AHRQ Awarded for Work To Reduce Diagnostic Errors

AHRQ Stats: Delivery Stays With a Substance Use Diagnosis

Among women giving birth in hospitals and diagnosed with substance use disorder, rates of severe pre-eclampsia/eclampsia were higher for those living in urban areas (44.3 per 1,000 delivery stays) than for those living in rural areas (31.8 per 1,000). (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #254: Obstetric Delivery Inpatient Stays Involving Substance Use Disorders and Related Clinical Outcomes, 2016.) 

Today's Headlines:

• AHRQ Awarded for Work To Reduce Diagnostic Errors.
• Patient Demand Drives Unnecessary Antibiotic Prescribing.
• AHRQ Releases New Antibiotic Stewardship Toolkit for Hospitals.
• New Action Plan Aims To Guide Health Systems' Efforts on Diagnostic Safety.
• Highlights From AHRQ's Patient Safety Network.
• AHRQ in the Professional Literature.

AHRQ Awarded for Work To Reduce Diagnostic Errors

AHRQ Director Gopal Khanna, M.B.A., and Jeffrey Brady, M.D., M.P.H., director of AHRQ's Center for Quality Improvement and Patient Safety, received an award from the Society to Improve Diagnosis in Medicine (SIDM) for the agency's ongoing work to reduce diagnostic errors. The 2019 Champion for Better Diagnosis Award was presented Nov. 12 in Washington, D.C., during a luncheon at SIDM's Diagnostic Error in Medicine 12th Annual International Conference. Inaccurate or delayed diagnoses affect nearly 1 in 20 U.S. adults every year, according to Improving Diagnosis in Health Care, a National Academy of Medicine report partially funded by AHRQ. Last month, Director Khanna identified reducing diagnostic errors as one of the agency's three strategic priorities. "That action clearly marks a watershed moment for our community," said Paul Epner, M.B.A., SIDM's chief executive officer. "We want to thank and honor not only Gopal's and Jeff's leadership, but the entire team at AHRQ. Our gratitude to all of you."

AHRQ is currently funding research projects on diagnostic safety that involve using new or existing analytic processes to study the incidence, associated factors and early indicators of diagnostic errors. Research results will inform future development and testing of strategies and interventions to reduce diagnostic errors.

Attending SIDM's annual conference are, left to right, David Newman-Toker, M.D., Ph.D., SIDM president; Jeffrey Brady, M.D., director of AHRQ's Center for Quality Improvement and Patient Safety; Gopal Khanna, M.B.A., director of AHRQ; and Paul Epner, M.B.A, SIDM chief executive officer.

Patient Demand Drives Unnecessary Antibiotic Prescribing

Perceived patient demand for antibiotics motivates clinicians to prescribe them even when they are unnecessary to treat the conditions of the medical visit, according to a new AHRQ-funded study published in Family Practice. The study, based on interviews with 25 clinicians from nine practices across three states, identified perceived patient demand as the most common reason for prescribing unnecessary antibiotics, such as to treat a viral instead of a bacterial infection. Other reasons included fear of missing an infection and being uncertain of a diagnosis, though these reasons often occurred alongside perceived patient demand. Access the abstract and article. 

AHRQ Releases New Antibiotic Stewardship Toolkit for Hospitals

Acute care facilities can develop or strengthen antibiotic stewardship programs and improve patient outcomes using AHRQ's new Toolkit To Improve Antibiotic Use in Acute Care Hospitals. Based on the experiences of more than 400 hospitals that participated in AHRQ's Safety Program for Improving Antibiotic Use, the toolkit guides users through its signature "Four Moments of Antibiotic Decision Making," a step-by-step approach for physicians to achieve optimal antibiotic prescribing. Among its more than 50 tools, AHRQ's toolkit includes best practices for diagnosis and treatment of infections, approaches to improve safety culture and sustain overall success, plus tactical recommendations to demonstrate the value of antibiotic stewardship program to hospital administrators and prescribers. 

New Action Plan Aims To Guide Health Systems' Efforts on Diagnostic Safety

A new action plan developed by AHRQ-funded researchers aims to jumpstart health systems' efforts to improve diagnostic safety. Insufficient progress has occurred, the authors asserted, since a 2015 National Academies of Sciences, Engineering, and Medicine report highlighted the cost and quality implications of diagnostic errors. The authors of the new action plan proposed that health systems be identified as LEDE (learning and exploration of diagnostic excellence) organizations by following five steps to achieve diagnostic excellence: implementing a virtual hub to coordinate activities for improving diagnosis; participating in new scientific initiatives to generate and translate evidence; focusing on measurement for improvement, rather than for punishment or reward; engaging clinicians in improving diagnosis activities and framing missed opportunities; and developing a culture of engaging and learning from patients. Access the abstract of an article on the action plan published in Academic Medicine. 

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:

• Comparing Rates of Adverse Events and Medical Errors on Inpatient Psychiatric Units at Veterans Health Administration and Community-based General Hospitals.
• Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit.

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

Risk adjustment in Medicare ACO Program deters coding increases but may lead ACOs to drop high-risk beneficiaries. Markovitz AA, Hollingsworth JM, Ayanian JZ, et al. Health Aff (Millwood) 2019 Feb;38(2):253-61. Access the abstract on PubMed®.

Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents. Hass Z, Woodhouse M, Grabowski DC, et al. Health Serv Res 2019 Jun;54(3):555-63. Epub 2019 Feb 6. Access the abstract on PubMed®.

What makes team communication effective: a qualitative analysis of interprofessional primary care team members' perspectives. Kim LY, Giannitrapani KF, Huynh AK, et al. J Interprof Care 2019 Nov-Dec;33(6):836-8. Epub 2019 Feb 6. Access the abstract on PubMed®.

Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open 2019 Feb 1;2(2):e187571. Access the abstract on PubMed®.

Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff. Jones CD, Jones J, Bowles KH, et al. J Am Med Dir Assoc 2019 Apr;20(4):487-91. Epub 2019 Feb 22. Access the abstract on PubMed®.

Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools. Hung A, Mullins CD, Slejko JF, et al. J Manag Care Spec Pharm 2019 Mar;25(3):342-9. Access the abstract on PubMed®.

Decision-making experiences of consumers choosing individual-market health insurance plans. Hero JO, Sinaiko AD, Kingsdale J, et al. Health Aff (Millwood) 2019 Mar;38(3):464-72. Access the abstract on PubMed®.

Developing and testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) instrument. Jue JJ, Cunningham S, Lohr K, et al. Ann Intern Med 2019 Apr 2;170(7):480-7. Epub 2019 Mar 19. Access the abstract on PubMed®.