EHC Program Inside Track Newsletter

Issue 18, September 2013
EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program.

In this issue:

Research in Action: EHC Program Tools Help NYC Clinicians, Patients Review Treatment Options

Urban Health Plan (UHP), a network of New York City health centers that serves more than 54,000 patients in the Bronx and Queens, is a leader among the many organizations that have partnered with AHRQ's Effective Health Care (EHC) Program.

An AHRQ partner since May 2012, UHP uses plain-language EHC Program publications to help patients and their families explore the benefits and risks of treatment options for various health conditions. The publications are based on recent AHRQ-funded evidence reviews.

Members of the Network's staff, meanwhile, use companion EHC Program research summaries for clinicians to support the practice of evidence-based medicine. Each clinician research summary includes a "Clinical Bottom Line" on treatment options and rates the evidence behind its findings.

"UHP is committed to providing high-quality health care to our patients," said Helen J. Arteaga, director of the UHP Plaza del Sol. "These free resources help keep our health team updated on the latest evidence, and support our patient engagement and education efforts. Our bottom line is improving the health of our communities."

Most UHP patients are Spanish-speaking and low-income. The network has ordered nearly 2,500 EHC Program summaries to support their English- and Spanish-language patient education efforts, including:

In addition to its main site in the Bronx, UHP has six satellite clinics, eight school-based programs, four part-time facilities, one mobile medical unit, and two administrative/program sites that house a variety of programs including their Women, Infants, and Children (WIC) program.

UHP, active with the Health Resources and Services Administration's Health Disparities Collaboratives, has received national recognition for its performance improvement work. Its work in the South Bronx, for example, has been recognized by The Joint Commission for reducing pediatric hospitalizations related to asthma.

New Interactive Map Spotlights Use of EHC Program Tools

"AHRQ's Impact on Health Care" is a new interactive Web page that highlights the use of AHRQ products – including comparative effectiveness research tools and resources from the EHC Program – to improve care. The page features an interactive map that allows searching by State, as well as a full text keyword search. Impact Case Studies are unique because they feature the "downstream" effects of AHRQ funding, highlighting people who have successfully used the tools and resources to change practice, change policy, or improve patient outcomes. For more information about Impact Case Studies or the products featured, or to provide your own feedback about an AHRQ product, please contact

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More New, Free Effective Health Care Program Resources

New Evidence-Based Treatment Summaries for Patients and Clinicians

Treatment summaries help patients and clinicians learn about treatment options and compare their effectiveness, benefits, and risks.

Restless Leg Syndrome: Effective Treatment Strategies

Options for Treating Restless Leg Syndrome: A Review of the Research for Adults.

New materials from AHRQ's Effective Health Care Program summarize evidence comparing the effectiveness and safety of restless leg syndrome treatment strategies. The patient summary details the benefits and potential harms of available medicines and non-medicine treatment strategies, as well as key questions that patients and clinicians should consider when choosing treatment options. Resources include—

Case Management: Strategies for Chronic Illness Management

New materials from AHRQ's Effective Health Care Program evaluate the evidence on outpatient case management (CM) as an intervention strategy for chronic illness management.

New materials from AHRQ's Effective Health Care Program evaluate the evidence on outpatient case management (CM) as an intervention strategy for chronic illness management. The patient summary discusses the benefits and potential difficulties of interventions and key questions patients and clinicians should consider. The clinician summary provides an overview of the available evidence on this disease management approach. Resources include—

New Research Reviews Comparing Treatment Options

Each of these reviews compares available evidence from numerous research studies.

Bariatric Surgery for Treating Diabetes

Bariatric Surgery is an accepted procedure usually performed on morbidly obese patients to lose weight and to treat and prevent weight-related comorbidities like diabetes. According to new AHRQ research published in The Journal of the American Medical Association (JAMA) on June 5, 2013, bariatric surgery may be effective in the short term for treating diabetes in patients with body mass index of at least 30 but less than 35 kg/m2. At one year, surgery patients also show much greater weight loss than usually seen in studies of diet, exercise, or other behavioral interventions. Read the full research review here: Comparative Effectiveness of Bariatric Surgery and Nonsurgical Therapy in Adults with Metabolic Conditions and a Body Mass Index of 30.0 to 34.9 kg/m2.

New Review Compares Treatment Approaches for Tinnitus

According to the latest research review from AHRQ, among treatments for tinnitus (ringing in the ears) – including pharmacological/food supplements, medical/surgical treatments, sound treatments/technologies, and psychological/behavioral treatments – there is low strength of evidence indicating that cognitive behavioral therapy interventions improve tinnitus-specific quality of life compared with inactive controls. The one pharmacological intervention with consistently significant effects on multiple outcomes in a clinical trial – including reducing loudness, improving global quality of life, and alleviating severity – is sertraline. However, for pharmacological interventions overall, the strength of evidence is low that neurotransmitter drugs improve subjective loudness compared with placebo in patients with tinnitus, and the strength of evidence is insufficient for all other pharmacological interventions and outcomes. In addition, there is not enough evidence to suggest that medical or sound technology interventions improve outcomes relative to inactive controls. Future research investigating the effectiveness of treatments for tinnitus should focus on improving collection of adverse effects, calculating sample size, and specifying doses for interventions. Additional research also is needed to investigate measures used to assess patients for management needs and the identification of prognostic factors. These findings are available in the research review Evaluation and Treatment of Tinnitus: A Comparative Effectiveness Review.

Undescended Testicles (Cryptorchidism): New Review Assesses Current Evaluation and Treatment Methods

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 did not find that any non-invasive technique could consistently determine the absence of testicles or the location of undescended testicles. Future studies should seek to identify if there is benefit from hormonal treatment and for whom. Read the full research review here: Evaluation and Treatment of Cryptorchidism.

Research Available on Hepatitis C Screening Effects in Adults

Hepatitis C Virus (HCV) is becoming a greater concern for many populations in the U.S. According to the latest research, 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. The review also noted that evidence remains limited on the effects of knowing one's HCV status on clinical health outcomes in patients diagnosed with HCV. Read the full research review here: Screening for Hepatitis C Virus Infection in Adults.

Heart Conditions: Stroke Prevention Approaches for Patients with Atrial Fibrillation

According to the latest research review by AHRQ, in patients with atrial fibrillation, CHADS2 and CHA2DS2-VASc scores have the greatest discrimination for predicting stroke events among the risk scores reviewed, whereas HAS-BLED provides the best discrimination of bleeding risk. However, additional information is needed to determine how scores should be utilized in clinical practice. The review finds that initial trials of newer oral anticoagulants, including apixaban and higher-dose dabigatran, show a high strength of evidence for reducing stroke and bleeding events compared with warfarin in patients with atrial fibrillation, though no studies directly compare the new therapies. In addition, the review finds that for patients not suitable for oral anticoagulation therapies, apixaban is more effective and has a better safety and tolerability profile than aspirin in stroke prevention. However, additional studies are required for common clinical scenarios encountered with patients on therapies for stroke prevention, including strategies for patients undergoing invasive procedures, switching among anticoagulant therapies, and starting or restarting anticoagulant therapy in patients with previous major bleeding events. These findings and others can be found in the full review, Stroke Prevention in Atrial Fibrillation.

Serious Mental Illness: Interventions for Incarcerated Adults

Treatment with antipsychotics other than clozapine appears to improve psychiatric symptoms more than clozapine in offenders with serious mental illness who are incarcerated, according to a new AHRQ research review. For all other incarceration-based interventions, including pharmacologic therapies, cognitive therapy, and modified therapeutic community, evidence was insufficient to draw any conclusions. Two interventions, discharge planning with Medicaid-application assistance and integrated dual disorder treatment programs, appear to be effective interventions compared with standard of care for seriously mentally ill offenders transitioning back to the community. More research is needed to increase the confidence in current low strength findings and to address interventions and populations where evidence is lacking. These findings can be found in the research review, Interventions for Adults with Serious Mental Illness Who Are Involved with the Criminal Justice System.

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Page last reviewed September 2013
Internet Citation: EHC Program Inside Track Newsletter. Content last reviewed September 2013. Agency for Healthcare Research and Quality, Rockville, MD.