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Electronic Newsletter

October 9, 2007, Issue No. 240

AHRQ News and Numbers

More than 17 million Americans under age 65—almost a third of whom are middle income—could be considered continuously uninsured. This means that they have not had health insurance to help cover their medical bills for at least 4 years. Middle income Americans are defined as living in families earning between 200 percent and 400 percent of the Federal poverty thresholds, which vary according to family size and composition. In 2004, the base year for these data, poverty level income for a family of four averaged $19,307. [Source: Agency for Healthcare Research and Quality (AHRQ), MEPS Statistical Brief #183: The Long-Term Uninsured in America, 2002-2005: Estimates for the U.S. Population under Age 65 (PDF Help).]

Today's Headlines

HHS Secretary announces plan at AHRQ's 2007 annual conference to share Medicare physician performance measurement results through local value exchanges
National effort to measure and report on quality and cost-effectiveness of health care unveiled
Evidence of benefit lacking for many common ways of treating osteoarthritis of the knee
AHRQ sponsors journal supplement on advances in comparative effectiveness
New AHRQ guide helps clinicians determine necessary preventive medical tests for patients
New online statistical report: HCUP Facts and Figures
Joint Commission receives AHRQ grant to study pre-operative nursing assessments in ambulatory surgery centers
Podcast discusses e-prescribing system, ADHD grant, and electronic health records
Second radio podcast on health insurance choices
Register now for MEPS and HCUP workshops at APHA; also, visit HCUP poster
AHRQ's free notification service brings news and information to your E-mail inbox
Highlights from our most recent monthly newsletter
AHRQ in the professional literature

1. HHS Secretary Leavitt Announces Plan at AHRQ's 2007 Annual Conference to Share Medicare Physician Performance Measurement Results Through Local Value Exchanges

On September 28, Department of Health & Human Services (HHS) Secretary Mike Leavitt delivered the keynote address to approximately 1,200 attendees at AHRQ's largest-ever annual conference where he announced a plan to make Medicare performance measurement information available at the community level. As part of this initiative, AHRQ is developing a process to recognize communities—known as Value Exchanges—that support the vision of fostering health care reform at the local level by engaging providers, consumers, and other key stakeholders. Attendees of the conference also heard from AHRQ researchers, including patient safety and health information technology (IT) researchers, policymakers, and other stakeholders. On September 26, presentations featured various topics on AHRQ's health information technology and patient safety research activities, including aggregation of patient safety data, e-prescribing, strategies and tools for patient safety and quality improvement, implementation of health IT developed to improve quality of care for children, medication management safety, patient safety culture, and patient-centered health IT. On September 27-28, sessions were organized into the following topic areas, with an emphasis on implementation of research findings to change health care practice and policy: data sharing, health care reporting, and the public trust, medication management and safety, strategies and tools for quality/safety improvement, value and sustainability in health IT, improving health care decisionmaking, system design and organizational change, and HHS' value-driven health care initiative. Select for conference presentations and other materials. Select to access the HHS fact sheet for more information about the Medicare performance measurement announcement. Select to read Secretary Leavitt's remarks or to access the video.

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2. National Effort To Measure and Report on Quality and Cost-Effectiveness of Health Care Unveiled

On October 3, AHRQ Director Carolyn M. Clancy, M.D., participated in a teleconference to announce the Robert Wood Johnson Foundation's (RWJF) support for a new national effort to measure and report on quality and cost-effectiveness of health care. With this project, RWJF will support the vision of the Quality Alliance Steering Committee to advance high-quality, cost-effective, patient-centered health care by providing a framework for implementing quality and cost improvement measures nationwide. The project will combine reports of physician performance from Medicare with private-sector data to provide a broader picture of physician care at the group-practice level. The project will use quality measures endorsed by the National Quality Forum, and it will collaborate to develop and implement new measures for comparing the cost of care. Select to read the RWJF press release.

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3. Evidence of Benefit Lacking for Many Common Ways of Treating Osteoarthritis of the Knee

AHRQ released a new evidence report that concludes that evidence of benefit is lacking for many common ways of treating osteoarthritis of the knee, including popular dietary supplement ingredients, a common surgical procedure, and injected preparations. The review, led by David J. Samson, M.S., associate director of AHRQ's Blue Cross and Blue Shield Association Evidence-based Practice Center in Chicago, found that glucosamine and chondroitin, over-the-counter dietary supplement ingredients that are used widely because of their purported benefits to relieve knee pain caused by osteoarthritis and improve physical functioning, appear to be no more effective than placebos. The report, which was requested and funded by Centers for Disease Control and Prevention (CDC), failed to find convincing evidence of benefit from arthroscopic surgery to clean the knee joint with or without removal of debris and loose cartilage. Select to read the report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

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4. AHRQ Sponsors Journal Supplement on Advances in Comparative Effectiveness

A series of articles on new approaches and advances in comparative effectiveness research are compiled in a special edition of Medical Care sponsored AHRQ. The supplement, "Emerging Methods in Comparative Effectiveness and Safety," contains 23 articles authored by AHRQ-funded researchers nationwide. The new supplement was produced through the Effective Health Care program's DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network, which supports accelerated practical studies on comparative effectiveness and safety. Articles in the new supplement address practical issues confronting researchers, including methodologic challenges to studying patient safety, analyzing observational data, and how to study prescription drug use with Medicaid claims data. The new Medical Care supplement does not endorse specific research methods but represents experts' current thinking on how science can utilize growing sources of electronic health information to improve health care. Medical Care, the journal of the Medical Care Section of the American Public Health Association, features articles on the administration and delivery of health care. Articles from Medical Care's new supplement can be found on AHRQ's Effective Health Care Web site.

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5. New AHRQ Guide Helps Clinicians Determine Necessary Preventive Medical Tests for Patients

AHRQ's 2007 Guide to Clinical Preventive Services is now available to help clinicians determine which preventive medical tests are necessary for patients. Based on recommendations from the U.S. Preventive Services Task Force, the guide contains recommendations on 58 clinical preventive services made by the Task Force from 2001 to 2006. The annually updated pocket guide puts evidence-based, "gold standard" recommendations from the Task Force at the point of care, maximizing the preventive medical tests clinicians are able to provide patients. This important resource supports clinicians in keeping their patients healthy and improving the quality of the health care system. Select to access the guide. A print copy is available by sending an E-mail at ahrqpubs@ahrq.hhs.gov.

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6. New Online Statistical Report: HCUP Facts and Figures

AHRQ has just released a new statistical report entitled HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2005. Using the Nationwide Inpatient Sample (NIS) databases, this report presents information about hospital care in 2005, as well as trends in care from 1993 to 2005. The HCUP Facts and Figures report showcases the wealth of statistics available from the Healthcare Cost & Utilization Project (HCUP) NIS database. It features an overview of numerous hospital-related topics, including general characteristics of U.S. hospitals and the patients being treated; information about the most common diagnoses, conditions, and procedures associated with inpatient stays; data focusing on the costs and charges associated with hospitalizations; and a discussion of uninsured hospitalizations. Highlights of hospital care in 2005 include the fact that 6 of the 20 most costly conditions associated with hospitalizations were related to the heart and that 6 percent of all hospital discharges involved a blood transfusion. Examples of trend information presented in the report include findings that the total number of inpatient bariatric surgeries increased 15-fold from 1995 to 2004, but stabilized in 2005; the number of hospital stays for septicemia (sepsis) rose 30 percent from 1997 to 2005; and the number of C-sections grew 67 percent between 1996 and 2005. HCUP Facts and Figures can be found in the Reports section of the HCUP-US Website. A description of the NIS is available on the HCUP-US Web site.

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7. Joint Commission Receives AHRQ Grant to Study Pre-Operative Nursing Assessments in Ambulatory Surgery Centers

AHRQ awarded a 1-year $198,000 grant to the Joint Commission to study the potential risks and weaknesses of inaccurate or incomplete pre-operative nursing assessments in ambulatory surgery centers. The Joint Commission will collaborate on the project with United Surgical Partners International and Battelle, Pacific Northwest Division, by conducting failure mode and effects analyses on pre-operative nursing assessments in 10 freestanding ambulatory surgery centers accredited by The Joint Commission under its Ambulatory Health Care accreditation program. Select to read the Joint Commission's press release.

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8. Podcast Discusses E-Prescribing System, ADHD Grant, and Electronic Health Records

In last week's Healthcare 411 Newscast, Jennifer Wilson-Norton, R.Ph., M.B.A., Director of Pharmacy at the Everett Clinic in Washington State, described how the clinic's e-prescribing system was developed and adapted to the needs of the clinic. The 7½ minute podcast also includes a story about the AHRQ/FDA collaboration on the ADHD study and research by Jeffrey Linder, M.D.,M.P.H., about how electronic health records by themselves do not necessarily improve quality health care. There is a link to a longer interview about the Everett Clinic in which Beth Devine, M.B.A., Pharm.D., of the University of Washington also discusses the University's role in evaluating the system. To access any of AHRQ's podcasts, visit our Healthcare 411 series main page.

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9. Second Radio Podcast on Health Insurance Choices

A recent Healthcare 411 Radiocast features AHRQ's new guide, "Questions and Answers about Health Insurance." AHRQ Director Carolyn M. Clancy, M.D., tells consumers that even if their employers offer only one health insurance plan, they still need to know how the plan works. Select to listen to the 2-minute radio program or to read the transcript.

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10. Register Now for MEPS and HCUP Workshops at APHA; Also, Visit HCUP Poster

AHRQ will be conducting two separate workshops at the American Public Health Association (APHA) Learning Institute, in Washington, DC, on two of its data resources. On November 3, there will be a 1-day lecture workshop on the Medical Expenditure Panel Survey (MEPS). The purpose of this workshop is to facilitate the use of the MEPS Household Component public use data files by the health services research community. On November 4, there will be a half-day workshop on the Healthcare Cost and Utilization Project (HCUP), to introduce health services and policy researchers to HCUP and to resources that will enable them to apply HCUP data to their research interests. Attendees will receive a CD with information about HCUP that includes research examples using HCUP, and instructions on obtaining HCUP data and tools. Both the MEPS and HCUP workshops are approved for CME, CHES, and nursing contact hours credits. Neither workshop requires SAS experience. Both workshops require registration.

Select for registration materials and more information. (MEPS is LI #1007 and HCUP is LI #2015.) The fee for the MEPS workshop is $50, and the fee for the HCUP workshop is $240. Please contact workshopinfo@ahrq.hhs.gov if you have questions about the MEPS workshop, and hcup@ahrq.hhs.gov if you have questions about the HCUP workshop.

Additionally, on November 5 from 12:30 p.m. to 1:30 p.m., within the "Statistical Analysis: Financing Health Care Cost" poster session, AHRQ will present a poster entitled "Using Administrative Data for Disease Surveillance." This poster will showcase how HCUP resources can be used in disease surveillance efforts.

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11. AHRQ's Free Notification Service Brings News and Information to Your E-mail Inbox

AHRQ has launched a free, user-friendly service on its Web site that allows subscribers to receive automatic E-mail notices when there is new information about the Agency, its publications, data, and research results. AHRQ's customizable service offers up to 44 subscription items in 10 categories, so subscribers will receive notices only on topics in which they are interested. To find a link to the new service, look for the red envelope icon under the home page banner and select "E-mail Updates" or go to https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ.

Subscribers only need to sign up for the service once; however, if their interests or E-mail addresses change, they will be able to access and update their account information at any time.

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12. Highlights From Our Most Recent Monthly Newsletter

Among the key articles in the online issue of Research Activities are:

Studies examine the safety of prescribing antipsychotics, acetylcholinesterase inhibitors, and beta-blockers to older adults.

Antipsychotic medications are prescribed for over a fourth of U.S. Medicare patients in nursing homes for dementia, delirium, psychosis, agitation, and affective orders, and for unapproved indications. Acetylcholinesterase inhibitors and beta-blockers are commonly prescribed for patients with Alzheimer's disease. Two AHRQ-funded studies examined the safety of prescribing these medications for the elderly. Select to read this article.