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Health Innovations State Law Database

The Health Innovations State Law Database created by the National Conference on State Legislatures is  a resource for identifying over 800 recently enacted state laws and regulations that address health policy innovations related to access, Medicaid, private and commercial insurance markets, the Accountable Care Act and social determinants of health.. The database supports searching by keyword, state, legislative status, bill number, sponsor, and/or these topics:

  • Exchanges and Health Marketplaces
  • Free Market; Challenges and Alternatives
  • Market-Cost Containment
  • Market-Coverage
  • Market-Delivery Reform [includes accountable care]
  • Market-Health Insurance Reforms
  • Market-Mandates and Essential Health Benefits
  • Market-Network Adequacy
  • Market-Other
  • Market-Payment Reforms
  • Market-Price Transparency
  • Medicaid Expansion and Waivers
  • Medicaid Payment Reform
  • Medicaid-General
  • PPACA – ACA-Health Reforms
  • State-Run Programs
  • Telehealth Programs

However, the full-text of the legislation located is restricted to NCLS members.

Source: Health innovations state law database: tracking state laws for health care transformation, 2015-2016. National Conference of State Legislatures, accessed Jan. 27, 2017. http://www.ncsl.org/research/health/health-innovations-database.aspx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

RESEARCH: Takes 17 years to translate to clinical practice

This is a brief interview with Andrew B. Bindman, M.D., the director of the federal Agency for Healthcare Research and Quality (AHRQ) about recent threats to the agency’s federal funding and program priorities.  Dr. Bindman mentions that one priority is to shorten the lag time that it takes for research evidence to be disseminated into use in clinical practice.  One approach is a program called EvidenceNOW that provides coaching to primary care physicians in small practices.  Another uses telemedicine and a hub-and-spoke approach to connect specialists and PCPs.  Dr. Bindman also mentions a new Comparative Health System Performance initiative intended to compare the organizational performance of multi-institutional health systems.

Source: Stephenson, J. (2016, Sept. 30). AHRQ director sets course for agency’s health services research. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2565313   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

INFECTION CONTROL: CUSP program found to reduce UTIs in non-ICU units

The federal government funded the Comprehensive Unit-based Safety Program (CUSP), a multi-year, nationwide effort to decrease the rate of urinary tract infection associated with the use of catheters in hospitalized patients.  This project was under the leadership of AHA’s Health Research & Educational Trust (HRET).  The project involved disseminating information and tool kits about best practices and collecting data.  Data from over 600 hospitals were studied; these findings represent part of the hospitals that participated.  It was found that hospital units that were not ICUs benefited from the program – as evidenced by a reduced UTI infection rate – but ICUs did not.

Reductions occurred mainly in non-ICUs, where catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days…”

Source: Saint, S., and others. (2016, June 2). A program to prevent catheter-associated urinary tract infection in acute care. The New England Journal of Medicine, 374(22), 2111-2119.  Click here for free full text: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1504906  Posted by AHA Resource Center (312)422-2050, rc@aha.org

ICUs: How do high-performing hospitals reduce CLABSI rates?

This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate.  High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year.  Low performers were defined as having over 3 infections per 1000 catheter-days.

I particularly like the tables and the appendices to this article.  The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff.  The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.

Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78.  Click here for publisher’s website:  http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TEAMWORK: How to build a successful team

Seminal work in the field of team effectiveness was done in the 1970s by organizational behavior expert J. Richard Hackman – and the authors of this article have validated and expanded this pioneering research.  They discuss conditions that contribute to the success of what they call “4-D teams” – those that are diverse, dispersed, digital, and dynamic – which today increasingly include people based in different locations, including different countries.  The factors that were identified decades ago as enablers include:

  • Compelling direction – a goal that is challenging enough to be inspiring, but not so challenging as to be dispiriting
  • Strong structure – a minimum number of people who together have the requisite skills
  • Supportive context – having the needed resources available

The new knowledge is that a fourth enabler is needed:

  • Shared mindset – common identity and understanding

The authors include a short assessment, “Does Your Team Measure Up,” that can be used periodically to take the temperature of the team.

Source: Haas, M., and Mortensen, M. (2016, June). The secrets of great teamwork: Collaboration has become more complex, but success still depends on the fundamentals. Harvard Business Review, 94(6), 71-76.  Click here: https://hbr.org/2016/06/the-secrets-of-great-teamwork  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICU: Wearing gowns and gloves for all ICU patients studied

Caregivers entering patient rooms in intensive care units typically use contact precautions – putting on gowns and gloves – when the patient is known to have antibiotic-resistant bacteria.  This study was a randomized trial of universal gown and glove use for adult patients in intensive care units in 2012.  Data on 1800 patients at different hospitals were studied.  The authors comment that:

  • “The observation that universal glove and gown use may result in fewer adverse events was unanticipated.  Universal glove and gown use could potentially have led to a decrease in HAIs [healthcare-associated infections] by serving as a barrier to acquiring new bacteria both through physical use of gloves and gowns as well as fewer HCW [health care worker] visits and better hand hygiene.”

Source: Croft, L.D., Harris, A.D., Pineles, L., and others. (2015, Aug. 15). The effect of universal glove and gown use on adverse events in intensive care unit patients. Clinical Infectious Diseases, 61(4), 545-553.  Click here for full text: cid.oxfordjournals.org/content/61/4/545.full.pdf  Posted by AHA Resource Center (312) 422-2003, rc@aha.org


BENCHMARKS: Mortality rate after lung cancer surgery

The Society of Thoracic Surgeons maintains a General Thoracic Surgery Database (GTSD), which keeps track of patients through the first 30 days after surgery.  In this study of records for over 26,000 patients, a link was made with Medicare data for patients aged 65 and older to see what happened over a longer period – 90 days.  The most common lung cancer resection surgery was found to be the lobectomy, which was performed for about two-thirds of the patients who were studied.  The next most common procedure was a wedge resection, which was performed in nearly 20 percent of patients studied.  These were the mortality rates found:

Surgical Mortality for the Lobectomy Cancer Surgery

  • 2.4 percent operative mortality
  • 4.3 percent mortality within 90 days of surgery

The cancer surgery procedure that was found to have the highest mortality at 90 days was pneumonectomy – at nearly 16 percent.  Experts who commented on this study noted the value of having data further out than 30 days, the challenge of having linked the GTSD with the Medicare data, and the fact that these outcomes represent data from the best surgeons at the best centers in the world.

Source: Fernandez, F.G., and others. (2016). Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery database in patients 65 years and older. Annals of Thoracic Surgery, 101, 2067-2072. Click here: http://www.annalsthoracicsurgery.org/article/S0003-4975%2816%2930136-9/pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org