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May 13, 2005, Issue No. 167

AHRQ News and Numbers

In 2001, the average c-section rate was 250 per 1,000 deliveries, but it was much higher among women 35 and older (344 per 1,000 deliveries). Women living in rural areas had higher c-section rates than those residing in metropolitan areas (267 vs. 248 per 1,000). The c-section rate increased steadily from 209 per 1,000 deliveries in 1997 to 250 per 1,000 in 2001. [Source: Agency for Healthcare Research and Quality, HCUP, HCUPnet.]

Today's Headlines:

  1. Ambulatory performance measures represent a major step in improving quality of health care
  2. New Citizens' Health Care Working Group begins meeting
  3. New HHS guide helps nurses encourage patients to quit smoking
  4. Routine use of episiotomy in uncomplicated births offers no benefits to women
  5. AHRQ releases Advances in Patient Safety—a four-volume compendium
  6. New AHRQ report finds depression is prevalent in women during pregnancy but often goes undetected
  7. Nominations for new AHRQ National Advisory Council members are due June 10
  8. AHRQ study supports conservative treatment for low-grade, localized prostate cancer
  9. Register for free Web conference on Mass Casualty Care on May 17
  10. Deadline extended for Research Activities mail list update
  11. AHRQ in the professional literature

1.  Ambulatory Performance Measures Represent a Major Step in Improving Quality of Health Care

In a major step toward improving quality in the U.S. health care system, the Ambulatory care Quality Alliance (AQA) has selected a "starter set" of 26 clinical performance measures for ambulatory care settings. The starter set of measures is intended to provide clinicians, consumers, and purchasers with a set of quality indicators that may be used for quality improvement, public reporting, and pay-for-performance programs. The AQA, initially convened by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and AHRQ, consists of a large body of stakeholders that represent clinicians, consumers, purchasers, health plans, and others. AQA's mission is "to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring, reporting, and improving performance at the physician level." A secondary aim of the AQA is to promote uniformity to provide consumers and purchasers with consistent information and to reduce the burden on providers. Select to read the AQA press release for more information.

2.  New Citizens' Health Care Working Group Begins Meeting

The new Citizens' Health Care Working Group met on May 11-13 to begin its work to develop proposals for how all Americans can obtain access to affordable, high-quality health care. The 15-member working group, which was established under Section 1014 of the Medicare Modernization Act, is expected to deliver its proposals to President Bush and members of Congress within 2 years. AHRQ provides administrative support to the independent working group as required under the Medicare law.

3.  New HHS Guide Helps Nurses Encourage Patients to Quit Smoking

In recognition of National Nurses Week, May 6-12, HHS released a new tool that will give nurses evidence-based information that they can use to help their patients quit smoking. The pocket guide, Helping Smokers Quit: A Guide for Nurses, was developed by AHRQ in collaboration with Tobacco Free Nurses, a national initiative funded by The Robert Wood Johnson Foundation to increase nurses' participation in tobacco control. The free pocket guide gives nurses easy access to information based on the "5 As" approach to cessation intervention: Ask, Advise, Assess, Assist, and Arrange. It also includes a current listing of smoking cessation medications approved by FDA and a referral to HHS' National Quitline, 1-800-QUIT NOW. Select to read our press release and the guide. A print copy of the guide is available by sending an E-mail to For additional information, please visit AHRQ's Tobacco Pathfinder. For additional Web-based resources for nurses, visit Tobacco Free Nurses.

4.  Routine Use of Episiotomy in Uncomplicated Births Offers No Benefits to Women

AHRQ released a new evidence report that shows routine use of episiotomy for uncomplicated vaginal births does not provide immediate or longer term benefits for the mother. Episiotomy is the surgical cutting of the perineum—the skin between the vaginal opening and the anus—and is a common procedure used in an estimated one-third of vaginal deliveries to hasten birth or prevent tearing of the skin during delivery. The findings are published in the May 4 issue of JAMA. The report, prepared by AHRQ's Evidence-based Practice Center at RTI-International-University of North Carolina at Chapel Hill and Raleigh, found that routine episiotomy, common in many practice settings, did not achieve any of the goals it is commonly believed to achieve. The topic was nominated by the American College of Obstetricians and Gynecologists, which intends to translate the findings into clinical practice guidelines for OB/GYNs. Select to read our press release and the summary. A print copy of the summary and the full report are available by sending an E-mail to

5.  AHRQ Releases Advances in Patient Safety—A Four-Volume Compendium

AHRQ and the Department of Defense recently released the first Federal compendium of studies on the successes and challenges of efforts to improve patient safety and reduce medical errors. Advances in Patient Safety: From Research to Implementation—a four-volume set of 140 peer-reviewed articles—represents an overview of patient safety studies by AHRQ-funded researchers and other government-sponsored research over the past 5 years following the release of a 1999 report by the Institute of Medicine, To Err is Human. The volumes contain information on virtually every dimension of the patient safety field. Select to read our press release for additional information. A limited number of four-volume printed sets are available, as well as free single copies of a searchable CD-ROM. To place an order, contact the AHRQ Publications Clearinghouse at (800) 358-9295, or send an E-mail to Select for individual articles that comprise the four volumes.

6.  New AHRQ Report Finds Depression Is Prevalent in Women During Pregnancy but Often Goes Undetected

AHRQ released a new evidence report which indicates that depression is as common in women during pregnancy as it is after giving birth. Roughly 1 of every 20 American women who is pregnant or has given birth in the past 12 months is suffering from major depression. The report was requested by the Safe Motherhood Working Group, a coalition of HHS agencies that includes the Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Mental Health, Substance Abuse and Mental Health Services Administration, National Institute on Drug Abuse, HHS Office on Women's Health, NIH Office of Research on Women's Health, National Institute of Child Health and Human Development, Food and Drug Administration's Office of Women's Health and Center for Drug Evaluation and Research, and AHRQ. The report, Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes, was prepared by AHRQ's RTI International-University of North Carolina Evidence-based Practice Center in Chapel Hill and Raleigh. Select to read our press release and the summary. A print copy of the summary and the full report are available by sending an E-mail to

7.  Nominations for New AHRQ National Advisory Council Members Are Due June 10

AHRQ is currently seeking nominations for seven new public members for its National Advisory Council for Healthcare Research and Quality, which advises the Secretary of HHS and the Director of AHRQ on matters related to actions of the Agency to enhance the quality, improve the outcomes, and reduce the costs of health care services. The 21-member Council meets in the Washington, DC, metropolitan area, generally in Rockville, MD, approximately three times a year. Members generally serve 3-year terms, and new members will start their service in the fall of 2005. Nominations are due June 10 and should be mailed to Deborah Queenan, AHRQ, 540 Gaither Road, Room 3238, Rockville, MD 20850, or faxed to her at (301) 427-1341. Select to the May 2 Federal Register notice which describes the seven expert categories for nominees.

8.  AHRQ Study Supports Conservative Treatment for Low-Grade, Localized Prostate Cancer

A new AHRQ-funded study reports long-term outcomes of 767 men with localized prostate cancer managed conservatively, by observation or androgen withdrawal therapy alone, and followed for a median of 24 years after diagnosis. Among those presenting with low-grade disease (Gleason 2-4) on biopsy, the risk of disease progression remained low even after 20+ years, and only 7 percent died of prostate cancer. Eighty-three percent of the men died from other identifiable or unknown causes, and 12 percent were still alive 20-33 years after diagnosis. In contrast, among men with high-grade tumors (Gleason 8-10), a majority died of prostate cancer within 10 years, regardless of their age when diagnosed, and only 1 percent survived to the end of the study. Those who had moderate-grade tumors had an intermediate long-term risk of dying as a result of their prostate cancer. The article, "Twenty-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer," appeared in the May 4 issue of JAMA. The study was led by Peter Albertsen, M.D., of the University of Connecticut in Farmington. Select to read the abstract in PubMed®.

9.  Register for Free Web Conference on Mass Casualty Care on May 17

Sign up now! AHRQ is sponsoring a free Web conference called "Mass Casualty Care: Overlooked Community Resources" on May 17, from 2:00 p.m. to 3:30 p.m. EDT. The Web conference will focus on potential resources for providing mass casualty care beyond the emergency department—in nursing homes, former (shuttered or converted) hospitals, and primary care networks and clinics. Speakers Lucy A. Savitz, Ph.D., M.B.A., Research Triangle Institute, Inc., Research Triangle Park, NC; Andrea Hassol, M.S.P.H., Abt Associates, Cambridge, MA; and Richard Zane, M.D., Brigham and Women's Hospital and Harvard Medical School, Boston, MA, will share results from ongoing AHRQ research studies. Debra Berg, M.D., Medical Director, Bioterrorism Hospital Preparedness Program, New York City Department of Health and Mental Hygiene, will describe a project currently supported by HRSA.

10.  Deadline Extended for Research Activities Mail List Update

Act now to renew your free subscription for Research Activities, the Agency's monthly research bulletin. If you are a current subscriber to this free publication, you must let us know that you wish to continue receiving it. The deadline for responding has been extended to May 31. Be sure to include your name, mailing address, and if you have your issue of Research Activities available, please also include your six-digit subscriber number, which appears next to your name on the mailing label.

11.  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.

Fletcher KE, Saint S, Mangrulkar RS. Balancing continuity of care with residents' limited work hours: defining the implications. Acad Med 2005 Jan; 80(1):39-43. Select to access the abstract on PubMed®.

Bonomi AE, Holt VL, Thompson RS, et al. Ascertainment of intimate partner violence in women seeking legal protection. Am J Prev Med 2005 Jan;28(1):52-8. Select to access the abstract on PubMed®.

Kivimaki M, Head J, Ferrie JE, et al. Working while ill as a risk factor for serious coronary events: the Whitehall II study. Am J Public Health 2005 Jan;95(1):98-102. Select to access the abstract on PubMed®.

Mehta SH, Thomas DL, Torbenson M, et al. The effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection. Hepatology 2005 Jan;41(1):123-31. Select to access the abstract on PubMed®.

Larson SL, Hill SC. Rural-urban differences in employment-related health insurance. J Rural Health 2005 Winter;21(1):21-30. Select to access the abstract on PubMed®.

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Current as of May 2005


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