June 27, 2012
Treatment of injuries resulting from all-terrain vehicle accidents were responsible for about 115,200 hospital emergency department visits and 12,800 hospital admissions in 2009. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #130: Emergency Department Visits and Inpatient Hospital Stays for All-Terrain Vehicle-Related Injuries, 2009.]
- AHRQ releases 2011 State Snapshots.
- Some noninvasive tests are better at detecting coronary artery disease in women.
- New AHRQ-funded tool aims to guide formulary role in drug prescribing.
- Limited evidence prevents firm conclusions on psoriatic and rheumatoid arthritis drug therapies.
- June issue of AHRQ Web M&M examines impact of delayed communication.
- AHRQ's Health Care Innovations Exchange focuses on clinical support following unexpected clinical events.
- New AHRQ funding opportunities announcements available.
- Highlights from AHRQ's Research Activities monthly newsletter.
- HCUP 2010 Nationwide Inpatient Sample database now available.
- AHRQ in the professional literature.
1. AHRQ Releases 2011 State Snapshots
AHRQ's 2011 State Snapshots offer an in-depth analysis of the quality of care provided in each State, by type of condition, level of care, treatment setting, race and income, and insurance status. This resource also includes strengths, weaknesses, and opportunities for improvement in each State and in the District of Columbia. 2011 State Snapshots feature easy-to-read charts and individual State performance summaries based on 150 quality measures, such as preventing pressure sores, screening for diabetes-related foot problems, and giving recommended care to pneumonia patients. Also included is a State Resource Directory that provides best practices and innovations highlighted on AHRQ's Health Care Innovations Exchange to help States learn about what others have used to improve the quality and safety of health care services. Select to access the 2011 State Snapshots. Data is included from more than 30 sources, including government surveys, health care facilities, and health care organizations.
2. Some Noninvasive Tests Are Better at Detecting Coronary Artery Disease in Women
Noninvasive tests that produce images of how well the heart is functioning, such as echocardiography and single proton emission computed tomography, more accurately diagnose coronary artery disease in women with symptoms of coronary artery disease than electrocardiography, which monitors heartbeats to detect restricted blood flow, according to a new AHRQ Effective Health Care Program research review. The review, Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women, found insufficient evidence from studies to determine which clinical or demographic factors may influence the diagnostic accuracy, risk determinations, prognostic value, treatment decisions, clinical outcomes, or harms associated with noninvasive tests for coronary artery disease in women. Cardiovascular disease is the leading cause of mortality for women in the U.S. and about one in three women have some form of cardiovascular disease.
3. New AHRQ-Funded Tool Aims to Guide Formulary Role in Drug Prescribing
A new AHRQ-funded tool is designed to help decision-making by drug formulary committees at hospitals, health systems, and insurance companies based on an evaluation of drug evidence, efficacy, and therapeutic alternatives. Researchers from AHRQ's University of Illinois Center for Education and Research on Therapeutics (CERTs) program note that while formularies have received much attention regarding cost containment, their role in guiding rational drug use could be enhanced by a more standardized critical evaluation of drugs proposed for formulary placement. The new tool, used at two U. S. teaching hospitals, consists of a six-domain checklist of 48 questions for evaluating drugs. The domains are: evidence of need (7 questions), efficacy (6), medication safety (6), misuse potential (7), cost issues (10), and decision-making process (12). CERTs researchers who applied the tool in the formulary of several hospitals and systems, say the checklist can facilitate more standardized and critical scrutiny of the evidence and therapeutic alternatives. Potential uses for the tool include: educating of new Pharmacy & Therapeutics committee members about new drug applications, guiding committee discussions of drugs proposed for formulary addition, and evaluating quality of committee decision-making to assess whether key questions were raised and addressed. The checklist is available in the article, "A Prescription for Improving Drug Formulary Decision-Making," published in PLoS Medicine on May 22. Select to access the article on PubMed.®
4. Limited Evidence Prevents Firm Conclusions on Psoriatic and Rheumatoid Arthritis Drug Therapies
Two updated research reviews from AHRQ's Effective Health Care Program found limited evidence to support the efficacy of biologic disease-modifying antirheumatic drugs (DMARDs) to treat psoriatic and rheumatoid arthritis. This finding reinforces the current standards of care for drug therapies for these conditions. However, the evidence is insufficient to draw firm conclusions about the effectiveness, functional status, health-related quality of life, or tolerability of DMARDs for treating psoriatic and rheumatoid arthritis. Select to access the psoriatic arthritis review, Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report and select to access the rheumatoid arthritis review, Drug Therapy for Rheumatoid Arthritis in Adults: An Update.
5. June Issue of AHRQ Web M&M Examines Impact of Delayed Communication
The June 2012 issue of AHRQ Web M&M features a Spotlight Case involving delayed communication between a small community hospital and a large academic medical center involving a 92-year-patient with a hip fracture. Although the patient was stable upon admission to the academic medical center and underwent surgery to repair the fracture, she died a few days thereafter. Following her operation, the team received medical records from the referring hospital that indicated the patient had recently experienced a cardiac arrest, information that would have changed the course of her treatment. A commentary on the case is provided by Isla M. Hains, Ph.D., a faculty member at the University of New South Wales, Sydney, Australia. The Perspectives on Safety section features an interview with Charles Vincent, MPhil, Ph.D., who directs the Imperial Center for Patient Safety and Service Quality at Imperial College, London. Physicians and nurses can receive free CME, CEU, or training certification by taking the Spotlight Quiz. Select to access AHRQ's Web M&M site.
6. AHRQ's Health Care Innovations Exchange Focuses on Clinical Support Following Unexpected Clinical Events
The June 6 issue of AHRQ's Health Care Innovations Exchange describes one hospital program that provides multidisciplinary team support to patients and families who experience an unexpected clinical event, and another program that provides support to clinicians who are the "secondary victims" of unexpected events. The St. Joseph Mercy Hospital's emergency department in Ann Arbor, MI, Next Step Program supports patients and family members after an unexpected death or another unexpected negative event. A team offers to meet with patients and family members and listens to their concerns in an empathetic, compassionate manner and to the extent possible, addresses and offers support, including an apology and financial remuneration, if appropriate. The program has helped patients and families deal with unexpected events, helped physicians improve their communication skills, and led to the development of new patient safety initiatives. Select to read profiles of innovations related to adverse clinical events on the Health Care Innovations Exchange Web site, which contains more than 700 searchable innovations and 1,500 QualityTools.
7. New AHRQ Funding Opportunities Announcements Available
AHRQ issued two new funding opportunities announcements addressing Patient-Centered Outcomes Research and Training.
- AHRQ Patient-Centered Outcomes Research Pathway to Independence Award will increase and maintain a strong cohort of new AHRQ-supported independent investigators trained in comparative effectiveness methods to conduct patient care outcomes research. The program is designed to facilitate a transition from a mentored postdoctoral research position to a stable independent research position with independent AHRQ or other independent research support. It targets investigators early in their career to support their development of new research skills in methodology and new interdisciplinary perspectives and capabilities in PCOR. Letters of Intent are due July 6 and the deadline to submit an application is July 31.
- AHRQ National Research Service Awards (NRSA) Institutional Research Training Grants focuses on promoting improvements in clinical and health systems' practices. These training programs are designed to provide institutional support for the training of qualified pre-doctoral and post-doctoral trainees interested in improving clinical practice or the health care system's ability to provide access to and deliver high quality, high-value health care; and/or providing policymakers with the ability to assess the impact of system changes on outcomes, quality, access to, cost, and use of health care services. Letters of Intent are due August 17 and the deadline to submit an application is September 12.
8. Highlights from AHRQ's Research Activities Monthly Newsletter
The June issue of Research Activities is available online. Key articles include:
- One in ten computer-generated prescriptions contain at least one error.
In the ambulatory care setting, use of electronic prescribing systems is one way to reduce the frequency of medication errors and adverse drug events (ADEs). However, a new study finds that 1 in 10 computer-generated prescriptions contain at least 1 error. The researchers conclude that implementing a computerized prescribing system without functionality and processes to ensure meaningful use does not decrease medication errors. Select to read this article.
Other articles include:
- Remote intensive care monitoring is cost effective for sickest patients.
- Paper reminders for doctors do not add value to electronic reminders from an electronic health record system.
- Decision support may aid emergency physicians in interpreting benign from serious eye movement patterns in dizzy patients.
- Patients recovering from stroke tend to continue using secondary preventive medications.
Select to read these articles and others.
9. HCUP 2010 Nationwide Inpatient Sample Database Now Available
AHRQ's Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2010 data is now available. The NIS is the largest all-payer inpatient care database and is nationally representative of all short-term, non-Federal hospitals in the U.S. It is drawn from the HCUP State Inpatient Databases and includes more than 8 million hospital stays. The NIS includes all patients from each sampled hospital, including persons covered by Medicare, Medicaid, private insurance, or without insurance. Researchers and policymakers use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes. NIS' size enables analyses of infrequent conditions, uncommon treatments, and special patient populations. The 2010 NIS can be purchased through the HCUP Central Distributor and data can be accessed via HCUPnet, a free online query system. Additional information about the NIS and other products is located on the HCUP-US Web site.
10. AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Access to the abstracts may be blocked because of firewalls or specific settings on individual computer systems. If you are having problems, ask your technical support staff for possible remedies.
Peron EP, Marcum ZA, Boyce R, et al. Year in review: medication mishaps in the elderly. Am J Geriatr Pharmacother 2011 Feb; 9(1):1-10. Select to access the abstract on PubMed.®
Hung DY, Green LA. Paying for prevention: associations between pay for performance and cessation counseling in primary care practices. Am J Health Promot 2012 Mar; 26(4):230-4. Select to access the abstract on PubMed.®
Sinaiko AD, Eastman D, Rosenthal MB. How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices. Health Aff 2012 Mar; 31(3):602-11. Select to access the abstract on PubMed.®
Kramer DB, Xu S, Kesselheim AS. Regulation of medical devices in the United States and European Union. N Engl J Med 2012 Mar 1; 366(9):848-55. Select to access the abstract on PubMed.®
Newman RE, Hedican EB, Herigon JC, et al. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics 2012 Mar; 129(3):e597-e604. Select to access the abstract on PubMed.®
Yu H, Dick AW. Impacts of rising health care costs on families with employment-based private insurance: a national analysis with state fixed effects. Health Serv Res 2012 Mar 14. [Epub ahead of print.] Select to access the abstract on PubMed.®
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Current as of June 2012
AHRQ Electronic Newsletter, June 27, 2012, Issue 347. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews347.htm