[Journal article] What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health

What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health 

From the January/February 2015 journal article abstract

If there is one thing that health care experts seem to agree on, it is the importance of preventive care. Anything that can help the American public to do a better job of understanding, accessing, and affording effective preventive care and thereby helping them to avoid potential threats to their health should be indisputably a good thing for individuals, families, and society.

Recommendations for the public about what preventive care services an individual might need at different points in his or her life can be one important tool in this tool box, and that goes double for recommendations that speak with the imprimatur of the U.S. Department of Health and Human Services (DHHS). So, a series of fact sheets on “staying healthy” from the Agency for Healthcare Research and Quality (AHRQ)—a branch of DHHS devoted to evidence-based improvements to the provision of U.S. health care—should be a welcome and valued resource (Agency for Healthcare Research and Quality (AHRQ), 2014a, Agency for Healthcare Research and Quality (AHRQ), 2014b).

In this light, it is disappointing to find the AHRQ fact sheets falling short of the mark in some critical ways related to their recommendations on sexual and reproductive health care. The four fact sheets—for women of all ages, women at age 50 and older, men of all ages, and men at age 50 and older—contain a wealth of good advice about screenings and preventive medicine that a patient might need. However, they leave out many effective sexual and reproductive health-related preventive services—perhaps most notably any mention of contraceptive services and supplies—that have been endorsed by other agencies in the DHHS and by the medical establishment more broadly, and that have been promoted through the Affordable Care Act’s (ACA) requirements for private health plans to cover preventive services without patient out-of-pocket costs (HealthCare.gov, 2014, Sonfield, 2012). The AHRQ fact sheets compound those oversights by seeming to imply that they embody the sum total of DHHS’s preventive care recommendations, when in reality they seem to be based almost exclusively on the recommendations of a single body, the U.S. Preventive Services Task Force.

Full text of the article here

[Research summary] New Research Review Looks at Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

From the AHRQ Web site

A new research review from AHRQ’s Effective Health Care Program  found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.

Related articles

• AHRQ: Little Evidence for Opioids in Managing Long-term Chronic Pain
• The Ineffectiveness of Opioids for Chronic Pain
• The Ineffectiveness of Opioids for Chronic Pain
• Risks of Opioids Outweigh Gains for Many Patients
• National study of discontinuation of long-term opioid therapy among veterans
• Heroin overdose deaths increased in many states through 2012
• Risks of opioids outweigh benefits for headache, low back pain, other conditions

To Gauge Hospital Quality, Patients Deserve More Outcome Measures One Comment

From the 15 February 2012 Health Care Blog item

Patients, providers and the public have much to celebrate. This week, the Centers for Medicare and Medicaid Services’ Hospital Compare websiteadded central line-associated bloodstream infections in intensive care units to its list of publicly reported quality of care measures for individual hospitals.

Why is this so important? There is universal support for the idea that the U.S. health care system should pay for value rather than volume, for the results we achieve rather than efforts we make. Health care needs outcome measures for the thousands of procedures and diagnoses that patients encounter. Yet we have few such measures and instead must gauge quality by looking to other public data, such as process of care measures (whether patients received therapies shown to improve outcomes) and results of patient surveys rating their hospital experiences….

Related Resources

• Hospital Quality Compare (Centers for Medicare & Medicaid Services)- compares quality of care for certain medical conditions at more than 4,200 hospitals. The site also includes a checklist to help you choose a hospital

• Leapfrog Hospital Ratings – information on this site is derived from hospitals’ voluntary submissions of The Leapfrog Hospital Survey. More about the Leapfrog Group at their About Page
  
• AHRQ (US Agency for Health Care Research and Quality
  • Consumer Page includes
    • Choosing Quality Health Care
    • Getting Safer Care
    • Comparing Medical Treatments
  • Clinical page includes
    • Outcomes and Effectiveness
    • Effective Health Care
      
• Medicare.gov includes
  • Home Health Compare
  • Nursing Home Compare

 

 

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AHRQ Offers Interactive Tool To Analyze National and State Health Care Data

From the AHRQ (Agency for Healthcare Research and Quality) press release

Mining for specific data on health care quality and disparities in the U.S.?  It’s an easy process with AHRQ’s NHQRDRnet online query system, which features data from the 2010 National Healthcare Quality Report and the National Healthcare Disparities Report.  At the State and national level, you’ll find quality-of-care data on clinical conditions ranging from asthma and diabetes to heart disease and cancer.  You can review data by specific age groups as well as by race, ethnicity, income, and education.  Using NHQRDRnet’s search tool, you can locate data tables based on selected words, chapters, or type of table.  Select to access AHRQ’s NHQRDRnet system.

Related Link

• Improving Data Collection to Reduce Health Disparities (Healthcare.gov)

 

AHRQ Releases Tool to Help Consumers Reduce Medication Errors

From the press release

Three out of four Americans are not following their doctor’s advice when it comes to taking prescription medication, according to U.S. Surgeon General Dr. Regina Benjamin.  AHRQ and the National Council on Patient Information and Education have released a revised guide to help patients learn more about how to take medicines safely.  “Your Medicines: Be Smart. Be Safe” is a booklet that includes a detachable, wallet-sized card that can be personalized to help patients keep track of all medicines they are taking, including vitamins and herbal and other dietary supplements.  Available in English and Spanish, the guide includes questions that patients can ask their doctors about their medications.  Select to access a copy of the guide.  Print copies are available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.

New Tutorials from HCUP (US Healthcare Cost and Utilization Project)

             
HCUP On-line Tutorial Series

HCUP Online Tutorial Series provides HCUP data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data.

From the AHRQ (Agency for Healthcare Research and Quality) press release

HCUP Offers New Online Tutorial Series’ Modules

AHRQ is pleased to announce the release of a new module and an updated re-release of a favorite in the HCUP Online Tutorial Series.  These online trainings are designed to provide data users with information about HCUP data and tools, as well as training on technical methods for conducting research using HCUP datasets.

• The all-new Calculating Standard Error tutorial is designed to help users determine the precision of the estimates they produce from the HCUP nationwide databases.  Users will learn two methods for calculating standard errors for estimates produced from the HCUP nationwide databases.
• The newly revised HCUP Overview Course is a helpful introduction to HCUP for new users.  The original course has been updated to include the latest additions to the HCUP family of databases and tools, including the Nationwide emergency Department Sample.

 The HCUP Online Tutorial Series is available on the HCUP-US Web site.  For more information, contact HCUP User Support at hcup@ahrq.gov.

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AHRQ News And Numbers: Medication Side Effects, Injuries, Up Dramatically

From the 13 April 2011 Medical News Today article

The number of people treated in U.S. hospitals for illnesses and injuries from taking medicines jumped 52 percent between 2004 and 2008 – from 1.2 million to 1.9 million — according to the latest News and Numbers from the Agency for Healthcare Research and Quality. These medication side effects and injuries resulted from taking or being given the wrong medicine or dosage.

The federal agency also found that in 2008:

– The top 5 medicines that had more than 838,000 people treated and released from emergency departments were: unspecified medicines (261,600); pain killers (118,100), antibiotics (95,100), tranquilizers and antidepressants (79,300), corticosteroids and other hormones (71,400).

– For patients admitted to the hospital, the top five medicines causing side effects and injuries were corticosteroids (used for such illnesses as asthma, arthritis, ulcerative colitis, and other conditions–283,700 cases), painkillers (269,400), blood-thinners (218,800), drugs to treat cancer and immune system disorders (234,300), and heart and blood pressure medicines (191,300).

– More than half (53 percent) of hospitalized patients treated for side effects or other medication-related injuries were age 65 or older, 30 percent were 45 to 64, 14 percent between 18 and 44, and 3 percent under age 18. Children and teenagers accounted for 22 percent of emergency cases.

– About 57 percent of the hospitalized patients and 61 percent of emergency department cases were female.

This AHRQ News and Numbers is based on data in Medication-related Adverse Outcomes in U.S. Hospitals and Emergency Departments, 2008. The report uses data from the agency’s 2008 Nationwide Inpatient Sample and 2008 Nationwide Emergency Department Sample. For information about these two AHRQ databases, go here.

Reports on Health Care Disparities at the State Level Available

Reports on Health Care Disparities at the State Level Available

From the AHRQ (Agency for Healthcare Research and Quality) press release

AHRQ has released two reports from its Healthcare Cost and Utilization Project that provide information on approaches to using race/ethnicity data for reducing disparities in the quality of health and health care.  The data is from the 2010 National Health Quality Report and National Healthcare Disparities Report.

The following reports focusing provide information on approaches to using race/ethnicity data for reducing disparities in the quality of health and health care.

• State Documentation of Racial and Ethnic Health Disparities to Inform Stategic Action (PDF file, 647 KB; HTML)
• State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities (PDF file, 205 KB)

 

Also…

2010 National Healthcare Quality & Disparities Reports

For the eighth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced

the National Healthcare Quality Report (NHQR) [Full Report (PDF File, 4.4 MB) PDF Help] and

the National Healthcare Disparities Report (NHDR [Full Report (PDF File, 4.3 MB) PDF Help{).

These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. New this year are chapters on care coordination, health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.

 

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Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

From the Agency for Healthcare Research and Quality (AHRQ) Press Release

ress Release Date: February 28, 2011

Improvements in health care quality continue to progress at a slow rate—about 2.3 percent a year; however, disparities based on race and ethnicity, socioeconomic status and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued today by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).The reports, which are mandated by Congress, show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.

“All Americans should have access to high-quality, appropriate and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal,” said AHRQ Director Carolyn M. Clancy, M.D. “We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement.”

Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008.

Other very modest gains were seen in rates of screening for preventive services and child and adult immunization; however, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation and substance abuse saw no improvement.

The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures.

Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.

Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations.

The quality and disparities reports are available online at http://www.ahrq.gov/qual/qrdr10.htm, by calling 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

For more information, please contact AHRQ Public Affairs: (301) 427-1892 or (301) 427-1855.

Use Twitter to get AHRQ news updates: http://www.twitter.com/ahrqnews/

 

 

 

AHRQ Healthcare 411 podcasts

AHRQ Healthcare 411 podcasts

From a recent AHRQ (Agency for Healthcare Research and Quality)  listserv item

AHRQ’s Healthcare 411 is a podcast series you can listen to at home or on the go.  Available in English and Spanish, 60-second audio podcasts are designed for consumers.  Log on and listen to Healthcare 411; or subscribe and we’ll send stories directly to your computer or personal media player. Select to listen to our latest audio podcast on e-prescribing and reducing medication costs.

A sampling of podcasts (Entire list is here ; Search option is here)

• Effective Health Care: Helping You Make Better Treatment Choices
• Tips on Going Home From the Hospital
• Asking Questions to Get the Care You Need
• Online Health Information
• Torn Rotator Cuff
• Treating Stable Coronary Heart Disease

 

Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems

Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems

Health Data Tools and Statistics:  Catalogue of Surveillance Systems
http://www.nccor.org/css

Resource to help researchers and practitioners more easily investigate childhood obesity in America. The catalogue describes and provides access to surveillance systems (national, state, local) that collect data related to childhood obesity.

This web tool provides a catalogue of existing surveillance systems that contain data relevant to childhood obesity research. It includes local, state, and national systems that provide data at multiple levels.

Surveillance systems for this Catalogue were identified by reviewing existing reports of available systems and soliciting expert review and suggestions. The systems were chosen because they provide access to publicly available raw data gathered in the United States.

Some systems have been in operation for many years; others are relatively new. All, however, contain data pertaining to the past 10 years.

The Search Page contains links to 77 systems, a search box, and limits (age groups, geographic divisions, racial/ethnic group, and more)

Health Data Tools and Statistics:  Health Indicators Warehouse (HIW)
http://healthindicators.gov/

 

The Health Indicators Warehouse serves as the data hub for the HHS Community Health Data Initiative by providing a single source for national, state, and community health indicators. (Related February 11 HHS press release may be found here)

Purpose

Access to high quality data improves understanding of a community’s health status and determinants, and facilitates the prioritization of interventions. The purpose of the HIW is to:

• Provide a single, user-friendly, source for national, state, and community health indicators
• Meet needs of multiple population health initiatives
• Facilitate harmonization of indicators across initiatives
• Link indicators with evidence-based interventions
• Serve as the data hub for the HHS Community Health Data Initiative, a flagship HHS open government initiative to release data; encourage innovative application development; and catalyze change to improve community health

The Indicators page allows one to search through and alphabetical list of filters including chronic diseases, health care, health behaviors, health risks, physical environment, and public health structure.

Resources include

Community Health Status Indicators (HRSA, CDC, NLM, PHF)

This web-based tool provides local public health agencies access to county health status profiles for improving community health by identifying resources and setting priorities. Visit the CHSI home page to read about the data sources, definitions, and notes, and then explore the CHSI dataset file.

County Health Rankings (RWJF and University of WI)

This interactive website provides access to 50 state reports with rankings of each county within each state according to its health outcomes and health determinants. The County Health Rankings are a key component of the Mobilizing Action toward Community Health (MATCH) project. MATCH is collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Healthy People (HHS)

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to: 1) Identify nationwide health improvement priorities; 2) Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress; 3) Provide measurable objectives and goals that are applicable at the national, State, and local levels; 4) Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge; and 5) Identify critical research, evaluation, and data collection needs. Healthy People 2020 contains 1200 objectives in 42 topic areas (923 with baseline data, 237 for which baseline data will be developed during the decade) designed to serve as this decade’s framework for improving the health of all people in the United States.

CMS Community Utilization & Quality Indicators (CMS)

Medicare Data for the Health Indicators Warehouse: A Methodological Overview (PDF)

CMS has assembled measures from Medicare claims data at the state level and for 306 Hospital Referral Regions. The measures encompass a range of data for 2008, including: Utilization measures (e.g., Emergency Department Visits and Hospital Readmissions), Quality measures (e.g., Hospital Compare, Agency for Health Research and Quality (AHRQ) Prevention Quality Indicator (PQI), and AHRQ Patient Safety Indicators (PSI)).

AHRQ Director Helps Consumers Navigate the Health Care System in a New Advice Column on the Web

AHRQ Director Helps Consumers Navigate the Health Care System in a New Advice Column on the Web

AHRQ Director Carolyn M. Clancy, M.D., offers advice to consumers in new, brief, easy-to-understand columns.  The columns will help consumers better navigate the health care system.  Select to read Dr. Clancy’s advice column on heart health.

What Is Comparative Effectiveness Research?

What Is Comparative Effectiveness Research?

From the US AHRQ (Agency for Healthcare Research and Quality) Web page

Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

There are two ways that this evidence is found:

• Researchers look at all of the available evidence about the benefits and harms of each choice for different groups of people from existing clinical trials, clinical studies, and other research. These are called research reviews, because they are systematic reviews of existing evidence.
• Researchers conduct studies that generate new evidence of effectiveness or comparative effectiveness of a test, treatment, procedure, or health-care service.

Comparative effectiveness research requires the development, expansion, and use of a variety of data sources and methods to conduct timely and relevant research and disseminate the results in a form that is quickly usable by clinicians, patients, policymakers, and health plans and other payers. Seven steps are involved in conducting this research and in ensuring continued development of the research infrastructure to sustain and advance these efforts:

1. Identify new and emerging clinical interventions.
2. Review and synthesize current medical research.
3. Identify gaps between existing medical research and the needs of clinical practice.
4. Promote and generate new scientific evidence and analytic tools.
5. Train and develop clinical researchers.
6. Translate and disseminate research findings to diverse stakeholders.
7. Reach out to stakeholders via a citizens forum.

Common questions about comparative effectiveness research

Q: Why is comparative effectiveness research needed? What problem is it trying to solve?

• If you don’t get the best possible information about your treatment choices, you might not make an informed decision on what treatment is best for you.
• When you shop for a new car, phone or camera, you have lots of information about your choices. But when it comes to choosing the right medicine or the best health-care treatment, clear and dependable information can be very hard to find.
• It’s true that some treatments may not work for everyone, and that some treatments may work better for some people than others. This research can help identify the treatments that may work best for you.

Q: What are the practical benefits of comparative effectiveness research?

• You deserve the best and most objective information about treating your sickness or condition. With this research in hand, you and your doctor can work together to make the best possible treatment choices.
• For example, someone with high blood pressure might have more than a dozen medicines to choose from. Someone with heart disease might need to choose between having heart surgery or taking medicine to open a clogged artery. Reports on these topics and others include the pros and cons of all the options so that you and your doctor can make the best possible treatment decision for you or someone in your family.
• Every patient is different — different circumstances, different medical history, different values. These reports don’t tell you and your doctor which treatment to choose. Instead, they offer an important tool to help you and your doctor understand the facts about different treatments.

Related Content

Can I Trust This Information?

What Is the Research Process?

How are Comparative Effectiveness Reviews Conducted?

…and AHRQ Effective Health Care Program Links

Guides for Patients and Consumers include research reviews, research reports, and summary guides

Glossary of Terms

Personalization and Social Media Tools – These tools (as an email list)allow you to personalize your experience with the EHC Program Web site and share it with colleagues, family, and friends.

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Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

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Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

From the February 15, 2011 Eureka news alert

(Elsevier) Elsevier/MEDai, a leading provider of advanced clinical analytic health-care solutions, announced today the launch of the latest version of Pinpoint Review, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

ORLANDO, FL – 14 February, 2011 – Elsevier / MEDai, a leading provider of advanced clinical analytic healthcare solutions, announced today the launch of the latest version of Pinpoint Review®, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

“Hospitals are facing an enormous amount of pressure to provide better, safer care with fewer complications while managing costs,” said Swati Abbott, President of Elsevier / MEDai. “Elsevier / MEDai has enhanced its predictive analytics product to continuously give hospitals and clinicians the most up-to-date tools they need to lower mortality rates and healthcare costs, provide a higher quality of care, increase patient safety and maintain regulatory compliance.”

Pinpoint Review generates predictions for acute-care patients, focusing on the likelihood of a patient developing a complication, contracting a healthcare-acquired infection or being readmitted within 30 days of discharge, while patients are still in the hospital and there is time to adjust care to avoid a negative outcome.

With the expansion of Pinpoint Review’s new predictions, care givers are able to enhance their efforts in proactive care management. Pinpoint Review unlocks the power of clinical and administrative hospital data by utilizing predictive technologies to turn data into actionable information. Empowering today’s hospitals with the ability to predict whether or not a patient will be admitted to the ICU or higher intensity care unit, a predicted length of hospital stay or patient expiration goes a long way in driving down the cost of care and brings a proactive approach to quality improvement.

Pinpoint Review addresses the increasing pressure on hospitals from entities such as the Agency for Healthcare Research and Quality and the Joint Commission on Accreditation of Healthcare Organizations to deliver a higher quality of care and fewer medical errors. Pinpoint Review alerts care providers to patients at risk for developing several of the conditions that the Centers for Medicare and Medicaid Services (CMS) no longer reimburse.

New Chapters for Effective Health Care Program’s Methods Guide for Comparative Effectiveness Reviews

New Chapters for Effective Health Care Program’s Methods Guide for Comparative Effectiveness Reviews

The Agency for Healthcare Research and Quality (AHRQ) ’s Effective Health Care Program has released two new chapters of the Methods Guide for Effectiveness and Comparative Effectiveness Reviews:

·         “Finding Evidence for Comparing Medical Interventions”

·         “Assessing the Applicability of Studies When Comparing Medical Interventions”

To learn more about the Methods Guide for Effectiveness and Comparative Effectiveness Reviews and to access other chapters in this guide.

How To Complain—And Get Heard (at the Hospital)

From a March 17, 2009 advice column by Carolyn M. CHow To Complain—And Get Heardlancy, MD, appearing in AHRQ (US Agency for Healthcare Research and Quality)

Whether it’s a car repair that didn’t fix the problem or a bad meal in a restaurant, many of us don’t hesitate to complain. Making our voices heard when something isn’t right is the first step in getting it corrected. But when we’re sick or need health care services, it’s hard to know where to direct a complaint. And it can be difficult to question people who may know more than we do, especially when we aren’t feeling well.

These reasons are valid, but they shouldn’t be obstacles. As a physician, I’m encouraged that consumers are becoming more comfortable asking their medical team questions. I hope this continues.

Hospitals and health groups have tried to make it easier for patients to raise concerns or complaints. But it’s still not easy to do. Health services are delivered in many different settings and are often not coordinated from one place to the next. So it’s up to the patient or his or her family to identify where to make a complaint and to follow through and report the problem.

A very helpful Government resource, called the Beneficiary Ombudsman, is available for people covered by Medicare or Medicare health plans. This Web site can serve as your first stop to learn how these and other Government programs work and how to file a complaint or an appeal.

People who are covered by private insurance should review the information they get when they enroll to find out who to contact when they have complaints.

Here are some resources for complaints or concerns that arise:

While you are in the hospital: If possible, first bring your complaints to your doctor and nurses. Be as specific as you can and ask how your complaint can be resolved. You can also ask to speak to a hospital social worker who can help solve problems and identify resources. Social workers also organize services and paperwork when patients leave the hospital.

If you are covered by Medicare, you can file a complaint about your care with your State’s Quality Improvement Organization (QIO).  These groups act on behalf of Medicare to address complaints about care provided to people covered by Medicare.

Typical complaints QIOs handle are getting the wrong medication, having the wrong surgery, or receiving inadequate treatment. You can also find your QIO by calling 1-800-MEDICARE.

If you get an infection while you are in the hospital or have problems getting the right medication, you can file a complaint with the Joint Commission. This group certifies many U.S. hospitals’ safety and security practices and looks into complaints about patients’ rights. It does not oversee medical care or how the hospital may bill you.

To find out what other patients had to say about their recent hospital stays, visit the Hospital Compare Web site. You’ll find answers from patients about how well doctors and nurses communicated, how well patients’ pain was controlled, and how patients rated their hospital.

If you are discharged before you’re ready: This is a big concern for many patients because insurers balk at long hospital stays. Talk to the hospital discharge planner (often a social worker) if you don’t think you’re medically ready to leave the hospital. The discharge planner will take your concerns to the doctor who makes this decision.

If you are covered by Medicare or by a Medicare managed care plan, you can file an appeal about a discharge while you are still in the hospital. You should get a form from the hospital titled “An Important Message from Medicare,” which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 to 3 days. The hospital cannot discharge you until the appeal is completed.

When you get your hospital bill: First, ask your doctor or the hospital’s billing department to explain the charges. Find out how the hospital handles complaints about bills, and make your case. If you still have questions, you should contact the Medicare carrier that handles billing issues for your Medicare program.

You can also call 1-800-MEDICARE about billing questions. Make sure you have the date of service, total charge in question, and the name of your doctor and hospital.

Even with this information, it’s not easy to be as assertive in a health care setting as it is in an auto repair shop or restaurant. But it’s a smart move that can help you get the quality care that you deserve.

I’m Dr. Carolyn Clancy and that’s my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality

Questions Are the Answer: Get More Involved With Your Health Care

http://www.ahrq.gov/questionsaretheanswer/

American Health Quality Association

Quality Improvement Organization (QIO) Locator

http://www.ahqa.org/pub/connections/162_694_2450.cfm

The Joint Commission

Report a Complaint about a Health Care Organization

http://www.jointcommission.org/GeneralPublic/Complaint/

Department of Health and Human Services

Beneficiary Ombudsman: Inquiries and Complaints

http://www.medicare.gov/Ombudsman/resources.asp

Department of Health and Human Services

Hospital Compare—A Quality Tool Provided by Medicare

http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp

Department of Health and Human Services

Medicare Appeals and Grievances

http://www.medicare.gov/basics/appeals.asp

Department of Health and Human Services

Helpful Contacts

http://www.medicare.gov/Contacts/Include/DataSection/Questions/SearchCriteria.asp

Current as of March 2009

Consumer Health Videos on YouTube by AHRQ

The US Agency for Healthcare Research and Quality (AHRQ)has a YouTube Channel

The growing list of video titles includes the following titles: Tips for Going Home from the Hospital, Asking Questions Before Surgery, Secondhand Smoke and Bring a Health Advocate to Appointments.

Audio Newscasts Available When You Have Time to Listen

From an announcement by the US Agency for Healthcare Research and Quality (AHRQ)

Are you looking for health-related news you can listen to at your convenience at home or on the go? AHRQ’s Healthcare 411 is your reliable audio news program, based on the latest research and available when and where you need it! You can listen to 60-second radiocasts with tips for heath care consumers and 10-minute audio podcasts featuring longer, more in-depth interviews with experts who provide evidence-based information on today’s critical health care topics. Log on and listen to Healthcare 411; or subscribe and we’ll send stories directly to your computer or personal media player.

Some recent titles

** Treating High Cholesterol
**Family Health Care (Tips for Selecting a New Health Plan)
**Specialty Care (Tips for Getting Access to it)
**How to Find Good Information Online