AHRQ Evidence Review Addresses Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Electronic Newsletter, Issue 339

The AHRQ Electronic Newsletter is issued periodically and summarizes Agency research and programmatic activities.

March 28, 2012

AHRQ News and Numbers

Fifty-eight percent of obese adults in the United States and nearly 69 percent of extremely obese adults age 20 or older reported suffering from joint pain in 2009. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #364: Obesity in America: Estimates for the U.S. Civilian Noninstitutionalized Population Age 20 and Older, 2009.]

Today's Headlines

  1. AHRQ Evidence Review Addresses Venous Thromboembolism Prophylaxis in Orthopedic Surgery
  2. New AHRQ study finds only 75 percent of HIV patients stay in care
  3. New AHRQ resource helps communities connect those at risk to health care services
  4. AHRQ's Health Care Innovations Exchange focuses on spreading innovations for cardiovascular health
  5. AHRQ offers free MEPS Data Users' workshop on April 25-26
  6. 2011 Eisenberg award for Safety and Quality recognizes national, local innovators
  7. Highlights from most recent monthly newsletter
  8. AHRQ in the professional literature 

1. AHRQ Evidence Review Addresses Venous Thromboembolism Prophylaxis in Orthopedic Surgery

Extending post-surgical use of medications to prevent blood clots may be beneficial for patients who have undergone major orthopedic surgery such as hip or knee replacement, according to a new AHRQ Effective Health Care Program review. Standard treatment currently calls for the use of anti-clotting medications from seven to 10 days post-surgery; however, the evidence suggests that up to 28 days or longer may be appropriate. While there is not enough evidence to determine which type of anti-clotting medication is best, within the heparin class of medications, low molecular-weight heparin was found to be superior to unfractioned heparin. More research, particularly clinical trials, is needed to compare the effectiveness of using single or combination therapies, including medications or mechanical prophylaxis, such as leg compression or foot pumps, and to evaluate the use of medications after less serious types of orthopedic surgery. Select to access the review.

2. New AHRQ Study Finds Only 75 Percent of HIV Patients Stay in Care

Only 75 percent of HIV/AIDS patients in the United States remain in care consistently, according to a new AHRQ-supported study published in the February 29 issue of the journal AIDS. The study is the first to provide a comprehensive national estimate of HIV care retention and information about patients who are most likely to continue their care over time. Researchers studied 17,425 adult patients cared for at 12 clinics within the AHRQ-supported HIV Research Network between 2001 and 2008. Only 42 percent of patients studied had what researchers defined as no "gap" in treatment - or intervals of no more than six months in between outpatient visits - over the seven-year period. Nearly one-third, or 31 percent of patients, had one or more treatment gap that extended between seven and 12 months. And about 28 percent of patients appeared to have gone without care for more than a year on one or more occasions. Women, white patients, older patients, male patients who were infected via sex with men, and patients who began treatment on Medicare (compared to those on private insurance) all were more likely to remain in care more consistently. Retention was also greater among patients whose CD4 counts-the measure of how advanced the disease is-were very low when they entered care. The study was led by Baligh Yehia, M.D., a post-doctoral fellow at the University of Pennsylvania Perelman School of Medicine, and Kelly Gebo, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine. Select to access the abstract on PubMed.®

3. New AHRQ Resource Helps Communities Connect Those at Risk to Health Care Services

A new AHRQ resource, Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways, can help community-based organizations improve coordination of health care services for patients with the greatest need and health risks. The guide is part of AHRQ's Health Care Innovations Exchange and provides assistance on how to create tools and resources to develop a community HUB. The HUB is an infrastructure that brings public and private community stakeholders together to determine local health needs and coordinate appropriate medical care and social services to be delivered without duplication of effort. The Quick Start guide gives an overview of this process and complements the more comprehensive guide released by AHRQ in 2010. To date, 16 HUBs have been established throughout the United States.

4. AHRQ's Health Care Innovations Exchange Focuses on Spreading Innovations for Cardiovascular Health

The March 28 issue of AHRQ's Health Care Innovations Exchange features profiles of four programs that developed improvements in the management of cardiovascular disease and chronic conditions. One such program is the Weekly Home Monitoring and Pharmacist Feedback Weekly Home Monitoring and Pharmacist Feedback in Denver, CO, which enabled hypertensive patients to monitor and report multiple blood pressure readings through an interactive voice response or secure online system. Pharmacists review the results, calling or e-mailing those with elevated readings to review medication adherence, adjust the medication regimen if necessary, and provide lifestyle counseling as appropriate. The program has reduced systolic and diastolic blood pressure, particularly for those with the highest readings entering the program, and generated high levels of patient satisfaction. The issue also features Taking Innovations To Scale, with new resources including success stories, tools, and videos to help innovators spread their innovations and potential adopters to implement innovations in their organization. Select to read more profiles of innovations related to cardiovascular health on AHRQ's Health Care Innovations Exchange Web Site, which contains more than 675 searchable innovations and 1,575 quality tools.

5. AHRQ Offers Free MEPS Data Users' Workshop on April 25-26

Registration is now open for AHRQ's two-day hands-on MEPS Data Users' Workshop in Rockville, MD, on April 25-26. On April 25, lectures that provide a general overview of the Medical Expenditure Panel Survey (MEPS), including information about survey design, file content, and the construction of analytic files, will be featured. Emphasis will be on health care utilization, expenditures, and medical conditions. On April 26, participants will gain hands-on experience by working with programmers and analysts to identify and assemble variables to build a data file to answer research questions. A PC will be available for each participant, and they will also work on SAS sample exercises. Time will be allotted for open discussion and for answering specific research questions from participants. To fully benefit from the second day, participants should have some prior knowledge of MEPS. A basic knowledge of SAS, STATA or SPSS is desirable. Exercises will be conducted with SAS only. Select for more information and to register.

6. 2011 Eisenberg Award for Safety and Quality Recognizes National, Local Innovators

The Society of Hospital Medicine (SHM), a medical society representing more than 34,000 hospital physicians, has been named the recipient of the 2011 John M. Eisenberg Patient Safety and Quality Award for innovation in safety and quality at the national level. The award, from the National Quality Forum (NQF) and the Joint Commission, recognizes SHM's mentored innovation model, which pairs hospital teams with a physician mentor in quality improvement, to address specific quality issues. In the individual achievement category, the Eisenberg Award will honor Kenneth I. Shine, M.D., executive vice chancellor at the University of Texas Medical Center and former president of the Institute of Medicine. In that capacity, Dr. Shine helped put the issue of patient safety and quality improvement on the national agenda through the landmark reports, To Err is Human and Crossing the Quality Chasm. At the local level, the Eisenberg Award recognizes the collaborative efforts at New York-Presbyterian Hospital that resulted in formation of a quality council of medical residents that has been credited with medication compliance levels that exceed 90 percent. A second award for innovation at the local level honors the Henry Ford Health System, Detroit, for a campaign that has reduced harm events by 26 percent and system-wide mortality by 12 percent. The Eisenberg Award for honorary lifetime achievement recognizes Jerod Loeb, Ph.D., who has led the performance measurement initiative at the Joint Commission since 1994. His work has resulted in the adoption of accurate performance measurements by thousands of hospitals and health organizations. The John M. Eisenberg Patient Safety and Quality Awards, which will be presented on April 5, were established by the NQF and the Joint Commission in 2002 in memory of the late AHRQ administrator. Dr. Eisenberg was a founding leader of the NQF, chaired the Quality Inter-Agency Coordination Task Force, and was an early advocate for patient safety research.

7. Highlights from Most Recent Monthly Newsletter

The March issue of Research Activities is available online. Key articles include

  • Growth in the physician assistant workforce will be insufficient to meet future needs of primary care.

    The growth of physician assistants (PAs) in the U.S. medical workforce will not be sufficient to meet the future needs of primary care, especially given the predicted shortage of primary care physicians, concludes a new study. The study simulated projected growth in PA supply between 2010 and 2025. It found that the current number of PAs (72,000) will grow by almost 72 percent by 2025. However, this growth rate will likely only provide 16 percent of the providers needed to address the projected primary care physician shortage. Select to read this article.

Other articles include:

  • Trauma patients with hospital-acquired infections have poor outcomes, including increased mortality risk.
  • Pneumococcal disease continues to lead to substantial health care use and costs.
  • Study uncovers the time spent on writing and viewing hospital electronic health records.
  • Preventing pressure ulcers in the home requires creative solutions by nurses.

Select to read these and others.

8. 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.

Chen PG, Curry LA, Bernheim SM, et al. Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. Acad Med 2011 Nov; 86(11):1383-8. Select to access the abstract on PubMed.®

Geng EH, Kahn JS, Chang OC, et al. The effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation. Clin Infect Dis 2011 Nov; 53(10):1008-14. Select to access the abstract on PubMed.®

Rattanaumpawan P, Tolomeo P, Bilker WB, et al. A clinical prediction rule for fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection. Infect Control Hosp Epidemiol 2011 Nov; 32(11):1124-6. Select to access the abstract on PubMed.®

Sege R, Flaherty E, Jones R, et al. To report or not to report: examination of the initial primary care management of suspicious childhood injuries. Acad Pediatr 2011 Nov-Dec; 11(6):460-6. Select to access the abstract on PubMed.®

Barnett S, Klein JD, Pollard RQ Jr, et al. Community participatory research with deaf sign language users to identify health inequities. Am J Public Health 2011 Dec; 101(12):2235-8. Select to access the abstract on PubMed.®

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Page last reviewed March 2012
Internet Citation: AHRQ Evidence Review Addresses Venous Thromboembolism Prophylaxis in Orthopedic Surgery: Electronic Newsletter, Issue 339. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/339.html