AHRQ Annual Highlights, 2009

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The Agency for Healthcare Research and Quality (AHRQ) is committed to helping the Nation improve our health care system. To fulfill its mission, AHRQ conducts and supports a wide range of health services research. This report presents key findings from AHRQ's research portfolio during Fiscal Year 2009.

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Contents

Introduction
Portfolios of Research
Comparative Effectiveness Portfolio
Patient Safety Portfolio
Health Information Technology Portfolio
Prevention/Care Management Portfolio
Value Portfolio and Related Activities
Knowledge Transfer and Implementation Program
Conclusion

Introduction

Fiscal year 2009 (FY09) was an exciting year for the American health care system. An infusion of funding from the American Recovery and Reinvestment Act (Recovery Act) and the debate over health reform brought new attention to the opportunities and the challenges the system faces in improving the safety and quality of health care, ensuring access to care, increasing the value of health care, reducing disparities, and increasing the use of health information technology.

The Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care (EHC) Program has successfully grown into a program that is collaborative, transparent, stakeholder-driven, relevant, and timely. Our goal is to develop evidence-based information that is both rigorous and relevant to clinical decisions and is available when decisions are made. We have learned that to achieve that goal, ongoing dialogue with public and private sector stakeholders is essential.

In order to gain and maintain the trust of all stakeholders, comparative effectiveness research (CER) must be fully transparent to all. Transparency has been a hallmark of the EHC Program. The transparency begins with an open process for setting research priorities, which the secretary of the Department of Health and Human Services (HHS) sets through discussion with and extensive input from stakeholders. Within the boundaries of those priorities, the public and other interested stakeholders have the opportunity to comment on the framing of specific research questions and to critique draft reports. In addition to the open invitation to comment, manufacturers are notified when a comparative effectiveness review begins on one of their products and are invited to submit relevant studies and data. Efforts to encourage outside input ensure that all stakeholders have equal and fair access to the process.

Comparative effectiveness research aims to improve health outcomes by developing and disseminating evidence-based information to patients, providers, and health care decisionmakers about the effectiveness of treatments relative to other options. AHRQ's comparative effectiveness research considers the effectiveness of treatments in specific subpopulations and the clinical utility and validity of genetic tests. Additionally, AHRQ supports research on the way patients and physicians receive and access the latest health care information. This research, along with information about each individual patient, can be used to optimize care for the individual and can help us achieve the vision of personalized medicine.

As 1 of 12 agencies within HHS, the mission of AHRQ is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The breadth of its mission puts AHRQ squarely in the middle of all efforts to meet these challenges and take advantage of these opportunities.

The Agency fulfills this mission by developing and working with the health care system to implement information that:

• Reduces the risk of harm from health care services by using evidence-based research and technology to promote the delivery of the best possible care.
• Transforms the practice of health care to achieve wider access to effective services and reduce unnecessary health care costs.
• Improves health care outcomes by encouraging providers, consumers, and patients to use evidence-based information to make informed treatment decisions.

Ultimately, the Agency achieves its goals by translating research into improved health care practice and policy. Health care providers, patients, policymakers, payers, administrators, and others use AHRQ research findings to improve health care quality, accessibility, and outcomes of care. Disseminating AHRQ's research findings helps support a Nation of healthier, more productive individuals and results in an enhanced return on the Nation's substantial investment in health care. This report presents key accomplishments, initiatives, and research findings from AHRQ's research Portfolios during FY09.

AHRQ 2009 Annual Conference AHRQ's conference "Research to Reform: Achieving Health System Change," was held September 13-16, 2009, and covered topics on the health care infrastructure, the organization of health care services, health care quality and safety, improving Americans' health status, provider performance and payment reform, and increasing patient and consumer involvement in their care. Sessions included: The Role of Health IT in Measuring and Reducing Disparities. Reducing Hospital-Associated Infections. Shared Decision-Making: Helping Patients be Partners in Their Care. Developing Research Infrastructure to Enhance Quality and Reduce Health Care Disparities. The American Recovery and Reinvestment Act (ARRA): AHRQ's Role in Comparative Effectiveness Research. Use of Outcome Measures in Payment Reform. Children's Health Care Quality: Responding to a New National Focus. Enhancing Patient Safety and Quality with Evidence-Based Health Care Design.

The Agency's mission helps HHS achieve its strategic goals to improve the safety, quality, affordability, and accessibility of health care; promote public health, disease prevention, and emergency preparedness; contribute to the economic and social well-being of individuals, families, and communities; and advance scientific and biomedical research and development related to health and human services. The Agency has a broad research portfolio that touches on nearly every aspect of health care including:

• Clinical practice.
• Outcomes of care and effectiveness.
• Evidence-based medicine.
• Primary care and care for priority populations.
• Health care quality.
• Patient safety/medical errors.
• Organization and delivery of care and use of health care resources.
• Health care costs and financing.
• Health care system and public health preparedness.
• Health information technology.
• Knowledge transfer.

AHRQ's Customers

Clinicians use AHRQ's evidence-based tools and research to deliver high-quality health care and to work with their patients as partners. AHRQ also provides clinicians with clinical decision-support tools as well as access to guidelines, preventive care recommendations, and quality measures.

Policymakers, purchasers, health plans, and health systems use AHRQ research to make more informed decisions on health care services, insurance, costs, access, and quality. Public policymakers use the information produced by AHRQ to expand their capability to monitor and evaluate changes in the health care system and to devise policies designed to improve its performance. Purchasers use the products of AHRQ-sponsored research to obtain high-quality health care services. Health plan and delivery system administrators use the findings and tools developed through AHRQ sponsored research to make choices on how to improve the health care system's ability to provide access to and deliver high-quality, high-value care.

AHRQ research helps consumers get and use objective, evidence-based information on how to choose health plans, doctors, or hospitals. In addition, AHRQ helps consumers play an active role in their health care and reduce the likelihood that they will be subject to a medical error. Personal health guides developed by AHRQ help people keep track of their preventive care and other health services they receive.

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Portfolios of Research

Research at AHRQ is performed under Portfolios that encompass nearly every aspect of health care. These research Portfolios include: Comparative Effectiveness, Patient Safety, Health Information Technology, Prevention/Care Management, and Value Research.

Comparative Effectiveness

The goal of the Comparative Effectiveness Portfolio is to provide high-quality research to help patients, health care providers, and policymakers make the best decisions they can about the health care they receive and provide. The Comparative Effectiveness Portfolio is dedicated to fulfilling this need through high-quality research and conveying that information to those who need it to make health care decisions. Comparative effectiveness research improves health care quality by providing patients and physicians with state-of-the-science information on which medical treatments work best for a given condition.

Patient Safety

The Patient Safety Portfolio helps identify risks and hazards that lead to medical errors and finds ways to prevent patient injury associated with delivery of health care. AHRQ supports research that provides information on the scope and impact of medical errors, identifies the root causes of threats to patient safety, and examines effective ways to make system-level changes to help prevent errors. Dissemination and translation of these research findings and methods to reduce errors is also critical to improving the safety and quality of health care. To make changes at the system level, there also must be an environment, or culture, within health care settings that encourages health professionals to share information about medical errors and ways to prevent them.

AHRQ Patient Safety Network (PSNet) AHRQ PSNet (http://psnet.ahrq.gov) is a national Web-based resource featuring the latest news and essential resources on patient safety. The site offers weekly updates of patient safety literature, news, tools, and meetings ("What's New"), and a vast set of carefully annotated links to important research and other information on patient safety ("The Collection"). Supported by a robust patient safety taxonomy and Web architecture, AHRQ PSNet provides powerful searching and browsing capability, as well as the ability for diverse users to customize the site around their interests (My PSNet). It also is tightly coupled with AHRQ WebM&M, the popular monthly journal that features user-submitted cases of medical errors, expert commentaries, and perspectives on patient safety.

Health Information Technology

The Health Information Technology (Health IT) Portfolio is a key element in the Nation's 10-year strategy to bring health care into the 21st century by advancing the use of information technology. Through this research Portfolio, AHRQ and its partners identify challenges to health IT adoption and use, solutions and best practices for making health IT work, and tools that will help hospitals and clinicians successfully incorporate new information technology. In addition, the Health IT Portfolio develops and disseminates evidence and evidence-based tools to inform policy and practice on how health IT can improve the quality of American health care.

Prevention/Care Management

The Prevention/Care Management Portfolio focuses on translating evidence-based knowledge into current recommendations for clinical preventive services that are implemented as part of routine clinical practice to improve the health of all Americans. It supports research to improve and reduce disparities of common chronic conditions like diabetes, asthma, and heart disease.

Value Research

The Value Research Portfolio aims to find a way to achieve greater value in health care—reducing unnecessary costs and waste while maintaining or improving quality—by producing the measures, data, tools, evidence and strategies that health care organizations, systems, insurers, purchasers, and policymakers need to improve the value and affordability of health care. The aim is to create a high-value system, in which providers produce greater value, consumers and payers choose value, and the payment system rewards value.

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Comparative Effectiveness Portfolio

Comparative effectiveness research provides information that people and their doctors can use to work together to choose the most appropriate treatment for an illness or condition. AHRQ conducts comparative effectiveness research through its Effective Health Care (EHC) Program. In FY09, the EHC Program was allocated $300 million of Recovery Act funding for comparative effectiveness research. In addition, it also released 5 comparative effectiveness reviews, 16 research reports, and 13 user guides. Among these publications are a comparative effectiveness review on drugs to reduce the risk of primary breast cancer; a research report on beta-blockers for heart failure; and guides for consumers, clinicians, and policymakers on subjects such as osteoarthritis of the knee and gestational diabetes, as well as Spanish language consumer guides on prostate cancer and other subjects.

Comparisons of drugs, medical devices, tests, surgeries, or ways to deliver health care can help patients and their families understand what treatments work best and how their risks compare, while allowing for choices for each individual patient. The EHC Program, created by Congress in Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, produces three primary products: research reviews, new research reports, and summary guides.

For more information on the EHC Program, go to http://effectivehealthcare.ahrq.gov.

American Recovery and Reinvestment Act

The American Recovery and Reinvestment Act, signed into law by President Obama in February 2009, provided AHRQ with greater opportunities to build upon its existing collaborative and transparent EHC program and provide patients, clinicians, and others with evidence-based information to make informed decisions about health care. Of the $1.1 billion contained within the Recovery Act for comparative effectiveness research, $300 million was allocated to AHRQ, $400 million for the National Institutes of Health (NIH), and $400 million to the Office of the Secretary of HHS. In FY09, AHRQ began its efforts to issue funding opportunity announcements to spend this new funding, and worked with NIH and the Office of the Secretary on coordinating comparative effectiveness under the Recovery Act.

For more information on the Recovery Act and AHRQ's funding opportunities, go to http://www.ahrq.gov/fund/cefarra.htm.

Research Reviews

These comprehensive reports are prepared by the Evidence-based Practice Centers (EPCs) and draw on scientific studies to make comparisons of treatments. They also show where more research is needed. Research reviews from the EHC Program are reported in several formats:

• Comparative Effectiveness Reviews (CERs) and Effectiveness Reviews evaluate which treatments work best while outlining treatments' side effects and other risks.
• Technical Briefs explain what is known—and what is not known—about new or emerging health care tests or treatments.
• Updates apply systematic methods to bring CERs and Evidence Reviews up to date by reviewing the current literature.

CERs and Effectiveness Reviews

CERs and Effectiveness Reviews systematically review and critically appraise existing research to synthesize knowledge on a particular topic. They also identify research gaps and make recommendations for studies and approaches to fill those gaps. CERs draw on completed scientific studies to make head-to-head comparisons of different health care interventions. They also show where more research is needed. Effectiveness reviews are original research reports that are based on clinical research and studies that use health care databases and other scientific resources and approaches to explore practical questions about the effectiveness—or benefits and harms—of treatments. Three CERs published in FY09 are briefly summarized here:

• Comparative Effectiveness of Drugs to Reduce the Risk of Primary Breast Cancer in Women. Three drugs reduce a woman's chance of getting breast cancer, but each drug carries distinct potential harms of its own. The review found that three drugs—tamoxifen, raloxifene, and tibolone—significantly reduce invasive breast cancer in midlife and older women, but that benefits and adverse effects can vary depending on the drug and the patient. The report is the first to make a direct, comprehensive comparison of the drugs so that women and their health care providers can assess the medications' potential effectiveness and adverse effects.
• Comparative Effectiveness of Lipid-Modifying Agents. This systematic review compares the benefits and risks of increasing the dose of a statin or using a statin in combination with a lipid-modifying agent of another class in terms of clinical events (e.g., heart attack, stroke, or death), levels of LDL cholesterol, and other measures. The review found that the available clinical trial evidence supporting the use of combination therapies over higher dose statin therapy is insufficient to guide clinical decisions. The long-term clinical benefits and risks of combination therapies have yet to be demonstrated.
• Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. This report examines the use of a procedure called radiofrequency catheter ablation to treat a type of irregular heartbeat known as atrial fibrillation. It found that the procedure has been shown to provide benefits in maintaining normal heart rhythm over short periods of time (up to 1 year). However, the report showed little evidence indicating whether the procedure reduces the chance that patients will experience atrial fibrillation over the long term.

Technical Briefs

A Technical Brief is a report on a topic involving an emerging clinical intervention. It provides an overview of key issues related to the intervention—for example, current indications for the intervention, relevant patient population and subgroups of interest, outcomes measured, and contextual factors that may affect decisions regarding the intervention. The emphasis of the Technical Briefs is to provide an early objective description of the state of science, a potential framework for assessing the applications and implications of the new interventions, a summary of ongoing research, and information on future research needs. Technical Briefs generally focus on interventions for which there are limited published data and too few completed protocol-driven studies to support definitive conclusions. The first published brief in this new series is summarized below.

• Particle Beam Radiation Therapies for Cancer. This technical brief found that it is not possible to draw conclusions about the comparative safety and effectiveness of particle beam radiation therapy (PBRT) at this time. The brief reviews the different types of PBRT, their potential advantages and disadvantages, and their current uses. At present, there is very limited evidence comparing the safety and effectiveness of PBRT with conventional radiation treatments for people with cancer.

Additional CERs and Technical Briefs will be published in FY 2010. Topics include Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions and Stereotactic Radiosurgery for Non-Brain Cancer and Maternal-Fetal Surgery.

Navigating the Health Care System AHRQ Director Carolyn Clancy, M.D., presents a series of brief, easy-to-understand advice columns for consumers on how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. In FY09, subjects included: What You Need to Know about Blood Thinner Pills. How To Make an Emergency Department Visit a Safe One. An Aspirin a Day? The Answer Is Different for Men and Women. Talking About End-of-Life Treatment Decisions. Keeping Track of Your Health Information. Asking Questions To Get the Care You Need. How To Complain—And Get Heard. How Tired Is Your Doctor? How To Choose Long-Term Care Services. New Hope for Chronic Disease Management. Keeping Healthy When the Economy Is Not. The advice columns are on the AHRQ Web site at http://www.ahrq.gov/consumer/cc.htm.

New Research Reports

These reports are based on clinical research and studies that use health care databases and other scientific resources and approaches to explore practical questions about the effectiveness and safety of treatments. They are produced by the Centers for Education & Research on Therapeutics (CERTs) and AHRQ's Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network. The DEcIDE Network is a network of research centers that AHRQ created as part of its EHC Program in 2005 to generate new knowledge. The DEcIDE Network consists of research-based health organizations with access to electronic health information databases and the capacity to conduct research. It conducts practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of health care items and services.

In FY09, the DEcIDE Network released 16 new research reports, 2 of which are summarized below:

• Use of Beta-Blockers in Elderly Patients. One study found that patients who took metoprolol tartrate had a slightly higher risk of death than patients who took atenolol. The risk of death was not significantly different between patients who took atenolol or carvedilol. A second study compared 1-year survival rates of beta-blockers for which there is evidence (carvedilol, metoprolol succinate, and bisoprolol fumarate) and beta-blockers that have not been tested in heart failure. The study found similar survival rates but higher hospitalization rates among patients who took the evidence-based beta-blockers. Each study was based on an analysis of over 11,000 heart failure patients aged 65 and older.
• Effectiveness of Tiotropium in Treating COPD. In a study of patients with COPD (chronic obstructive pulmonary disease) in the Veterans Health Administration system, the regimen of tiotropium plus inhaled corticosteroids plus long-acting beta-agonists was associated with a 40 percent reduced risk of death compared to inhaled corticosteroids plus long-acting beta-agonists. This combination was also associated with reduced risks of COPD exacerbations and hospitalizations. However, tiotropium in combination with two other medications was associated with increased risk of mortality, exacerbations, and hospitalization.

Summary Guides

These short, plain-language guides—tailored to clinicians, consumers, or policymakers—summarize research reviews' findings on the effectiveness and risks of different treatment options. Consumer guides provide useful background on health conditions. Clinician and policymaker guides rate the strength of evidence behind a report's conclusions. The guides on medications also contain basic wholesale price information.

Among the new consumer and clinical guides released in FY09 are:

• Osteoarthritis of the Knee, a new consumer guide for adults who have osteoarthritis of the knee and need information about available treatments for this condition.
• Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit, a clinician's guide for treatments for osteoarthritis of the knee.
• Gestational Diabetes: A Guide for Pregnant Women, a consumer guide, presents treatment options, including diet, insulin, or the oral diabetes medicines, glyburide or metformin, and gives women advice on what they should do after pregnancy.
• Gestational Diabetes: Medications, Delivery, and Development of Type 2 Diabetes, a clinician's guide covers these topics, provides an at-a-glance "clinical bottom line" for managing patients, along with ratings of the evidence for each treatment.

For more information on AHRQ's EHC Program, go to http://www.effectivehealthcare.ahrq.gov.

Evidence-Based Practice Centers

Under the Evidence-Based Practice Center (EPC) Program, institutions in the United States and Canada receive multi-year contracts to review all relevant scientific literature on clinical, behavioral, organizational and financing topics; methodology of systematic reviews; and other health care delivery issues; and produce evidence reports and technology assessments. The information in these reports is used by Federal and State agencies; private-sector professional societies; health delivery systems; providers; payers; and others committed to evidence-based health care for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines, and research agendas.

Recent research findings from the EPC program

Some of the new evidence reports and technology assessments released by the 14 EPCs include:

• Bariatric Surgery in Women of Reproductive Age: Special Concerns for Pregnancy. This review found that women who undergo weight-loss surgery, known as bariatric surgery, and later become pregnant after losing weight may be at lower risk for pregnancy-related diabetes and high blood pressure—complications that can seriously affect the mother or her baby—than pregnant women who are obese. The review was based on findings from 75 studies, including 3 that compared pregnancies of non-obese women with those of obese women as well as to pregnancies of women who lost weight surgically.
• Maternal and Neonatal Outcomes of Elective Induction of Labor. Researchers found that that elective induction of labor at 41 weeks of gestation and beyond may be associated with a decrease in both the risk of cesarean delivery and of meconium-stained amniotic fluid. Despite the evidence from the prospective randomized, controlled trials reviewed, there are concerns about the translation of such findings into actual practice. The evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion.
• Complementary and Alternative Medicine in Back Pain Utilization. Researchers found few studies evaluating the relative utilization of various complementary and alternative medicine (CAM) therapies for back pain. For those studies evaluating utilization of individual CAM therapies, the specific characteristics of the therapy, providers who use it, and the clinical presentation of the back pain patients were not adequately detailed nor was the overlap with other CAM or conventional treatments.
• Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved. This review shows that there are distinct factors that influence the use and usability of interactive consumer health IT by the elderly, chronically ill, and underserved populations. Researchers found that health IT systems that allow physicians to assess their patients' current health status, treatment plan and goals, and provide new or adjusted treatment advice are most successfully used. Barriers to adoption of health IT systems can occur when patients do not see the benefit of using computer or other interactive technologies for self-managing their health problems. Other barriers include time constraints for the patient, lack of trust in the information received, technical problems, and physician unresponsiveness to questions.
• Cost-Effectiveness of CT Colonography to Screen for Colorectal Cancer. This technology assessment shows that the screening benefit for 5-yearly computed tomography (CT) colonography, measured in terms of discounted life-years gained compared with no screening, was 2-7 life-years lower per 1,000 65-year-old individuals than colonoscopy screening every 10 years but comparable to that of 5-yearly flexible sigmoidoscopy plus an annual fecal occult blood test. At a per test cost of $488 the overall costs for the CT colonography strategy were higher than all of the other screening strategies.

The EPCs are currently working on the following topics:

• Exercise-Induced Bronchoconstriction and Asthma.
• Enhancing Use and Quality of Colorectal Cancer Screening.
• Diagnosis and Management of Ductal Carcinoma In Situ (DCIS).
• Lactose Intolerance and Health.
• Management of Acute Otitis Media, Update.

For more information about the EPC Program, go to http://www.ahrq.gov/clinic/epcix.htm.

New Spanish language consumer guides AHRQ released six consumer guides in Spanish on the subjects of treating prostate cancer, comparing blood pressure pills, rheumatoid arthritis medicines, osteoporosis treatments, antidepressant medicines, and renal artery stenosis treatments: Tratamiento para el cáncer de próstata—Guía para hombres con cáncer localizado de prostate. This guide on prostate cancer treatment discusses four common prostate cancer treatments and their side effects. Comparación de dos tipos de pastillas para la presión arterial alta: ACEI y ARB—Guía para adultos. This guide to blood pressure medication discusses the benefits, costs, and side effects of two different kinds of pills, ACE inhibitors (ACEI) and ARBs. Medicamentos para la artritis reumatoide—Guía para adultos. This guide to rheumatoid arthritis medicines discusses how arthritis affects the joints and two kinds of medicine used to treat it: disease-modifying anti-rheumatic drugs and steroids such as prednisone, which help with joint pain and swelling. Tratamientos para la osteoporosis que ayudan a prevenir fracturas de huesos—Guía para mujeres después de la menopausia. This guide to osteoporosis treatments discusses the benefits, side effects, and costs of osteoporosis treatments that help prevent broken bones. Medicamentos antidepresivos—Guía para adultos con depresion. This guide to antidepressant medicines discusses the symptoms of depression and the benefits, side effects, and costs of numerous antidepressants. Tratamientos para la estenosis de la arteria renal—Guía para el consumidor. The guide to renal artery stenosis (RAS) treatments discusses the health problems caused by RAS and two kinds of treatment for the condition. For copies of these guides, go to http://effectivehealthcare.ahrq.gov/spanishInfo.cfm.

Centers for Education and Research on Therapeutics

The Centers for Education and Research on Therapeutics (CERTs) is a national program that conducts research and provides education to advance the optimal use of drugs, biologicals, and medical devices. The CERTs program, which is administered by AHRQ in consultation with the Food and Drug Administration (FDA), was originally authorized by Congress in 1997 to examine the benefits, risks, and cost-effectiveness of therapeutic products; educate patients, consumers, doctors, pharmacists, and other clinical personnel; and improve quality of care while reducing unnecessary costs by increasing appropriate use of therapeutics and preventing adverse effects and their medical consequences.

Clinician-Consumer Health Advisory Information Network (CHAIN)

This new educational Web site offers expert perspectives, advice, and guidance on drugs, biological products, and medical devices. The Clinician-Consumer Health Advisory Information Network (CHAIN) links clinicians and consumers with information on therapeutics to assist in clinical practice and health care decisionmaking in areas where evidence is undergoing significant and rapid changes. The site also provides access to educational and informational resources developed from research conducted by CERTs. Its educational section includes materials to assist consumers with clinician-patient conversations and decisionmaking as well as an online medication record. Resources for clinicians include a slide library that can be adapted to educate clinical audiences and used for continuing medical education credit. For more information, go to http://www.chainonline.org.

Recent research findings from the CERTs program

• Atypical antipsychotic drugs and the risk of sudden cardiac death. Patients ages 30 to 74 who took atypical antipsychotics such as risperidone (Risperdal®), quetiapine (Seroquel®), olanzapine (Zyprexa®), and clozapine (Clozaril®) had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to researchers from the Vanderbilt University CERT. The risk of death increased with higher doses of the drugs taken. Atypical antipsychotics are commonly used to treat schizophrenia and bipolar disorders. They are also prescribed "off label" for symptoms such as agitation, anxiety, psychotic episodes, and obsessive behaviors. Atypical antipsychotics are less likely than typical antipsychotics to cause tremors and other serious movement disorders. (New England Journal of Medicine, January 2009)
• Patterns of hospital use by elderly patients with psychiatric conditions. A study by researchers from the Rutgers University CERT finds that 22 percent of elderly patients who were treated at and released from hospitals end up back in the hospital within 6 months. Hospital stays of 5 days or longer decreased the chances that patients with affective disorders (for example, depression or bipolar disorder) would be rehospitalized. The findings indicate that to prevent readmissions, patients should not be prematurely discharged, especially those with affective disorders. Patients could also benefit from tailored discharge plans and aftercare, suggest the authors, who used 2002 Medicare data for 41,839 patients for this study. (Psychiatric Services, September 2008)
• Specimens from multiple body sites needed to accurately test for MRSA. Researchers at the University of Pennsylvania School of Medicine CERT identified 56 individuals who had swab samples positive for MRSA. Swab specimens were taken from the nose, under the arm, throat, groin, and perineum. Immediately after these were taken, either the patient or the parent (for pediatric patients) took swab samples from the same body sites. For both provider- and patient-collected samples, the nose was the most common site where MRSA was present, followed by the throat. However, nearly a quarter of individuals would not have been identified as having MRSA if the nose had not been sampled. Likewise, 5 percent of cases would have been missed if samples were not obtained from the throat. Swab samples from the groin and perineum tested positive for probable community-acquired MRSA significantly more often (75 percent) than they did for hospital-acquired MRSA (33 percent). The researchers found strong agreement between the findings for patient-collected samples and provider-collected samples. As such, patient-collected sampling may be a way to improve the efficiency of community-based surveillance and research. (Infection Control and Hospital Epidemiology, April 2009)

More information about the CERTs program can be found at http://certs.hhs.gov.

American College of Physicians uses AHRQ research in creating clinical practice guidelines The American College of Physicians (ACP) relies primarily on two AHRQ programs—the EPC and the EHC program—in creating their guidelines. Douglas K. Owens, MD, MS, Chair of ACP's Clinical Efficacy Assessment Subcommittee, reports that nearly a dozen EPC reports have been used to create ACP guidelines. ACP also used AHRQ's EHC guide on depression medications. According to Amir Qaseem, MD, PhD, MHA, FACP, Senior Medical Associate at the American College of Physicians, who is responsible for the ACP's clinical practice guidelines program, these guidelines have reached wide audiences via print, television, and the internet. He shares specific examples, as follows: ACP Guideline No. of Print/Internet Stories No. of TV Stories No. of Downloads Total Audience, 2007-08 Diagnosis & Management of Chronic Obstructive Pulmonary Disease 165 102 4,500 7,480,387 Screening for Osteoporosis 155   35,300 24,865,850 Treatment of Depression 114 89 14,000 21,608,408 Treatment of Osteoporosis 54   34,400 7,936,165 Treatment of Dementia 54   55,400 7,870,523 Palliative Care at the End of Life 140   42,000 7,028,522 Since January 2007, ACP guidelines have had an estimated reach of 340 million people. The individual guidelines have been downloaded tens, even hundreds of thousands of times. ACP is the largest medical specialty organization and second largest physician group in the United States. Its membership of 126,000 includes internists, internal medicine subspecialists, medical students, residents, and fellows.

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