New Dashboard Tracks Progress Toward 50 Percent Reduction in Patient and Workforce Harm

AHRQ Stats: Trends in Severe Maternal Morbidity Complications

Between 2016 and 2021, the rate of delivery stays with respiratory-related severe maternal morbidity (SMM) complications increased 137 percent, the rate of stays with renal-related SMM complications increased 119 percent and the rate of stays with sepsis-related SMM complications increased 54 percent. (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #312, Trends in Severe Maternal Morbidity Complications by Patient Characteristics, 2016-2021 [PDF, 943 KB].)

Today's Headlines:

• New Dashboard Tracks Progress Toward 50 Percent Reduction in Patient and Workforce Harm.
• Evidence Review Provides New Insights on Diagnosis and Treatment of Obsessive Compulsive Disorders in Children.
• More Than Three Dozen New Definitions Included in Updated Healthcare Simulation Dictionary.
• Register Now: Jan. 16 Webinar Will Explore Addressing Health Risks in Older Adults.
• Highlights From AHRQ’s Patient Safety Network.
• Clinical Decision Support Collaborative Identifies Priorities To Improve Patient and Clinician Decision Making.
• New Research and Evidence From AHRQ.
• AHRQ in the Professional Literature.

New Dashboard Tracks Progress Toward 50 Percent Reduction in Patient and Workforce Harm

A new online dashboard developed by the National Action Alliance for Patient and Workforce Safety offers a comprehensive resource for understanding the current state of healthcare safety. The National Alliance is a collective effort of federal agencies and private partners led by AHRQ, whose National Advisory Council established a goal of reducing patient and healthcare workforce harm by 50 percent from its pandemic-driven high by 2026. The new dashboard makes national healthcare safety data more transparent and allows for a comprehensive understanding of healthcare safety in different care settings, beginning with hospitals. It also allows policymakers, patient advocates, professional associations, healthcare provider organizations and others to monitor the nation's progress on achieving a vision of safe care everywhere and zero preventable harm for all. Future dashboard expansions will include data on other healthcare settings, such as ambulatory clinics and nursing homes. Access the dashboard and a press release.

Evidence Review Provides New Insights on Diagnosis and Treatment of Obsessive Compulsive Disorders in Children

An AHRQ evidence review funded by the Patient-Centered Outcomes Research Institute has informed two articles in Pediatrics about diagnosis and management of obsessive compulsive disorders (OCD) in children:

• Treatment of Obsessive-Compulsive Disorder in Children and Youth: A Meta-Analysis showed therapy that includes exposure and response prevention, with or without medication, is likely more effective than medication. This approach is similarly effective when delivered in person or via telehealth.
• Brief Assessment Tools for Obsessive Compulsive Disorders in Children: A Systematic Review showed eight questions in a common screening questionnaire were sufficiently sensitive and specific to identify children and adolescents needing further evaluation for OCD.

The findings highlight the important lessons researchers are learning after the COVID-19 pandemic about the effectiveness of telehealth.

More Than Three Dozen New Definitions Included in Updated Healthcare Simulation Dictionary

The new third edition of AHRQ's Healthcare Simulation Dictionary (PDF, 1.8 MB) includes 170 definitions of terms ranging from “avatars” and “manikins” to “gamification” and “virtual reality.” Developed by AHRQ and the Society for Simulation in Healthcare, the dictionary standardizes simulation terms in a rapidly expanding field that aims to advance patient safety and improve healthcare delivery. Simulation can provide a safe learning environment for healthcare researchers and practitioners to test new clinical processes and enhance individual and team skills in procedures before touching patients. Examples include inserting ultrasound-guided central venous catheters, diagnosing skin cancer and measuring laparoscopic surgical skills. The updated dictionary includes 41 new terms—including 16 aimed at supporting patient safety efforts—and more than 125 new and revised definitions.

Register Now: Jan. 16 Webinar Will Explore Addressing Health Risks in Older Adults

An AHRQ webinar on Jan. 16 from 2 to 3:15 p.m. will explore the role of primary care in optimizing health and well-being for older adults. The event, sponsored by AHRQ’s National Center for Excellence in Primary Care Research, will cover the state of the science around the diagnostic process in older adults, including challenges and recommendations for practice improvement, research and policy to reduce the risk of diagnostic errors. AHRQ-funded researchers will discuss their primary care research on tools and approaches that address risks for cardiovascular events and opioid use in older adults. Register now.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• How many is too many? Using cognitive load theory to determine the maximum safe number of inpatient consultations for trainees.
• "It is not the fault of the health care team - it is the way the system works": a mixed-methods quality improvement study of patients with advanced cancer and family members reveals challenges navigating a fragmented healthcare system and the administrative and financial burdens of care.
• Safety of inpatient care in surgical settings: cohort study.

Review additional new publications in PSNet’s current issue, including recent cases and commentaries and AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Clinical Decision Support Collaborative Identifies Priorities To Improve Patient and Clinician Decision Making

An article published in Journal of the American Medical Informatics Association Open discusses insights from the May 2023 meeting of AHRQ’s Clinical Decision Support Innovation Collaborative, a community of diverse stakeholders organized and funded by AHRQ’s Digital Healthcare Research Program who use technology to support care teams, patients and caregivers. The collaborative’s meeting brought together more than 70 participants—including healthcare providers, researchers, patients and technology developers—to consider how to advance patient-centered clinical decision support (PC-CDS). The group identified priorities to improve how patients and clinicians make health decisions together. Themes included establishing feedback loops between patients and clinicians, enhancing workflows, expanding research and ensuring health equity. They also explored the potential role of artificial intelligence and considered ways to make PC-CDS scalable. Access the article.

New Research and Evidence From AHRQ

• Medical Expenditure Panel Survey Statistical Brief #558: Lack of Reliable Transportation for Daily Living Among Adults: United States, 2021.

AHRQ in the Professional Literature

Identifying interventions to improve diagnostic safety in emergency departments: protocol for a participatory design study. Seo W, Park SY, Zhang Z, et al. JMIR Res Protoc 2024 Jun 21;13:e55357. Access the abstract on PubMed®.

Antibiotic use among extremely low birth-weight infants from 2009 to 2021: a retrospective observational study. Flannery DD, Barboza AZ, Mukhopadhyay S, et al. Arch Dis Child Fetal Neonatal Ed 2024 Jul 20. [Epub ahead of print.] Access the abstract on PubMed®.

Machine learning-augmented interventions in perioperative care: a systematic review and meta-analysis. Mehta D, Gonzalez XT, Huang G, et al. Br J Anaesth 2024 Dec;133(6):1159-72. Epub 2024 Sep 24. Access the abstract on PubMed®.

Essential advance care planning intervention features in low-income communities: a qualitative study. Kimpel CC, Frechman E, Chavez L, et al. J Pain Symptom Manage 2024 Sep 24. [Epub ahead of print.] Access the abstract on PubMed®.

Implementation strategies used by facilitators to improve control of cardiovascular risk factors in primary care. Cole AM, Keppel GA, Baldwin LM, et al. J Am Board Fam Med 2024 Aug;37(3):444-54. Access the abstract on PubMed®.

A model for predicting clinically significant prostate cancer using prostate MRI and risk factors. Lacson R, Haj-Mirzaian A, Burk K, et al. J Am Coll Radiol 2024 Sep;21(9):1419-27. Epub 2024 May 6. Access the abstract on PubMed®.

Disparities in mentorship and implications for US surgical resident education and wellness. Silver CM, Yuce TK, Clarke CN, et al. JAMA Surg 2024 Jun;159(6):687-95. Access the abstract on PubMed®.

Establishing data elements and exchange standards to support long COVID healthcare and research. Dolin G, Saitwal H, Bertodatti K, et al. JAMIA Open 2024 Oct;7(3):ooae095. Epub 2024 Sep 11. Access the abstract on PubMed®.