miércoles, 23 de agosto de 2017

2016 National Healthcare Quality and Disparities Report | Agency for Healthcare Research & Quality

2016 National Healthcare Quality and Disparities Report | Agency for Healthcare Research & Quality

AHRQ News Now

AHRQ Stats: Health Care Coverage for Young Adults

Young adults ages 18 to 29 made up the largest percentage of people gaining health care coverage from 2010 to 2016. The uninsured rate for this group declined by more than half, from 31 percent to 15 percent. (Source: AHRQ, 2016 National Healthcare Quality and Disparities Report.) 

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Cover of 2016 National Healthcare Quality and Disparities Report



2016 National Healthcare Quality and Disparities Report

For the 14th year in a row, AHRQ is reporting on health care quality and disparities. The annual National Healthcare Quality and Disparities Report (QDR) is mandated by Congress to provide a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. The report assesses the performance of our health care system and identifies areas of strengths and weaknesses, as well as disparities, for access to health care and quality of health care. Quality is described in terms of the National Quality Strategy priorities, which include patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Selected findings in each priority area are shown in this report, as are examples of large disparities, disparities worsening over time, and disparities showing improvement. The report is produced with the help of an Interagency Workgroup led by AHRQ.
Print version (PDF, 1.31 MB). In addition, you may select separately the Introduction and Methods (PDF, 831 KB).
A final typeset version of this report will be available by September 2017.

Contents

Appendixes
This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated. Suggested citation: 2016 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; July 2017. AHRQ Pub. No. 17-0001.
Page last reviewed July 2017
Page originally created June 2017


Internet Citation: 2016 National Healthcare Quality and Disparities Report. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/index.html

AHRQ Deputy Director Calls Improving Diagnosis the ‘Next Critical Leap’ in Patient Safety

dx-2017-0016.pdf

dx-2017-0017.pdf

AHRQ News Now

AHRQ Deputy Director Calls Improving Diagnosis the ‘Next Critical Leap’ in Patient Safety





Improving diagnosis represents the “next critical leap in patient safety,” according to an editorial by AHRQ Deputy Director Sharon B. Arnold, Ph.D., in the journal Diagnosis. The editorial accompanied publication of proceedings from last year’s AHRQ Research Summit on Improving Diagnosis in Health Care, whose participants detailed that diagnostic error is common, costly and preventable. The Sept. 28 summit convened diverse experts from inside and outside government to summarize knowledge gaps, clarify challenges to improving diagnosis and identify areas of potential future research. Access the proceedings and Dr. Arnold’s editorial for more about this emerging patient safety topic.

AHRQ Deputy Director Calls Improving Diagnosis the ‘Next Critical Leap’ in Patient Safety

dx-2017-0017.pdf

AHRQ News Now

AHRQ Deputy Director Calls Improving Diagnosis the ‘Next Critical Leap’ in Patient Safety





Improving diagnosis represents the “next critical leap in patient safety,” according to an editorial by AHRQ Deputy Director Sharon B. Arnold, Ph.D., in the journal Diagnosis. The editorial accompanied publication of proceedings from last year’s AHRQ Research Summit on Improving Diagnosis in Health Care, whose participants detailed that diagnostic error is common, costly and preventable. The Sept. 28 summit convened diverse experts from inside and outside government to summarize knowledge gaps, clarify challenges to improving diagnosis and identify areas of potential future research. Access the proceedings and Dr. Arnold’s editorial for more about this emerging patient safety topic.

AHRQ Research Summit on Improving Diagnosis in Health Care | Agency for Healthcare Research & Quality

AHRQ Research Summit on Improving Diagnosis in Health Care | Agency for Healthcare Research & Quality

AHRQ News Now



AHRQ Deputy Director Calls Improving Diagnosis the ‘Next Critical Leap’ in Patient Safety





Improving diagnosis represents the “next critical leap in patient safety,” according to an editorial by AHRQ Deputy Director Sharon B. Arnold, Ph.D., in the journal Diagnosis. The editorial accompanied publication of proceedings from last year’s AHRQ Research Summit on Improving Diagnosis in Health Care, whose participants detailed that diagnostic error is common, costly and preventable. The Sept. 28 summit convened diverse experts from inside and outside government to summarize knowledge gaps, clarify challenges to improving diagnosis and identify areas of potential future research. Access the proceedings and Dr. Arnold’s editorial for more about this emerging patient safety topic.

AHRQ Research Summit on Improving Diagnosis in Health Care


AHRQ Research Summit: Improving Diagnosis in Health Care. Sept 28 2016 8:30 - 5 pm AHRQ 5600 Fishers Lane Rockville MD 20957
Date: September 28, 2016, 8:30am – 5:00pm
Location:
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
Most patients will experience at least one diagnostic error in their lifetime, according to the AHRQ-sponsored report, Improving Diagnosis in Health Care, published by the National Academies of Medicine in September 2015. These errors occur in all settings of care, contribute to about 10 percent of patient deaths, and are the primary reason for medical liability claims. Substantial effort is needed to identify research priorities, including how to measure and reduce diagnostic errors, and ensure this information is integrated into practice, where it will translate meaningful benefits for patients. This interactive meeting explored the state of the science of diagnosis in health care and discussed ways AHRQ and other stakeholders can contribute to a collaborative approach to improving diagnostic performance, as well as identify the research and evidence, tools and training, and data and measures that are needed to improve diagnostic performance.  
Agenda and Speakers:
Presentations are available and can be accessed from the presentation titles on the Agenda page. You can also view videos of the conference on the Agenda page.
Background Materials:
National Academies of Sciences, Engineering, and Medicine. 2015. Improving diagnosis in health care. Washington, DC: The National Academies Press.
3 Summary Documents:
3 specific chapters, aligning with the breakout sessions:
Learn more about AHRQ's efforts to improve diagnostic errors.
Page last reviewed August 2017
Page originally created June 2016
Internet Citation: AHRQ Research Summit on Improving Diagnosis in Health Care. Content last reviewed August 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/ahrq-research-summit-diagnostic-safety.html

Laser treatment of infantile hemangioma: A systematic review. - PubMed - NCBI

Laser treatment of infantile hemangioma: A systematic review. - PubMed - NCBI



 2016 Mar;48(3):221-33. doi: 10.1002/lsm.22455. Epub 2015 Dec 29.

Laser treatment of infantile hemangioma: A systematic review.

Abstract

BACKGROUND AND OBJECTIVE:

To systematically review studies of laser treatment of infantile hemangioma (IH).

STUDY DESIGN/METHODS AND MATERIALS:

We searched multiple databases including MEDLINE® and EMBASE from 1982 to June 2015. Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature.

RESULTS:

We identified 29 studies addressing lasers: 4 randomized controlled trials, 8 retrospective cohort studies, and 17 case series. Lasers varied across studies in type, pulse width, or cooling materials. Most comparative studies (n = 9) assessed variations of pulsed dye laser (PDL) and examined heterogeneous endpoints. Most studies reported on treatment of cutaneous lesions. Overall, longer pulse PDL with epidermal cooling was the most commonly used laser for cutaneous lesions; Nd:YAG was the most commonly used intralesionally. Most studies reported a higher success rate with longer pulse PDL compared with observation in managing the size of IH, although the magnitude of effect differed substantially. CO2 laser was used for subglottic IH in a single study, and was noted to have a higher success rate and lower complication rate than both Nd:YAG and observation. Studies comparing laser with β-blockers or in combination with β-blockers reported greater improvements in lesion size in combination arms versus β-blockers alone and greater effects of lasers on mixed superficial and deep IH. Strength of the evidence for outcomes after laser treatments ranged from insufficient to low for effectiveness outcomes. Strength of the evidence was insufficient for the effects of laser compared with β-blockers or in combination with β-blockers as studies evaluated different agents and laser types. Studies assessing outcomes after CO2 and Nd:YAG lasers typically reported some resolution of lesion size, but heterogeneity among studies limits our abilities to draw conclusions.

CONCLUSION:

Studies of laser treatment of IH primarily addressed different laser modalities compared with observation or other laser modalities. PDL was the most commonly studied laser type, but multiple variations in treatment protocols did not allow for demonstration of superiority of a single method. Most studies reported a higher success rate with longer pulse PDL compared to observation in managing the size of IH, although the magnitude of effect differed substantially. Studies generally found PDL more effective than other types of lasers for cutaneous lesions. When first introduced as a primary treatment for IH, various laser modalities generally offered superior outcomes compared with steroid therapy and observation. In the era of β-blocker therapy, laser treatment may retain an important role in the treatment of residual and refractory lesions.

KEYWORDS:

Nd:YAG; pulsed dye laser; vascular lesions

PMID:
 
26711436
 
DOI:
 
10.1002/lsm.22455

[Indexed for MEDLINE]

Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. - PubMed - NCBI

Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. - PubMed - NCBI





 2016 Apr;23(e1):e146-51. doi: 10.1093/jamia/ocv147. Epub 2015 Nov 13.

Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers.

Abstract

BACKGROUND:

Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions.

METHODS:

A stratified random sample of primary care practices in Michigan (n = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so.

RESULTS:

The top three barriers, as identified by >65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients' treatment and ensure they know about their patients' visits to other providers.

CONCLUSION:

The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits.

KEYWORDS:

care coordination; electronic health records; health information exchange; meaningful use; primary care

PMID:
 
26567327
 
PMCID:
 
PMC4954634
 
DOI:
 
10.1093/jamia/ocv147

[Indexed for MEDLINE] 
Free PMC Article

Treatment motivation among caregivers and adolescents with substance use disorders. - PubMed - NCBI

Treatment motivation among caregivers and adolescents with substance use disorders. - PubMed - NCBI





 2017 Apr;75:10-16. doi: 10.1016/j.jsat.2017.01.003. Epub 2017 Jan 14.

Treatment motivation among caregivers and adolescents with substance use disorders.

Abstract

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (NDyads=15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement.

KEYWORDS:

Adolescents; Caregivers; Dyads; Motivation; Self-determination theory; Substance use treatment

PMID:
 
28237049
 
PMCID:
 
PMC5330196
 [Available on 2018-04-01]
 
DOI:
 
10.1016/j.jsat.2017.01.003