Report Explores Workflow Impact of Health Information Technology on Care Coordination in Ambulatory Care

AHRQ Stats: Hospital Care for Mental and Substance-Use Disorders

Nearly one in three hospital stays in 2012 involved at least one mental or substance-use disorder diagnosis, accounting for 8.6 million hospital stays that year. This analysis excludes hospital stays for maternal and neonatal conditions. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #191: Hospitalizations Involving Mental and Substance Use Disorders Among Adults, 2012.)

Today's Headlines

1. Report Explores Workflow Impact of Health Information Technology on Care Coordination in Ambulatory Care.
2. New Study Finds Few Medicare Patients Get Implantable Cardioverter Defibrillators Following Heart Attack.
3. AHRQ-Funded Articles Find Little to No Impact of CMS Policy on Healthcare-Associated Infections.
4. AHRQ Chartbook: Trends in Health Care Affordability Stable From 2010 to 2012.
5. AHRQ Study Examines Nursing Homes With Pay-for-Performance Programs.
6. Register Now: July 22 Webinar on Dissemination and Implementation Research.
7. Register Now: AHRQ Research Conference October 4-6.
8. Featured Impact Case Study: AHRQ Toolkit Reduces Infections in Wisconsin Dialysis Centers.
9. AHRQ in the Professional Literature.

1. Report Explores Workflow Impact of Health Information Technology on Care Coordination in Ambulatory Care

A new AHRQ report that presents findings from a six-site qualitative study (PDF File, 2 MB) highlights a number of opportunities to improve the impact of health information technology on care coordination activities in primary care. These opportunities include changing system design, adding missing features, addressing work activity variation and improving the user interface. Stronger impact from the care coordination role was noted when there were well-defined workflows, tools designed to fit the workflow, adequate training, good team communication, physical co-location of care coordinators with other care team members, stronger team relationships and time to allow the new work system to stabilize and learning to take place.

2. New Study Finds Few Medicare Patients Get Implantable Cardioverter Defibrillators Following Heart Attack

More than 350,000 people experience sudden cardiac death in the United States each year, yet fewer than 1 in 10 Medicare patients receives an implantable cardioverter-defibrillator (ICD) as a preventive measure following a heart attack, according to results of a new study published with an abstract in the June 23 issue of the Journal of the American Medical Association. In this large observational study, funded in part by AHRQ, a research team led by Duke University Medical Center sought to determine ICD implantation rates and associated mortality among patients 65 years and older with previous heart attack and low ejection fraction, a measure that determines how well the heart can pump blood. Evidence indicates that ICDs are underused in routine clinical practice, especially among older patients whose risks of heart attack and heart disease increase with age. Data for the study were drawn from 10,318 Medicare patients whose information was entered into a national cardiovascular registry and who were treated at 441 U.S. hospitals between 2007 and 2010. In addition to the low rate of ICD implantation among older patients, researchers also found that one-year ICD implantation was associated with significantly lower two-year mortality. Patients who had more contact with the health care system through early cardiology follow-up or readmission for heart attack or heart failure were more likely to undergo an ICD implantation, the study found. Further research is needed to determine evidence-based approaches to increase ICD implantation among eligible patients, researchers concluded. 

3. AHRQ-Funded Articles Find Little to No Impact of CMS Policy on Healthcare-Associated Infections

Two recent articles in the journal Infection Control and Hospital Epidemiology examined the impact of Medicare's policies on healthcare-associated infections (HAIs) and associated billing. The articles, funded by AHRQ, scrutinized the Centers for Medicare & Medicaid Services' (CMS) 2008 policies that ended additional payments to hospitals for the costs of care associated with certain "preventable events," sometimes known as hospital-acquired conditions, including specific HAIs contracted during hospitalization. One paper, "Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals," found that the policy had no impact on rates of central line-associated bloodstream infections and ventilator-associated pneumonia in hospitals, which were already declining. The paper and abstract were published in June. The other study, "Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections," published with an abstract in April, found that there was an immediate drop in billing rates followed by a slight downward trend for two other HAIs, vascular catheter-associated infections and catheter-associated urinary tract infections, following implementation of the CMS policy.

4. AHRQ Chartbook: Trends in Health Care Affordability Stable From 2010 to 2012

Health care affordability was stable between 2010 and 2012, ending an eight-year trend in which it had been becoming less affordable, according to AHRQ's new "Chartbook on Care Affordability." The overall percentage of people unable to get or delayed in getting medical or dental care or prescription drugs due to financial or insurance reasons decreased from 71.4 percent in 2010 to 69.3 percent in 2012, after having grown from 61.2 percent in 2002. The percentage of people reporting they did not have a usual place to go for health care also decreased, from 21.2 percent in 2010 to 20.2 percent in 2012, after having increased from 15.6 percent in 2002. The rate of individuals under age 65 with health insurance premiums and out-of-pocket costs exceeding 10 percent of their annual family income remained stable at 17.5 percent in 2006 and 17.9 percent in 2012. The chartbook is a supplement of the 2014 National Healthcare Quality and Disparities Report.

5. AHRQ Study Examines Nursing Homes With Pay-for-Performance Programs

Creating a reimbursement context that facilitates the collection and use of reliable local evidence is an important consideration for nursing home leaders contemplating pay-for-performance policies, AHRQ-funded researchers concluded in a study in BMJ. Pay-for-performance programs are used in organizations aiming to improve the quality of care. This study explored ways in which data were collected and used as a result of participation in a pay-for-performance program. Interviews were conducted with 232 employees from 70 nursing homes that participated in pay-for-performance-sponsored quality improvement projects. Interviewees included supervisors, nurses and nursing assistants, therapists, other patient care staff and administrators. Researchers found that data and evidence played an important role in quality improvement project implementation. Nursing home staff discussed using data to identify problems, track progress, motivate employees and increase the marketability of the organization. The study and abstract, "Pay-for-Performance Policy and Data-Driven Decision making Within Nursing Homes," appeared online March 6.

6. Register Now: July 22 Webinar on Dissemination and Implementation Research

AHRQ's Practice-Based Research Network program is hosting a webinar on July 22 from 12:30 to 2 p.m. ET featuring the authors of the new book, "Dissemination and Implementation Research in Health: Translating Science to Practice." Key challenges that will be discussed include how to evaluate the evidence base on effective interventions, which strategies will produce the greatest impact, how to design an appropriate study and how to track a set of essential outcomes. Application for continuing medical education credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. Registration is open.

7. Register Now: AHRQ Research Conference October 4-6

Registration is open for the 2015 AHRQ Research Conference, "Producing Evidence and Engaging Partners to Improve Health Care," scheduled for October 4-6 at the Crystal Gateway Marriott Hotel and Convention Center in Crystal City, Virginia. The conference, which is being co-hosted by AcademyHealth, will bring together authorities in health care research and policy to participate in sessions focused on addressing today's challenges in improving quality, safety, access and value in health care. In addition, AHRQ and AcademyHealth will team with the Patient-Centered Outcomes Research Institute to hold sessions October 6, also at the Crystal Gateway Marriott. Those sessions will address key issues in dissemination and implementation of patient-centered outcomes research.

8. Featured Impact Case Study: AHRQ Toolkit Reduces Infections in Wisconsin Dialysis Centers

The Purity Dialysis Center in Wisconsin achieved a 75 percent decline in infections among dialysis patients after participating in an AHRQ-funded project that resulted in a toolkit that helps dialysis facilities reduce infection. Eight other dialysis centers across Wisconsin have since adopted policy changes to reduce infections.

9. AHRQ in the Professional Literature

Saloner B, Lê Cook B. An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Aff 2014 Aug;33(8):1425-34. Select to access the abstract on PubMed®.

Gardner W, Morton S, Byron SC, et al. Using computer-extracted data from electronic health records to measure the quality of adolescent well-care. Health Serv Res 2014 Aug;49(4):1226-48. Epub 2014 Jan 29. Select to access the abstract on PubMed®.

Liss DT, Reid RJ, Grembowski D, et al. Changes in office visit use associated with electronic messaging and telephone encounters among patients with diabetes in the PCMH. Ann Fam Med 2014 Jul; 12(4):338-43. Select to access the abstract on PubMed®.

Baker DW, Brown T, Buchanan DR, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med 2014 Aug;174(8):1235-41. Select to access the abstract on PubMed®.

Barton JL, Trupin L, Tonner C, et al. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol 2014 Jul;41(7):1290-7. Select to access the abstract on PubMed®.

Drake KM, Hargraves JL, Lloyd S, et al. The effect of response scale, administration mode, and format on responses to the CAHPS Clinician and Group survey. Health Serv Res 2014 Aug;49(4):1387-99. Epub 2014 Jan 29. Select to access the abstract on PubMed®.

Abdus S. Part-year coverage and access to care for nonelderly adults. Med Care 2014 Aug;52(8):709-714. Select to access the abstract on PubMed®.

Dy CJ, Bozic KJ, Padgett DE, et al. Is changing hospitals for revision total joint arthroplasty associated with more complications? Clin Orthop Relat Res 2014 Jul;472(7):2006-15. Epub 2014 Mar 11. Select to access the abstract on PubMed®.