About CERTs
Annual Report Year 1
Year 2 and Beyond
Developing Knowledge | Managing Risk | Improving Practice | Informing Policies
Developing Knowledge
We will improve knowledge by completing the demonstration projects at individual research centers and developing synergy among centers.
Children and Adolescents
We will continue our effort to understand the relation between rickets and breast-feeding, by monitoring how many breast-feeding women are getting vitamin D, tracking new cases of rickets, and repeating our survey of doctors' recommendations about vitamin use to their patients.
Another project will assess the usefulness of a large health-maintenance organization (HMO) database for studying the safety of and reasons for antibiotic use in children. This will allow us to identify targets to improve prescribing, to ensure that children receive antibiotics when needed but avoid the unnecessary prescribing that gives rise to antibiotic resistance.
Adults
Although the 87 percent rate of aspirin use in people with heart disease is encouraging, we intend to survey the remaining men and women to find out why they were not taking aspirin. Depending upon the results, we will design an intervention to increase the use of aspirin or similar drugs whenever possible.
A similar survey in the beta-blocker project is identifying the specific drugs and doses being used, if any, or the reasons for not taking these drugs. We will determine physician awareness, understanding, agreement, and adoption of the beta-blocker recommendations. We also will try to identify barriers to the use of beta-blockers in medical practice, and develop an intervention to improve the rate of use.
We will continue our work to identify drugs that prolong the QT interval and cause torsades de pointes, and to identify related risk factors for this complication.
For the dofetilide project, we will examine nationwide prescribing patterns for all antiarrhythmic drugs, including dofetilide. We hope to identify trends in use by practitioner characteristics. We also will evaluate compliance with the FDA-required risk-management program for dofetilide use.
"First weigh the considerations, then take the risks."
—Helmuth von Moltke
We will survey caregivers and administrators to assess their perceptions, understanding, and acceptance of the risk-management program. We will obtain a time-cost estimate to implement this program. We also will evaluate inpatient-prescribing patterns of all antiarrhythmic drugs at one hospital.
The last component of the dofetilide project will be a nationwide survey of physicians and nurses, to assess their understanding about the risks of using drugs, including dofetilide, that prolong the QT interval on the electrocardiogram. With all of this information, we hope to develop a nationwide continuing medical education program to improve understanding and minimize the risk with the use of these agents. A manuscript also is planned on the differences in the approval and marketing of two antiarrhythmic drugs for atrial fibrillation.
Almost 16 million people in the United States have diabetes, and the costs of treatment range up to $98 billion each year. Most people with diabetes do not require insulin injections but rather take drugs by mouth to control their disease. We will assess the usefulness of a large HMO database for studying the safety and effectiveness of oral drugs for diabetes.
An estimated 4.6 million Americans have heart failure, and this number is increasing each year. The death rate from heart failure at 5 years is 50 percent, and Medicare paid $3.6 billion in heart failure costs in 1996. We will assess the usefulness of a large HMO database for studying the safety and effectiveness of drugs to treat heart failure.