AHRQ’s Opioid Medication Management Program Yields Positive Results

AHRQ Stats: Depression Screening

Fewer than half of all Americans ages 35 and older were screened for depression in 2015. (Source: AHRQ, MEPS Research Findings #41: Use of Clinical Preventive Services in the United States: Estimates from the Medical Expenditure Panel Survey (MEPS), 2015.)

Today's Headlines

• AHRQ’s Opioid Medication Management Program Yields Positive Results.
• New Report Measures Premium Increases, Declining Takeup Rates for Private-Sector Employer-Sponsored Insurance.
• Highlights From AHRQ’s Patient Safety Network.
• AHRQ Primer on Maternal Safety Addresses Efforts To Combat Pregnancy-Related Mortality.
• Clinicians With High Trust in Their Practice Are More Satisfied, Feel Less Stress and Are More Likely To Stay.
• Featured Impact Case Study: Texas Hospital Used AHRQ Tools To Create Multimedia Patient Decision Aid.
• AHRQ in the Professional Literature.

AHRQ’s Opioid Medication Management Program Yields Positive Results

An AHRQ-funded opioid medication management program known as the Six Building Blocks led to a decrease in opioid prescribing, according to a study in the Annals of Family Medicine. After Six Building Blocks was used to redesign opioid medication management at 20 rural primary care clinics, the number of patients prescribed a 100-milligram or greater morphine equivalent dose daily, which determines a patient’s total intake of any opioid over 24 hours, decreased by 2 percent, and the number of patients on long-term opioid therapy fell by 14 percent during a 15-month period. Study authors noted that primary care health teams can use the Six Building Blocks framework to improve opioid-prescribing practices to be more consistent with current opioid guidelines. 

New Report Measures Premium Increases, Declining Takeup Rates for Private-Sector Employer-Sponsored Insurance

Premiums for employer-sponsored health insurance from private-sector employers in the United States ranged from $6,715 for single coverage to nearly $20,000 for family coverage in 2018, an increase on average of about 5 percent from 2017 rates, according to an AHRQ report. The analysis highlights data from AHRQ’s Medical Expenditure Panel Survey–Insurance Component, which provides a detailed review of employer-sponsored health insurance in America. The new report also showed that among private-sector employees at establishments that offer insurance, the percent who were eligible increased from 77 to 78 percent from 2017 to 2018. Among those who were eligible, however, the percent who enrolled in health insurance fell from 74 to 72 percent. Employer-sponsored insurance is the primary source of health insurance coverage for individuals under age 65. AHRQ surveys more than 42,000 business establishments across the country to make available national and state-level estimates of employer-sponsored health insurance, including offer rates, costs, employee eligibility and the number of enrollees. 

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:

• Clinician perspectives on electronic health records, communication, and patient safety acrossdiverse medical oncology practices.
• 'Poking the skunk': ethical and medico-legal concerns in research about patients' experiences of medical injury.
• Evaluating a handheld decision support device in pediatric intensive care settings.

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 Primer on Maternal Safety Addresses Efforts To Combat Pregnancy-Related Mortality

A new AHRQ primer that looks at the significant risks associated with pregnancy and childbirth examines how those risks are being addressed nationally through the development of maternal care safety bundles and safety tools. Safety bundles are sets of evidence-based clinical practices developed to improve care. Pregnancy-related deaths have more than doubled in the United States, from 7.2 deaths per 100,000 live births in 1987 to 17.2 deaths per 100,000 live births between 2011 and 2015. AHRQ offers a perinatal safety toolkit from which two strategies—communication and teamwork—are currently being integrated with two maternal safety bundles and evaluated for effectiveness. Access the new primer from AHRQ’s Patient Safety Network (PSNet).

Clinicians With High Trust in Their Practice Are More Satisfied, Feel Less Stress and Are More Likely To Stay

Survey responses from 165 clinicians at 34 Midwest and East Coast primary care practices showed that clinicians with improved or stable high trust in their organizations reported higher satisfaction and less stress, and were less likely to think about leaving the practice compared with clinicians whose trust declined or remained low. Trust was higher in practices that, among other qualities, offered workload control, had cultures that encouraged cohesiveness, and emphasized quality versus productivity. Researchers also found that female clinicians were less likely than males to express a high level of trust in their organizations. The researchers concluded that trust can be improved and may lead to lower burnout rates, better patient outcomes and less turnover. Access the abstract of the study published in JAMA Network Open. 

Featured Impact Case Study: Texas Hospital Used AHRQ Tools To Create Multimedia Patient Decision Aid

The University of Texas Health at San Antonio (UT Health SA) used three AHRQ tools to help develop a multimedia decision aid to help patients understand and consent to the use of peripherally inserted central catheters, or PICC lines. In a study at UT Health SA’s teaching hospital, the decision aid was found to improve patients’ understanding about the procedure compared with the standard consent process. Access the Impact Case Study. 

AHRQ in the Professional Literature

Design of healthy hearts in the heartland (H3): A practice-randomized, comparative effectiveness study. Ciolino JD, Jackson KL, Liss DT, et al. Contemp Clin Trials 2018 Aug;71:47-54. Epub 2018 Jun 2. Access the abstract on PubMed®.

Duration of uninsured spells for nonelderly adults declined after 2014. Vistnes JP, Cohen JW. Health Aff (Millwood) 2018 Jun;37(6):951-5. Access the abstract on PubMed®.

"Minimally invasive research?" Use of the electronic health record to facilitate research in pediatric urology. Vemulakonda VM, Bush RA, Kahn MG. J Pediatr Urol 2018 Oct;14(5):374-81. Epub 2018 Jun 9. Access the abstract on PubMed®.

Listening to patients' voices: workarounds patients use to construct pain intensity ratings. Dannecker EA, Warne-Griggs MD, Royse LA, et al. Qual Health Res 2018 Jun 1:1049732318773714. [Epub ahead of print.] Access the abstract on PubMed®.

Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis. Pulia M, Kern M, Schwei RJ, et al. Antimicrob Resist Infect Control 2018 Jun 14;7:74. eCollection 2018. Access the abstract on PubMed®.

Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid Services SEP-1 measure. Rhee C, Brown SR, Jones TM, et al. Infect Control Hosp Epidemiol 2018 Aug;39(8):994-6. Epub 2018 Jun 22. Access the abstract on PubMed®.

Decision-making skills improve with critical care training: using simulation to measure progress. Murray DJ, Boyle WA, Beyatte MB, et al. J Crit Care 2018 Oct;47:133-8. Epub 2018 Jun 25. Access the abstract on PubMed®.

Methods for patient-centered interface design of test result display in online portals. Nystrom DT, Singh H, Baldwin J, et al. EGEMS (Wash DC) 2018 Jun 26;6(1):15. Access the abstract on PubMed®.