Fear, Reflexive Habits Prompt the Ordering of Blood Cultures

AHRQ Stats: Average Per-Pill Prices for Prescriptions

In 2016, average prescription prices ranged from $1.00 per pill for nonspecialty generic drugs to $324.65 per pill for specialty drugs. People with private insurance had an overall per-pill price averaging $14.46, which was two to three times as high as the average per-pill price paid by those with Medicare Part D ($6.95), Medicaid ($7.67), and the uninsured ($4.25). (Source: AHRQ, Medical Expenditure Panel Survey Research Findings #44: Retail Drug Prices, Out-of-Pocket Costs, and Discounts and Markups Relative to List Prices: Trends and Differences by Drug Type and Insurance Status, 2011 to 2016. [PDF]) 

Today's Headlines:

• Fear, Reflexive Habits Prompt the Ordering of Blood Cultures.
• AHRQ Views Blog: Using Antibiotics Safely in Hospitals: Then, Now and Beyond.
• Highlights From AHRQ’s Patient Safety Network.
• Initiative To Improve Antibiotic Stewardship in Primary Care.
• Featured Studies on the Nation's Health Systems.
• AHRQ in the Professional Literature.

Fear, Reflexive Habits Prompt the Ordering of Blood Cultures

Fear and reflexive habits are common drivers for ordering blood cultures for patients in pediatric intensive care units (PICUs), according to an AHRQ-funded study published in Pediatric Critical Care Medicine. Researchers explored practice variation and clinician beliefs and attitudes about blood culture testing in critically ill children in 15 hospital PICUs participating in the Bright Star collaborative, a nationwide quality improvement project led by Johns Hopkins University School of Medicine. Among the study findings: 86 percent of survey respondents reported that blood cultures are ordered reflexively; 71 percent did not examine patients before ordering cultures; and 90 percent obtained cultures for PICU patients with a new fever. Eighty percent of clinicians noted the fear of missing sepsis as a barrier to not reducing unnecessary cultures. Researchers concluded these habits may contribute to overtesting for bacteremia, and that further investigation is needed on how to optimize blood culture use. Access the study abstract. 

AHRQ Views Blog: Using Antibiotics Safely in Hospitals: Then, Now and Beyond

AHRQ’s support of the current U.S. Antibiotic Awareness Week, which each year raises awareness about antibiotic resistance and the importance of appropriate antibiotic use, is the subject of a new blog post by Melissa A. Miller, M.D., M.S., a medical officer for AHRQ’s Healthcare-Associated Infections Program. Each year 2.8 million people in the United States get an antibiotic-resistant infection, and at least 35,000 people die, according to the most recent statistics. AHRQ has long funded research and developed practical tools to help clinicians use antibiotics appropriately. The most recent is the new Acute Care Hospital Toolkit, developed after more than 400 hospitals participated in the AHRQ Safety Program for Improving Antibiotic Use. The toolkit helps hospitals develop or improve antibiotic stewardship programs. Access the blog post. To receive all blog posts, submit your email address and select "AHRQ Views Blog." 

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:

• Identifying 'avoidable harm' in family practice: a RAND/UCLA Appropriateness Method consensus study.
• How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis.
• Preventable adverse drug events: Descriptive epidemiology.

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). 

Initiative To Improve Antibiotic Stewardship in Primary Care

Webinars on Nov. 26 or Dec. 2 teach how primary care practices can join a free 12-month AHRQ Safety Program for Improving Antibiotic Use. Participants will receive expert coaching, online training, and patient and family education materials, plus antibiotic use guidelines for common infections, among other resources. The program can help ambulatory care practices meet the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) requirements and demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard effective Jan. 1, 2020. The enrollment deadline is Dec. 15.

Featured Studies on the Nation's Health Systems

AHRQ's Comparative Health System Performance Initiative funds studies about how healthcare delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. Publications include:

• Understanding U.S. Health Systems: Using Mixed Methods to Unpack Organizational Complexity.
• How Do Accountable Care Organizations Deliver Preventive Care Services?: A Mixed Methods Study.
• How Are Medical Groups Identified as High-Performing? The Effect of Different Approaches to Classification of Performance.

Access the initiative's Compendium of U.S. Health Systems, 2016, the first publicly available database that gives researchers, policymakers and healthcare administrators a snapshot of the nation's health systems. 

AHRQ in the Professional Literature

Building consensus toward a national nursing home information technology maturity model. Alexander GL, Powell K, Deroche CB, et al. J Am Med Inform Assoc 2019 Jun 1;26(6):495-505. Access the abstract on PubMed®.

Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities. Gupta S, Zengul FD, Davlyatov GK, et al. Inquiry 2019 Jan-Dec;56:46958018817994. Access the abstract on PubMed®.

Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory. Perry CK, Damschroder LJ, Hemler JR, et al. Implement Sci 2019 Mar 21;14(1):32. Access the abstract on PubMed®. 

Effects of public reporting legislation of nurse staffing: a trend analysis. de Cordova PB, Rogowski J, Riman KA, et al. Policy Polit Nurs Pract 2019 May;20(2):92-104. Epub 2019 Mar 28. Access the abstract on PubMed®. 

Use of internal performance measurement to guide improvement within medical groups. Chen PG, Harrison MI, Bergofsky LR, et al. Jt Comm J Qual Patient Saf 2019 Jul;45(7):487-94. Epub 2019 Mar 31. Access the abstract on PubMed®.

Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis. Salwei ME, Carayon P, Hundt AS, et al. Ergonomics 2019 Jul;62(7):864-79. Epub 2019 Apr 30. Access the abstract on PubMed®. 

Barriers and facilitators impacting reliability of the electronic health record-facilitated total testing process. Murphy DR, Satterly T, Rogith D, et al. Int J Med Inform 2019 Jul;127:102-8. Epub 2019 Apr 8. Access the abstract on PubMed®. 

Medicaid and nursing home choice: why do duals end up in low-quality facilities? Sharma H, Perraillon MC, Werner RM, et al. J Appl Gerontol 2019 Apr 8:733464819838447. [Epub ahead of print.] Access the abstract on PubMed®.