Mostrando las entradas con la etiqueta Agency for Healthcare Research and Quality. Mostrar todas las entradas
Mostrando las entradas con la etiqueta Agency for Healthcare Research and Quality. Mostrar todas las entradas
08 mayo, 2013
Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement
US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. uspstf@ahrq.hhs.gov
05 mayo, 2013
Why Patients Don’t Report Medical Errors
Are we talking only about Medicare in USA ? Seems to be genocide.
I was recently browsing through the nearly 200 stories we’ve compiled with our Patient Harm Questionnaire,
when I was reminded again of a troubling truth. Many of the people who
suffer harm while undergoing medical care do not file formal complaints
with regulators. The reasons are numerous: They’re often traumatized,
disabled, unaware they’ve been a victim of a medical error or don’t
understand the bureaucracy.
That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.
We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.
It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”
Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.
We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.
The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.
I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion:
That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.
We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.
It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”
Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.
We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.
The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.
I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion:
- Robin Karr said that based on her experience, she’s skeptical about reporting harm directly to the government “but not without hope” about the proposed program.
- Debra Van Putten said she knows many people who have filed complaints about harm they suffered, but little came of their efforts. Patients want more than mere acknowledgement, she said. They want accountability for whoever is responsible.
- Martha Deed said there are so many barriers to a patient reporting harm -- emotional trauma and physical disabilities, feeling intimidated by providers, social pressure not to complain -- that a passive questionnaire is unlikely to elicit responses. Instead, the patient harm information should be gathered in a way that’s standardized, she said, like the national survey that’s administered to recently discharged hospital patients that has results publicly reported on Hospital Compare.
That’s food for thought for those developing the program. Official public comment is due Nov. 9 and can be sent to Doris Lefkowitz, the AHRQ reports clearance officer: doris.lefkowitz@AHRQ.hhs.gov.
We’d also love to hear your comments. How do those of you who work in the medical field feel about this type of reporting system? Patients, what do you think about it? And what would you recommend as characteristics that would be essential to such a program?
07 octubre, 2011
Teen Use of ADHD Meds Up Sharply
| By Nancy Walsh, Staff Writer, MedPage Today Published: September 29, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner  Image via WikipediaThe use of stimulant medications among children with attention deficit hyperactivity disorder (ADHD) continues to rise, particularly among adolescents, a nationally representative survey showed.In 2008, these medications were used by 3.5% (95% CI 3.0 to 4.1) of children ages 18 and younger compared with 2.4% (95% CI 1.8 to 2.9) in 1996, according to Samuel H. Zuvekas, PhD, of the Agency for Healthcare Research and Quality in Rockville, Md., and Benedetto Vitiello, MD, of the National Institute of Mental Health in Bethesda, Md. But among those ages 13 to 18, the rate of use increased by 6.5% annually, rising from 2.3% (95% CI 1.5 to 3.1) in 1996 and reaching 5% (95% CI 3.9 to 6.1) by 2008 (P<0.001), the researchers reported online in the American Journal of Psychiatry. Action Points
Some 9% of children ages 6 to 17 at some time have been diagnosed as having ADHD. Prescribing of stimulant medications rose sharply in the 1990s, and in the subsequent decade numerous new formulations were developed. "As the market for ADHD medications has expanded, concerns have been raised about the possible misuse and abuse of stimulants, especially because the increase in ADHD diagnoses has been most marked in adolescents," the researchers wrote. To examine the patterns of use of drugs such as methylphenidate and amphetamines among young people, Zuvekas and Vitiello analyzed data from the Medical Expenditure Panel Survey, an ongoing report that follows trends in the treatment of psychiatric disorders. They found that approximately 2.8 million children were using stimulants in 2008, a number that had risen by 3.4% each year since 1996. The rate of use was highest among children ages 6 to 12, and that rate has held fairly steady over time -- 4.2% (95% CI 3.2 to 5.2) were treated with stimulant medications in 1996, while 5.1% (95% CI 4.1 to 6.1) were on the drugs in 2008. Children younger than 6 were the least common recipients of stimulant medications. Before 2004, yearly estimates for this age group were 0.3% to 0.4%, but thereafter fell to and remained at 0.1%, which was a significant decrease (t=3.71, P<0.001), according to the researchers. Although a clinical trial in 2006 demonstrated efficacy for methylphenidate among preschool-age children, it also identified a higher incidence of adverse effects, and the current data showed that, in fact, ADHD medications are little used in the youngest children, Zuvekas and Vitiello pointed out. Reflecting the gender predominance of ADHD, three times as many boys as girls were treated with stimulants (5.3% versus 1.6%). Use was highest in whites, being 4.4% in 2008, compared with 3% of African Americans and 2.1% of Hispanics. And although use was lower in minorities, it had risen notably from 1.9% and 0.7% in 1996 among African Americans and Hispanics, respectively. This reflects a growing recognition of ADHD among groups that have often been underserved in mental health resources, while also suggesting that cultural barriers remain, according to the researchers. Rates were low (1.3%) among children lacking health insurance, and those with public insurance were more likely to be on the medications than those with private insurance (OR 1.36, t=2.14, P=0.016). Geography also influenced use, with 4.6% of children in the Northeast taking stimulants in 2008 compared with 1.6% of those living in the West. The survey suggested that the majority of children with ADHD actually do not receive stimulant medications. "This may not be unexpected, since about half of those diagnosed present with only mild symptoms and since other treatments, including psychosocial interventions and nonstimulant medications, are available," the researchers explained. Among other medications taken by small numbers of children were clonidine, guanfacine, and atomoxetine (Strattera). The findings of this study should be interpreted in light of certain limitations, they noted, such as possible recall bias and underestimation of medication use, as well as a lack of validation for diagnoses in the survey. The authors reported no financial disclosures. |
Primary source: American Journal of Psychiatry Source reference: Zuvekas S, Vitiello B "Stimulant medication use in children: a 12-year perspective" Am J Psychiatry 2011; DOI: 10.1176/appi.ajp.2011.11030387.  |
06 octubre, 2011
Attention! More Teens Are Taking ADHD Pills
Source: Pharmalot by
Thanks to an increasing reliance on stimulants among parents and schools to combat attention deficit disorders among kids, more meds have been prescribed in recent years. But what does that usage look like exactly? Well, ADHD pills were used by 3.5 percent of children 18 years old and younger in 2008, up from 2.4 percent in 1996, according to a new study in the American Journal of Psychiatry.
Thanks to an increasing reliance on stimulants among parents and schools to combat attention deficit disorders among kids, more meds have been prescribed in recent years. But what does that usage look like exactly? Well, ADHD pills were used by 3.5 percent of children 18 years old and younger in 2008, up from 2.4 percent in 1996, according to a new study in the American Journal of Psychiatry.However, usage was most pronounced among teenagers: the rate increased 6.5 percent annually. In 1996, 2.3 percent of those between 13 and 18 years old were taking ADHD pills, rising to 5 percent by 2008. This increased use occurred as the meds became more popular and new formulations appeared. As MedPage Today notes, 9 percent of kids ages 6 to 17 have been diagnosed with ADHD at some point, raising concerns that misuse occurred.
“As the market for ADHD medications has expanded, concerns have been raised about the possible misuse and abuse of stimulants, especially because the increase in ADHD diagnoses has been most marked in adolescents,” wrote the researchers, Samuel Zuvekas of the Agency for Healthcare Research and Quality and Benedetto Vitiello of the National Institute of Mental Health.
To gauge patterns, they analyzed data from the Medical Expenditure Panel Survey and found that approximately 2.8 million children were using stimulants in 2008, which amounted to annual increase of 3.4 percent since 1996. And while the usage rate was highest among children ages 6 to 12, this has remained steady – 4.2 percent using the pills in 1996, compared with 5.1 percent in 2008.
Not surprisingly, perhaps, three times as many boys as girls were given ADHD pills – 5.3 percent compared with 1.6 percent. As for the youngest kids, usage among those under 6 years old was estimated at 0.3 percent to 0.4 percent before 2004, but fell to 0.1 percent thereafter and remained at that level. Among whites, usage was 4.4 percent compared with 3 percent among African Americans and 2.1 percent among Hispanics; rates for minories, by the way, rose since 1996 (here is the abstract).
26 mayo, 2011
Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations
Image via WikipediaPURPOSE: To summarize the benefits and harms of metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 receptor agonists, as monotherapy and in combination, to treat adults with type 2 diabetes.
DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception through April 2010 for English-language observational studies and trials. The MEDLINE search was updated to December 2010 for long-term clinical outcomes.
STUDY SELECTION: Two reviewers independently screened reports and identified 140 trials and 26 observational studies of head-to-head comparisons of monotherapy or combination therapy that reported intermediate or long-term clinical outcomes or harms.
DATA EXTRACTION: Two reviewers following standardized protocols serially extracted data, assessed applicability, and independently evaluated study quality.
DATA SYNTHESIS: Evidence on long-term clinical outcomes (all-cause mortality, cardiovascular disease, nephropathy, and neuropathy) was of low strength or insufficient. Most medications decreased the hemoglobin A(1c) level by about 1 percentage point and most 2-drug combinations produced similar reductions. Metformin was more efficacious than the DPP-4 inhibitors, and compared with thiazolidinediones or sulfonylureas, the mean differences in body weight were about -2.5 kg. Metformin decreased low-density lipoprotein cholesterol levels compared with pioglitazone, sulfonylureas, and DPP-4 inhibitors. Sulfonylureas had a 4-fold higher risk for mild or moderate hypoglycemia than metformin alone and, in combination with metformin, had more than a 5-fold increased risk compared with metformin plus thiazolidinediones. Thiazolidinediones increased risk for congestive heart failure compared with sulfonylureas and increased risk for bone fractures compared with metformin. Diarrhea occurred more often with metformin than with thiazolidinediones.
LIMITATIONS: Only English-language publications were reviewed. Some studies may have selectively reported outcomes. Many studies were small, were of short duration, and had limited ability to assess clinically important harms and benefits.
CONCLUSION: Evidence supports metformin as a first-line agent to treat type 2 diabetes. Most 2-drug combinations similarly reduce hemoglobin A(1c) levels, but some increased risk for hypoglycemia and other adverse events. Primary Funding Source: Agency for Healthcare Research and Quality.
Source: Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011 May 3;154(9):602-13. Epub 2011 Mar 14. (Review) PMID: 21403054
Suscribirse a:
Entradas (Atom)