| October 11, 2016, Issue #537 About 35 percent of cesarean sections, or C-sections, were performed for low-risk deliveries in 2013. Low-risk C-section rates varied tenfold (from 4.6 to 46.9 per 100 low-risk deliveries) among the largest hospitals that account for 80 percent of all births, and there was even wider variation among smaller hospitals. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #211, Variation in the Rate of Cesarean Section Across U.S. Hospitals, 2013.) In states that expanded Medicaid under the Affordable Care Act, a significant decline occurred between 2011-13 and 2014 in the percentage of physician and emergency department visits by people who were uninsured, according to a new AHRQ analysis. Physician visits by the uninsured decreased from 8 percent in 2011-2013 to 6 percent in 2014, according to the AHRQ statistical brief. Meanwhile, uninsured patients' visits to emergency departments fell from 20 percent to 11 percent during the same period. Authors conducted the study by examining data from AHRQ's Medical Expenditure Panel Survey, the only national data source measuring how Americans use and pay for medical care, health insurance and out-of-pocket spending. Access the statistical brief, Insurance Coverage of Ambulatory Care Visits in the Last Six Months of 2011-13 and 2014, by Medicaid Expansion Status, or learn more from a blog post by the statistical brief authors in Health Affairs. Health care organizations should take essential steps to ensure that physicians and other clinicians get adequate sleep and rest, according to a new patient safety primer, Fatigue, Sleep Deprivation, and Patient Safety, available on the AHRQ Patient Safety Network. Sleep deprivation can affect cognitive function, potentially impairing mood, motivation, response time and initiative. Given the importance of sleep, The Joint Commission has called on health care organizations to take steps to mitigate the impact of extended work hours. Recommended steps include conducting risk assessments, ensuring evidence-based handoff practices, involving staff in design of work schedules, implementing a fatigue management plan, educating personnel about strategies to promote appropriate sleep and ensuring an adequate environment for sleep breaks. Registration is open for the 9th international conference on Diagnostic Error in Medicine in Hollywood, California. The Nov. 6-8 event will focus on the challenges of preventing diagnostic errors, which may occur because of wrong diagnoses, missed diagnoses or unnecessarily delayed diagnoses. Common but poorly understood, diagnostic errors affect nearly 12 million adults in the United States every year in outpatient settings alone. The Diagnostic Error in Medicine conference will cover the epidemiology of diagnostic error, predisposing factors for diagnostic error and strategies to detect or reduce diagnostic error. The cross-cutting conference is designed for all health care professionals and patients and their families. Access the registration information. Registration is open for a webinar on Oct. 28, from noon to 1 p.m. EDT, on research findings on the results of implementing "Lean" redesigns of primary care workflows in a large ambulatory care system. Lean is an organizational redesign approach derived from the automotive industry that is increasingly used in health care. It focuses on eliminating all types of waste and standardizing care. AHRQ's webinar will highlight redesigns that occurred across 17 clinics. Strategies included standardizing medical equipment and supplies, revamping call center operations, creation of small teams with new workflows and co-locating physicians and medical assistants in shared workspaces. The webinar will examine conditions affecting the implementation and its outcomes. Omdurman Hospital used AHRQ's Hospital Survey on Patient Safety Culture and has set the standard for patient safety culture for teaching hospitals in Arabic-speaking countries in the Middle East and North Africa. Ribat University Hospital implemented TeamSTEPPS and demonstrated significant improvements in five of 12 safety culture areas after the trainings. Access the case study. | AHRQ in the Professional Literature
Vital signs are still vital: instability on discharge and the risk of post-discharge adverse outcomes. Nguyen OK, Makam AN, Clark C, et al. J Gen Intern Med. 2016 Aug 8. [Epub ahead of print.] Access the abstract in PubMed®. Design and rationale of the STRIVE trial to improve cardiometabolic health among children and families. Oreskovic NM, Fletcher R, Sharifi M, et al. Contemp Clin Trials. 2016 Jul;49:149-54. Epub 2016 Jul 11. Access the abstract in PubMed®.
Quality measures to assess care transitions for hospitalized children. Leyenaar JK, Desai AD, Burkhart Q, et al. Pediatrics. 2016 Aug;138(2). Access the abstract in PubMed®.
Volume-outcome relationships in pediatric acute lymphoblastic leukemia: association between hospital pediatric and pediatric oncology volume with mortality and intensive care resources during initial therapy. Wilkes JJ, Hennessy S, Xiao R, et a. Clin Lymphoma Myeloma Leuk. 2016 Jul;16(7):404-10.e1. Epub 2016 May 4. Access the abstract in PubMed®.
The inpatient burden of psoriasis in the United States. Hsu DY, Gordon K, Silverberg JI. J Am Acad Dermatol. 2016 Jul;75(1):33-41. Epub 2016 May 20. Access the abstract in PubMed®.
In low-income Latino patients, post-Affordable Care Act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon. Heintzman J, Bailey SR, DeVoe J, et al. J Racial Ethn Health Disparities. 2016 Apr 22. [Epub ahead of print.] Access the abstract in PubMed®. Primary care providers' views of patient portals: interview study of perceived benefits and consequences. Miller DP Jr, Latulipe C, Melius KA, et al. J Med Internet Res. 2016 Jan 15;18(1):e8.
Access the abstract in PubMed®. Clinical complexity in medicine: a measurement model of task and patient complexity. Islam R, Weir C, Del Fiol G. Methods Inf Med. 2016;55(1):14-22. Epub 2015 Sep 25. Access the abstract in 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. |
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