Research Activities, January 2014
News and Notes
Report shows that health information technology can improve care for those with complex health care needs
Providing patients and clinicians with information and support using health information technology (IT) is effective in improving care outcomes and quality, according to a new AHRQ report. The "Findings and Lessons From the Improving Management of Individuals with Complex Health Care Needs Through Health IT Grant Initiative" documents the findings of more than 10 research projects that investigated how health IT applications can support shared-decisionmaking and communication during care transitions, as well as facilitate secure exchange of information across multiple settings of care. Several studies showed positive impacts on process, intermediate, health, and economic outcomes.
You can access the report at http://healthit.ahrq.gov/asqmcpreport.
AHRQ research explores impact of self-management support
AHRQ has awarded a 2-year, $500,000 grant to the Oregon Rural Practice-Based Research Network to implement self-management support tools with patients and health care practices. Self-management support assists patients and providers by promoting and delivering education to increase patients' skills to cope with the burden of chronic illness. The study will assess the impact of self-management support tools on patients and their health care teams, and aims to identify factors associated with successful implementation of self-management programs in primary care.
New atlas fills need for measuring integrated behavioral health care
As greater numbers of primary care organizations implement integrated behavioral health services, there is a growing need to measure the extent to which integrated behavioral health care is being provided. The 2013 Atlas of Integrated Behavioral Health Care Quality Measures helps primary care organizations and researchers identify and assess quality measures for integrating behavioral health care. It was developed by AHRQ's Academy for Integrating Behavioral Health and Primary Care and features nine core measures that describe specific characteristics, actions, and selected outcomes of integrated care. All measures were chosen based on criteria established by a panel of experts. New measures will be added as they become available.
New AHRQ tools help assess and improve medication safety in community pharmacies and outpatient settings
Three new online resources funded by AHRQ and developed by the Institute for Safe Medication Practices can help community pharmacies and outpatient settings improve medication safety and protect patients from the adverse effects of medication errors:
- High-Alert Medications Consumer Leaflets—Patient-education checklists developed during a study of the impact of community pharmacies that counseled consumers who picked up prescriptions for certain high-alert medications, including warfarin, fentanyl patches, and more.
- Assessing Barcode Verification System Readiness in Community Pharmacies—A free tool that helps community pharmacies assess their readiness and prepare for future implementation of a barcode product verification system.
- High-Alert Medication Modeling and Error-Reduction Scorecards (HAMMERS™)—A free tool designed to help community pharmacies identify their unique set of system and behavioral risks associated with dispensing certain high-alert medications. Pharmacies use a series of scorecards to estimate how often prescribing and dispensing errors reach patients and assess how the frequency will change if certain interventions are implemented.
You can access these tools at (http://www.ismp.org/AHRQ).
AHRQ review evaluates treatment scenarios in patients with unstable angina/non-ST elevation myocardial infarction
A new AHRQ research review evaluates the effectiveness and safety of antiplatelet and anticoagulant medications used in three treatment scenarios for patients with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI). The treatment scenarios include an early invasive approach, an initial conservative approach, and treatment after hospitalization (postdischarge). Treatment of patients with UA/NSTEMI with an early invasive or percutaneous coronary intervention (PCI)-based strategy, precatheterization treatment with glycoprotein IIb/IIIa inhibitors (GPIs), does not improve ischemic endpoints, but is associated with lower rates of revascularization. However, there is a higher risk of major bleeding at 30 days with this strategy than occurs with both pretreatment and deferred clopidogrel administration.
The review also finds that in patients undergoing an initial conservative approach, the anticoagulant enoxaparin reduces ischemic events, with no difference in the rate of major bleeding, compared with unfractionated heparin at around 30 days. The addition of GPIs to unfractionated heparin reduced the rate of mortality up to 30 days, but minor bleeding rates were increased. Finally, in UA/NSTEMI patients receiving postdischarge treatment, dual antiplatelet therapy reduces the rates of composite ischemic outcomes and nonfatal myocardial infarction compared with single antiplatelet therapy. Uncertainty remains about the optimal dosing, timing, duration, and treatment combinations, especially in subpopulations of interest (e.g., the elderly, diabetics, women, obese patients, and people with coexisting conditions). Inconsistencies in the small number of studies that were eligible for inclusion in this review limit the applicability of findings. Further research is needed to determine the effectiveness and safety of newer agents in combination with other antiplatelet and anticoagulant treatment strategies.
These findings and others can be found in the research review Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non-ST Elevation Myocardial Infarction, which is available at http://go.usa.gov/Zjkh.
Multicomponent dissemination strategies better at encouraging use of health-related evidence
A new research review from AHRQ's Effective Health Care Program finds that multicomponent dissemination strategies that address a combination of reach, ability, or motivation, appear to be more effective than one strategy alone in affecting change in clinicians' behaviors, particularly clinician guideline adherence. However, there is insufficient evidence to determine the comparative effectiveness of various dissemination strategies.
The report does recommend that clear communication and active dissemination of evidence to all relevant audiences in easy-to-understand formats are critical to increase awareness, consideration, adoption, and use of health- related evidence. Specific factual statements (e.g., "It takes time to establish the safety...") and advice ("Ask for the drug that….") were found to help patients choose treatments with direct evidence of benefit and had the highest likelihood of net benefit. Expanding investment in comparative effectiveness research of communication, implementation, and dissemination strategies is needed to help identify strategies most likely to aid effective translation of health care evidence and provide benefit to the patient and clinician.
These findings can be found in the research review Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence at http://go.usa.gov/Zj9C.
Review examines biomarkers' value for diagnosis, prognosis, and treatment of heart failure
A new AHRQ research review finds that in both emergency and primary care settings, the biomarkers B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) have good diagnostic performance to rule out, but lesser performance to rule in, the diagnosis of heart failure because of a high sensitivity and low specificity of the test. While the diagnosis of heart failure, a condition affecting approximately 5.7 million Americans, is a difficult challenge, BNP and NT-proBNP are emerging as promising markers for HF diagnosis, prognosis, and treatment.
According to the review, in patients with decompensated or chronic stable heart failure, higher levels of BNP and NT-proBNP are associated with a greater risk of morbidity and mortality. The majority of studies assessing prognosis showed associations between BNP and NT-proBNP and mortality, morbidity, and outcomes across different time intervals in patients with decompensated and chronic stable heart failure. However, the clinical utility of using multifactor prognostic scoring needs to be designed and evaluated before this becomes an established clinical tool. The review finds an association also exists between NT-proBNP and the outcomes of morbidity and mortality in the general population. There is a low strength of evidence that BNP/NT-proBNP-guided therapy reduces all-cause mortality when compared with usual care. Because expression of these biomarkers is highly variable in individual patients with and without heart failure, serial measurements should be interpreted with caution. Additional studies are needed to confirm the diagnostic, prognostic, and therapeutic value of the biomarkers BNP and NT-proBNP in patients with heart failure.
These findings and others can be found in the research review Use of Natriuretic Peptide Measurement in the Management of Heart Failure available at http://go.usa.gov/ZjXJ.
AHRQ releases interactive decision aid on urinary incontinence
Health care professionals who treat women with urinary incontinence can now share with patients the third Web-based decision aid offered by AHRQ's Effective Health Care (EHC) Program. EHC Program decision aids are interactive resources that help patients understand the facts about common health conditions and think about what is important to them when talking to their health care team about treatment options.