December 17, 2007, Issue No. 246
AHRQ News and Numbers
Charges billed by U.S. hospitals grew to $873 billion in 2005—a nearly 90 percent increase from the $462 billion in charges in 1997. The average yearly rate of increase in the national hospital bill over the last several years was 4.5 percent. At this rate, researchers estimate that the annual national hospital bill may reach $1 trillion by 2008. [Source: Agency for Healthcare Research and Quality (AHRQ), HCUP Statistical Brief #42: The National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer.]
Today's Headlines
- Many osteoporosis medications prevent fractures, but none is proven best
- AHRQ director delivers opening remarks at Institute of Medicine workshop on resident work hours and patient safety
- AHRQ releases toolkits to help providers and patients implement safer health care practices
- New AHRQ guides summarize effectiveness, safety of oral diabetes medications
- Many employers not seeking more value for their health care dollars
- Spanish-language consumer guide on osteoarthritis drugs is available
- Task Force reaffirms recommendation for high blood pressure screening for all adults
- AHRQ launches new consumer-oriented video on health care value and quality
- Podcast spotlights health care quality, HIV hospitalizations, emergency preparedness, and hospital design
- AHRQ releases evidence report on the prevention of urinary and fecal incontinence in adults
- AHRQ in the professional literature
1. Many Osteoporosis Medications Prevent Fractures, but None Is Proven Best
Many medications reduce the risk of
bone fractures in people with osteoporosis, but the most commonly used
drugs—bisphosphonates—have not been proven more effective than alternatives,
according to a new AHRQ-funded report. The AHRQ report compared the effectiveness and risks of six
bisphosphonates: alendronate (sold as Fosamax), etidronate (Didronel), ibandronate
(Boniva), pamidronate (Aredia), risedronate (Actonel) and zoledronic acid (Zometa). The report also looked at estrogen, calcitonin (a man-made hormone), calcium, vitamin D,
testosterone, parathyroid hormone and selective estrogen receptor modulators
(SERMs). The report, Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone
Density or Osteoporosis, was authored by AHRQ's Southern California Evidence-based Practice Center-RAND Corporation in Santa Monica, CA. Select to read our press release and select to access the report.
2. AHRQ Director Delivers Opening Remarks at Institute of Medicine Workshop on Resident Work Hours and Patient Safety
AHRQ Director Carolyn M. Clancy,
M.D., discussed the need for incentives to promote safe work schedules in
graduate medical education settings as a part of her opening remarks at a public
meeting of the Institute
of Medicine on December 3.
Dr. Clancy told members of the IOM Committee on Optimizing Graduate Medical
Trainee Hours and Work Schedules that AHRQ research has shown a correlation
between extended work hours and quality of care. Although the maximum
number of hours that medical residents should work was capped at 80 hours a week
in 2003 by the Accreditation Council for Graduate Medical Education, the culture
and traditions in training remain strong and, as a result, the problem continues
to exist throughout health care. Dr. Clancy also identified four primary
areas of focus for the IOM committee—developing a current evidence base on
resident work hours and schedules and their impact on safety; identifying and
developing strategies for implementing reasonable work hours; analyzing the
benefits and harms of updating work hours and schedules; and developing
recommendations for action by various stakeholders. AHRQ is sponsoring an
IOM study that is expected to produce recommendations on resident work hours in
late 2008.
Select to read Dr. Clancy's remarks; IOM committee objectives; and a list
of future IOM meetings on the
topic.
3. AHRQ Releases
Toolkits to Help Providers and Patients Implement Safer Health Care
Practices
AHRQ released
an array of toolkits designed to help doctors, nurses, hospital managers,
patients, and others reduce medical errors. The toolkits were developed through
AHRQ's Partnerships in Implementing Patient Safety (PIPS) program. The 17 toolkits, developed by
AHRQ-funded experts who specialize in patient safety research, are free,
publicly available, and can be adapted to most health care settings. The
toolkits range from checklists to help reconcile medications when patients are
discharged from the hospital to processes to enhance effective communication
among caregivers and with patients to toolkits to help patients taking
medications. In addition, the 17 PIPS
toolkits correlate with the Joint Commission's National Patient Safety Goals,
which promote system-wide improvements in patient safety. Select for more
information and a complete
listing of the 17
toolkits.
4. New AHRQ Guides
Summarize Effectiveness, Safety of Oral Diabetes
Medications
AHRQ released a pair of
plain-language guides that outline the latest scientific evidence on the
effectiveness and safety of oral medications for adults with type 2
diabetes. AHRQ's analysis is the
first to summarize evidence on the effectiveness and adverse events for all
commonly used type 2 diabetes medications. As new classes of oral diabetes medications have become available,
patients and clinicians have faced a growing list of treatment options and
choices.
The consumer-targeted
guide, called Pills
for Type 2 Diabetes: A Guide for Adults, includes information on types of diabetes
pills commonly available for adults, how well they work, possible side effects,
and medication costs. The
clinician's guide, called Comparing
Oral Medications for Adults With Type 2 Diabetes, includes more detail on
those topics and "confidence ratings" for evidence to support research
conclusions.
Print copies of the
guides are available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.
5. Many Employers Not
Seeking More Value for Their Health Care
Dollars
A new survey of more than 600 large
employers across the nation found that many have not looked at data on the
quality of the physicians in the health plans they offer their workers or have
not shared the health plan or physician data with their employees. The survey, conducted between July 2005
and March 2006, was part of an AHRQ-funded study led by Arnold M. Epstein, M.D.,
of Harvard University's School
of Health. The survey found that 65 percent of
the employers examine health plan quality data, but only 17 percent use it for
performance awards and 23 percent use it to influence employees. Moreover, only 16 percent of the
employers examine data on physician quality, 8 percent use the information to
influence their employees' choice of provider, and just 2 percent use the data
to reward physicians for their performance. "Employers' Use of Value-Based
Purchasing Strategies" was published in the November 21 issue of JAMA. Select to read the abstract in
PubMed®.
6. Spanish-Language
Consumer Guide on Osteoarthritis Drugs Is Available
AHRQ released a new Spanish-language
guide to help patients understand the latest scientific evidence on
osteoarthritis pain relievers. The
guide, Escogiendo Medicamentos para el Dolor por Osteoarthritis
(Choosing Pain Medication for Osteoarthritis), uses plain
language to summarize the evidence on both prescription and over-the-counter
drugs. It includes information on effectiveness, cost, and potential side
effects for non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors,
Tylenol, and others.
Select to
access the guide in Spanish and in English. A print copy is available by sending an
E-mail to ahrqpubs@ahrq.gov.
7. Task Force Reaffirms Recommendation for High
Blood Pressure Screening for All Adults
The U.S. Preventive Services Task
Force has reaffirmed its recommendation that all adults be screened for high blood
pressure. The recommendation appears in the December 4 issue of the Annals of Internal Medicine and
reaffirms the 2003 Task Force recommendation on screening for high blood
pressure. High blood
pressure contributes to significant adverse health outcomes, including
premature deaths, heart attacks, decreased kidney function, and stroke.
There is good evidence that measuring blood pressure can identify adults at
increased risk for heart disease due to high blood pressure. The 2007
summary of the updated literature search, as well as the 2003
recommendation and supporting materials, can be found on the AHRQ Web site.
Visit AHRQ's Electronic Preventive Services
Selector to access this recommendation and other Task
Force recommendations via the Web or download to a Palm Handheld or Windows
Mobile Devices (PocketPC).
8. AHRQ Launches New
Consumer-Oriented Video on Health Care Value and Quality
AHRQ has launched a
new consumer-oriented video on health care value. The video, Health Care Value: What
Are We Getting for What We Spend?, features AHRQ Director Carolyn M.
Clancy, M.D., and Reed Tuckson,
M.D., Executive Vice President and Chief of Medical Affairs, United Health
Group. In the program, experts discuss the barriers to quality and value in
health care today; what is being done by government, insurance companies,
employers, and patient groups to improve the quality and value of health care;
and what individual patients can do to help guarantee that they receive the
highest quality health care for the best price. Select to access the video.
9. Podcast Spotlights Health Care Quality, HIV
Hospitalizations, Emergency Preparedness, and Hospital Design
This week's AHRQ Healthcare 411
audio podcast features AHRQ Director Carolyn M. Clancy, M.D., giving consumers
tips on how to spot high-quality health care. Another story looks at HIV-related hospitalizations that are on
the decline for younger Americans. Also featured is a new tool that
prepares community call centers to assist in emergency response. Another piece discusses a new AHRQ DVD
that shows how to design hospitals for quality and safety. Select to listen to this audio podcast or
select to read the transcript.
Another Healthcare 411 audio podcast
features AHRQ Director Carolyn M. Clancy, M.D., giving consumers tips on how to
choose a hospital. A project
designed by the University of Rochester Medical Center uses telemedicine to
bring virtual health care into the classroom. MEPS data reveal the costs of an
uncomplicated pregnancy. Select to
listen to the audio podcast. Select to read the transcript.
In addition, shorter versions of these
stories and more are airing on 125 radio stations nationwide.
10. AHRQ Releases
Evidence Report on
the Prevention of Urinary and Fecal
Incontinence in Adults
AHRQ released an
evidence report that looked at the prevalence of and risk factors for urinary
and fecal incontinence in adults in long-term care settings and in the
community. The report, Prevention of Fecal and
Urinary Incontinence in Adults, indicates that individualized, conservative management programs can improve
incontinence in long-term care facility residents, and they require ongoing
effort to sustain. People at high
risk for incontinence include pregnant or menopausal women, women with vaginal
prolapse, men treated for prostate disease, patients with rectal prolapse, and
frail elderly and nursing home residents. The report suggests that routine
clinical evaluation could include an assessment of the risk factors, symptoms,
and signs of incontinence. The report was prepared by AHRQ's Minnesota
Evidence-based Practice Center and requested and
funded by the National Institutes of Health (NIH) Office of Medical
Applications of Research. Select to
access the report. A print copy is available by sending an
E-mail to ahrqpubs@ahrq.hhs.gov.
AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.
Moore C, McGinn T, Halm E. Tying up loose ends: discharging
patients with unresolved medical issues. Arch Intern
Med 2007 Jun 25; 167(12):1305-11. Select to read the abstract in PubMed®.
Cooper WO, Willy ME, Pont SJ, et
al. Increasing use of
antidepressants in pregnancy. Am J Obstet
Gynecol 2007 Jun; 196(6):544. e1-e5. Select to read the abstract in PubMed®.
Hobson WL, Knochel ML, Byington CL,
et al. Bottled, filtered, and tap
water use in Latino and non-Latino children. Arch Pediatr Adolesc
Med 2007 May; 161(5):457-61. Select to read the abstract in PubMed®.
Langfitt JT, Westerveld M, Hamberger
MJ, et al. Worsening quality of
life after epilepsy surgery. Neurology 2007 Jun 5; 68(23):1988-1994. Select to read the abstract in PubMed®.
Howard DL, Hakeem FB, Njue C, et
al. Racially disproportionate
admission rates for ambulatory care sensitive conditions in North
Carolina. Public Health
Rep 2007 May-Jun; 122(3):362-72. Select to read
the abstract in
PubMed®.
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Current as of December 2007
Internet Citation:
AHRQ Electronic Newsletter. December 17, 2007, Issue No. 246. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews246.htm