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Electronic Newsletter

March 25, 2010

AHRQ News and Numbers

Purchases of cholesterol and diabetes prescription drugs by elderly Medicare beneficiaries reached nearly $19 billion in 2007—about one-fourth of the approximately $82 billion spent for medications for the elderly. [Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #280: Expenditures for the Top Five Therapeutic Classes of Outpatient Prescription Drugs, Medicare Beneficiaries, Age 65 and Older, 2007.]

Today's Headlines

Task Force releases screening recommendations for obesity in kids and teens
New AHRQ evidence report shows vaginal birth after cesarean is safe for most women
Michigan intensive care units maintain low rates of catheter-related bloodstream infections over three years
AHRQ launches new HCUP databases and tools webinar series
Register for AHRQ's HCUP hands-on training workshop set for April 26
AHRQ announces interest in research of prevention and management of health care-associated infections
AHRQ announces DEcIDE-2 Network funding opportunity
Request for comments on proposed NIH, AHRQ, and CDC process change for electronic submission of grant applications
AHRQ releases supplemental files for tracking repeat visits to different hospital settings
Highlights from our most recent monthly newsletter
AHRQ in the professional literature

1. Task Force releases screening recommendations for obesity in kids and teens

The U.S. Preventive Services Task Force recommends that clinicians screen children ages 6 and older for obesity and offer or refer them to intensive counseling and behavioral interventions to promote improvements in weight. The recommendation and the accompanying summary of evidence appeared in the February issue of Pediatrics. The Task Force found adequate evidence that comprehensive, moderate- to high-intensity programs that include dietary, physical activity, and behavioral counseling components for obese children and teens between the ages of 6 and 18 can yield short-term—up to 12 months—improvements in weight. After examining new and existing evidence, the Task Force found that effective comprehensive weight management programs incorporated counseling and other interventions that targeted diet and physical activity. Behavioral management techniques were also used in these programs. Parent involvement was a part of interventions aimed at younger children. The Task Force did not find sufficient evidence for screening children younger than the age of 6. The evidence on the effectiveness of low-intensity interventions—those with 25 or less contact hours over 6 months—was inadequate, according to the Task Force. Select to access the recommendation.

2. New AHRQ evidence report shows vaginal birth after cesarean is safe for most women

AHRQ has released a new report that found that vaginal birth after cesarean section is a safe and reasonable choice for a majority of women. Each year, more than 1 million cesarean surgeries are performed, and in 2007 nearly one in three births was cesarean in the U.S. A steady increase in repeat cesarean births over the past decade has been attributed, in part, to studies that suggested there may be significant harms associated with vaginal birth after cesarean section. Investigators found evidence which showed that while rare, maternal mortality was significantly higher for elective repeat cesarean versus trial of labor. Additionally, risks for uterine rupture and perinatal death remain rare, but elevated for trial of labor. Other important outcomes such as hemorrhage/transfusion, adhesions, surgical injury, and wound complications remain uncertain due to lack of consistent definition and reporting. Moreover, investigators also found increasing evidence that women with multiple cesarean deliveries were at significant risk of life threatening conditions. Led by Jeanne-Marie Guise, M.D., M.P.H., researchers note that evidence-based research regarding factors, such as medical liability, economics and hospital staffing that may influence patient, provider and hospital-related decisions between both types of delivery is not sufficient. The report, Vaginal Birth After Cesarean: New Insights, was conducted by AHRQ's Oregon Health and Science University Evidence-based Practice Center and was prepared for the National Institutes of Health (NIH) Consensus Development Conference held on March 8-10. Select to access the report abstract.

3. Michigan intensive care units maintain low rates of catheter-related bloodstream infections over three years

Over 100 participating intensive care units in Michigan have been able to keep the rates of central line-associated bloodstream infections to near zero—even three years after first adopting standardized procedures. The project, known as the Michigan Health & Hospital Association Keystone ICU project, involved the use of a comprehensive unit-based safety program to reduce these common, costly and potentially lethal infections. This project used a model to translate evidence into practice with the comprehensive patient safety intervention to improve culture, educate staff, learn from mistakes, and involve senior leaders. Last year, AHRQ announced new funding that has expanded the project to all 50 States, Puerto Rico, and the District of Columbia. In addition, more hospitals will be involved in each State, other settings in addition to ICUs will be able to participate, and other types of infections will be addressed. The study, "Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study," was published in the February 4 issue of the British Medical Journal. Select to access the abstract.

4. AHRQ launches new HCUP databases and tools webinar series

AHRQ will host a two-session free webinar series on the Healthcare Cost and Utilization Project (HCUP) databases, products, and tools. Registration is now open for each session. The first one-hour webinar, set for April 12 from 2:00-3:00 p.m., EST, will introduce health services and policy researchers to the HCUP databases and related resources that can enhance their research studies by providing a general overview of the HCUP databases. The second one-hour webinar, set for May 10 from 2:00-3:00 p.m., EST, will focus on the HCUP products and tools, with particular emphasis on HCUPnet, the free online data query system. Select to register.

5. Register for AHRQ's HCUP hands-on training workshop set for April 26

AHRQ will sponsor a full-day, intermediate level, hands-on workshop for health services researchers interested in learning more about Healthcare Cost and Utilization Project (HCUP) data resources. Participants will gain exposure to HCUP databases and related tools (including HCUPnet) through hands-on manipulation of the data, including file construction, producing national estimates, creating State-level output, and applying critical methods to produce correct standard deviations. Access to the HCUP Nationwide Inpatient Sample and State Inpatient Databases will be provided during the workshop. The course will be held at the AHRQ Conference Center in Rockville, Maryland. Select for additional information and to register. Class size is limited.

6. AHRQ announces interest in research of prevention and management of health care-associated infections

AHRQ has issued a funding opportunity announcement (FOA) for extramural health services research, demonstration, dissemination, and evaluation grants aimed at preventing and more effectively managing health care associated infections. The FOA sets a multi-year research framework, based on the distillation of existing, peer-reviewed research, case studies, HHS' 2009 National Action Plan on Healthcare-associated Infections, and qualitative information resulting from a series of listening sessions that occurred in selected cities across the United States in 2009. Select to access the announcement. Deadline to submit an application is March 29.

7. AHRQ announces DEcIDE-2 Network funding opportunity

AHRQ is soliciting proposals for research centers to participate in the "Developing Evidence to Inform Decisions about Effectiveness" (DEcIDE) Research Network program. Through this solicitation, new DEcIDE contracts (DEcIDE-2) will be awarded for 36 months. DEcIDE-2 research centers awarded under this contract will be expected to work closely and collaboratively with other AHRQ-supported investigators and programs involved with comparative effectiveness. These programs include the Evidence-based Practice Centers, the John M. Eisenberg Center for Clinical Decisions and Communications Science (Eisenberg Center), Effective Health Care stakeholder and citizens' forums, Effective Health Care horizon scanning systems, the Centers for Education and Research on Therapeutics program, investigator-initiated grant programs, training grant recipients, and most notably, all DEcIDE-1 and DEcIDE-2 research centers. Select to access the announcement. Deadline to submit a proposal is April 27.

8. Request for comments on proposed NIH, AHRQ, and CDC process change for electronic submission of grant applications

The NIH, AHRQ, and the Centers for Disease Control and Prevention (CDC) seek comments from the public on the impact and timing of eliminating the error correction window from the electronic grant application submission process. AHRQ is accepting comments from individuals and organizations on the impact of this change. We are also interested in feedback on possible timing of the change. Questions include: Is there support for making the change in the next 3-6 months, a year, or is more time needed to make the change should the agencies decide to move forward? Select to submit comments. Deadline is April 19 to submit your comments.

9. AHRQ releases supplemental files for tracking repeat visits to different hospital settings

AHRQ has released Revisit Files, the newest addition to the supplemental files created under HCUP. The Revisit files are designed to facilitate analyses for tracking patients across time and hospital settings in the HCUP State Inpatient Databases, State Ambulatory Surgery Databases, and State Emergency Department Databases while adhering to strict privacy guidelines. These files enhance the value of the HCUP State databases by allowing for a variety of interesting analyses such as evaluating repeat emergency department use, readmissions to the hospital, admissions to the hospital after ambulatory surgery, or patterns of emergency department and hospital utilization for chronic conditions. For more information about the HCUP Supplemental Revisit files is available on the HCUP-US Web site.

10. Highlights from our most recent monthly newsletter

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

Wellness education and physical therapy improve health and functioning of persons with multiple sclerosis

Multiple sclerosis (MS) causes the immune system to attack nerve cells causing muscle weakness, fatigue, and other symptoms. Although there is no cure for MS, regular physical activity can help patients slow down the decline. A new study comparing physical rehabilitation to a group wellness program shows that both approaches improve physical activity and reduce fatigue in patients with MS. Each approach, however, may have unique benefits.Select to read this article.