Outcomes of genetic testing in adults with a history of venous thromboembolism

prepared for Agency for Healthcare Research and Quality ; prepared by The Johns Hopkins University Evidence-based Practice Center ; investigators, Jodi B. Segal ... [et al.]."June 2009."This report was requested and funded by the Centers for Disease Control and Prevention (CDC), Office of Public Health Genomics (OPHG).Includes bibliographical references (p. 91-98)

Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children

ObjectiveThe objective was to test the hypothesis that in‐hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index ED visit.MethodsThis was a retrospective analysis of ED visits by children age 0 to 17 to hospitals in Florida and New York in 2013. Children hospitalized during an ED return visit within 7 days were classified as “ED return admissions” (discharged at ED index visit and admitted at return visit) or “readmissions” (admission at both ED index and return visits). In‐hospital outcomes for ED return admissions and readmissions were compared to “index admissions without return admission” (admitted at ED index visit without 7‐day return visit admission).ResultsAmong 1,886,053 index ED visits to 321 hospitals, 75,437 were index admissions without return admission, 7,561 were ED return admissions, and 1,333 were readmissions. ED return admissions had lower intensive care unit admission rates (11.0% vs. 13.6%; adjusted odds ratio = 0.78; 95% confidence interval [CI] = 0.71 to 0.85), longer length of stay (3.51 days vs. 3.38 days; difference = 0.13 days; incidence rate ratio = 1.04; 95% CI = 1.02 to 1.07), but no difference in mean hospital costs (($7,138 vs.$7,331; difference = –$193; 95$479 to $93) compared to index admissions without return admission.ConclusionsCompared with children who experienced index admissions without return admission, children who are initially discharged from the ED who then have a return visit admission had lower severity and similar cost, suggesting that ED return visit admissions do not involve worse outcomes than do index admissions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142896/1/acem13324_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142896/2/acem13324.pd

Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

Objective To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects. Principal Findings Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare\u27s efforts to contain hospital outpatient costs

The Use of the Agency Healthcare Research and Quality Patient Safety Indicator 11 Toolkit to Decrease Postoperative Respiratory Failure

Postoperative respiratory failure incidents can lead to adverse outcomes, including prolonged hospitalizations, increased admissions to intensive care units, and the risk of complications such as ventilator-associated pneumonia, sepsis, and mortality. This project aimed to assess the effectiveness of implementing the Agency for Healthcare Research and Quality Patient Safety Indicator 11 toolkit intervention for noninvasive positive-pressure ventilation in reducing postoperative respiratory failure rates compared to traditional practices. Adopting evidence- based toolkits, such as those provided by the Agency for Healthcare Research and Quality, aids healthcare organizations in enhancing the quality of patient care. The quality improvement project employed a quasi-experimental design, comparing two groups: one receiving the toolkit intervention and another adhering to traditional practices. Postoperative respiratory failure incidences in the year prior within the same timeframe were compared to the outcomes of the quality improvement project. These positive outcomes underscore the importance of implementing the Agency for Healthcare Research and Quality Patient Safety Indicator 11 toolkit intervention as a quality improvement initiative in healthcare organizations. This intervention has the potential to substantially reduce postoperative respiratory failure rates and associated complications

Moving research into practice: lessons from the US Agency for Healthcare Research and Quality's IDSRN program

BACKGROUND: The U.S. Agency for Healthcare Research and Quality's (AHRQ) Integrated Delivery Systems Research Network (IDSRN) program was established to foster public-private collaboration between health services researchers and health care delivery systems. Its broad goal was to link researchers and delivery systems to encourage implementation of research into practice. We evaluated the program to address two primary questions: 1) How successful was IDSRN in generating research findings that could be applied in practice? and 2) What factors facilitate or impede such success? METHODS: We conducted in-person and telephone interviews with AHRQ staff and nine IDSRN partner organizations and their collaborators, reviewed program documents, analyzed projects funded through the program, and developed case studies of four IDSRN projects judged promising in supporting research implementation. RESULTS: Participants reported that the IDSRN structure was valuable in creating closer ties between researchers and participating health systems. Of the 50 completed projects studied, 30 had an operational effect or use. Some kinds of projects were more successful than others in influencing operations. If certain conditions were met, a variety of partnership models successfully supported implementation. An internal champion was necessary for partnerships involving researchers based outside the delivery system. Case studies identified several factors important to success: responsiveness of project work to delivery system needs, ongoing funding to support multiple project phases, and development of applied products or tools that helped users see their operational relevance. Factors limiting success included limited project funding, competing demands on potential research users, and failure to reach the appropriate audience. CONCLUSION: Forging stronger partnerships between researchers and delivery systems has the potential to make research more relevant to users, but these benefits require clear goals and appropriate targeting of resources. Trade-offs are inevitable. The health services research community can best consider such trade-offs and set priorities if there is more dialogue to identify areas and approaches where such partnerships may have the most promise. Though it has unique features, the IDSRN experience is relevant to research implementation in diverse settings

Framing quality improvement tools and techniques in healthcare: the case of Improvement Leaders' Guides

The paper presents a study of how quality improvement tools are framed within healthcare settings.\ud \ud The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated using a case study of the NHS Modernisation Agency Improvement Leaders’ Guides.\ud \ud Improvement Leaders’ Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobililsation of tools and techniques, the experience also illustrated the challenges in distributing such approaches.\ud \ud The paper provides a contribution to our understanding of framing the 'social act' of quality improvement. Given the ongoing emphasis on quality improvement and the persistent challenges involved, it also provides information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.\ud \ud \u