Health System Integration Is Not Associated With Improved Care Quality

AHRQ Stats: Most Expensive Medical Conditions

The five most expensive medical conditions requiring hospitalization in 2017 were septicemia, osteoarthritis, live birth, heart attack and heart failure. These conditions accounted for about one-quarter of the $434 billion in total hospitalization costs that year. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #261, National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2017.)

Today's Headlines:

• Health System Integration Is Not Associated With Improved Care Quality.
• Study Finds Differences in Diagnostic Approaches, Reveals Strategies To Improve Accuracy.
• Low Albumin Levels Raise Patient Risks in Peripheral Arterial Disease Surgeries.
• Highlights From AHRQ’s Patient Safety Network.
• New Research and Evidence From AHRQ.
• AHRQ in the Professional Literature.

Health System Integration Is Not Associated With Improved Care Quality

Health systems’ increasing financial integration—in which multiple hospitals or physician practices are owned by a single entity—generally has not led to higher quality of care, according to an AHRQ-funded study published in Health Affairs. In surveys administered to 739 hospitals and 2,189 physician practices, researchers measured the adoption of nine quality-related care delivery reforms, such as use of evidence-based guidelines, screening for clinical conditions and participation in quality-focused payment programs. Little relationship between financial integration of hospitals and physician practices and better quality was found. In no case did physician practices in complex systems have higher scores. Bigger system size was not associated with better scores. Access the abstract.

Study Finds Differences in Diagnostic Approaches, Reveals Strategies To Improve Accuracy

Physicians can improve diagnostic accuracy with strategies such as considering a wider range of conditions and pausing to eliminate bias, according to an AHRQ-funded study published in Diagnosis. The authors presented standardized patient case information to hospital medicine physicians between June 2017 and August 2018 to learn how diagnostic thinking unfolds. The research revealed significant variations in diagnostic strategies and identified approaches that may assist in improving accuracy. The authors noted that few interventions have shown success in reducing diagnostic errors and suggested that this study provides a foundation for future research aimed at curbing cognitive biases in diagnosis. Access the abstract.

Low Albumin Levels Raise Patient Risks in Peripheral Arterial Disease Surgeries

Delaying surgery for peripheral arterial disease (PAD) should be seriously considered for patients with low levels of albumin, according to an AHRQ-supported study published in the Journal of Vascular Surgery. The study examined the association of low levels of albumin (a protein made by the liver that helps keep fluid in the bloodstream) with outcomes in patients undergoing open and endovascular lower-extremity surgery for PAD. Among 6,170 patients undergoing PAD surgery from 2008 to 2015, low albumin levels were associated with adverse outcomes, including in-hospital death, increased length of stay, infection, renal failure and cardiac complications including heart attack. Given that many lower-extremity procedures are elective, researchers concluded that nutritional assessments should be made and interventions deferred until albumin levels are optimized. Access the study 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:

• A clinical pharmacist-led integrated approach for evaluation of medication errors among medical intensive care unit patients.
• Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis.
• Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method.

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 Research and Evidence From AHRQ

• Rapid Evidence Product: Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder.

AHRQ in the Professional Literature

The limits of syndrome recognition: time to look beyond the bedside to drive adoption of low tidal volume ventilation in acute respiratory distress syndrome? Barbash IJ. Crit Care Med 2020 Jun;48(6):926-8. Access the abstract on PubMed®.

The changing landscape of perinatal regionalization. Kunz SN, Phibbs CS, Profit J. Semin Perinatol 2020 Jun;44(4):151241. Epub 2020 Mar 13. Access the abstract on PubMed®.

Leveraging technology to improve care of older adults. Powell KR, Wakefield BJ, Alexander GL. J Gerontol Nurs 2020 Jul;46(7):2. Access the abstract on PubMed®.

Understanding the costs associated with surgical care delivery in the Medicare population. Kaye DR, Luckenbaugh AN, Oerline M, et al. Ann Surg 2020 Jan;271(1):23-8. Access the abstract on PubMed®.

Development and validation of eRADAR: a tool using EHR data to detect unrecognized dementia. Barnes DE, Zhou J, Walker RL, et al. J Am Geriatr Soc 2020 Jan;68(1):103-11. Epub 2019 Oct 14. Access the abstract on PubMed®.

Exploring national trends of patient- and family-centered care among US children. Anderson AC, Akre E, Chen J. J Child Health Care 2019 Jun;23(2):200-12. Epub 2018 Jul 17. Access the abstract on PubMed®.

Surgical technical evidence review for acute cholecystectomy conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Liu JY, Hu QL, Lamaina M, et al. J Am Coll Surg 2020 Mar;230(3):340-54.e1. Epub 2019 Dec 26. Access the abstract on PubMed®.

Effectiveness of a mouth care program provided by nursing home staff vs standard care on reducing pneumonia incidence: a cluster randomized trial. Zimmerman S, Sloane PD, Ward K, et al. JAMA Netw Open 2020 Jun 1;3(6):e204321. Access the abstract on PubMed®.