use of data.

4. Problematic Medication Use Still High Among Seniors, but Dropping

The use of potentially inappropriate medications among older people declined between 2006–2007 and 2009–2010, an AHRQ-funded study found. However, there is still an overall high use of such medications, which contributes to poor outcomes and adverse events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most prevalent of the potentially problematic medications. The article and abstract, "Prevalence of Potentially Inappropriate Medication Use in Older Adults Using the 2012 Beers Criteria," appeared online March 6 in the Journal of the American Geriatrics Society. Coauthors included AHRQ's G. Edward Miller, Ph.D., and Eric M. Sarpong, Ph.D. The study reported that use of potentially inappropriate medications among older people declined from 45.5 percent in 2006–2007 to 40.8 percent in 2009–2010. Researchers used AHRQ's 2006–2010 Medical Expenditure Panel Survey data and updated the Beers criteria in the study. The Beers list is a guideline for health care professionals to help improve the safety of prescribing medications for older adults.

5. Register Now: June 10 AHRQ Webinar Features Success Stories From Hospital Patient Safety Organization Members

A free AHRQ webcast will highlight the AHRQ Patient Safety Organization (PSO) program and present success stories from hospitals that are members of one or more PSOs. Hospitals will share how their organizations have used their PSO for meaningful patient safety and quality improvement.

Speakers:

• Diane Cousins, R.Ph., AHRQ, Rockville, Maryland (Moderator).
• Vereline Johnson, R.N., M.S.N., Saint Francis Medical Center, Cape Girardeau, Missouri.
• Chris Dickinson, M.D., University of Michigan Health System, Ann Arbor, Michigan.

Registration is open.

6. Register Now: June 24 AHRQ Webinar on Improving Informed Consent and End-of-Life Communication

AHRQ will host a webinar June 24 from 1 to 2 p.m. ET to share results from recent reviews of interventions to improve informed consent processes and documentation of patients' preferences for end-of-life care. Research shows the informed consent process is often incomplete and patient recall and comprehension of the discussion is usually low. Additionally, care patients receive at the end of life is often not consistent with their preferences. Effective patient-provider communication can make a difference. The webinar will describe the seven elements of the informed consent process. The webinar also will address strategies to improve advance health care directive completion for end-of-life care. Continuing education is available.

7. Featured Impact Case Study: Memorial Hospital Uses AHRQ Resources To Cut Readmissions, Promote Patient Self-Management

The readmissions rate at Memorial Hospital declined to single-digit percentages after the 97-bed community hospital in Marysville, Ohio, implemented AHRQ's Re-Engineered Discharge (RED) toolkit to help discharged patients follow their treatment plans.

8. AHRQ in the Professional Literature

Galt KA, Fuji KT, Faber J. Patient safety problem identification and solution sharing among rural community pharmacists. J Am Pharm Assoc 2013 Nov-Dec;53(6):584-94. Select to access the abstract on PubMed®.

Cleary PD, Meterko M, Wright SM, et al. Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals. Med Care 2014 Jul;52(7):619-25. Select to access the abstract on PubMed®.

Masinter LM, Feinglass J, Grobman WA, et al. Likelihood of continued childbearing after cesarean delivery in the United States. Obstet Gynecol 2014 Jul;124(1):111-9. Select to access the abstract on PubMed®.

Simon TD, Cawthon ML, Stanford S, et al. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 2014 Jun;133(6):e1647-54. Epub 2014 May 12. Select to access the abstract on PubMed®.

Davis AE, Mehrotra S, McElroy LM, et al. The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States. Transplantation 2014 May 27;97(10):1049-57. Select to access the abstract on PubMed®.

Klann JG, Buck MD, Brown J, et al. Query Health: standards-based, cross-platform population health surveillance. J Am Med Inform Assoc 2014 Jul-Aug;21(4):650-6. Epub 2014 Apr 3. Select to access the abstract on PubMed®.

Chang E, Chan KS, Han HR. Factors associated with having a usual source of care in an ethnically diverse sample of Asian American adults. Med Care 2014 Sep;52(9):833-41. Select to access the abstract on PubMed®.

Toh S, Shetterly S, Powers JD, et al. Privacy-preserving analytic methods for multisite comparative effectiveness and patient-centered outcomes research. Med Care 2014 Jul;52(7):664-8. Select to access the abstract on PubMed®.