AHRQ Electronic Newsletter, August 25, 2015, Issue #484

August 25, 2015 Issue #484 AHRQ Stats: Mortality Rate for Heart Failure and Stroke Between 2002 and 2012, decreases in congestive heart failure and stroke mortality were largest for patients in the poorest communities (34 percent and 30 percent respectively) and smallest for those in the wealthiest communities (24 percent and 23 percent respectively). (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #194: Trends in Observed Adult Inpatient Mortality for High-Volume Conditions, 2002-2012.) Today's Headlines: Hospital Readmissions of Children May Be Underestimated, New Study Says Newborn and Maternal Hospitalizations Related to Substance Abuse on the Rise, According to New AHRQ Brief Magnetic Resonance Imaging, Computed Tomography Provide Higher Sensitivity for Liver Cancer Diagnosis: AHRQ Review AHRQ’s Health Care Innovations Exchange Focuses on Reducing Emergency Care by Connecting Frequent Users to Community-Based Services Featured Impact Case Study: Wisconsin Critical Access Hospital Achieves Multiple Improvements With AHRQ Patient Safety Tools Hospital Readmissions of Children May Be Underestimated, New Study Says Failure to track hospital readmissions to different hospitals can underestimate readmissions of children by as much as 13.9 percent, according to a new study in the journal JAMA Pediatrics. Hospital readmission rates are a common measure of hospital quality. Same-hospital readmission rates (SHRs) are most commonly tracked and reported. Hospitals usually lack data on different-hospital readmissions (DHRs) – that is, whether their patients are readmitted within a specific timeframe to a different hospital. In this AHRQ-funded study, researchers sought to determine the rate of 30-day pediatric DHRs. They analyzed 701,263 pediatric discharges from 177 acute-care hospitals in New York over a five-year period to identify an SHR rate, a DHR rate and an all-hospital readmission rate. The researchers concluded that DHRs, which constituted 13.9 percent of all readmissions in the study, affect all-hospital readmission rates and make SHRs an incomplete measure of readmissions and thus of quality. The study and abstract, “Same-Hospital Readmission Rates as a Measure of Pediatric Quality of Care,” were published August 3. Newborn and Maternal Hospitalizations Related to Substance Abuse on the Rise, According to New AHRQ Brief Between 2006 and 2012, the rate of newborn (neonatal) hospitalizations related to substance use increased by 71 percent, from 5.1 to 8.7 per 1,000 stays, according to a recently published statistical brief from AHRQ's Healthcare Cost and Utilization Project (HCUP). HCUP data also show that the rate of maternal hospitalizations related to substance use increased by 33 percent, from 13.4 to 17.9 per 1,000 stays during that period. Total associated hospital costs for that period rose by 135 percent, from $253 to $595 million, for neonatal hospitalizations, and by 35 percent, from $258 to $349 million, for maternal hospitalizations. While the rate of maternal hospital stays for cocaine use fell by 50.5 percent, the rate of maternal hospital stays for opiate use rose by 134.7 percent. Twenty percent of neonatal stays with a substance-related condition had low birth weight, compared with 7 percent of all other neonatal stays. The brief also said that in 2012, mental disorders were indicated in 25 percent of maternal stays related to substance use, compared with 4 percent of other maternal stays. An AHRQ infographic highlights these findings. Magnetic Resonance Imaging, Computed Tomography Provide Higher Sensitivity for Liver Cancer Diagnosis: AHRQ Review The use of magnetic resonance imaging (MRI) and computed tomography (CT) to diagnose liver cancer is associated with higher sensitivity than ultrasonography without contrast, according to an AHRQ-funded literature review of different imaging techniques. Sensitivity refers to the ability of the test to correctly identify individuals with the disease. Worldwide, liver cancer is the fifth most common type of cancer and the third most common cause of death from cancer. The systematic review and meta-analysis, published in the journal Annals of Internal Medicine, included data from 1998 through 2014. It found that sensitivity was higher for MRI than for CT. For evaluation of focal liver lesions, sensitivities for the three imaging modalities were similar. The review, “Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis,” and abstract were published May 19 AHRQ’s Health Care Innovations Exchange Focuses on Reducing Emergency Care by Connecting Frequent Users to Community-Based Services The latest issue of AHRQ’s Health Care Innovations Exchange features three programs that reduced emergency department use by providing access to community-based services for frequent 911 callers and at-risk individuals. One of the profiles describes the Michigan Pathways to Better Health program, in which a community health worker partners with local emergency service providers to identify and refer at-risk individuals to community-based care. Key elements of the program include education of emergency service providers about Michigan Pathways to Better Health and those who might benefit from it, steps to make referrals to the program as easy as possible and financial support to cover a portion of the additional costs involved. The partnerships have enhanced access to needed community-based services, leading to less reliance on emergency care among frequent 911 callers. Featured Impact Case Study: Wisconsin Critical Access Hospital Achieves Multiple Improvements With AHRQ Patient Safety Tools Amery Hospital & Clinic, a critical-access hospital in rural Wisconsin, used AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to reduce surgical site infections from 33 percent to just 3 percent. The facility also used the Re-Engineered Discharge (RED) toolkit to reduce 30-day readmissions by nearly 30 percent and implemented TeamSTEPPS® to bring more structure to its quality improvement efforts. AHRQ in the Professional Literature Bakullari A, Metersky ML, Wang Y, et al. Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011. Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S10-6. Select to access the abstract on PubMed®. Kahvecioglu D, Ramiah K, McMaughan D, et al. Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011. Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S48-55. Select to access the abstract on PubMed®. Greene MT, Fakih MG, Fowler KE, et al. Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative. Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S99-106. Select to access the abstract on PubMed®. Powell ES, Khare RK, Courtney DM, et al. The weekend effect for patients with sepsis presenting to the emergency department. J Emerg Med. 2013 Nov;45(5):641-8. Epub 2013 Aug 30. Select to access the abstract on PubMed®. Lee CI, Jarvik JG. Patient-centered outcomes research in radiology: trends in funding and methodology. Acad Radiol. 2014 Sep;21(9):1156-61. Epub 2014 Jul 4. Select to access the abstract on PubMed®. Chung S, Azar KM, Baek M, et al. Reconsidering the age thresholds for type II diabetes screening in the U.S. Am J Prev Med. 2014 Oct;47(4):375-81. Epub 2014 Aug 15. Select to access the abstract on PubMed®. Gupta S, Brenner AT, Ratanawongsa N, et al. Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med. 2014 Oct;47(4):417-23. Epub 2014 Jul 29. Select to access the abstract on PubMed®. Jarrín O, Flynn L, Lake ET, et al. Home health agency work environments and hospitalizations. Med Care. 2014 Oct;52(10):877-83. Select to access the abstract on PubMed®. Contact Information Please address comments and questions about the AHRQ Electronic Newsletter to Jeff Hardy at: (301) 427-1802 or Jeff.Hardy@ahrq.hhs.gov.