Agency Of Healthcare Research And Quality Research Articles

Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary.

As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.

Văn hoá an toàn người bệnh và một số yếu tố ảnh hưởng tại Bệnh viện Phạm Ngọc Thạch, Thành phố Hồ Chí Minh năm 2023

Objective: To measure patient safety culture and some factors influence in 12 areas relating to patient care in Pham Ngoc Thach Hospital. Methods: Cross-sectional research. The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire of the Agency of Healthcare Research and Quality (AHRQ) version Vietnamese was used in this survey. All medical staff working in the Pham Ngoc Thach Hospital were asked to complete the questionnaire. We employed the software Stata 16.0 and Microsoft Excel 2010 to perform the statistical analysis of the survey data. Average positive response rate in 12 patient safety culture dimensions in Pham Ngoc Thach Hospital was 75%, higher than in Taiwan (64%). Worthy of note were the high positive response rates observed in the following areas: Teamwork within units (94%), manager views and actions promoting patient safety (91%), management support for patient safety, learning-continuous improvement (89%), and feedback and communication about errors (85,6%). However, there were three areas that still received many negative responses and showed room for improvement such as handoff, transitions, staffing, and non-punitive response to errors. The survey in Pham Ngoc Thach Hospital which provides an overview of the patient safety culture in the hospital. Although most medical staff had positive responses regarding patient safety in many areas relating to patient care within their departments as well as in the whole hospital, but there were still areas that had a low positive response and needed to be improved.

A Comprehensive Literature Review of Digital Health Interventions in the Treatment of Substance Use Disorder With Special Focus on Mobile Applications.

COVID-19 quarantine showed an increase in opioid-related deaths partially due to the limited capacity of clinics and treatment centers. Digital health interventions (DHIs) such as telehealth have improved access to treatment, reduced psychosocial barriers, and helped patients with substance use disorder (SUD). An in-depth literature review was conducted to gauge the efficacy and usefulness of DHIs on substance use disorder. PubMed was used with string search terms to identify studies analyzing telehealth for substance use disorders. Studies were eligible and selected if they used health interventions (HIs) and reported outcomes on the efficacy of DHIs, benefits of DHIs, and limitations of DHIs. The Agency of Healthcare Research and Quality (AHRQ) was used to analyze the impact of DHIs on SUD. Lastly, Apple's App Store was used to identify the current DHI available.The analysis indicated that mobile phone apps were the most appropriate sources to use for patients with substance use disorders. The search also found 36 mobile applications available on the market for patients, containing mainly pain medication diaries and trackers. The study did not find any apps for clinical usage that met the standards necessary for adequate healthcare in the opioid crisis, largely due to a lack of clinician involvement in using applications. Developing adequate DHIs has the potential to improve outcomes in patients with SUD and aid in recovery time.The research concluded that physicians looking to develop DHIs should take into consideration the mode of delivery of DHI, the aim to produce specific health outcomes as opposed to multiple outcomes, and clinician involvement in DHI development. DHIs can become a vital tool for medical professionals, especially during the COVID-19 crisis, as the use of healthcare technology has limited in-person contact, maintained current doctor-patient relationships, and allowed for contact tracing of the disease.

The association of patient safety culture with patient satisfaction: The role of the pharmacist's performance

Background and objective A cross-sectional research, the questionnaire-based study aimed to investigate the association between patient safety culture and patient satisfaction through pharmacist performance, between patient safety culture and pharmacist performance, between pharmacist performance and patient satisfaction, and between patient safety culture and patient satisfaction. Methods Pharmacists and pharmacy technicians working in the community pharmacies evaluated the patient safety culture using an online self-administrated questionnaire filled out by participants. The first research questionnaire was adopted from the agency of healthcare research and quality (AHRQ), which was reliable and valid. Pharmacist performance and patient satisfaction were measured by using an online self-completion questionnaire that patients filled out. To measure performance, a previously validated questionnaire was used. For measuring patient satisfaction, The Patient Satisfaction with Pharmacist Clinical Services Questionnaire the final version (PSPSQ 2.0) was used. A total of 204 pharmacists, pharmacy technicians, and 204 patients constitute the research sample. Results The results showed that there is a significant association between the patient safety culture and the pharmacist's performance; an insignificant association between the patient safety culture and patient satisfaction; a significant association between the pharmacist’s performance and patient satisfaction; and a pharmacist’s performance mediates the relationship between patient safety culture and patient satisfaction. Conclusion The pharmacy sector may effectively reinforce patient safety culture in community pharmacies and enhance pharmacists’ performance to improve the quality of care and increase patient satisfaction.

Rate of Radiation Therapy Patient Safety Events by Severity at a Large Academic Medical Center

<h3>Purpose/Objective(s)</h3> To determine the rate of patient safety events by severity at a large academic institution. The rate can be used to compare to other radiation therapy institutions and other industries. <h3>Materials/Methods</h3> A voluntary incident reporting system was used to collect patient safety events over a six-year period (CY2016-2021), representing a rather mature state of the quality and safety improvement program that began around 2009. Events were defined broadly as any condition, defect, event, situation, or miscommunication that could have or did reach the patient, with or without harm. Each event was analyzed by a multidisciplinary committee using a severity score and categorized on a scale of 1-6, comparable to that of the Agency of Healthcare Research and Quality (AHRQ) harm scale. A total of 2,583 events were scored in this six-year period. <h3>Results</h3> See Table 1, below. <h3>Conclusion</h3> Rates of events with severity 1-2 declined over time by around 40% over six years. In contrast, the rate of events with severity 3-6, with or without harm, has stayed constant and may reflect complex technological changes, variabilities in treatment planning approaches and issues with coordination of care. Further research is needed to understand why the rate of events with severity 1-2 has decreased, while that of severity 3-6 has stayed constant and how this compares to other radiation therapy centers and other industries.

What Are the Drivers of Readmission for Serious Venous Thromboembolic Events after Primary Total Knee Arthroplasty? An Analysis of 862,915 Patients.

Venous thromboembolism (VTE) is a relatively common complication among patients undergoing primary total knee arthroplasty (TKA). This complication occurs in a spectrum of severity ranging from an incidental finding to serious readmission-requiring events. To date, the risk factors of serious VTE that require readmission have not been characterized. This study examines the patient and hospital characteristics associated with readmission for serious VTE after TKA. The National Readmission Database (NRD) from the Agency of Healthcare Research and Quality (AHRQ) was queried for patients who underwent primary TKA from January 2016-December 2018. The study population consisted of patients who were readmitted within 90 days following primary TKA with a primary diagnosis of VTE. Multivariable regression models were constructed to evaluate patient characteristics (age, sex, insurance, elective nature of procedure, hospital characteristics, discharge status, income, and comorbidities) associated with higher risk of developing readmission-requiring VTE. Readmission rates for VTE exhibited a higher incidence in patients older than 61 (compared with 40 and under), males (OR:1.08, 95%CI [1.03-1.14]), patients with nonelective procedures (OR:20.21, 95% CI [19.16-21.32]), patients at large hospitals(OR:1.17, 95% CI [1.09-1.25]), patients at private hospitals (OR:1.19, 95% CI [1.09-1.29]), and patients with non-home discharge statuses. Comorbidities of paralysis (OR:1.52, 95% CI [1.19-1.94]), neurological disorders (OR:1.12, 95% CI [1.02-1.23]), metastatic cancer (OR:1.48, 95% CI [1.01-2.17]), obesity (OR:1.11, 95% CI [1.06-1.17]), fluid and electrolyte imbalance (OR:1.28, 95% CI [1.18-1.38]), blood loss anemia (OR:1.29, 95% CI [1.02-1.64]), and iron deficiency anemia (OR:1.24, 95 % CI [1.15-1.33]) increased risk of VTE. Certain comorbidities requiring chronic anticoagulation were associated with lower risk of VTE. Insurance status and patient income did not exhibit any correlation with VTE incidence. Patient characteristics of male sex, age > 61, and baseline comorbidities (paralysis, neurological disorders, metastatic cancer, obesity, fluid and electrolyte imbalance, and blood loss/iron deficiency anemia) were at an increased risk of developing serious VTE. Patients without continued supervision at their discharge environment were at higher risk of developing serious VTE. Extra prophylaxis and special protocols may be warranted in these patients to prevent VTE complications.

Abstract TMP45: Potential For Unwarranted Poor Institutional Patient Safety Scores From Inclusion Of Endovascular Thrombectomy In Us National Ahrq Patient Safety Indicator Program

Introduction: The US Agency of Healthcare Research and Quality (AHRQ) has defined 19 Patient Safety Indicators (PSIs) identifying preventable inpatient events. For endovascular and surgical procedures, PSI-4 is applied: detection of mortality after post-procedural complications of pneumonia, DVT/PE, sepsis, GI hemorrhage, or shock/cardiac arrest. But while a potentially useful metric for elective procedures with expected good outcomes, PSI-4 is also appled to emergent endovascular thrombectomy (EVT) for acute ischemic stroke, which has a high rate of unavoidable fatal outcomes. The appropriateness of PSI-4 for EVT assessment has not been empirically studied. Methods: 1) Systematic literature review to identify comparative rates of unwanted outcomes across all PSIs and diverse endovascular/surgical procedures. 2) Detailed review of consecutive EVT cases at a CSC administratively receiving a PSI-4 safety concern finding by independent non-interventional stroke and neurointerventional experts. Results: The systematic literature review found the overall national event frequency for PSI-4 across all endovascular/surgical procedures was one to several orders of magnitude higher than for the other 18 PSIs, 11.9% vs 0.0004% to 2.1%. Further, within PSI-4, the national event rate for EVT was substantially higher than for general endovascular and surgical procedures, 40.1% vs 11.9%. During a 3-year period from 2016-2018 at the CSC, EVT cases accounted for 11% of neurosurgical PSI-4 findings though they represented only 1.5% of neurosurgical procedures. Detailed analysis of 4 consecutive EVT cases coded as PSI-4 safety events from administrative data per AHRQ algorithms revealed that in all cases patient deaths were actually related to complications of the index stroke, not of the EVT procedure - the cases raised no actual safety concerns. Conclusion: AHRQ Patient Safety Indicator-4 does not identify preventable events among EVT patients and has the potential to misleadingly suggest poor quality of care at hospitals that provide a high volume of endovascular stroke interventions. To avoid unintended consequences of discouraging institutions from pursuing EVT or incorrectly profiling their safety performance, revision of PSI-4 is indicated.

Trends and Outcomes of Venous Thromboembolism in Hospitalized Patients with Pancreatic Cancer: Results from National Inpatient Sample Database 1998-2016

Introduction: Pancreatic cancer (PC) has a known association with venous thromboembolism (VTE), with incidence of approximately 17%. There is limited published data about trends and outcomes of PC patients with VTE. The purpose of this study was to describe the prevalence and mortality trends in PC with VTE and analyze VTE impact on hospitalized PC patients from 1998 to 2016. Methods: We analyzed data from the National Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). Adults≥18 years with PC as well as presence of VTE were identified by using ICD-9 or ICD-10 codes. Cost of hospitalization was adjusted for inflation in reference to 2016. Comorbidities were classified using the Elixhauser comorbidity index. Demographic characteristics, trends and in-hospital outcomes between PC with and without VTE were compared. Multiple logistic regression was used to obtain risk-adjusted odds ratio (OR) to compare inpatient mortality, length of stay (LOS), total charges, and disability at discharge between PC patients with and without VTE. The regression model was adjusted for age, sex, primary expected payer, teaching status of the hospital, hospital location, and presence of comorbid conditions. Results: 96,777 (6.5%) of a total of 1,488,543 hospitalized PC patients had an accompanying diagnosis of VTE. Mean age of the study population was 67 years. African Americans, younger age, and metastatic disease are associated with higher VTE prevalence rate. After adjusting for potential confounders, compared with those without VTE, PC patients with VTE had significantly higher inpatient mortality (12.6% vs 9.7%; OR, 1.41 [confidence interval (CI), 1.34-1.49]; P&lt;0.001), longer LOS (8.04 vs 7.98 days; OR, 1.27 [CI, 1.23-1.32]; P&lt;0.001), higher average cost of hospitalization (US $71,332 vs US $57,117; OR, 1.4 [CI, 1.34-1.46]; P&lt;0.001), and greater likelihood of moderate to severe disability (defined as any beyond routine home discharge; ranging from short-term stay to skilled nursing facility to death upon discharge) (62.2% vs 50.6%, OR, 1.71 [CI, 1.65-1.78]; P&lt;0.001). Although the annual prevalence of VTE among PC increased from 2.1% to 8.8%, in-hospital mortality declined from 23.3% in 1998 to 12.9% in 2016 (P&lt;0.001). Conclusion: In the NIS cohort of hospitalized patients with PC and VTE from 1998-2016, annual prevalence increased while mortality overall decreased. When compared to patients without VTE, PC patients with VTE had higher inpatient mortality, longer length of stay, higher hospital cost and higher degree of disability upon discharge. Consideration for anticoagulation and interventions to limit VTE in PC patients may improve in-hospital outcomes. Figure Disclosures No relevant conflicts of interest to declare.

Trends, Predictors and Outcomes of Portal Vein Thrombosis in Hospitalized Pancreatic Cancer Patients: National Inpatient Sample Analysis 1998-2016

Introduction: Portal vein thrombosis (PVT) is usually associated with intra-abdominal malignancies, particularly pancreatic cancer (PC). PVT prevalence rate and impact on outcome of PC patients are not well studied, especially on a large scale of cohort. We described the prevalence and mortality trends of PVT amongst PC patients and analyzed their demographic characteristics. We also studied the impact of PVT with PC on hospitalization outcomes. Methods: We queried the 1998-2016 National Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). Hospitalized adult patients (age≥18 years) with diagnosis of PC as well as presence of PVT were identified by using ICD-9 or ICD-10 codes. Cost of hospitalization was adjusted for inflation in reference to 2016. Comorbidities were classified using the Elixhauser comorbidity index. We used linear regression models to analyze trends in prevalence and outcomes over time. Logistic regression models were generated to evaluate multivariate predictors of length of stay (LOS), total charges, mortality, and complications in PC patients with and without PVT. The regression model was adjusted for age, sex, primary expected payer, teaching status of the hospital, hospital location, comorbid conditions, and presence of venous thromboembolism (VTE). Results: Among a total of 1,488,543 hospitalized PC patients, 19,725 (1.3%) experienced PVT. Mean age was 68 years. Hispanic Americans, younger age, teaching hospital, urban hospital and metastatic disease were associated with higher PVT prevalence rate. Interestingly, VTE prevalence in PC patients with and without PVT were 11% and 6% respectively, P&lt;0.001. After adjusting for potential confounders, compared with those without PVT, PC patients with PVT had significantly higher inpatient mortality (10.5% vs 9.9%; odds ratio (OR), 1.16 [confidence interval (CI), 1.03-1.30]; P=0.013), longer LOS (8.29 vs 7.03 days; OR, 1.27 [CI, 1.19-1.36]; P&lt;0.001), higher average cost of hospitalization (US $81,858 vs US $57,722; OR, 1.54 [CI, 1.43-1.67]; P&lt;0.001), and greater likelihood of moderate to severe disability (defined as any beyond routine home discharge; ranging from short-term stay to skilled nursing facility to death upon discharge)(55.9% vs 51.3%, OR, 1.4 [CI, 1.31-1.50]; P&lt;0.001). Although the annual prevalence of PVT among PC increased from 0.3% to 3.0% (p&lt;0.001), in-hospital mortality declined significantly from 29.2% in 1998 to 8.0% in 2016 (p&lt;0.001). Conclusion: In retrospective analysis of the NIS cohort of hospitalized patients with PC and PVT from 1998-2016, the prevalence increased by 10 folds. However, in-hospital mortality decreased significantly. Compared to those without PVT, patients with PC with PVT had higher inpatient mortality, longer length of stay, higher hospital cost and higher degree of disability upon discharge. Further studies are warranted to reveal a certain subgroup of PC patients who may benefit from prophylactic anticoagulation. Figure Disclosures No relevant conflicts of interest to declare.

Relationship between patient safety indicator events and comprehensive stroke center volume status in the treatment of unruptured cerebral aneurysms.

OBJECTIVE The Agency of Healthcare Research and Quality (AHRQ) has defined Patient Safety Indicators (PSIs) for assessments in quality of inpatient care. The hypothesis of this study is that, in the treatment of unruptured cerebral aneurysms (UCAs), PSI events are less likely to occur in hospitals meeting the volume thresholds defined by The Joint Commission for Comprehensive Stroke Center (CSC) certification. METHODS Using the 2002-2011 National (Nationwide) Inpatient Sample, patients treated electively for a nonruptured cerebral aneurysm were selected. Patients were evaluated for PSI events (e.g., pressure ulcers, retained surgical item, perioperative hemorrhage, pulmonary embolism, sepsis) defined by AHRQ-specified ICD-9 codes. Hospitals were categorized by treatment volume into CSC or non-CSC volume status based on The Joint Commission's annual volume thresholds of at least 20 patients with subarachnoid hemorrhage and performance of 15 or more endovascular coiling or surgical clipping procedures for aneurysms. RESULTS A total of 65,824 patients underwent treatment for an unruptured cerebral aneurysm. There were 4818 patients (7.3%) in whom at least 1 PSI event occurred. The overall inpatient mortality rate was 0.7%. In patients with a PSI event, this rate increased to 7% compared with 0.2% in patients without a PSI event (p < 0.0001). The overall rate of poor outcome was 3.8%. In patients with a PSI event, this rate increased to 23.3% compared with 2.3% in patients without a PSI event (p < 0.0001). There were significant differences in PSI event, poor outcome, and mortality rates between non-CSC and CSC volume-status hospitals (PSI event, 8.4% vs 7.2%; poor outcome, 5.1% vs 3.6%; and mortality, 1% vs 0.6%). In multivariate analysis, all patients treated at a non-CSC volume-status hospital were more likely to suffer a PSI event with an OR of 1.2 (1.1-1.3). In patients who underwent surgery, this relationship was more substantial, with an OR of 1.4 (1.2-1.6). The relationship was not significant in the endovascularly treated patients. CONCLUSIONS In the treatment of unruptured cerebral aneurysms, PSI events occur relatively frequently and are associated with significant increases in morbidity and mortality. In patients treated at institutions achieving the volume thresholds for CSC certification, the likelihood of having a PSI event, and therefore the likelihood of poor outcome and mortality, was significantly decreased. These improvements are being driven by the improved outcomes in surgical patients, whereas outcomes and mortality in patients treated endovascularly were not sensitive to the CSC volume status of the hospital and showed no significant relationship with treatment volumes.

Impact of end stage kidney disease on costs and outcomes of Clostridium difficile infection

ObjectivesTo assess the impact of end stage kidney disease (ESKD) on the outcomes of Clostridium difficile infection (CDI), including complications of infection, length of hospital stay, overall mortality, and healthcare burden. MethodsThe National Inpatient Sample (NIS) database created by the Agency of Healthcare Research and Quality (AHRQ) was used, covering the years 2009 through 2013. Manufacturer-provided sampling weights were used to produce national estimates. ResultsAll-cause unadjusted in-hospital mortality was significantly higher for patients with CDI and ESKD than for patients without ESKD (11.6% vs. 7.7%, p<0.001). The in-hospital mortality remained higher even after adjusting for age, sex, race, and Charlson index group using multivariate logistic regression (odds ratio 1.47, confidence interval 1.41–1.53). The median length of stay was found to be longer by 2days in the ESKD group (9 vs. 7 days, p<0.001). The average cost of hospitalization for patients with CDI and ESKD was also significantly higher compared to the non-ESKD group (USD $35 588 vs. $23 505, in terms of the 2013 value of the USD, p<0.001). ConclusionsThe presence of end stage kidney disease in hospitalized patients with Clostridium difficile infection is associated with higher mortality, a longer length of stay, and a higher cost of hospitalization.

Quality and performance measures of strain on intensive care capacity: a protocol for a systematic review.

BackgroundThe matching of critical care service supply with demand is fundamental for the efficient delivery of advanced life support to patients in urgent need. Mismatch in this supply/demand relationship contributes to “intensive care unit (ICU) capacity strain,” defined as a time-varying disruption in the ability of an ICU to provide well-timed and high-quality intensive care support to any and all patients who are or may become critically ill. ICU capacity strain leads to suboptimal quality of care and may directly contribute to heightened risk of adverse events, premature discharges, unplanned readmissions, and avoidable death. Unrelenting strain on ICU capacity contributes to inefficient health resource utilization and may negatively impact the satisfaction of patients, their families, and frontline providers. It is unknown how to optimally quantify the instantaneous and temporal “stress” an ICU experiences due to capacity strain.MethodsWe will perform a systematic review to identify, appraise, and evaluate quality and performance measures of strain on ICU capacity and their association with relevant patient-centered, ICU-level, and health system-level outcomes. Electronic databases (i.e., MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and the Agency of Healthcare Research and Quality (AHRQ)—National Quality Measures Clearinghouse (NQMC)) will be searched for original studies of measures of ICU capacity strain. Selected gray literature sources will be searched. Search themes will focus on intensive care, quality, operations management, and capacity. Analysis will be primarily narrative. Each identified measure will be defined, characterized, and evaluated using the criteria proposed by the US Strategic Framework Board for a National Quality Measurement and Reporting System (i.e., importance, scientific acceptability, usability, feasibility).DiscussionOur systematic review will comprehensively identify, define, and evaluate quality and performance measures of ICU capacity strain. This is a necessary step towards understanding the impact of capacity strain on quality and performance in intensive care and to develop innovative interventions aimed to improve efficiency, avoid waste, and better anticipate impending capacity shortfalls.Systematic review registrationPROSPERO, CRD42015017931Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0145-9) contains supplementary material, which is available to authorized users.

Predictors and outcomes of venous thromboembolism in hospitalized lung cancer patients: A Nationwide Inpatient Sample database analysis.

Patients with lung cancer are at high risk of developing venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism. We sought to characterize the clinical factors associated with development of VTE and the impact of VTE on outcomes for hospitalized lung cancer patients. We analyzed data captured in the Nationwide Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). The study included all lung cancer patients hospitalized between 2006 and 2010 who had VTE captured as one of the top three discharge diagnoses. Demographics and outcomes of this population were compared to those of inpatient lung cancer patients without a VTE diagnosis. All analyses were performed using SAS version 9.3. Out of 570,304 lung cancer hospitalizations, 20,672 had a clinically relevant diagnosis of VTE, accounting for 3.6% of all events. The median age of lung cancer patients with VTE was 68 years; 48% were females, 79% were Caucasians, and 43% had metastatic disease. When compared to a lung cancer cohort without VTE (n=502,153), patients with VTE had significantly longer length of stay (LOS) (7.15 days vs. 6.05 days, OR 1.12), higher inpatient mortality (10.03% vs. 8.69%, OR 1.06), higher total hospital charges ($43,800 vs. $37,800, OR 1.07), and greater likelihood of moderate to severe disability upon discharge (55% vs. 49%, OR 1.23). VTE in hospitalized lung cancer patients is associated with longer LOS, higher inpatient mortality rates, increased cost and greater disability upon discharge compared to other inpatient lung cancer patients.

Health Services & Policy Research in translational medicine.

Translational medicine is often defined through its process. Researchers from different disciplines may see the process differently (Figure 1) (1). Basic scientists and clinicians may describe it as the “bench to bedside” approach of medical research (2). Only a few institutes of translational medicine realize that Health Services & Policy Research (HSPR) is an important component in translational medicine (3,4). Health services & policy researchers can bridge laboratory research, clinical studies, community practice, and health policy to improve public health. Figure 1 Process of translational medicine from different researchers’ perspective. The goal of translational medicine is to translate academic research into population health (5). US National Health Institute launched the Clinical and Translational Science Awards (CTSA) program in 2006 to strengthen the full spectrum of translational research. In 2012, NIH published a summary report based on the stakeholders’ feedback about the CTSA program. Only two vague long-term outcomes were proposed to measure the value added by the CTSA program: increased utilization of new treatments in the community and community health indicators improvement (6). However, the CTSA program has realized that NIH should engage with Center of Medicare and Medicaid Services (CMS) and Agency of Healthcare Research and Quality (AHRQ) to promote HSPR such as comparative effectiveness research and patient centered outcomes research. Basic scientists and clinicians need to work synergistically with health services & policy researchers in the translational process. HSPR in translational medicine is different from the biostatistical support in the current CTSA program. HSPR evaluates effectiveness and cost-effectiveness of the new technology or treatment with observational data and survey data when the new treatment expands discovery to larger patient populations. HSPR employs comparative effectiveness research to determine if a certain treatment or technology works in a real-world setting when the practice-oriented stage of translational research is implemented and find out subgroups of patients who benefit the most (or the least) from the new therapy. If everything was successful, we need to evaluate the current healthcare policy and delivery system to identify barriers to disseminate and implement the new therapy and propose certain policy changes to efficiently reach clinicians and patients. In summary, translational medicine is not just bench to bedside, prototype to device, or beaker to pill. HSPR is an essential component of translational medicine. It is a critical move for Annals of Translational Medicine to create a new HSPR column. This new column will provide a forum for the researches that bridge academic research, health policy, and medical practice. The articles appearing in this column will be authored by scholars from universities, government, private research organizations, and industry. We welcome all submissions that examine how and whether new therapies and research knowledge reach the intended people and are implemented efficiently. The publications from the HSPR column will strengthen communication with practitioners and policymakers and influence medical practice and health policy at all administrative levels.

Transfusion errors and management

Error is an inherent component and an intrinsic by-productof every activity in which humans are involved. This ten-dency to err is philosophically perhaps one of the definingtraits that characterize us as human beings. Transfusionerrors probably existed once blood transfusion became anessential component of medical treatment. However, thesystematic acknowledgement, recognition and analysis ofthese errors are certainly a much more recent phenomenon.According to an Institute of Medicine (IOM) reportreleased in 1999 [1], medical errors are one of the leadingcause of death in the US and have caused an estimated44 000–98 000 deaths per year, which is soberingly morethan the motor vehicle accident death rate of 43 458 forthat particular year.Errors and adverse events carry a high financial burden.The Agency of Healthcare Research and Quality (AHRQ)estimated that the cost of medical errors resulting inadverse events is approximately $37AE6 billion per year, and$17 billion of those costs are preventable [1]. Significantly,the AHRQ has reported that medical errors are not onlybecause of medication errors but can result from bloodtransfusion errors, misdiagnosis, misinterpretation of labo-ratory results with incorrect therapy, equipment failure,hospital acquired infections or misinterpretation medicalorders.Looking specifically at transfusion mortality, Schmidtreviewed 69 records of deaths labelled as transfusion mor-tality and concluded that 31 (44AE9%) were directly attribut-able to transfusion, of which 25 were due to red cellincompatibilities and discrepancies [2]. Myhre reviewed113 records fatalities reported to the Food and DrugAdministration (FDA) as a sequelae of blood or blood prod-uct transfusion from 3 April 1976 to 31 December 1979 [3].Thirty-three fatalities were due to post-transfusion hepati-tis, and three involved plasmapheresis or leucopheresisdonors. The remaining 77 cases were of three categories:the vast majority were preventable errors: 47 cases (61%)were due to ‘‘clerical errors’’ such as drawing the wrongblood specimen or giving the wrong unit of blood to thepatient; 8 cases consisted of genuine errors that occurred inthe laboratory and 22 miscellaneous cases.Many other recent reports exist with the majority retro-spective and involving registry data (e.g. reporting to theFDA). Honig and Bove listed 70 fatalities, 38 of which weredue to transfusion errors [4]. Camp and Monaghan studied126 FDA reports from 1976 through 1980. They found that64 reactions that were due to simple clerical errors, such asgiving the blood to the wrong patient [5].In a landmark paper, Sazama and colleagues studiedtransfusion-related deaths reported to the US FDA for10 years and identified 131 fatal ABO incompatible trans-fusions. The study showed that the most frequent errorleading to a fatal outcome was administration to someoneother than the intended recipient [6]. Records of transfusionerrors in the New York State for the past 10 years (Linden)showed that erroneous blood administration was observedin 1 out of 19 000 RBC units administered. Half of theseevents occurred outside the blood bank (administration tothe wrong recipient, phlebotomy errors, testing of thewrong specimen, transcription errors and issuance of thewrong unit) with 15% of cases involving multiple errors [7].McClelland and Phillips conducted a study and analysedthe data from haematology laboratories in the UK for theyears 1990 and 1991. They sent a questionnaire to 400 lab-oratories involved in blood transfusion and only 245 (61%)submitted their reply. The reports included data on deaths,morbidity and near misses. One-third of the laboratoriesreported incidents in which the patient received a wrongunit of blood [8].

The Experience of Living with Co-Morbidities of Chronic Lymphatic Filariasis among Patients 15 Years and Older in Developing Countries: A Systematic Review.

Review Objectives The objective of this systematic review is to understand the experiences of persons 15 years and older living with Chronic Lymphatic Filariasis (CLF) in developing countries. The specific review questions are: 1. What are the experiences of persons living with CLF? 2. What are the experiences of persons with CLF about strategies used to prevent/ treat the condition? 3. What is the influence of CLF on social relationships of persons affected? Inclusion criteria Types of Participants The review will consider publications that focus on developing countries and specifically include people of 15 years and older with manifestations of CLF. Phenomena of Interest The review will focus on studies that investigate the experience of living with manifestations of CLF. The review will also focus on studies that address the experiences and subjective opinions of persons that have employed various strategies of prevention/ treatment of the condition. The review will also consider studies that address the social relationships of persons living with CLF.

Evaluation of conflicting literature and application to formulary decisions

Guidelines were developed for grading the quality, quantity, and consistency of drug literature in support of formulary recommendations. Four developmental steps were taken to create a comprehensive literature evaluation system. The first step identified the attributes of a body of literature that were most reflective of its applicability to patient care. The next step defined each domain (quality, quantity, consistency), as determined by the Agency of Healthcare Research and Quality (AHRQ), in terms of the specific qualities to be assessed; a value was assigned to those qualities. Also, a literature search was conducted to identify strategies for evaluating bodies of literature employed in published assessment tools. Following the analysis of previously published systems, which were evaluated with respect to their inclusion of the AHRQ-identified domains, the next step was the development of specific domains and definitions to get a composite grade (with "better" evidence earning more points) for formulary recommendations. The final step was the creation of a system that aggregated the final score for the recommendation. The recommendation was categorized according to quality, quantity, and consistency of supporting evidence, and the total number of points was calculated and the recommendation given letter and numerical grades. The guidelines that were developed allow the user to accurately, consistently, and easily determine the strength of recommendations for a body of literature that may be conflicting. The addition of criteria for quantity and consistency to previously-published grading systems has made the guidelines more objective. A system that accounts for the quality, quantity, and consistency of drug literature was developed to assist in making formulary decisions.