Research Activities, June 2013
Cannon, C.P., Brindis, R.G., Chaitman, B.R., and others. (2013, March 5). "2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease." Circulation 127(9), pp. 1052-1089. Reprints (AHRQ Publication No. 13-R045) are available from AHRQ.
The authors, on behalf of the American College of Cardiology Foundation and the American Heart Association, have undertaken to define and disseminate clinical data standards—sets of standardized data elements and corresponding definitions. The specific goals of clinical data standards are: (1) to establish a consistent, interoperable, and universal clinical vocabulary, (2) to promote the ubiquitous use of electronic health records and facilitate the exchange of data across systems, and (3) to facilitate the further development of clinical registries and quality- and performance-improvement programs.
Eckrich, M.J., Wang, W.C., Yang, E., and others. (2013). "Adherence to transcranial Doppler screening guidelines among children with sickle cell disease." (AHRQ grant HS10384). Pediatric Blood Cancer 60, pp. 270-274.
The goal of this study was to assess adherence to transcranial Doppler (TCD) screening guidelines in a group of at-risk children the year before and the years following the original National Heart, Lung, and Blood Institute’s recommendations. It found that the yearly cumulative incidence of annual TCDs rose from 2.5 percent in 1997 to 68.3 percent in 2008.
El-Kassar, N., Flomerfelt, F.A., Choudhury, B., and others. (2013). "High levels of IL-7 cause dysregulation of thymocyte development." International Immunology 24(10), pp. 661-671. Reprints (AHRQ Publication No. 13-R046) are available from AHRQ.
Given the importance of IL-7 on thymopoeisis (process in the thymus by which thymocytes differentiate into mature T lymphocytes) and the recent clinical use of super-physiological levels to enhance T-cell reconstitution following bone marrow transplant, the researchers sought to determine the effect of chronic high-level IL-7 exposure on thymus function. They provide the first demonstration that high levels of IL-7 antagonize Notch-1 signaling, and suggest that IL-7 may affect T- versus B-lineage choice in the thymus.
Fisher, C.E., Spaeth-Rublee, B., and Pincus, H.A. (2013). "Developing mental health-care quality indicators: Toward a common framework." (AHRQ grant HS16097). International Journal for Quality in Health Care 25(1), pp. 75-80.
This paper describes an initial component of a project to develop a set of mental health quality indicators that would be a reasonably comprehensive and compatible scheme for international comparisons. By collecting and organizing measures through an inductive compilation of existing programs, the study has generated a maximally inclusive basis for the creation of a common framework of international mental health quality indicators.
Keenan, G.M., Yakel, E., Yao, Y., and others. (2012, October). "Maintaining a consistent big picture: Meaningful use of a Web-based POC EHR system." (AHRQ grant HS16097). International Journal of Nursing Knowledge 23(3), pp. 119-133.
The focus of this study is on the feasibility and utility in real practice conditions of implementing a technology-supported standardized method, Hands-on Automated Nursing Data System (HANDS), and collecting and presenting plan-of-care information as a succinct summary of care goals, interventions, and outcomes. It is designed to keep clinicians caring for a patient on the same page.
Linder, J. (2013, February). "Antibiotic prescribing for acute respiratory infections—success that’s way off the mark." (AHRQ grant HS18419). JAMA Internal Medicine 173(4), pp. 273-275.
The author discusses the need for reducing current levels of antibiotic prescribing for acute respiratory infections (over 70 percent) and various efforts to achieve a reduction in such prescribing. He recommends several steps to effectively reduce current overprescribing, such as using continuous quality improvement techniques instead of controlled trials, and being clearer with patients about the individual benefits and risks associated with antibiotic prescribing.
Strasberg, H.R., Del Fiol, G., and Cimino, J.J. (2013). "Terminology challenges implementing the HL7 context-aware knowledge retrieval (‘Infobutton’) standard." (AHRQ grant HS18352). Journal of the American Medical Informatics Association 20, pp. 218-223.
Infobuttons are context-sensitive links from electronic health records to knowledge resources, sometimes involving an intermediate broker known as an InfoButton Manager. This paper describes some of the challenges faced by knowledge resources in trying to locate the most relevant content based on the attribute values for a given Infobutton request.
Taylor, E.F., Machta, R.M., Meyers, D.S., and others. (2013, January/February). "Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers." Annals of Family Medicine 11(1), pp. 80-83. Reprints (AHRQ Publication No. 13-R040) are available from AHRQ.
The authors explain the function of two new types of staff (practice facilitators and care managers), who will help primary care practices successfully undergo redesign to improve the patient experience, achieve better health, and reduce costs. In addition to comparing and contrasting the functions of these new positions, the authors discuss how each might be funded (for example, through government programs or as paid employees of the practice).
Wachter, R.M., Pronovost, P.J., and Shekelle, P.G. (2013, March). "Strategies to improve patient safety: The evidence base matures." (AHRQ Contract No. 290-07-10062). Annals of Internal Medicine 158(5) Part 1, pp. 350-353.
This editorial introduces evidence reviews underpinning 10 patient safety strategies that are published in this supplement. The supplement also includes an overview article that describes the entire reexamination process and identifies 10 strongly encouraged and 12 encouraged patient safety strategies that are ready for adoption now.