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Electronic Newsletter

January 27, 2012

AHRQ News and Numbers

Hospital stays involving Clostridium difficile infections, which can cause severe diarrhea, colitis and even death, increased 300 percent between 1993 and 2008, but the number of hospital stays leveled off between 2008 and 2009. There were 86,000 hospital stays involving C. difficile in 1993, increasing to 349,000 in 2008, but in 2009 there were about 337,000 stays. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #124: Clostridium difficile Infections (CDI) in Hospital Stays, 2009]

Today's Headlines

Wheeled mobility service delivery review highlights need for research.
Some diabetes practice guidelines do not reflect all available evidence.
News on early treatments for type 2 diabetes.
AHRQ's Health Care Innovations Exchange focuses on culturally tailored programs.
Podcast highlights AHRQ-funded study on e-prescribing's benefits and barriers.
Highlights from most recent Monthly Newsletter.
AHRQ in the professional literature.

1. Wheeled Mobility Service Delivery Review Highlights Need for Research

Insufficient research on the delivery of wheeled mobility, or wheelchair, services may ultimately lead to an absence of high-quality products for consumers, according to a new report, Wheeled Mobility (Wheelchair) Service Delivery. The report provides an overview of the literature and expert opinions on delivery of wheeled mobility service to long-term wheelchair users with complex rehabilitation needs and focuses on the elements that affect the quality of a match between patients and their devices. It describes the process of the service delivery that affects how well a wheeled device meets patients' needs and highlights the need for additional research in the field. Select to access the report.

2. Some Diabetes Practice Guidelines Do Not Reflect All Available Evidence

Not all clinical practice guidelines on the use of oral medications for type 2 diabetes are consistent with a systematic review of the available scientific evidence funded by AHRQ, according to a new analysis published on January 3 in the Annals of Internal Medicine. None of the guidelines, however, included recommendations that contradicted available evidence. The evaluation, conducted by researchers at Johns Hopkins University, found that some diabetes treatment guidelines did not fully reflect evidence identified in a 2007 systematic review on diabetes treatments developed by AHRQ's Effective Health Care Program. The analysis, An Evaluation of Guideline Recommendations Related to Oral Medication Treatment for Type 2 Diabetes Mellitus, examined 11 diabetes guidelines that met the study criteria and assessed whether the guidelines agreed with seven evidence-based conclusions from the 2007 systematic review. Seven guidelines agreed with the conclusion that "metformin is favored as the first line agent," and 10 agreed that "thiazolidinediones are associated with higher rates of edema and congestive heart failure." The analysis also found variability in guideline quality. Most guideline development processes did not include a systematic method for determining which evidence to incorporate. Select for additional information about type 2 diabetes oral medications, including a 2011 update of AHRQ's 2007 report. Select to access the abstract on PubMed.®

3. News on Early Treatments for Type 2 Diabetes

A new original research report from AHRQ's Effective Health Care Program published in Kidney International shows that compared with diabetes patients using the metformin class of drugs, patients using the sulfonylurea class have an increased risk of experiencing a decline in kidney function, end-stage renal disease, or death. Patients who were started on sulfonylureas had a 20 percent increased risk of a persistent decline in kidney function rate of 25 percent or more, or a diagnosis of end-stage kidney disease compared to those started on metformin. Because of these new findings, the current recommendation to limit the use of metformin alone in patients with mild to moderate kidney disease should be re-examined to avoid or delay changes in medical therapy. Select to access the abstract for "Comparative Effectiveness of Incident Oral Antidiabetic Drugs on Kidney Function" on PubMed.®

4. AHRQ's Health Care Innovations Exchange Focuses on Culturally Tailored Programs

The January 18 issue of AHRQ's Health Care Innovations Exchange profiles of three programs that deliver culturally tailored services to promote behavior change and improve health status among targeted populations. One program is the Fond du Lac Smoking Cessation Program in Minnesota. The program offers flexible, culturally tailored support to members of the Reservation of the Fond du Lac Band of Lake Superior Chippewa who want to quit smoking. Specially trained counselors meet with members one on one or in groups. The curriculum incorporates cultural and historic characteristics from the tribe, distinguishing between abusing commercial tobacco and using it appropriately in ceremonies and offerings of prayer. The program has significantly reduced tobacco use and generated high levels of engagement and satisfaction among participants. Select to read more about culturally tailored innovations on the AHRQ Health Care Innovations Exchange Web site.

5. Podcast Highlights AHRQ-funded Study on E-prescribing's Benefits and Barriers

A new AHRQ Healthcare 411 podcast highlights findings of a recent AHRQ-funded study on e-prescribing. The study found electronic prescribing is safe and efficient, but barriers to its use remain. In the segment, AHRQ Health IT expert Teresa Zayas-Caban, Ph.D., describes highlights that include the perception among physician practices and pharmacies that e-prescribing can improve patient safety and save time, offset by barriers to realizing the technology's full benefit. Select to listen to the podcast.

6. Highlights from Most Recent Monthly Newsletter

The January issue of Research Activities is available online. Key articles include:

Medical residents can use quality improvement methods to promote obesity screening. Although traditionally excluded from quality improvement (QI) initiatives, more medical residents are being trained in the use of QI methods to analyze their practice. A new study found that a medical resident QI initiative to improve obesity screening in a primary care clinic not only increased the documentation of body mass index (BMI) in the patients' charts, but also promoted lifestyle counseling efforts. After undergoing QI training, second-year residents created ways to streamline the way BMI documentation was collected. They also developed a variety of educational materials to be used as part of the screening initiative. Select to read this article.