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Frisse, M.E. (2005, September). "State and community-based efforts to foster interoperability." (AHRQ Contract No. 290-05-0006). Health Affairs 24(5), pp. 1190-1196.

This paper describes the success of a regional health information technology demonstration project in the southwest region of Tennessee, the MidSouth eHealth Alliance. The project's goal was to create a health information infrastructure that improves the care of people in three urban and rural southwest counties of the State. The author attributes success in the Alliance's first year to sustained leadership, a systematic assessment of regional needs and capabilities, a flexible technical architecture, and a critical review of best practices from four different data exchange models already operating in other States. Long-term evolution to a truly interoperable health information infrastructure will depend on the extent to which consumers and practitioners find the alliance of value.

Lanier, D. (2005, September). "Lost in translation: The value of qualitative data." Journal of the American Board of Family Practice 18(5), pp. 409-410. Reprints (AHRQ Publication No. 06-R008) are available from the AHRQ Publications Clearinghouse.

Qualitative data that provide a better understanding of clinical practice and better ways of facilitating positive practice change should be routinely collected as part of research efforts, asserts the author of this commentary. He discusses the rich qualitative data provided by a study in which an intervention increased documentation of mammograms and Pap smears among eligible women in less than a third of primary care practices. According to the author, the descriptions of the initial conditions in these practices—including the values of the practice leaders, the relationships among clinicians and staff, and methods of responding to the often chaotic health care environment—adds greatly to our understanding of why practice change in the United States is often so difficult. He notes that such information is all too frequently not collected or not included in published reports of more quantitative research.

Mandelblatt, J., M.P.H., Schechter, C., Yabroff, K., and others (2005, June). "Toward optimal screening strategies for older women." Journal of General Internal Medicine 20, pp. 487-496. Reprints (AHRQ Publication No. 05-R072) are available from the AHRQ Publications Clearinghouse.

The optimal age to stop breast cancer screening remains uncertain. According to a recent study, however, lifetime screening is not cost-effective at $151,434 per life-year saved (LYS) if women receive idealized treatment (treatment and survival that is comparable to clinical trials). Researchers, including William Lawrence, M.D., M.Sc., now with the Agency for Healthcare Research and Quality, conducted the study using a model to simulate the life history of women to evaluate the incremental societal costs and benefits of biennial screening from age 50 until age 70, 79, or a lifetime. The model incorporated age-related differences in tumor biology and emulated the effects of age or life expectancy to address the optimal time to stop screening. The researchers concluded that if all women receive idealized treatment, the benefits of mammography beyond age 79 are too low relative to their costs to justify continued screening. However, if treatment is not ideal, extending screening beyond age 79 could be considered, especially for women in the top 25 percent of life expectancy for their age.

Simonsen, L., Viboud, C., Elixhauser, A., and others (2005, September). "More on RotaShield and intussusception: The role of age at the time of vaccination." Journal of Infectious Diseases 192, pp. S36-S43. Reprints (AHRQ Publication No. 06-R002) are available from the AHRQ Publications Clearinghouse.

RotaShield, a vaccine intended to prevent severe rotavirus diarrhea among infants and children, was withdrawn in July 1999 because of a temporal link between the vaccine and intussusception (intestinal obstruction) in vaccinated infants. However, the incidence of intussusception associated with the first dose of RotaShield increases with age, concludes this study. The researchers reanalyzed a case-control database of the Centers for Disease Control and Prevention by using a 21-day window to define vaccine-associated events. They combined that data with data on vaccine use and data on incidence of intussusception to estimate how absolute risk varied with age. Infants 90 days old and older accounted for 80 percent of cases of intussusception associated with the first dose of RotaShield. The researchers calculated that a two-dose neonatal vaccination schedule administered at 0-29 days and 30-59 days of age would greatly reduce the risk of intussusception. This vaccination schedule would lead to, at most, a 7 percent increase in the incidence of intussusception above the annual background incidence.

Terrin, N., Schmid, C.H., and Lau, J. (2005, September). "In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias." (AHRQ grant HS10254). Journal of Clinical Epidemiology 58, pp. 894-901.

Publication bias and related biases can lead to overly optimistic conclusions in systematic reviews of research studies. The funnel plot, which is frequently used to detect such biases, has not yet been subjected to empirical evaluation as a visual tool. Authors and readers of systematic reviews need to be aware of the limitations of the funnel plot (which displays the relationship of effect size to sample size), conclude these investigators. They asked 41 medical researchers, faculty in clinical care research, and experienced systematic reviewers to complete a questionnaire with funnel plots containing 10 studies each. On average, participants correctly identified 52.5 percent of the plots as being affected or unaffected by publication bias.

Wallstrom, G.L., Wagner, M., and Hogan, W. (2005, August). "High-fidelity injection detectability experiments: A tool for evaluating syndromic surveillance systems." (AHRQ Contract No. 290-00-0009). Morbidity and Mortality Weekly Report 54(Suppl.), pp. 85-91.

When public health surveillance systems are evaluated, the Centers for Disease Control and Prevention (CDC) recommends that the expected sensitivity, specificity, and timeliness of surveillance systems be characterized for outbreaks of different sizes, etiologies, and geographic or demographic scopes. High-Fidelity Injection Detectability Experiments (HiFIDE) is a software tool that enables public health departments to perform system validations recommended by the CDC, concludes this study. The researchers describe HiFIDE and illustrate how it can be used to investigate the detectability of a water-borne Cryptosporidium outbreak in the Washington, D.C. area by assessing data from sales of over-the-counter diarrheal remedies.

Young, G.J., White, B., Burgess Jr., J.F., and others (2005, May). "Conceptual issues in the design and implementation of pay-for-quality programs." (AHRQ grant HS13591). American Journal of Medical Quality 20(3), pp. 144-150.

The authors of this article identify and discuss key conceptual issues in the design and implementation of pay-for-quality programs. Such programs offer financial incentives to providers, often physicians, for achieving predefined quality targets. More than 35 pay-for-quality programs now exist in the United States, in both the private and public sectors. The purpose of the article is to provide health care professionals with a framework for designing, implementing, and evaluating pay-for-quality programs. The authors draw examples from the Rewarding Results demonstration project, for which they serve as the national evaluation team.

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