AHRQ Briefs Probe Issue of Hospital Readmissions for Psychiatric Conditions

AHRQ Stats: Access to Care

About 53.4 million American adults under age 65 (28 percent) in 2012 reported having no usual place to go for medical care when they got sick. Overall, among this age group, men were more likely to not have a usual place to go for care (34 percent) than women (22 percent). (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #461: Access to Health Care of Adult Men and Women, Ages 18-64, 2012.)

Today's Headlines

1. AHRQ Briefs Probe Issue of Hospital Readmissions for Psychiatric Conditions.
2. AHRQ Study: Hospital Management Practices Can Influence Efforts To Prevent Bloodstream Infections.
3. AHRQ Study Finds Increased Patient Loads Affect Telemetry Staff's Ability To Detect Emergencies.
4. Nominations Being Accepted for AHRQ National Advisory Council.
5. AHRQ Webinar Exploring Hospital-Based Intervention Programs Available Online.
6. Featured Impact Case Study: TeamSTEPPS® Training Required for Loyola Students.
7. AHRQ in the Professional Literature.

1. AHRQ Briefs Probe Issue of Hospital Readmissions for Psychiatric Conditions

Two new briefs from AHRQ examine the issue of readmissions for psychiatric hospitalization. A statistical brief from AHRQ's Healthcare Cost and Utilization Project found that 30-day readmission rates in 2012 were 15.7 percent when the primary diagnosis was schizophrenia and 9 percent when the primary diagnosis involved mood disorders. This compares with a 30-day readmission rate of 3.8 percent for all other non-mental health/substance abuse conditions. Meanwhile, a technical brief from AHRQ's Effective Health Care Program found that the availability and implementation of strategies to reduce hospital readmissions for psychiatric conditions vary widely and that these readmissions are probably undercounted. It concluded that more research is needed to determine which strategies work best to reduce readmissions for psychiatric conditions, ways to accurately measure the most meaningful outcomes and the best ways to apply effective strategies in settings with varying resources. In 2012, nearly one quarter of U.S. adults experienced some form of mental or substance use disorder.

2. AHRQ Study: Hospital Management Practices Can Influence Efforts To Prevent Bloodstream Infections

Specific hospital management practices can influence the effectiveness of central line-associated bloodstream infection prevention efforts, an AHRQ-funded study found. Researchers interviewed staff from eight hospitals participating in implementation of AHRQ's Comprehensive Unit-based Safety Program to identify management practices that differentiated higher-performing hospitals from lower-performing ones. They found that the degree of commitment to the goal of "getting to zero" infections was a determining factor in the effectiveness of this prevention effort. At higher-performing hospitals, this goal was stated explicitly, widely embraced and aggressively pursued. At lower-performing hospitals, the goal was viewed as an aspiration and was not part of an integrated strategy to prevent infections, the study stated. Additional management practices – top-level commitment, physician-nurse alignment, systematic education, meaningful use of data, and rewards and recognition – were nearly exclusively present in the higher-performing hospitals. The study presents a management practice "bundle" with suggestions for implementing strategies to prevent infections. The article and abstract, "Preventing Central Line-Associated Bloodstream Infections: A Qualitative Study of Management Practices" were published online February 23 in the journal Infection Control & Hospital Epidemiology. AHRQ's Michael I. Harrison, Ph.D., is a coauthor of the study.

3. AHRQ Study Finds Increased Patient Loads Affect Telemetry Staff's Ability To Detect Emergencies

If hospital staff monitor too many heart patients at once, care for patients experiencing serious heart problems might be delayed, according to an AHRQ-funded study. A growing number of at-risk patients are monitored remotely by staff who watch patients' heart monitors for long hours. While the number of patients being monitored at one time varies among hospitals, a staff member may monitor as many as 72 patients at a time. Response times for different numbers of patients were compared In "Patient Load Effects on Response Time to Critical Arrhythmias in Cardiac Telemetry: A Randomized Trial," published online with an abstract March 5 in the journal Critical Care Medicine. As the number of patients being monitored increased, response times to critical events were slower. More than 200,000 U.S. hospital patients are treated for cardiac arrest each year. The average survival rate for cardiac arrest is 17 percent. However, with quick and proper medical care, the survival rate approaches 40 percent.

4. Nominations Being Accepted for AHRQ National Advisory Council

AHRQ is seeking nominations for seven new public members to serve on the National Advisory Council for Healthcare Research and Quality. The Council advises the Secretary of HHS and the Director of AHRQ on matters related to activities of the agency to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable, and to work within HHS and with other partners to make sure the evidence is understood and used. The 21-member Council meets in the Washington, D.C., metropolitan area, generally in Rockville, Maryland, approximately three times a year. Members generally serve three-year terms, and the new members will start their service in spring 2016. AHRQ seeks individuals who are distinguished in the conduct of research, demonstration projects and evaluations with respect to health care; the fields of health care quality research or health care improvement; the practice of medicine or other health professions; representation of the private health care sector (including health plans, providers and purchasers) or administrators of health care delivery systems; the fields of health care economics, information systems, law, ethics, business or public policy; and representation of the interests of patients and consumers of health care. Nominations are due on or before July 8. A Federal Register notice has instructions for submitting nominations.

5. AHRQ Webinar Exploring Hospital-Based Intervention Programs Available Online

A recording is available for AHRQ's May 20 continuing-education webinar that explored how hospital-based medication reconciliation interventions can reduce medication errors during transitions of care. Some evidence shows that pharmacist-led processes could prevent medication errors and potential adverse drug events. Findings from an AHRQ report that explored this topic and information from the MATCH toolkit, a step-by-step guide for improving the medication reconciliation process, were reviewed during the webinar.

6. Featured Impact Case Study: TeamSTEPPS® Training Required for Loyola Students

Loyola University Chicago requires that the approximately 300 students in its schools of medicine and nursing be introduced to AHRQ's TeamSTEPPS patient safety training program.

7. AHRQ in the Professional Literature

Ellimoottil C, Miller S, Ayanian JZ, et al. Effect of insurance expansion on utilization of inpatient surgery. JAMA Surg 2014 Aug;149(8):829-36. Select to access the abstract on PubMed®.

McGlynn EA, Lieu TA, Durham ML, et al. Developing a data infrastructure for a learning health system: the PORTAL network. J Am Med Inform Assoc 2014 Jul-Aug;21(4):596-601. Epub 2014 May 12. 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®.

Angier H, Gold R, Gallia C, et al. Variation in outcomes of quality measurement by data source. Pediatrics 2014 Jun;133(6):e1676-82. Select to access the abstract on PubMed®.

Dy CJ, Bozic KJ, Pan TJ, et al. Risk factors for early revision after total hip arthroplasty. Arthritis Care Res 2014 Jun;66(6):907-15. Select to access the abstract on PubMed®.

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®.