AHRQ-Funded Centers To Study Health Systems and Their Efforts To Disseminate Patient-Centered Outcomes Research

AHRQ Stats: Behavioral Medication Use

The percentage of boys ages 5-18 taking one or more behavioral medication in 2012 was more than double that of girls: 6.0 percent versus 2.3 percent. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #473: Behavioral Medication Utilization in Children and Teenagers Ages 5–18 in the U.S. Civilian Noninstitutionalized Population, 2012).

Today's Headlines

1. AHRQ-Funded Centers To Study Health Systems and Their Efforts To Disseminate Patient-Centered Outcomes Research.
2. Electronic Health Record Triggers Can Identify Patients With Suspected Lung Cancer, Study Indicates.
3. AHRQ Report Shows Coordinated Care Slowly Changing From Goal to Reality.
4. Measuring Patient-Reported Outcomes Can Help Identify Patients at Higher Risk for Hospital Readmission, AHRQ Study Finds.
5. New Software Release Supports Use of AHRQ Quality Indicators.
6. Continuing Education Webinar on Health IT Impact on Workflow Scheduled for June 25.
7. Featured Impact Case Study: AHRQ Research Prompts Efforts at Banner Desert To Reduce Drug Errors in ED Patients.
8. AHRQ in the Professional Literature.

1. AHRQ-Funded Centers To Study Health Systems and Their Efforts To Disseminate Patient-Centered Outcomes Research

AHRQ Director Richard Kronick, Ph.D., has announced that AHRQ plans to fund three Centers of Excellence to study how high-performing health care systems promote evidence-based practices in delivering care. The centers will identify the characteristics of health systems that successfully disseminate and apply evidence from patient-centered outcomes research and analyze the connections between successful dissemination, patient health outcomes and effective use of resources. The three grants, which will begin in September, will provide approximately $52 million over five years to study how complex delivery systems disseminate evidence-based findings and provide lessons learned to inform the dissemination of findings in other settings. The award recipients will be:

• Dartmouth College, in collaboration with the University of California at Berkeley, Harvard University and the High Value Healthcare Collaborative (18 systems).
• National Bureau of Economic Research, in collaboration with the Health Research & Educational Trust.
• RAND Corporation, in collaboration with Pennsylvania State University.

The three Centers of Excellence will identify, classify, track and compare health care delivery systems to understand the organizational and environmental factors affecting the use of evidence-based medicine. The effort is part of the with the Agency's effort to accelerate the dissemination and implementation of patient-centered outcomes research findings into practice. It is also tied to the wider HHS delivery system reform initiative to encourage "Better Care, Smarter Spending and Healthier People."

2. Electronic Health Record Triggers Can Identify Patients With Suspected Lung Cancer, Study Indicates

A "trigger" algorithm in electronic health record (EHR) systems can be used to identify patients who may have cancer for whom follow-up screening was delayed, according to an article and abstract that were published online May 11 in the journal Radiology. The research, supported in part by an AHRQ grant, sought to establish whether an EHR-based trigger notification could identify delays in follow-up of imaging results that suggested lung cancer. Researchers designed the trigger as an alert to notify clinicians when a patient with an abnormal lung imaging result did not receive a follow-up diagnostic evaluation in a timely manner. They tested it in a large health care facility over a one-year period. In that period, 89,168 patients visited the facility, 24,829 had at least one chest image taken and 538 had findings that radiologists flagged as suspicious. The trigger algorithm identified 131 patients, of whom 75 were found to have a delay in follow-up action, which was confirmed through a manual review of records.

3. AHRQ Report Shows Coordinated Care Slowly Changing From Goal to Reality

Health providers are getting better at working with patients to make sure they get the care they need and understand their role in the process, according to AHRQ's newly released Chartbook on Care Coordination. Progress was most significant (improved by more than 10 percent in one year) in one measure, which tracked hospital patients with heart failure who received complete, written discharge instructions when they left the hospital. No care coordination measures showed worsening quality, and no measure showed elimination or widening of disparities. Another measure of care coordination, use of electronic health records, found that a majority of patients in all ethnic and educational groups said it was "very important" that their health providers be able to share their medical information electronically. This trend held among patients regardless of educational level, including those with less than a high school education. Their preference for electronic medical information increased from 39 percent in 2008 to 51 percent in 2013. AHRQ offers a variety of resources involving hospital discharges.

4. Measuring Patient-Reported Outcomes Can Help Identify Patients at Higher Risk for Hospital Readmission, AHRQ Study Finds

Despite widespread efforts to accurately predict which patients are at greatest risk for being readmitted to the hospital within 30 days of discharge, patient-reported outcome measures are infrequently used in predictive models. To find out whether patients' self-reported views of their health services can accurately predict readmission, a research team at Cook County Health and Hospital System in Chicago administered the Memorial Symptom Assessment Scale and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health short form to 196 patients at discharge. Patients also took the health assessment surveys at 30, 90 and 180 days after discharge. Patients who scored poorly on the PROMIS measures of general self-rated health and mental health were at greater risk of rehospitalization within 14 days of discharge, researchers found. However, low scores by patients on the Memorial Symptom Assessment Scale and the PROMIS measures of global physical health were better able to predict readmission. Because the sample size of the population was relatively small, researchers acknowledged that the findings may be limited. They recommended that systems to obtain patient-reported outcomes be developed as a routine part of clinical care. The study, "When Do Patient-Reported Outcome Measures Inform Readmission Risk?" and abstract were published online on April 9 in Journal of Hospital Medicine.

5. New Software Release Supports Use of AHRQ Quality Indicators

An upgrade of the WinQI software now allows hospitals and other organizations to more effectively apply AHRQ Quality Indicators (QIs) to their own inpatient administrative data to measure and improve health care quality. The AHRQ QIs help assess quality performance, highlight potential concerns, identify areas that need further investigation and track improvement over time. WinQI version 5.0, which builds on previous versions of the Windows-based software, includes current measure specifications and methodological details, updates to software files, new data tables and benchmarks and bug fixes. WinQI version 5.0 is available for download from the WinQI Software page on the AHRQ Web site. The WInQI software is one of two options AHRQ provides to calculate the AHRQ QIs. The other option is SAS QI, which is statistical software often preferred by researchers who want to write programs that use the statistical capabilities available in SAS. In contrast, the WinQI software has a graphical user interface designed for nonprogrammers. WinQI requires an SQL Server®, a free version of which may also be downloaded from the AHRQ Web site.

6. Continuing Education Webinar on Health IT Impact on Workflow Scheduled for June 25

AHRQ is hosting a webinar June 25 from 1:30 to 3 p.m. ET to discuss workflow impacts of health information technology (IT) and practice redesign and present the results of two studies. The first study analyzed the causal relationship between health IT implementation and ambulatory care workflow redesign, social and technical factors and the role these factors play in mitigating or increasing health IT's workflow impacts, as well as the workflow impacts of health IT-associated interruptions. The second study focused on the workflow impact of implementing health IT-enabled care coordination for patients with diabetes within six ambulatory primary care clinics. Registration is open, and continuing education credit is available.

7. Featured Impact Case Study: AHRQ Research Prompts Efforts at Banner Desert To Reduce Drug Errors in ED Patients

Research funded under AHRQ's "Partnerships in Implementing Patient Safety" grants helped inspire Banner Desert Medical Center in Mesa, Arizona, to expand its emergency department pharmacy program by using pharmacy technicians. Three months after implementing the program, technicians were capturing the medication histories of nearly 90 percent of patients admitted through the emergency department.

8. AHRQ in the Professional Literature

Heintzman J, Bailey SR, Hoopes MJ, e 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®.

Forrest CB, Margolis PA, Bailey LC, et al. PEDSnet: a National Pediatric Learning Health System. J Am Med Inform Assoc 2014 Jul-Aug;21(4):602-6. Epub 2014 May 12. Select to access the abstract on PubMed®.

Cochran GL, Haynatzki G. Comparison of medication safety effectiveness among nine critical access hospitals. Am J Health Syst Pharm 2013 Dec 15;70(24):2218-24. 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®.

Sharif R, Parekh TM, Pierson KS, et al. Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014 Jun;11(5):685-94. 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®.

Taylor DH Jr. Medicare as insurance innovator: the case of hospice. Am J Hosp Palliat Care 2013 Sep;30(6):556-7. Epub 2012 Sep 25. Select to access the abstract on PubMed®.