PCORI, AHRQ Announce Research Team Selected to Compare Treatments for Uterine Fibroids and Progress To Improve Care
About 12 percent of adults in 2011 agreed with the statement "I'm healthy enough that I really don't need health insurance," compared with 9 percent of adults in 2001. About 24 percent of adults in 2011 agreed with the statement "Health insurance is not worth the money it costs," compared with nearly 22 percent of adults in 2001. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #433: Attitudes toward Health Insurance and Their Persistence over Time, Adults, 2001-2011.)
- PCORI, AHRQ Announce Research Team Selected to Compare Treatments for Uterine Fibroids.
- AHRQ's State Snapshots Measure Health Care Quality, Access Across Nation.
- Adverse Drug Events Reduced in Hospitals That Adopt Meaningful Use Medication Management.
- New Journal Supplement Explores Methods for Studying Rare Diseases.
- AHRQ Study Shows Indication Alerts at CPOE Can Intercept Medication Errors.
- New Implementation Guide Advises on Care Management Entity Design.
- Some Imaging Tests May Help Diagnose and Stage Pancreatic Cancer.
- AHRQ Health Care Innovations Exchange Focuses on Surgical Care.
- AHRQ in the Professional Literature.
The Patient-Centered Outcomes Research Institute (PCORI) and AHRQ announced that AHRQ has selected the research team that will conduct a five-year, $20 million project funded by PCORI to evaluate the effectiveness of different treatment strategies for women with uterine fibroids.
Evan Myers, M.D., M.P.H., of Duke University School of Medicine’s Department of Obstetrics and Gynecology and the Duke Clinical Research Institute, will lead the team that will conduct the study titled, Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF). AHRQ has awarded the team a $3.95 million, first-year award. Uterine fibroids are the most common noncancerous tumors in women of childbearing age and the second most common reason these women undergo surgery. Uterine fibroids can lead to significant pain, bleeding and fertility problems. Treatment options include watchful waiting; treatment with drugs or hormones, embolization or ultrasound; and invasive procedures such as partial or total hysterectomy. However, there is little evidence about the effectiveness of these therapies or their outcomes, including fibroid reoccurrence and women’s ability to have children.
"We know uterine fibroids are common, and that they disproportionally affect African-American women, who often undergo more invasive treatments," said AHRQ Director Richard Kronick, Ph.D. "We need better evidence on which treatments work best for which patients. Our partnership with PCORI, together with the research team at Duke and the clinical centers, offers an important opportunity to work together so that health care providers and patients have the information they need to achieve the best possible outcomes."
The project team comprises a research and data coordinating center based at Duke Clinical Research Institute and nine clinical centers, each contributing information about geographically, racially, ethnically and clinically diverse women who have been treated for uterine fibroids, and the centers will report on what happens to the women over time. The overall design of this patient registry, which emphasizes capturing real treatment experiences and focusing on outcomes that matter most to patients, comes directly from conferences funded by PCORI and AHRQ that sought input from patients and other stakeholders.
Which states are showing the most improvement in the quality of health care they deliver to patients and access to services they provide? AHRQ's [[State Snapshots]] answer that question with easy-to-read charts on the strengths, weaknesses and opportunities for improvement in each state and the District of Columbia. State Snapshots data can be analyzed by type of care, treatment setting, clinical condition, insurance status, race and income. State Snapshots data are drawn from the 2013 National Healthcare Quality Report and National Healthcare Disparities Report, which comprise the most complete source of data on the use of health care and health insurance coverage in the nation. Trend data for most measures span from 2000–2002 to 2010–2011.
A study of electronic medical record use in Florida hospitals reveals that adopting all five core meaningful use (MU) medication management elements correlated with large reductions in adverse drug events (ADEs). The study, co-authored by AHRQ’s William E. Encinosa, examined 2010 data from hospitals considered early adopters of Stage 1 MU requirements. ADE rates were reduced by MU across the board, even among hospitals challenged with cost barriers, low quality or MU implementation issues. However, the researchers also found that physician buy-in is critical to the success of MU. "Without physician buy-in at the hospital, MU will have no impact on adverse drug events," the study stated. "Meaningful Use IT Reduces Hospital-Caused Adverse Drug Events Even At Challenged Hospitals," was published online August 8 in Healthcare: The Journal of Delivery Science and Innovation.
An AHRQ-sponsored journal supplement that explores innovative research methods for studying health outcomes in rare diseases is now available online from AHRQ and the Journal of General Internal Medicine (JGIM). The supplement includes more than 15 articles on important research being done in the United States and abroad to improve methods for studying health outcomes in people with rare and complex diseases, a patient community increasingly recognized in primary care and in health policy discourse. Topics include integration of stakeholder involvement in assessing health outcomes; economic, regulatory, ethical, legal and social issues related to the study of rare disease health outcomes; emerging data sources and novel analytic methods for observational research; and the study of patients’ health outcomes in clinical trials. Articles are intended for researchers, clinicians, health policymakers and other stakeholders. The supplement was developed through AHRQ’s new Center for Evidence and Practice Improvement. Articles can be downloaded for free from AHRQ and JGIM.
Using alerts for computerized physician order entry (CPOE)-prescribed medications without a corresponding coded indication, AHRQ-funded researchers found the alerts intercepted sound-alike medication errors. In a six-year retrospective study of medication orders placed using CPOE, the researchers found that 176 drug name confusion cases were intercepted out of 127,458 alerts. The authors stated that "institutions with CPOE should consider implementing indication prompts both to improve the quality of problem lists and to prevent drug name confusion errors and wrong patient errors." The study and abstract, titled "Indication Alerts Intercept Drug Name Confusion Errors During Computerized Entry of Medication Orders," appeared July 15 in PLOS ONE.
AHRQ has published the second implementation guide from the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. "Designing Care Management Entities for Youth With Complex Behavioral Health Needs" provides information about care management entities (CMEs), which coordinate services provided by state agencies that serve youth with complex behavioral needs. The implementation guide, available under What We Learned on the national evaluation Web site, draws on the experiences of the three CHIPRA quality demonstration states—Georgia, Maryland and Wyoming—that are using funds to implement or expand CMEs, supplemented with additional guidance and resources. The guide can be helpful to states interested in implementing or improving CMEs for youth with complex behavioral health needs and their families. It may also be useful for county agencies if they are responsible for financing behavioral health or social services in the state. AHRQ is leading the national evaluation of the CHIPRA Quality Demonstration Program. The Centers for Medicare & Medicaid Services funds the evaluation. If you have questions or comments, please contact the national evaluation team via Email.
A new research review from AHRQ found that current evidence permits tentative conclusions about the comparative effectiveness of imaging tests for diagnosing and determining the extent of the spread of pancreatic cancer, but research gaps remain. The evidence showed that multidetector computed tomography (MDCT) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) have similar accuracy in assessing resectability in patients who have undergone an assessment of the spread, or staging, of the disease. EUS-FNA has a slight advantage over MDCT with respect to tumor staging (specifically, a lower chance of undersizing the tumor), according to the new review, "Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma." However, MDCT and magnetic resonance imaging (MRI) are similarly accurate with respect to both diagnosing and assessing vessel involvement, and positron emission tomography–computed tomography (PET/CT) is more accurate than MDCT in assessing distant metastases. Prominent gaps in evidence include minimal information on MDCT angiography; imprecise data on other imaging techniques; a lack of comparative data on patient-oriented outcomes and factors that could influence comparative accuracy; and lack of test-specific data on screening accuracy.
Two of the featured innovations in the latest issue of AHRQ’s Health Care Innovations Exchange describe how medical centers in Vineland, New Jersey, and Birmingham, Alabama, redesigned processes related to surgical care by implementing the use of electronic systems. The changes led to reductions in surgical delays, better operating room utilization and increased overall efficiency. A third profile describes a hospital that established an innovative cross-division surgical quality group to identify opportunities for systematic improvement, leading to lower surgery-related mortality rates. The featured QualityTools provide resources and checklists to help hospitals deliver safer surgical care by reducing surgical infections, complications and related deaths and preventing wrong-site surgeries.
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