GESTIÓN EN SALUD PÚBLICA

The time burden of alcohol-bas... [Infect Control Hosp Epidemiol. 2013] - PubMed - NCBI

2013-05-24T07:43:00.003-07:00

The time burden of alcohol-bas... [Infect Control Hosp Epidemiol. 2013] - PubMed - NCBI

2013 Jan;34(1):96-8. doi: 10.1086/668781. Epub 2012 Nov 27.

The time burden of alcohol-based hand cleanser when using nonsterile gloves.

Reardon JM, Valenzuela JE, Parmar S, Venkatesh AK, Schuur JD, Allen MB, Pallin DJ.

Source

Harvard Medical School, Boston, Massachusetts, USA.

Abstract

We quantified the time burden of alcohol-based handrub accompanying nonsterile-glove use among emergency physicians, through observation in controlled and clinical settings. We report gloving episodes per hour, gloving times with and without handrub, and handrub recommendations compliance. Handrub adds 46 seconds to each glove-use episode, and we provide national extrapolations.

PMID:: 23221200; [PubMed - indexed for MEDLINE]

Burden and well-being among a diverse ... [J Pain Symptom Manage. 2012] - PubMed - NCBI

2013-05-24T07:43:00.001-07:00

Burden and well-being among a diverse ... [J Pain Symptom Manage. 2012] - PubMed - NCBI

2012 Sep;44(3):410-20. doi: 10.1016/j.jpainsymman.2011.09.018. Epub 2012 Jun 22.

Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers.

Burton AM, Sautter JM, Tulsky JA, Lindquist JH, Hays JC, Olsen MK, Zimmerman SI, Steinhauser KE.

Source

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1439, USA. aburton@mdanderson.org

Abstract

CONTEXT:

Three important causes of death in the U.S. (cancer, congestive heart failure, and chronic obstructive pulmonary disease) are preceded by long periods of declining health; often, family members provide most care for individuals who are living with serious illnesses and are at risk for impaired well-being.

OBJECTIVES:

To expand understanding of caregiver burden and psychosocial-spiritual outcomes among understudied groups of caregivers-cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers-by including differences by disease in a diverse population.

METHODS:

The present study included 139 caregiver/patient dyads. Independent variables included patient diagnosis and function; and caregiver demographics, and social and coping resources. Cross-sectional analyses examined distributions of these independent variables between diagnoses, and logistic regression examined correlates of caregiver burden, anxiety, depressive symptoms, and spiritual well-being.

RESULTS:

There were significant differences in patient functioning and caregiver demographics and socioeconomic status between diagnosis groups but few differences in caregiver burden or psychosocial-spiritual outcomes by diagnosis. The most robust social resources indicator of caregiver burden was desire for more help from friends and family. Anxious preoccupation coping style was robustly associated with caregiver psychosocial-spiritual outcomes.

CONCLUSION:

Caregiver resources, not patient diagnosis or illness severity, are the primary correlates associated with caregiver burden. Additionally, caregiver burden is not disease specific to those examined here, but it is rather a relatively universal experience that may be buffered by social resources and successful coping styles.
Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

PMID:: 22727950; [PubMed - indexed for MEDLINE]
PMCID:: PMC3432705; [Available on 2013/9/1]

Sickle cell disease patients' perce... [J Natl Med Assoc. 2012 Sep-Oct] - PubMed - NCBI

2013-05-24T07:42:00.001-07:00

Sickle cell disease patients' perce... [J Natl Med Assoc. 2012 Sep-Oct] - PubMed - NCBI

2012 Sep-Oct;104(9-10):449-54.

Sickle cell disease patients' perceptions of emergency department pain management.

Porter J, Feinglass J, Artz N, Hafner J, Tanabe P.

Source

St. Jude Children's Research Hospital, Department of Psychology, Memphis, TN 38105, USA.

Abstract

Patients with sickle cell disease (SCD) experience painful crises that often require admission to the emergency department (ED) for pain management. Factors such as ED overcrowding and negative perception and stigmatization of SCD may impact patients' perceptions of the quality of pain management in the ED. Data from a multisite prospective cohort study was assessed to determine whether demographic (age and sex), clinical (time to administration of initial analgesia, number of analgesic doses, discharge disposition, and clinical site), or interpersonal factors (separately measured perceptions of being treated with trust and respect by ED triage nurses, nurses, and physicians) were associated with patient ratings of their pain management in the ED. Patients were adults with SCD seen at 3 EDs (2 urban and 1 rural). Demographic and clinical information was derived from medical record review; interpersonal and ED pain management ratings were derived from interviews conducted 1 week post ED visit. A total of 209 interviews by 98 patients were analyzed. Results indicated significant differences among the ED sites on the demographic, clinical, and interpersonal factors. Overall, patients reported being treated with trust and respect by ED clinicians. Adjusted logistic regression analyses indicated that ED clinical site 1 (odds ratio [OR], 10.42; 95% confidence interval [Cl], 1.44-7.36) and being treated with trust and respect by the ED physician (OR, 25.53; 95% CI, 2.07-314.96) predicted good ED pain management ratings. Interpersonal health care experiences may be an important indicator of patient satisfaction and quality of care received by patients with SCD in the ED.

PMID:: 23342819; [PubMed - indexed for MEDLINE]

A matched-pair cluster-randomized trial of ... [J Gen Intern Med. 2013] - PubMed - NCBI

2013-05-24T07:41:00.001-07:00

A matched-pair cluster-randomized trial of ... [J Gen Intern Med. 2013] - PubMed - NCBI

2013 May;28(5):612-21. doi: 10.1007/s11606-012-2287-y.

A matched-pair cluster-randomized trial of guided care for high-risk older patients.

Boult C, Leff B, Boyd CM, Wolff JL, Marsteller JA, Frick KD, Wegener S, Reider L, Frey K, Mroz TM, Karm L, Scharfstein DO.

Source

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, cboult@jhsph.edu.

Abstract

BACKGROUND:

Patients at risk for generating high health care expenditures often receive fragmented, low-quality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients.

OBJECTIVE:

We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services.

DESIGN:

32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices.

PATIENTS:

The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate.

INTERVENTION:

A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for self-management, caregiver support, and access to community-based services.

MAIN MEASURES:

Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively.

KEY RESULTS:

Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference = 0.27, 95 % CI = 0.08-0.45) and 29 % lower use of home care (95 % CI = 3-48 %).

CONCLUSIONS:

Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

PMID:: 23307395; [PubMed - in process]
PMCID:: PMC3631081; [Available on 2014/5/1]

Exploring strategies to improve emergency depart... [J Emerg Med. 2012] - PubMed - NCBI

2013-05-24T07:40:00.003-07:00

Exploring strategies to improve emergency depart... [J Emerg Med. 2012] - PubMed - NCBI

2012 Jul;43(1):149-58. doi: 10.1016/j.jemermed.2011.03.007. Epub 2011 May 28.

Exploring strategies to improve emergency department intake.

Welch S, Savitz L.

Source

Intermountain Institute for Health Care Delivery Research, Salt Lake City, Utah, USA.

Abstract

BACKGROUND:

The emergency department (ED) is the point of entry for nearly two-thirds of patients admitted to the average United States (US) hospital. Due to unacceptable waits, 3% of patients will leave the ED without being seen by a physician.

OBJECTIVES:

To study intake processes and identify new strategies for improving patient intake.

METHODS:

A year-long learning collaborative was created to study innovations involving the intake of ED patients. The collaborative focused on the collection of successful innovations for ED intake for an "improvement competition." Using a qualitative scoring system, finalists were selected and their innovations were presented to the members of the collaborative at an Association for Health Research Quality-funded conference.

RESULTS:

Thirty-five departments/organizations submitted abstracts for consideration involving intake innovations, and 15 were selected for presentation at the conference. The innovations were presented to ED leaders, researchers, and policymakers. Innovations were organized into three groups: physical plant changes, technological innovations, and process/flow changes.

CONCLUSION:

The results of the work of a learning collaborative focused on ED intake are summarized here as a qualitative review of new intake strategies. Early iterations of these new and unpublished innovations, occurring mostly in non-academic settings, are presented.
Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:: 21621363; [PubMed - indexed for MEDLINE]

Informatics and operations--let's get ... [J Am Med Inform Assoc. 2013] - PubMed - NCBI

2013-05-24T07:40:00.001-07:00

Informatics and operations--let's get ... [J Am Med Inform Assoc. 2013] - PubMed - NCBI

2013 Jan 1;20(1):122-4. doi: 10.1136/amiajnl-2012-001194. Epub 2012 Sep 1.

Informatics and operations--let's get integrated.

Marsolo K.

Source

Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. keith.marsolo@cchmc.org

Abstract

The widespread adoption of commercial electronic health records (EHRs) presents a significant challenge to the field of informatics. In their current form, EHRs function as a walled garden and prevent the integration of outside tools and services. This impedes the widespread adoption and diffusion of research interventions into the clinic. In most institutions, EHRs are supported by clinical operations staff who are largely separate from their informatics counterparts. This relationship needs to change. Research informatics and clinical operations need to work more closely on the implementation and configuration of EHRs to ensure that they are used to collect high-quality data for research and improvement at the point of care. At the same time, the informatics community needs to lobby commercial EHR vendors to open their systems and design new architectures that allow for the integration of external applications and services.

PMID:: 22940670; [PubMed - in process]
PMCID:: PMC3555339; [Available on 2014/1/8]

The effect of contact precauti... [Infect Control Hosp Epidemiol. 2013] - PubMed - NCBI

2013-05-24T07:39:00.001-07:00

The effect of contact precauti... [Infect Control Hosp Epidemiol. 2013] - PubMed - NCBI

2013 Jan;34(1):69-73. doi: 10.1086/668775. Epub 2012 Nov 20.

The effect of contact precautions on healthcare worker activity in acute care hospitals.

Morgan DJ, Pineles L, Shardell M, Graham MM, Mohammadi S, Forrest GN, Reisinger HS, Schweizer ML, Perencevich EN.

Source

University of Maryland School of Medicine, Baltimore, Maryland, USA. dmorgan@epi.umaryland.edu

Abstract

BACKGROUND AND OBJECTIVE:

Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities.

DESIGN:

Prospective cohort study.

PARTICIPANTS AND SETTING:

Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus.

METHODS:

Trained observers performed "secret shopper" monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods.

RESULTS:

A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; [Formula: see text]).

CONCLUSION:

Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.

PMID:: 23221195; [PubMed - indexed for MEDLINE]

Smoking is bad for babies: obstet... [Am J Health Promot. 2013 Jan-Feb] - PubMed - NCBI

2013-05-24T07:38:00.001-07:00

Smoking is bad for babies: obstet... [Am J Health Promot. 2013 Jan-Feb] - PubMed - NCBI

2013 Jan-Feb;27(3):170-6. doi: 10.4278/ajhp.110624-QUAL-265.

Smoking is bad for babies: obstetric care providers' use of best practice smoking cessation counseling techniques.

Chang JC, Alexander SC, Holland CL, Arnold RM, Landsittel D, Tulsky JA, Pollak KI.

Source

Center for Research in Health Care, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA. jchang@mail.magee.edu

Abstract

PURPOSE:

To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange).

DESIGN:

Observational study using audio recordings of first obstetric visits.

SETTING:

An urban academic hospital-based clinic.

PARTICIPANTS:

Obstetric care providers and pregnant women attending their first obstetric visit.

METHOD:

First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling.

RESULTS:

Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking.

CONCLUSION:

Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.

PMID:: 23286593; [PubMed - in process]

National Healthcare Quality & Disparities Reports | Agency for Healthcare Research & Quality (AHRQ)

2013-05-24T07:37:00.001-07:00

National Healthcare Quality & Disparities Reports | Agency for Healthcare Research & Quality (AHRQ)

Health Care Quality Slowly Improving, While Some Americans Still Lack Access

The quality of U.S. health care is slowly improving, while access to health care remains a great challenge for some Americans, especially racial and ethnic minorities and low-income people, according to AHRQ’s 2012 National Healthcare Quality Report and National Healthcare Disparities Report. The new reports call for “urgent attention” on continuing improvements in the quality of diabetes care, maternal and child health care, and treatment for conditions such as pressure ulcers and blood clots. Included in this year’s reports are new measures on early and adequate prenatal care, colorectal cancer screening, national rate of hospital-acquired conditions, standardized infection ratios at the state level for central line-associated bloodstream infections, and patient safety culture hospital survey findings. Quality and access data predate passage of the Affordable Care Act, which is addressing many of these issues. The reports are available online at http://www.ahrq.gov/research/findings/nhqrdr/index.html. To order a print copy, email ahrqpubs@ahrq.hhs.gov or call 1-800-358-9295.

National Healthcare Quality & Disparities Reports

Tools for measuring health care quality, including the National Healthcare Disparities and Quality Reports, AHRQ Quality Indicators, and ambulatory clinical performance measures. For the 10th year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. The reports present, in chart form, the latest available findings on quality of and access to health care.

National Healthcare Quality Report (NHQR)

2012 PDF Version [ - 4.89 MB] (Accessible version available in June; for assistance, Email Doreen.Bonnett@ahrq.hhs.gov or call 301-427-1899).
2011 Web Version | PDF Version [ - 4.89 MB] | State Snapshots - Order Online
2010 Web Version | PDF Version [ - 27.53 MB] | State Snapshots
2009 Web Version | PDF Version [ - 3.14 MB] | State Snapshots
2008 Web Version | PDF Version [ - 2.42 MB] | State Snapshots

National Healthcare Disparities Report (NHDR)

2012 PDF Version [ - 5.25 MB] (Accessible version available in June; for assistance, Email Doreen.Bonnett@ahrq.hhs.gov or call 301-427-1899).
2011 Web Version | PDF Version [ - 11.2 MB] | State Snapshots - Order Online
2010 Web Version | PDF Version [ - 31.46 MB] | State Snapshots
2009 Web Version | PDF Version [ - 7.9 MB] | State Snapshots
2008 Web Version | PDF Version [ - 2.61 MB] | State Snapshots

Related Information

Current as of May 2013

Internet Citation: National Healthcare Quality & Disparities Reports. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/index.html

County-Based Accountable Care Organization for Medicaid Enrollees Features Shared Risk, Electronic Data Sharing, and Various Improvement Initiatives, Leading to Lower Utilization and Costs | AHRQ Innovations Exchange

2013-05-24T07:36:00.001-07:00

County-Based Accountable Care Organization for Medicaid Enrollees Features Shared Risk, Electronic Data Sharing, and Various Improvement Initiatives, Leading to Lower Utilization and Costs | AHRQ Innovations Exchange

AHRQ’s Health Care Innovations Exchange Focuses on Accountable Care Organizations

Two accountable care organizations (ACOs) that used financial risk sharing and various improvement initiatives to reduce health care utilization and costs for defined patient populations are featured by the AHRQ’s Health Care Innovations Exchange. One profile describes a county-based accountable care organization that integrates medical, behavioral, and social services with the goal of improving outcomes and reducing costs for newly enrolled Medicaid beneficiaries in Hennepin County, Minn. Known as Hennepin Health, the ACO is a partnership among several entities within the county government that share financial risk. An assigned care coordinator works to ensure that each enrollee receives appropriate services based on his or her medical, mental, and social service needs. Partners share data electronically to generate complete information on each enrollee and jointly implement initiatives to improve care and promote appropriate utilization. The organization has seen higher enrollment; lowered admissions, readmissions, and emergency department visits; and high enrollee satisfaction. Access more innovation profiles and tools related to accountable care organizations on the Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 Quality Tools.

New Funding Opportunity Seeks Patient Centered Outcomes Research to Close Health Care Disparities

2013-05-24T07:35:00.001-07:00

New Funding Opportunity Seeks Patient Centered Outcomes Research to Close Health Care Disparities

AHRQ is soliciting Research Demonstration Cooperative Agreement applications from institutions to establish and engage relationships with diverse stakeholders to identify effective strategies to reduce racial and ethnic health care disparities through shared decision-making. Institutions also will demonstrate how to reduce disparities through the translation, dissemination, and implementation of Patient Centered Outcomes Research (PCOR) findings. This funding opportunity focuses on racial and ethnic minorities in underserved settings. Application deadline is July 31.

Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness - Research Review - Final | AHRQ Effective Health Care Program

2013-05-24T07:34:00.001-07:00

Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness - Research Review - Final | AHRQ Effective Health Care Program

Limited Evidence on Best Approaches for Pressure Ulcer Treatment and Prevention, AHRQ Reviews Find

Limited evidence is available to draw firm conclusions about the best approaches for treating pressure ulcers, a finding consistent with other recent reviews, according to a new research review from AHRQ’s Effective Health Care Program. Given the serious impact pressure ulcers have on health status, costs, and patient quality of life, treatments are needed to promote and shorten healing and minimize the risk of complications. Some evidence suggests wound improvement (reduction in ulcer size) was better on air-fluidized beds compared to other support surfaces, including standard hospital beds. Nutritional supplementation also resulted in wound improvement when used with other measures for treating pressure ulcers. Advancing pressure ulcer care will take more rigorous studies to solidify the evidence base on widely used treatments. These findings can be found in the full review, Pressure Ulcer Treatment Strategies: Comparative Effectiveness. A related research report found that commonly used instruments to assess patients’ risk of pressure ulcers can identify patients at increased risk for ulcers when compared with clinical judgment. Frequently used instruments include the Braden, Norton, and Waterlow scales. In higher risk populations, studies consistently found advanced static support mattresses and overlays were associated with lower risk of pressure ulcers compared with standard mattresses, with no clear differences between different advanced static support surfaces. More research is needed to understand the effectiveness of other preventive interventions in relation to standard care, and the comparative effectiveness of preventive interventions. These findings can be found in the full review, Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness.

AHRQ to Demonstrate HCUP, MEPS at Health Datapalooza on June 3-4

2013-05-24T07:33:00.003-07:00

AHRQ to Demonstrate HCUP, MEPS at Health Datapalooza on June 3-4

As a supporter of widespread use of health data to promote quality, efficiency, and effectiveness, AHRQ will participate in the fourth annual Health Datapalooza conference, to be held on June 3-4 in Washington, D.C. The conference features new and innovative uses of health data by individuals, academic organizations, private and non-profit companies, start-ups and government agencies. AHRQ will demonstrate the latest applications of its two powerful health databases, the Healthcare Cost and Utilization Project (HCUP) and the Medical Expenditure Panel Survey (MEPS). HCUP is the largest collection of longitudinal hospital care data in the United States, representing 97 percent of all inpatient hospital discharges. MEPS is the most complete source of U. S. data on the cost and use of health care services and insurance coverage, obtained through large-scale, annual surveys of families, individuals, medical providers and employers. AHRQ is a member of the Health Data Consortium, the event’s organizer, and a collaborative of government, non-profit and private organizations that advocates data best practices and information sharing. Select to register for the conference.

Register for June 5 Web Event on Building Health Information Exchanges to Support ACOs and Medical Homes: Delaware’s Experience

2013-05-24T07:33:00.001-07:00

Register for June 5 Web Event on Building Health Information Exchanges to Support ACOs and Medical Homes: Delaware’s Experience

Join the AHRQ Health Care Innovations Exchange on June 5 from 1:00 to 2:00 p.m. EDT for an interactive dialogue exploring strategies for building health information exchanges to promote accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). The webinar is the third in a series designed to share novel experiences and lessons learned in putting ACO/PCMH principles into practice. Learn how Delaware’s innovative Health Information Network, an integrated, statewide health data system, supports the information needs of consumers, health plans, policymakers, providers, purchasers and research to improve the quality and efficiency of health care services. Select to register for the Web event.

Register for The People’s Scientific Conference to Promote Health and Eliminate Health Disparities on June 14-15

2013-05-24T07:32:00.002-07:00

Register for The People’s Scientific Conference to Promote Health and Eliminate Health Disparities on June 14-15

The People’s Scientific Conference to Promote Health and Eliminate Health Disparities, to be held at the University of Florida at Gainesville on June 14-15, will feature presentations by nationally known medical and research experts on common health problems among racial and ethnic minority, low-income, and other underserved communities. The conference is sponsored by the University of Florida Health Disparities Research and Intervention Program in partnership with the University of Florida Prostate Disease Center and the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health. Select to register for the conference and to get additional information. Registration is required by June 10.

COMUNICADO

2013-05-24T07:30:00.000-07:00

Estimados amigos, lectores y seguidores, volveremos a encontrarnos el lunes 27 de Mayo.
Gracias por vuestra presencia.
Hasta entonces.

AHRQ Innovations Exchange ▲ May 22, 2013 Issue

2013-05-24T07:29:00.001-07:00

AHRQ Innovations Exchange

May 22, 2013 Issue
Improving Care for Frontier Populations

This issue includes

Innovations:

QualityTools:

Next issue: Health Information Exchanges

Spotlight On...
New Innovations Exchange Video Series

AHRQ announces a new video series, Healthcare Policy Innovations: Changing Care, Improving Health, which highlights policy innovations that led to more efficient follow-up care for patients discharged from the hospital, enhanced access to care for low-income patients, and improved health for children with asthma.

New Perspective

	Telehealth Improves Access and Quality of Care for Alaska Natives Stewart Ferguson, PhD, Chief Information Officer for the Alaska Native Tribal Health Care Consortium
	and John Kokesh, MD, Medical Director of the Department of Otolaryngology at the Alaska Native Medical Center

Events & Podcasts
Upcoming TweetChat
Join us on Twitter Tuesday, June 18, at noon ET for a live TweetChat with Dr. Rebecca Weintraub Brendel, Clinical Director of the Veterans Program at the Red Sox Foundation and Massachusetts General Hospital Home Base Program and Dr. Benjamin Miller, Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine. We will discuss how the Boston Red Sox Foundation has teamed with Massachusetts General Hospital to support veterans with PTSD and their families. Use the #AHRQIX hashtag to participate in the conversation. For more information, visit the Event page.

Upcoming Web Event
Join the Innovations Exchange for the last Web event in our new series designed to share experiences and lessons learned in putting accountable care organization and patient-centered medical home principles into practice. Registration is required.

Wednesday, June 5, 1 – 2 pm ET
Building Health Information Exchanges To Support Accountable Care Organizations and Medical Homes: Delaware’s Experience

Thank you for participating!
Thank you for joining us May 9 for the Web event titled A Close Look at Care Coordination Within Patient-Centered Medical Homes: West Virginia’s Experience. Event materials are available on the Event page.

Learn & Network Get advice and ideas from experts and practitioners. Participate in discussions and learning networks.

View all Learn & Network

Articles & Guides Access resources for problem-solving and innovation adoption.

The State of Accountable Care Organizations: A Conversation With Health Policy and Management Expert Stephen M. Shortell, PhD, MPH, MBA
Image courtesy of Jim Block with permission

The U.S. Preventive Services Task Force Will Soon Issue a Final Recommendation on HIV Screening for Adolescents and Adults: A Conversation With USPSTF Member Douglas K. Owens, MD, MS
Image courtesy of Steve Fisch with permission

View all Articles & Guides

White House Issues Executive Order on Open Data

2013-05-24T07:21:00.001-07:00

White House Issues Executive Order on Open Data

May 24, 2013 • 0 comments • By Miguel Gomez, Director, AIDS.gov, and Senior Communications Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

This week marks the one-year anniversary of the Digital Government Strategy, and we want to take a moment to reflect on a recent White House Executive Order about open data. This Executive Order and accompanying Open Data Policy [PDF 6MB] requires that, going forward, all data generated by the federal government be made available in ways that make the data easy to find, accessible, and usable (read about it in this blog post). Executive orders are official actions through which the President of the United States manages the operations of the federal government. This Executive Order has implications for all of us.

What does “open data” mean?

Open data are complete, accessible, machine-readable, and freely available to anyone, to the extent possible without compromising individuals’ personally identifiable information and right to privacy.
It is important to note that “data” refers not only to tabular data, which is typically numerical, but also to web content (i.e. text). The move to make both numerical and text data more open has many important benefits; for example, it makes it possible to create a web page that automatically pulls together content related to a given topic or issue, such as HIV treatment or prevention.

Why is an open data policy important?

An open data policy allows individuals, businesses, nonprofit groups, and other entities to use–for free–currently existing federal data that might cost them millions of dollars to collect on their own, and then to analyze and repurpose that data for other needs. For example, decades ago, the federal government made both weather data and the Global Positioning System (GPS) freely available to anyone. Since then, American entrepreneurs and innovators have used these resources to create navigation systems, weather newscasts, location-based apps, precision farming tools, and much more.

Who needs to be involved in open data efforts?

For open data efforts to be successful, all those responsible for the domains of content, communications, and technology must be involved. With their full participation and buy-in, the move toward open data can be one of the most powerful examples of collaboration in our work.

How does an open data policy support our national response to HIV/AIDS?

The National HIV/AIDS Strategy recognizes that, in order to be effective, HIV/AIDS prevention, treatment, and care efforts must be data-driven. The Strategy calls for increased coordination of HIV programs across the federal government, as well as the development of improved mechanisms to monitor and report on progress, including streamlining and improving data collection efforts. By improving how we collect and share data between agencies and with the public, we can more effectively target our efforts and resources to where they will have the greatest impact in reducing new HIV infections, improving health outcomes for people living with HIV, and reducing HIV-related disparities. In addition, by making data more open, accessible, and available to HIV/AIDS service providers, program planners, policymakers, and others, we can enhance their ability to repurpose that information as needed to reduce HIV transmission and better support people living with HIV/AIDS in their communities.

How does AIDS.gov use open data?

At AIDS.gov, we use open data (service provider names, phone numbers, locations, etc.) to populate our HIV/AIDS Prevention and Care Services Locator. With this Locator, users can enter their ZIP codes and be linked to nearby HIV testing sites, housing providers, health centers, and other HIV/AIDS service providers. The Locator is an “application programming interface” (API), meaning that it uses open data that are available for others to access and repurpose to generate their own products. Government leaders like Chief Information Officer Steven VanRoekel have referred to APIs as the “secret sauce” behind the next wave of technical innovation.
Others have already used this data to build their own clinic location finders. For example, recently, a national organization dedicated to providing and promoting comprehensive sexual health education to young people incorporated open data on HIV testing centers and family planning clinics to provide a customized map of services to visitors. By doing so, the organization was able to use AIDS.gov’s open data to meet the needs of its target audiences.

Anyone is welcome to access and use this data to develop websites, apps, and databases to connect people to HIV prevention and treatment services. We are excited to make this important resource available to you and excited to see what you do with it!

More information

Read the Executive Order (EO) on open data
Read the new Open Data Policy [PDF 6MB]
Watch a 2-minute video about the new EO and Policy

Editor’s Note: In the future, AIDS.gov will provide updates on an effort led by the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) to evaluate the feasibility of establishing a centralized, secure data reporting tool for HHS grantees providing HIV services, an undertaking consistent with the White House’s Open Data Policy and the HHS Open Data Plan. To gather ideas about this project, OHAIDP issued a Request for Information (RFI) on May 2, 2102, and work on the tool has been underway since September. Read about it in this blog post.

'Neumonía Zero': 341 muertes menos y 163 millones más - DiarioMedico.com

2013-05-24T06:51:00.001-07:00

'Neumonía Zero': 341 muertes menos y 163 millones más - DiarioMedico.com

unos resultados muy positivos

'Neumonía Zero': 341 muertes menos y 163 millones más

El proyecto presenta sus datos finales, con una tasa de 6'56 NVM. La cifra en las unidades con menos participación es de 10,2 NVM.

David Rodríguez Carenas. Madrid | david.rodriguez@diariomedico.com | 24/05/2013 11:04

Francisco Álvarez Lerma, coordinador nacional de Neumonía Zero. (DM)

Tras el adelanto de noviembre de 2012, que ya auguraba un cierre con muy buena nota, la Sociedad Española de Medicina Intensiva, Cuidados Críticos y Unidades Coronarias (Semicyuc) y la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (Seeiuc) han presentado los datos finales del proyecto Neumonía Zero, de prevención de la neumonía relacionada con ventilación mecánica (NVM).

En total, 242 UCI han participado en el proyecto entre abril de 2011 y diciembre de 2012, es decir, "un porcentaje muy alto", según Francisco Álvarez Lerma, coordinador nacional de Neumonía Zero. Los paquetes de medidas implantados -higiene de manos y bucal, controlar la presión del neurotaponamiento...- han logrado reducir mucho las tasas. Así, de las 17,1 NVM por mil días de ventilación mecánica de 2000, y de las 11 de inicios de 2011 -cuando comenzó el proyecto-, se ha logrado bajar hasta las 6,56 NVM.

"Los resultados nos sorprendieron hasta a nosotros. El objetivo era llegar a una tasa de 9. Por eso hemos variado el estándar de calidad, que ahora es de 7 NVM en los hospitales más complejos y de 6 en los más pequeños", reconoce Álvarez Lerma, presidente del Comité Científico de la Semicyuc y jefe de Sección del Servicio de Medicina Intensiva del Hospital del Mar, de Barcelona.

Implicación
Además de cambiar la forma de funcionar y el nivel de aceptación de lo que es la calidad, Neumonía Zero ha logrado algo más importante: evitar 341 muertes y ahorrar 52.577 estancias y 163 millones de euros durante su funcionamiento.

Todo se ha logrado gracias a "la persistencia de los programas de seguridad. Los profesionales han hecho suyas las medidas", determina el coordinador de Neumonía Zero. La importancia de la persistencia se observa en que las 196 UCI que participaron más de 12 meses en el proyecto obtuvieron una tasa de 6,3 NVM, por la de 10,2 de las 46 que estuvieron un año o menos.

Ahí es donde se quiere incidir ahora: "La implicación ha sido muy diferente entre comunidades autónomas". Sin citarlas, reconoce que hay tres que mantienen una tasa media mayor de 9 NVM. "No se puede justificar que haya unidades con esas tasas y que no intenten disminuirlas".

Para voltear este aspecto, propone "que la Administración se implique, porque las unidades que no cumplen están identificadas. Se les puede dar un toque administrativo, por ejemplo en los acuerdos económicos". No obstante, Álvarez Lerma reconoce que vivimos un momento económico crítico, que, si bien aumenta el valor de la implicación de los profesionales, también ha reducido la inversión de la Administración. "En Bacteriemia Zero el Ministerio de Sanidad, Servicios Sociales e Igualdad aportó dos millones de euros, y en Neumonía Zero no ha llegado a 100.000 euros. Y eso, pese a los resultados, se nota".

Los fármacos no ayudan al 30% de epilépticos - DiarioMedico.com

2013-05-24T06:50:00.001-07:00

Los fármacos no ayudan al 30% de epilépticos - DiarioMedico.com

100.000 PERSONAS requieren TERAPIA ALTERNATIVA

Los fármacos no ayudan al 30% de epilépticos

En España hay más de 400.000 afectados por epilepsia y cada año se detectan 20.000 nuevos casos. Esta patología, que afecta al 1 por ciento de la población, se manifiesta a través de crisis de distintos tipos que tienen origen en descargas excesivas e incontroladas de las neuronas cerebrales.

Redacción | 24/05/2013 00:00

Se calcula que más del 70 por ciento de los afectados están controlados con fármacos y pueden hacer una vida normal, pero cerca de 100.000 personas necesitarían terapia alternativa, incluyendo cirugía. El coste medio anual de los recursos utilizados por un paciente resistente al tratamiento se estima en 6.935 euros.

Según datos del Libro Blanco de la Epilepsia, el 82,5 por ciento de los pacientes pertenecen a una asociación, por lo que están más formados y requieren información de calidad. Entre los problemas más comunes, los afectados destacan la disponibilidad de medicación, el cambio a fármacos genéricos, la desinformación sobre los riesgos ante el embarazo y el impacto económico de los costes indirectos.

Día mundial
Con motivo del Día Nacional de la Epilepsia que se celebra hoy con el lema Epilepsia. Ven y conócela, la Asociación Madrileña de Epilepsia ha organizado mesas informativas y conferencias, y ayer presentó el cuento para niños Epilepto, un amigo especial y un pasaporte especial para afectados.

La adicción a los alimentos poco saludables podría aumentar la tasa de obesidad mundial - DiarioMedico.com

2013-05-24T06:48:00.001-07:00

La adicción a los alimentos poco saludables podría aumentar la tasa de obesidad mundial - DiarioMedico.com

Se puede ser adicto a la comida

La adicción a los alimentos poco saludables podría aumentar la tasa de obesidad mundial

Una investigación en ratas ha demostrado que la comida muy calórica puede causar cambios en el comportamiento similares a las producidas por las drogas de abuso como la cocaína.

Redacción | 23/05/2013 19:08

Francesco Leri, autor del estudio, de la Universidad de Guelph (Canadá) presentó estos resultados en la reunión anual de la Asociación Canadiense de Neurociencias (ACN).

El estudio sugiere que se puede ser adicto a la comida de la misma forma que se puede ser a las drogas. Para probar esta hipótesis, Leri estudió la respuesta que tenían las ratas al comer alimentos que contienen altas concentraciones de carbohidratos y grasas , como el jarabe de maíz rico en fructosa y alimentos como galletas de chocolate.

La amplia disponibilidad de este tipo de alimentos podría explicar en parte la alta incidencia de obesidad en el mundo, pero no explicaría por qué algunas personas son obesas y otras no, teniendo en cuenta que todos cuentan con esta gran oferta de alimentos poco saludables. Leri y su equipo, sugieren que un factor importante podría ser la diferencia individual en la vulnerabilidad a la adicción.

Las encuestas de consumo de cocaína muestran que aunque muchas personas prueban esta droga, sólo un pequeño porcentaje de ellos se vuelven adictos. Leri pretende descubrir si pasa lo mismo con la comida que contiene altas concrentraciones de carbohidratos y grasas, para ello investigó los cambios de conducta, químicos y neurobiológicos inducidos por el consumo de "alimentos adictivos" en los cuerpos y los cerebros de las ratas.

Este estudio podría colaborar a crear una estrategia eficaz para combatir la obesidad e informar a la gente sobre las causas y consecuencias que tienen estos alimentos.

"Nuestra investigación ha evidenciado en ratas la existencia de una vulnerabilidad compartida que desarrolla preferencias por los alimentos dulces y la cocaína. Existen evidencias neurobiológicas y de comportamiento que indican que es posible ser adicto a la comida. Nuestro principal objetivo es descubrir predictores biológicos de vulnerabilidad" concluyó Leri.

CESM eleva una queja al Justicia de Aragón contra el plan de RRHH - DiarioMedico.com

2013-05-24T06:47:00.001-07:00

CESM eleva una queja al Justicia de Aragón contra el plan de RRHH - DiarioMedico.com

SÓLO SE REPONDRÁN 58 JUBILACIONES

CESM eleva una queja al Justicia de Aragón contra el plan de RRHH

El Sindicato Médico de Aragón y la autodenominada Plataforma de Médicos Indignados de Aragón, que encabeza Celso Mostacero, expresidente del Colegio de Zaragoza, han presentado una queja ante el Justicia de Aragón contra el Plan de Recursos Humanos del Salud, aprobado en mesa sectorial con el rechazo de CESM.

Redacción | 24/05/2013 00:00

Lorenzo Arracó, secretario general de CESM, y Mostacero -que han pedido, además, una entrevista con el Justicia- arguyen que el proyecto del Salud (que fija la jubilación a los 65 años) "carece de los requerimientos técnico" para ser un plan de personal, y que, por tanto, la jubilación se impone "en contra del Estatuto Marco", que obliga a tener previamente esa "herramienta indispensable". Afirman, además, que, con la tasa de reposición (fijada en el 10 por ciento), de las 581 jubilaciones médicas previstas hasta 2017, sólo se repondrán 58.

Las repescas en una OPE deben ser notificadas - DiarioMedico.com

2013-05-24T06:46:00.001-07:00

Las repescas en una OPE deben ser notificadas - DiarioMedico.com

4 procesales valoradas en 3.000 como máximo

Las repescas en una OPE deben ser notificadas

El TS condena al SAS a incluir a un médico en la adjudicación de plazas tras reorganizar las listas y no comunicárselo hasta que pasó el plazo.

G.E. | dmredaccion@diariomedico.com | 23/05/2013 00:00

El médico que no supera un concurso-oposición pero finalmente logra opción a una plaza por la reorganización de las listas -por ejemplo, a consecuencia de renuncias e impugnaciones- tiene derecho a que esta circunstancia se le notifique personalmente. De otro modo, perdería el puesto por una negligencia atribuible a la Administración, según ha declarado el Tribunal Supremo.

La primera comunicación que recibió la demandante del Servicio Andaluz de Salud fue una llamada diciéndole que había transcurrido el plazo para pedir destino

La Sala de lo Contencioso-administrativo del alto tribunal ha estudiado el caso de una médico que participó en una oferta pública de empleo de Medicina de Familia y que no superó el concurso-oposición, según pudo saber a través de la correspondiente resolución, fechada el 15 de marzo de 2010 y publicada en el Boletín Oficial de la Junta de Andalucía.

La profesional no impugnó la puntuación obtenida, pero sí lo hicieron otros participantes, que presentaron recurso administrativo. Por otra parte, medio centenar de aspirantes aprobados renunció a elegir destino. La combinación de ambos factores provocó una importante reorganización de la lista de aprobados, que se publicó el 23 de julio siguiente: en ella sí figuraba la médico.

Sin notificación
El origen del litigio se encuentra en que la primera noticia que recibió sobre su repesca fue "una llamada telefónica del SAS en la que se le indicaba que había transcurrido el plazo de 15 días naturales concedido para que presentara la documentación y solicitara destino", razón por la que perdía la plaza. Inmediatamente presentó un escrito explicando que no se le había notificado personalmente su incorporación a la lista de aprobados y por eso no había podido solicitar puesto; en ese mismo acto, indicó la correspondiente relación de plazas a las que aspiraba. El Servicio Andaluz de Salud (SAS) declinó aceptar estas explicaciones y la excluyó definitivamente del proceso selectivo.

Llegado el caso al Supremo, la Dirección General de Personal y Desarrollo Profesional alegó que se había limitado a cumplir la normativa vigente al publicar la nueva lista de aprobados en los tablones de anuncios designados en la convocatoria de la oferta de empleo, procedimiento que sí había servido al resto de aspirantes. Los magistrados del alto tribunal reconocen que, en efecto, este es el mecanismo que se prevé en la Ley de Régimen Jurídico de las Administraciones Públicas, "sin embargo, la médico, que estaba entre quienes accedían a esas listas, pero que no había interpuesto recurso de reposición, aceptando las primeras listas que le excluían del proceso selectivo, no tenía ya, a partir de ese momento, la necesidad de consultar el tablón de anuncios, puesto que había sido apartada, y lo había consentido, del proceso. En consecuencia, el acto favorable del que había sido beneficiada, al repescarle para las listas de aprobados, debió notificársele personalmente, y al no haberlo hecho así, "el SAS incurrió en una vulneración de la ley que incide en el derecho fundamental" al acceso a la función pública en condiciones de igualdad.

Confirma fallo del TSJ
El Supremo, cuya sentencia ha sido facilitada por Aranzadi, confirma la resolución del TSJ de Andalucía, y condena a tomar las medidas necesarias para incluir a la recurrente en la adjudicación de plazas según los puntos obtenidos y los destinos solicitados.

Además, impone al SAS las costas procesales en cuantía máxima de 3.000 euros, de forma que la médico no tenga que asumir los gastos de abogado y procurador generados por el recurso que la Administración presentó contra la sentencia de primera instancia, que ya respaldó su petición.

En la capacidad de consentir del enfermo se valora su competencia - DiarioMedico.com

2013-05-24T06:44:00.001-07:00

En la capacidad de consentir del enfermo se valora su competencia - DiarioMedico.com

Limites de consentimiento en menores

En la capacidad de consentir del enfermo se valora su competencia

"El consentimiento por representación se otorga cuando existe incapacidad manifiesta y evaluada por el médico responsable de la asistencia de que un paciente, por su estado físico o psíquico, no es capaz de hacerse cargo de una situación; si existe una incapacitación legal del enfermo o cuando es menor de edad y no es capaz ni intelectualmente ni emocionalmente de comprender el alcance de su situación clínica".

E.Mezquita. Valencia | 23/05/2013 00:00

Así lo ha recordado Dolores Marhuenda, vocal del Comité de Bioética Asistencia (CBA), en la jornada La relevancia del consentimiento informado del paciente en su tratamiento: aspectos bioéticos y legales, organizado por el Comité de Bioética Asistencial del Departamento de Salud de Elche-Hospital General.
La experta en Bioética ha aclarado que "todas las situaciones que contempla la Ley de Autonomía del Paciente sobre el consentimiento del enfermo tienen una clara relación con el concepto de competencia", que puede definirse como "suficiente madurez psicológica y cognitiva para apreciar una situación sanitaria, comprender la información relevante acerca de ella y que será la base de una elección basada en la ponderación de los riesgos y beneficios asociados a tal elección".ç

Cuestiones del menor
Sobre los límites del consentimiento por representación en menores, Marhuenda considera que son especialmente sensibles las relacionadas con "el consentimiento para pruebas diagnósticas que ponen a disposición de otras personas, vinculadas o no al menor, información personal que puede afectar su vida y su futuro; y el consentimiento y confidencialidad en solicitudes de asistencia en problemas asociados al comportamiento sexual, o en problemas psiquiátricos como alteraciones de la conducta alimentaria que son altamente frecuentes en la adolescencia".

"Todos los hospitales deberían tener unidades de Medicina Legal" - DiarioMedico.com

2013-05-24T06:43:00.001-07:00

"Todos los hospitales deberían tener unidades de Medicina Legal" - DiarioMedico.com

Los ciudadanos entablan cada vez más demandas y reclamaciones

"Todos los hospitales deberían tener unidades de Medicina Legal"

Las demandas judiciales contra los profesionales sanitarios podría reducirse si las administraciones crearan unidades de Medicina Legal Hospitalaria.

S.Rego. Santander | 23/05/2013 00:00

Así el facultativo sabría cómo actuar, con criterios médico legales, frente a las acciones administrativas y judiciales que puedan ejercer los pacientes y los familiares que no están satisfechos con la asistencia sanitaria recibida. Así lo ha manifestado Mariano Casado Blanco, especialista forense del Instituto de Medicina Legal de Badajoz, profesor de la Universidad de Extremadura y miembro de la Comisión Deontológica de la OMC, en un seminario sobre los aspectos legales en el ejercicio de la Medicina, celebrado en el Colegio de Médicos de Cantabria.

Trabajo por hacer
Casado ha explicado que todavía son pocos los hospitales del Sistema Nacional de Salud que poseen unidades o servicios de Medicina Legal -forenses, abogados, médicos del trabajo, y expertos en bioética, entre otros- capaces de "identificar y prevenir situaciones de riesgo que puedan acarrear una denuncia contra el facultativo, bien sea por presunta mala praxis o por un problema organizativo del centro".

Las pocas unidades que funcionan en España destacan, igualmente, por un aspecto positivo: "Las unidades hacen una seria apuesta por la formación y el reciclaje en el Derecho sanitario, lo que favorece un ambiente de mayor seguridad y calidad en todas las actividades. Aun siendo importante lo científico, el médico ha de conocer las obligaciones y deberes legales de su profesión, dado que su incumplimiento puede generar responsabilidad", ha añadido.

El profesor de Medicina Legal ha reconocido que, tradicionalmente, los aspectos éticos y legales relacionados con la profesión sanitaria han sido soslayados por quienes la ejercen. "Muchos médicos los consideran desvinculados de su actividad, ya que hasta hace poco el modelo de atención que primaba se desarrollaba de tal manera que los pacientes rara vez protestaban y acudían a instancias colegiales y judiciales".

Sin embargo, según Casado, en la actualidad los usuarios conocen mejor sus derechos y, al notar transgresiones en su atención, entablan cada vez más demandas y reclamaciones. "Por ello, es necesario que los facultativos recuerden la necesidad de adentrarse en los conocimientos éticos y legales que rigen su profesión. De hecho, la Ley de Ordenación de las Profesiones Sanitarias establece la formación continuada como un derecho y una obligación de los profesionales".

Paciente informado
En opinión de Casado, es ahora cuando el médico tiene delante "al paciente más y mejor informado de toda la historia de la Medicina, el momento de ser consciente no sólo de conocer la trascendencia de los aspectos legales del ejercicio de su profesión, como la normativa estatal básica y la autonómica de la comunidad en donde ejerce", ha apuntado.