Study Highlights Effective Use of Blood Cultures and Diagnostic Stewardship in Pediatric Intensive Care Units

AHRQ Stats: Trauma During Childbirth

The rate of obstetric trauma during childbirth involving instruments such as forceps or vacuums declined from 2000 to 2015, from 196 to 119 instances per 1,000 deliveries, respectively. (Source: AHRQ, 2017 National Healthcare Quality and Disparities Report Chartbook on Patient Safety.)

Today's Headlines:

• Study Highlights Effective Use of Blood Cultures and Diagnostic Stewardship in Pediatric Intensive Care Units.
• ADHD Medication Use in Children and Adults Increased Worldwide.
• Highlights From AHRQ’s Patient Safety Network.
• AHRQ Researchers Propose a Care and Learn Model To Inform Research To Improve Care Delivery and Outcomes.
• New Research and Evidence From AHRQ.

Study Highlights Effective Use of Blood Cultures and Diagnostic Stewardship in Pediatric Intensive Care Units

Three pediatric intensive care units (ICUs) that implemented a five-part Blood Culture Improvement Framework reduced unnecessary blood cultures by 32 percent in critically ill children, according to new research supported by AHRQ. Clinicians use blood cultures to test for the diagnosis of sepsis or bloodstream infections. However, false positive results are not uncommon with blood cultures and may lead to misdiagnosis and the unneeded use of antibiotics, contributing to the spread of antibiotic resistance. This research confirmed that diagnostic stewardship programs can be adapted and implemented by different institutions and in various clinical settings—in this case, a medical/surgical pediatric ICU, a cardiovascular ICU, and a mixed medical/cardiac ICU. The project also demonstrated that diagnostic stewardship is possible on a large scale in critically ill children. Access the abstract of the study, published in Pediatric Quality and Safety. 

ADHD Medication Use in Children and Adults Increased Worldwide

A new AHRQ-funded study showed a sharp increase in the use of attention-deficit/hyperactivity disorder (ADHD) medications in children and adults at 15 participating sites in North America, Asia, Australia, northern Europe and western Europe between 2001 and 2015. In all areas, methylphenidate was the most commonly prescribed drug for ADHD. Researchers found that the prevalence of ADHD medication use among children increased over time in all countries and regions, and the absolute increase per year ranged from 0.02 percent to 0.26 percent. Among adults aged 19 years or older, the prevalence of any ADHD medication use in 2010 varied between 0.003 percent and 1.48 percent. Access the abstract of the study, published in The Lancet Psychiatry.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Changes in prevalence of health care–associated infections in U.S. hospitals.
• Bachelor's degree nurse graduates report better quality and safety educational preparedness than associate degree graduates.
• Why doctors hate their computers.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

AHRQ Researchers Propose a Care and Learn Model To Inform Research To Improve Care Delivery and Outcomes

A group of AHRQ researchers has designed a model to analyze the agency’s research portfolio, identify gaps, develop and prioritize its research agenda and evaluate its performance. The model connects two broad functions of the health care system: caring and learning, emphasizing that the health care system’s primary function is to respond (and improve that response by learning) to the needs of people by caring with evidence. The agency and the health services research and improvement communities can use this care and learn model to frame an evidence-based understanding of vexing clinical, health care delivery and population health problems and to identify targets for investment, innovation and investigation. Access the abstract of the model, which was published in the Journal of General Internal Medicine. 

New Research and Evidence From AHRQ

• Methods Research Report: Development and Usability Testing of EPC Evidence Review Dissemination Summaries for Health Systems Decisionmakers.
• Research White Paper: Standardized Library of Atrial Fibrillation Outcome Measures.

AHRQ in the Professional Literature

HIV prevention fatigue and HIV treatment optimism among young men who have sex with men. Macapagal K, Birkett M, Janulis P, et al. AIDS Educ Prev 2017 Aug;29(4):289-301. Access the abstract on PubMed®.

Beliefs regarding development and early intervention among low-income African American and Hispanic mothers. Magnusson DM, Minkovitz CS, Kuhlthau KA, et al. Pediatrics 2017 Nov;140(5). Epub 2017 Oct 16. Access the abstract on PubMed®.

Provision of medication therapy management by pharmacists to patients with type-2 diabetes mellitus in a federally qualified health center. Ndefo UA, Moultry AM, Davis PN, et al. PT 2017 Oct;42(10):632-7. Access the abstract on PubMed®.

Sex-specific comparative effectiveness of oral anticoagulants in elderly patients with newly diagnosed atrial fibrillation. Palamaner Subash Shantha G, Bhave PD, Girotra S, et al. Circ Cardiovasc Qual Outcomes 2017 Apr;10(4). Access the abstract on PubMed®.

A dance intervention for cancer survivors and their partners (RHYTHM). Pisu M, Demark-Wahnefried W, Kenzik KM, et al. J Cancer Surviv 2017 Jun;11(3):350-9. Epub 2017 Jan 9. Access the abstract on PubMed®.

Leveraging the electronic health record to improve quality and safety in rheumatology. Schmajuk G, Yazdany J. Rheumatol Int 2017 Oct;37(10):1603-10. Epub 2017 Aug 29. Access the abstract on PubMed®.

Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups. Taira DA, Seto BK, Davis JW, et al. J Pharm Health Serv Res 2017 Dec;8(4):247-53. Epub 2017 Aug 7. Access the abstract on PubMed®.

A new era of quality measurement in rheumatology: electronic clinical quality measures and national registries. Tonner C, Schmajuk G, Yazdany J. Curr Opin Rheumatol 2017 Mar;29(2):131-7. Access the abstract on PubMed®.