AHRQ Identifies Themes for Successful Transformation to Patient-Centered Medical Home
- AHRQ Identifies Themes for Successful Transformation to Patient-Centered Medical Home.
- NGC Announces Revised Criteria for Inclusion of Clinical Practice Guidelines.
- AHRQ Review Shows Bariatric Surgery May Help Treat Diabetes in Some People.
- AHRQ's Health Care Innovations Exchange Focuses on Health Information Exchanges.
- AHRQ Patient Safety Primer Highlights Benefits, Challenges of Computerized Provider Order Entry.
- Radiation Treatments Show Similar Results in Prostate Cancer Patients After Surgery, AHRQ Study Finds.
- AHRQ in the professional literature.
Five common themes have been identified among primary care practices that have successfully transformed into patient-centered medical homes (PCMHs), according to an AHRQ-funded supplement to the May issue of Annals of Family Medicine. AHRQ funded 14 studies of diverse U.S. primary care practices from 2010-2012 to identify common approaches and methods for successful transformation to the PCMH model. The five themes, identified among approximately 3,800 practices reviewed, are: a strong structural capacity such as having a functional electronic health record, as well as operational management systems and broad organizational support; an understanding that PCMH transformation takes time and is challenging; the ability to integrate more team-based care, which allows for new team members, expanded roles and cross training; visionary leadership and a supportive culture to facilitate change; and, contextual factors such as state and local policies that are closely linked to outcomes. These themes are detailed in an editorial titled "Lessons Learned from the Study of Primary Care Transformation," which is co-authored by AHRQ's Robert J. McNellis, M.P.H., P.A., Janice L. Genevro, Ph.D., M.S.W. and David S. Meyers, M.D. Select to access the Annals of Family Medicine supplement.
On June 3, AHRQ's National Guideline Clearinghouse (NGC) announced its revised criteria for inclusion of clinical practice guidelines. The new criteria reflect the Institute of Medicine's definition of a clinical practice guideline provided in its 2011 standards-setting publication, Clinical Practice Guidelines We Can Trust. The two main changes to the NGC inclusion criteria are that the guideline:
- Be based on a systematic review of the evidence, through a literature review that summarizes evidence by identifying, selecting, assessing, and synthesizing the findings of similar but separate studies.
- Contains an assessment of the benefits and harms of the recommended care and alternative care options.
The revised criteria will become effective June 2014.
Select to access more information on NGC's revised criteria and its mission. Select for frequently asked questions about the new inclusion criteria or to compare clinical practice guidelines and other related information.
Bariatric surgery may be effective in the short term for treating diabetes in some moderately obese patients, a new research review from AHRQ's Effective Health Care Program finds. The findings were published in the June 5 issue of the Journal of the American Medical Association (JAMA). Evidence suggests that laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy are effective for treating diabetes and impaired glucose tolerance in patients with a body mass index of at least 30 but less than 35. Although the short-term harms associated with bariatric surgery were relatively low, there is not enough evidence to determine if bariatric surgery is effective for these patients over the long term. These findings can be found in the full review, Bariatric Surgery and Nonsurgical Therapy in Adults with Metabolic Conditions and a Body Mass Index of 30.0 to 34.9 kg/m2.
The latest issue of AHRQ's Health Care Innovations Exchange features two examples of successful implementation of health information exchanges. One of the featured profiles is the Delaware Health Information Network, which seeks to support health care quality, safety, and efficiency for patients who receive care from Delaware providers. Through the network, clinicians have immediate access to patient-specific laboratory results, radiology reports, and other data that allow them to make informed clinical decisions, improve patient safety, and avoid unnecessary tests. The network delivers more than 10 million clinical results and reports to providers annually and helps member hospitals fulfill all public health reporting requirements by transmitting data directly to a statewide health registry. The system tracks nearly 88 percent of Delaware's patient population, and is used by 97 percent of Delaware providers. The other featured profile from the National Association of Boards of Pharmacy provides interstate access to information about controlled substance prescriptions to help identify cases of misuse. Access more innovation profiles and tools related to health information exchange and to data exchange on the Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 Quality Tools.
Computerized provider order entry (CPOE), where clinicians enter medication orders into a computer system which then transmits the order directly to the pharmacy, are becoming more common in hospitals as a method to reduce medication errors, according to a patient safety primer available on AHRQ's Patient Safety Network (PSNet). The primer provides a summary of the benefits and implementation issues commonly seen in CPOE use, including unintended consequences, alert fatigue and possible integration with Clinical Decision Support Systems. Select to access the full patient safety primer, titled Computerized Provider Order Entry.
New research from AHRQ's Effective Health Care Program finds that for prostate cancer patients who require radiotherapy following prostatectomy, the prostate cancer therapies intensity-modulated radiotherapy (IMRT) and conformal radiotherapy (CRT) achieved similar morbidity and cancer control results. Men who received IMRT versus CRT showed no significant difference in rates of long-term gastrointestinal morbidity, urinary nonincontinent morbidity, urinary incontinence, or erectile dysfunction. There was also no significant difference in subsequent treatment for recurrent disease. IMRT is a newer and more costly treatment option for postprostatectomy patients with adverse pathology results or recurrent disease. It remains unclear whether the potential benefits of a more focused radiation technique will be realized in terms of improving outcomes of men with localized prostate cancer. The report, titled Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy, appeared online May 20 in JAMA Internal Medicine. Select to access the abstract on PubMed®.
Jiang HJ, Friedman B, Jiang S. Hospital cost and quality performance in relation to market forces: an examination of U.S. community hospitals in the "post-managed care era." Int J Health Care Finance Econ 2013 Jan 26. Select to access the abstract on PubMed®.
Rangachari P. Effective communication network structures for hospital infection prevention: a study protocol. Qual Manag Health Care 2013 Jan-Mar; 22(1):16-24. Select to access the abstract on PubMed®.
Birken SA, Lee SY, Weiner BJ, et al. Improving the effectiveness of health care innovation implementation: middle managers as change agents. Med Care Res Rev 2013 Feb; 70(1):29-45. Select to access the abstract on PubMed®.
Cooper LA, Ghods Dinoso BK, Ford DE, et al. Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: the BRIDGE study. Health Serv Res 2013 Feb; 48(1):150-74. Select to access the abstract on PubMed®.
Samia LW, Ellenbecker CH, Friedman DH, et al. Home care nurses' experience of job stress and considerations for the work environment. Home Health Care Serv Q 2012 Jul; 31(3):243-65. Select to access the abstract on PubMed®.
Lee BY, Singh A, Bartsch SM, et al. The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2013 Feb; 34(2):151-60. Select to access the abstract on PubMed®.
Fisher CE, Spaeth-Rublee B, Pincus HA, et al. Developing mental health-care quality indicators: toward a common framework. Int J Qual Health Care 2013 Feb; 25(1):75-80. Select to access the abstract on PubMed®.
Fraenkel L. Incorporating patients' preferences into medical decision making. Med Care Res Rev 2013 Feb; 70(1 Suppl):80S-93S. Select to access the abstract on PubMed.
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