Birth Defects May Be Linked to High Blood Pressure, Not Use of ACE Inhibitors in Early Pregnancy

Electronic Newsletter, Issue 326

Septicemia, an illness caused by blood infections with bacteria such as E. coli and MRSA, was the single most expensive condition treated in U.S. hospitals at approximately $15.4 billion in 2009.

Septicemia, an illness caused by blood infections with bacteria such as E. coli and MRSA, was the single most expensive condition treated in U.S. hospitals at approximately $15.4 billion in 2009. [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #122: Septicemia in U.S. Hospitals, 2009.]

Today's Headlines

  1. Birth defects may be linked to high blood pressure, not use of ACE inhibitors in early pregnancy
  2. Report explores noninvasive techniques to detect skin cancer
  3. Uncertainty surrounds use of terbutaline to prevent preterm birth
  4. Task Force seeks public comment on draft recommendations
  5. AHRQ's Innovations Exchange focuses on reducing hospital-acquired infections
  6. AHRQ's announces CERTs awards
  7. AHRQ awards grants for the redesign and transformation of primary care practice
  8. AHRQ's health IT 2010 annual report is available
  9. Study of diabetes patients electronic medical records shows frequent encounters with doctors leads to better care and outcomes
  10. Register for AHRQ's webcast on using CAHPS patient-centered medical home item set for November 3
  11. AHRQ in the professional literature

1. Birth Defects May Be Linked to High Blood Pressure, Not Use of ACE Inhibitors in Early Pregnancy

Women who take angiotensin-converting enzyme (ACE) inhibitors to treat high blood pressure in the first trimester of their pregnancies are at no greater risk of having babies with birth defects than are women who take other types of high blood pressure medication or who take no blood pressure drugs, according to a new AHRQ study. The study, Maternal Exposure to Angiotensin Converting Enzyme Inhibitors in the First Trimester and Risk of Malformations in Offspring: A Retrospective Cohort Study, suggests that the underlying high blood pressure itself may increase the risk of birth defects, rather than blood pressure medications taken during the first trimester of pregnancy. Results of the study, prepared for AHRQ's Effective Health Care Program by the HMO Research Network—a member of AHRQ's Developing Evidence to Improve Decisions about Effectiveness (DEcIDE) Network—were published in the October 18 issue of BMJ. Select to access the abstract on PubMed.® or to read our press release. 

2. Report Explores Noninvasive Techniques to Detect Skin Cancer

A new technical brief explores current and emerging noninvasive techniques to detect skin cancer. Most noninvasive diagnostic techniques are commonly used in dermatology practices, but not widely used in primary care settings. In comparison to the "gold standard" of biopsy, future research is needed to evaluate the test accuracy, clinical impact, and potential adverse events associated with noninvasive imaging technologies. These findings and future research needs are summarized in the technical brief, Noninvasive Diagnostic Techniques for the Detection of Skin Cancers. 

3. Study of Diabetes Patients' Electronic Medical Records Shows Frequent Encounters with Doctors Leads to Better Care and Outcomes

Having more physician/patient encounters may lead to quicker control of type 2 diabetes measurements and improve outcomes, according to an AHRQ-funded study. The article "Encounter Frequency and Serum Glucose Level, Blood Pressure, and Cholesterol Level Control in Patients With Diabetes Mellitus," published in the September 26 issue of the Archives of Internal Medicine,compared the electronic medical records (EMRs) of 26,496 patients who had encounters with their primary care physicians over 1 to 2 weeks versus 3 to 6 months. Defined by the study authors as "any note made in the EMR," doctor-patient encounters included face-to-face interactions, as well as remote communication between doctor and patient, such as those taking place by telephone. More physician contact improved disease management across the board. The authors caution, however, that increasing patient encounters with providers could increase demand on health care resources. Select to access the abstract on PubMed.® 

4. Task Force Seeks Public Comment on Draft Recommendations

The U.S. Preventive Services Task Force is inviting public comment on its draft recommendation statements on screening for coronary heart disease with electrocardiography (ECG), hearing loss in adults ages 50 years and older, prostate cancer, and cervical cancer. Select to provide comments.

5. AHRQ's Innovations Exchange Focuses on Reducing Hospital-Acquired Infections

This week's issue of AHRQ's Health Care Innovations Exchange features profiles of three programs that used infection control measures to reduce hospital-acquired infections. One such profile is the nurse-physician teams at the University of Maryland Medical Center in Baltimore. The teams conduct weekly grand rounds on hospital units with clinical staff and develop collegial relationships, perform surveillance, evaluate patient care needs, provide education, answer questions, and identify opportunities for system-wide quality improvement. The program reduced central line—associated bloodstream infections by 70 percent, surgical site infections associated with instrumented spinal surgery by 50 percent, and bloodstream infections associated with antibiotic-resistant bacteria by 25 percent.

Select to read more innovations and tools about hospital-acquired infections on the Innovations Exchange Web Site. 

6. AHRQ's Announces CERTs Awards

AHRQ recently awarded $30 million over the next 5 years in cooperative agreement grants to continue the Centers for Education and Research on Therapeutics (CERTs) program. Kaiser Permanente's Center for Health Research in Portland, OR, will serve as the CERTs Scientific Forum to provide expanded scientific and logistical support for the CERTs National Steering Committee and CERTs-wide collaborations and outreach originating from six CERTs research centers. The six research centers and their therapeutic foci are Brigham and Women's Hospital in Boston (health information technology); Cincinnati's Children's Hospital Medical Center (pediatric health care quality); Duke University (cardiovascular disorders); Rutgers, The State University of New Jersey (mental health disorders); University of Alabama at Birmingham (musculoskeletal disorders); and University of Illinois at Chicago (medication safety). The CERTs program, overseen by AHRQ in partnership with the FDA, was originally authorized by Congress in 1997 to examine the benefits, risks, and cost-effectiveness of therapeutic products; educate patients, consumers, doctors, pharmacists, and other clinical personnel; and improve quality of care while reducing unnecessary costs by increasing appropriate use of therapeutics and preventing adverse effects and their medical consequences. Select for details about the CERTs program. 

7. AHRQ Awards Grants for the Redesign and Transformation of Primary Care Practice

AHRQ has awarded four cooperative grants to support model State-level initiatives using primary care extension agents in small- and medium-sized independent primary care practices to assist with redesign and transformation. These "Infrastructure for Maintaining Primary Care Transformation (IMPaCT) — Support for Models of Multi-sector, State-level Excellence" grants are targeted to support four successful, established programs that will serve as models to others. They are:

  • HEROs: New Mexico's Health Extension as a Model for Primary Care Transformation (University of New Mexico Health Sciences Center)
  • North Carolina IMPaCT: Advancing and Spreading Primary Care Transformation (University of North Carolina)
  • PA SPREAD: PA Spreading Primary Care Enhanced Delivery Infrastructure (Penn State Hershey College of Medicine)
  • Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation (University of Oklahoma Health Sciences Center).

8. AHRQ's Health IT 2010 Annual Report Is Available

AHRQ's Health Information Technology Portfolio has released its 2010 Annual Report. This Annual Report is designed to disseminate information on the research areas and progress at both the portfolio and project levels. The Portfolio is summarized by a number of broad categories of projects, including Health IT Portfolio strategic goals, AHRQ business goals, funding mechanisms, geographic distribution, and lifetime funding as of 2010. The report also describes activities that took place throughout the year and synthesizes challenges, outputs, and successes of the 180 active projects. In addition, as part of the report, an individual project summary for each of the 121 grants and 59 contracts projects provides an overview of the project's long-term objectives, status updates of the specific aims and objectives, and updates on completed or ongoing project activities. The report also highlights the dissemination activities of the projects and the AHRQ Health IT team. Select to access the abridged report. 

9. Uncertainty Surrounds Use of Terbutaline to Prevent Preterm Birth

A new AHRQ Effective Health Care Program research report concludes that not enough evidence is available to determine whether terbutaline administered by a subcutaneous infusion pump is both effective and safe in preventing repeat episodes of preterm labor. The report, Terbutaline Pump for the Prevention of Preterm Birth, found that the adverse effects of terbutaline pump therapy for mothers or their children, in both the short term and long term, are not fully understood. AHRQ's new review found that the safety of the terbutaline pump is unclear, although post-marketing surveillance detected serious harms. Some evidence suggests that pump therapy is beneficial for maintenance tocolysis. However, the studies have a high risk of bias and are insufficient in size to produce statistically significant results. 

10. Register for AHRQ's Webcast on Using CAHPS® Patient-Centered Medical Home Item Set on November 3

Register for AHRQ's Webcast, titled "Measuring Patients' Experiences with Medical Homes Using the CAHPS Patient-Centered Medical Home (PCMH) Item Set" on November 3 at 2:00 — 3:30 p.m. EDT. This free Webcast, hosted by the CAHPS® User Network, will discuss using the CAHPS Clinician and Group Survey with new Patient-Centered Medical Home items to measure patients' experiences with the domains of primary care that define the medical home. The Webcast features Christine Crofton, Ph.D., CAHPS Project Officer at AHRQ; David Meyers, M.D., Director of the Center for Primary Care, Prevention, and Clinical Partnerships at AHRQ;Patricia Gallagher, Ph.D., Senior Research Fellow at the Center for Survey Research, University of Massachusetts Boston; and Sarah Scholle, Dr. P.H., Vice President for Research at the National Committee for Quality Assurance. 

11. 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.

Carey K, Stefos T. Controlling for quality in the hospital cost function. Health Care Manag Sci 2011 Jun; 14(2):125-34. Select to access the abstract on PubMed.®

Reiter KL, Harless DW, Pink GH, et al. The effect of minimum nurse staffing legislation on uncompensated care provided by California hospitals. Med Care Res Rev 2011 Jun; 68(3):332-51. Select to access the abstract on PubMed.®

Mainous AG 3rd, Diaz VA, Matheson EM, et al. Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997-2006. Public Health Rep 2011 May-Jun; 126(3):354-60. Select to access the abstract on PubMed.®

Friedman B, Berdahl T, Simpson LA, et al. Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality. Acad Pediatr 2011 Ju1-Aug; 11(4):263-270. Select to access the abstract on PubMed.®

Blustein J, Weissman JS, Ryan AM, et al. Analysis raises questions on whether pay-for-performance in Medicaid can efficiently reduce racial and ethnic disparities. Health Aff 2011 Jun; 30(6):1165-75. Select to access the abstract on PubMed.®

Warholak TL, Hines LE, Saverno KR, et al. Assessment tool for pharmacy drug-drug interaction software. J Am Pharm Assoc 2011 May-Jun; 51(3):418-24. Select to access the abstract on PubMed.®

Dusetzina SB, Alexander GC. Drug vs. class-specific black box warnings: does one bad drug spoil the bunch? J Gen Intern Med 2011 Jun; 26(6):570-2. Select to access the abstract on PubMed.®

Mukamel DB, Harrington C, Spector WD, et al. Does state regulation of quality impose costs on nursing homes? Med Care 2011 Jun; 49(6):529-34. Select to access the abstract on PubMed.®

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Current as of October 2011
Internet Citation: Birth Defects May Be Linked to High Blood Pressure, Not Use of ACE Inhibitors in Early Pregnancy: Electronic Newsletter, Issue 326. October 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/326.html