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Utilization of Intensive Care Services, 2011 (December 2014)

February 16, 2015 Comments off

Utilization of Intensive Care Services, 2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, 26.9 percent of hospital stays in 29 States involved intensive care unit (ICU) charges, accounting for 47.5 percent of aggregate total hospital charges.
  • Common conditions and procedures with high ICU utilization varied across body systems. The highest rate of ICU use (93.3 percent) was for respiratory disease with ventilator support.
  • Cardiac conditions accounted for 8 of the 18 conditions and procedures with high ICU utilization. ICU utilization for cardiac conditions ranged from 40.6 percent for stays for chest pain to 70.3 percent for stays for acute myocardial infarction with major complications or comorbidities.
  • Hospital stays that involved ICU services were 2.5 times more costly than other hospital stays.
  • ICU services were on average three times more likely when patients experienced major complications or comorbidities.
  • Greater utilization of ICUs tended to occur in hospitals that were large, private/for profit, located in metropolitan areas, trained medical students, and had a high-level trauma center.

Decision Aids for Cancer Screening and Treatment

January 13, 2015 Comments off

Decision Aids for Cancer Screening and Treatment
Source: Agency for Healthcare Research and Quality

Decision Aids for Cancer Screening and Treatment, a new research review from AHRQ’s Effective Health Care Program, examined the effectiveness of decision aids used by people facing treatment or screening decisions for early cancer. Considerable diversity in both format and available evidence among the aids were found.

The review is useful for creators of patient decision aids and those considering whether to use decision aids. It found strong evidence that cancer-related decision aids increase knowledge about available treatments and next steps without negatively impacting decisionmaking ability or causing additional anxiety. The review also found evidence that decision aids can help users make informed decisions and choices that best agree with their values and provide accurate understanding about the risks of treatment.

AHRQ Quality Indicators™ Toolkit for Hospitals

December 10, 2014 Comments off

AHRQ Quality Indicators™ Toolkit for Hospitals
Source: Agency for Healthcare Research and Quality

The QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). More information on the QIs is available in the Fact Sheets on the IQIs.

The QI Toolkit supports hospitals that want to improve performance on the IQIs and PSIs by guiding them through the process, from the first stage of self-assessment to the final stage of ongoing monitoring. The tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multistakeholder improvement teams. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge.

Trends in Use and Expenditures for Cancer Treatment among Adults 18 and Older, U.S. Civilian Noninstitutionalized Population, 2001 and 2011

November 21, 2014 Comments off

Trends in Use and Expenditures for Cancer Treatment among Adults 18 and Older, U.S. Civilian Noninstitutionalized Population, 2001 and 2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, approximately 15.8 million adults or 6.7 percent of the adult U.S. population received treatment for cancer. This represents an increase from 2001, when 10.2 million adults or 4.8 percent of the population reported receiving treatment for cancer.
  • Medical spending to treat cancer increased from $56.8 billion in 2001 (in 2011 dollars) to $88.3 billion in 2011.
  • Ambulatory expenditures for care and treatment of cancer increased from $25.5 billion in 2001 to $43.8 billion in 2011.
  • Expenditures on retail prescription medications for cancer increased from $2.0 billion in 2001 to $10.0 billion in 2011.
  • Mean annual retail prescription drug expenditures for those with an expense related to cancer increased more than three times, from $201 per person in 2001 (in 2011 dollars) to $634 per person in 2011.
  • Inpatient hospital expenditures accounted for 47 percent of total spending for cancer treatment in 2001, but fell to 35 percent of the total by 2011.

Care Management Guide for Youth with Behavioral Health Needs

November 3, 2014 Comments off

Care Management Guide for Youth with Behavioral Health Needs
Source: Agency for Healthcare Research and Quality

Designing Care Management Entities for Youth With Complex Behavioral Health Needs is the second implementation guide to be published from AHRQ’s Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. The guide provides information about care management entities (CMEs), which coordinate services provided by State agencies that serve youth with complex behavioral needs.

The guide, available under What We Learned on the national evaluation Web site, draws on the experiences of the three CHIPRA quality demonstration States—Georgia, Maryland, and Wyoming—that are using funds to implement or expand CMEs, supplemented with additional guidance and resources. The guide can be helpful to States interested in implementing or improving CMEs for youth with complex behavioral health needs and their families. It may also be useful for county agencies responsible for financing behavioral health or social services in the State.

AHRQ — Women: Stay Healthy at Any Age (2014 Update)

October 21, 2014 Comments off

Women: Stay Healthy at Any Age (2014 Update)
Source: Agency for Healthcare Research and Quality

Use this information to help you stay healthy. Learn which screening tests you need and when to get them, which medicines may prevent diseases, and steps you can take for good health.

Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma

September 29, 2014 Comments off

Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma (PDF)
Source: Agency for Healthcare Research and Quality

Objectives
Our objectives were to synthesize the available information on the diagnostic accuracy and clinical utility of commonly used imaging tests for the diagnosis and staging of pancreatic adenocarcinoma , as well as screening for pancreatic adenocarcinoma in high risk individuals .

Data sources
We searched Embase , MEDLINE, PubMed, and The Cochrane Library from 1980 through November 1, 2013 , for English – la nguage, full – length articles on the role of m ultidetector computed tomography ( MD CT), endoscopic ultrasound with fine – needle aspiration (EUS – FNA), magnetic resonance imaging (MRI), and positron emission tomography – computed tomography ( PET/CT ) in screening, diagnosis, and staging pancreatic adenocarcinoma. The searches identified 9, 776 citations; after screening against the inclusion criteria, we included 15 systematic reviews and 108 primary studies.

Methods
We extracted data from the included studies and constructed evidence tables. Comparative o utcomes of interest included diagnostic accuracy (sensitivity and specificity) , staging accuracy, screening accuracy, clinical management, quality of life, survival, and harms of imaging tests. For studies of a single imaging test, the key outcomes were accuracy and procedural harms. Where possible, we pooled the data using bivariate binomial regression models for comparative accuracy. For each pair of tests and each assessed aspect (e.g., determination of metastase s), we determined whether the evidence was sufficient to permit a conclusion of a difference, a conclusion of similar accuracy , or neither (i.e., insufficient ). We rated the risk of bias of individual studies using an internal validity instrument and grade d the overall strength of evidence of conclusions using Evidence – based Practic e Center methods . For dat a on single – test accuracy, procedural harms, patient tolerance, and screening accuracy, we tabulated the important information and summarized the evidenc e qualitatively.

Results
We included 15 systematic reviews and 108 primary studies. Regarding comparative accuracy, the evidence was sufficient to conclude that MDCT and EUS – FNA have similar accuracy in assess ing resectability in patients whose disease is unstaged , and that EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) . Further, we concluded that MDCT and MRI are similarly accurate with respect to both diagnos ing and asses s ing vessel involvement. For PET/CT , evidence was generally inconclusive, but we f ound low – strength evidence to conclude that PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity) . No ne of the included studies reported comparative data on clinical management, survival, quality, or the impact on comparative accuracy of patient characteristics , tumor characteristics , or operator experience. Many studies have reported procedural harms, but har ms are generally rare and are different for different imaging modalities. In the screening of people at high risk of developing pancreatic adenocarcinoma , a vailable studies do not correlate the results of a given imagin g test to subsequent diagnoses.

Conclusions.
Current evidence permits some tentative conclusions about the comparative assessment of imaging tests for diagnosing and staging pancreatic adenocarcinoma, but many gaps remain. The conclusions we did draw are as follows: MDCT and EUS – FNA have similar accuracy in assessing resectability in patients whose disease is unstaged ; EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) ; MDCT and MRI are similarly accurate with respect to both diagnos ing and assess ing vessel involvement ; and PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity). The prominent gaps include minimal information on MDCT angiography , impr ecis e data on other imaging techniques, a lack of comparative data on patient – oriented outco mes and factors that could influence comparative accuracy, and test – specific data on screening accuracy.

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