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Wednesday, March 25, 2009 9:00 AM

Newscast: Lead Story - Speaking Up About Your Health Care Needs

(opening music)

Rand: This is Healthcare 411 for the week of March 25, 2009.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Debra: I’m Debra James.

Rand: And I’m Rand Gardner.

Debra: Coming up:

Rand: This week on Healthcare 411: outpatient prescription painkillers. AHRQ data shows spending and the rate of purchases are on the rise.

Debra: In research news, we tackle the issue of central line-associated bloodstream infections. A new project funded by AHRQ aims to reduce these costly and potentially deadly infections nationwide.

Rand: Plus, AHRQ Director Dr. Carolyn Clancy offers advice for navigating the health care system. This week’s topic: speaking up about your health care needs.

Debra: All this is coming up on Healthcare 411.


[Begin PSA: Take Charge of Your Health]

Fran: Hi, I’m Fran Drescher. It took me two years to get a proper diagnosis of uterine cancer, so here are some tips I learned the hard way: Go to the doctor armed with lots of questions, and bring a friend with you, even right into the examining room, to write down the answers, and get a second opinion to do a check on your diagnosis and treatment. To get a list of questions to ask, go to ahrq.gov. It’s your life. Be in charge of your health.

Narrator: A message from H.H.S. and the Cancer Schmancer Foundation.

[End PSA]


Rand: Now the numbers.


Rand: Spending on outpatient prescription painkillers has tripled in the past ten years, according to the latest AHRQ data. Research shows spending increased from $4.2 billion in 1996 to more than $13 billion in 2006. And costs aren’t the only thing on the rise. The total number of prescription purchases has also gone up, from about 164 million to 231 million.

Debra: AHRQ is funding a new project to test methods for reducing central line-associated bloodstream infections in hospital intensive care units. Hospital associations and patient safety groups in 10 states will be involved in the project. With us to talk about this effort is Dr. Peter Pronovost from the Johns Hopkins University Quality and Safety Research Group. Dr. Pronovost is also co-principal investigator on the project. Welcome.

Dr. Pronovost: Thank you.

Debra: Let’s start big picture. What are central line-associated bloodstream infections?

Dr. Pronovost: Well, central lines, or central venous catheters, are tubes that are placed into the large veins in a patient’s neck, sometimes in the chest or groin, to administer medication or fluids, or to collect blood samples while patients are hospitalized. Typically sicker patients are the ones who get these. By definition, bloodstream infections are considered to be associated with a central line if it was in use during the 48-hour period before a bloodstream infection develops.

Debra: So is this a major issue in our hospitals today?

Dr. Pronovost: It really is. These infections are common, costly, and often lethal. Research shows that there are about 250,000 cases of central line-associated infections in US hospitals every year. These infections are also very costly in terms of lives and dollars. At least 30,000 patients who get a central line-associated bloodstream infection die each year, and the average hospital cost for each of these infections is more than $36,000.

Debra: So how can clinicians reduce the risks to their patients?

Dr. Pronovost: Much could be done to prevent these infections. Proper placement of the central line is critical. Also, clinicians can greatly reduce the risk of spreading germs by always washing their hands before and after the procedure, and by wearing a hat, mask, sterile gown and gloves. There’s also a soap called Chlorhexidine that reduces infection, and importantly, that they take out these catheters when they’re no longer needed.

Debra: Let’s talk about the AHRQ-funded project. Who’s taking part, and what are you hoping to achieve?

Dr. Pronovost: Well this is an exciting project that ultimately, our goal is to reduce the average rate of central line-associated blood stream infections across the US in all hospitals by 80 percent. Right now, the national average is five infections per 1,000 catheter days, and we want to get that down to less than one per 1,000 catheter days. The project involves 10 states: California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania, Texas, and Washington.

Debra: How do you hope to achieve that very large goal?

Dr. Pronovost: Well, one of the things we learned is that no one group can do this alone. It has to be a team effort, so we’ll be participating with hospitals to implement a checklist that ensures that patients receive the evidence-based practices that they’re supposed to, and that staff use those practices. However, using a checklist is only a beginning. Hospitals will have to educate staff about exactly what they’re supposed to do. They’ll need to monitor, in a valid way, what their infection rates are, and track those, and we’ll have to work to create a culture of teamwork where nurses could question physicians to make sure patients always get these evidence-based interventions. We’re really excited to work with these diverse groups, and we have plans to expand this project to additional participants with private funding.

Debra: And how successful do you think this project will be?

Dr. Pronovost: Well we’re extremely optimistic that we can be successful at reducing these central-line-associated infections. We applied these tools with great success throughout the state of Michigan. Infection rates dropped to zero - that is, the median was zero - in over half of the hospitals that participated in this project. There were over 103 ICUs participating. This 50 percent drop occurred within 3 months, and I believe we can see these same types of results again. We’ve learned an awful lot about how to do it. It’s not easy, but with diligent effort of combining evidence with valid measurement, and culture and teamwork change, we’re confident that we could achieve these results. And through this, not only will we save lives and dollars from these infections, but we will put joy back into the clinicians’ lives who toil so often at the bedside, and importantly, build national capacity to tackle one of the many other ills that befall our health care system.

Debra: Dr. Pronovost, thank you for taking the time today to talk to us about this project.

Dr. Pronovost: My pleasure.

Debra: To learn more about AHRQ’s patient safety research, visit ahrq.gov/qual/errorsix.htm. Up next, health care advice for navigating the health care system.


Rand: What should you do if you don’t know why your nurse is giving you a certain medication? Or if you’re about to be discharged from the hospital, but you think you need to stay another night? If something is happening with your care and you don’t understand why, it’s important to ask questions. Here’s AHRQ Director Dr. Carolyn Clancy to offers tips for speaking up.

Dr. Clancy: Patients are very sensitive to the fact that health care professionals these days are often incredibly busy and they kind of get the message that I don’t have time now. I think that is simply a signal to consumers to say I know you might be busy right now, but tell me when I can get my questions answered.

Rand: Now I’ve heard that asking another person to help you talk with your clinician is a good option for some people. Sort of an extra set of eyes and ears to make sure you get the relevant information you need and that your needs are heard.

Dr. Clancy: A family advocate could be a close friend, it could be a co-worker: someone that you trust and who brings your best interest to the encounter. An advocate could also be very helpful with issues related to transportation, dealing with issues of medication compliance and potential side effects, asking questions about follow-up care after surgery, or even specific types of tests done on an outpatient basis.

Rand: So it’s really about staying involved in your care.

Dr. Clancy: For individuals who are able, the very best advice is, be active in your own health care, which means you should take the initiative. Speak up. Don’t worry about being polite.

Rand: Dr. Clancy, do you have any other advice about being active in your health care?

Dr. Clancy: It’s very important to be as involved as possible in all aspects of your health care. Ask questions, consult with your health care professional, and get as much information as you can because, in the end, you’re going to have better results if you do.

Rand: For more great consumer tips, check out AHRQ’s Consumer and Patients Web site at ahrq.gov/consumer.


Debra: That’s it for this week. For more information on these and other health-related stories and topics, go to healthcare411.ahrq.gov.

Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Debra James, I’m Rand Gardner. Please join us for the next edition of Healthcare 411.

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