AHRQ Electronic Newsletter, September 23, 2015, Issue #487

September 23, 2015, Issue #487 AHRQ Stats: Periods of Uninsurance About half of individuals who earn less than $10 per hour were uninsured sometime during 2013, approximately twice the proportion of individuals who made $15 to $19.99 an hour. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #476: Spells of Uninsurance: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65, 2013.) Today's Headlines: New Report Calls for Increased Focus on Diagnostic Errors AHRQ Study: Using Electronic Triggers Can Speed Cancer Diagnosis Adults With HIV Have 1.5 Times Higher Hospital Readmission Risk: AHRQ Study Register Now: September 30 Webinar Overview of HCUP Products and Tools AHRQ Releases New Patient Safety Primer on High-Reliability Organizations Featured Impact Case Study: AHRQ Resources Used To Train Graduate-Level Physician Assistants New Report Calls for Increased Focus on Diagnostic Errors A new report released by the National Academy of Medicine (formerly the Institute of Medicine or IOM) outlines how health care stakeholders can more quickly identify, resolve and reduce the incidence of diagnostic errors and improve patient safety. Improving Diagnosis in Health Care reveals that most people will experience at least one diagnostic error in their lifetime, whether an incorrect diagnosis or a diagnosis that’s delayed. These errors, according to the report, contribute to approximately 10 percent of patient deaths and between 6 percent and 17 percent of hospital adverse events. Diagnostic errors are also the largest category of paid medical malpractice claims and are almost twice as likely to have resulted in a patient death compared with other claims, according to the report. The report identifies eight recommendations to improve diagnosis, including how patients and health professionals can better communicate, as well as how diagnostic errors can serve as the catalyst for delivering safer care, both of which align with AHRQ’s core mission. Read AHRQ Director Richard Kronick’s blog about how AHRQ will address the new recommendations. AHRQ Study: Using Electronic Triggers Can Speed Cancer Diagnosis Electronic prompts can reduce the time it takes to diagnose colorectal and prostate cancer, as well as improve follow-up care, a new AHRQ-funded study found. The same kind of intervention could improve the timeliness of diagnosis of other serious conditions, the authors stated. Published online August 24 in the Journal of Clinical Oncology, the article described how using electronic health records (EHRs) helped primary care providers test for cancer earlier, thus improving diagnostic safety. The researchers tested whether the use of EHR-based “trigger”algorithms to identify patients at risk of diagnostic delays could reduce the time it takes to identify the need for cancer testing. They studied 72 primary care providers and records for an estimated 118,400 patients under their care from April 2011 to July 2012. Red-flag criteria were found in 10,673 records; of those, 11.8 percent were verified as at high risk for delayed diagnostic evaluation. Read the abstract for the study, “An Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer.” Adults With HIV Have 1.5 Times Higher Hospital Readmission Risk: AHRQ Study Adults living with HIV have a higher likelihood of being readmitted to the hospital within 30 days than those not infected with the virus, according to a new AHRQ study. Risk-adjusted 30-day hospital readmission rates are a commonly used benchmark for hospital care quality and Medicare reimbursement. In this study, researchers used AHRQ’s 2011 Healthcare Cost and Utilization Project hospital discharge data from nine states to compare readmission rates. Nonadjusted readmission rates were 11.2 percent for people without HIV and 19.7 percent for those with HIV. Predicted, adjusted readmission rates were higher for people with HIV in every insurance category, including Medicaid and Medicare, and within every diagnostic category. The findings should encourage policymakers and insurers to consider HIV status when setting readmission standards, researchers stated. The study, “Thirty-Day Hospital Readmissions for Adults With and Without HIV Infection,” and abstract were published July 14 in the journal HIV Medicine. Register Now: September 30 Webinar Overview of HCUP Products and Tools AHRQ will host a webinar on the research-enhancing products of its Healthcare Cost and Utilization Project (HCUP). The Overview of HCUP Products and Tools, set for 2-3 p.m. ET on September 30, will introduce HCUP reports, supplemental files and software tools, with an emphasis on HCUPnet, the free online data query system. The webinar will be useful for health services and policy researchers interested in HCUP’s hospital care databases with all-payer, encounter-level information. Registration details are available on the HCUP User Support Web site. AHRQ Releases New Patient Safety Primer on High-Reliability Organizations Organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures are known as high-reliability organizations. The concept of high reliability is attractive in health care due to the complexity of operations and the risk of significant and even potentially catastrophic consequences when failures occur. A new Patient Safety Primer on High Reliability, posted on AHRQ’s Patient Safety Network, takes a deeper look into what makes a high-reliability organization.The primer provides a detailed overview of the different characteristics that make up high-reliability organizations. For example, such organizations use systems engineering techniques to evaluate and design for safety but are keenly aware that safety is an emergent, rather than a static, property. Another example is that high-reliability organizations work to create an environment in which potential problems are anticipated, detected early, and virtually always responded to quickly enough to prevent catastrophic consequences. Featured Impact Case Study: AHRQ Resources Used To Train Graduate-Level Physician Assistants Stony Brook University’s Health Sciences Center in New York uses three of AHRQ’s evidence-based products and data resources— TeamSTEPPS®, Effective Health Care Program publications, and Healthcare Cost and Utilization Project Statistical Briefs—to train graduate-level physician assistants. AHRQ in the Professional Literature Nichols GA, Schroeder EB, Karter AJ, et al. Trends in diabetes incidence among 7 million insured adults, 2006-2011: the SUPREME-DM project. Am J Epidemiol. 2015 Jan 1;181(1):32-9. Epub 2014 Dec 16. Select to access the abstract on PubMed®. Lebrun-Harris LA, Fiore MC, Tomoyasu N, et al. Cigarette smoking, desire to quit, and tobacco-related counseling among patients at adult health centers. Am J Public Health. 2015 Jan;105(1):180-8. Select to access the abstract on PubMed®. Siddiqui M, Cooper LA, Appel LJ, et al. Recruitment and enrollment of African Americans and Caucasians in a health promotion trial for persons with serious mental illness. Ethn Dis. 2015 Winter;25(1):72-7. Select to access the abstract on PubMed®. Andrews RM, Moy E. Racial differences in hospital mortality for medical and surgical admissions: variations by patient and hospital characteristics. Ethn Dis. 2015 Winter;25(1):90-7. Select to access the abstract on PubMed®. Viswanathan M, Kahwati LC, Golin CE, et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med. 2015 Jan;175(1):76-87. Select to access the abstract on PubMed®. DeVoe JE, Marino M, Angier H, et al. Effect of expanding Medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment. JAMA Pediatr. 2015 Jan;169(1):e143145. Epub 2015 Jan 5. Select to access the abstract on PubMed®. Baier RR, Wysocki A, Gravenstein S, et al. A qualitative study of choosing home health care after hospitalization: the unintended consequences of 'patient choice' requirements.J Gen Intern Med. 2015 May;30(5):634-40. Epub 2015 Jan 9. Select to access the abstract on PubMed®. Patrick SW, Kawai AT, Kleinman K, et al. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics. 2014 Oct;134(4):705-12. Epub 2014 Sep 8. Select to access the abstract on PubMed®. Contact Information Please address comments and questions about the AHRQ Electronic Newsletter to Bruce Seeman at: (301) 427-1998 or Bruce.Seeman@ahrq.hhs.gov.