Monitoring of Low-Risk Prostate Cases Not Tracked on Timely Basis

AHRQ Stats: Patients’ Usual Source of Provider Care

Among adults who had four or more office visits to their usual source of provider care in 2016, more were treated at a large medical practice (31 percent) as compared with small or medium-sized practices (27 percent each). (Source: AHRQ, Medical Expenditure Panel Survey Statistical Brief #523: Number of Adult Visits by Characteristics of Practices Identified as Usual Source of Care Providers during 2016—Results from the MEPS Medical Organizations Survey.) 

Today's Headlines:

• Monitoring of Low-Risk Prostate Cases Not Tracked on Timely Basis.
• New AHRQ Grantee Profile Highlights How Alex H. Krist, M.D., M.P.H., Engages Patients in Their Care Decisions .
• Highlights From AHRQ’s Patient Safety Network.
• Case Study Highlights Denver Health’s Efforts To Improve Care as a Learning Health System.
• State Medicaid Policies Influence Benefits for Low-Income Medicare Recipients.
• AHRQ in the Professional Literature. 

Monitoring of Low-Risk Prostate Cases Not Tracked on Timely Basis

Most studies examining outcomes of men with low-risk prostate cancer on active surveillance do not measure or report on adherence to monitoring protocols, according to an AHRQ-funded systematic review. Researchers reviewed 45 qualifying studies from 1990 to 2019 that represented approximately 29,000 patients on “active surveillance,” which includes regular monitoring using PSA blood tests, digital rectal exams and repeat biopsies. The authors noted that since the premise of active surveillance is to provide routine scheduled monitoring of the disease to assess disease progression, timely adherence is needed to retain the window of opportunity for cure. The authors recommended developing standard active surveillance adherence definitions and measures, making protocol adherence a quality improvement measure for active surveillance outcomes, and tracking factors for why some patients may not obtain regular follow-up. Access the abstract of the study, published in European Urology Oncology. 

New AHRQ Grantee Profile Highlights How Alex H. Krist, M.D., M.P.H., Engages Patients in Their Care Decisions

AHRQ’s latest grantee profile highlights how agency funding is helping researcher Alex H. Krist, M.D., M.P.H., professor of family medicine and population health at Virginia Commonwealth University, Richmond, develop tools to promote better conversations between patients and physicians about care decisions. Dr. Krist’s latest AHRQ-funded project will focus on how to engage patients with multiple chronic conditions so they can decide which concerns are most important to address. Check out Dr. Krist’s profile and profiles of other AHRQ grantees who have made major advances in health services research.

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:

• Association of residency work hour reform with long term quality and costs of care of US physicians: observational study.
• Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
• Investigating the impact of intensive care unit interruptions on patient safety events and electronic health records use: an observational study.

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).

Case Study Highlights Denver Health’s Efforts To Improve Care as a Learning Health System

Leaders at Denver Health, a safety-net health system that treats more than 200,000 patients a year in its 525-bed hospital and 26 family health and school-based clinics, share insights in a new case study (PDF, 162.15 KB) about how a learning health system (LHS) can use data to improve care. For example, surgical site infections declined after Denver Health reviewed its data and changed preoperative procedures to take patient limitations into account. CEO Robin Wittenstein discusses Denver Health’s approach to improving outcomes with data, culture and workforce investments as part of a series of four real-world case studies developed by AHRQ to help C-suite leaders better understand what it takes to create an LHS. 

State Medicaid Policies Influence Benefits for Low-Income Medicare Recipients

From 2012 to 2016, close to 20 percent of low-income Medicare recipients who were also Medicaid enrollees stopped receiving benefits that paid for services like long-term nursing home care and out-of-pocket deductibles that Medicare doesn’t cover, according to an AHRQ-supported study published in Health Affairs. For some low-income Medicare beneficiaries, Medicaid provides financial protection against Medicare’s out-of-pocket costs, but many Medicare beneficiaries who qualify for Medicaid are not continuously enrolled. The study showed that lapses in Medicaid coverage were lower in states that automatically enrolled Supplemental Security Income program recipients for Medicaid, offered more generous Medicaid provider reimbursements and were less restrictive regarding asset limits to qualify for Medicaid. Researchers concluded that these state policy features, coupled with those that reduce administrative barriers to Medicaid re-enrollment, can support Medicare recipients in maintaining the Medicaid benefits for which they are eligible. Access the abstract. 

AHRQ in the Professional Literature

Caregiver and health care provider perspectives on cloud-based shared care plans for children with medical complexity. Desai AD, Jacob-Files EA, Wignall J, et al. Hosp Pediatr 2018 Jul;8(7):394-403. Epub 2018 Jun 5. Access the abstract on PubMed®.

Interventions to reduce intraoperative costs: a systematic review. Childers CP, Showen A, Nuckols T, et al. Ann Surg 2018 Jul;268(1):48-57. Access the abstract on PubMed®.

Patient perspectives on clinical scribes in primary care. Yan C, Rose S, Rothberg M, et al. J Gen Intern Med 2018 Nov;33(11):1859-61. Access the abstract on PubMed®.

Real-time surveys reveal important safety risks during interhospital care transitions for neurologic emergencies. Sather J, Rothenberg C, Finn EB, et al. Am J Med Qual 2019 Jan/Feb;34(1):53-8. Epub 2018 Jul 10. Access the abstract on PubMed®.

Efficiency, efficacy, and power in the implementation of a medication adherence aid. Cherian R, Sarkar U, Khoong EC, et al. Health Lit Res Pract 2018 Jul 11;2(3):e128-31. eCollection 2018 Jul. Access the abstract on PubMed®.

Uncovering a role for electronic personal health records in reducing disparities in sexually transmitted infection rates among students at a predominantly African American university: mixed-methods study. Jackman KM, Baral SD, Hightow-Weidman L, et al. JMIR Med Inform 2018 Jul 12;6(3):e41. Access the abstract on PubMed®.

Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad. Manojlovich M, Frankel RM, Harrod M, et al. BMJ Qual Saf 2019 Feb;28(2):160-6. Epub 2018 Jul 14. Access the abstract on PubMed®.

An assessment of public preferences for newborn screening using best-worst scaling. Tarini BA, Simon NJ, Payne K, et al. J Pediatr 2018 Oct;201:62-8.e1. Epub 2018 Jul 16. Access the abstract on PubMed®.