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Please go to www.ahrq.gov for current information.

January 19, 2007, Issue No. 218


AHRQ News and Numbers

People who currently have asthma are much more likely to rely on drugs that offer quick relief for symptoms such as shortness of breath, wheezing, or coughing, than on medications for long-term control. Approximately 31 percent of sufferers say that they use quick-relief medications to control symptoms of asthma, compared with about 14 percent who rely on longer-term preventive medicines for control. Another 31 percent use both types of medications and 24 percent use no medication. [Source: Agency for Healthcare Research and Quality (AHRQ), MEPS Statistical Brief No. 152: Asthma Treatment and Management among the U.S. Civilian Noninstitutionalized Population, 2004 (PDF File, 103 KB; PDF Help).]

Today's Headlines

1. Missed Opportunities: Too Few Americans Being Screened, Counseled to Prevent Colorectal Cancer, Obesity, Other Conditions
2. Evidence Lacking To Support Many Off-Label Uses of Atypical Antipsychotics
3. Obesity Surgeries Have Jumped Dramatically Since 1998
4. AHRQ-Funded Study on Compliance With Well-Child Visits
5. Podcast on AHRQ's Quality and Disparities Reports Topic of Healthcare 411
6. New Evidence Report on Strategies To Improve Asthma Management Is Available
7. AHRQ Is Transitioning to Electronic Grant Applications
8. AHRQ in the Professional Literature


1. Missed Opportunities: Too Few Americans Being Screened, Counseled to Prevent Colorectal Cancer, Obesity, Other Conditions

The overall quality of the U.S. health care system is improving, but providers are missing important chances to help Americans avoid disease or serious complications, according to annual reports issued by AHRQ. The 2006 National Healthcare Quality Report and National Healthcare Disparities Report both found that the use of proven prevention strategies lags significantly behind other gains in health care:

  • Only about 52 percent of adults reported receiving recommended colorectal cancer screenings. About 56,000 Americans die from colorectal cancer, and 150,000 new cases are diagnosed each year.
  • Fewer than half of obese adults reported being counseled about diet by a health care professional. About one-third of American adults are obese, increasing the risks of high blood pressure, type 2 diabetes, stroke, heart disease, and osteoarthritis.
  • Only 49 percent of people with asthma said they were told how to change their environment, and 28 percent reported receiving an asthma management plan. Asthma causes about 500,000 hospitalizations annually.
  • Only 48 percent of adults with diabetes received all three recommended screenings—blood sugar tests, foot exams and eye exams—to prevent disease complications. AHRQ estimates about $2.5 billion could be saved each year by eliminating hospitalizations related to diabetes complications.

The National Healthcare Quality Report tracks the health care system through quality measures, such as what proportion of heart attack patients received recommended care when they reached the hospital, or what percentage of children received recommended vaccinations. The National Healthcare Disparities Report, meanwhile, summarizes which racial, ethnic, or income groups are most likely to benefit from improvements in health care. Select to access our press release.

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2. Evidence Lacking To Support Many Off-Label Uses of Atypical Antipsychotics

Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective. The comparative effectiveness of these drugs, called atypical antipsychotics, review by AHRQ's Southern California/RAND Evidence-based Practice Center identified the medications' potential for serious side effects while pointing to an “urgent need” for more research into new treatments for the growing population of dementia patients who display severe agitation. In addition, some studies suggest that atypical antipsychotics may help patients with mental health conditions for which there are no FDA-approved alternatives.

Overall, however, researchers found that much of the scientific evidence for off-label use of antipsychotics was of insufficient quality because studies were too small or lacked scientific rigor. Review authors evaluating the potential benefits and risks of the medications also found strong evidence that atypical antipsychotics can increase chances of adverse events. Some of the drugs increase risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems.

The report, Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics, is the newest analysis from AHRQ's Effective Health Care program. Select to access our press release and review the full report.(PDF File, 550KB; PDF Help).

Return to Today's Headlines

3. Obesity Surgeries Have Jumped Dramatically Since 1998

Obesity surgeries for patients between the ages of 55 and 64 in the United States soared from 772 procedures in 1998 to 15,086 surgeries in 2004—a nearly 2,000 percent increase. The report, Bariatric Surgery Utilization and Outcomes in 1998 and 2004, HCUP Statistical Brief No. 22, also found a 726 percent increase in surgeries among patients age 18 to 54. There were a total of 121,055 surgeries performed on patients of all ages in 2004.

Among the reasons for the extremely dramatic increases is that the mortality outcomes from obesity surgery have improved greatly. The national death rate for patients hospitalized for bariatric surgery declined 78 percent, from 0.9 percent in 1998 to 0.2 percent in 2004. Certain procedures, known collectively as bariatric surgery, have been proven beneficial in obese persons who have tried and failed to lose excess weight by diet, exercise, and other means. Select to review the statistical brief (PDF File,192 KB; PDF Help).

Return to Today's Headlines

4. AHRQ-Funded Study on Compliance With Well-Child Visits

A new, nationwide AHRQ study shows that children in the United States, especially those who are in uninsured families or who are not citizens, visit the doctor less often for well-child visits than recommended by the American Academy of Pediatrics (AAP). The study found that, as a whole, 56 percent of U.S. children from birth to 18 years of age had not had a well-child visit within 12 months, and 39 percent had not had one within 2 years.

The study focuses especially on children's compliance with AAP guidelines, which recommend more frequent well-child visits for younger children. The average compliance ratio for all children was 61 percent. Uninsured children eligible for public coverage, such as the State Children's Health Insurance Program, had the lowest compliance rate—28 percent—followed by other uninsured children (35 percent), non-citizens (44 percent), and teenagers (49 percent).

The study, “Compliance with Well-Child Visit Recommendations: Evidence from the Medical Expenditure Panel Survey, 2000-2002” by Thomas M. Selden, Ph.D., was published in the December 1, 2006, online issue of Pediatrics. Select to access the abstract in PubMed®.

Return to Today's Headlines

5. Podcast on AHRQ's Quality and Disparities Reports Topic of Healthcare 411

In this week's Healthcare 411 audio program, AHRQ Director Carolyn M. Clancy, M.D., discusses the main findings of AHRQ's 2006 National Healthcare Quality Report and 2006 National Healthcare Disparities Report. She explains that while the reports show that the overall quality of the U.S. health care system is improving, there still are many missed opportunities to help Americans avoid disease or serious complications, especially among minorities and low-income groups. Select to access this 7-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 podcasts 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.

Return to Today's Headlines

6. New Evidence Report on Strategies To Improve Asthma Management Is Available

AHRQ released a new evidence report that finds several quality improvement strategies are effective at improving the management of asthma in children and adults, and using more than one strategy may offer greater improvements in symptoms. There is good evidence about the effectiveness of strategies that teach patients to self-manage and self-monitor their disease.

For young children with asthma, strategies that involve parents and caregivers improve symptoms and reduce asthma-related school absenteeism more than strategies directed exclusively at children. School-aged children who used medicine while being observed by school nurses or other school personnel were more likely to use their asthma medicines (including inhaled corticosteroids) and had fewer emergency room visits and hospital admissions than children who only used their medicine at home. The most effective strategies are those that are designed to change patient behavior, provide repeated sessions with health care providers over an extended period of time, and use multiple methods of instruction.

The report was prepared by AHRQ's Stanford University-University of California, Berkeley and San Francisco (UCSF) Evidence-based Practice Center in California. Select to review the report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

Return to Today's Headlines

7. AHRQ Is Transitioning to Electronic Grant Applications

AHRQ continues its transition to electronic grant applications. All R01 research grant applications for the February 5 deadline must be submitted electronically using form set SF 424 (R&R). One-time registrations for both Grants.gov and the eRA Commons systems must be completed before application submission.

Applicants should submit applications early—ideally 4 weeks before the deadline. This transition continues through May 2007. Select for additional information.

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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.

Poon EG, Cina JL, Churchill W, et al. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 2006 Sep 19;145(6):426-34. Select to access the abstract in PubMed®.

Needham DM, Bronskill SE, Rothwell DM, et al. Hospital volume and mortality for mechanical ventilations of medical and surgical patients: a populations-based analysis using administrative data. Crit Care Med 2006 Sep;34(9):2349-54. Select to access the abstract in PubMed®.

Cohen LA, Manski MJ. Visits to non-dentist health care providers for dental problems. Fam Med 2006 Sep;38(8):556-64. Select to access the abstract in PubMed®.

Arega A, Berkmeyer NJ, Lurie JD, et al. racial variation in treatment preferences and willingness to randomize in the Spine Patient Outcomes Research Trial (SPORT). Spine 2006 Sep 1;31(19):2263-9. Select to access the abstract in PubMed®.

Mitchell JB, Haber SG, Hoover S. What happens to children who lose public health insurance coverage? Med Care Res Rev 2006 Oct;3(5):623-35. Select to access the abstract in PubMed®.

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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

 

The information on this page is archived and provided for reference purposes only.

 

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