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January 5, 2007, Issue No. 217


AHRQ News and Numbers

Hospitalization rates for cervical cancer cases declined 36 percent between 1994 and 2004—from 26 admissions to 17 admissions per every 100,000 women. The number of admissions per year fell from 34,600 to 24,800 during the same period. [Source: Agency for Healthcare Research and Quality (AHRQ) HCUP Statistical Brief No. 22: Hospital Stays for Cervical Cancer, 2004.]

Today's Headlines

1. AHRQ Study Finds that Adding Lab Data and Refining Secondary Diagnosis Information Improves Measurement of Hospital Quality
2. New Study Finds Intervention Lowers Catheter-Related Bloodstream Infections in Hospital ICUs
3. New Evidence Report on Genetic Testing in Depression Treatment Is Available
4. Research on Use of Drug-Coated Stents Is Featured Story in AHRQ's Healthcare 411 Audio Podcast
5. Study Finds Medication Therapy Management Programs Vary Widely on Patient Enrollment and Assistance
6. Do You Know How AHRQ's Research Is Being Used?
7. Calling All AHRQ Researchers! “Help Us to Help You.”
8. AHRQ in the Professional Literature


1. AHRQ Study Finds that Adding Lab Data and Refining Secondary Diagnosis Information Improves Measurement of Hospital Quality

Use of new billing codes and readily available numerical laboratory data has been shown to dramatically increase the accuracy of comparisons of the quality of care provided by hospitals, according to a new AHRQ-funded study. The study, “Enhancement of Claims Data to Improve Risk-Adjustment of Hospital Mortality,” led by Michael Pine, M.D., M.B.A., of the University of Chicago, was published in the January 3 issue of JAMA. Researchers found that adding the new information to current claims data improved by 24 percent the accuracy of a common measure of hospital quality: risk-adjusted inpatient mortality.

Accurate measurement of clinical performance is critical to ensure the integrity of public reporting, pay-for-performance programs, and the effectiveness of quality improvement initiatives. Clinical quality in hospitals currently is measured using administrative claims data such as a patient's age, sex, principal diagnosis, secondary diagnoses, and procedures performed during hospitalization. Health care researchers have been concerned that these data are insufficient to measure hospital quality.

By supplementing claims data with numerical results of 20 common laboratory tests performed on admission and limiting secondary diagnoses to those that were present at admission, the study's authors achieved levels of accuracy only 5 percent lower than were achieved using complete, often difficult to obtain clinical data. Select to access the abstract in PubMed®.

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2. New Study Finds Intervention Lowers Catheter-Related Bloodstream Infections in Hospital ICUs

An evidenced-based intervention at 103 intensive care units (ICUs) in Michigan to reduce the incidence of catheter-related bloodstream infections substantially lowered the rate of these infections; results that continued throughout an 18-month period, according to a new study funded by AHRQ and published in the December 28, 2006, New England Journal of Medicine. Central venous catheters may cause an estimated 80,000 catheter-related bloodstream infections and, consequently, up to 28,000 deaths among patients in ICUs.

As part of a larger patient safety initiative under way in Michigan hospital ICUs, researchers from Johns Hopkins School of Medicine, Baltimore, and the University of Michigan, Ann Arbor, targeted clinicians' use of five evidence-based procedures recommended by the Centers for Disease Control and Prevention (CDC) as having the greatest effect on the rate of catheter-related bloodstream infections and the lowest barriers to implementation. CDC's recommended procedures are: hand washing, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site, and removing unnecessary catheters.

Researchers reported that the overall median rate of catheter-related bloodstream infections decreased from 2.7 infections per 1,000 catheter days at baseline to 0, at 0 to 3 months following the intervention. The initial drop was sustained at 0 during 18 months of followup. A significant decrease in the rate of bloodstream infections was seen in teaching and non-teaching hospitals and in small and large hospitals, researchers reported. Select to access the abstract in PubMed® of the study “An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU.”

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3. New Evidence Report on Genetic Testing in Depression Treatment Is Available

AHRQ released a new evidence report that finds there is insufficient evidence to determine if current gene-based tests intended to personalize the dose of medications in a class of drugs called selective serotonin reuptake inhibitors (SSRIs) improve patient outcomes or aid doctors or patients in making treatment decisions. The available studies indicate that the tests are largely accurate at evaluating differences in genes belonging to the Cytochrome P450 (CYP450) family that affect the rate at which a person metabolizes SSRIs. However, additional well-designed studies are needed to determine the usefulness of test results in the clinical setting.

The evidence report is the first step in the two-step process of CDC's Evaluation of Genomic Applications in Practice and Prevention (EGAPP) pilot project to evaluate and make recommendations regarding the use of gene-based tests. The report was prepared by AHRQ's Duke University Evidence-based Practice Center in Durham, North Carolina. Select to access our press release and to download the report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

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4. Research on Use of Drug-Coated Stents Is Featured Story in AHRQ's Healthcare 411 Audio Podcast

This week's program features Elise Berliner, Ph.D., director of AHRQ's technology assessment program, discussing AHRQ-funded research that showed the risk of death or heart attack with drug-coated stents appears lower with longer use of anti-clotting treatment. The story also includes comments from Andrew Farb, M.D., cardiologist and Medical Officer at the Food and Drug Administration's (FDA) Center for Devices and Radiological Health, about the use of drug-eluting stents.

The newscast also includes data from AHRQ's Medical Expenditure Panel Survey that shows retail workers get no bargains on health insurance; a related story announces that AHRQ's insurance database now makes it easy to compare costs for insurance between cities. Select to access this 10-minute audio podcast.

You can listen to the audio program directly through your computer—if it has a sound card and speakers and can play MP3 audio files—or you can download it to a portable audio device. In any case, you will be able to listen at your convenience. To access any of AHRQ's newscasts and special reports or to sign up for a free subscription to the series to receive notice of all future AHRQ podcasts, visit our Healthcare 411 series main page.

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5. Study Finds Medication Therapy Management Programs Vary Widely on Patient Enrollment and Assistance

New programs intended to help older Americans use medicines more effectively and safely vary widely based on which patients are enrolled and how they are assisted, according to an AHRQ-funded study in the November/December issue of the Journal of the American Pharmacists Association. The Medication Therapy Management (MTM) programs were mandated by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. The legislation did not mandate which Medicare patients would be included in MTM programs, however.

According to the new study, a survey showed enrollment was based on patient variables such as the number of diseases diagnosed, types of diseases, and the number of medications prescribed. Direct mailings to enrollees and establishment of call centers were common strategies to help enrollees take medications more effectively and safely. The survey included 21 MTM programs representing 70 health programs covering 12.1 million of the 20.7 million Medicare enrollees who enrolled in Medicare Part D prescription drug plans.

The MTM article was authored by AHRQ's Chicago-area DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) center. Select to access the abstract in PubMed®.

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6. Do You Know How AHRQ's Research Is Being Used?

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 impact case studies describe AHRQ research findings in action. These case studies are used in testimony, budget documents, and speeches.

We would like to know if you are aware of any impact your AHRQ-funded research has had on health care policy, clinical practice, or patient outcomes. Contact AHRQ's Impact Case Studies Program at Jane.Steele@ahrq.hhs.gov or (301) 427-1243 with your impact stories.

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7. Calling All AHRQ Researchers! “Help Us to Help You.”

As you may know, AHRQ can help you promote the findings of your research, but we can't do it without you. AHRQ has been successful in working with our grantees and contractors to promote findings to the media and to transfer knowledge based on the research to appropriate audiences in the health care community. However, we know that we can do better. We need you to notify us when you have an article accepted for publication.

Please send a copy of the manuscript, anticipated publication date, and contact information for the journal and your institution's PR office to your AHRQ project officer and to AHRQ Public Affairs at journalpublishing@ahrq.hhs.gov. Your manuscript will be reviewed to determine what level of marketing we will pursue. Please be assured that AHRQ always honors the journal embargo. Thank you for your cooperation.

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8. 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.

Muennig P, Lubetkin E, Jia H, et al. Gender and the burden of disease attributable to obesity. Am J Public Health 2006 Sep;96(9):1662-8. Select to access the abstract in PubMed®.

Siu AL, Boockvar KS, Penrod JD, et al. Effect of inpatient quality of care on functional outcomes in patients with hip fracture. Med Care 2006 Sep;44(9):862-9. Select to access the abstract in PubMed®.

Paliwal P, Gelfand AE. Estimating measure of diagnostic accuracy when some covariate information is missing. Stat Med 2006 Sep 15;25(17):2981-93. Select to access the abstract in PubMed®.

Ray MN, Houston TK, Yu FB, et al. Development and testing of a scale to assess physician attitudes about handheld computers with decision support. J Am Med Inform Assoc 2006 Sept-Oct;13(5):567-72. Select to access the abstract in PubMed®.

Schade CP, Hannah K, Ruddick P, et al. Improving self-reporting of adverse drug events in a West Virginia hospital. Am J Med Qual 2006 Sept-Oct;21(5);335-41. Select to access the abstract in PubMed®.

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If you are a new subscriber or would like to reference information in a previous issue, an archive of this newsletter can be found on AHRQ's Web site at http://www.ahrq.gov/news/newsletters/e-newsletter/index.html.

Contact Information

Please address comments and questions to Nancy Comfort at Nancy.Comfort@ahrq.hhs.gov or (301) 427-1866.


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Current as of January 2007

 

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