JAMA Article Details HHS Initiative on Multiple Chronic Conditions and Progress To Improve Care
Mental disorders were the most expensive conditions ($13.8 billion) to treat among children, followed by asthma/chronic obstructive pulmonary disease ($11.9 billion), trauma-related disorders ($5.8 billion), acute bronchitis and upper respiratory infection ($3.3 billion) and otitis media ($3.2 billion) in 2011. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #434: The Five Most Costly Children's Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17.)
- JAMA Article Details HHS Initiative on Multiple Chronic Conditions and Progress To Improve Care .
- AHRQ Study Finds Ultrasound as Effective as CT in Diagnosing Kidney Stones Without Added Radiation Risk.
- Early Elective Deliveries Reached Nearly 4 Percent Before Widespread Efforts To Promote Full-Term Births.
- New Study Compares Effectiveness of Imaging Tests for Staging Colorectal Cancer.
- Study Compares the Effectiveness of Treatments for Diffuse Large B-Cell Lymphoma.
- Million Hearts® Initiative Seeks Hypertension Control Champions by October 10.
- AHRQ in the Professional Literature.
An overview of a U.S. Department of Health and Human Services (HHS) initiative designed to improve care for people with multiple chronic conditions (MCCs) is featured in the Journal of the American Medical Association. The article, "Optimizing Health for the Multiple Chronic Conditions Population," appears in the September 24 print edition (and is available online) and describes four goals and the progress made to improve care for people with MCCs. AHRQ Director Richard Kronick, Ph.D., is a co-author. The HHS initiative, called the Strategic Framework on Multiple Chronic Conditions, was announced in 2010 to address challenges related to the high health care costs and poor health outcomes for those with MCCs. The strategic framework, developed with private-sector input, provides HHS and its partners with a roadmap for improving the health status of persons with MCCs. The four overarching goals—with improvements noted for each—are as follows:
- Fostering health systems change: New models of care, such as accountable care organizations and patient-centered medical homes, are being developed to manage care for individuals with MCCs.
- Empowering individuals: Evidence-based self-management programs, such as one funded by the Administration on Aging at Stanford University, have helped improve care for people with MCCs.
- Equipping providers: HHS works with stakeholders to refine clinical practice guidelines and provide educational and training initiatives to address care for people with MCCs.
- Enhancing research: Examples include the Food and Drug Administration's policy to examine recruitment in clinical trials to include people with MCCs and AHRQ's funding to expand its nationwide MCC Research Network.
HHS will continue to release data on MCCs so health leaders can better identify specific populations and geographic areas to deliver more coordinated and comprehensive approaches to prevention and treatment.
Broader use of ultrasound in diagnosing kidney stones may be effective and result in less exposure to potentially harmful radiation, according to a new study funded by AHRQ. Abdominal computed tomography (CT) scan has become the most common initial imaging test for suspected cases of kidney stones. However, CT scans expose patients to potentially harmful radiation doses, can reveal findings that lead to unnecessary care and are more costly to perform than ultrasonography. Ultrasound does not expose patients to radiation, can be performed in the emergency or radiology department and is less expensive than CT. The results do not suggest that patients should undergo only ultrasound imaging, but rather that ultrasonography should be used as the initial diagnostic imaging test, with further imaging studies performed at the discretion of the physician on the basis of clinical judgment. An article, "Ultrasonography Versus Computed Tomography for Suspected Nephrolithiasis," was published along with an abstract September 17 in the New England Journal of Medicine.
Nearly 4 percent of uncomplicated births occurred before 39 weeks and were associated with adverse outcomes, according to an AHRQ-funded study that analyzed 7.3 million births from California, Missouri and Pennsylvania from 1995 to 2009. The study period predated widespread initiatives that advocated full-term births, such as "Choosing Wisely." Researchers found that among uncomplicated births, the average gestational age declined from 40 weeks in 1992 to 39 weeks in 2002. The rate of nonindicated early-term births peaked in 2006 at more than 4 percent of uncomplicated births. Newborns delivered before 39 weeks' gestation were found to experience a higher incidence of respiratory distress as well as longer hospital stays. The study, "Trends in Childbirth Before 39 Weeks' Gestation Without Medical Indication," was funded by AHRQ and the Eunice Kennedy Shriver National Institute for Child Health and Human Development. The article and abstract were published in the July issue of Medical Care.
A new research review by AHRQ finds there is evidence to make tentative conclusions about the accuracy and effectiveness of imaging tests for establishing the extent of the spread of colorectal cancer in patients, but many research gaps remain. According to the review, low-strength evidence suggests endoscopic rectal ultrasound (ERUS) is more accurate than computed tomography (CT) for preoperative rectal cancer tumors for assessing the spread of cancer, called staging. The review, "Imaging Tests for the Staging of Colorectal Cancer: Comparative Effectiveness," also finds that magnetic resonance imaging (MRI) is similar in accuracy to ERUS in the same setting. Moderate-strength evidence suggests MRI is more likely to detect colorectal liver metastases than CT. The review says more research is needed to better assess various issues, including the interim restaging of both colon and rectal cancer and the impact of combining different imaging modalities on pretreatment and interim staging assessments.
Patients with limited stage diffuse large B-cell lymphoma tolerated treatment with an abbreviated chemotherapy course plus radiation more easily than a full course of chemotherapy alone, according to a study and abstract published online August 6 in the journal Leukemia & Lymphoma. Researchers analyzed patient records from the Surveillance, Epidemiology and End Results-Medicare database and the Dana-Farber Lymphoma Clinical Research Information System. They found that while both treatments resulted in similar overall survival rates, abbreviated chemotherapy with radiation was associated with a lower risk of retreatment, fever and neutropenia (a reduction in white blood cells).
The U.S. Department of Health and Human Services (HHS) Million Hearts initiative is seeking nominations for blood pressure control champions for the 2014 Million Hearts Hypertension Control Challenge. The challenge seeks to recognize high-performing small and large practices and health systems that have worked with their patients to achieve hypertension control rates at or above 70 percent. This competition is part of efforts by Million Hearts to help prevent 1 million heart attacks and strokes by 2017. The submission deadline is October 10. Success stories about the 2013 winners are available, along with information about hypertension from AHRQ.
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Buys DR, Borch C, Drentea P, et al. Physical impairment is associated with nursing home admission for older adults in disadvantaged but not other neighborhoods: results from the UAB Study of Aging. Gerontologist 2013 Aug;53(4):641-53. Epub 2012 Oct 3. Select to access the abstract on PubMed®.
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