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August 2, 2005, Issue No. 174
AHRQ News and Numbers
Americans spent a total of $151 billion on outpatient prescriptions in 2002—an amount nearly 2.5 times greater than the $65 billion spent in 1996. This figure does not include any over-the-counter remedies or drugs prescribed in hospitals, nursing homes, or other institutions. The top 10 list of costliest drugs, with a combined price tag of nearly $30 billion, was led by Lipitor®, the cholesterol-lowering drug, at a cost of $5.9 billion. Competitors Zocor® and Pravachol® also made the top 10, as did anti-ulcer drugs Prevacid® and Prilosec®, and anti-depressants Paxil® and Zoloft®. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #60: Top 10 Outpatient Prescription Medicines Ranked by Utilization and Expenditures for the Community Population, 2002. (PDF File, 92 KB; PDF Help).]
- Dr. Clancy testifies on AHRQ's health information technology research
- National project launched to reduce surgical complications by 25 percent
- AHRQ study finds weight-loss surgeries quadrupled in 5 years
- Cost-effectiveness analysis in U.S. health care decisionmaking: Where is it going?
- AHRQ study finds Americans frequently visit doctors for treatment of adverse drug effects
- Latest issue of AHRQ WebM&M is available online
- New CERTs program brief on women's health is available
- Chronic care for low-income children with asthma: New research synthesis available
- New program brief on AHRQ research activities relevant to the American Indian and Alaska Native community is available
- Do you know how AHRQ's Hospital Survey on Patient Safety Culture is being used to improve patient safety?
- Visit AHRQ's National Patient Safety Network Web site
- AHRQ in the professional literature
1. Dr. Clancy Testifies on AHRQ's Health Information Technology Research
On July 27, AHRQ Director Carolyn M. Clancy, M.D., testified before the House Government Reform Committee's Subcommittee on the Federal Workforce on how AHRQ's research portfolio is making significant advances in health information technology to reduce medical errors, lower health care costs, and improve quality. Dr. Clancy noted that Americans should be able to count on receiving health care that is safe, and that this requires a commitment by all stakeholders to a culture of safety and improved information systems. She explained that health IT alone cannot provide the improvements needed in our health care system, but that improvements will depend on the integration of high-quality health IT into individual clinical practices, hospitals, and other settings. "To accelerate the pace of health IT adoption and implementation, we must ensure that best practices and new knowledge and experience are disseminated widely in order to maximize the potential for quality improvement as well as reduce economic risk," Dr. Clancy said. Select to read Dr. Clancy's testimony.
2. National Project Launched to Reduce Surgical Complications by 25 Percent
In an effort to improve surgical care in hospitals nationwide, a partnership of leading public and private health care organizations including AHRQ has launched a project to reduce surgical complications by 25 percent by the year 2010. The Surgical Care Improvement Project is designed to provide hospitals, physicians, nurses, and other caregivers with effective strategies to reduce four common surgical complications—surgical wound infections, blood clots, perioperative heart attack, and ventilator-associated pneumonia. The strategies are based on the best available science and will be refined and improved as new scientific information becomes available. SCIP is one of the first national quality improvement initiatives to unite national hospital, physician and nursing organizations; the federal government; the organization that accredits hospitals; and private sector experts in far-reaching quality improvement and patient safety efforts. Select to read more information about SCIP.
3. AHRQ Study Finds Weight-Loss Surgeries Quadrupled in 5 Years
The number of Americans having weight-loss surgery more than quadrupled between 1998 and 2002—from 13,386 to 71,733—with part of the increase driven by a 900 percent rise in operations on patients between the ages of 55 and 64, according to a new AHRQ study. During the same period, hospital costs for treating patients who underwent weight-loss surgery increased by more than six times—from $157 million a year to $948 million a year—and the average cost per surgery increased by roughly 13 percent, from $11,705 to $13,215. The study, "Use and Costs of Bariatric Surgery and Prescription Weight-Loss Medications," was published in the July 12 issue of Health Affairs. Select to read our press release and select to read the abstract in PubMed®. A limited numbers of copies of the reprint are available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
4. Cost-Effectiveness Analysis in U.S. Health Care Decisionmaking: Where Is It Going?
The July issue of Medical Care features an AHRQ-sponsored supplement describing recent developments in the use of cost-effectiveness analysis in U.S. health care decisionmaking. Although cost-effectiveness is frequently invoked as a desirable goal—and is a formal input to health care decisions in other countries—cost-effectiveness information has not been widely employed in U.S. health care. Nonetheless, there has been a noticeable evolution in its use over the past several years. The articles in this supplement reveal a range of views on the utility of cost-effectiveness analysis, obstacles to its wider use, potential of new and emerging systems for incorporating cost-effectiveness analysis in decisionmaking processes, and requisite future steps. Included are an analysis by authors from the United Kingdom and an update from Ontario to offer context and contrast, discussions of recent U.S. efforts in both the public and private sectors, and commentary on these developments. The articles focus on pharmaceutical decisions, reflecting the strong interest in economic analysis in this sector. The supplement provides a resource for policymakers, researchers, and administrators working to develop better ways of integrating information on the value of health care interventions into U.S. health care decisions. A limited number of copies are available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
5. AHRQ Study Finds Americans Frequently Visit Doctors for Treatment of Adverse Drug Effects
More than 4.3 million visits to physician's offices, hospital outpatient departments, and hospital emergency departments in 2001 were for treatment of adverse drug effects, up from 2.7 million in 1995, according to a new study by AHRQ researchers. The study, "Ambulatory Care Visits for Treating Adverse Drug Effects in the United States, 1995-2001," was published in the July issue of the Joint Commission Journal on Quality and Patient Safety. In 2001, 74 percent of all visits for treating adverse drug effects were made to physician's offices, 20 percent to hospital emergency departments, and 6 percent to hospital outpatient departments. Antibiotics and other anti-infectives were most frequently associated with visits for adverse drug effects, followed by hormones and other synthetic substitutes. The most frequent adverse effects suffered include dermatological symptoms, such as a skin rash, followed by gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain. These rates were higher for people 65-74 years old and were more prevalent in women. A print copy is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
6. Latest Issue of AHRQ WebM&M Is Available Online
The July-August issue of AHRQ WebM&M, the online patient safety journal, is available. The Perspectives on Safety section highlights nursing and patient safety. This month's user-submitted cases include one in which a woman who receives morphine via a patient-controlled analgesia pump is found barely breathing a few hours after arriving at the unit. In another case, a nurse who is preparing a patient for transfer out of the ICU discovers the guidewire used for central line placement a week earlier was still in the patient's leg vein. In the Spotlight Case, an intern increases a patient's warfarin dosage nightly based on subtherapeutic international normalized ratio (INR) levels drawn each morning. After several days, the patient develops potentially life-threatening bleeding. As always, the Spotlight Case includes a downloadable set of slides. By completing the Spotlight Quiz, physicians can receive CME credit, nurses can obtain CEUs, and trainees can receive certification in patient safety. Please submit cases to AHRQ WebM&M via the "Submit Case" button. All previously published cases and commentaries are available under "Case Archive."
7. New CERTs Program Brief on Women's Health Is Available
AHRQ released a new program brief on women's health from its Centers for Education and Research on Therapeutics (CERTs) program. The program brief highlights risks and benefits identified in CERTs studies of medical therapies in women such as the association between cholesterol-lowering drugs and hip fractures, as well as heart rhythms and the menstrual cycle, and antibiotic resistance and urinary tract infections. It also addresses current treatment information for physicians and their patients on the use of hormone therapy and prescription drug use by pregnant women. Select to read the program brief. A print copy is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
8. Chronic Care for Low-Income Children with Asthma: New Research Synthesis Available
AHRQ released a new research synthesis called Chronic Care for Low-Income Children with Asthma: Strategies for Improvement. This synthesis highlights AHRQ-funded research which has shown that reorganizing the way chronic care is delivered can increase the appropriate use of medications among children with asthma. The report also provides promising strategies that could help policymakers and purchasers of health care and health insurance improve care for children with asthma. Select to read the synthesis. A print copy of the synthesis is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
9. New Program Brief on AHRQ Research Activities Relevant to the American Indian and Alaska Native Community Is Available
AHRQ released a new program brief titled AHRQ Research and Other Activities Relevant to American Indians and Alaska Natives. AHRQ research topics include examining organizational factors influencing rural health care providers, reducing disparities in the American Indian/Alaska Native population, developing electronic data systems for Primary Care Practice-based Research Networks (PBRNs), and implementing AHRQ's Put Prevention Into Practice program. AHRQ funds research that enhances the health services research infrastructure and knowledge base, while building relationships with other Federal agencies. Select to read the program brief. A print copy is available by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
10. Do You Know How AHRQ's Hospital Survey on Patient Safety Culture Is Being Used to Improve Patient Safety?
As reported previously, AHRQ worked with Premier, Inc., the Department of Defense, and the American Hospital Association on its Hospital Survey on Patient Safety Culture. The survey, which Premier has now made available in Spanish, is designed to assess the safety culture of a hospital as a whole and specific units within hospitals, as well as to track changes in patient safety over time and evaluate the impact of patient safety interventions. At AHRQ, we are always looking for ways in which AHRQ-funded research, products, and tools have changed people's lives, influenced clinical practice, improved policies, and affected patient outcomes. These examples are used by AHRQ in testimony, budget documents, and speeches. Therefore, if you are actively using this survey instrument, we would like to hear from you. Please contact Nate Robinson at NRobinso@ahrq.gov with your examples. Select for more information on AHRQ's Hospital Survey on Patient Safety Culture.
11. Visit AHRQ's National Patient Safety Network Web Site
AHRQ's new national Web site—AHRQ Patient Safety Network—is a valuable gateway of resources for improving patient safety and preventing medical errors. It is the first comprehensive effort to help health care providers, administrators, and consumers learn about all aspects of patient safety. The Web site includes summaries on tools and findings related to patient safety research; information on upcoming meetings and conferences; links to articles, books, and reports; and a listing of annotated bibliographies. Physicians, nurses, hospital administrators, and others can customize the site around their unique interests and needs through the Web site's unique "My PSNet" feature.
12. 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.
Majumdar SR, Ross-Degnan D, Farraye FA, et al. Controlled trial of interventions to increase testing and treatment of Helicobacter pylori and reduce medication use in patients with chronic acid-related symptoms. Aliment Pharmacol Ther 2005 Apr 15;21(8):1029-39. Select to access the abstract on PubMed®.
Chang RK, Qi N, Larson J, et al. Comparison of upright and semi-recumbent postures for exercise echocardiography in healthy children. Am J Cardiol 2005 Apr 1;95(7):918-21. Select to access the abstract on PubMed®.
Plunkett BA, Grobman WA. Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis. Am J Obstet Gynecol 2005 Apr;192(4):1153-61. Select to access the abstract on PubMed®.
Sherman KJ, Cherkin DC, Eisenberg DM, et al. The practice of acupuncture: who are the providers and what do they do? Ann Fam Med 2005 Mar-Apr;3(2):151-8. Select to access the abstract on PubMed®.
Schwartz MD, Basco WT Jr, Grey MR, et al. Rekindling student interest in generalist careers. Ann Intern Med 2005 Apr 19;142(8):715-24. Select to access the abstract on PubMed®.
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Current as of August 2005