| January 25, 2022, Issue #797 Fourteen percent of emergency department (ED) visits in 2018 resulted in hospital admissions. Circulatory and digestive system conditions were the most common reasons for these ED visits. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #286, Most Frequent Reasons For Emergency Department Visits, 2018.) Variation in Medicare spending by geographic location is often used as a flag for wasteful spending. To assess the impact the Affordable Care Act (ACA), AHRQ-funded researchers examined trends in geographic variation in Medicare fee-for-service spending per beneficiary before and after passage of the law. The cross-sectional study, published in JAMA Health Forum, included all fee-for-service Medicare enrollees 65 years or older from January 1, 2007, to December 31, 2018. While geographic variation held steady from 2007 to 2011, it declined steadily from 2012 to 2018, driven largely by reduced variation in post-acute care spending, specifically for home healthcare. The difference in total monthly Medicare spending per patient between high spending areas and low spending areas was $415 per month in 2007, falling to $361 in 2018. Anti-fraud enforcement efforts and payment reforms enacted as part of the ACA may have reduced geographic variation in Medicare spending, researchers concluded. Access the abstract. A new AHRQ data visualization shows that the respiratory drug albuterol, the antibiotic azithromycin and the steroid prednisone were the three most commonly used drugs before the COVID-19 pandemic among the drugs later used to treat COVID-19. Users can view the total number of people who used each drug, total prescription fills, total expenditures and per-user data. The data from AHRQ's Medical Expenditure Panel Survey can also be sorted by sociodemographic characteristics, such as age and insurance status. Quantifying the use and expenditures of these medications before COVID-19 suggests how the drugs' new uses may cause shortages or price increases that affect people who were using these drugs prior to the pandemic. Access the data visualization and other AHRQ data visualizations.  Vineet Chopra, M.D., AHRQ grantee and chair of the Department of Medicine at the University of Colorado, has focused on making peripherally inserted central catheters (PICC) safer for patients by creating guidelines for appropriate use. With support from AHRQ, Dr. Chopra developed a tool called the Michigan Appropriateness Guide for Intravenous Catheters that has been used in more than 50 hospitals across Michigan and affecting the outcomes of more than 50,000 patients. Learn more about Dr. Chopra in a new grantee profile as well as profiles of other AHRQ grantees. | Two new Web M&M (Morbidity & Mortality Rounds on the Web) case studies from AHRQ's Patient Safety Network (PSNet) include expert analyses of medical errors submitted by PSNet users. In one case, an 18-year-old man with a history of untreated depression and suicide attempts did not receive a suicide risk assessment until he was found in a hotel room with a loaded gun. In another case, a 52-year-old breast cancer patient scheduled for a lumpectomy did not receive the necessary injection of radiotracer dye before being placed under general anesthesia. In addition to the most recent Web M&M, PSNet regularly highlights journal articles, books and tools related to patient safety. Articles featured this week include: Review additional new publications in PSNet's current issue. AHRQ's latest Impact Case Study describes how the Maine Developmental Disabilities Council is working with two patient safety organizations (PSOs)—The Maine Primary Care Association PSO, and ECRI and the Institute for Safe Medication Practices PSO—to improve care for patients with intellectual and developmental disabilities. Patients with these disabilities often avoid regular checkups and preventive care because primary care physicians lack experience treating them, so visits can be stressful and uncomfortable. The Maine initiative uses PSO data analysis and customized tools and training to help doctors better serve these patients. Access the Impact Case Study. AHRQ's Center for Evidence and Practice Improvement is seeking Federal or non-federal applicants to serve as division director in the Center for Evidence and Practice Improvement. The supervisory physician will identify and develop solutions to the most pressing problems in clinical practice. The selected candidate will also lead development of policies, objectives and goals to ensure comprehensive and integrated health services research, implementation science and dissemination and implementation projects. Access more information about required qualifications, salary range and how to apply. Applications are due Feb. 18. | AHRQ in the Professional Literature Age cutoffs for hospitalization at hospitals without pediatric inpatient capability. Michelson KA, Neuman MI. Hosp Pediatr. 2021 Mar;11(3):284-6. Epub 2021 Feb 9. Access the abstract on PubMed®. Safety evaluation of the second dose of messenger RNA COVID-19 vaccines in patients with immediate reactions to the first dose. Krantz MS, Kwah JH, Stone CA, Jr., et al. JAMA Intern Med. 2021 Nov;181(11):1530-3. Access the abstract on PubMed®. Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia. Ma C, McDonald MV, Feldman PH, et al. Med Care. 2021 Oct;59(10):913-20. Access the abstract on PubMed®. Socioeconomic disparities in functional status in a national sample of patients with rheumatoid arthritis. Izadi Z, Li J, Evans M, et al. JAMA Netw Open. 2021 Aug 2;4(8):e2119400. Access the abstract on PubMed®. Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system. Roberts ET, Song Z, Ding L, et al. JAMA Health Forum. 2021 Oct;2(10):e213105. Epub 2021 Oct 8. Access the abstract on PubMed®. Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices. Brown TT, Hurley VB, Rodriguez HP. BMJ Open. 2021 Nov 26;11(11):e053121. Access the abstract on PubMed®. Community discharge among post-acute nursing home residents: an association with patient safety culture? Guo W, Li Y, Temkin-Greener H. J Am Med Dir Assoc. 2021 Nov;22(11):2384-8.e1. Epub 2021 May 21. Access the abstract on PubMed®. Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success. Chhabra KR, Sheetz KH, Regenbogen SE, et al. Ann Surg. 2021 Dec 1;274(6):e1078-84. Access the abstract on PubMed®. Contact Information For comments or questions about AHRQ News Now, contact Bruce Seeman, (301) 427-1998 or Bruce.Seeman@ahrq.hhs.gov. |
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