Research Activities, July 2012, No. 383
Aaronson, D.S., Odisho, A.Y., and Hills, N. (2012, February). "Proton beam therapy and treatment for localized prostate cancer: If you build it, they will come." (AHRQ grant HS19356). Archives of Internal Medicine 172(3), pp. 280-283.
Patients with localized prostate cancer who live in a hospital referral region where a proton beam facility is available are more likely to receive proton beam therapy. However, no study has demonstrated superiority of this form of therapy to photon-based therapy in terms of either cancer or improved quality of life. Also, proton beam therapy is substantially more expensive than the other treatment.
Baddley, J.W., Winthrop, K.L., and Patkar, N.M. (2011, September). "Geographic distribution of endemic fungal infections among older persons, United States." (AHRQ grant HS18517). Emerging Infectious Diseases 17(9), pp. 1664-1669.
A national study using Medicare data finds that the incidence of two types of fungal infections, histoplasmosis and blastomycosis, was highest in the Midwest; the third type, coccidioidomycosis, is most prevalent in the West. Knowledge of areas of increased incidence may improve diagnostic or prevention measures in older adults at risk for endemic fungal infections.
Bailey, S.C., Hasnain-Wynia, R., and Chen, A.H. (2012). "Developing multilingual prescription instructions for patients with limited English proficiency." (AHRQ grant HS19435). Journal of Health Care for the Poor and Underserved 23, pp. 81-87.
The authors describe the development of a set of patient-centered prescription medication instructions and their translation into five languages. Findings from this process of improving, translating, and adapting prescription instructions can be used to better inform the development of other patient materials within the pharmacy or in other health care settings.
Basu, J. (2011). "Admissions for CABG procedure in the elderly. Was there a change in access to teaching hospitals after 1997?" Social Work in Public Health 26, pp. 605-620. Reprints (Publication No. 12-R037) are available from the AHRQ Publications Clearinghouse.
This study identifies patient attributes related to admission to New York and Pennsylvania teaching hospitals for coronary artery bypass graft surgery during 1997-2001. Patient characteristics associated with a higher likelihood of admission to teaching hospitals included racial/ethnic status, transfer cases, and Medicaid and private health maintenance organization insurance. Access to teaching hospitals disproportionately declined for Medicaid patients during this period, which saw growing financial constraints for hospitals.
Brach, C., Dreyer, B., Schyve, P., and others. (2012, January). "Attributes of a health literate organization." Institute of Medicine. Discussion Paper. Washington, D.C.: National Academies Press. Reprints (Publication No. 12-R060) are available from the AHRQ Publications Clearinghouse.
This paper describes ten attributes of a health literate organization, that is, an organization that makes it easier for people to navigate, understand, and use information and services to take care of their health. It explains which organizations should use these attributes and how they should be used. Several examples of each of the ten attributes are also given.
Clancy, C. (2011, January). "Checking in about innovation." Healthcare Informatics 28(2), pp. 48-64. Reprints (Publication No. 12-R056) are available from the AHRQ Publications Clearinghouse.
The editor interviews the director of the Agency for Healthcare Research and Quality on using information technology strategically to improve care delivery, quality, patient safety, and efficiency. The topics addressed include: learning in a systematic way from off-label use of medications, the pace of information technology advances, patient-centered care, and physician engagement in performance measurement.
Clancy, C. (2011, February). "Focus on heart health. Learn the signs and treatments for heart disease." AARP Bulletin. Reprints (Publication No. 12-R039) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality discusses angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, medications for stable coronary heart disease, which are the subject of an AHRQ report. She also discusses how people can lower their risk of heart problems through exercise, lifestyle changes, and knowing when to consult a doctor.
Clancy, C., Glied, S.M., and Lurie, N. (2012, February). "From research to health policy impact." HSR: Health Services Research 47(10, Part II), pp. 337-343. Reprints (Publication No. 12-R049) are available from the AHRQ Publications Clearinghouse.
This commentary, by authors now directly engaged in policy, describes the ways that research influences policy and offers reflections on the culture and imperatives of a policy environment. Topics discussed include: defining the contours of a problem, identifying the strengths and weaknesses of policy options, estimating the costs and consequences of legislative proposals, and the implementation of legislation.
Clancy, C. (2011, October). "How to get patients to ask—and doctors to listen." AARP Bulletin. Reprints (AHRQ Publication No. 12-R043) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality discusses the importance of patients becoming more active in their own care by asking questions of their health care providers. She gives the example of an individual heart patient who learned the importance of becoming more active in his care.
Clancy, C. (2011, November). "How to get the best value for your health insurance plans." AARP Bulletin. Reprints (Publication No. 12-R044) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality discusses how people in various situations can find health insurance appropriate to their needs. In particular, she discusses insurance options for the Medicare-eligible, the self-employed, the unemployed, those who have lost insurance due to job loss, and those who are uninsured because of a pre-existing condition. She also discusses the different basic types of private coverage ranging from conventional indemnity insurance to health maintenance organizations.
Clancy, C. (2012). "Let the data be our guide: Trends and tools for research on health care utilization." Health Economics 21, pp. 19-23. Reprints (Publication No. 12-R036) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality offers examples of inefficiencies in the health care system (drug-related adverse outcomes, readmission to the hospital for the same conditions) and describes the challenges and prospects for improved efficiency. One such area is the measurement and documentation of inefficiencies. Another is the bringing together of different data collections (State data organizations, hospital associations, and private data organizations in the Healthcare Cost and Utilization Project).
Clancy, C. (2011, February). "Making the right thing the easy thing to do." AARC Times. Reprints (Publication No. 12-R041) are available from the AHRQ Publications Clearinghouse.
In a keynote address to the American Association for Respiratory Care, the director of the Agency for Healthcare Research and Quality discusses various topics: patient-centered outcomes research, the Affordable Care Act, how to leverage the best evidence (e.g., the Michigan Keystone Project), and the role of respiratory therapists in improving the patient's experience.
Clancy, C. and Collins, F.S. (2010). "Patient-centered outcomes research institute: The intersection of science and health care." Science and Translational Medicine 2(37), pp. 1-3. Reprints (Publication No. 12-R045) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality and the director of the National Institutes of Health discuss the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit corporation created by the Affordable Care Act. They emphasize PCORI's opportunities to contribute to a robust portfolio of scientific inquiry that builds on their agencies' investment in comparative effectiveness research.
Clancy, C. (2011, September). "Protocol for all. Smaller hospitals can adopt proven tools for reducing central-line infections." Modern Healthcare, p. 20. Reprints (Publication No. 12-R059) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality discusses the Comprehensive Unit-Based Safety Program (CUSP) to reduce central line-associated bloodstream infections. The CUSP protocol uses a checklist of evidence-based safety practices that both small and mid-sized hospitals can use. The article describes how the initial program, developed for Michigan, has spread to hospitals in all 50 States.
Clancy, C. (2011, September). "Which treatments work best for you?" AARP Bulletin. Reprints (AHRQ Publication No. 12-R042) are available from the AHRQ Publications Clearinghouse.
The director of the Agency for Healthcare Research and Quality discusses consumer guides that address various areas of women's health. Topics range from drugs to reduce the risk of breast cancer for women at high risk and how to manage pain from a broken hip to osteoporosis treatments, gestational diabetes, and induced labor.
Cohen, S.B. (2011, August). "The utility of the integrated design of the Medical Expenditures Panel Survey to inform mortality related studies." AHRQ Working Paper No. 11004. Reprints (Publication No. 12-R055) are available from the AHRQ Publications Clearinghouse.
This study enhances the capacity to conduct longitudinal analyses by augmenting the Medical Expenditure Panel-National Health Interview Survey linkages with further matches to the National Death Index to inform mortality-related studies. Attention is given to enhancing an understanding of the data linkage process and to articulating an estimation strategy to permit longitudinal analyses, as well as the development of the necessary estimation weight.
Croswell, J., and Fall, B. (2012, February). "Screening for bladder cancer." American Family Physician 85(4), pp. 401-402. Reprints (Publication No. 12-R054) are available from the AHRQ Publications Clearinghouse.
The authors present a case study, complete with questions and answers, on screening for bladder cancer. It is based on the recommendations of the U.S. Preventive Services Task Force. For more information, go to the Task Force Web site at http://www.uspreventiveservicestaskforce.org/uspstf/uspsblad.htm .
Davis, M.M., Gross, C.P., and Clancy, C. (2012, February). "Building a bridge to somewhere better: Linking health care research and health policy." HSR: Health Services Research 47(1), pp. 329-336. Reprints (Publication No. 12-R058) are available from the AHRQ Publications Clearinghouse.
The authors provide an introduction to a series of articles written by investigators connected with the Robert Wood Johnson Foundation Clinical Scholars Program. The articles address important barriers to bridging the gap between research and policy. Among the topics discussed: the practice patterns of urologists, value-based insurance design, changes in patient safety indicators from 1998 to 2009, insurance coverage and the quality of asthma care, and the screening of athletes for sickle cell trait.
Doorenbos, A.Z., Jacobsen, C., Corpuz, R., and others. (2011). "A randomized controlled calendar mail-out to increase cancer screening among urban American Indian and Alaska Native patients." (AHRQ grant HS10854). Journal of Cancer Education 26, pp. 549-554.
This study seeks to ascertain whether a culturally tailored art calendar could improve participation in cancer screening activities. The results suggest that printed materials with health messages are likely too weak an intervention to produce the desired behavioral outcomes in cancer screening.
Eapen, Z.J., Fonarow, G.C., Dai, D., and others. (2011). "Comparison of composite measure methodologies for rewarding quality of care." (AHRQ grant HS16964). Circulation: Cardiovascular Quality and Outcomes 4, pp. 610-618.
The researchers conducted an observational analysis to determine the influence of the opportunity-based and all-or-none composite performance measures on hospital rankings. They examined 194,245 patients with heart attacks. They found that the two performance measures are highly correlated and yield similar ranking of the top and bottom quintiles of hospitals.
Encinosa, W., Du, D., and Bernard, D. Anti-obesity drugs and bariatric surgery. Social Science Insights into Prevention, Treatment and Policy, pp. 792-807, The Oxford Handbook of the Social Science of Obesity (Editor: John Cawly). London: Oxford University Press, 2011. Reprints (Publication No. 12-R058) are available from the AHRQ Publications Clearinghouse.
The authors first describe the range of anti-obesity drugs and bariatric surgery and the research evaluating their outcomes. They conclude that bariatric surgery results in much more weight loss, reduction in comorbidities such as diabetes, and reduced mortality.
Koh, H.K., Berwick, D.M., Clancy, C., and others. (2011). "New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care.'" Health Affairs 31(2), pp. 434-443. Reprints (Publication No. 12-R050) are available from the AHRQ Publications Clearinghouse.
Recent federal policy initiatives such as the Department of Health and Human Services' National Action Plan to Improve Health Literacy have brought health literacy to a tipping point—that is-poised to make the transition from the margin to the mainstream. If public and private organizations make it a priority to become health literate, the nation's health literacy can be advanced to the point at which it will play a major role in improving health care and health for all Americans.
Krumholz, H.M., Curry, L.A., and Bradley, E.H. (2011). "Survival after acute myocardial infarction (SAMI) study: The design and implementation of a positive deviance study." (AHRQ grant HS16929). American Heart Journal 162, pp. 981-987.
Positive deviance studies combining qualitative and quantitative designs (a mixed-methods approach) can discover strategies to produce exemplary performance. The authors present the SAMI study, a national mixed-methods study to discover hospital strategies that are associated with higher survival rates for patients hospitalized with a heart attack. They also convey key principles and considerations in designing and implementing positive deviance studies.
Meltzer, D.O., Hoomans, T., Chung, J.W., and Basu, A. (2011). "Minimal modeling approaches to value of information analysis for health research." (AHRQ Contract No. 290-07-58, grant HS16067). Medical Decision Making 31, pp. E1-E22.
The authors develop a framework to define and classify minimal modeling approaches to value of information (VOI) techniques, review existing VOI studies that apply minimal modeling approaches, and illustrate the application of the minimal modeling to new clinical applications to which the approach appears well suited. They conclude that minimal modeling approaches can be readily applied in some instances to estimate the expected benefits of clinical research.
Meyers, D., and Clancy, C.M. (2011). "The patient-centered medical home: Putting the patient at the center of care." Journal of Primary Care & Community Health 2(1), pp. 2-5. Reprints (Publication No. 12-R038) are available from the AHRQ Publications Clearinghouse.
The patient-centered medical home (PCMH) model holds great promise as a way to improve health care by reshaping how primary care is organized, delivered, and integrated with other aspects of care. The Agency for Healthcare Research and Quality has taken a leadership role in developing the PCMH as a potential model to achieve high-quality, accessible, and efficient health care. The authors describe the function and attributes of a medical home.