Nursing Research Focuses On Health Trajectory Research

From the 8 June 2011 Medical News Today article

Health care research typically focuses on final outcomes such as cure or death overlooking the fact that health and illness are dynamic states that evolve and change over time. A special collection of articles on health trajectory research is now available in a supplement to Nursing Research***, official journal of the Eastern Nursing Research Society and the Western Institute of Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special supplement presents a series of original studies and commentaries on the development of nursing intervention science focused on the “promotion, maintenance, and restoration of health over time.” It reflects a growing interest in studying the ways that health care interventions can affect health trajectories at different stages of life…

…Several types of health trajectories can be affected by nursing interventions. Developmental trajectories refer to normal physiologic changes such as puberty, menopause, or aging or even life transitions such as marriage or retirement. Acute illness trajectories have to do with illnesses that tend to resolve or improve over time, while chronic illness trajectories are associated with illnesses that aren’t curable, but can still have positive health outcomes. Other categories include disability trajectories and end-of-life or dying trajectories. “Having a better understanding of these various health trajectories and how they can be shaped through interventions will help clinicians provide better care for individuals and families at all stages of their lives,” Drs. Wyman and Henly write.

Articles in the special issue present the nursing science perspective on health trajectory research and important theoretical considerations in studying health and illness over time including advances in statistical modeling that support this area of research. The supplement also includes a series of original studies illustrating the health trajectory perspective in health and illness; in community, hospital, and laboratory settings; and across time scales ranging from seconds to years. Topics include:

— Changes in functioning of the parasympathetic nervous system related to feeding in newborns after surgery for major congenital heart abnormalities.

— Changes in patterns of condom use by sexually active teens participating in a pregnancy-prevention program.

— Changes in anxiety related to mechanical ventilation in critically ill patients.

— Changes in patterns of pain (claudication) during treadmill testing in patients with peripheral artery disease.

— Changes in gastrointestinal symptoms in incontinent patients being treated with fiber supplements.

— Changes in burden and depression in caregivers of spouses with dementia as they transition to nursing care.

 

***For suggestions on how to get these articles for free or at low cost, click here

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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Institute of Medicine Report: Better measurement can improve U.S. health outcomes

Institute of Medicine  Report: Better measurement can improve U.S. health outcomes

Excerpts from the press release:

Despite medical care expenditures that are the highest of any industrialized nation, deficiencies in the way health information is collected and a lack of agreement on the best indicators by which to measure progress are hindering efforts to improve Americans’ health, according to a new national report.

Released in December by the Institute of Medicine, the report calls on the nation’s health leaders to develop a core, standardized set of indicators to integrate and align health data and health outcome measurement at the national, state and local levels. According to the report, numerous health indicator sets developed in recent years and deployed in different contexts make assessment and comparison difficult for policy-makers and other decision-makers by highlighting similar information in different ways….

The report committee’s vision of the factors that create health in populations — community-based factors and social and environmental determinants — is “very different” from the way the current U.S. health care delivery system is structured, said Gold, noting that the report calls on the U.S. Department of Health and Human Services to produce an annual report informing policy-makers, health leaders and the public about important trends and disparities in the social and environmental determinants that affect health.

“The public health community…shares a commonality of interests and insight as to what the true determinants of health are, and what this report tries to put into sharp relief is that we need to do a better job of measuring the variables that create and detract from health in this country, and that we need to move that measurement strategy away from traditional biomedical variables,” said Gold, who is a professor and chair of community health and social medicine at the Sophie Davis School of Biomedical Education at the City College of New York.

The report, “For the Public’s Health: The Role of Measurement in Action and Accountability,” also recommends that the United States adopt a single, summary measure of population health. Death rates have long been used as the standard measure of population health, the report said, but life expectancy by itself cannot capture information about the health-related quality of life associated with chronic illnesses and injuries. Summary measures of population health, such as health-adjusted life expectancy, capture an overall picture of the well-being of communities.

Moreover, the report recommends that HHS assign the National Center for Health Statistics a leadership role in a “renewed population-health information system” through better coordination and integration of the determinants of health. The report further recommends that the National Prevention, Health Promotion and Public Health Council — the federal body created as part of last year’s health reform law — update Congress annually on NCHS’ progress in assuming such a leadership role.

To ensure the public’s awareness of the quality, safety, efficiency and appropriateness of clinical care services delivered in their communities, the report calls on state and local public health agencies in each state to collaborate with clinical care delivery systems. Local performance reports about overuse, underuse and misuse should be made available for selected interventions, the report said, including preventive and diagnostic tests, procedures and treatment.

The report also recommends that HHS work with relevant federal, state and local public-sector and private-sector partners and stakeholders to develop a performance-measurement system that promotes accountability among governmental and private-sector organizations that have responsibilities for protecting and improving population health at local, state and national levels.

Authoring committee member Martin J. Sepulveda, MD, FACP, called the report a “wake-up call” to the health care delivery system, policy-makers, governmental public health leaders, employers and other payers.

“It tells policy-makers that you can control the ‘mix’ part of total cost by focusing on the medical care delivery system — namely the proportions of controlled versus complicated people with chronic diseases, but the avalanche of new people with chronic diseases will continue to flood the system and will keep total cost high,” Sepulveda, IBM fellow and vice president for integrated health services at IBM Corp. in Somers, N.Y., told The Nation’s Health.

The report also tells governmental public health that it needs to “think differently” about its role in the health crisis and forge new relationships with the health care delivery system to break down barriers and create and use shared pools of data to inform policy-makers and consumers about critical performance matters such as overuse, underuse and misuse of medical care, Sepulveda said.

“It needs to play a key role in helping people know where health care value lies and who is and isn’t delivering it in their communities,” Sepulveda said.

Sponsored by the Robert Wood Johnson Foundation, the report is the first of three on public health strategies to improve health. Reports examining public health and the law and public health and financing are due to be released within the next year.

For more information or to read the report, visit www.iom.edu/reports.

 

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

From the January 31, 2011 AHRQ (Agency for Healthcare Research and Quality) press release

Older Americans who were treated in Michigan intensive care units (ICUs) saw larger decreases in their likelihood of dying while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS’ Agency for Healthcare Research and Quality (AHRQ). The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce HAI rates. This study, “Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis,” published in today’s British Medical Journal, is the first to link these programs to reduced death rates. “This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives—the most important outcome for patients and doctors,” said AHRQ Director Carolyn M. Clancy, M.D. “AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country.” Researchers led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that overall a person’s chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented. “We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” says Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine. Dr. Pronovost led development of the AHRQ-sponsored Keystone Intensive Care Unit Project and implemented it in Michigan hospitals with the help of the Michigan Health and Hospital Association. “These results are very exciting, and further research should be done to address other important issues impacting the safety and quality of patient care,” added Dr. Lipitz-Snyderman. The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams, and implementing practices based on guidelines by the Centers for Disease Control and Prevention (CDC), such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. AHRQ continues to support the Keystone Project through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For AHRQ’s recently funded HAI projects, go to http://www.ahrq.gov/qual/haify10.htm. According to the CDC, HAIs are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections, and 99,000 associated deaths in 2002. These infections are responsible for $28 billion to $34 billion in preventable health care expenses every year. Infectious agents, such as bacteria, found in health care settings can cause patients to develop HAIs when they have surgery or require central lines or urinary tract catheters. The Keystone Project is part of a Department-wide effort to address HAIs, as outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html). Partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services, and National Institutes of Health, are working together to achieve the goals of the Action Plan. For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1855. Use Twitter to get AHRQ news updates:http://www.twitter.com/ahrqnews/

Additional articles about this news release

• Safety checklist use yields 10 percent drop in hospital deaths (Science Blog)
• Program reduces serious hospital infections – report (Reuters)

Articles about related studies

• Study finds MRSA screening saves hospitals money
• Private room intensive care unites associated with lower infection rates
• More doctors must join nurses, administrators in leading efforts to improve patient safety, outcomes