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Electronic Newsletter

November 10, 2011

AHRQ News and Numbers

The cost of treating patients for heart disease topped $47 billion for men and $44 billion for women in 2008, leading a list of the 10 most expensive conditions for all patients age 18 and older. Cancer was the second most costly disease to treat, at$34 billion for men and $38 billion for women. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #331: Top 10 Most Costly Conditions among Men and Women, 2008: Estimates for the U.S. Civilian Noninstitutionalized Adult Population, Age 18 and Older.]

Today's Headlines

AHRQ awards $34 million to expand fight against healthcare-associated infections.
AHRQ awards $4.5 million to create clinical preventive services research centers.
AHRQ releases evidence report on transition of care programs for heart attack and stroke patients.
AHRQ releases new Common Format for patient safety data collection on venous thromboembolism; seeks feedback on beta version.
New issue of AHRQ's WebM&M examines role of physical therapy for ICU patients.
Evidence is thin on non-drug strategies for treatment-resistant depression.
New technical brief assesses multidisciplinary pain programs.
New issue highlights innovations using algorithm-based treatment decision support in patient care.
HCUP releases 2009 Nationwide Emergency Department Sample (NEDS).
AHRQ in the professional literature.

1. AHRQ Awards $34 Million To Expand Fight Against Healthcare-Associated Infections

AHRQ announced that it has awarded $34 million in fiscal year 2011 for grants and contracts to hospitals, academic medical institutions, and health care research organizations to expand the fight against healthcare-associated infections (HAIs). These awards include projects to develop, test and spread the use of new modules of the Comprehensive Unit-based Safety Program (CUSP), a proven method to prevent and reduce HAIs. Since 2008, AHRQ has been promoting the nationwide adoption of CUSP to reduce central line-associated blood stream infections (CLABSIs). The new modules target three additional types of infections that are also areas of focus for the Partnership for Patients:

Catheter-associated urinary tract infections, the most common HAI, which can occur in patients with urinary catheters.
Surgical site infections, a complication of surgery that can occur at the incision site or deeper within the body.
Ventilator-associated pneumonia, which can occur in patients who require mechanically assisted breathing and, as a result, have a higher risk of developing health care-associated pneumonia. This new module will be pilot tested in two States with funding from the HHS Office of Healthcare Quality.

Other newly funded projects include research on ways of reducing infections from methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that is resistant to certain antibiotics, and from Clostridium difficile, an organism that often affects patients on prolonged antibiotic treatment; using health care facility design to reduce HAIs; and aligning work system factors to maximize and sustain successful HAI reduction efforts. A novel 36-month project will synthesize the results of AHRQ-funded HAI projects in fiscal years 2007-2010. The goals of the project are to identify and promote the application of effective HAI prevention approaches and to identify gaps in the science base that can be filled with additional research. AHRQ is also continuing to fund research on HAIs in long-term care, dialysis facilities and ambulatory care. Select for a complete list of the projects funded in fiscal year 2011 and select to read our press release.

2. AHRQ Awards $4.5 Million to Create Clinical Preventive Services Research Centers

AHRQ has awarded three-year grants totaling $4.5 million to support research in three centers that will focus on improving clinical preventive services and practices such as screening, counseling and use of preventive medications for patients. The project will be led by three universities and includes a separate award for coordination and evaluation of the research. The grants funding these centers comes from the Prevention and Public Health Fund, part of the Affordable Care Act, and is designed to expand and sustain the capacity to prevent disease, detect it early and manage conditions before they become severe. States and communities also receive funding to promote healthy living. Through this initiative, the National Prevention Strategy was established to establish priorities for knowledge and implementation of preventive health. Each center will conduct research projects during the three-year grant, including pilot and exploratory projects affecting children, the elderly, minorities, those with disabilities and those who receive health care in rural and inner city settings. The centers will be located at the following institutions:

Northwestern University, Chicago—Award: $1.4 million.
University of North Carolina at Chapel Hill—Award: $1.5 million.
University of Colorado, Anschutz Medical Campus—Award: $1.5 million.

In addition, Abt Associates, Cambridge, MA, has received an award to help coordinate and evaluate the research being conducted at the three centers. Select to read our press release.

3. AHRQ Releases Evidence Report on Transition of Care Programs for Heart Attack and Stroke Patients

Few studies support the adoption of any specific transition of care program as a matter of health policy, according to a new AHRQ report. Despite advances in the quality of acute-care management of stroke and heart attacks, gaps in knowledge persist about effective programs that improve the post-hospitalization quality of care for patients who have undergone a stroke or heart attack. Researchers at AHRQ's Duke University Evidence-based Practice Center conducted the evidence review found no interventions that consistently improved functional recovery after stroke or heart attack. None seemed to consistently improve quality of life or factors such as anxiety or depression. The researchers, led by DaiWai M. Olson, Ph.D., found that some components of care transition, such as early supported discharge from hospital with rehabilitation at home following stroke, appear to shorten the length of hospital stay without increased death rates or adverse effects on functional recovery. Additionally, specialty care followup after a heart attack was associated with reduced mortality. Researchers noted that additional research is needed before any conclusion can be reached that a specific care transition approach is effective and worthy of widespread adoption. Select to access a copy of the report, "Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention."

4. AHRQ Releases New Common Format for Patient Safety Data Collection on Venous Thromboembolism; Seeks Feedback on Beta Version

AHRQ has released a new Common Format designed to help health care providers collect information about patient safety events related to venous thromboembolism, or VTE. Common Formats refer to the common definitions and reporting formats that let health care providers collect and submit standardized information on patient safety events. The VTE Common Format, which includes deep vein thrombosis and pulmonary embolism, is currently available in a beta version for public review and comment. It will be revised based on feedback and incorporated into the next version for acute care hospitals and skilled nursing facilities. AHRQ has contracted with the National Quality Forum (NQF) to assist in the collection and analysis of feedback on the beta version. The Agency seeks feedback from the private and public sectors to guide improvement. Select to view the VTE Common Format and post comments through the NQF tool, go to the PSO Privacy Protection Web site.

5. New Issue of AHRQ's WebM&M Examines Role of Physical Therapy for ICU Patients

The October issue of AHRQ Web M&M examines the risks of immobility associated with an intensive care unit (ICU) stay and the criteria that can indicate if a patient is a good candidate for physical therapy. The Spotlight Case involves a man with a prolonged ICU visit for injuries that included a dislocated shoulder. The physical therapist consulted after the patient's release from the ICU felt that the limitations due to the shoulder injury could have been mitigated with earlier physical therapy interventions in the ICU. A commentary on the case, including criteria to inform decision-making, is provided by Jim Smith, an associate professor of physical therapy at Utica College, NY. The Perspectives on Safety section features an interview with Paul G. Shekelle, M.D., Ph.D., who directs the Southern California Evidence-based Practice Center at Rand Corporation. Dr. Shekelle led an AHRQ-funded effort to better define the role of context in patient safety. In the accompanying Perspective, Dr. John Øvretveit, Ph.D., professor of health improvement, implementation and evaluation at The Karolinska Institute, Stockholm, Sweden, discusses how social sciences can help us understand influences that affect patient safety.

6. Evidence is Thin on Non-Drug Strategies for Treatment-Resistant Depression

A new AHRQ research review has found there is insufficient evidence to evaluate whether nonpharmacologic treatments are effective for treatment-resistant depression. The review summarizes evidence of the effectiveness and efficacy of four non-pharmacologic treatments: electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and cognitive behavioral therapy or interpersonal psychotherapy. These findings and the future research needs are all summarized in the review, Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults.

7. New Technical Brief Assesses Multidisciplinary Pain Programs

A new technical brief that summarizes available research on Multidisciplinary Pain Programs (MPPs) is available from AHRQ's Effective Health Care Program. The technical brief, titled Multidisciplinary Pain Programs for Chronic Non-Cancer Pain, describes some of the key trends and challenges that will have implications for the future of MPPs in the treatment of chronic non-cancer pain. The most pressing problems facing MPPs are declining access to these types of programs and providers receiving inadequate reimbursement from third-party payers, according to the brief.

8. New Issue Highlights Innovations using Algorithm-Based Treatment Decision Support in Patient Care

The latest article featured on AHRQ's Health Care Innovations Exchange highlights the innovations at two different hospitals that are using algorithms to improve patient care. Also featured are QualityTools that present several algorithms that support decision-making in the prevention, treatment, and evaluation of various health conditions and diseases. More innovations and tools related to the use of algorithms in patient care are available on AHRQ's Health Care Innovations Exchange Web site, which contains more than 650 searchable innovations and 1,625 searchable QualityTools. The spotlight features:

Quality Tool: Medical Algorithms (Medal.org) has compiled more than 17,000 algorithms for the evaluation, treatment, and management of health care conditions and diseases.
New Funding Announcement: The Center for Medicare and Medicaid Innovation has launched the Innovation Advisors Program, which will select up to 200 individuals nationwide to test and refine new models to drive delivery system reform. The application deadline is November 15.

9. AHRQ Releases 2009 Nationwide Emergency Department Sample (NEDS)

AHRQ has released its newest Healthcare Cost and Utilization Project (HCUP) database, the 2009 Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department (ED) database in the United States. The NEDS was created to enable analyses of ED utilization patterns and support decision making among public health professionals, administrators, policymakers, and clinicians. The NEDS contains information that is important for research applications, including hospital characteristics, patient characteristics, geographic region and the nature of the ED visits. It also provides information on "treat-and-release" ED visits, as well as ED visits in which the patient was admitted to the same hospital for further care. The database includes all visits regardless of payer – including persons covered by Medicare, Medicaid, private insurance, and the uninsured. The 2009 NEDS contains data from nearly 29 million ED visits and encompasses all-encounter data from more than 950 hospital-based EDs in 29 States. It approximates a 20-percent stratified sample of EDs from community hospitals. Weights are provided to calculate national estimates pertaining to the approximately 130 million ED visits that took place in 2009. The 2009 NEDS can be purchased through the HCUP Central Distributor. Statistics from the NEDS are available on HCUPnet, the free online query system. More information about the NEDS can be found on the HCUP-US Website.

10. 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.

Tsai TT, Messenger JC, Brennan JM, et al. Safety and efficacy of drug-eluting stents in older persons with chronic kidney disease: a report from the Linked CathPCI Registry–CMS Claims Database. J Am Coll Cardiol 2011 Oct; 58:1859-69. Select to access the abstract on PubMed.®

Quest TE, Asplin BR, Cairns CB, et al. Research priorities for palliative and end-of-life care in the emergency setting. Acad Emerg Med 2011 Jun; 18(6):e70-e76. Select to access the abstract on PubMed.®

Alexander GC, O'Connor AB, Stafford RS. Enhancing prescription drug innovation and adoption. Ann Intern Med 2011 Jun 21; 154(12):833-7. Select to access the abstract on PubMed.®

Akincigil A, Olfson M, Walkup J, et al. Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. J Am Geriatr Soc 2011 Jun; 59(6):1042-51. Select to access the abstract on PubMed.®

Nunez-Smith M, Bradley EH, Herrin J, et al. Quality of care in the US territories. Arch Intern Med 2011 Sep 26; 171(17): 1528-40. Select to access the abstract on PubMed.®

Rattanaumpawan P, Tolomeo P, Bilker WB, et al. Risk factors for fluoroquinolone resistance in Enterococcus urinary tract infections in hospitalized patients. Epidemiol Infect 2011 Jun; 139(6):955-61. Select to access the abstract on PubMed.®

Nanji KC, Rothschild JM, Salzberg C, et al. Errors associated with outpatient computerized prescribing systems. J Am Med Inform Assoc 2011 Nov 1; 18(6): 767-73. Select to access the abstract on PubMed.®

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Current as of November 2011

Internet Citation:

AHRQ Electronic Newsletter, November 10, 2011, Issue 328. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews328.htm