Lance's Corner

AHRQ Issues Regulatory Update

May 14, 2024

The Agency for Healthcare Research and Quality has issued its weekly regulatory update, which can be read below.

May 14, 2024, Issue #913

AHRQ Stats: Maternal Deaths by Race/Ethnicity

In 2020, out of every 100,000 maternity admissions, an average of 12.2 Black women died—more than double the average of 5.6 deaths for every 100,000 maternity admissions among White women. Hispanic women also faced higher rates of death than White women, with an average of 8.5 deaths for every 100,000 maternity admissions. (Source: AHRQ 2024 Chartbook on Patient Safety.)

Today's Headlines:

Data Reveal Uneven Impact of COVID-19 on Urban, Rural Hospitals

rural The COVID-19 pandemic impacted rural hospitals more significantly than those in urban settings, according to two studies using data from AHRQ’s Healthcare Cost and Utilization Project (HCUP). One study, published in Health Affairs, revealed that 35 percent of rural hospitals experienced more than 20 percent increases or decreases in the daily patient volume during the pandemic, compared with just 13 percent of urban hospitals. Rural hospitals that were most impacted were likely to be small-sized, or owned by State or local governments, or classified as critical access hospitals. The other study, published in JAMA Network Open, found that the odds of in-hospital mortality for sepsis increased by 35 percent at rural hospitals during the pandemic, compared with an increase of 27 percent at urban hospitals. The authors of both studies suggested that tailoring responses to the unique needs of rural hospitals could reduce the uneven impact of future health crises.

AHRQ Views Blog Post: Working Together To Tackle Inequities, Centering the Voice of Women

AHRQ’s support for National Women's Health Week and the potential of empowered women to pursue lives of wellness and resilience is the subject of a new AHRQ Views blog post. The theme aligns with AHRQ’s ongoing efforts to address the healthcare needs of all women. For example, a recent AHRQ-funded evidence report explored how the healthcare community can effectively deliver respectful maternity care. Also highlighted among AHRQ activities is the agency’s EvidenceNow: Managing Urinary Incontinence (UI), an initiative to disseminate strategies in primary care for nonsurgical treatment of UI in women. Access the blog post, authored by Kamila B. Mistry, Ph.D., M.P.H., deputy director for AHRQ’s Office of Extramural Research, Education, and Priority Populations; Emily Chew M.P.H., senior advisor for women’s health and gender research; Kisha I. Coa, Ph.D., M.P.H., division director for priority populations. To receive all blog posts, submit your email address.

Diagnostic Error in Mental Healthcare Common but Not Well Defined

Dx errorDiagnostic error is well understood to be a problem in mental healthcare, but there is a lack of consensus on how to conceptualize, define and measure errors in diagnosis, according to an AHRQ-funded review published in BMJ Quality & Safety. Researchers summarized the state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. They found that few studies used clear definitions or frameworks for understanding diagnostic error in mental health, but several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Access the abstract.

New Mental Health Resources From AHRQ

During Mental Health Awareness Month, AHRQ’s Academy for Integrating Behavioral Health and Primary Care is highlighting Integrating Harm Reduction into Primary Care Practices, a resource that emphasizes the importance of helping patients reduce or prevent the harms of substance use. Harm reduction principles and practices prioritize engaging directly with patients with substance use disorders to prevent overdoses and infectious disease, improve physical and mental health and offer appropriate mental health disorder treatment. The Academy is also highlighting Mental Health Awareness Month Resources, which highlight resources from leading mental health agencies and organizations.

New AHRQ Funding Notices

  • A Notice of Intent (NOI) signals AHRQ’s intention to invite grant applications that support healthcare safety by determining whether and how certain breakthrough uses of artificial intelligence (AI) systems can affect patient safety, and how AI systems can be safely implemented and used.
  • A Special Emphasis Notice (SEN) announces AHRQ’s interest in health services research to improve care delivery, access, quality, equity and health outcomes for older adults. The SEN builds on AHRQ’s prior work, including the Optimizing Health and Function as We Age Roundtable Report .

Registration Open for Free Safety Program To Improve Antibiotic Use in Telemedicine

telemedicineThe AHRQ Safety Program for Telemedicine: Improving Antibiotic Use is recruiting primary and urgent care practices and retail clinics that use telemedicine for a no-cost, 18-month program to strengthen antibiotic prescribing practices. The program will begin in June and provide evidence-based guidance to improve antibiotic prescribing and patient satisfaction. Participants may receive continuing education credits, continuing medical education credits and American Board of Internal Medicine Maintenance of Certification points through live and/or self-paced materials. Access more information, including how to sign up for an informational webinar on May 21, noon to 12:30 pm ET.

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, including recent cases and commentaries and AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Upcoming AHRQ Webinars


New Research and Evidence From AHRQ

AHRQ in the Professional Literature

Rural-urban differences in mortality among mechanically ventilated patients in intensive and intermediate care. Harlan EA, Venkatesh S, Morrison J, et al. Ann Am Thorac Soc. 2024 May;21(5):774-81. Access the abstract on PubMed®.

Addressing pregnancy and parenting in mental health care: perspectives of women with serious mental illness. Fenwick K, Dossett EC, Gitlin R, et al. Health Affairs. 2024 Apr;43(4):582-9. Access the abstract on PubMed®.

Evaluation of critical care pharmacist evening services at an academic medical center. Chase AM, Forehand CC, Keats KR, et al. Hosp Pharm. 2024 Apr;59(2):228-33. Epub 2023 Nov 1. Access the abstract on PubMed®.

Antibiotic stewardship interventions for urinary tract infections in outpatient settings: a narrative review. Grigoryan L, Trautner BW. Infect Dis Clin North Am. 2024 Jun;38(2):277-94. Epub 2024 Apr 4. Access the abstract on PubMed®.

Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias. Idnay B, Liu J, Fang Y, et al. J Am Med Inform Assoc. 2024 Apr 19;31(5):1062-73. Access the abstract on PubMed®.

Medication safety event reporting: factors that contribute to safety events during times of organizational stress. Cohen TN, Berdahl CT, Coleman BL, et al. J Nurs Care Qual. 2024 Jan-Mar;39(1):51-7. Epub 2023 May 9. Access the abstract on PubMed®.

COVID-19-associated acute kidney injury and longitudinal kidney outcomes. Aklilu AM, Kumar S, Nugent J, et al. JAMA Intern Med. 2024 Apr;184(4):414-23. Access the abstract on PubMed®.

Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes. Beck AF, Seid M, McDowell KM, et al. Learn Health Syst. 2024 Apr;8(2):e10403. Epub 2023 Dec 11. Access the abstract on PubMed®.

Contact Information
For comments or questions about AHRQ News Now, contact Bruce Seeman, (301) 427-1998 or Bruce.Seeman@ahrq.hhs.gov.

 

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc