Studies Show Computerized Decision Tools Can Aid Acute Coronary Syndrome, Pulmonary Embolism Diagnoses
In 2010, there were approximately 12.1 million diabetes-related emergency department (ED) visits for adults 18 years or older, which represented 9.4 percent of all adult ED visits. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #167: Emergency Department Visits for Adults with Diabetes, 2010.)
- Studies Show Computerized Decision Tools Can Aid Acute Coronary Syndrome, Pulmonary Embolism Diagnoses.
- AHRQ Looks To Fund Projects Promoting Safer Health IT Practices.
- Some Statin Combination Therapy Better at Lowering LDL Than Statin Intensification, but Effects on Clinical Outcomes Unknown.
- Register Now: February 20 Webinar Will Cover Using Health IT To Improve Coordination for Patients With Complex Care Needs.
- Register Now: February 28 Webinar on EHR Functionality To Support Primary Care.
- Register Now: AHRQ Long-Term Care Patient Safety Training Models Are Topic of March 12 Webinar.
- AHRQ's Health Care Innovations Exchange Focuses on Community-Wide Initiatives To Enhance Access for Vulnerable Populations.
- AHRQ in the professional literature.
New AHRQ-funded research finds that computerized diagnostic testing can help clinicians assess whether their patients are suffering serious, acute cardiovascular events such as heart attacks. Traditionally, pretest probability assessment—in which clinicians use their experience to discern whether a patient is in danger—has played a central role in diagnosis. This clinical judgment, or "doctor's best guess," can help reduce unnecessary and dangerous testing. However, pretest probability assessment is imperfect for ruling out acute coronary syndrome [ACS] (which includes heart attack and unstable angina) and pulmonary embolism [PE] (a sudden blockage in the lung artery). One AHRQ-funded paper, published in Annals of Emergency Medicine, found that clinicians routinely overestimated pretest probability of both ACS and PE compared with computerized pretest methods. A second paper, based on the same study and also published in Annals of Emergency Medicine, found that patients at very low risk of ACS or PE (less than 2.5 percent) may be able to skip imaging (which is often used to test for ACS and PE) and reduce their exposure to radiation. A third paper, published in Circulation: Cardiovascular Imaging, found that computerized pretest probability screening reduces dangerous and expensive testing (including the risk of radiation exposure) in low-risk ambulatory patients with symptoms of ACS and PE. This demonstrates direct benefit of an electronic decision support to aid in diagnosis. All three papers were based on AHRQ-funded research led by Jeffrey A. Kline, M.D., from the Department of Emergency Medicine, Department of Cellular and Integrative Physiology, Indiana University School of Medicine.
AHRQ is interested in funding projects that will generate evidence on safe health information technology (IT) practices that other federal agencies can use to inform health IT certifications and other forms of policy guidance. AHRQ has issued two funding announcements called Special Emphasis Notices (SENs) following receipt of a fiscal year 2014 appropriation of an additional $4 million in health IT funding for research on the impact of health IT on patient safety. The (R01) SEN focuses on projects that promote post-deployment safety testing of electronic health records (EHRs) for high prevalence, high-impact EHR-related patient safety risks, and focused research demonstration projects that provide evidence to inform the safe use of health IT. The (R21) SEN focuses on applications addressing any of the following:
- Clinical patient safety: Clinical patient safety topics impacted most by health IT.
- EHR system integrity: Frequency of and optimal mitigation strategies for EHR downtimes.
- Health IT safety reporting: Optimal health IT patient safety reporting strategies.
AHRQ will prioritize funding of applications that address at least one of these subjects.
A research review from AHRQ finds that to reduce abnormal lipoprotein levels and prevent coronary heart disease, a combination of statin with ezetimibe or bile acid sequestrant lowered low-density lipoprotein (LDL-c) better than intensification of statin monotherapy. However, evidence for clinical outcomes (mortality, acute coronary events, and revascularization procedures) was insufficient across all potency comparisons for all combination therapy regimens. The American Heart Association has estimated that cardiovascular disease affects 83.6 million individuals, contributes to 32.3 percent of deaths, and is a leading cause of disability. Findings from the report, "Combination Therapy Versus Intensification of Statin Monotherapy: An Update," were published February 11 in Annals of Internal Medicine. The report said more research, particularly in high-risk coronary heart disease populations and populations with greater burden of cardiovascular disease, is needed to evaluate long-term clinical benefits and harms.
AHRQ is hosting a Webinar February 20 from 2:30 p.m. to 3:30 p.m. ET on how health IT can improve outcomes for patients with multiple chronic conditions seen across a variety of settings. The projects presented will discuss care coordination, medication management systems, and ways to facilitate information availability during care transitions.
- Elizabeth Ciemins, Ph.D., research director, Billings Clinic Foundation, Billings, MT.
- Penny Feldman, Ph.D., senior vice president for Research and Evaluation, Visiting Nurse Service of New York.
- Eric Eisenstein, D.B.A, associate professor in medicine, Duke University, Durham, NC.
- Moderator: Vera Rosenthal, M.P.H., program manager, AHRQ.
Select to register.
AHRQ is hosting a Webinar February 28 from 2:30 p.m. to 4:00 p.m. ET on EHR functionality needed to support primary-care delivery. The expert panel will discuss the need for EHRs to move beyond documentation to interpreting and tracking information over time, supporting patient partnering activities, enabling team-based care, and allowing providers to use population-management tools to facilitate care delivery.
- Alexander H. Krist, M.D., co-director, Ambulatory Care Outcomes Research Network, Virginia Commonwealth University.
- Christoph Lehmann, M.D., director, Clinical Informatics Education, Vanderbilt University, Nashville, TN.
- James Mold, M.D., director, Oklahoma Physicians Research/Resource Network, University of Oklahoma Health Sciences Center.
- Robert Phillips, Jr., M.D., vice president of research and policy, American Board of Family Medicine.
- Moderator: Rebecca Roper, M.S., M.P.H., director, Practice-Based Research Network Initiative, AHRQ.
Select to register.
AHRQ is hosting a Webinar March 12 from 1:00 p.m. to 2:00 p.m. ET on the use of the "Improving Patient Safety in Long-Term–Care (LTC) Facilities: Training Modules." The Webinar, targeted at LTC nurses and staff educators, will provide an overview on using the materials to train direct-care staff on how to detect and communicate changes in a resident's condition, with a special focus on falls prevention.
Select to register.
The latest issue of AHRQ's Health Care Innovations Exchange features three profiles about community-wide initiatives to increase access to health care for vulnerable populations. One featured profile describes a community-funded, nonprofit organization called Doctors Care that matches eligible uninsured and underinsured patients in a three-county area outside of Denver County, CO, with providers who agree to serve them at a discounted rate. High levels of participation among area providers and enhanced patient access to care has led to a 15 percent rate of emergency department visits by Doctors Care patients, well below the 21 percent national average for uninsured patients. Other innovation profiles and tools related to collaborative efforts to enhance access for vulnerable populations are located on the Innovations Exchange Web site, which contains more than 825 searchable innovations and 1,550 quality tools.
Rao SV, Hess CN, Dai D, et al. Temporal trends in percutaneous coronary intervention outcomes among older patients in the United States. Am Heart J. 2013 Aug;166(2):273-81.e4. Epub 2013 Jul 1. Select to access the abstract on PubMed®.
Solomon DH, Curtis JR, Saag KG, et al. Cardiovascular risk in rheumatoid arthritis: comparing TNF-α blockade with nonbiologic DMARDs. Am J Med. 2013 Aug;126(8):730.e9-730.e17. Select to access the abstract on PubMed®.
Tsai J, Grant AM, Soucie JM, et al. Clustering patterns of comorbidities associated with in-hospital death in hospitalizations of U.S. adults with venous thromboembolism. Int J Med Sci. 2013 Aug 19;10(10):1352-60. Select to access the abstract on PubMed®.
Rantz MJ, Skubic M, Miller SJ, et al. Sensor technology to support Aging in Place. J Am Med Dir Assoc. 2013 Jun;14(6):386-91. Epub 2013 Apr 3. Select to access the abstract on PubMed®.
Gawron AJ, Jung B, Fought AJ, et al. A colorectal cancer screening program in an underserved, ethnically diverse population in Chicago, IL. J Community Health. 2013 Aug;38(4):603-8. Select to access the abstract on PubMed®.
Avery TR, Kulldorff M, Vilk Y, et al. Near real-time adverse drug reaction surveillance within population-based health networks: methodology considerations for data accrual. Pharmacoepidemiol Drug Saf. 2013 May;22(5):488-95. Epub 2013 Feb 12. Select to access the abstract on PubMed®.
Montgomery JS, Miller DC, Weizer AZ. Quality indicators in the management of bladder cancer. J Natl Compr Canc Netw. 2013 Apr 1;11(4):492-500. Select to access the abstract on PubMed®.
Bayliss EA, Bronsert MR, Reifler LM, et al. Statin prescribing patterns in a cohort of cancer patients with poor prognosis. J Palliat Med. 2013 Apr;16(4):412-18. Epub 2013 Jan 10. Select to access the abstract on PubMed®.
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