Research Activities, May 2012, No. 381
Amiel, J.M., Pincus, H.A. (2011). "The medical home model: New opportunities for psychiatric services in the United States." (AHRQ grant HS16097). Current Opinions in Psychiatry 24, pp. 562-568.
This review examines the development of integrated care systems into the current concept of the patient-centered medical home (PCMH). It also describes two basic implementation frameworks: the integration of psychiatric services into a PCMH and the integration of medical services into a patient-centered psychiatric home.
Bessman, S.C., Agada, N.O., Ding, R., and others (2011). "Comparing National Institutes of Health funding of emergency medicine to four medical specialties." (AHRQ grant HS17957). Academic Emergency Medicine 18, pp. 1001-1004.
This study compared NIH funding received by emergency medicine (EM) to the specialties of internal medicine, pediatrics, anesthesiology, and family medicine in 2008. It determined that EM is one of the least funded specialties, perhaps because of its youth, emphasis on clinical research, and the opportunity costs of clinical practice.
Cegala, D.J. (2011). "An exploration of factors promoting patient participation in primary care medical interviews." (AHRQ grant HS90110). Health Communication 26(5), pp. 427-436.
This study explored aspects of Street's ecological model as a means of identifying factors that promote or impede patient participation during a medical interview. The analysis revealed eight significant predictors of patient participation. A broader goal of this research was to contextualize physician-patient communication within a multilevel interdependent perspective.
Chen, P.G-C., Curry, L.A., Bernheim, S.M., and others (2011, November). "Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training." (AHRQ grant T32 HS17589). Academic Medicine 86(11), pp. 1383-1388.
Foreign-born graduates of medical school other than those in the United States and Canada report challenges acculturating while attending U.S. residency programs. To understand the problems they face, and to suggest possible remedies, the researchers conducted in-depth interviews with 25 foreign-born graduates who were practicing physicians in Connecticut, New York, or New Jersey.
Chou, R., Arora, B., Dana, T., and others (2011). "Screening asymptomatic adults with resting or exercise electrocardiography: A review of the evidence for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155(6), pp. 375-385.
Despite an additional 7 years of studies, the evidence remains inadequate to support the use of resting or exercise electrocardiography to screen adults without symptoms for abnormalities that would indicate increased risk of coronary heart disease (CHD), according to a new evidence review conducted for the United States Preventive Services Task Force. None of the 65 articles that met the selection criteria provided consistent evidence on the potential benefits or harms of screening.
Chou, R., Croswell, J.M., Dana, T., and others (2011). "Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155, pp. 762-771.
The purpose of this review was to update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer. It concluded that prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality, and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
Clancy, C. (2012). "Alleviating 'second victim' syndrome: How we should handle patient harm." Journal of Nursing Care Quality 27(1), pp. 1-5. Reprints (AHRQ Publication No. 12-R030) are available from the AHRQ Publications Clearinghouse.
Adverse events in health care can be devastating�and not just to patients whom they strike, but to physicians, nurses, and other clinicians connected to these events. The author, director of the Agency for Healthcare Research and Quality, discusses the systemic nature of patient safety events and the importance of disclosure. She describes the role of Patient Safety Organizations in the systematic reporting of patient safety events as well as the success of the Michigan model for disclosure of these events to the affected patients.
Crosson, J.C., Etz, R.S., Wu, S., and others (2011, October). "Meaningful use of electronic prescribing in 5 exemplar primary care practices." (AHRQ grant HS16391 and Contract No. 290-06-0017). Annals of Family Medicine 9(5), pp. 392-397.
To understand why some primary care practices are successful in their transition to electronic prescribing, while many are not, the researchers conducted a comparative case study of five primary care practices. The practices had different organizational structures, primary care specialties, and patient populations. Each practice responded to an advance questionnaire and underwent a 3-day site visit, from which common themes were identified.
De Achaval, S., and Suarez-Almazor, M. (2011). "Acetaminophen overdose: A little recognized public health threat." (AHRQ grants HS17991, HS16093). Pharmacoepidemiology and Drug Safety 20, pp. 827-829.
This article comments on two studies in the same issue that provide updated estimates of the rates of acetaminophen overdose. It also highlights major areas of concern, including patient populations who may be at higher risk of overdose and who may be targets for educational or behavioral interventions. The authors encourage more efforts to educate consumers and prescribers and to redesign the process by which acetaminophen doses are measured and administered to children.
Friedly, J. (2012, January). "Imaging and uncertainty in the use of lumbar epidural steroid injections." (AHRQ grant HS19222). Archives of Internal Medicine 172(2), pp. 142-143.
The author comments on a study in the same issue that sought to determine if magnetic resonance imaging (MRI) improved outcomes of epidural steroid injections for lumbar radiculopathy and if imaging altered treatment decisions. Radiculopathy refers to symptoms (e.g., pain, weakness, numbness) caused by nerves that are not working properly. The author concluded that better data are needed on the cost-effectiveness of injections performed with and without MRI.
Gartlehner, G., Hansen, R.A., Morgan, L.C., and others (2011). "Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder. An updated meta-analysis." (AHRQ Contract No. 290-07-10056). Annals of Internal Medicine 155, pp. 772-785.
This article updates a previous AHRQ-funded systematic review on the use of major antidepressants for major depressive disorder. After reviewing data from 234 studies, the authors find that current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. No differences in efficacy were seen in subgroups based on age, sex, ethnicity, or comorbid conditions.
Giardina, T.D., and Singh, H. (2011, December). "Should patients get direct access to their laboratory test results?" (AHRQ grant HS17820). Journal of the American Medical Association 306(22), pp. 2502-2503.
A proposed Federal rule allows patients to access test results directly from the laboratory by request. Currently, there is a lack of consensus in the literature about best practices in direct patient notification of abnormal results. The authors consider patient and clinician perspectives on the potential effects of this approach. They also discuss issues to consider in the implementation of this proposed rule.
Kesselheim, A.S., Cresswell, K., Phansalkar, S., and others (2011). "Clinical decision support systems could be modified to reduce �alert fatigue' while still minimizing the risk of litigation." (AHRQ grant HS18465). Health Affairs 30(12), pp. 2310-2317.
Physicians and other users of clinical decision support systems often suffer "alert fatigue" caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. The authors' analysis of product liability principles and existing research into clinical decision support systems concludes that more finely tailored or parsimonious warnings could ease alert fatigue without imparting a high risk of litigation.
McKibbon, K.A., Lokker, C., Handler, S.M., and others (2012). "The effectiveness of integrated health information technologies across the phases of medication management: A systematic review of randomized controlled trials." (AHRQ Contract No. 290-07-10061). Journal of the American Medical Informatics Association 19, p. 22-30.
This review describes the process of collecting and synthesizing the findings from randomized controlled trials on the effectiveness and effects of medication management information technology on all phases of medication management. The review reports results for process changes, clinical outcomes, and other outcomes related to use, usability, knowledge, skills, and attitudes.
Pickard, A.S., Lee, T.A., Solem, C.T., and others (2011, December). "Prioritizing comparative–effectiveness research topics via stakeholder involvement: An application in COPD." (AHRQ Contract No. 290-05-0038). Clinical Pharmacology & Therapeutics 90(6), pp. 888-892.
In order to identify and prioritize comparative effectiveness research (CER) topics in chronic obstructive pulmonary disease (COPD) that could be addressed using a prospective study design, the authors sought input from clinical researchers and stakeholders about the generation and prioritization of research questions. They describe the process they adopted in identifying and prioritizing research questions for the conduct of a CER study in COPD.
Schneeweiss, S., Gagne, J.J., Glynn, R.J., and Rassen, J.A. (2011, December). "Assessing the comparative effectiveness of newly marketed medications: Methodological challenges and implications for drug development." Clinical Pharmacology & Therapeutics 90(6), pp. 777-790.
This article characterizes the methodological challenges faced when assessing the comparative effectiveness (CE) of newly marketed medications as they are used in day-to-day care. The authors propose a framework that integrates evidence from multiple sources for assessing the CE of drugs in the early marketing period. They also make suggestions for structural changes throughout the development process in order to support early generation of CE evidence.
Toh, S., Platt, R., Steiner, J.F., and Brown, J.S. (2011, December). "Comparative-effectiveness research in distributed health data networks." (AHRQ grant HS19912). Clinical Pharmacology & Therapeutics 90(6), pp. 883-887.
To meet the need to use the growing amount of electronic health data to address important comparative effectiveness questions, a distributed as opposed to a centralized network is preferred. That is because it can perform essentially all the functions desired of a centralized database, while avoiding many of the latter's disadvantages. The recent development of more adaptable network architectures ensures future expansion and scalability to meet the growing comparative effectiveness research needs of a variety of stakeholders.
Varley, C.D., Gross, N.D., Marx, D.P., and Winthrop, K.L. (2011). "Tuberculosis of the nasolacrimal duct." (AHRQ grant HS17552). Ophthalmic Plastic and Reconstructive Surgery 27(5), pp. e129-e131).
The authors describe an extremely unusual case of postprimary tuberculosis of the nasolacrimal system with inferior turbinate enlargement and cervical adenopathy. After dacryocystorhinostomy and nine months of standard four-drug antituberculosis therapy, complete resolution of symptoms occurred.
Vogelsmeier, A. and Scott-Cawiezell, J. (2011). Achieving quality improvement in the nursing home: Influence of nursing leadership on communication and teamwork. (AHRQ Grant HS14281). Journal of Nursing Care Quality 26(3), pp. 236–242.
Nursing leaders at nursing homes, who facilitate open communication and teamwork, achieve quality improvement while nursing leaders who obstruct these elements of organizational change fail to improve quality of care, concludes this comparative case study. The research was part of a larger study of the effect on medication safety practices of the formation of multidisciplinary medication safety teams in five Midwestern nursing homes that implemented an electronic medication administration record.
Wang, S., Linkletter, C., Maclure, M., and others (2011). "Future cases as present controls to adjust for exposure trend bias in case-only studies." (AHRQ grant T32 HS00011). Epidemiology 22, pp. 568-574.
Self-matched, case-only studies control by design for time-invariant confounders, but they do not control for confounders that vary with time. The authors present an alternative case-only method for handling exposure-time trends within a pharmacoepidemiologic framework. Their proposed method requires that the effect of exposure be transient and that outcome occurrences be distributed across calendar time.
Ward M.M., Clabaugh, G., Evans, T.C., and Herwaldt, L. (2012). "A successful voluntary, multicomponent Statewide effort to reduce health care-associated infections." (AHRQ Contract No. 290-06-00021). American Journal of Medical Quality 27(1), pp. 66-73.
The authors describe a Statewide multicomponent approach to reduce health care-associated infections (HAIs) in Iowa. The Iowa Healthcare Collaborative's success in developing a Statewide voluntary reporting system, and in significantly improving the rate of influenza immunization among health care workers demonstrates that a committed collaborative can effectively mobilize hospitals to implement HAI prevention and control measures.
Whitlock, E.P., Vesco, K.K., Eder, M., and others (2011, November). "Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: A systematic review for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155(10), pp. 687-697.
This paper systematically reviews the evidence on liquid-based cytology (LBC) and high-risk papillomavirus (HPV) screening for use by the U.S. Preventive Services Task Force in updating its 2003 recommendation. It finds that evidence supports the use of LBC or conventional cytology for cervical cancer screening, but more complete evidence is needed before HPV-enhanced primary screening is widely adopted for women aged 30 years or older.
Wysocki, A., Butler, M., Shamliyan, T., and Kane, R.L. (2011, November). "Whole-body vibration therapy for osteoporosis: State of the science." (AHRQ Contract No. 290-2007-10064). Annals of Internal Medicine 155(10), pp. 680-686.
Whole-body vibration therapy is a proposed intervention for preventing and treating osteoporosis. It is not approved by the U.S. Food and Drug Administration. After speaking with key informants and reviewing the scant literature on this subject, the researchers believe that the mechanism by which it may increase bone density is not well-understood. The efficacy and safety of this treatment are unknown. More research is needed to understand the role of this investigational therapy.
Yu, Z., and Liu, L. (2011). "A joint model of recurrent events and a terminal event with a nonparametric covariate function." (AHRQ grant HS16543). Statistics in Medicine 30, pp. 2683-2695.
The authors extend the shared frailty model of recurrent events and a dependent terminal event to allow for a nonparametric covariate function. Numerical analysis results show that the proposed estimate performs well for both the nonparametric and parametric components. They apply their method to analyze the hospitalization rate of patients with heart failure.
Zhang, J., Saag, K.G., and Curtis, J.R. (2011). "Long-term safety concerns of antiresorptive therapy." (AHRQ grants HS13852, HS18517). Rheumatic Diseases Clinic of North America 37, pp. 387-400.
Although bisphosphonates prescribed for osteoporosis were well-tolerated and safe during large-scale clinical trials, several rare and potentially serious adverse events (osteonecrosis of the jaw, atypical fractures, and esophageal cancer) have been reported to be associated with long-term bisphosphonate use from postmarketing studies and epidemiologic studies. The authors summarize studies examining the association between long-term bisphosphonate use and these adverse outcomes.
Zrelak, P.A., Utter, G.H., Sadeghi, B., Cuny, J., and others. (2012, April). "Using the Agency for Healthcare Research and Quality Patient Safety Indicators for targeting nursing quality improvement." (AHRQ Contract 290-04-0020). Journal of Nursing Care Quality 27(2), pp. 99-108.
These authors evaluate opportunities for improving nursing care related to the Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) identified through a detailed review of a national sample of medical records of patients who have at least one event of interest. Systematic review of cases flagged by the PSIs demonstrates opportunities for improvement in nursing care and nursing documentation and supports the importance of nurse-led system-level changes.