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July 20, 2000, Issue No. 11
AHRQ News and Numbers
- Summit on medical errors—nominations of potential witnesses sought
- Article in JAMA on survival in end-stage dementia following acute illness
- Nathan Davis award
- AHRQ appropriations update
- National Advisory Council meeting
- Market forces grant awards
- Evidence report on end-stage renal disease
- Evidence report on criteria for weaning from mechanical ventilation
- AHRQ has new data about cost of health care
- Smoking guideline web chats
- AHRQ small research grant program notice
- AHRQ co-sponsors methods seminar
- Job openings at AHRQ
- HIV cost and services utilization study
- Marginal benefits from invasive heart attack treatments vary according to patients' insurance coverage
- Highlights from the most recent edition of our monthly newsletter
- New AHRQ publications
- Guidelines added to National Guideline Clearinghouse™
- AHRQ in the news
1. Summit on Medical Errors—Nominations of Potential Witnesses Sought
AHRQ and its partners on the Quality Interagency Coordination (QuIC) Task Force will sponsor a national research summit on medical errors and patient safety on September 11 in Washington. This initiative is part of the Federal response to the Institute of Medicine's November 1999 report, To Err is Human: Building a Safer Health System. The summit, which will be open to the public and members of the press, will review the information needs of those people and organizations attempting to improve patient safety, assess the current state of medical errors and patient safety research, and most importantly, gather information to support the development of a coordinated research agenda. Nominations of potential witnesses are presently being sought by AHRQ and the other QuIC agencies. Individuals interested in presenting statements should contact AHRQ before Friday, August 4.
2. Article in JAMA on Survival in End-Stage Dementia Following Acute Illness
Drs. Sean Morrison and Albert Siu published a study, Survival in End-Stage Dementia Following Acute Illness, in the July 5 issue of JAMA. The AHRQ-funded study found that, although 6-month mortality was higher for patients with end-stage dementia and either pneumonia or hip fractures, they received care that was similar to care received by patients who were cognitively intact with the same conditions. Treatment plans for these patients also did not address the high symptom burdens typically associated with these two conditions. They also saw no consideration of limiting burdensome interventions for patients with end-stage dementia and either of the two additional conditions, and there was no palliative care planning for this group. Dr. Morrison is associated with the Department of Geriatrics and Adult Development at the Hertzberg Palliative Care Institute, and Dr. Siu is affiliated with the Mount Sinai School of Medicine.
3. Nathan Davis Award
The AMA announced on July 13 the 11 recipients of the 2000 Dr. Nathan Davis Award for Outstanding Government Service. The award recognizes elected and career officials in Federal, State, or municipal service whose outstanding contributions have promoted the art and science of medicine and the betterment of the public health. Dr. John Eisenberg, AHRQ Director, was presented the award for outstanding service by a political appointee in the executive branch of the Federal government.
4. AHRQ Appropriations Update
The House-passed appropriations bill includes $223,649,000 for AHRQ. The Senate bill provides $269,943,000. A conference committee will be meeting to reconcile the differences.
5. National Advisory Council (NAC) Meeting
The AHRQ NAC is scheduled to meet on Friday, July 28 at 6010 Executive Boulevard, Rockville, MD. The Council will discuss these specific topics:
- Technology assessment.
- International health.
- Research on health insurance and costs.
- The grants process.
6. Market Forces Grant Awards
AHRQ announced on July 19 the award of $12.5 million in total projected funding over the next 5 years to establish three new centers of excellence to conduct research on how market forces are affecting the quality of health care, access to care, and health care costs.
7. Evidence Report on End-Stage Renal Disease
On July 17, AHRQ announced the availability of a summary of an evidence report evaluating the Social Security Administration's current Listing of Impairments for determining disability in individuals with chronic renal failure (CRF). The report seeks to determine whether the CRF criteria for disability status, last revised in 1979, are still applicable, as newer treatments may have allowed some patients to continue normal daily activities within the limitations of their condition. Select to access the to see the Emergency Care Research Institute Evidence-based Practice Center summary of Determinants of Disability in Patients with Chronic Renal Failure. Print copies of the summary are available from the AHRQ Publications Clearinghouse, 800-358-9295. Copies of the full report will be available in late 2000.
8. Evidence Report on Criteria for Weaning from Mechanical Ventilation
On July 17, AHRQ announced the availability of a summary of an evidence report evaluating criteria for weaning patients from mechanical ventilation. The AHRQ-funded McMaster University Evidence-based Practice Center was charged with analyzing the evidence related to weaning patients from mechanical ventilation because of the high rates of morbidity and mortality and the high costs associated with its use. A guideline based on that report is expected to be released next year by the American College of Chest Physicians, American Association for Respiratory Care and the Society for Critical Care Medicine. Select to access the summary. Print copies of the summary are available from the AHRQ Publications Clearinghouse, 800-358-9295. Copies of the full report will be available later this year.
9. AHRQ Has New Data About the Cost of Health Care
The Medical Expenditure Panel Survey (MEPS) has new data available on the out-of-pocket health care expenses encountered by the civilian non-institutionalized U.S. population. In 1996, about $554 billion in payments were made for health care services and supplies used by this population. The average cost per person who had medical expenses was about $2,400. However, half of these people had medical expenses of less than $559. The first chart shows that only small proportions of the population had expenses for inpatient hospital (6.8%) and home health services (2.4%), although the second chart shows that these health services had the highest average annual expenses ($11,492 for inpatient hospital and $5,191 for home health care). Select to access MEPS publications.
10. Smoking Guideline Web Chats
AHRQ used the information superhighway to drive the news of the Public Health Service (PHS) tobacco cessation guideline to the public. Live "chats" were arranged for Dr. Michael Fiore, the chair of the PHS
expert panel, on the popular health site WebMD at http://my.webmd.com/content/article/1700.50617, the Boston University School of Public Health's Quitnet.org at http://www.quitnet.org/chat_new/fiore/, and the Washington Post's site. These live discussions focused on the latest drug therapies and counseling techniques for quitting smoking. You can obtain copies of the Washington Post's transcript from the AHRQ Publications Clearinghouse at 800-358-9295.
11. AHRQ Small Research Grant Program Notice
AHRQ recently released a notice to inform potential applicants that the budget limit on small project grant applications has been increased from $50,000 in total direct costs to $100,000 in total costs (direct costs, plus facilities and administrative costs). In our previous issue, we gave you an incorrect link. Select to access the correct announcement and for more details on how to submit applications.
12. AHRQ Co-Sponsors Methods Seminar
A 3-day methods seminar on "Using Federal and State Databases" will be held October 30 - November 1, 2000, in Washington, DC. The seminar is being presented by the Academy for Health Services Research and Health Policy with four Federal co-sponsors:
Two AHRQ databases will be covered during the seminar:
13. Job Openings at AHRQ
Select http://www.ahrq.gov/about/vacancy.htm to access the complete list.
14. HIV Cost and Services Utilization Study
The HIV Cost and Services Utilization Study (HCSUS) funded by AHRQ and other organizations provides evidence-based information from a national probability sample of the health services utilization and costs among HIV-infected people. For the latest findings, see HIV-Infected Parents and Their Children in the United States, by Mark Shuster, M.D., et al; Delays in Seeking HIV Care Due to Competing Caregiver Responsibilities by Michael D. Stein, M.D., et al; and Perceived Unmet Need for Oral Treatment Among a National Population of HIV-Positive Medical Patients: Social and Clinical Correlates, by Marvin Marcus, D.D.S., et al, published in the July 2000 issue of the American Journal of Public Health (Vol. 90, No. 7). A fourth article from the HCSUS study, National Estimates of HIV-Related Symptom Prevalence from the HIV Cost and Services Utilization Study, by William Christopher Mathews, M.D., appears in the July 2000 issue of Medical Care( Vol. 38, No. 7).
15. Marginal Benefits from Invasive Heart Attack Treatments Vary According to Patients' Insurance Coverage
A new study using AHRQ's HCUP data shows that uninsured heart attack patients received the greatest "marginal" benefits from invasive surgical treatments, which may mean that such treatments are underutilized for this patient group. The study, conducted by researchers at the University of Iowa, Stanford University, and AHRQ, used discharge records of over 30,000 patients who were treated for heart attacks in Washington State hospitals between 1989-1994. For more information, see the recent article The Marginal Benefits of Invasive Treatments for Acute Myocardial Infarction: Does Insurance Coverage Matter? published in Inquiry 2000.
16. Highlights from the Most Recent Edition of Our Monthly Newsletter
The new issue of Research Activities is in the mail. The key articles are:
- Early angiography should be used for suspected heart attack victims even when ECGs appear normal.
- Studies focus on diagnostic testing and treatment for prostate cancer.
- < Researchers find that complex gastrointestinal procedures are not just for specialists anymore.
- Most Mexican Americans prefer conventional medical care for their diabetes rather than alternative and traditional treatments.
Select http://www.ahrq.gov/research/jun00/ to access the entire June issue.
17. New AHRQ Publications
- MEPS Highlights No. 12, Per Capita Health Care Expenses, 1996.
- Evidence Report/Technology Assessment Number 10, An Evaluation of Beta-Blockers, Calcium Antagonists, Nitrates, and Alternative Therapies for Stable Angina: Summary.
18. Guidelines Added to National Guideline Clearinghouse™ (NGC)
During the month of June, 22 guidelines were added to the NGC. There are now more than 812 guidelines in the NGC. Select http://www.guideline.gov to access these guidelines and others.
- Prostate specific antigen (PSA): best practice policy.
- Guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies.
- Practice parameter for the recognition, management, and prevention of adverse consequences of blood transfusion.
- Driving and heart disease.
- Heart rate variability: Standards of measurement, physiological interpretation and clinical use.
- Guidelines for the management of heavy menstrual bleeding.
- Hypertension diagnosis and treatment.
- Diagnosis and management of attention deficit hyperactivity disorder in primary care.
- Breast cancer treatment.
- Breast cancer diagnosis.
- Tobacco use prevention and cessation for adults and mature adolescents.
- Tobacco use prevention and cessation for infants, children and adolescents.
- Colorectal cancer screening.
- Lipid screening in children and adolescents.
- Treatment of lipid disorder in adults.
- Preventive counseling and education.
- Cervical cancer screening.
- Stable coronary artery disease.
- Recommendations to prevent hepatitis B virus transmission-United States-Update.
- Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices.
- Treating tobacco use and dependence.
19. AHRQ in the News
Berman S. The AMA Clinical Quality Improvement Forum on Addressing Patient Safety. Jt Comm J Qual Improv 2000 July; 26(7):428-433
CEI #4055, Administrative healthcare data for research-the Healthcare Cost and Utilization Project (HCUP). Nation's Health 2000 July; 30(6 Pt II):66
CEI #4083, Fundamental measurement of quality of care: results from the MEPS and CAHPS®. Nation's Health 2000 July; 30(6 Pt II):66
Craig SR, Amin RV, Russell DW, et al. Blood cholesterol screening: influence of fasting state on cholesterol results and management decisions. J Gen Intern Med 2000 June; 15(6):395-399
Fitzmaurice JM, Rose JS. Cutting to the chase: what physician executives need to know about HIPAA. Phys Exec 2000 May-June; 26(3):42-49
Fowler FJ, Collins MM, Albertsen PC, et al. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA 2000 June 28; 283(24):3217-3222
Green LA. Putting practice into research: a 20-year perspective. Fam Med 2000 June; 32(6):396-39.
Guadagnoli E, Epstein AM, Zaslavsky A, et al. Providing consumers with information about the quality of health plans: the Consumer Assessment of Health Plans Demonstration in Washington State. Jt Comm J Qual Improv 2000 July; 26(7):410-420
Keating NL, Zaslavsky AM, Ayanian JZ. Physicians' reports of focused expertise in clinical practice. J Gen Intern Med 2000 June; 15(6):417-420
Scientific Session #4143, The uninsured: one cure does not fit all. Nation's Health 2000 July; 30(6 Pt II):74
Wilt TJ. Uncertainty in prostate cancer care (editorial). JAMA 2000 June 28; 283(24):3258-3260
Asthma and infections (including pneumonia and bronchitis) account for more than half of hospitalizations for children aged 1-4 in the U.S. [McCormick, M.C., et al. "Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States-1999." Pediatrics 105, no. 1 pt. 3 (2000): 219-30]
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Current as of July 2000