Three new evidence report summaries were released recently by the Agency for Healthcare Research and Quality. They represent the results of systematic reviews of the evidence on interventions to modify dietary behavior related to cancer risk, technologies for identifying acute cardiac ischemia in the ER, and management of preterm labor. The reports were prepared by Evidence-based Practice Centers (EPCs) supported by the Agency for Healthcare Research and Quality. They provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies.
There are 12 AHRQ-supported EPCs; they systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. The goal is to inform health plans, providers, purchasers, and the health care system as a whole by providing essential information to improve health care quality.
Evidence report summaries are now available from AHRQ, both online and in print. Copies are available from the AHRQ Publications Clearinghouse. Copies of the full evidence reports will be available in the near future.
Efficacy of Interventions to Modify Dietary Behavior Related to Cancer Risk
A number of studies are being conducted to examine the role of dietary change in cancer risk reduction. The Research Triangle Institute-University of North Carolina at Chapel Hill EPC undertook a systematic review of the literature to clarify the available evidence on the efficacy and effectiveness of behavioral interventions in promoting dietary change. They compared interventions to assess effectiveness in helping individuals or population groups modify their diets to consume more fruits and vegetables and less fats. They also looked for evidence on the efficacy of dietary interventions by population subgroup, particularly those defined by ethnicity and sex. And finally, they looked for evidence of cost-effectiveness. The EPC identified considerable evidence on the efficacy and/or effectiveness of different types of interventions in helping individuals modify their dietary behavior. Few studies could be analyzed for efficacy according to population subgroup, and no studies met the EPC's review criteria on cost-effectiveness.
Copies of the report summary (AHRQ Publication No. 01-E028) are available from the AHRQ Publications Clearinghouse. Copies of the full report (AHRQ Publication No. 01-E029) will be available in spring 2001.
Evaluation of Technologies for Identifying Acute Cardiac Ischemia in Emergency Departments
The Evidence-based Practice Center at New England Medical Center (contract 290-97-0019) conducted a systematic review of recently published (1994 forward) scientific evidence on technologies for early diagnosis of acute cardiac ischemia (ACI) in the emergency department. The EPC used their review to update an earlier report on the topic prepared by a working group convened by the National Heart Attack Alert Program (NHAAP). NHAAP is made up of representatives from the National Heart, Lung, and Blood Institute and 40 professional organizations. The EPC review identified studies on a diverse array of technologies with varying degrees of diagnostic accuracy and cost-effectiveness that are available for use in general or selected populations to diagnose ACI in the ER. Findings include:
- Prehospital 12-lead ECG has moderate sensitivity and specificity for diagnosis of ACI.
- Only ACI-TIPI has been shown to reduce unnecessary hospitalizations without decreasing appropriate admissions for patients with ACI.
- The Goldman chest pain protocol has good sensitivity for acute myocardial infarction, but there is no evidence to show differences in hospitalization rate, length of stay, or estimated costs.
- Single measurement of biomarkers at ER presentation has poor sensitivity for AMI. Serial measurements can greatly increase sensitivity while maintaining specificity. Biomarkers cannot identify most patients with unstable angina.
- Diagnostic technologies such as echocardiography, sestamibi perfusion imaging, and stress ECG may have very good to excellent sensitivity in selected populations, but they have not been sufficiently studied.
Copies of the report summary (AHRQ Publication No. 00-E031) are available from the AHRQ Publications Clearinghouse. Copies of the full report (AHRQ Publication No. 01-E006) will be available from AHRQ in early 2001.
Management of Preterm Labor
The Research Triangle Institute-University of North Carolina EPC (under contract 290-97-0011) reviewed the available evidence on detection and management of preterm labor. In preparing their evidence report, the EPC addressed four main issues:
- Appropriate criteria for diagnosing preterm labor, specifically with respect to the use of three biologic markers and their positive and negative predictive value.
- Efficacy and effectiveness of tocolytics to arrest uterine contractions.
- Efficacy and effectiveness of antibiotics to treat undiagnosed infections that might trigger preterm labor.
- Efficacy of home monitoring of uterine activity.
Copies of the report summary (AHRQ Publication No. 01-E020) are available from the AHRQ Publications Clearinghouse. The full report (AHRQ Publication No. 01-E021) is expected in early 2001.
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