Research Activities, October 2010, No. 362
Clancy, C. M. (2010, March/April). "Comparative effectiveness research: Promising area of study for pharmacists." Journal of the American Pharmacists Association 50(2), pp. 131-133. Reprints (AHRQ Publication No. 10-R065) are available from the AHRQ Publications Clearinghouse.
Comparative effectiveness research (CER) has generated a lot of interest in the health care policy community lately. The author, director of the Agency for Healthcare Research and Quality (AHRQ), defines and explains CER and elucidates AHRQ's leading role in CER through its Effective Health Care Program. Initiated in 2005, the program uses current unbiased information to make head-to-head comparisons of treatment alternatives, including drugs. This program has been greatly expanded by the 2009 American Recovery and Reinvestment Act. Its implications for pharmacists are explained by contrasting CER with traditional Phase III randomized controlled trials (RCTs) that have long been used in the drug approval process. In contrast with RCTs, CER asks "Does the drug work in normal practice and how does it compare with therapeutic alternatives?" AHRQ looks forward to working with the full pharmacy community to apply CER to health care quality improvement efforts.
Clancy, C. (2010). "Focusing the research enterprise on the patient." NCI Cancer Bulletin 7(8), pp. 1-2. Reprints (AHRQ Publication No. 10-R066) are available from the AHRQ Publications Clearinghouse.
The essence of patient-centered care is that it is of high quality only when the ultimate needs of the patient are met. To illustrate, the author presents a case study of a woman treated for stage III melanoma, who died 7 years after the initial diagnosis. Her story had elements of suboptimal quality of care and poor patient adherence. In general, statistics tracked by the Agency for Healthcare Research and Quality (AHRQ) indicate that the quality of cancer care in the United States could be much better. Comparative effectiveness research is built on the question "What is the best treatment for me?" Through its research on comparative effectiveness, AHRQ is working to improve the quality of care. AHRQ's Effective Health Care Program has cancer as one of its priority areas and has produced several reports on cancer-related topics such as particle beam radiation therapy, a comparison of tamoxifen and other medicines for breast cancer, and a comparison of therapies for clinically localized prostate cancer.
Clancy, C. M. (2010, March/April). "Preventing healthcare-associated infections: Initiating promising solutions and expanding proven ones." Patient Safety & Quality Healthcare, pp. 6-8. Reprints (AHRQ Publication No. 10-R067) are available from the AHRQ Publications Clearinghouse.
As part of a comprehensive Federal strategy to prevent and reduce all types of health care-associated infections (HAIs), the Agency for Healthcare Research and Quality (AHRQ) has launched a $17 million national initiative to fight HAIs by expanding earlier projects in hospital settings and funding new efforts to find other promising solutions to reduce and prevent HAIs in ambulatory and long-term care settings. Earlier work had led to the introduction of five specific interventions in hospital surgical intensive care units that reduced central line associated bloodstream infections to zero. The program that resulted from those interventions is known today as CUSP. The article describes its successful implementation in Michigan and its subsequent expansion to 10 States.
DeVoe, J. E., Ray, M., Krois, L., and Carlson, M. J. (2010, February). "Uncertain health insurance coverage and unmet children's health care needs." (AHRQ grants HS14645 and HS16181). Family Medicine 42(2), pp. 121-132.
Forty percent of children in the United States are covered by Medicaid or State children's insurance programs. When parents are uncertain whether or not their child is insured, it increases the child's risk of having unmet health care needs, according to a new study. Researchers identified children whose parents were uncertain about their coverage from data on 2,691 low-income families living in Oregon. In 13.2 percent of cases, the parents were uncertain whether their child had public health insurance or not. These children had greater odds of having unmet medical needs compared with children whose parents were sure of their health insurance status. Uninsured children had the highest odds of experiencing unmet health care needs.
Glance, L. G., Mukamel, D. B., Meredith, W., and Dick, A. W. (2009, December). "Hospital performance in caring for injured patients." (AHRQ grant HS16737). Archives of Surgery 144(12), pp. 1121-1126.
Trauma centers rely on overall risk-adjusted mortality measures to increase their quality improvement (QI) efforts. However, categorizing mortality measures by the type of patient trauma would help trauma centers better target QI efforts, suggests this study. Researchers customized the Trauma Mortality Probability Model by creating separate injury-specific models for patients treated at trauma centers for blunt trauma, gunshot wounds, pedestrian trauma, or motor vehicle accident trauma. They used these new models to analyze data from the National Trauma Data Bank on hospitals with 250 or more trauma admissions per year. The study found that there was poor-to-fair agreement between hospital quality measures (high, intermediate, and low quality) when hospital quality was based on outcomes for all trauma patients vs. specific subgroups of trauma patients. The researchers conclude that quality improvement data on specific trauma injuries may provide additional opportunities to improve patient care based on a particular injury.
Greene, S. K., Kulldorff, M., Lewis, E. M., and others (2010, January). "Near real-time surveillance for influenza vaccine safety: Proof-of-concept in the Vaccine Safety Datalink Project." (AHRQ grant HS13908). American Journal of Epidemiology 171(2), pp. 177-188.
As the threat of H1N1 loomed large in 2009, a vaccine to combat pandemic influenza was swiftly approved and deployed in the United States alongside a vaccine for seasonal influenza. This widespread vaccination effort brought the issue of vaccine safety into the spotlight. Employing three approaches to determine patients' risk of experiencing adverse events, this study found that vaccine safety surveillance can be accomplished in near real-time. As a result of the surveillance, the research team found that the 1,195,552 doses children received and the 4,773,956 doses adults over 18 received resulted in no elevated risk of adverse events. The authors suggest that these findings may serve to bolster public confidence in the safety of the influenza vaccine.
Hansen, R. A., Dusetzina, S. B., Dominik, R. C., and Gaynes, B. N. (2010). "Prescription refill records as a screening tool to indentify antidepressant non-adherence." (AHRQ grant T32 HS00032). Pharmacoepidemiology and Drug Safety 19, pp. 33-37.
Since more than three-fourths of patients with depression discontinue treatment within 3 months, better ways are needed to identify patients who are at highest risk of not taking their antidepressants. Using insurance records from a large health plan, researchers identified 4,545 patients with newly diagnosed major depression. They looked for gaps in prescription refills during the first 90 days of acute treatment. The researchers determined that a maximum continuous gap of 14 days had a sensitivity level of 87 percent for predicting later discontinuation of prescribed antidepressant medication. Four of every five patients at risk for discontinuing can be accurately identified by using this method and criteria. Physicians could benefit from a system in place that alerts them to when such refill gaps occur.
Holden, D. J., Jonas, D. E., Porterfield, D. S., and others (2010). "Systematic review: Enhancing the use and quality of colorectal cancer screening." (AHRQ Contract No. 290-2007-1005). Annals of Internal Medicine 152, pp. 668-676.
The purpose of this systematic review is to summarize evidence on factors that influence colorectal cancer screening (CRC) and strategies that increase the appropriate use and quality of CRC screening. A total of 116 publications met inclusion criteria for the full report. The review confirmed that important problems exist in the underuse, overuse, and misuse of CRC screening. It also found underuse and low quality of discussion between patients and health professionals about CRC screening, even though national guideline groups recommend such discussion. There was a lack of research on the problems of overuse, including assessing the net benefit of attempts to identify and remove all polyps. Very few studies focused on misuse. The researchers believe that there should be less emphasis on developing new screening tests and more emphasis on implementing existing effective tests.
Jegier, B. J., Meier, P., Engstrom, J. L., and McBride, T. (2010). "The initial maternal cost of providing 100 mL of human milk for very low birth weight infants in the neonatal intensive care unit." (AHRQ grant HS16012). Breastfeeding Medicine 5(2), pp. 71-77.
Human milk (HM) feeding reduces the risk of costly and handicapping morbidities in a dose-response manner during the early postbirth period for very-low-birth weight (VLBW) infants. This study examined the initial cost for 111 mothers to provide 100 mL of HM for their VLBW infants during the early postbirth period in the neonatal intensive care unit (NICU). The researchers compared this cost to alternative donor milk and commercial formula. They calculated costs for the breast pump rental fee, the breast pump collection kit, and the maternal opportunity cost, a measure of the value of maternal time. The mean cost of providing 100 mL of HM varied from $2.60 to $6.18 when maternal opportunity cost was included and from $0.95 to $1.55 when it was excluded. The researchers concluded that human milk for VLBW infants costs less than donor milk and less than many types of commercial formula used in NICUs.
Jiang, H. J. (2010, March/April). "Enhancing quality oversight." Healthcare Executive 25(2), pp. 80-83. Reprints (AHRQ Publication No. 10-R068) are available from the AHRQ Publications Clearinghouse.
In the past 10 years, hospitals have paid increasing attention to quality improvement. A recent survey is evidence that hospital boards are continuing to fulfill this responsibility. The Governance Institute's 2009 survey provides updates on the extent to which boards have adopted the 13 recommended quality oversight practices. Ninety percent of hospitals and health systems surveyed have adopted 4 of the 13 practices, including annual reviews of patient satisfaction scores. Five other practices have shown significantly increasing adoption rates. Among these practices are having a standing quality committee and requiring the organization to report its quality/safety performance to the general public. After comparing this survey's results to hospital quality performance measures, this study found that better quality performance was significantly associated with the existence of a board quality committee and the adoption of six particular governance practices.
Kattah, J. C., Talkand, A. V., Wang, D. Z., and others (2009, November). "HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging." (AHRQ grant HS17755). Stroke 40(11), pp. 3504-3510.
Acute vestibular syndrome (AVS)—dizziness combined with nausea and vomiting, gait unsteadiness, intolerance for head movements, and rapid eye movements (nystagmus)—is a cause of many emergency department visits annually in the United States. Previous research suggests that 25 percent or more of AVS cases represent strokes in the brainstem. The researchers found that a simple, 1-minute bedside test of abnormal head and eye movements appears to be more sensitive than early magnetic resonance imaging in identifying strokes in patients who go to the emergency department for rapid-onset dizziness. The brief three-test battery is termed HINTS, for Head-Impulse/Nystagmus/Test-of-Skew. Using the HINTS battery could potentially replace complete neurological workups and brain imaging without loss of diagnostic accuracy, conclude the researchers. The study included 101 patients with AVS and at least 1 risk factor for stroke seen at an urban academic hospital.
Khwaja, A. (2010). "Estimating willingness to pay for Medicare using a dynamic life-cycle model of demand for health insurance." (AHRQ grant HS10574). Journal of Econometrics 156, pp. 130-147.
The author estimates the willingness to pay (WTP) for Medicare benefits using a dynamic random utility model in a life-cycle human capital framework with endogenous production of health. The model accounts for the feature that the demand for health insurance is derived through the demand for health. The WTP measure incorporates the effects of Medicare insurance on medical expenditures, medical utilization, and health outcomes. The change in lifetime expected utility resulting from delaying the age of Medicare eligibility to 67 was estimated to be $24,947 (in 1991 dollars) on average. However, the less educated have a higher WTP to avoid a policy change that delays availability of Medicare benefits, notes the author.
Kumar, R., Korthuis, P. T., Saha, S., and others (2010, June). "Decision-making role preferences among patients with HIV: Associations with patient and provider characteristics and communication behaviors." (AHRQ grant HS13903). Journal General Internal Medicine 25(6), pp. 517-23.
Some patients prefer that their doctor make all the decisions, others want to share that responsibility with their doctor, and yet others want to make the final call after hearing all the options their doctor presents. A new study finds that doctors should discuss decisionmaking preferences with their patients who have HIV, because although some patients say they want to participate, their communication styles may not reflect this desire. The study of 45 providers and 434 patients with HIV found that 72 percent of patients preferred to share decisionmaking duties with their provider, 23 percent wanted their provider to make decisions on their behalf, and 5 percent wanted to make their own decisions. Patients who were depressed and patients who were not very satisfied with provider-patient communications were more inclined to have their provider make decisions for them.
Landon, B. E., Gill, J. M., Antonelli, R. C., and Rich, E. C. (2010, May). "Prospects for rebuilding primary care using the patient-centered medical home." (AHRQ grant HS17995). Health Affairs 29(5), pp. 827-834.
There is wide agreement that the current U.S. primary care system is failing, and that a revitalized primary care system will be needed if we are to realize the goal of improving quality and patients' experiences while also controlling cost growth. The patient-centered medical home shows promise as the policy strategy for the long-overdue reinvigoration of U.S. primary care, note these authors. It can provide a financing platform for traditional primary care that fee-for-service has failed to support. It can also promote enhanced primary care services enabled by 21st century information technology and measurement tools. The authors analyze potential barriers to implementing the medical home model for policymakers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice.
Liu, L., Strawderman, R. L., Cowen, M. E., and Shih, Y-C. T. (2010). "A flexible two-part random effects model for correlated medical costs." (AHRQ grant HS10730). Journal of Health Economics 29, pp. 110-123.
Medical cost data are frequently right-skewed, involve a substantial portion of zero values, and may exhibit heteroscedasticity. To account for correlated medical cost data, the authors propose a new two-part model that incorporates correlated random effects. The primary novelties are the use of the very flexible generalized gamma regression model and the incorporation of heteroscedasticity into Part II of the model. The proposed model simultaneously takes into account the presence of true zeros, right-skewness, and heteroscedasticity of positive-response values. It further permits cluster-level correlation between the odds of observing a positive response and the actual level of this response. The resulting model encompasses a substantial subset of the parametric models for semicontinuous data previously proposed in the literature, providing a useful framework in which competing models can be evaluated.
M'ikanatha, N. M., Gasink, L. B., Warren, K., and Lautenbach, E. (2010, April). "Child care center exclusion policies and directors' opinions on the use of antibiotics." (AHRQ grant HS10399). Infection Control and Hospital Epidemiology 31(4), pp. 408-411.
Child care center directors are required by State regulations to exclude children with specific communicable diseases from their centers. Children in child care centers may be at increased risk for inappropriate antibiotic prescriptions. Not only are children at increased risk for acute infectious illnesses, but center directors may influence antibiotic misuse by enforcing exclusion policies unnecessarily or by inappropriately referring children to physicians. To guide public health interventions, the researchers surveyed 135 center directors regarding exclusion policies and opinions regarding antibiotic use. Almost all of them reported writing policies on exclusion of children for acute illnesses. Although 52.4 percent of respondents agreed that children are prescribed antibiotics unnecessarily, 89.1 percent believed that parents pressure physicians to prescribe unnecessary antibiotics. They also found that many center directors believe that antibiotics are necessary for treatment of viral illnesses and that centers often exclude ill children until antibiotics are prescribed.
Onega, T., Duell, E. J., Shi, X., and others (2010). "Influence of place of residence in access to specialized cancer care for African Americans." (AHRQ grant T32 HS00070). Journal of Rural Health 26, pp. 12-19.
Blacks who live in rural areas may not be getting the level of cancer care enjoyed by urban residents regardless of race, according to a new study. This suggests that racial disparities in access to specialized cancer care may be affected by place of residence. Using 2000 Census data, researchers calculated the travel times to specialized cancer centers, including National Cancer Institute (NCI) centers, and oncologists for all Zip code areas. Overall, the proportion of blacks living less than 30 minutes from a cancer center or oncologist was greater than that observed for whites. Rural blacks, however, were found to have the longest travel times to NCI centers. They were 58 percent less likely to attend these national centers compared with rural white patients. The researchers suggest ways of bringing sophisticated cancer care to rural residents, such as telemedicine, offering transportation support, and improving cancer care at the local level.
Owens, D. K., Lohr, K. N., Atkins, D., and others (2010). "AHRQ series paper 5: Grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program." Journal of Clinical Epidemiology 63, pp. 513-523. Reprints (AHRQ Publication No. 10-R070) are available from the AHRQ Publications Clearinghouse.
These authors sought to establish guidance on grading strength of evidence for comparative effectiveness reviews produced by the Evidence-based Practice Center (EPC) program of the Agency for Healthcare Research and Quality (AHRQ). They reviewed authoritative systems for grading strength of evidence, identified domains and methods that should be considered when grading bodies of evidence in systematic reviews, considered public comments, and discussed their approach with representatives of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The EPC approach to rating the strength of evidence is conceptually and substantively similar to GRADE. The authors recommend that EPCs rate strength of evidence based on a core group of domains that include risk of bias, consistency, directness, and precision. EPCs and the GRADE working group will continue to collaborate to facilitate consistency across grading systems.
Peterson, E. D., Dai, D., DeLong, E. R., and others (2010, May 4). "Contemporary mortality risk prediction for percutaneous coronary intervention." (AHRQ grant HS16964). Journal of the American College of Cardiology 55(18), pp. 1923-1932.
The researchers sought to create contemporary models for predicting percutaneous coronary intervention (PCI) mortality risk for different subpopulations. They used the National Cardiovascular Data Registry (NCDR) CathPCI database to study 181,775 procedures performed between January 2004 and March 2006 together with 2 prospective validation cohorts (the first with 121,183 procedures and the second 285,440 procedures). Three separate models were developed: a full model including all candidate variables; a second "pre-cath" model excluding NCDR angiographic data; and a third "limited" pre-cath model including only those variables with the strongest explanatory power. They found that overall PCI in-hospital mortality was 1.27 percent, ranging from 0.65 percent in elective PCI, to 4.81 percent in elevated ST-segment heart attack patients. Each of the three models had excellent predictive accuracy throughout the full spectrum of patient risk, and important patient subgroups.
Rassen, J. A., Choudhry, N. K., Avorn, J., and Schneeweiss, S. (2009). "Cardiovascular outcomes and mortality in patients using clopidogrel with proton pump inhibitors after percutaneous coronary intervention or acute coronary syndrome." (AHRQ grant HS18088). Circulation 120, pp. 2322-2329.
Clopidogrel is a blood-thinning drug often used for cardiac patients to prevent further heart attacks following percutaneous coronary intervention or hospitalization for acute coronary syndrome. However, in some patients, it causes bleeding, which is counteracted by using proton pump inhibitors (PPIs). Some researchers have raised questions about the safety of combining clopidogrel and PPIs. In a recent study of clopidogrel users, a team of researchers from Brigham and Women's Hospital and Harvard Medical School found that clopidogrel patients who used a PPI had a 2.6 percent rate of hospitalization for a heart attack, compared with a 2.1 percent rate for those who did not. These data suggest that if there is a true clopidogrel/PPI interaction, its effect is modest and unlikely to exceed a 20 percent risk increase, note the researchers. The current study looked at 18,565 community-dwelling, elderly clopidogrel users, who lived in Pennsylvania, New Jersey, and British Columbia between 2001 and 2005.
Rathore, S. S., Ketcham, J. D., Alexander, G. C., and others (2009). "Influence of patient race on physician prescribing decisions: A randomized on-line experiment." (AHRQ grant HS15699). Journal of General Internal Medicine 24(11), pp. 1183-1191.
Prior research has demonstrated that blacks receive poorer quality of care than whites in management of their hypertension, diabetes, and high cholesterol. However, in a Web-based survey taken by 716 primary care physicians, race did not appear to influence the decision to prescribe a new medication. The survey consisted of three clinical vignettes illustrating patients with high blood pressure, high cholesterol, and diabetes. Race did influence the choice of the specific medication in the vignettes for hypertension. For example, physicians recommended calcium channel blockers more often for black patients (20.8 percent) than white patients (3.2 percent). The researchers suggest that this practice likely reflects racial differences in treatment response cited in current practice guidelines, that is, that whites tend to respond better to angiotensin converting enzyme inhibitors and blacks tend to respond better to calcium channel blockers.
Routh, J. C., Inman, B. A., and Reinberg, Y. (2010). "Dextranomer/Hyaluronic acid for pediatric vesicoureteral reflux: Systematic review." (AHRQ grant T32 HS00063). Pediatrics 125, pp. 1010-1019.
Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder back up the tubes (ureters) leading from the kidneys. The goal of this systematic review was to evaluate the accumulated literature on the surgical treatment of pediatric VUR by using Dextranomer/Hyaluronic acid (Dx/HA) and to determine the extent to which reported success rates are influenced by VUR grade, conflicts of interest (COIs), or other underlying patient or study-level factors. After the initial screening of 1157 reports, 47 studies met the review's inclusion criteria. Study results were markedly heterogeneous, with 87 percent of the total variability in pooled outcomes related to between-study variability. Of 7,303 ureters injected with Dx/HA, 5,633 (77 percent) were successfully treated according to the authors' definitions. The preoperative VUR grade was the single most important factor affecting the Dx/HA injection success rate. COI was not independently associated with an increased success rate.
Schmittdiel, J. A., Traylor, A., Uratsu, C. S., and others (2009, December). "The association of patient-physician gender concordance with cardiovascular disease risk factor control and treatment in diabetes." (AHRQ grant HS13902). Journal of Women's Health 18(12), pp. 2065-2070.
Patient and physician gender and gender concordance are modestly associated with cardiovascular disease risk factor control and treatment in diabetes, concludes a new study. It found that female patients of female primary care physicians (PCPs) were more likely to have well-controlled diabetes (70 percent) than either women treated by male doctors (68 percent) or men treated by doctors of either sex (66 percent). However, women were less likely to have controlled levels of low-density lipoprotein cholesterol (LDL-C below 100 mg/dL) or systolic blood pressure (SBP below 130 mm Hg), which are risk factors for cardiovascular disease, whether they were treated by male or female doctors. However, no difference in intensification in diabetes treatment was observed for patients whose diabetes, blood lipids, or blood pressure were over target levels, when analyzed by patient sex, physician sex, or the interaction of these two factors.
Shah, N. R., and Stewart, W. F. (2010). "Clinical effectiveness: Leadership in comparative effectiveness and translational research. The 15th annual HMO Research Network conference, April 26-29, 2009 Danville, Pennsylvania." (AHRQ grant HS18024). Clinical Medicine & Research 8(1), pp. 28-29.
The authors report on the Health Maintenance Organization Research Network (HMORN) 2009 conference. HMORN is a consortium of 16 health care delivery systems with integrated research divisions. Expert panels discussed: (1) Federal funding and industry views on comparative effectiveness research (CER), (2) the Agency for Healthcare Research and Quality's role in CER, and (3) system-level health care innovation and research. There were 2 scientific poster sessions and 20 concurrent sessions with oral abstract presentations across a wide range of topics. Also, there were more than 25 ancillary sessions, most of which reflected new or developing partnerships focused on critical topics such as the Cardiovascular Research Network, child health, the Cancer Research Network, and informatics.
Shim, J. K. (2010). "Cultural health capital: A theoretical approach to understanding health care interactions and the dynamics of unequal treatment." (AHRQ grant HS10582). Journal of Health and Social Behavior 51(10), pp. 1-15.
Cultural health capital (CHC) is the repertoire of cultural skills, verbal and nonverbal competencies, attitudes and behaviors, and interactional styles cultivated by patients and clinicians alike that, when deployed, may result in more optimal health care relationships. The author offers an overview of what CHC is, positing its key elements. She then argues that the concept of CHC helps to account for several issues significant to understanding the social production of unequal treatment that are not fully addressed by the current literature. She believes that the concept of CHC offers a coherent framework for understanding the impact of important changes in the U.S. health care system.
Sobota, A., Graham, D. A., Heeney, M. M., and others (2010, January). "Corticosteroids for acute chest syndrome in children with sickle cell disease: Variations in use and association with length of stay and readmission." (AHRQ grant T32 HS00063). American Journal of Hematology 85(1), pp. 24-28.
Hospitals vary widely in their use of corticosteroids, drugs used to fight inflammation, in the treatment of acute chest syndrome (ACS) in children with sickle cell disease (SCD), according to a new study. This variation is unexplained by medical reasons. ACS is a frequent cause of sickness and death in patients with SCD, and is often due to bacterial infection or obstructed circulation in the lungs. The researchers reviewed records on 5,247 admissions for ACS (representing 3,090 individual patients) at 32 pediatric hospitals in the United States. Corticosteroid use varied dramatically between hospitals, ranging from 10 to 86 percent for all patients with ACS and 18 to 92 percent for patients with asthma. Since systemic corticosteroids are recommended as treatment for acute asthma requiring hospitalization, the fact that on average only half of children with asthma and ACS received them is disturbing, note the researchers.
Tapp, H., and Dulin, M. (2010). "The science of primary health-care improvement: Potential use of community-based participatory research by practice-based research networks for translation of research into practice." (AHRQ grant HS16023). Experimental Biology and Medicine 235, pp. 290-299.
The authors describe the background and development of community-based participatory research (CBPR) and practice-based research networks (PBRNs) and the ways in which they currently function and are envisaged to blend in the future. Their analysis is based on a review of key research papers that demonstrate how the two fields can be connected and research successfully implemented. The authors also provide examples of a few common types of research from CBPR and PBRNs as well as studies where community is already a large component of PBRN research. Finally, they discuss ways to set up a PBRN within the community infrastructure. One of the several ways in which CBPR has the potential to significantly advance PBRN research is by allowing rapid translation of results from the study back into clinical practice and the community.
Taylor, J. A., Geyer, L. J., and Feldman, K. W. (2010, January). "Use of supplemental vitamin D among infants breastfed for prolonged periods." (AHRQ grant HS16029). Pediatrics 125(1), pp. 105-111.
Because human breast milk may be low in vitamin D, the American Academy of Pediatrics (AAP) guidelines recommend that all breastfed infants receive at least 400 IU of supplemental vitamin D daily. Yet a new study of breastfed infants reveals that only a minority of these infants receive supplemental vitamin D. The researchers found that only 36.4 percent of 44 pediatricians surveyed routinely recommended supplemental vitamin D for all of their breastfed patients. Of 1,140 infants who were predominantly breastfed for at least the first 6 months after birth, 181 of these children (15.9 percent) were routinely given vitamin D supplements. Even for those children whose pediatricians recommended vitamin D supplements, only 44.6 percent received vitamin D. The factors most significantly associated with the likelihood of supplementation were the parent agreeing that the child's doctor recommended vitamin D supplements and the parent agreeing that vitamins are important for the child's overall health.
Winthrop, K. L. (2010). "Pulmonary disease due to nontuberculous mycobacteria: an epidemiologist's view." (AHRQ grant HS17552). Future Microbiology 5(3), pp. 343-345.
Little is known regarding the epidemiology of nontuberculous mycobacterial (NTM) disease. This editorial summarizes the latest developments in pulmonary NTM disease epidemiology, and highlights key areas for future research. In earlier years, pulmonary NTM disease had been observed to mostly affect elderly males. However, in the last 20 years, it has generally increased, with more reports of female patients. In a recent study, annual prevalence rates of pulmonary NTM disease were highest among women 70 years and older (9.4/100,000) compared with similarly aged men (7.6/100,000). The assumption is that the disease is acquired from environmental sources such as municipal water, soil, and other potential water exposures. Yet, little scientific work has successfully documented the types of environmental exposures necessary to cause disease. Additional epidemiologic work must be done to ascertain disease risk factors and identify potentially modifiable exposures for those who are at risk.
Witsil, J. C., Aazami, R., Murtaza, U. I., and others (2010). "Strategies for implementing emergency department pharmacy services: Results from the 2007 ASHP Patient Care Impact Program." (AHRQ grant HS15818). American Journal of Health-System Pharmacists 67, pp. 375-379.
A higher prevalence of preventable adverse drug events has been reported in emergency departments (EDs) than in other hospital units. Only a small percentage of EDs nationally have dedicated clinical pharmacists. To help provide experiential training to practicing pharmacists looking to establish ED services in their institutions, the American Society of Health-System Pharmacists (ASHP) offered a 6-month patient care impact program in 2007. This article describes the experiences of 19 pharmacist participants in the program, focusing on the challenges of implementing pharmacy services in EDs and the strategies used to address these challenges. Challenges included gaining hospital administration approval and determining how best to define the role of the pharmacist in the ED. The end result of the ASHP program was that all 19 clinical emergency pharmacy programs have been successfully implemented in the participating community, academic, and tertiary care hospitals.
Wong, S. T., Nordstokke, D., Gregorich, S., and Perez-Stable, E. J. (2010). "Measurement of social support across women from four ethnic groups: Evidence of factorial invariance." (AHRQ grant HS10856). Journal of Cross-Cultural Gerontology 25, pp. 45-58.
Having a social network of valued relationships with others plays a critical role in an individual's health status. Evidence strongly suggests that social support keeps people healthy and helps speed recovery from illness. The purpose of this study was to examine if a multidimensional, self-report social support instrument originally developed for older Chinese and Koreans can be used for meaningful comparisons across four ethnic groups of women (African American, Latino, Chinese, and non-Latino white). The final sample group for the 22-item survey consisted of 1,074 women. Social support items in the survey were divided among three categories: tangible support, informational support, and financial support. After analysis of survey results, the researchers derived a valid and reliable eight-item social support instrument available in English, Spanish, and Chinese. The study provides evidence that mean comparisons of different dimensions of social support can be reported across four different ethnic groups in women.