Routine Hysterectomies Uncover Unexpected Cancer

AHRQ Stats: Diagnosis of Diabetes Among Adults by Race/Ethnicity

In 2015-16, 13 percent of blacks were diagnosed with diabetes, compared with 10 percent of Hispanics and 9 percent each of whites and Asians. (Source: AHRQ, Medical Expenditure Panel Survey Statistical Brief #518: Treatment and Monitoring of Adults with Diagnosed Diabetes by Race/Ethnicity, 2015-2016.) 

Today's Headlines:

• Routine Hysterectomies Uncover Unexpected Cancer.
• AHRQ Views Blog: With New Challenge Competition, AHRQ Asks Innovators for a Tool To Forecast the Future.
• Report Summarizes Effectiveness of Drugs To Treat Osteoporosis.
• Highlights From AHRQ’s Patient Safety Network.
• Emergency Department Patient Datasets Available for Medical Informatics Research.
• Studies on the Nation's Health Systems.
• Featured Impact Case Study: AHRQ App Helps Nursing Students Provide More Comprehensive Care.
• AHRQ in the Professional Literature.

Routine Hysterectomies Uncover Unexpected Cancer

Nearly 1 in 100 women who have a hysterectomy for fibroids, menstrual disorders or other noncancerous conditions are found to have undetected uterine cancer, according to recent AHRQ-funded study published in the American Journal of Obstetrics and Gynecology. Researchers analyzed 2003 to 2013 data on about 230,000 women in New York State who had a hysterectomy with no previous cancer diagnosis. Of them, about 1,700 unexpectedly had cancer of the uterine lining and nearly 400 had cancer of the muscular wall of the uterus. Researchers used the results to develop risk prediction models based on ethnicity, age, obesity, medical conditions and personal and family histories to help assess uterine cancer risks. Assessing a patient’s risk of cancer is important for planning the surgical approach and surgical team composition, researchers concluded. Access the abstract.  

AHRQ Views Blog: With New Challenge Competition, AHRQ Asks Innovators for a Tool To Forecast the Future

Director Gopal Khanna, M.B.A., notes that his recent appearance at AcademyHealth's 2019 Health Datapalooza meeting was a chance to inform data experts about the agency's most recent challenge competition, "Bringing Predictive Analytics to Healthcare." While other industries have used predictive analytics and related methods to anticipate future challenges and opportunities, healthcare has lagged behind. AHRQ’s competition is intended to help spur innovation and develop faster solutions to the healthcare issues that affect patients. Challenge participants will use predictive analytics and related methods to estimate hospital inpatient data for selected U.S. counties in 2017. Access the blog post and more information about the challenge. To receive all blog posts, submit your email address and select “AHRQ Views Blog.”

Report Summarizes Effectiveness of Drugs To Treat Osteoporosis

A new AHRQ-supported report summarizes the effects of long-term osteoporosis drug treatments in postmenopausal women aged 50 years and older and shows two therapies—alendronate and zoledronic acid—can reduce fracture risk. The evidence review also demonstrates that long-term bisphosphonate treatment beyond three to five years may reduce risk for vertebral fractures, but increases the risk for rare adverse events, such as osteonecrosis of the jaw and atypical femoral fracture. Based on nearly 50 studies from 1995 to 2018, the review also concludes that long-term hormone therapy reduces hip fracture risks but can lead to serious harms. Access the report and the abstract to an Annals of Internal Medicine article based on the review. This report was conducted in partnership with the NIH Office of Disease Prevention for the Pathways to Prevention workshop: Appropriate Use of Drug Therapies for Osteoporotic Fracture Prevention. An independent panel also developed a companion article to summarize gaps in knowledge and recommend areas for new research. A commentary piece accompanies both reports in the April 23 issue of Annals of Internal Medicine.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Potential consequences of patient complications for surgeon well-being: a systematic review.
• Using incident reports to assess communication failures and patient outcomes.
• Community Pharmacy Survey on Patient Safety Culture: 2019 User Comparative Database Report.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web). 

Emergency Department Patient Datasets Available for Medical Informatics Research

De-identified patient data collected in a busy emergency department over a one-year period is now available to researchers seeking to study and improve patient monitoring technologies. The main PERSEUS dataset contains recorded vital signs, electrocardiograms and oxygen saturation waveform recordings, and red alarm information from 15 urgent care spaces. The ATOMICS data subsets include original, red alarm patient datastreams with annotations to support machine learning for experimental patient monitoring research. The resources, developed through an AHRQ grant awarded to researchers at Rhode Island Hospital/Alpert Medical School at Brown University, may be openly accessed and used to investigate topic areas such as more effective filtering of noise distractions or development of monitoring algorithms to predict patient deterioration. Access the datasets or email the project’s principal investigator, Leo Kobayashi, M.D., at lkobayashi@lifespan.org, for questions. 

Studies on the Nation's Health Systems

AHRQ's Comparative Health System Performance Initiative funds studies about how healthcare delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. Publications include:

• Forgotten patients: ACO attribution omits those with low service use and the dying.
• How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.
• Comparison of populations served in hospital service areas with and without Comprehensive Primary Care Plus medical homes.

Access the initiative's Compendium of U.S. Health Systems, 2016, the first publicly available database that gives researchers, policymakers and healthcare administrators a snapshot of the nation's health systems. 

Featured Impact Case Study: AHRQ App Helps Nursing Students Provide More Comprehensive Care

Some 600 students who have completed a master's-level course for family nurse practitioners at Georgetown University in Washington, D.C., use a mobile app from AHRQ to access evidence-based preventive services recommendations, according to a new AHRQ Impact Case Study. The Electronic Preventive Services Selector, or ePSS, educates students about recommendations from the U.S. Preventive Services Task Force on appropriate screening, counseling and preventive care. Access the Impact Case Study.  

AHRQ in the Professional Literature

Screening for latent tuberculosis infection in adults. Fan T, Rogers A. Am Fam Physician 2017 Nov 15;96(10):675-6. Access the abstract on PubMed®.

Health services research in rehabilitation and disability-the time is now. Graham JE, Middleton A, Roberts P, et al. Arch Phys Med Rehabil 2018 Jan;99(1):198-203. Epub 2017 Aug 4. Access the abstract on PubMed®.

Having your cake and EATing it too: early timing of multiple allergen introduction does not increase the risk of developing food allergy in standard risk, breastfed infants. Greenhawt M, Venter C. Evid Based Med 2017 Apr;22(2):60. Epub 2017 Jan 4. Access the abstract on PubMed®.

Medical home characteristics and quality of diabetes care in safety net clinics. Gunter KE, Nocon RS, Gao Y, et al. J Community Health 2017 Apr;42(2):303-11. Access the abstract on PubMed®.

Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist? Hanauer DA, Branford GL, Greenberg G, et al. J Am Med Inform Assoc 2017 Apr 1;24(e1):e157-e165. Access the abstract on PubMed®.

Informed and patient-centered decision-making in the primary care visits of African Americans with depression. Hines AL, Roter D, Ghods Dinoso BK, et al. Patient Educ Couns 2018 Feb;101(2):233-40. Epub 2017 Jul 25. Access the abstract on PubMed®.

Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Hinson JS, Martinez DA, Schmitz PSK, et al. Int J Emerg Med 2018 Jan 15;11(1):3. Access the abstract on PubMed®.

Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record. Hu Z, Melton GB, Arsoniadis EG, et al. J Biomed Inform 2017 Apr;68:112-20. Epub 2017 Mar 16. Access the abstract on PubMed®.