EHC Program Inside Track Newsletter

Issue 11, February 2013

EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program.

In this issue:

Expanding Opportunities for Continuing Education

More than 70 free online continuing education courses are now available from the Effective Health Care (EHC) Program, with opportunities open to physicians, physician assistants, nurses, nurse practitioners, pharmacists, dietitians, case managers, health educators, and medical assistants.

The EHC Program’s growing inventory of continuing medical education/continuing education (CME/CE) courses helps health care professionals engage in evidence-based treatment comparisons for heart disease, diabetes, depression, arthritis, cancer, and many other conditions. More than 65,000 certificates have been issued to more than 34,000 health care professionals.

The modules, which may be composed of videos, articles, slide presentations, case examples, and links to references and tools, are all accredited and satisfy requirements that courses be developed by expert faculty and peer-reviewed. In addition to providing important clinical data and comparative effectiveness research findings, the modules include discussions about the clinical implications and rationale for using the findings.

Several organizations in the EHC Program’s national partnership network promote the courses to members, including the Academy of Managed Care Pharmacy, the American College of Cardiology, the American College of Osteopathic Family Physicians, the American Nurses Association, and the American Osteopathic Association.

"We're always looking for evidence-based opportunities for learning, and AHRQ is a wonderful resource for disseminating the latest research," said Mary Jo Goolsby, Ed.D., M.S.N., vice president of research, education, and professional practice for American Association of Nurse Practitioners (AANP), an EHC Program partner.

A full list of CME/CE activities for all health care disciplines grouped by disease, such as high blood pressure, cancer, mental health, or diabetes, can be accessed here. Most activities are available on mobile phones, tablets, and Droid smartphones.

Top of Page 

Evidence-Based Care Challenge Winners Announced

Winners have been chosen in the competition that challenged nurse practitioners and physician assistants to translate AHRQ research reports into user-friendly information resources adaptable for peers in retail clinics.

The "Evidence-Based Care Challenge," launched in June 2012, required that entries be based on findings from the AHRQ Health Literacy report, plus either the Otitis Media report or the Screening for Obesity in Children and Adolescents report.

The winners are—

  • A Web site featuring evidence-based content on otitis media for both health care providers and patients. The Web site was developed by a team led by Kelly McGee, a nurse practitioner from New Albany, OH.
  • A double-sided brochure on otitis media intended to help patients navigate treatment decisions with providers at the point-of-care. The brochure was developed by a team led by Janette Capaci, a nurse practitioner from Lexington, SC.
  • An illustrated “flipbook” on otitis media designed for providers and patients to simultaneously review useful information on otitis media. The flipbook was developed by a team led by Nicola Archie, a nurse practitioner from Tampa, FL.

Submissions were scored by an expert panel and the first place winner will receive a $7,500 seed-funding award to further develop their product and implement it in a retail setting.

AHRQ supports involvement of diverse groups in its comparative effectiveness research. The Agency launched this pilot project to engage clinician groups in the EHC Program. AHRQ developed the challenge in collaboration with the American Institutes for Research and AcademyHealth. Click here to learn more about the challenge.

Top of Page 

AHRQ Research Explores Evidence on Screening, Treatment, Adherence for Hepatitis C Virus

Three new EHC Program reports on the Hepatitis C virus (HCV) summarize the effectiveness and risks of methods for screening, treating, and promoting treatment adherence. The evidence reports are being used to inform upcoming updates to the U.S. Preventive Services Task Force guidelines for screening and treatment of Hepatitis C. In the United States, HCV is the most common chronic blood borne pathogen and is associated with an estimated 15,000 deaths each year.

  • AHRQ’s research review on Screening for Hepatitis C Virus Infection in Adults finds that although screening strategies for Hepatitis C can accurately identify adults with the disease, more research is needed to understand the effects of targeted screening strategies in adults. Evidence also remains limited on how a person’s health status is affected upon receiving an HCV diagnosis.
  • According to Treatment of Hepatitis C Virus Infection in Adults: A Comparative Effectiveness Review, patients with HCV who achieve a sustained virologic response (SVR), defined as undetectable levels of HVC 6 months after completing treatment, appear to have a decreased risk of death compared with those without an SVR. The review also compared the effectiveness of dual and triple drug combinations in achieving SVR.
  • The review on Interventions To Improve Patient Adherence to Hepatitis C Treatment: Comparative Effectiveness summarizes evidence comparing the benefits and harms of treatment adherence interventions for adults receiving combination antiviral therapy for chronic Hepatitis C. However, evidence is too limited to draw firm conclusions. Some evidence suggests that patient-level and regimen-related interventions improved medication and treatment plan adherence when compared with standard care. These interventions included patient support groups and therapeutic education, as well as special drug packaging with instructions (i.e., RibaPak) to reduce pill load. While these suggest promise for clinical practice, the uncertain evidence suggests that caution should be used when applying them to patient care.

Summaries of these reports for both clinicians and patients are forthcoming. Currently available EHC Program research summaries can be found here.

Top of Page 

More New, Free Effective Health Care Program Resources

New Research Reviews Comparing Treatment Options

Each of these reviews compares available evidence from numerous research studies. Companion summary resources for patients and clinicians will be available for each of these reviews in the future.

Undescended Testicles (Cryptorchidism): Evaluation and Treatment

According to the latest research review from AHRQ, for infant males with undescended testicles, both laparoscopic and open surgical techniques are effective for moving undescended testicles to a normal position in the scrotum. However, the review also finds that no specific imaging technique can consistently determine the presence or absence of testicles or the location of undescended testicles. There also is not enough evidence to evaluate if hormonal stimulation testing can determine the absence of testicles. Additional studies comparing various imaging techniques are needed to determine which techniques produce the best results and eliminate the need for surgical evaluation. Future studies should seek to identify the appropriate age for treatment and which types of patients would benefit from hormonal treatment for undescended testicles. Read the full research review here: Evaluation and Treatment of Cryptorchidism.

Colorectal Cancer: Metastasis to the Liver

A new AHRQ review finds that in cases when colorectal cancer liver metastases are not able to be surgically removed, there is not enough evidence available to compare the effectiveness of local therapies that target the liver. There are also extensive gaps in the research, even when looking at critical benefits or harms, and the quality of the available studies is generally low. This review describes several types of therapies that target colorectal cancer that has spread to the liver in patients who are not candidates for surgery. The therapies in the review that target the liver include ablation (destruction of tissue by heating or cooling), embolization (blocking blood vessels that feed the cancer), and radiotherapy (directed radiation to destroy cancer cells). Read the full research review here: Local Hepatic Therapies for Metastases to the Liver from Unresectable Colorectal Cancer: Effectiveness and Comparative Effectiveness.

Chronic Cough: Effective Assessment and Management Strategies

New AHRQ research finds that several tools are valid and reliable for evaluating chronic cough severity, frequency, and impact on quality of life. Evidence suggests the Leicester Cough Questionnaire (LCQ) and Cough-specific Quality of Life Questionnaire (CQLQ) for adults and the Parent Cough-specific Quality of Life questionnaire (PC-QOL) for children may be valid instruments. While a wide variety of medicines have been used to treat the symptom of chronic cough, nonopioid/nonanesthetic antitussives like codeine and dextromethorphan in particular have been shown to be effective in reducing cough frequency and severity compared with placebo. However, given limited evidence it is too early to make strong conclusions about the comparative effectiveness of these medicines. Read the full research review here: Assessment and Management of Chronic Cough.

Case Management: Strategy for Chronic Illness Management

Case management has some limited impact on patient-centered outcomes, quality of care, and resource utilization among patients with chronic medical illness. Case management (CM), as defined in this report, is a one such supplemental service, in which a person, usually a nurse or social worker, takes responsibility for coordinating and implementing a patient’s care plan, either alone or in conjunction with a team of health professionals. CM is a process in which a member of the health care team is designated to manage multiple aspects of a patient’s care, including planning and assessment, coordination of services, patient education, and clinical monitoring. The impact of CM may be greatest for patients with the highest previous levels of health care use, such as those with low levels of social support, and/or patients at highest risk for poor outcomes. These findings and others can be found in the full review, Outpatient Case Management for Adults with Medical Illness and Complex Care Needs.

Other New Research

Aldosterone Antagonist Therapy: Risks of Mortality and Readmission Among Patients With Heart Failure

According to new research from AHRQ’s Effective Health Care Program, among older patients experiencing heart failure and reduced ejection fraction, using aldosterone antagonist therapy at hospital discharge was not independently associated with improved mortality or cardiovascular readmission. However, it was associated with a modest reduction in the risk of hospitalization for heart failure. Additional research is needed to evaluate the clinical effectiveness of aldosterone antagonists in the broad population of patients with heart failure and to identify strategies to overcome disparities between findings of clinical efficacy and clinical effectiveness.
To learn more, access the report here: Associations Between Aldosterone Antagonist Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Reduced Ejection Fraction.

AHRQ Launches the Registry of Patient Registries (RoPR)

The Registry of Patient Registries (RoPR) is a repository of information about patient registries recently launched by AHRQ. The RoPR is a data collection tool that contains information about patients' medical conditions and/or treatments and is intended to promote collaboration, reduce redundancy, and improve transparency among registry holders. To learn more about the RoPR, click here.

Top of Page

Current as of February 2013
Internet Citation: EHC Program Inside Track Newsletter: Issue 11, February 2013. February 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/insidetrack/11/index.html