Chronic Care

Research Findings

Research Activities, October 2012:
Diabetes treatment involves more multidrug regimens and high financial burden
Survival rates for colon cancer patients on chemotherapy improve with addition of oxaliplatin
Diagnostic coding formulas underestimate hospitalizations for acute exacerbations of COPD
About three fourths of patients in the United States estimated to remain in HIV care
Electronic health records improve diabetes care and outcomes
Children with juvenile idiopathic arthritis are at high risk of hospital stays that involve bacterial infections
Noninvasive positive pressure ventilation improves COPD patient outcomes

Research Activities, September 2012:
Distance-based training in spirometry use increases the quality of asthma diagnosis
Opioid prescriptions for treating chronic abdominal pain doubled between 1997 and 2008
Response to etanercept for rheumatoid arthritis can be predicted by 12 weeks
About three-fourths of patients in the United States estimated to remain in HIV care
No link found between stimulant treatment of youth with ADHD and cardiovascular problems
Pediatric visits for ADHD have risen and the condition is increasingly being managed by psychiatrists
Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes
Despite more widespread prescribing of antiretroviral therapy for HIV infection, disparities remain
Clinician and patient resources now available on ADHD treatment options

Research Activities, August 2012:
Insulin pump and glucose monitoring improve blood-sugar control for diabetes patients
Screening based on risk factors and birth year boosts screening rates for hepatitis C
Provider-patient dialogue could be improved to foster medication adherence in HIV care
Single-lung transplantation for COPD improves access to transplantation without jeopardizing survival
Fewer patients with primary sclerosing cholangitis die while awaiting liver transplants than those with other liver diseases
No significant link found between treatments used for juvenile idiopathic arthritis and development of cancer

Research Activities, July 2012:
Experts seek better diagnosis and treatment for women's urinary incontinence and chronic pelvic pain
Urinary Incontinence—New Hope
Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs
Costly, ineffective tests used more often than more effective, but inexpensive tests to diagnose peripheral neuropathy
Depressed patients with anxiety who fail initial antidepressant therapy may benefit from adding a second drug
Key treatments for high blood pressure and high blood lipids do not reduce elderly patients' risk of limited mobility
Rise in prescription copays puts different patients at risk for nonadherence to medications
Primary care practices can boost clinical preventive services with electronic health records and quality improvement support
Web videonovela series helps Spanish-speaking patients compare treatments for diabetes
Limited evidence prevents firm conclusions on rheumatoid arthritis drug therapies
Consumer and clinician summaries now available on chronic pelvic pain treatment options

Research Activities, June 2012:
Dual Veterans Administration/Medicare users are not hospitalized more for ambulatory care sensitive conditions
Paper previsit reminders for doctors do not add value to electronic reminders from an electronic health record system
Limited evidence prevents firm conclusions on psoriatic arthritis drug therapies
Glaucoma treatments can lower eye pressure
Inmates remain at risk for HIV and HCV after release from prison

Research Activities, May 2012:
Clinical inertia may represent good clinical judgment in hypertension telemanagement
Study outlines factors associated with untreated diabetes
Teenage body size does not predict heart failure in older adults
Annual screening for malignancy among children with spina bifida with cystoplasty unlikely to be cost effective
Children with special health care needs with disabilities have greater unmet health care needs than those without disabilitiesOnly 75 percent of HIV patients stay in care

Research Activities, April 2012:
Injection of hyaluronic acid, a natural joint lubricant, appears effective in reducing pain from wear and tear on the knee
Heart failure hospitalization and mortality rates drop between 1998 and 2008
Drug-eluting stents appear safe for older patients with chronic kidney disease
Market forces underlie provision of peritoneal dialysis by dialysis facilities
Self-measured blood pressure monitoring to manage hypertension may offer a small benefit
Hospital readmissions higher for chronic conditions

Research Activities, March 2012:
Patients with hepatitis C virus infection who adhere to their drug regimen are more likely to show long-term benefit
Older patients with chronic conditions have greater risk of problems and death following bilateral knee replacement
Nine percent of adults with hypertension have resistant hypertension
Routinely collecting clinical data can improve pneumococcal vaccination of rheumatology patients on immunosuppressant drugs
Little evidence for benefit of interventions in the early stage of chronic kidney disease
Some diabetes practice guidelines do not reflect all available evidence

Research Activities, February 2012:
Tough questions get answers through health IT
Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes
Increasing body mass index lowers quality of life in obese individuals
HIV outcomes and medication use are similar between rural and urban HIV patients
Physicians need better understanding of factors that patients use to decide about colorectal cancer screening
Depending on a woman's age, hysterectomy may be the best option for resolving chronic pelvic pain and heavy bleeding
Depression, hearing impairment, and health literacy influence older adults' abilities to self-manage their care
Bronchitis and asthma most commonly treated conditions among children

Research Activities, January 2012:
Pediatric cardiology centers vary in treatment of infants with single ventricle congenital heart disease
Lower educational level increases the likelihood of preclinical changes in mobility in older women
Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization

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Research Activities, December 2011:
Many challenges remain in the design and use of consumer health informatics interventions
For-profit dialysis chains have higher mortality rates than non-profit dialysis chain
Overweight or obese patients have higher health care expenditures
Fewer than 1 in 5 emergency departments implement recommendations for HIV screening
Patients with myelodysplastic syndrome have shorter survival times if they have coexisting medical conditions
Moving adolescents with sickle cell disease from pediatric to adult care hampered by lack of knowledgeable adult hematologists
Children's use of asthma controller drugs doubles
Evidence lacking on transition-of-care programs for heart attack and stroke patients after hospital discharge

Research Activities, November 2011:
Primary care model helps treat underserved patients with hepatitis C virus infection
Brief psychotherapy helps multiple sclerosis patients with insomnia and depression -
Study finds regional differences in physicians’ recommendations of implantable cardioverter-defibrillators
Hospital readmissions for COPD highest among black patients

Research Activities, October 2011:
Minimally invasive heart treatments have reduced bypass surgeries and influenced valve repair and replacement
Full use of evidence-based therapies for heart failure could save nearly 70,000 lives each year
Cancer patients more likely to face higher cost burdens than those with other chronic conditions
Possible blood biomarkers for poorer asthma control identified
Study identifies fractures most and least likely to be caused by osteoporosis
A structured goal-setting approach can improve care outcomes for patients with type 2 diabetes

Research Activities, September 2011:
The challenge of prioritizing care for complex patients
Metformin just as effective as other medications for treating type 2 diabetes
Fewer heart bypass surgeries performed
Administrative data alone are insufficient to understand equivalence of two common blood pressure drugs
HIV/AIDS drugs have varied effects on lipid levels
Clinicians cautioned about use of antihypertensive in children receiving kidney transplants who take tacrolimus
The quality of children's asthma care is affected by emergency department crowding
Informal caregivers of older adults need more practical information to care for loved ones
Drug expenses for children with asthma more than doubled in 10 years

Research Activities, August 2011:
Patients with heart failure are older, have more illnesses, and take more medications than earlier
Drugs to treat hepatitis B may not prevent patients from liver disease later
The likelihood of bacterial blood infections among patients with HIV has risen slightly in recent years
Caregivers for advanced cystic fibrosis patients want to discuss intensive treatments and symptom relief
Studies examine possible disparities surrounding implantable cardioverter defibrillators

Research Activities, July 2011:
Studies examine safety of pain killers among older adults
A high percentage of patients with sickle cell disease self-discharge from hospital care
Chronic Care Model linked to exercise discussions during primary care office visits for diabetes
Metformin remains the medication of first choice in treating type 2 diabetes
Empowerment approach to diabetes education works better than the traditional didactic approach
Preventive care for patients with lupus could be improved
Trends in treating depression favor psychotropic medications over psychotherapy
Connecting local providers to academic medical centers using video improved hepatitis C outcomes

Research Activities, June 2011:
Patients with chronic diseases who pay coinsurance less likely to refill their medication than those with fixed copayments
Half of all annual medical expenditures are for chronic diseases
Patients with sickle cell disease employ various strategies to control their pain
Older persons with chronic kidney disease and lower systolic blood pressure have higher mortality rates

Research Activities, May 2011:
Inhaler costs contribute to medication nonadherence for Medicare patients with chronic pulmonary disease
Care for patients with HIV remains expensive
Diabetes testing plummets among poor, minority, and inner-city adults

Research Activities, April 2011:
Obese patients with hypertension and diabetes have a greater risk of dying after noncardiac surgery
Medications differ in their effect on risk of foot ulcers and limb amputations in patients with diabetes
Diet and medication adherence can reduce cardiovascular disease for patients with type 2 diabetes
Provider's communication style boosts results for acupuncture on arthritic knees
One in four U.S. adults reported having high blood pressure in 2008
Nearly 4 million adults reported being treated for kidney disease between 2003 and 2007
Spending for prescriptions to control diabetes, cholesterol, and other metabolic conditions exceeds $52 billion
Patients' income and where they live influence hospitalization for chronic lung disease

Research Activities, March 2011:
Asthma project helps resident physicians improve care for minority patients
AHRQ report finds unclear value of pretesting autoimmune disorder patients before prescribing thiopurine drugs

Research Activities, February 2011:
Telephone coaching improves quality of life for parents of children with asthma
Nurse-facilitated guided care for elders and their caregivers leads to improved perceptions of quality of care
The number of U.S. adults treated for diabetes more than doubled between 1996 and 2007

Research Activities, January 2011:
Patients taking only salmeterol seen in the emergency department for asthma more likely to be hospitalized
Most patients with type 2 diabetes suffer an adverse event between office visits
Some personality factors may affect success of chronic illness self-management programs
Medical complications add 30 percent to employers' chronic care costs

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Research Activities, December 2010:
Access to care for patients with lupus affected by several local factors
Brand-name drugs not better than generics for controlling epilepsy
Fragmentation of care for complex diabetes patients may be associated with greater use of the emergency department
For hypertensive patients with diabetes, blood pressure drops quicker with more frequent interactions with clinicians
Despite their helpfulness to guiding care, home blood pressure readings are rarely documented in routine clinical care
Uncontrolled asthma events among Massachusetts patients declined between 2002 and 2007
Patients with inherited cancer syndrome need help with decisions and long-term support from their surgeons
Telephone counseling helps Korean Americans who speak little English improve hypertension management

Research Activities, November 2010:
Stroke recurrence rates vary by U.S. region
A simple test can help assess how accurately patients report colorectal cancer screening
Human growth hormone shows promise in treating cystic fibrosis symptoms
Potentially avoidable hospitalizations high among Medicare and Medicaid patients

Research Activities, October 2010:
Most spending on children's health care in Medicaid and CHIP goes for children with chronic health problems

Research Activities, September 2010:
Public insurance linked to longer perception of disease burden among children with asthma
Physicians report care barriers for young adults with childhood onset chronic diseases
Certain patients with lupus are more likely to end up in the emergency department three or more times a year
Impact of anti-arthritis drug on lipid levels in patients with rheumatoid arthritis remains unclear
Hydroxychloroquine still underused by patients with lupus, but use more likely if treated by rheumatologists
Being overweight does not have a negative impact on quality of life after a kidney transplant
Evidence-based care processes are associated with improved outcomes for heart failure
Predicting cardiovascular risk in patients with metabolic syndrome depends on definition used for the syndrome
Study shows Guided Care benefits family caregivers, chronically ill older adults, and physicians, and may reduce costs

Research Activities, August 2010:
Rate of extrapulmonary TB highest among blacks
More stress means worse asthma in inner-city adults
Care setting affects likelihood that children with persistent asthma will receive inhaled steroids
Health literacy level has no impact on frequency of blood-glucose monitoring for inner-city patients with diabetes

Research Activities, July 2010:
Community health center collaboratives improve care quality but have little impact on disparities
Disparities widen in the use of asthma medications

Research Activities, June 2010:
Physician-pharmacist teams can help lower blood pressure
Patient tool helps determine adherence to asthma medication
Personality factors play a role in responsiveness to disease self-management programs
Doctors underprescribe warfarin to prevent strokes in patients with atrial fibrillation and heart failure
Study reveals high rates of rehospitalizations and emergency pain treatment for sickle cell disease
More adults with diabetes are getting flu shots

Research Activities, May 2010:
Atypical antipsychotic medications increase fracture risk in patients with Parkinson's disease
Opioid-naïve nursing home residents are commonly prescribed long-acting opioids, a potentially dangerous practice
Team-based care of patients with hypertension improves control of blood pressure

Research Activities, April 2010:
Making nursing home quality reports public leads to improved posthospitalization care
Providing customized clinical information to patients and physicians does not improve diabetes care
Counseling education does not significantly boost residents' dietary counseling of patients with diabetes
A guided care approach helps curb health care costs of elderly patients with chronic conditions
Caregiver dissatisfaction affects outpatient care for the elderly with dementia

Research Activities, March 2010:
Wellness education and physical therapy improve health and functioning of persons with multiple sclerosis
Primary care organizational characteristics are linked to the self-management behaviors of patients with diabetes
Inner-city minority adults with chronic asthma are more likely to take inhaled medicine if they believe in its benefits

Research Activities, February 2010:
Health care costs of obesity are passed off to obese workers
Many patients with coronary artery disease who could benefit from cardiac rehabilitation are not referred for this treatment
Computerized tomography angiography may help determine appropriate treatment for stroke patients
Primary care doctors often don't know that a child sought care for asthma in the emergency department

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Research Activities, December 2009:
Lifestyle changes are needed in addition to drugs to prevent heart attacks
Best time to start statins in patients with diabetes depends on the cardiovascular risk model used
Care is poor for diabetic patients without insurance and no regular care provider
New guidelines issued for nephrotic syndrome in children
Electronic patient-provider messaging is linked to good diabetes control
Smoking is particularly hazardous for individuals with HIV infection

Research Activities, November 2009:
Chronic disease self-management program improves illness management for up to 6 months, then effectiveness wanes
Medicare coverage gap may prompt some patients with diabetes to cut back on their medicines
Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

Research Activities, October 2009:
Cost and depression serve as barriers to performing self-care behaviors for people with diabetes
Self-management support results in better diabetes outcomes
Exercise is not being used enough to treat low back and neck pain
Without medical evidence, clinicians' judgment about chronic pain is often influenced by patient and situational factors
Risk factors for harboring multiple strains of E. coli are elusive

Research Activities, September 2009:
Dysfunctional uterine bleeding carries large financial and quality-of-life costs
Persons with lupus have trouble getting and staying employed
Patient hopelessness is linked to poor participation in cardiac rehabilitation exercise
Electronic health records help identify patients with hypertension and cardiac problems
Genetic factors are linked to symptoms in patients with chronic obstructive pulmonary disease
Study examines outpatient use of medication and lifestyle counseling to manage osteoporosis

Research Activities, August 2009:
Study finds high medication error rates among adults and children receiving outpatient cancer treatment
The complications and costs of obesity surgery are declining
A greater number of different chronic conditions increases hospital readmissions and costs
Coronary artery bypass surgery may be better than angioplasty for older patients and those with diabetes
Medicare's end-stage renal disease program seems to have reduced outcome disparities among dialysis patients

Research Activities, July 2009:
Underresourced clinics with more challenging patients may underlie poor chronic disease outcomes of minorities
Fewer than half of patients with diabetes are referred for lifestyle counseling, nutrition, and exercise
Patients with diabetes and depression are less likely to achieve goals for glucose control
Low omega-3 fatty acid levels found in patients with acute coronary syndrome and depression
Obesity boosts risk of diverticulitis and diverticular bleeding
Personality factors influence how patients with chronic disease view their health and functioning
The prevalence of chronic, impairing low back pain has risen significantly in North Carolina
Using a chronic care model improves smoking cessation programs in primary care clinics
Nearly two in three publicly insured adults under age 65 suffer from one or more chronic conditions

Research Activities, June 2009:
Home care problems can put patients with diabetes at risk for visits to the emergency room or hospitalization
Failure to intensify drug therapies may lead to suboptimal control of diabetes despite adequate monitoring
Perceptions about fruit and vegetable intake are influenced by individual and community factors
Primary care recognition and treatment of chronic kidney disease can be markedly improved with a few approaches
Clinician interviews are the best method to determine whether patients with kidney failure are also depressed
Caregivers of individuals with Alzheimer's dementia are more likely to visit emergency departments or be hospitalized when depressed
Lupus increases direct health care costs and loss of work productivity
Pharmacists' efforts to contact patients or physicians do not improve refills for chronic disease medications
Weekly telephone calls help patients with limited English proficiency and literacy self-manage diabetes
Adult drug for sickle cell anemia may be safe for children
Quality of asthma care varies significantly in emergency departments

Research Activities, May 2009:
Telephone nurse support can be cost-effective to help improve functioning and quality of life for patients with diabetes
Use of a chronic care model framework in primary care practices can influence patient health status
Lack of self-efficacy keeps inner-city primary care providers from following national asthma management guidelines

Research Activities, April 2009:
Young women with diabetes do not receive recommended preventive services
Older patients stop using inhalers and end up in the hospital when insurers enact deductibles and copayments
The chronic care model improves care delivery and patient outcomes, but practices need better tools to implement it
Newest diabetes medications are more costly and widely prescribed than older diabetes drugs
Older patients with multiple chronic conditions desire personalized care plans from their providers
Higher education and income levels are associated with increased willingness to pay for a psoriasis cure

Research Activities, March 2009:
Nuts, corn, and popcorn are fine for patients with diverticular disease
Indigent patients with diabetes who get free medications have lower blood-sugar levels

Research Activities, February 2009:
Leadership support and fair work distribution keep morale high during quality improvement initiatives
Social support did not yield better health results in study of patients with diabetes
Telephone coaching following hospitalization for acute coronary syndrome adds little to in-hospital counseling

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