Skilled Nursing Facility Discharges Associated With Fewer Readmissions for Healthcare-Associated Infections

Editor’s note: Due to the holiday season, AHRQ News Now will not publish again until Jan. 7. Happy holidays!

AHRQ Stats: Employee Healthcare Contributions

The average annual employee contribution for single coverage in employer-sponsored health insurance plans rose from $723 in 2005 to $1,427 in 2018. For family coverage, the contribution increased from $2,890 in 2005 to $5,431 in 2018. (Source: AHRQ, Medical Expenditure Panel Survey—Insurance Component 2018 Chartbook.) 

Today's Headlines:

• Skilled Nursing Facility Discharges Associated With Fewer Readmissions for Healthcare-Associated Infections.
• 2017 Data Now Available for AHRQ’s Healthcare Cost and Utilization Project.
• Most Sinus Surgery Patients Prescribed More Opioids Than Needed.
• Highlights From AHRQ’s Patient Safety Network.
• New AHRQ eBook Explores Interoperability in Patient Registries.
• AHRQ in the Professional Literature.

Skilled Nursing Facility Discharges Associated With Fewer Readmissions for Healthcare-Associated Infections

Among Medicare patients admitted to the hospital with healthcare-associated infections (HAIs), those discharged to skilled nursing facilities (SNFs) were less likely to be readmitted for treatment for the same infection compared with those discharged to their homes or home health care, an AHRQ-funded study has found. The study, published in the Journal of the American Geriatrics Society, used AHRQ Healthcare Cost and Utilization Project (HCUP) data to review more than 700,000 hospital admissions involving HAIs in 2013 and 2014. About half of these patients were discharged to an SNF, with the rest being discharged to home or home health care. Patients discharged to an SNF had more accompanying illnesses, but were 38 percent less likely to be readmitted to the hospital for treatment of their initial infection. The authors called for research to identify strategies to improve home-based infection care. Access the abstract.

2017 Data Now Available for AHRQ’s Healthcare Cost and Utilization Project

To support researchers and policymakers who seek accurate and timely healthcare data on hospital inpatient stays, emergency department visits and ambulatory surgery utilization, AHRQ has released four 2017 Healthcare Cost and Utilization Project (HCUP)  databases: 

• The National Inpatient Sample (NIS) is the largest publicly available inpatient healthcare database in the United States, covering all patients regardless of expected payer for the hospital stay.
• The Nationwide Emergency Department Sample (NEDS) is the largest publicly available all-payer emergency department (ED) database in the nation. It enables the study of a broad range of conditions and procedures among patients treated in the ED and released, or admitted to the same hospital.
• The Nationwide Readmissions Database (NRD) generates national estimates of hospital readmissions and contains discharge data for patients with and without repeat hospital visits and those who have died in the hospital. This database provides information on hospital readmissions for all patients, regardless of expected payer.
• The Nationwide Ambulatory Surgery Sample (NASS) tracks information about major ambulatory surgery encounters in more than 2,700 hospital-owned facilities across the United States. It provides information on patient characteristics, clinical diagnostic and surgical procedure codes, disposition of patients, total charges and expected source of payment, and facility characteristics.

The HCUP family of healthcare databases and related software tools and products is made possible by a federal-state-industry partnership sponsored by AHRQ. The databases are available for purchase via the HCUP Central Distributor.

Most Sinus Surgery Patients Prescribed More Opioids Than Needed

Patients recovering from sinus surgery took, on average, only about half of the opioids prescribed to treat their pain, according to an AHRQ-funded study published in International Forum of Allergy and Rhinology. Researchers surveyed 400 patients between March 2017 and August 2018 after sinonasal surgery at a large hospital system. Patients were asked how they had used prescribed opioids and how they had discarded excess pills. About 52 percent used only half of the pills they were given, 12 percent reported using no opioids and only about 3 percent refilled their prescription. Researchers also discovered that about 76 percent of patients reported improperly disposing of or storing excess pills. They concluded that opioids are being overprescribed after sinonasal surgery and recommended improved patient education on correct disposal methods. Access the abstract. 

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:

• Awareness of diagnosis and follow up care after discharge from the emergency department.
• Association between measured teamwork and medical errors: an observational study of prehospital care in the USA.
• Association between physician depressive symptoms and medical errors: A systematic review and meta-analysis.

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). 

New AHRQ eBook Explores Interoperability in Patient Registries

A new AHRQ eBook, Tools and Technologies for Registry Interoperability, is part of a series that helps researchers and stakeholders who are involved in creating and using patient registries. The eBook is the second addendum to AHRQ’s most recent registries handbook, Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition, which provides practical information on the design, operation and analysis of registries. The new eBook explores the push for interoperability in registries, including data sources and data standards, integration with electronic health records and application of the Outcome Measures Framework. 

AHRQ in the Professional Literature

Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals. Govindan S, Snyder A, Flanders SA, et al. Crit Care Med 2018 Dec;46(12):e1136-44. Access the abstract on PubMed®.

Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain. Graves JM, Fulton-Kehoe D, Jarvik JG, et al. Med Care 2018 Jun;56(6):520-8. Access the abstract on PubMed®.

Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naive youth in the HIV Research Network. Griffith DC, Farmer C, Gebo KA, et al. HIV Med 2019 Feb;20(2):169-74. Epub 2018 Dec 18. Access the abstract on PubMed®.

Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors. Gupta A, Harrod M, Quinn M, et al. Diagnosis (Berl) 2018 Sep 25;5(3):151-6. Access the abstract on PubMed®.

The diagnosis of asymptomatic disease is associated with fewer healthy days: a cross sectional analysis from the national health and nutrition examination survey. Hanmer J, Yu L, Li J, et al. Br J Health Psychol 2019 Feb;24(1):88-101. Epub 2018 Sep 28. Access the abstract on PubMed®.

Shortening self-report mental health symptom measures through optimal test assembly methods: development and validation of the Patient Health Questionnaire-Depression-4. Ishihara M, Harel D, Levis B, et al. Depress Anxiety 2019 Jan;36(1):82-92. Epub 2018 Sep 20. Access the abstract on PubMed®.  

Life-space mobility and clinical outcomes in COPD. Iyer AS, Wells JM, Bhatt SP, et al. Int J Chron Obstruct Pulmon Dis 2018 Sep 4;13:2731-8. eCollection 2018. Access the abstract on PubMed®.

Paid maternity leave in the United States: associations with maternal and infant health. Jou J, Kozhimannil KB, Abraham JM, et al. Matern Child Health J. 2018 Feb;22(2):216-25. Access the abstract on PubMed®.