AHRQ Electronic Newsletter, February 3, 2015, Issue #457

February 3, 2015, Issue #457 AHRQ Stats: Health Care Expenses Half of the U.S. population accounted for more than 97 percent of total health care expenses in 2012, while the other half of the population accounted for the remaining 3 percent. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #448: Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2012.) Today's Headlines: AHRQ Study Links Hospital Nurse Staffing Increases to Fewer Adverse Events, Lower Lengths of Stay AHRQ Report Features Hospitals’ Use of 'Lean' Process Redesign New AHRQ Funding Seeks To Expand Evidence Base on Health IT System Safety AHRQ Seeks Feedback on Proposed Update of CAHPS Clinician & Group Survey AHRQ Study Links Hospital Nurse Staffing Increases to Fewer Adverse Events, Lower Lengths of Stay Increases in hospital nurse staffing levels are associated with reductions in adverse events and lengths of stay and do not lead to increased costs, a longitudinal study by AHRQ concluded. Researchers also found that increasing the number of registered nurses, as opposed to other nursing positions, led to reduced costs. The authors linked hospital nurse staffing data to AHRQ’s Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from California, Maryland and Nevada between 2008 and 2011 to estimate the causal relationship between nurse staffing (level and skill mix), quality (adverse events as measured by nurse-sensitive patient safety indicators), lengths of stay and cost. The findings suggest that increased staffing of registered nurses can improve patient outcomes and efficiency. "Examining the Value of Inpatient Nurse Staffing: An Assessment of Quality and Patient Care Costs" and the abstractappeared in the November issue of Medical Care. Authors included AHRQ’s H. Joanna Jiang, Ph.D., and Carol Stocks, Ph.D., R.N. AHRQ Report Features Hospitals’ Use of 'Lean' Process Redesign A new AHRQ-funded report shows how hospitals used an organizational redesign approach known as “Lean” to enhance the quality and efficiency of various health care processes. The report, “Improving Care Delivery Through Lean: Implementation Case Studies,” includes six in-depth case studies that explain how Lean principles were applied in 13 distinct implementation projects. The implementation projects included improving patient flow during hospital care, electronic prescribing of medicines, reducing the cost of hip and knee replacement surgery and preventing urinary tract infection. For each case study, researchers assessed how Lean was implemented. They identified success factors and implementation challenges that affected achievement of outcomes, such as improvement in quality, efficiency, costs and employee satisfaction. Among the organizational factors shaping project success and the progress of the overall Lean initiative were executive and project leadership; the organization’s existing improvement structure; information technology support; project planning and scheduling. The practical information from this analysis can help other hospitals and health systems apply Lean principles to their own efforts. New AHRQ Funding Seeks To Expand Evidence Base on Health IT System Safety AHRQ has published a Special Emphasis Notice to support projects to generate new evidence on health information technology (IT) system safety. The standing R01 and R21 Funding Opportunity Announcements will support research regarding the safety of health IT. Patient Safety Organization involvement in R01 projects is strongly encouraged, as is industry partnership. AHRQ is interested in funding applications that will conduct research on safe health IT practices specifically related to the design, implementation, usability and safe use of health IT by all users, including patients. These projects would generate new evidence on safe health IT practices that could be used to inform health IT certification and other forms of policy guidance. AHRQ Seeks Feedback on Proposed Update of CAHPS Clinician & Group Survey AHRQ is inviting comments on several proposed changes to the Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CG-CAHPS) Survey and the Patient-Centered Medical Home Item Set. The proposed changes are summarized in a Federal Register Notice published January 21. Comments on the proposed changesmust be received no later than 5 p.m. ET February 20. Please submit comments by email, with “CG-CAHPS Proposed Changes” in the subject line. CAHPS surveys ask consumers about their experiences with health care. The CAHPS program at AHRQ supports the development and promotion of CAHPS surveys, toolkit materials and comparative databases and provides technical assistance to users. AHRQ in the Professional Literature Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care: a systematic review.JAMA Intern Med. 2014 May;174(5):710-8. Select to access the abstract on PubMed®. Schwartz AL, Sommers BD. Moving for Medicaid? Recent eligibility expansions did not induce migration from other states. Health Aff. 2014 Jan;33(1):88-94. Select to access the abstract on PubMed®. Myers SR, Salhi RA, Lerner EB, et al. A pilot study describing access to emergency care in two states using a model emergency care categorization system. Acad Emerg Med. 2013 Sep;20(9):894-903. Select to access the abstract on PubMed®. Navar-Boggan AM, Fanaroff A, Swaminathan A, et al. The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice. Am Heart J. 2014 Apr;167(4):466-71. Epub 2014 Jan 16. Select to access the abstract on PubMed®. Crane HM, Heckbert SR, Drozd DR, et al. Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. Am J Epidemiol. 2014 Apr 15;179(8):996-1005. Epub 2014 Mar 11. Select to access theabstract on PubMed®. Hays RD, Berman LJ, Kanter MH, et al. Evaluating the psychometric properties of the CAHPS Patient-Centered Medical Home survey. Clin Ther. 2014 May;36(5):689-96.e1. Epub 2014 May 5. Select to access the abstract on PubMed®. Albrecht JS, McGregor JC, Fromme EK, et al. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manage.2013 Oct;46(4):483-90. Epub 2013 Jan 11. Select to access the abstract on PubMed®. Thomas KS. The relationship between Older Americans Act in-home services and low-care residents in nursing homes. J Aging Health. 2014 Mar;26(2):250-60. Epub 2013 Dec 10. Select to access theabstract 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.