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May 20, 2005, Issue No. 168
AHRQ News and Numbers
The number of babies born annually in the United States increased from just over 3.8 million in 1993 to nearly 4.2 million in 2002, while the number of episiotomies performed annually has dropped from just over 1 million in 1993 to about 617,000 in 2002. [Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2002, HCUPnet.]
- AHRQ Director testifies on HHS telemedicine activities
- New AHRQ report finds depression is widespread among heart attack patients
- New bioterrorism and emergency preparedness white paper available
- Almost 1,600 participate in May 17 AHRQ Web conference on mass casualty care
- Task Force makes recommendation against routine use of estrogen
- AHRQ announces new triage tools for hospital emergency departments
- Selected findings on child and adolescent health care fact sheet available
- AcademyHealth Annual Research meeting set for June 26-28
- Last call: renew your Research Activities subscription by May 31
- AHRQ in the professional literature
1. AHRQ Director Testifies on HHS Telemedicine Activities
On May 18, AHRQ Director Carolyn M. Clancy, M.D., testified before the House Veterans Affairs Committee's Health Subcommittee to provide a brief overview of HHS' telemedicine activities. Dr. Clancy noted that HHS has had a long-standing commitment to understanding and advancing the effective use of health information technologies, including telemedicine, to improve the health of all Americans. She explained that the Department has awarded more than $250 million in telemedicine projects in every State since 1988, with over 400 communities benefiting from these grants. She also outlined an evolving collaboration between HHS' Indian Health Service and the Veterans Health Administration telemedicine programs that exemplifies the benefit of interagency information exchange and sharing. In addition, Dr. Clancy noted that AHRQ's ongoing review of the scientific literature in the field indicates that the evidence base for telemedicine is still incomplete but improving. She noted that telemedicine has long been viewed as a promising tool for enhanced access to health care services, improved patient safety, and timely medical decisionmaking. "Widespread adoption of individual telemedicine applications in the private sector will continue to grow slowly, however, unless creative ways are found to speed the development of solid, scientifically generalizable findings of their effectiveness," Dr. Clancy noted. Further, a number of legal issues, including cross-State licensure and antitrust concerns, must be resolved, she added. Select to read Dr. Clancy's testimony.
2. New AHRQ Report Finds Depression Is Widespread Among Heart Attack Patients
One in five patients hospitalized for heart attack suffers from major depression, and these patients may be more likely than other heart attack patients to need hospital care again within a year for a cardiac problem, and they are three times as likely to die from a future attack or other heart problem, according to a new AHRQ evidence report, Post-Myocardial Infarction Depression. The scientific evidence review on which the report is based suggests that 60 percent to 70 percent of individuals who become depressed when hospitalized for heart attack continue to suffer from depression for 1 month to 4 months or more after discharge. The reviewers also found that during the first year following a heart attack, those with major depression can have a delay in returning to work, worse quality of life and worse physical and psychological health. In fact, some studies show that depression that begins while the patient is hospitalized can continue to affect his or her psychological and physical health for as long as 5 years after discharge. Roughly 765,000 Americans were discharged following treatment for heart attacks in 2002, according to national hospital data from AHRQ. The American Academy of Family Physicians, which requested the evidence review, plans to use the report to develop evidence-based clinical practice guidelines. The study was led by David E. Bush, M.D., and Roy C. Ziegelstein, M.D., of the AHRQ-supported Johns Hopkins University Evidence-Based Practice Center in Baltimore. Select to read our press release and select to read the summary. A print copy is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
3. New Bioterrorism and Emergency Preparedness White Paper Available
AHRQ released a new product from its Bioterrorism and Emergency Preparedness Program. Altered Standards of Care in Mass Casualty Events is a white paper that provides guidance for officials on how to plan for delivering health and medical care in a mass casualty event. The report includes the recommendations of an expert panel convened by AHRQ and HHS' Office of Public Health Emergency Preparedness. Select to read our press release and the white paper. A print of the report is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
4. Almost 1,600 Participate in May 17 AHRQ Web Conference on Mass Casualty Care
Almost 1,600 people participated in the AHRQ-sponsored Web conference, "Mass Casualty Care: Overlooked Community Resources," on May 17. The Web conference presented strategies for mobilizing community resources in response to a mass casualty event and focused on potential resources beyond the emergency department—in nursing homes, former (shuttered or converted) hospitals, and primary care networks and clinics. Speaker Lucy A. Savitz, Ph.D., M.B.A., Research Triangle Institute, Inc., Research Triangle Park, NC, discussed her research on nursing home surge capacity in various States and development of related State-wide atlases as a tool to identify resources and gaps. She also found that although nursing homes have disaster plans in place, most have not been included in preparedness planning. Andrea Hassol, M.S.P.H., Abt Associates, Cambridge, MA, and Richard Zane, M.D., Brigham and Women's Hospital and Harvard Medical School, Boston, MA, discussed their research on reopening shuttered hospitals to expand surge capacity. Facilities that maintain operational utilities and safety systems, for example, could quickly be used for services such as medical and post-surgical care for stable patients, they said. Debra Berg, M.D., Medical Director, Bioterrorism Hospital Preparedness Program, New York City Department of Health and Mental Hygiene, described a project currently supported by HRSA focusing on including primary care centers and clinics in community-wide emergency preparedness plans.
5. Task Force Makes Recommendation Against Routine Use of Estrogen
The U.S. Preventive Services Task Force issued a new recommendation against the routine use of estrogen to prevent chronic conditions such as heart disease, stroke, and osteoporosis in postmenopausal women who have undergone a hysterectomy. The new Task Force recommendation was published in the May 17 issue of the Annals of Internal Medicine. In 2002, the Task Force found insufficient evidence to recommend for or against the routine use of estrogen alone to prevent chronic conditions in women who have completed menopause and had a hysterectomy. Now, after reviewing new findings from NIH's Women's Health Initiative, the Task Force noted that although estrogen can have positive effects such as reducing the risk for fractures, hormone therapy should not be used routinely because it appears to increase women's risk for other serious health problems. These include potentially life-threatening clots that block blood vessels (venous thromboembolism), stroke, dementia, and mild cognitive impairment. In addition, the Task Force reaffirmed its earlier recommendation against the routine use of combined estrogen and progestin for preventing chronic conditions in postmenopausal women. Select to read our press release and the recommendation. A print copy of the recommendation is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
6. AHRQ Announces New Triage Tools for Hospital Emergency Departments
AHRQ has three new products for emergency department staff based on the Agency's Emergency Severity Index (ESI). The ESI is a five-level emergency department (ED) triage algorithm that yields rapid, reproducible, and clinically relevant stratification of patients into five groups to allow patients to be categorized by both acuity and hospital resources. These new products include a set of two DVDs entitled Emergency Severity Index, Version 4: Everything You Need To Know, an accompanying, spiral-bound Implementation Handbook covering all the details of ESI, and a poster of the ESI triage algorithm that is designed for EDs. The Everything You Need to Know DVD set provides information to help hospital ED staff decide whether the ESI is right for their ED, tools for training ED nurses in the use of the ESI, advice on how to roll out ESI department-wide, as well as practice case scenarios and implementation strategies. The Implementation Handbook, which can be used while or after viewing the DVDs, discusses ESI and the research behind it and contains sections on the history of triage, evaluation and quality improvement, and additional cases to assess nurses' competency after training. The ESI DVD and handbook are valuable resources for ensuring that ED staff are well trained in applying the ESI. Visit the AHRQ Web site or send an E-mail to AHRQPubs@ahrq.hhs.gov for a print copy.
7. Selected Findings on Child and Adolescent Health Care Fact Sheet Available
A new fact sheet presents findings from the 2004 National Healthcare Quality Report and National Healthcare Disparities Report on health care quality, access, and utilization for children and adolescents. Select to read the fact sheet. A print copy is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
8. AcademyHealth Annual Research Meeting Set for June 26-28
The AcademyHealth Annual Research Meeting will be held June 26-28 at the Hynes Convention Center in Boston, MA. The meeting will bring together health services researchers, providers, and key decisionmakers to address the critical challenges confronting the health care delivery system. The meeting provides opportunities to present and hear about cutting-edge research, debate timely policy issues, and learn about new methods and funding sources. Select to register and for more information.
9. Last Call: Renew Your Research Activities Subscription by May 31
Act now to renew your free subscription for Research Activities, the Agency's monthly research bulletin. If you are a current subscriber to this free publication, you must let us know that you wish to continue receiving it. The deadline for responding has been extended to May 31. Be sure to include your name, mailing address, and if you have your issue of Research Activities available, please also include your six-digit subscriber number, which appears next to your name on the mailing label.
10. AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.
Hobson WL, Avant-Mier R, Cochella S, et al. Caring for the underserved: using patient and physician focus groups to inform curriculum development. Ambul Pediatr 2005 Mar-Apr;5(2):90-5. Select to access the abstract on PubMed®.
Ding L, Landon BE, Wilson IB, et al. Predictors and consequences of negative physician attitudes toward HIV-infected drug users. Arch Intern Med 2005 Mar 28;165(6):618-23. Select to access the abstract on PubMed®.
Kawamoto K, Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005 Apr 2;330(7494):e765. Select to access the abstract on PubMed®.
Marcus MM, Freed JR, Younai F, et al. Oral white patches in a national sample of medical HIV patients in the era of HAART. Community Dent Oral Epidemiol 2005 Apr;33(2):99-106. Select to access the abstract on PubMed®.
Porell FW, Carter M. Discretionary hospitalization of nursing home residents with and without Alzheimer's disease. J Aging Health 2005 Apr;17(2):207-38. Select to access the abstract on PubMed®.
Beach MC, Price EG, Gary TL, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care 2005 Apr; 43(4):356-373. Select to access the abstract on PubMed®.
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Current as of May 2005