Readmission Among Dialysis Patients Carries Greater Risks, AHRQ Study Finds

AHRQ Stats: Uninsured Population

The percentage of adults ages 18 to 64 who were uninsured at any time during the calendar year fell from about 24 percent in 2015 (45.1 million adults) to 22 percent in 2016 (42.3 million adults). (Source: AHRQ, Medical Expenditure Panel Survey Research Findings #42: Non-Elderly Adults Ever Uninsured During the Calendar Year, 2013-2016.) 

Today's Headlines:

• Readmission Among Dialysis Patients Carries Greater Risks, AHRQ Study Finds.
• AHRQ Views Blog: Measuring Americans' Healthcare Spending by Going Door to Door.
• Article Describes AHRQ Process for Evaluating Interventions for Implementation.
• Non-opioid Drugs May Be as Effective as Opioids in Prehospital Settings.
• Comprehensive Annual Report on Employer-Sponsored Health Insurance Provides Updates on Deductibles, Premium Increases.
• Highlights From AHRQ’s Patient Safety Network.
• AHRQ in the Professional Literature. 

Readmission Among Dialysis Patients Carries Greater Risks, AHRQ Study Finds

Patients receiving dialysis who were hospitalized multiple times had a higher risk of poor outcomes than those who were not hospitalized or were only hospitalized once, an AHRQ-funded study has found. The study, published in BMC Nephrology, found that nearly one in five patients in the first year of dialysis were admitted to a hospital and then were readmitted within 30 days of discharge. Such patients were at substantially higher risk of subsequent hospitalization and death and a lower likelihood of kidney transplantation than other dialysis patients, researchers found. The authors concluded that identifying strategies to prevent readmission among dialysis patients may improve outcomes. Access the abstract. 

AHRQ Views Blog: Measuring Americans' Healthcare Spending by Going Door to Door

AHRQ’s standing as the nation’s top resource on out-of-pocket healthcare spending would not be possible without the efforts of hundreds of field interviewers, according to a new blog post by Joel Cohen, Ph.D., director of the agency’s Center for Financing, Access and Cost Trends. Those interviewers meet with thousands of families each year to produce the Medical Expenditure Panel Survey (MEPS), which since 1996 has informed healthcare policy at state and national levels and has been the basis of more than 500 statistical briefs on topics ranging from out-of-pocket costs to dental visits to prescription drugs. MEPS is central to AHRQ’s plans for establishing an integrated data, analytics and information platform, one that will helppolicymakers have timely and accurate data and useful analytic resources to make informed policy decisions about the healthcare system. Access the blog post. To receive all blog posts, submit your email address and select “AHRQ Views Blog.” 

Article Describes AHRQ Process for Evaluating Interventions for Implementation

A new AHRQ article published in the journal Medical Care describes the process by which the agency has evaluated 35 patient-centered outcomes research interventions for implementation. The evaluation led to the identification of two practice interventions—cardiac rehabilitation after heart attack and screening/treatment for unhealthy alcohol use—as having sufficient evidence, impact and feasibility to justify an AHRQ investment to provide primary care practices the resources to implement interventions. Funding has been earmarked for these two interventions as a result of this evaluation process, which took place over a two-year period ending in June 2018. In April, AHRQ announced a new initiative to save lives by increasing patient participation in cardiac rehabilitation after cardiovascular events such as heart attacks, heart failure, angioplasty or heart surgery. The agency will soon announce a series of grants aimed at testing strategies for curbing alcohol use disorder. For more information about the process by which the interventions were evaluated, access the article abstract. 

Non-opioid Drugs May Be as Effective as Opioids in Prehospital Settings

For people in moderate to severe pain who have not yet reached a hospital, opioids are no more effective for pain relief than ketamine, acetaminophen and nonsteroidal anti-inflammatory drugs given primarily intravenously by emergency medical personnel, according to a new AHRQ evidence review. As many as 43 percent of adults and 85 percent of children have insufficient prehospital pain relief, review authors reported. Their review of pain relief options indicated that acetaminophen may cause fewer side effects overall and less dizziness than other medications, while ketamine may cause more dizziness or overall side effects, and opioids may cause difficulty breathing. The report also found that combining an opioid with ketamine may be more effective in reducing pain compared with opioids alone. Access the report from AHRQ’s Evidence-based Practice Center Program, plus the abstract of an article in Prehospital Emergency Care. 

Comprehensive Annual Report on Employer-Sponsored Health Insurance Provides Updates on Deductibles, Premium Increases

Average deductibles for single and family enrollees in employer-sponsored health insurance plans with deductibles did not increase significantly in 2018, according to an annual AHRQ report on employer-sponsored health insurance. It was the first time during the 2005–2018 period that deductibles did not increase significantly for those groups. The Medical Expenditure Panel Survey–Insurance Component Chartbook 2018 showed that average premiums for employer-sponsored health insurance from private-sector employers ranged from $6,715 for single coverage to nearly $20,000 for family coverage in 2018, an increase of about 5 percent from 2017 rates. The Chartbook is an online resource that provides a comprehensive annual update of private, employer-sponsored health insurance in the United States. It is based on surveys of more than 42,000 business establishments across the country that make available national and state-level estimates of private 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:

• Association of primary care clinic appointment time with opioid prescribing.
• A mixed-methods study of challenges experienced by clinical teams in measuring improvement.
• Use of "Doctor" badges for physician role identification during clinical training.

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 in the Professional Literature

Mapping the flow of pediatric trauma patients using process mining. Durojaiye AB, McGeorge NM, Puett LL, et al. Appl Clin Inform 2018 Jul;9(3):654-66. Epub 2018 Aug 22. Access the abstract on PubMed®.

Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair. Tarbunou YA, Smith JB, Kruse RL, et al. J Vasc Surg 2019 Mar;69(3):763-73.e3. Epub 2018 Aug 25. Access the abstract on PubMed®.

Effectiveness of outpatient antibiotics after surgical drainage of abscesses in reducing treatment failure. Pulia MS, Schwei RJ, Patterson BW, et al. J Emerg Med 2018 Oct;55(4):512-21. Epub 2018 Aug 24. Access the abstract on PubMed®.

Estimation of the acquisition and operating costs for robotic surgery. Childers CP, Maggard-Gibbons M. JAMA 2018 Aug 28;320(8):835-6. Access the abstract on PubMed®.

Optimization of prehospital triage of patients with suspected ischemic stroke. Ali A, Zachrison KS, Eschenfeldt PC, et al. Stroke 2018 Oct;49(10):2532-5. Access the abstract on PubMed®.

Comparing the effectiveness of four different design media in communicating desired performance outcomes with clinical end users. Wingler D, Machry H, Bayramzadeh S, et al. HERD 2019 Apr;12(2):87-99. Epub 2018 Aug 30. Access the abstract on PubMed®.

Variation in medication therapy management delivery: implications for health care policy. Snyder ME, Jaynes HA, Gernant SA, et al. J Manag Care Spec Pharm 2018 Sep;24(9):896-902. Access the abstract on PubMed®.

Scoping reviews and systematic reviews: is it an either/or question? Chang S. Ann Intern Med 2018 Oct 2;169(7):502-3. Epub 2018 Sep 4. Access the abstract on PubMed®.