Abstract Background The AHRQ Safety Program for MRSA Prevention utilizes evidence-based infection prevention interventions and the Comprehensive Unit-based Safety Program (CUSP) framework to decrease invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in intensive care units (ICUs), non-ICUs, surgical services, and long-term care facilities. We report the program's effect on hospital-onset MRSA bacteremia rates (HOB-MRSA) in 106 ICUs and 87 non-ICUs from 94 US hospitals.Table 1.Educational Toolkit Content for the AHRQ Safety Program for MRSA Prevention Methods The ICU/non-ICU Safety Program for MRSA Prevention was implemented from April 2022 to September 2023. The Safety Program aimed to decrease invasive MRSA infections through education, technical support, reinforcement of safety culture, and implementation of evidence-based infection prevention practices. Chlorhexidine bathing and nasal decolonization were major foci of the intervention, along with disinfection of the environment and practices to prevent person-based MRSA transmission and device-related infections. The project team provided 22 live webinars, supporting materials, and other tools to assist units with MRSA prevention (Table 1). Units were also assigned an implementation adviser who provided support through monthly coaching calls. Units submitted monthly data for HOB-MRSA per 10,000 patient days (PD) as well as data regarding process measures. Linear mixed effects models were employed to calculate pre-post intervention changes in HOB-MRSA events. Results 106 ICUs and 87 non-ICUs from 94 hospitals completed the Safety Program, including 31 (33%) academic medical centers (AMC), 37 (39%) non-AMC teaching hospitals, and 26 (28%) non-teaching community/other hospitals. From July-September 2021 to July-September 2023, HOB-MRSA events declined from 5.7 to 1.5 per 10,000 PD among ICUs (p< 0.001)(Figure 1) and from 3.4 to 0.2 for non-ICUs (p< 0.001) (Figure 2). Similar results were found in comparisons among other pre-program vs, end-of-program quarters. Conclusion The AHRQ Safety Program for MRSA Prevention supported implementation of evidence-based infection prevention practices, including decolonization, and was associated with reduced HOB-MRSA rates across participating ICUs and non-ICUs. Disclosures All Authors: No reported disclosures
Trafficking of adults and children for both sex and labor is a human rights violation occurring with alarming frequency throughout the world, and resulting in profound harm to close-knit communities and severe health consequences for victims. Certain areas, such as the country of Paraguay, are at a higher risk for trafficking due to unique economic, cultural, and geographic factors. Thousands of people, especially children, are trafficked within Paraguay’s borders, and many eventually are transported to neighboring countries and sometimes to Europe and elsewhere. Using case study methodology and “city” as the unit of study, researchers interviewed 18 key anti-trafficking stakeholders from government and nongovernmental organizations in two major metropolitan centers for trafficking in Paraguay, Asunción, and Encarnación. Through semistructured interviews, this qualitative study examines risk factors for trafficking, health outcomes, interventions needed within the health care sector, and programs needed to combat trafficking. We identified risk factors including poverty, marginalization of indigenous people, gender inequality, domestic servitude of children (criadazgo), and political hesitance to enact protective legislation. Victims of trafficking were reported to suffer from physical injuries, unintended pregnancies, sexually transmitted infections, and mental health issues such as depression and posttraumatic stress disorder. These predispose victims to difficulties reintegrating into their communities and ultimately to retrafficking. A major gap was identified in the lack of sufficient lodging and rehabilitation services for rescued victims, affordable access to trauma-sensitive health care for victims, and scarce mental health services. Many of the findings are applicable across the world and may be of use to guide future anti-trafficking efforts in Paraguay and beyond.
Team-based care approaches are effective at improving hypertension control and have been used in clinical practice to improve hypertension outcomes. This study implemented and evaluated the Hypertension Management Program (HMP), which was originally developed in a high-resource health setting, in a health system with fewer resources and a patient population disproportionately affected by hypertension. Our objectives were to describe how a health system could adapt HMP to meet their needs and calculate total program costs. HMP uses a team-based, patient-centered approach involving clinical pharmacists who contribute to managing patients who have hypertension and ultimately preventing premature death due to uncontrolled hypertension. HMP has 10 components (e.g., EHR patient registries and outreach lists, no copayment walk-in blood pressure checks). Our project involved implementing the key components of HMP in a federally qualified health center (FQHC) in South Carolina. Adaptations from the key components of HMP were made to fit the participants' settings. A mixed-methods evaluation assessed implementation processes, program costs, and implementation facilitators and barriers. From September 2018 to December 2019, clinical pharmacists conducted 758 hypertension management visits (HMVs) with 316 patients with hypertension. Total program costs for HMP were $325,532 overall and $16,277 per month. Monthly cost per patient was $3.62. The high engagement among clinical pharmacists, along with provider engagements, followed up by the subsequent referral of patients to HMP, facilitated the implementation process. Staff members observed improvements in hypertension control, which increased participation buy-in. Barriers included staff turnover, the perception among some providers that HMP took too much time, as well as perception of HMP as a pharmacy-specific initiative. A team-based, patient-centered approach to hypertension management can be adapted for FQHCs or similar settings that serve patient populations disproportionately affected by hypertension.
Objective In April 2018, JUUL Labs announced a $30 million investment in efforts to combat underage use of its products through ‘independent research, youth and parent education and community engagement’. Prior evidence demonstrates that tobacco industry-funded prevention programmes are ineffective and may work against tobacco control efforts; they do not discourage novices and youth from tobacco use but often improve the tobacco industry’s public image. We describe the nature, timing of and expenditures related to the JUUL underage use prevention advertisements across media channels. Methods Expenditures for newspaper, magazine, television, and radio marketing and promotional efforts were collected through Kantar Media’s ‘Stradegy’ dashboard, an online platform which provides counts of advertisement occurrences and expenditures on various media channels. JUUL public relations and corporate social responsibility ads were identified in the Kantar Database. All ad expenditures were extracted and aggregated by date. Analysis of the expenditure data was triangulated with newspaper and industry advertisement archives. Results Advertisements aired nationally and in over half of all US-designated market areas (n=130) across media platforms including newspapers, magazines, radio, and online in mobile web and internet displays. In 2018, JUUL Labs spent $30 million, predominantly for print advertising. The ‘What Parents Need to Know about JUUL’ ads primarily advertised JUUL’s smoking reduction ‘mission’ and promoted the product. By 2019, advertising increased to $36.2 million. JUUL’s message strategy transitioned to ‘Cracking Down on Underage Sales in Retail Stores’ and featured adult smoker testimonies, linking JUUL to smoking cessation. Discussion Marketing expenditures promoting JUUL’s corporate social responsibility mission exceeded their $30 million investment in the underage use prevention efforts. The expenditures were focused on the media market areas where health organisation and legislative officials were launching investigations into JUUL social media and other promotional strategies.
Improving maternal, newborn, and child health is a leading priority worldwide. It is a particularly urgent issue in South Sudan, which suffers from the world’s worst maternal mortality and among the worst newborn and child mortalities. A leading barrier to improving these health indices is limited frontline health worker capacity. In partnership with the Ministry of Health, the Division of Global Health and Human Rights (Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA) has developed and is currently implementing its novel Maternal, Newborn, and Child Survival (MNCS) Initiative throughout much of South Sudan. The purpose of MNCS is to build frontline health worker capacity through a training package that includes: 1. A participatory training course 2. Pictorial checklists to guide prevention, care, and referral 3. Re-useable medical equipment and commodities. Program implementation began in November 2010 utilizing a training-of-trainers model. To date, 72 local trainers and 632 frontline health workers have completed the training and received their MNCS checklists and commodities. Initial monitoring and evaluation results are encouraging as further evaluation continues. This innovative training package may also serve as a model for building capacity for maternal, newborn, and child health in other resource limited settings beyond South Sudan.
PROLOGUE: Practically since its inception, the Agency for Health Care Policy and Research (AHCPR) has been a target of budget-cutting Congressmen. To take one recent example, in May 1998 the House Budget Committee proposed a $90 million reduction in AHCPR's annual budget—a substantial sum when one considers the fact that the agency's current budget is a fairly modest $146 million. Underlying this proposal was the committee's belief that the agency duplicates private-sector activity in the area of medical practice standards and guidelines. Contrary to what some in Congress might believe, Dan Mendelson and colleagues report that, although there is considerable private-sector activity under way in this area, government's role is by no means obviated by this activity. The authors boast a wealth of experience in the field of science and technology policy, with scores of journal articles to their credit. Mendelson recently became the associate director for health at the Office of Management and Budget. Prior to entering government, Mendelson spent eight years with the Lewin Group in Fairfax, Virginia, where he was most recently senior vice-president and director of the medical technology practice. He holds a master's degree from Harvard's Kennedy School. Cliff Goodman is a senior manager with the Lewin Group. He earned a doctorate from Pennsylvania's Wharton School. Robert Rubin, president of the Lewin Group, earned his medical degree from Cornell University. Roy Ahn was an associate in the medical technology practice at the Lewin Group when this paper was written. He holds a master's degree from Yale University. ABSTRACT: Private-sector health care organizations increasingly tout the use of outcomes and effectiveness research in activities ranging from pharmaceutical research to insurance coverage determinations. The rapid development of this research raises important questions about the role of the Agency for Health Care Policy and Research (AHCPR) as the producer, funder, and champion of outcomes and effectiveness research. To address this issue, we reviewed the activities of pharmaceutical companies, insurers, managed care organizations, health information technology companies, and other private-sector actors in outcomes and effectiveness research. We found that it is being used in a focused way to promote business goals and other organizational objectives, particularly in the pharmaceutical, insurance, and managed care industries. We also found significant gaps in its application to important public health issues and virtually no overlap with prior federal activities in this area.
