Health Research and Educational Trust

Chicago, IL, United States

Health Research and Educational Trust

Chicago, IL, United States
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ANN ARBOR, MI - They're a double-edged sword for nursing home residents and staff - making it easier and safer to handle a basic bodily function, but putting frail patients in danger of infections that can lead to confusion, falls and death. Now, a new study shows a way to keep urinary catheters from posing such a risk to the 1.4 million Americans currently in long-term and post-acute care. The research shows that urinary tract infections related to catheters fell by 54 percent in 404 nursing homes in 38 states that took part in a national patient safety effort. The drop in catheter-associated UTI, or CAUTI, happened across the board, with 75 percent of nursing homes seeing at least a 40 percent drop. The rate of infection dropped even though the same percentage of patients used catheters to empty their bladders - about 4.5 percent of all patients in the nursing homes. The results are published in JAMA Internal Medicine and were presented at the American Geriatrics Society annual meeting. A broad team of researchers, coaches, and content experts helped the nursing homes adopt a specially designed toolkit of training materials. It's designed to help staff understand -- and effectively and consistently use -- proven infection-prevention practices, and best use of catheters and lab tests, while empowering teams to implement changes and engage patients and family members. The toolkit is available online for free from the Agency for Healthcare Research and Quality (AHRQ), the federal agency that funded the study. At the same time that infection rates were dropping, the number of lab tests that clinicians ordered to check patients for infections dropped by 15 percent - indicating that they were using urine culture tests more appropriately. "When we first looked at the results, we were pleasantly surprised to see that our strategy was so effective. Our study shows that with the right thoughtful mix of education, training, coaching and local empowerment, we can apply evidence-based practices consistently, for the benefit of patients and staff alike," says Lona Mody, M.D., M.Sc., first author of the new paper. Mody is a professor of internal medicine at the University of Michigan and VA Ann Arbor Geriatric Research, Education and Clinical Center. The study reported results from the AHRQ Safety Program for Long-Term Care which focused on reducing CAUTI and other healthcare-associated infections. The project adapted principles and methods from AHRQ's Comprehensive Unit-based Safety Program, previously found to be effective in hospitals, to the long term care setting. The project enrolled nursing homes over the course of two and a half years, and provided a toolkit of materials to help their leaders and staff implement and sustain use of evidence-based practices for infection prevention. Conducted by the Health Research and Educational Trust, the research arm of the American Hospital Association, the effort included faculty from U-M and other partners including Abt Associates, the Association for Professionals in Infection Control and Epidemiology, Baylor College of Medicine, Contrast Creative, Qualidigm, and the Society of Hospital Medicine; federal agency partners included the Centers for Disease Control and Prevention. The study built on the previous success of two other efforts to reduce CAUTI. The first was a National Institutes of Health-funded randomized clinical trial that Mody led, which was published in JAMA Internal Medicine in 2015 and showed a 31 percent reduction in CAUTI using a multi-component strategy in a consortium of Michigan nursing homes. The other was a national AHRQ-funded effort to reduce CAUTI in hospitals described in a study led by her U-M colleague, Sanjay Saint, M.D., M.P.H. That effort published results in the New England Journal of Medicine last year, showing a 32 percent drop in CAUTI in non-intensive care unit inpatients in hospitals that used a similar implementation strategy. CAUTI, Mody notes, are typical of the healthcare-acquired infections that nursing home residents face. Such infections factor heavily into the "revolving door" that sends 1 in 4 nursing home residents to the hospital for infections each year, costing the healthcare system $4 billion. Mody notes that public reporting of catheter use rates in nursing homes over the past decade and a half has driven down catheter use markedly. The federal government's Nursing Home Compare website allows anyone to see catheter use rates for long-term residents at any nursing home that accepts Medicare. Currently, when they are used, urinary catheters stay in patients for prolonged periods of time. Infections in those patients continue to be a major and costly issue. Before the nursing homes started participating in this study, their residents experienced 6.4 CAUTIs per 1,000 catheter days. That is, for every 1,000 days of catheter use by all the catheter-using patients, 6.4 infections occurred. As the nursing homes started implementing specific infection prevention strategies, that rate dropped to 3.33 per 1,000 catheter days. These results incorporate adjustment for factors that made the nursing homes different from one another. Through monthly content training and coaching calls, the project team taught staff techniques grounded in research about which patients need catheters, how to care for and maintain catheters in people who have them, which patients are appropriate candidates for lab tests and antibiotics, as well as how to improve communication, leadership and staff engagement, and safety culture to promote consistent use of these practices. During these calls, they received simplified information sheets, slide sets, interactive hands-on activities and more for nursing home clinical leaders to use, and to adapt to their institution's culture. Importantly, the facilities received personalized monthly data feedback to evaluate if these strategies were effective or not. Urine lab cultures were performed 3.52 times for every 1,000 patient days at the start of the project, but went down to 3.09 per 1,000 at the end of the project. Too much testing can lead to false-positive results, and the use of antibiotics when they aren't needed, which can encourage drug-resistant "superbugs" to evolve and spread. Instead of relying on urine culture results, staff received education to help them recognize the early symptoms of a UTI, including in people with dementia who cannot always communicate that they are experiencing pain or burning during urination. This allowed staff to use standardized criteria for defining UTIs in catheterized nursing home patients, and rule out other issues like dehydration that can also cause the confusion that often accompanies UTIs in older and medically fragile people. Co-author Sarah Krein, Ph.D., R.N., adds, "Overall, several implementation teams indicated that the program was extremely valuable. It is an industry that so desperately needs these resources. A specific benefit identified was greater staff empowerment. Staff felt more knowledgeable and thus, empowered to speak with physicians and other team members regarding the necessity of catheters and the ordering of urine cultures." Mody notes that the next horizon is to reduce other healthcare associated infections in institutionalized older adults - and that the combination of technical and socio-adaptive tools implemented with external facilitation created for CAUTI reduction could be replicated for other patient safety hazards. "CAUTI is a model for other adverse events, and shows the way to develop an implementation model to enhance safety and reduce harm," she says. "Translating the basic evidence from laboratory-based and patient-oriented research to a full-scale nationwide implementation is possible." Mody and Saint, and their Michigan co-authors on the new paper, are members of the U-M Institute for Healthcare Policy and Innovation and the U-M/VA Patient Safety Enhancement Program.

News Article | May 15, 2017

The guide is part of an ongoing focus on reducing the occurrence of pressure ulcers in the healthcare community. In the past five years, New Jersey hospitals have reduced the incidence of pressure ulcers by 38 percent, with an accompanying cost savings of $34.4 million, according to data from the New Jersey Hospital Association. NJHA Healthcare Business Solutions is an NJHA affiliate. The pocket-size guide is designed to fit in a lab coat pocket, giving physicians, nurses, certified nurses aides and others an easily accessible reference tool to identify and document pressure ulcers. Using universal language on pressure ulcers – sometimes also referred to as pressure injuries – the guide targets a broad cross section of clinicians and caregivers across the healthcare continuum. The enhanced guide adds treatment strategies and approaches, has an amplified section on infection control as well as enriched information on palliative care for wounds. Vivid new photographs and illustrations depict medical-device related wounds. "Pressure ulcers remain a major health problem that affects close to 3 million adults annually despite strides to prevent, accurately diagnose and treat pressure ulcers every day," notes Dr. Levine. "Preventing, staging and treating pressure ulcers is now a multidisciplinary responsibility within healthcare institutions." Adds Dr. Ayello, "Clinicians at every level and in every setting can use this tool to become even more expert in wound care and improve outcomes. Our format is unique and covers accurate staging, documentation and treatment of pressure issues with the goal of educating providers with easy-to-access, relevant information." The Pocket Guide to Pressure Ulcers, Fourth Edition, is affordably priced at $15.99. More information is available at The New Jersey Hospital Association, based in Princeton, is the statewide advocate for its member hospitals and post-acute providers and the patients they serve. Its Health Research and Educational Trust is an industry leader in collaboratives to improve hospital quality and patient safety, including a focus on reducing pressure ulcers and other hospital-acquired conditions. NJHA Healthcare Business Solutions is an NJHA affiliate which provides group purchasing and other products and services to help healthcare providers reduce healthcare costs and increase value. To view the original version on PR Newswire, visit:

News Article | November 22, 2016

The international community needs to stand up for medical neutrality in war zones, and mandate the UN Security Council to act in the face of persistent and blatant breaches of the Geneva Convention, urge global health experts in an editorial in the online journal BMJ Global Health. Some 196 countries ratified the International Humanitarian Law, which specifically promotes medical neutrality and protection of medical services for people in war zones, as set out in the four Geneva Conventions of 1949.Breaches of the law, which was modified in 1977 and 2005 to strengthen it further, are regarded as war crimes, because of their impact on civilians and medical staff who have a duty of care to those wounded in war-torn countries. "But over the years, war crimes have persisted with little or no definitive action by the international community to stem the tide," insist the authors, Drs Soumitra Bhuyan, School of Public Health, University of Memphis, Ikenna Ebuenyi, King's College London and London School of Hygiene and Tropical Medicine, and Jay Bhatt, The Health Research and Educational Trust, Chicago. The inaction dates back to the 1970s in Mozambigue, and is still evident today in Syria, Iraq, Afghanistan and South Sudan, they point out. And the destruction of healthcare facilities around the world shows no sign of abating. In 2015-16, 600 such attacks were recorded--228 of them in Syria alone--killing1000 people and injuring more than 1500 others. According to data from the World Health Organization, 113 healthcare facilities in 17 countries were attacked in the first 6 months of the 2016 alone. And as of the first week of October, every hospital in eastern Aleppo in Syria has been hit at least once, with one of the main trauma hospitals hit four times within a 5-day period. Since the war in Syria started, 654 doctors and nurses have lost their lives. The impact of these attacks is "enormous," say the authors, outlining the psychological trauma for the survivors and the erosion of preventive healthcare, such as vaccinations and infectious disease control. "The [International Humanitarian Law] is explicit and provides for the protection of patients, health facilities, health personnel and patients in times of war as long as they are not directly involved in hostilities," they write. "The international community needs to rise to the occasion and match action with words by mandating the United Nations Security Council to provide protection for health facilities in war zones and enter into dialogue with government and warring groups to respect the principles of medical neutrality in conflict areas," they urge. This means that the Council and governments of all nations need to develop some form of punishment that would deter aggressors from further breaches of the legislation and educate armed forces personnel to respect medical neutrality and the Geneva Convention, they say. Editorial: Persisting trend in the breach of medical neutrality: a wake-up call to the international community http://gh. BMJ Global Health is one of 60 specialist journals published by BMJ. http://gh.

DesRoches C.M.,Mathematica Policy Research | Charles D.,United Information Technology | Furukawa M.F.,United Information Technology | Joshi M.S.,Health Research and Educational Trust | And 4 more authors.
Health Affairs | Year: 2013

The US health care system is in the midst of an enormous change in the way health care providers and hospitals document, monitor, and share information about health and care delivery. Part of this transition involves a wholesale, but currently uneven, shift from paper-based records to electronic health record (EHR) systems. We used the most recent longitudinal survey of US hospitals to track how they are adopting and using EHR systems. Only 44 percent of hospitals report having and using what we define as at least a basic EHR system. And although 42.2 percent meet all of the federal stage 1 "meaningful-use" criteria, only 5.1 percent could meet the broader set of stage 2 criteria. Large urban hospitals continue to outpace rural and nonteaching hospitals in adopting EHR systems. The increase in adoption overall suggests that the positive and negative financial incentives currently in place across the US health care system are working as intended. However, achieving a nationwide health information technology infrastructure may require efforts targeted at smaller and rural hospitals. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.

Fakih M.G.,St John Hospital And Medical Center | George C.,Michigan Health and Hospital Association | Edson B.S.,Health Research and Educational Trust | Goeschel C.A.,Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality | Saint S.,University of Michigan
Infection Control and Hospital Epidemiology | Year: 2013

Catheter-associated urinary tract infection (CAUTI) represents a significant proportion of healthcare-associated infections (HAIs). The US Department of Health and Human Services issued a plan to reduce HAIs with a target 25% reduction of CAUTI by 2013. Michigan's successful collaborative to reduce unnecessary use of urinary catheters and CAUTI was based on a partnership between diverse hospitals, the state hospital association (SHA), and academic medical centers. Taking the lessons learned from Michigan, we are now spreading this work throughout the 50 states. This national spread leverages the expertise of different groups and organizations for the unified goal of reducing catheter-related harm. The key components of the project are (1) centralized coordination of the effort and dissemination of information to SHAs and hospitals, (2) data collection based on established definitions and approaches, (3) focused guidance on the technical practices that will prevent CAUTI, (4) emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges), and (5) partnering with specialty organizations and governmental agencies who have expertise in the relevant subject area. The work may serve in the future as a model for other large improvement efforts to address other hospital-acquired conditions, such as venous thromboembolism and falls. © 2013 by The Society for Healthcare Epidemiology of America.

Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Kaiser Family Foundation | Damico A.,University of Chicago | Kenward K.,Health Research and Educational Trust | Osei-Anto A.,Brandeis University
Health Affairs | Year: 2012

Health care premiums rose moderately for single and family employer-sponsored coverage this year, the 2012 annual Kaiser Family Foundation/Health Research and Educational Trust (HRET) Survey of Employer Health Benefits found. Even with the lingering effects of the recession, cost-sharing levels remained relatively stable in 2012. Also remaining stable was the rate at which employers offered coverage, according to the survey, which was based on telephone interviews with 2,121 public and private employers contacted from January through May 2012. The average annual premiums in 2012 were $5,615 for single coverage and $15,745 for family coverage, an increase of 3 and 4 percent, respectively, from 2011. The percentage of firms offering health benefits, 61 percent, was similar to last year's, as was the percentage of workers at offering firms who were covered by their firm's health benefits, 62 percent. One noteworthy change, because of a provision of the Affordable Care Act, is that 2.9 million young adults who would not otherwise have been enrolled in a parent's employer-sponsored health insurance were covered by that insurance in 2012. © 2012 Project HOPE- The People-to-People Health Foundation, Inc.

Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Kaiser Family Foundation | Panchal N.,Kaiser Family Foundation | Damico A.,Kaiser Family Foundation | And 3 more authors.
Health Affairs | Year: 2013

Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm's health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.

Jha A.K.,Harvard University | DesRoches C.M.,HealthCare Partners | Kralovec P.D.,Health Forum | Joshi M.S.,Health Research and Educational Trust
Health Affairs | Year: 2010

Given the substantial federal financial incentives soon to be available to providers who make "meaningful use" of electronic health records, tracking the progress of this health care technology conversion is a policy priority. Using a recent survey of U.S. hospitals, we found that the share of hospitals that had adopted either basic or comprehensive electronic records has risen modestly, from 8.7 percent in 2008 to 11.9 percent in 2009. Small, public, and rural hospitals were less likely to embrace electronic records than their larger, private, and urban counterparts. Only 2 percent of U.S. hospitals reported having electronic health records that would allow them to meet the federal government's "meaningful use" criteria. These findings underscore the fact that the transition to a digital health care system is likely to be a long one. © 2010 Project HOPE- The People-to-People Health Foundation, Inc.

Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Henry J Kaiser Family Foundation | Panchal N.,Henry J Kaiser Family Foundation | Whitmore H.,University of Chicago | And 3 more authors.
Health Affairs | Year: 2015

The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. The percentage of firms offering health benefits and the percentage of workers covered by their employers' plans remained statistically unchanged from 2014. Eighty-one percent of covered workers were enrolled in a plan with a general annual deductible. Among those workers, the average deductible for single coverage was $1,318. Half of large employers either offered employees the opportunity or required them to complete biometric screening. Of firms that offer an incentive for completing the screening, 20 percent provide employees with incentives or penalties that are tied to meeting those biometric outcomes. The 2015 survey included new questions on financial incentives to complete wellness programs and meet specified biometric outcomes as well as questions about narrow networks and employers' strategies related to the high-cost plan tax and the employer shared-responsibility provisions of the Affordable Care Act. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.

Yu J.B.,Yale University | Soulos P.R.,Yale University | Herrin J.,Yale University | Herrin J.,Health Research and Educational Trust | And 5 more authors.
Journal of the National Cancer Institute | Year: 2013

BackgroundProton radiotherapy (PRT) is an emerging treatment for prostate cancer despite limited knowledge of clinical benefit or potential harms compared with other types of radiotherapy. We therefore compared patterns of PRT use, cost, and early toxicity among Medicare beneficiaries with prostate cancer with those of intensity-modulated radiotherapy (IMRT).MethodsWe performed a retrospective study of all Medicare beneficiaries aged greater than or equal to 66 years who received PRT or IMRT for prostate cancer during 2008 and/or 2009. We used multivariable logistic regression to identify factors associated with receipt of PRT. To assess toxicity, each PRT patient was matched with two IMRT patients with similar clinical and sociodemographic characteristics. The main outcome measures were receipt of PRT or IMRT, Medicare reimbursement for each treatment, and early genitourinary, gastrointestinal, and other toxicity. All statistical tests were two-sided.ResultsWe identified 27,647 men; 553 (2%) received PRT and 27,094 (98%) received IMRT. Patients receiving PRT were younger, healthier, and from more affluent areas than patients receiving IMRT. Median Medicare reimbursement was $32,428 for PRT and $18,575 for IMRT. Although PRT was associated with a statistically significant reduction in genitourinary toxicity at 6 months compared with IMRT (5.9% vs 9.5%; odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.96, P =. 03), at 12 months post-treatment there was no difference in genitourinary toxicity (18.8% vs 17.5%; OR = 1.08, 95% CI = 0.76 to 1.54, P =. 66). There was no statistically significant difference in gastrointestinal or other toxicity at 6 months or 12 months post-treatment.ConclusionsAlthough PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment. © 2012 The Author.

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