March 31, 2009
AHRQ News and Numbers
Opening blocked arteries, trying to keep heart attack victims alive, fixing defective heart valves, and treating other heart ailments cost $78 billion in 2006—roughly 8 percent of the more than $1 trillion spent on all medical care for the community population. [Source: Agency for Healthcare Research and Quality, MEPS, Total Expenses for Selected Conditions by Type of Service: United States, 2006 Expenses are Reported in Millions.]
- AHRQ-funded study finds lower risk of death and heart attack in patients with drug-coated stent implants compared to those with bare metal stents
- AHRQ's National Advisory Council seeks public comments on comparative effectiveness program
- Task Force recommends using aspirin to prevent cardiovascular disease when the benefits outweigh the harms
- Task Force recommends screening adolescents for clinical depression
- AHRQ director testified on the quality of health carein the United States
- Plain language comparison of insulin treatments for Type 2 diabetes are available
- Task Force recommends primary care counseling to promote breastfeeding
- Register for AHRQ HCUP workshop on May 6
- AHRQ in the professional literature
1. AHRQ-Funded Study Finds Lower Risk of Death and Heart Attack in Patients with Drug-Coated Stent Implants Compared to Those with Bare Metal Stents
Heart disease patients 65 and older who receive stents coated with medicine to prevent blockages are more likely to survive and less likely to suffer a heart attack than people fitted with stents not coated with medication, according to a new study supported by AHRQ and the American College of Cardiology's National Cardiovascular Data Registry. A team of researchers from Duke University, AHRQ and Kaiser Permanente found that, compared with patients who received bare metal stents, those fitted with stents coated with medication, called drug-eluting stents, had an 18 percent better survival rate over the 30-month study period and were 16 percent less likely to suffer a heart attack. The study, "Clinical Effectiveness of Coronary Stents in the Elderly: Results from 262,700 Medicare Patients in ACC-NCDR," led by Pamela S. Douglas, M.D., will be published online on March 28 at 9:30 a.m., to coincide with her presentation at the American College of Cardiology's 58th Annual Scientific Session. Select to read our press release.
2. AHRQ's National Advisory Council Seeks Public Comments on Comparative Effectiveness Program
The National Advisory Council for Healthcare Research and Quality is seeking public comment at a public meeting on Friday, April 3, on the comparative effectiveness program funded by AHRQ. At the meeting, the Council, which advises the AHRQ Director and the Secretary of HHS on priorities for a national health services research agenda, will discuss the American Recovery and Reinvestment Act and its investment in the AHRQ comparative effectiveness research program. The Recovery Act provides $1.1 billion for comparative effectiveness research: $300 million for AHRQ, $400 million for NIH, and $400 million for HHS' Office of the Secretary. The Council will meet at the AHRQ Conference Center, 540 Gaither Road, Rockville, Maryland, 20850, beginning at 9:00 a.m., E.D.T.
3. Task Force Recommends Using Aspirin to Prevent Cardiovascular Disease When the Benefits Outweigh the Harms
Patients and clinicians should consider risk factors—including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding—before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. The recommendations were published in the March 17 issue of the Annals of Internal Medicine. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The more risk factors people have, the more likely they are to benefit from aspirin. The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk of having a heart attack when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk of having an ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. Because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55, and because limited evidence exists in these age groups, the Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under 55. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in people 80 years or older. Select to read our press release and to access the recommendation.
4. Task Force Recommends Screening Adolescents for Clinical Depression
The U.S. Preventive Services Task Force now recommends screening adolescents 12 to 18 years of age for clinical depression only when systems are in place to ensure accurate diagnosis, treatment, and follow up. The Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression. The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 and 18 years of age.
The recommendations appeared in the April issue of Pediatrics. Select to read our press release and to access the recommendation.
5. AHRQ Director Testified on the Quality of
Health Care in the United States
On March 18, AHRQ Director Carolyn M. Clancy, M.D., testified before the Senate Finance Committee's health subcommittee about the state of health care quality in America. Dr. Clancy defined health care quality as "getting the right care to the right patient at the right time—every time," and addressed escalating health care costs, progress in reducing disparities, and quality measurement. Focusing efforts on performance, transparency, and innovations will help clearly identify areas of improvement in health care as well as accelerate the pace of improvement, which is essential to sustainable health care reform, Dr. Clancy noted. She also stressed the importance of health IT as the foundation that support quality measurement and improvement, care coordination, and provides clinicians and patients the information necessary to optimize care. Select to read Dr. Clancy's complete testimony.
6. Plain Language Comparison of Insulin Treatments for Type 2 Diabetes Are Available
AHRQ released plain-language guides for consumers and clinicians comparing the efficacy, effectiveness, and side effects of newer premixed insulin analogues to conventional insulin (human insulin) and other preparations used to control Type 2 diabetes. The consumer guide, called Premixed Insulin for Type 2 Diabetes: A Guide for Adults, is a primer on diabetes, diabetes testing, and treatments. The clinician guide, called Premixed Insulin Analogues: A Comparison with Other Treatments for Type 2 Diabetes, includes additional information, including a confidence scale that rates available evidence. Copies of the guides are available by sending an E-mail to email@example.com.
7. Task Force Recommends Primary Care Counseling to Promote Breastfeeding
The U.S. Preventive Services Task Force released a new recommendation supporting primary care counseling to encourage and support breastfeeding during pregnancy, around the time of delivery, and after child birth. The Task Force concludes that coordinated interventions in primary care offices: labor, delivery, and postpartum inpatient settings and patient homes, throughout pregnancy, birth, and infancy can increase when a mother starts breastfeeding, how long she breastfeeds, and the possibility that she will only breastfeed.
The recommendation appeared in the October 21 issue of the Annals of Internal Medicine. Select to access the recommendation.
8. Register for AHRQ HCUP Workshop on May 6
AHRQ is sponsoring a free one-day workshop for health services researchers on the use of databases and software tools from the Healthcare Cost and Utilization Project (HCUP) on May 6 from 9:00 a.m. - 4:30 p.m. in Rockville, MD. Participants will work with actual data from HCUP's national and State databases. HCUP databases and tools enable research on a broad range of health research and policy issues at the national, State and local market levels, including cost and quality of health services, medical practice patterns, access to health care and outcomes of treatment. Researchers can learn about HCUP prior to the course by taking the HCUP online overview course. Please register nearly as space is limited.Deadline to register is April 24.
9. 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.
Kim SE, Perez-Stable EJ, Wong S, et al. Association between cancer risk perception and screening behavior among diverse women. Arch Intern Med 2008 Apr 14; 168(7):728-34. Select to access the abstract on PubMed®.
Li P, Bahensky JA, Jaana M. et al. Role of multihospital system membership in electronic medical record adoption. Health Care Manage Rev 2008 Apr-Jun; 33(2):169-77. Select to access the abstract on PubMed®.
Jensen PM, Saunders RL, Thierer T, et al. Factors associated with oral health-related quality of life in community-dwelling elderly person with disabilities. J Am Geriatr Soc 2008 Apr; 56(4):711-17. Select to access the abstract on PubMed®.
Cheung K, Moiduddin A, Chin MH, et al. The perceived financial impact of quality improvement efforts in community health centers. J Ambul Care Manage 2008 Apr-Jun; 31(2):111-19. Select to access the abstract on PubMed®.
Koya DL, Hill EG, Darden PM. The effect of vaccinated children on increased hepatitis B immunization among high-risk adults. Am J Public Health 2008 May; 98(5):832-38. Select to access the abstract on PubMed®.
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Current as of March 2009
AHRQ Electronic Newsletter, March 31, 2009, Issue #273. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews273.htm