AHRQ Director Carolyn Clancy featured in Government Health IT Commentary

Electronic Newsletter, Issue 355

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

September 25, 2012

AHRQ Stats

More than 21,000 hospitalizations of children for cancer occurred in 2009 with leukemia, cancers of the brain and nervous system, and cancers of the bone and connective tissue accounting for the most hospitalizations. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #132: Pediatric Cancer Hospitalizations, 2009.] http://www.hcup-us.ahrq.gov/reports/statbriefs/sb132.jsp

Today's Headlines

  1. AHRQ director Carolyn Clancy featured in Government Health IT commentary.
  2. Tactics to improve medication adherence in short-term shown effective.
  3. Breathing retraining techniques may help adult asthma.
  4. Two new quality reports: Impact of bundled payments and interventions to reduce disparities.
  5. Medicaid providers face common barriers to meaningful use.
  6. New research review on methods to diagnosis plasma cancers.
  7. Pump and glucose monitoring improve diabetes management.
  8. Comparative effectiveness on venous thromboembolism in orthopedic surgery.
  9. AHRQ's Health Care Innovations Exchange focuses on workforce development and the role of community health workers.
  10. AHRQ awards eight institutions to support collaborative centers for primary care practice-based research.
  11. AHRQ announces new Patient-Centered Outcomes Research Pathway to Independence award.
  12. AHRQ in the professional literature.

1. AHRQ Director Carolyn Clancy featured in Government Health IT Commentary

AHRQ Director Carolyn Clancy, M.D., is featured in Government Health IT, urging continued use of health IT to improve patient care as National Health IT Week is recognized. Dr. Clancy identifies some of the Agency's key health IT research initiatives including Project ECHO, Project RED, and the Active Aging Research Center. These projects leverage technology to achieve patient-centered care by tracking and reducing medical errors, bringing care to vulnerable and complex patient groups, and ensuring that every patient gets care according to his or her wishes. In addition to health IT research, AHRQ provides practical resources for healthcare practitioners. AHRQ has developed a workflow assessment toolkit, e-prescribing toolsets, and a guide for clinicians to establish interactive personal health records. Select to read Dr. Clancy's commentary http://www.govhealthit.com/blog/national-health-it-week-celebrating-hit-essential-tool. Select for more information about National Health IT Week http://www.healthitweek.org. 

2. Tactics to Improve Medication Adherence in Short-Term Shown Effective

A new AHRQ evidence report found consistent evidence that patients were more likely to follow medication instructions if given incentives such as reductions in out-of-pocket prescription drug costs or improvements in prescription drug coverage. Case management and educational interventions were also shown to improve medication adherence. The tactics were shown to be effective for a wide range of chronic illnesses, including asthma, depression, diabetes, and cardiac conditions. Studies estimate that half of all medications for chronic conditions are not taken as prescribed, and medication non-adherence costs the U.S. health care system between $100 billion and $289 billion annually in direct medical costs. The strongest evidence came from studies using medication self-management for asthma patients, collaborative care or case management for patients taking drugs for depression, and pharmacist-led approaches to improve systolic blood pressure in hypertensive patients. According to Meera Viswanathan, Ph.D., who led the team of RTI-University of North Carolina Evidence-based Practice Center researchers, there was limited evidence as to whether the approaches studied have broad applicability for chronic conditions and patient populations. They also found limited evidence for long-term medication adherence or health outcomes. The review is part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, and builds on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Select to read "Medication Adherence Interventions: Comparative Effectiveness http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1249." An article on this report was published today in the Annals of Internal Medicine. Select to access the abstract http://www.ncbi.nlm.nih.gov/pubmed/22964778 on PubMed.® 

3. Breathing Retraining Techniques May Help Adult Asthma

A new evidence-based review from AHRQ's Effective Health Care Program finds that complementary breathing retraining methods such as hyperventilation (over-breathing) reduction breathing, when compared to other breathing techniques, may reduce asthma symptoms and may decrease use of quick relief medications. Only minor harms were reported in these studies. Patients considering intensive asthma-focused training should not change their use of asthma medication without consulting with their medical provider. Select to access the research review, Comparative Effectiveness of Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1251&PCem=EN. 

4. Two New Quality Reports: Impact of Bundled Payments and Interventions to Reduce Disparities

AHRQ has released two reports that are part of a larger initiative, Closing the Quality Gap: Revisiting the State of the Science, and build on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. One report prepared by AHRQ's RAND Evidence-based Practice Center found that the introduction of bundled payments to reimburse providers for the expected cost of related health care services reduced health care spending and use. But the evidence for the effect of bundled payments on quality measures was inconsistent and generally had small effects. The researchers found the overall evidence to be low because most of the studies examined bundled payment for single institutions and many had quality concerns. The lead researcher Peter S. Hussey, Ph.D., says the report provides policymakers some support that bundling payment is likely to be an effective strategy, and while the method's effects on quality are less certain, the evidence does not support the worst concerns about potentially adverse effects. Select to access the report, "Bundled Payment: Effects on Health Care Spending and Quality http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1235." The other report in this series, AHRQ's Vanderbilt University Evidence-based Practice Center researchers led by Melissa L. McPheeters, Ph.D., found that, as a whole, quality interventions to reduce health care disparities have not been shown to be effective, although they did find a few studies showing that quality improvement interventions affected health care disparities in certain disadvantaged populations. Select to access the report, "Quality Improvement Interventions to Address Health Care Disparities http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1242." 

5. Medicaid Providers Face Common Barriers to Meaningful Use

A new AHRQ report examines challenges Medicaid providers face in achieving Meaningful Use (MU) of health information technologies. The report finds barriers to adoption and MU of Electronic Health Records (EHRs) were not associated with serving a predominantly Medicaid-insured population. However, providers such as dentists, pediatricians, and nurse midwives who were only eligible under the Medicaid program reported some difficulty finding a certified EHR appropriate for their specialty, and that some required measures, such as blood pressure, were irrelevant due to the age of the patient groups they serve. The reported barriers to adoption and achievement of MU were consistent with those cited in past studies, including limited awareness of the Medicaid EHR Incentive program, difficulty in selecting and functionality of EHRs and limited ability to implement core measures of Stage 1 MU. The report recommended greater collaboration between all stakeholders to provide more targeted technical assistance tools and development of a body of knowledge to address the socio-cultural, technical, and training needs of Medicaid providers. Select to access the full report http://healthit.ahrq.gov/BarrierstoMeaningfulUseFinalReport. 

6. New Research Review on Methods to Diagnosis Plasma Cancers

A new research review from AHRQ's Effective Health Care Program found there may not be sufficient evidence to determine whether the addition of the Serum Free Light Chain (SFLC) investigative procedure to traditional testing increases diagnostic accuracy for Plasma Cell Dyscrasias (PCD, a cancer of the plasma cells) or whether it helps predict disease progression. Although the SFLC procedure has been in use for a decade for PCD diagnosis, how best to incorporate it into practice remain unclear. The review, Serum-Free Light Chain Analysis for the Diagnosis, Management, and Prognosis of Plasma Cell Dyscrasias http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1229&PCem=EN, determined that the evidence was mostly insufficient as to what extent adding SFLC to current tests improves diagnosis, prognosis, monitoring of therapy, and treatment decisions. The review found that more research is needed to understand the exact role of SFLC and the most effective use of the procedure across the full range of PCD cancers and clinical settings. 

7. Pump and Glucose Monitoring Improve Diabetes Management

Sensor-augmented insulin pumps (intensive insulin therapy combined with real time continuous glucose-blood sugar monitoring) are superior to multiple daily insulin injections and self-monitoring of blood glucose (fingersticks) to lower hemoglobin A1c (the preferred method of assessing blood sugar control in the blood) in patients with type 1 diabetes, a new review from AHRQ's Effective Health Care Program has found. The review found an improved quality of life of patients who are using insulin intensive therapies and real time self-monitoring of glucose (sensors attached to the body that continuously measure blood sugar). Generally, additional research should focus on standardizing treatment goals and evaluating the effectiveness of insulin delivery methods and glucose monitoring technologies in different patient populations. These findings and future research needs are summarized in Methods of Insulin Delivery and Glucose Monitoring: A Comparative Effectiveness Review http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=749&PCem=RA. 

8. Comparative Effectiveness on Venous Thromboembolism in Orthopedic Surgery

For patients who have undergone major orthopedic surgery such as hip or knee replacement, extending post-surgery use of medications, from the standard 7-10 days to 28 days or longer, to prevent blood clots may be beneficial, according to a new AHRQ Effective Health Care Program review. 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, Venous Thromboembolism Prophylaxis in Orthopedic Surgery http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=992&PCem=EN. 

9. AHRQ's Health Care Innovations Exchange Focuses on Workforce Development and the Role of Community Health Workers

The September 12 issue of AHRQ's Health Care Innovations Exchange (http://www.innovations.ahrq.gov) features two profiles related to policies that support the development and expansion of the health care workforce to leverage community members and health workers. One of the policies created a new staff position within primary care clinics and hospitals that was filled by community members with experience as caregivers. Known as "Grand-Aides http://www.innovations.ahrq.gov/content.aspx?id=3689," these new members of the health care team completed a rigorous training and certification process before performing a variety of tasks intended to streamline and reduce the costs of patient care, and assist health care teams in providing appropriate care to patients. Though their work varied depending on the setting (primary care or transitional care after discharge), Grand-Aides typically had face-to-face interactions and/or telephone conversations with patients, focusing on assessment of needs, education on preventive and self-care, ongoing monitoring, and followup in two pilot sites, Grand-Aides reduced unnecessary physician visits and demonstrated the potential to generate significant cost savings. This new health workforce role is currently being tested and spread to sites in California, Pennsylvania, Virginia, and Texas. Select to read more innovation profile related to community health workers http://go.usa.gov/ryQe on the Health Care Innovations Exchange Web site, which contains more than 725 searchable innovations and 1,500 QualityTools. 

10. AHRQ Awards Eight Institutions to Support Collaborative Centers for Primary Care Practice-Based Research

AHRQ has announced grant awards to eight institutions to support collaborative centers for primary care practice-based research. For over a decade, AHRQ has invested in primary care practice-based research networks (PBRNs) - groups of ambulatory medical practices devoted principally to the primary care of patients that join to conduct and disseminate research to improve the practice of primary care. While AHRQ has supported PBRNs with as few as 15 primary care practices, each Center created through this program has a minimum of 120 member practices and several have more than 500. Many of the Centers are collaborations between smaller well-established PBRNs. By leveraging common resources, these Centers are expected to improve productivity and to develop the ability to plan and conduct independent research projects more quickly and produce results that are more generalizable than they would as separate PBRNs. Select to read more about the new Centers http://www.ahrq.gov/research/rescenters.htm. 

11. AHRQ Announces New Patient-Centered Outcomes Research Pathway to Independence Award

AHRQ is seeking applications for the new Patient-Centered Outcomes Research (PCOR) Pathway to Independence Award program. The primary purpose of this program is to increase and maintain a strong cohort of new and talented AHRQ-supported independent investigators trained in comparative effectiveness methods to conduct patient care outcomes research. The program is designed to facilitate a timely transition from a junior non-tenure track faculty or a postdoctoral research position (or their equivalents) to a stable independent research career. It targets investigators early in their careers to support their development in new sophisticated methodological comparative effectiveness research skills, interdisciplinary perspectives, and capabilities in PCOR. Deadline to submit an application is December 17. Select to access the announcement http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-13-002.html. 

12. 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 experience problems in accessing articles, ask your technical support staff for possible remedies.

Gawron AJ, Rothe J, Fought AJ, et al. Many patients continue using proton pump inhibitors after negative results from tests for reflux disease. Clin Gastroenterol Hepatol 2012 Jun; 10(6):620-5. Select to access the abstract on PubMed.®

Emerson CB, Eyzaguirre LM, Albrecht JS, et al. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012 Jun; 33(6):539-44. Select to access the abstract on PubMed.®

Whipple EC, Dixon BE, McGowan JL. Linking health information technology to patient safety and quality outcomes: a bibliometric analysis and review. Inform Health Soc Care 2012 Jun 1 [Epub ahead of print.] Select to access the abstract on PubMed.®

Weiner JP, Fowles JB, Chan KS. New paradigms for measuring clinical performance using electronic health records. Int J Qual Health Care 2012 Jun; 24(3):200-5. Select to access the abstract on PubMed.®

West A, Cox M, Zimmer LO, et al. An evaluation of stroke education in AVAIL registry hospitals. J Neurosci Nurs 2012 Jun; 44(3):115-23. Select to access the abstract on PubMed.®

Dusetzina SB, Higashi AS, Dorsey ER, et al. Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review. Med Care 2012 Jun; 50(6):466-78. Select to access the abstract on PubMed.®

Wilkins TL, Rust GS, Sambamoorthi U. Changing BMI categories and healthcare expenditures among elderly Medicare beneficiaries. Obesity 2012 Jun; 20(6):1240-8. Select to access the abstract on PubMed.®

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Current as of September 2012
Internet Citation: AHRQ Director Carolyn Clancy featured in Government Health IT Commentary: Electronic Newsletter, Issue 355. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/355.html