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December 17, 2007, Issue No. 246

AHRQ News and Numbers

Charges billed by U.S. hospitals grew to $873 billion in 2005—a nearly 90 percent increase from the $462 billion in charges in 1997. The average yearly rate of increase in the national hospital bill over the last several years was 4.5 percent. At this rate, researchers estimate that the annual national hospital bill may reach $1 trillion by 2008. [Source: Agency for Healthcare Research and Quality (AHRQ), HCUP Statistical Brief #42: The National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer.]

Today's Headlines

  1. Many osteoporosis medications prevent fractures, but none is proven best
  2. AHRQ director delivers opening remarks at Institute of Medicine workshop on resident work hours and patient safety
  3. AHRQ releases toolkits to help providers and patients implement safer health care practices
  4. New AHRQ guides summarize effectiveness, safety of oral diabetes medications
  5. Many employers not seeking more value for their health care dollars
  6. Spanish-language consumer guide on osteoarthritis drugs is available
  7. Task Force reaffirms recommendation for high blood pressure screening for all adults
  8. AHRQ launches new consumer-oriented video on health care value and quality
  9. Podcast spotlights health care quality, HIV hospitalizations, emergency preparedness, and hospital design
  10. AHRQ releases evidence report on the prevention of urinary and fecal incontinence in adults
  11. AHRQ in the professional literature

1. Many Osteoporosis Medications Prevent Fractures, but None Is Proven Best

Many medications reduce the risk of bone fractures in people with osteoporosis, but the most commonly used drugs—bisphosphonates—have not been proven more effective than alternatives, according to a new AHRQ-funded report. The AHRQ report compared the effectiveness and risks of six bisphosphonates: alendronate (sold as Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel) and zoledronic acid (Zometa). The report also looked at estrogen, calcitonin (a man-made hormone), calcium, vitamin D, testosterone, parathyroid hormone and selective estrogen receptor modulators (SERMs). The report, Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis, was authored by AHRQ's Southern California Evidence-based Practice Center-RAND Corporation in Santa Monica, CA. Select to read our press release and select to access the report.

2. AHRQ Director Delivers Opening Remarks at Institute of Medicine Workshop on Resident Work Hours and Patient Safety

AHRQ Director Carolyn M. Clancy, M.D., discussed the need for incentives to promote safe work schedules in graduate medical education settings as a part of her opening remarks at a public meeting of the Institute of Medicine on December 3.

Dr. Clancy told members of the IOM Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules that AHRQ research has shown a correlation between extended work hours and quality of care. Although the maximum number of hours that medical residents should work was capped at 80 hours a week in 2003 by the Accreditation Council for Graduate Medical Education, the culture and traditions in training remain strong and, as a result, the problem continues to exist throughout health care. Dr. Clancy also identified four primary areas of focus for the IOM committee—developing a current evidence base on resident work hours and schedules and their impact on safety; identifying and developing strategies for implementing reasonable work hours; analyzing the benefits and harms of updating work hours and schedules; and developing recommendations for action by various stakeholders. AHRQ is sponsoring an IOM study that is expected to produce recommendations on resident work hours in late 2008.

Select to read Dr. Clancy's remarks; IOM committee objectives; and a list of future IOM meetings on the topic.

3. AHRQ Releases Toolkits to Help Providers and Patients Implement Safer Health Care Practices

AHRQ released an array of toolkits designed to help doctors, nurses, hospital managers, patients, and others reduce medical errors. The toolkits were developed through AHRQ's Partnerships in Implementing Patient Safety (PIPS) program. The 17 toolkits, developed by AHRQ-funded experts who specialize in patient safety research, are free, publicly available, and can be adapted to most health care settings. The toolkits range from checklists to help reconcile medications when patients are discharged from the hospital to processes to enhance effective communication among caregivers and with patients to toolkits to help patients taking medications. In addition, the 17 PIPS toolkits correlate with the Joint Commission's National Patient Safety Goals, which promote system-wide improvements in patient safety. Select for more information and a complete listing of the 17 toolkits.

4. New AHRQ Guides Summarize Effectiveness, Safety of Oral Diabetes Medications

AHRQ released a pair of plain-language guides that outline the latest scientific evidence on the effectiveness and safety of oral medications for adults with type 2 diabetes. AHRQ's analysis is the first to summarize evidence on the effectiveness and adverse events for all commonly used type 2 diabetes medications. As new classes of oral diabetes medications have become available, patients and clinicians have faced a growing list of treatment options and choices.

The consumer-targeted guide, called Pills for Type 2 Diabetes: A Guide for Adults, includes information on types of diabetes pills commonly available for adults, how well they work, possible side effects, and medication costs. The clinician's guide, called Comparing Oral Medications for Adults With Type 2 Diabetes, includes more detail on those topics and "confidence ratings" for evidence to support research conclusions.

Print copies of the guides are available by sending an E-mail to

5. Many Employers Not Seeking More Value for Their Health Care Dollars

A new survey of more than 600 large employers across the nation found that many have not looked at data on the quality of the physicians in the health plans they offer their workers or have not shared the health plan or physician data with their employees. The survey, conducted between July 2005 and March 2006, was part of an AHRQ-funded study led by Arnold M. Epstein, M.D., of Harvard University's School of Health. The survey found that 65 percent of the employers examine health plan quality data, but only 17 percent use it for performance awards and 23 percent use it to influence employees. Moreover, only 16 percent of the employers examine data on physician quality, 8 percent use the information to influence their employees' choice of provider, and just 2 percent use the data to reward physicians for their performance. "Employers' Use of Value-Based Purchasing Strategies" was published in the November 21 issue of JAMA. Select to read the abstract in PubMed®.

6. Spanish-Language Consumer Guide on Osteoarthritis Drugs Is Available

AHRQ released a new Spanish-language guide to help patients understand the latest scientific evidence on osteoarthritis pain relievers. The guide, Escogiendo Medicamentos para el Dolor por Osteoarthritis (Choosing Pain Medication for Osteoarthritis), uses plain language to summarize the evidence on both prescription and over-the-counter drugs. It includes information on effectiveness, cost, and potential side effects for non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, Tylenol, and others.

Select to access the guide in Spanish and in English. A print copy is available by sending an E-mail to

7. Task Force Reaffirms Recommendation for High Blood Pressure Screening for All Adults

The U.S. Preventive Services Task Force has reaffirmed its recommendation that all adults be screened for high blood pressure. The recommendation appears in the December 4 issue of the Annals of Internal Medicine and reaffirms the 2003 Task Force recommendation on screening for high blood pressure. High blood pressure contributes to significant adverse health outcomes, including premature deaths, heart attacks, decreased kidney function, and stroke. There is good evidence that measuring blood pressure can identify adults at increased risk for heart disease due to high blood pressure. The 2007 summary of the updated literature search, as well as the 2003 recommendation and supporting materials, can be found on the AHRQ Web site.

Visit AHRQ's Electronic Preventive Services Selector to access this recommendation and other Task Force recommendations via the Web or download to a Palm Handheld or Windows Mobile Devices (PocketPC).

8. AHRQ Launches New Consumer-Oriented Video on Health Care Value and Quality

AHRQ has launched a new consumer-oriented video on health care value. The video, Health Care Value: What Are We Getting for What We Spend?, features AHRQ Director Carolyn M. Clancy, M.D., and Reed Tuckson, M.D., Executive Vice President and Chief of Medical Affairs, United Health Group. In the program, experts discuss the barriers to quality and value in health care today; what is being done by government, insurance companies, employers, and patient groups to improve the quality and value of health care; and what individual patients can do to help guarantee that they receive the highest quality health care for the best price.

9. Podcast Spotlights Health Care Quality, HIV Hospitalizations, Emergency Preparedness, and Hospital Design

This week's AHRQ Healthcare 411 audio podcast features AHRQ Director Carolyn M. Clancy, M.D., giving consumers tips on how to spot high-quality health care. Another story looks at HIV-related hospitalizations that are on the decline for younger Americans. Also featured is a new tool that prepares community call centers to assist in emergency response. Another piece discusses a new AHRQ DVD that shows how to design hospitals for quality and safety. Select to listen to this audio podcast or select to read the transcript.

Another Healthcare 411 audio podcast features AHRQ Director Carolyn M. Clancy, M.D., giving consumers tips on how to choose a hospital. A project designed by the University of Rochester Medical Center uses telemedicine to bring virtual health care into the classroom. MEPS data reveal the costs of an uncomplicated pregnancy. Select to listen to the audio podcast. Select to read the transcript.

In addition, shorter versions of these stories and more are airing on 125 radio stations nationwide.

10. AHRQ Releases Evidence Report on the Prevention of Urinary and Fecal Incontinence in Adults

AHRQ released an evidence report that looked at the prevalence of and risk factors for urinary and fecal incontinence in adults in long-term care settings and in the community. The report, Prevention of Fecal and Urinary Incontinence in Adults, indicates that individualized, conservative management programs can improve incontinence in long-term care facility residents, and they require ongoing effort to sustain. People at high risk for incontinence include pregnant or menopausal women, women with vaginal prolapse, men treated for prostate disease, patients with rectal prolapse, and frail elderly and nursing home residents. The report suggests that routine clinical evaluation could include an assessment of the risk factors, symptoms, and signs of incontinence. The report was prepared by AHRQ's Minnesota Evidence-based Practice Center and requested and funded by the National Institutes of Health (NIH) Office of Medical Applications of Research. Select to access the report. A print copy is available by sending an E-mail to

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.

Moore C, McGinn T, Halm E. Tying up loose ends: discharging patients with unresolved medical issues. Arch Intern Med 2007 Jun 25; 167(12):1305-11. Select to read the abstract in PubMed®.

Cooper WO, Willy ME, Pont SJ, et al. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007 Jun; 196(6):544. e1-e5. Select to read the abstract in PubMed®.

Hobson WL, Knochel ML, Byington CL, et al. Bottled, filtered, and tap water use in Latino and non-Latino children. Arch Pediatr Adolesc Med 2007 May; 161(5):457-61. Select to read the abstract in PubMed®.

Langfitt JT, Westerveld M, Hamberger MJ, et al. Worsening quality of life after epilepsy surgery. Neurology 2007 Jun 5; 68(23):1988-1994. Select to read the abstract in PubMed®.

Howard DL, Hakeem FB, Njue C, et al. Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina. Public Health Rep 2007 May-Jun; 122(3):362-72. Select to read the abstract in PubMed®.

If you are a new subscriber or would like to reference information in a previous issue, an archive of this newsletter can be found on AHRQ's Web site at

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Current as of December 2007


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