miércoles, 22 de noviembre de 2017

Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes. - PubMed - NCBI

Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes. - PubMed - NCBI



 2016 May 20;16:99. doi: 10.1186/s12872-016-0275-6.

Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes.

Abstract

BACKGROUND:

Comorbid diabetes is common in heart failure and associated with increased hospitalization and mortality. Nonetheless, the association between glycemic control and outcomes among patients with heart failure and diabetes remains poorly characterized, particularly among low income and minority patients.

METHODS:

We performed a retrospective cohort study of outpatients with heart failure and diabetes in the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States. Cox proportional hazard models were used to measure the association between HbA1c levels and outcomes of all-cause hospitalization, heart failure hospitalization, and mortality.

RESULTS:

Of 4723 patients with heart failure and diabetes, 42.6 % were black, 30.5 % were Hispanic/Latino, 31.4 % were Medicaid beneficiaries and 22.9 % were uninsured. As compared to patients with an HbA1c of 8.0-8.9 %, patients with an HbA1c of <6.5, 6.5-6.9, 7.0-7.9, and ≥9.0 % had an adjusted hazard ratio (aHR) (95 % CI) for all-cause hospitalization of 1.03 (0.90-1.17), 1.05 (0.91-1.22), 1.03 (0.90-1.17), and 1.13 (1.00-1.28), respectively. An HbA1c ≥ 9.0 % was also associated with an increased risk of heart failure hospitalization (aHR 1.33; 95 % CI 1.11-1.59) and a non-significant increased risk in mortality (aHR 1.20; 95 % CI 0.99-1.45) when compared to HbA1c of 8.0-8.9 %.

CONCLUSIONS:

Among a cohort of primarily minority and low income patients with heart failure and diabetes, an increased risk of hospitalization was observed only for an HbA1c greater than 9 %.

KEYWORDS:

Diabetes; Heart failure; hbA1c

PMID:
 
27206478
 
PMCID:
 
PMC4875651
 
DOI:
 
10.1186/s12872-016-0275-6

[Indexed for MEDLINE] 
Free PMC Article

Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis-Requiring AKI (AKI-D) After Cardiac Catheterization in the National I... - PubMed - NCBI

Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis-Requiring AKI (AKI-D) After Cardiac Catheterization in the National I... - PubMed - NCBI



 2016 Mar 15;5(3):e002739. doi: 10.1161/JAHA.115.002739.

Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis-Requiring AKI (AKI-D) After Cardiac Catheterization in the National Inpatient Sample.

Abstract

BACKGROUND:

Acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) are common, serious complications of cardiac procedures.

METHODS AND RESULTS:

We evaluated 3 633 762 (17 765 214 weighted population) cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI-D in the United States from 2001 to 2011. Odds ratios for both conditions and associated in-hospital mortality were calculated for each year in the study period using multiple logistic regression. The number of cardiac catheterization or PCI cases resulting in AKI rose almost 3-fold from 2001 to 2011. The adjusted odds of AKI and AKI-D per year among cardiac catheterization and PCI patients were 1.11 (95% CI: 1.10-1.12) and 1.01 (95% CI: 0.99-1.02), respectively. Most importantly, in-hospital mortality significantly decreased from 2001 to 2011 for AKI (19.6-9.2%) and AKI-D (28.3-19.9%), whereas odds of associated in-hospital mortality were 0.50 (95% CI: 0.45-0.56) and 0.70 (95% CI: 0.55-0.93) in 2011 versus 2001, respectively. The population-attributable risk of mortality for AKI and AKI-D was 25.8% and 3.8% in 2001 and 41.1% and 6.5% in 2011, respectively. Males and females had similar patterns of AKI increase, although males outpaced females.

CONCLUSIONS:

The Incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States, and this should be addressed by implementing prevention strategies. However, mortality has significantly declined, suggesting that efforts to manage AKI and AKI-D after cardiac catheterization and PCI have reduced mortality.

KEYWORDS:

acute kidney injury; acute renal failure; glomerular filtration rate; renal failure

PMID:
 
27068629
 
PMCID:
 
PMC4943252
 
DOI:
 
10.1161/JAHA.115.002739

[Indexed for MEDLINE] 
Free PMC Article

Funding the Next Generation of Learning-Health-System Researchers | Agency for Healthcare Research & Quality

Funding the Next Generation of Learning-Health-System Researchers | Agency for Healthcare Research & Quality

AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care



AHRQ Views

Blog posts from AHRQ leaders
Gopal KhannaThe health care community is finding common ground when it comes to identifying essential elements of a learning health system (LHS). At their core, organizations that apply LHS principles are committed to improving patient care through the generation, adoption, and application of evidence to improve health care quality and safety and patients' outcomes.
However, the promise of better care through the rigorous use of evidence cannot be realized without an ingredient that's even more basic: a health care workforce properly trained to conduct research within a learning health system.
With that pressing need in mind, our organizations—the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute Link to Exit Disclaimer (PCORI)—are excited to collaborate on an initiative to award up to $8 million in total annually to as many as 10 institutions to support training programs to establish a sustainable corps of learning-health-system researchers.
As summarized in a new funding opportunity announcement, the ideal LHS researcher works within a health system, encourages collaboration with other scholars and stakeholders, and is involved in the rapid, continuous production and translation of evidence into patient-centered care.
We envision that programs supported by these training funds will prepare clinician scientists and research scientists for independent research careers within care delivery systems, equipping the scientists to advance the field through their training and scholarship as the next generation of LHS researchers.
Joe SelbyApplicants must be academic institutions or health care systems with a track record of excellence in training clinical research scientists to work and conduct research within these systems. Academic applicants must establish collaborative relationships with at least one health system. Health system applicants are encouraged to demonstrate collaborative relationships with at least one academic training institution.
We believe this approach will produce a cadre of researchers, mentors, and rapid learning initiatives that can accelerate health system performance and improvements in patient outcomes. These improvements will come through application of core LHS competencies, which include integration of the principles and practices of patient-centered outcomes research (PCOR).
The ultimate goal, of course, is to improve the quality of care and patient outcomes. For that reason this effort focuses on the best ways to provide trainees skills in patient-centered methods to rapidly implement evidence.
While the full details appear in the funding opportunity announcement, applicants are generally expected to:
  • Identify, recruit, and train clinician and research scientists
  • Establish LHS Centers of Excellence
  • Support a learning collaborative across the Centers of Excellence
  • Demonstrate a focus on conducting PCOR
In their proposals and training programs, applicants will also be expected to apply AHRQ's LHS researcher core competencies, knowledge- and skill-based competencies that guide the design, implementation, and evaluation of training programs for LHS researchers. They must also incorporate the PCORI Methodology Standards Link to Exit Disclaimer in their curricula.
This partnership further aligns with both AHRQ's and PCORI's organizational goals. AHRQ has made it a priority to support the training of researchers in the health care workforce to put the results of research into practice; and PCORI has made it a goal to help patients and those who care for them make better-informed decisions about the health care choices they face through the conduct of patient-centered comparative effectiveness research. With these combined goals, the potential is enormous for improving efficiency and quality of patient care.
We believe coming together will help achieve these shared goals. The deadline to apply for this funding opportunity is January 24, 2018. We look forward to receiving excellent proposals!
Gopal Khanna is Director of AHRQ and Joe Selby is Executive Director of PCORI
Page last reviewed October 2017
Page originally created October 2017
Internet Citation: Funding the Next Generation of Learning-Health-System Researchers. Content last reviewed October 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/blog/ahrqviews/funding-learning-health-system-researchers.html

RFA-HS-17-012: Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute Learning Health Systems Mentored Career Development Program (K12)

RFA-HS-17-012: Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute Learning Health Systems Mentored Career Development Program (K12)

AHRQ News Now



Application Deadline Approaching for Learning Health Systems Training Grants

Jan. 30 is the deadline for organizations to apply for grants aimed at training clinicians and research scientists to work in learning health systems. Grantees will prepare newly trained scientists for independent research careers with the ultimate goal of improving quality of care and patient outcomes. The initiative is co-sponsored by AHRQ and the Patient-Centered Outcomes Research Institute. Access more information about the grant opportunity as well as a recent AHRQ Views blog post about the initiative.

Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices

Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices



Analysis Finds Inconsistent Use of Health Literacy Techniques Among Clinicians

A new AHRQ study found that most health care providers did not always adopt “health literacy universal precautions,” such as checking that their instructions were clear enough for patients to understand. The study, published in Health Literacy Research and Practice, analyzed AHRQ Medical Expenditure Panel Survey data to determine the extent to which providers were adopting precautions such as clear instructions, “teach back” methods and help with filling out forms. People who were older, less educated or members of racial or ethnic minority groups were more likely to be asked to confirm their understanding or be offered help with forms. Access the article


AHRQ News Now



Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices

Lan Liang, PhD; Cindy Brach, MPP

Abstract

BACKGROUND:
Experts have recommended the adoption of health literacy universal precautions, whereby health care providers make all health information easier to understand, confirm everyone's comprehension, and reduce the difficulty of health-related tasks. The U.S. Department of Health and Human Services selected three health literate practices to track progress in the adoption of health literacy universal precautions.
OBJECTIVES:
This study sought to examine whether there has been an increase in the delivery of health literate care and whether recommendations for health literacy universal precautions are being followed.
METHODS:
This study used trend and multiple regression analyses of data from 2011 to 2014 from the Medical Expenditure Panel Survey, a national household survey.
KEY RESULTS:
The proportion of adults in the U.S. who reported receiving health literate care increased from 2011 to 2014, but fell far short of health literacy universal precautions recommendations of delivering health literate care to everyone. In 2014, 70% of the population reported their providers always gave them instructions that were easy to understand, but only 29% were asked to Teach-Back the instructions and only 17% were offered help with forms. Older, less educated, and racial and ethnic minority group members were more likely to report receiving health literate care than more advantaged groups. People who perceived their health and mental health as fair or poor were less likely to report receiving health literate care.
CONCLUSIONS:
Failure to adopt health literacy universal precautions in the face of the high prevalence of limited health literacy in the general population may perpetuate adverse health outcomes that are costly to society. Greater efforts should be made to increase providers' health literacy skills, particularly those who serve populations that are more likely to have limited health literacy, including those with poor health. [Health Literacy Research and Practice. 2017;1(4):e216–e230.]

WebM&M Cases & Commentaries | AHRQ Patient Safety Network

WebM&M Cases & Commentaries | AHRQ Patient Safety Network

AHRQ News Now



Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:




Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Medical Expenditure Panel Survey Home

Medical Expenditure Panel Survey Home

MEPS Home

What's New Highlights
New Publications
Research Findings 38: Dental Services: Use, Expenses, Source of Payment, Coverage and Procedure Type, 1996 - 2015 This Research Finding presents Medical Expenditure Panel Survey (MEPS) data for a 20 year period from 1996 to 2015 on dental use, expenses, source of payments, coverage and procedure type for the U.S civilian noninstitutionalized (community) population. Estimates are presented for the total population as well as for specific population groups categorized in terms of sex, race/ethnicity, age, income, dental insurance coverage, employment, and education.

New Data Files
This updated file provides combined variance stratum and PSU variables for use with pooled data from the MEPS Full Year 1996-2015 public use files MEPS HC-036: MEPS 1996-2015 Pooled Linkage Variance Estimation File.

This updated file provides balanced repeated replication (BRR) half-sample indicators for variance estimation for use with pooled or individual year data from the MEPS Full Year 1996-2015 public use files MEPS HC-036BRR: MEPS 1996-2015 Replicates for Variance Estimation File