November 18, 2010
A Special Message from AHRQ Director Carolyn M. Clancy, M.D., on the 300th issue of the Agency's Electronic Newsletter
The Agency for Healthcare Research and Quality is proud to bring you the 300th issue of our AHRQ Electronic Newsletter. Since its inception in February 2000, the newsletter has become an invaluable source of information, research, and tools that can be used to provide evidence-based, safe, high-quality health care and serve as the readership which has climbed from an initial list of 800 to more than 60,000 and growing every day! Please tell your friends and colleagues about our newsletter so they too can benefit from the information we provide. I also urge you continue to tell us about your experiences using AHRQ tools, knowledge and information so we know what kind of impact our work has. As always, we welcome your feedback, and thank you! To subscribe to the newsletter, go to http://www.ahrq.gov/news/enewsix.htm.
AHRQ News and Numbers
Dental bills in California averaged $813 per patient in 2007, roughly a quarter more than the national average of $643. [Source: Agency for Healthcare Research and Quality, MEPS, Statistical Brief #299: Dental Expenditures in the 10 Largest States, 2007 (PDF File, Plugin Software Help).
- AHRQ awards $34 million to expand fight against healthcare-associated infections
- Register for December 2-3 Conference on Methodological Challenges in Comparative Effectiveness Research
- Register for December 8 Webcast on ways to implement the CAHPS® Clinician and Group Survey
- Register for the Bone Health Conference set for December 9-10
- Effective health care program Methods Guide for Effectiveness and Comparative Effectiveness Reviews
- New report on the impact of human factors on home health care quality and safety is available
- New AHRQ evidence report on Inhaled Nitric Oxide Therapy to Preterm Infants
- New AHRQ evidence report on Complementary and Alternative Therapies for Back and Neck Pain
- Free patient education videos, pamphlets in Spanish
- New report examines impacts of health IT on workflow in outpatient settings
- New guides on rotator cuff tears in adults are available
- 2008 HCUP facts and figures report—provides statistics on hospital visits
- AHRQ in the professional literature
1. AHRQ Awards $34 Million to Expand Fight against Healthcare-Associated Infections
AHRQ announced the award of $34 million in projects focused on preventing one of the top ten leading causes of death in the United States—health care-associated infections (HAIs). This new funding will help improve the quality of care delivered to patients and expand the fight against HAIs in hospitals, ambulatory care settings and long-term care facilities. Each year, there are nearly 2 million HAIs in hospitals, which contribute to almost 100,000 deaths. While there is a growing body of knowledge regarding the number of infections and methods to reduce those infections within hospitals, there is not enough information currently available on infections originating in other health care settings. These settings include ambulatory surgery centers, end-stage renal disease facilities and long-term care facilities. Select to read our press release and select to access a complete list of institutions and funded projects.
2. Register for December 2-3 Conference on Methodological Challenges in Comparative Effectiveness Research
AHRQ and the National Institutes of Health are cosponsoring a conference on "Methodological Challenges in Comparative Effectiveness Research " to be held on December 2-3 on the main NIH campus in Bethesda, MD. The conference will make use of case studies that pose difficult questions about what kinds of research, methods, and analyses should be used to address limitations in current evidence for interventions and tests being examined by decision making bodies. The cases will address a variety of important comparative effectiveness research questions facing U.S. researchers, care providers, health systems, and patients. Topics include:
- Comparative effectiveness of surgical and radiotherapy treatments for prostate cancer: Best methods for studying multilevel heterogeneous effects.
- Comparative effectiveness of medical and surgical treatments for stable is chemic heart disease within subgroups of patients and in the face of rapidly evolving treatments.
- Comparative effectiveness and costs of imaging strategies for diagnosing and monitoring patients with cancer.
- Evaluation of two high profile comparative drug safety cases: Aprotinin and Rosiglitazone.
- Challenges of designing a "Learning Healthcare Systems " for Comparative Effectiveness Research in "Learning Healthcare Systems."
In addition to the case-based discussions noted above, consumers, economists, methodologists, policymakers, and statisticians will present two additional sessions:
- Methods for Addressing Confounding in Observational Studies.
- Value of Information Techniques for Setting Research Priorities.
3. Register for December 8 Webcast on Ways to Implement the CAHPS® Clinician and Group Survey
The CAHPS® User Network will host a free Webcast to present strategies for implementing the CAHPS Clinician and Group Survey in physician practices across communities on December 8 at 2:00 - 3:00 p.m. EST. The Clinician and Group Survey assess patients' experiences with physicians and their office staff. The Webcast features Dale Shaller, author of Leverage Existing Efforts or Use a Centralized Approach? Two Strategies for Community-Wide Implementation of the CAHPS Clinician & Group Survey. Speakers also include Donna Marshall, Executive Director of the Colorado Business Group on Health and Thomas Schlesinger, Ph.D., Executive Consultant with Gundersen Lutheran Health System in LaCrosse, Wisconsin.
4. Register for the Bone Health Conference Set for December 9-10
Registration is open for the AHRQ-sponsored Bone Health Conference on December 9-10 to be held at the Omni Shoreham Hotel in Washington, DC. This conference is a collaboration among the Centers for Education and Research in Therapeutics, the University of Alabama at Birmingham and the National Action Plan for Bone Health Initiative. This state-of-the-art conference convenes clinicians, health care system leaders, health policy setters, and others committed to improving systems of care to optimize bone health and osteoporosis care in the U.S. The conference will:
- Identify best practices in fracture prevention and fracture treatment
- Discuss successful strategies to implement best practices for a variety of settings and populations
- Identify barriers to implementation in health systems
- Establish and prioritize an outcomes research agenda for health systems' implementation strategies to determine best practices for the future
5. Effective Health Care Program Methods Guide for Comparative Effectiveness Reviews
AHRQ's Effective Health Care Program announces the release of a new chapter for the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. This new chapter, "Conducting Quantitative Synthesis When Comparing Medical Interventions: AHRQ and the Effective Health Care Program " is now available on the EHC Program Web site. Select to learn more about the Methods Guide for Effectiveness and Comparative Effectiveness Reviews and to view other chapters in this Guide.
6. New Report on the Impact of Human Factors on Home Health Care Quality and Safety is Available
A new AHRQ- funded report examines the impact of human factors on home health care quality and safety. The report includes seven commissioned papers on topics that include matching care to people in their home care environment; the prevalence, characteristics, and care provision ability of informal caregivers; medical devices and information technology and systems in home care; impact of social, cultural, and community environments on home care; and the effects of policy, reimbursement, and regulation on home health care. Based on proceedings from an October 2009 workshop, the report, The Role of Human Factors in Home Healthcare: Workshop Summary and Papers, also features summaries of the discussion at the workshop on how home care quality and safety are impacted by the capabilities and limitations of patients and providers in the use of technologies. The workshop summary report, which is published by the National Academy of Sciences' National Research Council under contract to AHRQ, is available for free download from their Web site. A final consensus report and designers' guide for home-based consumer health IT developers, which build on the workshop proceedings, are under development and will include recommendations related to the safety and quality of home health care. The report and designers' guide are expected to be released in spring 2011.
7. New AHRQ Evidence Report on Inhaled Nitric Oxide Therapy for Preterm Infants
AHRQ released a new evidence report that found insufficient evidence to support giving inhaled nitric oxide therapy to preterm infants requiring mechanical ventilation to improve survival, or decrease pulmonary morbidity or neurodevelopment impairment. Led by Marilee C. Allen and Pamela K. Donohue at the AHRQ Johns Hopkins University Evidence-based Practice Center found a small reduction in the risk of the composite outcome of bronchopulmonary dysplasia or death for infants at 36 weeks postmenstrual age, who were treated with inhaled nitric oxide. They found insufficient data to determine if the therapy reduces the rate of bronchopulmonary dysplasia in preterm infants. Researchers found insufficient evidence to determine if inhaled nitric oxide therapy impacts long-term health outcomes such as respiratory symptoms, rehospitalization after intensive care unit discharge, and growth. There was insufficient evidence that use of inhaled nitric oxide therapy influences the incidence of cognitive, motor or sensory impairment or neurodevelopmental disability in preterm infants who require mechanical ventilation, though there was evidence that suggested that there may be a decrease in the use of respiratory medications at one year of age. There was insufficient evidence to determine if there was a differential effect based on birth weight, gender, race/ethnic group, gestational age, or severity of illness. Investigators noted that more research is needed to explore the possibility that inhaled nitric oxide may someday become a component of treatment strategy for some preterm infants receiving respiratory support. The results of this report, Inhaled Nitric Oxide in Preterm Infants, was presented at the National Institutes of Health Consensus Development Conference on October 27-29, 2010. Select to download a copy of the report.
8. New AHRQ Evidence Report on Complementary and Alternative Therapies for Back and Neck Pain
AHRQ released a a new evidence report that concludes that the benefits of complementary and alternative medicine (CAM therapies), which include acupuncture and spinal manipulation for low back pain, neck pain, and disability, were modest in size and were mostly evident immediately or shortly after treatment. The observed benefit appeared to fade over time. The researchers, who were co-led by Andrea Furlan, M.D., Ph.D., Alexander Tsertsvadze, M.D. M.Sc., and Fatemeh Yazdi M.Sc., with the AHRQ-supported University of Ottawa Evidence-based Practice Center, were not able to draw more definitive conclusions because the evidence was of low to moderate quality, heterogeneous, often inconsistent, and sometimes lacking. Some general findings of the report include the following:
- CAM therapies tended to reduce pain and/or disability more than usual medical care (generally anti-inflammatory drugs and exercise), physical therapy, or no treatment;
- Acupuncture was better than placebo (e.g., sham-TENS, sham-laser, or sham-medication), but only for reducing pain intensity immediately after treatment;
- For people with chronic neck pain, acupuncture was no different from sham-acupuncture, pain medication, mobilization or traction, or laser therapy for reducing pain or disability after treatment.
- Manipulation was better than placebo, and equivalent to pain medication for reducing pain intensity.
- Mobilization was better than placebo for reducing acute and subacute neck pain, but not chronic neck pain.
- Massage was better than placebo for reducing intensity of acute or subacute pain, but not chronic pain.
This review was requested and supported by the National Institutes of Health's National Center for Complementary and Alternative Medicine. Select to access the full report, Complementary and Alternative Therapies for Back Pain II.
9. Free Patient Education Videos, Pamphlets in Spanish
AHRQ is offering health providers its 60-second patient education videos in Spanish for organizations to show on closed-circuit television or on their Web sites. These are:
- Taking Medicines (Conozca susmedicamentos).
- Having Surgery (Consejos para la cirugia).
- ER Visits (Consejos para cuando tenga que acudir a la sala de emergencia).
- Gestational Diabetes (Diabetes gestacional).
- Blood Clots (Los coágulos).
- Osteoporosis (La osteoporosis).
AHRQ also has new patient guides in Spanish or English on gestational diabetes, elective induced labor, cholesterol medications, breast biopsy methods, breast cancer risk-reduction drugs, premixed insulins, and other topics. Select to access the guides in Spanish and in English. You can also order a new bilingual guide, Como cuidarme: Guia para cuando salga del hospital/Taking Care of Myself: A Guide for When I Leave the Hospital.
10. New Report Examines Impacts of Health IT on Workflow in Outpatient Settings
AHRQ released a new summary report, Incorporating Health IT into Workflow Redesign,prepared by the University of Wisconsin-Madison's Center for Quality and Productivity Improvement. The report summarizes existing research and evidence related to the impact of health IT on workflow in outpatient settings. Key information obtained from the research will be incorporated into a toolkit to assist small and medium-sized practices in workflow analysis and redesign before, during, and after health IT implementation. The toolkit, Workflow Assessment for Health IT, is expected to be available in January 2011. Select to access the Incorporating Health IT into Workflow Redesign Summary Report (PDF file; Plugin Software Help) and the associated appendix, Incorporating Health IT Into Workflow Redesign Summary Report Appendix F: Tool Compendium (PDF file; Plugin Software Help).
11. New Guides on Rotator Cuff Tears in Adults Are Available
AHRQ's Effective Health Care Program released new summary guides on Treatment Options for Rotator Cuff Tears: A Guide for Adults and Comparative Effectiveness of Interventions for Rotator Cuff Tears in Adults: A Guide for Clinicians. Tears to the shoulder's rotator cuff, which is composed of four muscle-tendon units, are comment among older adults. I Rotator cuff tears can cause significant pain and limit arm motion. Injuries to the rotator cuff are treatable, but it is unclear which treatment option—surgical or non-surgical treatments such as physical therapy or medication—is best, according to the comparative effectiveness report prepared by the AHRQ-funded University of Alberta Evidence-based Practice Center. The research review from which the new guides were derived examined treatment and rehabilitative options for rotator cuff tears. It found that all treatments, either surgical or nonsurgical, result in improvement, but found little difference between interventions. The report did not find evidence indicating ideal timing of surgery. In addition, a CME activity and a slide talk are also now available.
12. 2008 HCUP Facts and Figures Report—Provides Statistics on Hospital Visits
AHRQ's Healthcare Cost and Utilization Project released the latest annual update of HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008. The new report uses HCUP Nationwide Inpatient Sample database to present information about hospital care in 2008, as well as trends in care from 1993 to 2008. HCUP Facts and Figures features an overview of numerous hospital-related topics, including general characteristics of U.S. hospitals and the patients treated; the most common diagnoses, conditions, and procedures associated with inpatient stays; the costs and charges associated with hospitalizations; and the payers for inpatient stays. A special section of this year's report is an examination of trends in inpatient and emergency department care for mental health and substance abuse conditions.
13. 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.
Greene SK, Kulldorff M, Lewis EM, et al. Near real-time surveillance for influenza vaccine safety: proof-of-concept in the Vaccine Safety Datalink Project. Am J Epidemiol 2010 Jan 15; 171(2):177-88. Select to access the abstract abstract on PubMed.®
Santucci AK, Gold MA, Akers AY, et al. Women's perspectives on counseling about risks for medication-induced birth defects. Birth Defects Res A Clin Mol Teratol 2010 Jan; 88(1):64-9.] Select to access the abstract abstract on PubMed.®
Cantrell J, Shelley D. Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study. BMC Fam Pract 2009 Dec 17; 10:81. Select to access the abstract abstract on PubMed.®
Lightdale JR, Valim C, Mahoney LB, et al. Agitation during procedural sedation and analgesia in children. Clin Pediatr 2010 Jan; 49(1):35-42. Select to access the abstract abstract on PubMed.®
Castaldi PJ, Cho MH, Cohn M, et al. The COPD genetic association compendium: a comprehensive online database of COPD genetic associations. Hum Mol Genet 2010 Feb 1; 19(3):526-34. Select to access the abstract abstract on PubMed.®
Carlson JN, Mayrose J, Wang HE. How much force is required to dislodge an alternate airway? Prehosp Emerg Care 2010 Jan-Mar; 14(1):31-5. Select to access the abstract abstract on PubMed.®
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Current as of November 2010
AHRQ Electronic Newsletter, November 18, 2010, Issue #300. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews300.htm