AHRQ Electronic Newsletter, March 10, 2015, Issue #461

March 10, 2015, Issue #461 AHRQ Stats Nearly 7.2 percent of the population (22.5 million) paid $2,000 or more in out-of-pocket medical expenses in 2012, compared with 6.9 percent (21.5 million) in 2011. In both 2011 and 2012, nearly 1.5 percent (4.8 million) of Americans paid $5,000 or more, and 0.4 percent (1.3 million) paid at least $10,000. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #450, Differentials in the Concentration in Out-of-Pocket Health Expenditures across Population Subgroups in the U.S., 2012, and Statistical Brief #423,Differentials in the Concentration in the Level of Out-of-Pocket Health Expenditures across Population Subgroups in the U.S., 2011.) Today's Headlines: Affordable Care Act Provision Leads to More Efficient ED Use, New Study Suggests Expanding Medicaid to Parents Is Associated With Increased Coverage for Children, According to AHRQ Study AHRQ Study Finds No Awareness of Home Health Agency Quality Reports AHRQ Announces Funding Opportunity for Ambulatory, Long-Term Care Patient Safety Research Register Now: TeamSTEPPS® Online Master Trainer Course Affordable Care Act Provision Leads to More Efficient ED Use, New Study Suggests A new study indicates that the Affordable Care Act’s expansion of coverage for dependents has increased the efficiency of medical care delivery by reducing non-urgent emergency department (ED) use among young adults. The study by a team of researchers, including one from AHRQ, found that the Affordable Care Act’s dependent coverage provision, which allows young adults to stay on their parents’ private health plan until age 26, was associated with a modest decrease in the use of hospital EDs. In the study, researchers examined data from more than 17 million ED visits over a 5-year period (2007–2011) from AHRQ’s Healthcare Cost and Utilization Project. They found that the quarterly ED-visit rate decreased by a small but statistically significant amount (1.6 per 1,000 population) among young adults after the implementation of the Affordable Care Act provision. The study, “Changes in Emergency Department Use Among Young Adults After the ACA’s Dependent Coverage Provision,” was published March 10 in the journal Annals of Emergency Medicine. Expanding Medicaid to Parents Is Associated With Increased Coverage for Children, According to AHRQ Study An AHRQ-funded study published in the journal JAMA Pediatrics found that children whose parents applied for and received Medicaid insurance had a higher probability of also being covered. The study assessed results of Oregon’s expansion of Medicaid in 2008 when uninsured, low-income individuals were randomly selected to apply for coverage. The study found that parents selected to apply for Medicaid conveyed 18 percent higher odds of their children also getting coverage within the first six months. Children of parents who both applied for and later obtained Medicaid had more than double the odds of receiving coverage compared with children whose parents were not selected. These results demonstrate a causal link between parents’ access to Medicaid coverage and their children’s coverage, researchers said. The study, “Effect of Expanding Medicaid for Parents on Children’s Health Insurance Coverage: Lessons From the Oregon Experiment,” and abstract were published January 5. AHRQ Study Finds No Awareness of Home Health Agency Quality Reports Despite state and federal efforts in publishing quality and satisfaction ratings designed to assist consumers when choosing health care providers, a recent AHRQ-funded study found no awareness of the existence of such reports on home health agencies. This study examined how patients selected a home health agency for care following hospital discharge. The study and abstract, “A Qualitative Study of Choosing Home Health Care After Hospitalization: The Unintended Consequences of ‘Patient Choice’ Requirements,” appeared online January 9 in theJournal of General Internal Medicine. Thirteen consumers and 28 case managers from five hospitals participating in the study were all unaware of existing state or Medicare home health agency public reports, thereby limiting consumers’ ability to make informed decisions and their case managers’ ability to assist them. Case managers felt unable to respond to consumers’ requests for help in choosing a home health agency because they did not have additional information and feared violating federal laws concerning patient choice. Authors noted that public reports can be marketed as tools that case managers can use to help patients choose among providers, while supporting patient autonomy. AHRQ Announces Funding Opportunity for Ambulatory, Long-Term Care Patient Safety Research AHRQ is launching a major initiative to expand patient safety research beyond hospitals. To that end, AHRQ recently released a Funding Opportunity Announcement (FOA) for research in ambulatory and long-term care settings. There is a growing need to generate new knowledge and reexamine available evidence for improving patient safety in ambulatory settings and resident safety in long-term care settings. To address this need, AHRQ is seeking grant proposals to expand the scientific evidence, strategies and tools available for improving safety in ambulatory and/or long-term care settings. It is expected that the results of these projects will add to the existing knowledge base as AHRQ seeks to make care safer in all health care settings. The FOA features a call for proposals with a specific research focus on understanding and eliminating disparities in ambulatory patient and resident safety. Submissions are due by April 27 and can be accepted as early as March 27. Total costs awarded under this announcement are capped at $500,000 a year and $1.5 million for the entire project period. The project period may not exceed three years. For more information, contact AHRQ’s Center for Quality Improvement and Patient Safety or phone 301-427-1515. Register Now: TeamSTEPPS® Online Master Trainer Course AHRQ is offering TeamSTEPPS Master Training online as free accredited continuing education for health care professionals interested in improving patient safety and health care quality. TeamSTEPPS is an evidence-based teamwork approach to improve communication and teamwork skills among health care professionals. Spaces are available now in the virtual course. In order to review course options, register and enroll in a course, health care professionals must create an account. Registration is open. AHRQ in the Professional Literature Butler JM, Carter M, Hayden C, et al. Understanding adoption of a personal health record in rural health care clinics: revealing barriers and facilitators of adoption including attributions about potential patient portal users and self-reported characteristics of early adopting users. AMIA Annu Symp Proc. 2013 Nov 16; 2013:152-61. Select to access the abstract on PubMed®. Dixon BE, Lai PT, Grannis SJ. Variation in information needs and quality: implications for public health surveillance and biomedical informatics. AMIA Annu Symp Proc. 2013 Nov 16; 2013:670-9. Select to access the abstract on PubMed®.  Bleser WK, Miller-Day M, Naughton D, et al. Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home. Ann Fam Med. 2014 Jan-Feb;12(1):37-45. Select to access the abstract on PubMed®. Barocas DA, Chen V, Cooperberg M, et al. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study. J Comp Eff Res. 2013 Jul; 2(4):445-60. Select to access the abstracton PubMed®.  Cooper WO, Cheetham TC, Li DK, et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol. 2014 Feb;66(2):444-50. Select to access the abstract on PubMed®.  Raju MG, Pachika A, Punnam SR, et al. Statin therapy in the reduction of cardiovascular events in patients undergoing intermediate-risk noncardiac, nonvascular surgery. Clin Cardiol. 2013 Aug;36(8):456-61. Epub 2013 May 13. Select to access the abstract on PubMed®.  Campbell NL, Unverzagt F, LaMantia MA, et al. Risk factors for the progression of mild cognitive impairment to dementia. Clin Geriatr Med. 2013 Nov;29(4):873-93. Select to access the abstracton PubMed®.  Palar K, Mendel P, Derose KP. The organization of HIV and other health activities within urban religious congregations.J Urban Health. 2013 Oct;90(5):922-33. Select to access the abstract on PubMed®. Contact Information Please address comments and questions about the AHRQ Electronic Newsletter to Jeff Hardy at: (301) 427-1248 orJeff.Hardy@ahrq.hhs.gov.