Accidental iatrogenic pneumothorax in hospitalized patients.

Objective: Iatrogenic pneumothorax (IP) is an inherent risk to patients who undergo procedures that involve the intentional puncturing of the lung. IP also could occur accidentally to patients who do not undergo such procedures; such accidental IP (AIP) is suggestive of lapses in safe care. This study assessed the risk for AIP in patients hospitalized with specific diagnoses who underwent specific procedures.

Ambulatory care visits for treating adverse drug effects in the United States, 1995-2001.

Background: Adverse d[rug events (ADEs) are a well-recognized patient safety 4concern, but their magnitude is unknown. Ambulatory viisits for treating adverse drug effects (VADEs) as recordeed in national surveys offer an alternative way to estimatte the national prevalence of ADEs because each VA]DE indicates that an ADE occurred and was seriousenough to require care.

Methods: A nationallyrepresentative sample of visits to physician offices, hospital outpatient departments, and emergency departments was analyzed.

Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes.

Objectives: Considerable differences in prevalence of diabetes and management of the disease exist among racial/ethnic groups. We examined the relationship between race/ethnicity and hospital readmissions for diabetes-related conditions.

Methods: Nonmaternal adult patients with Medicare, Medicaid, or private insurance coverage hospitalized for diabetes-related conditions in 5 states were identified from the 1999 State Inpatient Databases of the Healthcare Cost and Utilization Project.

Assessing patient safety in the United States: challenges and opportunities.

Background: In 1999, the US Congress mandated the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), to report annually to the nation about healthcare quality. One chapter in the National Healthcare Quality Report (NHQR) is focused on patient safety.

Objectives: The objectives of this study were to describe the challenges in reporting the national status on patient safety for the first NHQR and discuss emerging opportunities to improve the comprehensiveness and reliability of future reporting.

The national healthcare quality and disparities reports: an overview.

Background: Congress directed the Agency for Healthcare Research and Quality (AHRQ) to lead an effort for the US Department of Health and Human Services (DHHS) to develop 2 annual reports: a National Healthcare Quality Report (NHQR) and a National Healthcare Disparities Report (NHDR).

Objectives: This article lays out key concepts, definitions, statistical methods, and findings from these first ever national reports on quality and disparities. We also summarize some possible future directions for the reports.

Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations.

Objectives: To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings.

Design: Retrospective analysis of the 1995-2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Setting: Physician offices and hospital outpatient departments.

From theory to practice: improving the impact of health services research.

Background: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers.

Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.

Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers.

Multiple hospitalizations for patients with diabetes.

Objective: To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics.

Research Design And Methods: Using the Healthcare Cost and Utilization Project complete discharge data for five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number of stays per patient.

Outcomes and effectiveness research: capacity building for nurse researchers at the Agency for Healthcare Research and Quality.

Several of AHRQ's priority areas including disease prevention, health promotion, primary care, quality of care, service delivery, and patient safety are particularly relevant to nurse researchers. With much national attention focused on nursing-related issues such as staff shortages, training, mandatory overtime, working conditions, and autonomy, it is mandatory that nursing research be conducted to inform healthcare delivery and policy. Nurses also need to contribute to the health services literature so that an even balance of discipline perspective is represented.

Translating research into practice: the future ahead.

Objective: To summarize and analyze the focus and methodologies of the Translating Research into Practice (TRIP) projects funded in 1999-2000 by the US Agency for Healthcare Research and Quality (AHRQ).

Data Sources And Study Design: An analysis of the successful applications for the TRIP I and II requests for applications in 1999 and 2000 was produced from the data collected.

Data Collection: The following items were abstracted from each of the successful applications: provider focus, patient population, vulnerable populations, methodologies, interventions for change, outcomes measured, and conceptual framework used.

The development and role of predictive instruments in acute coronary events: improving diagnosis and management.

The diagnosis and management of acute myocardial infarction and unstable angina pectoris are frequent challenges for emergency department staff. Strategies must quickly and accurately identify all patients requiring admission, monitoring, and reperfusion therapy to maximize outcomes without overdiagnosing. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address this need.