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Electronic Newsletter

March 16, 2009

AHRQ News and Numbers

People in the Northeastern United States are one-third more likely than those in the South or West to be hospitalized for treatment of brain cancer or to have brain cancer when they are hospitalized for another illness or complication. In 2006, about 30 of every 100,000 people in the Northeast were hospitalized with brain cancer. That compares to 23 per 100,000 for people in both the South and West. The rate was slightly higher for people in the Midwest—25 per 100,000. [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #68: Hospitalizations for Brain Cancer, 2006 (PDF File, 147 KB; Plugin Software Help).

Comparative Effectiveness Funding in the American Recovery and Reinvestment Act

AHRQ is excited about the new opportunities under the American Recovery and Reinvestment Act (ARRA) to provide patients, clinicians, and others evidence-based information to make informed decisions about health care. ARRA contains $1.1 billion for comparative effectiveness research. Of the total, $300 million is for AHRQ to build on its existing collaborative and transparent Effective Health Care program. This program allows for input from all perspectives into the development of the research and implementation of the findings.

Of the remaining funds, $400 million each will go to NIH and the Office of the HHS Secretary. The legislation calls on the Institute of Medicine to recommend research priorities for these funds and gather stakeholder input. A report is due June 30, 2009. In addition, the Federal Coordinating Council for Comparative Effectiveness Research will be created to offer guidance and coordination on the use of these funds.

AHRQ is gearing up to make the most of this additional funding. We are undertaking a process to determine what will be funded, as guided by the Federal Coordinating Council, the IOM, and other external sources. We will work closely with NIH and the Office of the Secretary to ensure that we use these funds in the most effective manner and that we are coordinating our plans to maximize effectiveness of this important investment.

We will let you know about opportunities for the field to contribute to this enterprise as soon as possible. Go to Effective Health Care Web page to sign up for updates. Also, please go to the AHRQ Web site, and check out AHRQ's standing program and training award announcements.

Today's Headlines

AHRQ announces new members of the U.S. Preventive Services Task Force
AHRQ releases new survey to assess medical office safety culture
AAHRQ issues recommendations for safeguarding children during public health emergencies
AHRQ commentary on Transformation of Health Care at the Front Line
Triggers and Targeted Injury Detection Systems Expert Panel Meeting Summary
New AHRQ evidence report on Management of Chronic Hepatitis B produced for NIH conference is available
U.S. Preventive Services Task Force recommends high-intensity behavioral counseling to prevent sexually transmitted
Register for AHRQ Webcast on Improving Performance on the CAHPS Health Plan Survey
New MEPS Statistical Brief examines the level of health expenditures over time
HHS Measure Inventory has updated features
AHRQ in the professional literature

1. AHRQ Announces New Members of the U.S. Preventive Services Task Force

AHRQ Director Carolyn M. Clancy, M.D., announced the appointment of three new members of the U.S. Preventive Services Task Force. Susan Curry, Ph.D., of Iowa City; Joy Melnikow, M.D., M.P.H., of Sacramento; and Wanda Nicholson, M.D., M.P.H., M.B.A., of Baltimore will join the Task Force this month. The Task Force, which is sponsored by AHRQ, consists of 16 health care experts in the specialties of family medicine, pediatrics, internal medicine, obstetrics and gynecology, geriatrics, preventive medicine, public health, behavioral medicine and nursing. Select to read our press release.

2. AHRQ Releases New Survey to Assess Medical Office Safety Culture

AHRQ released a new free, evidence-based tool to help organizations assess how their staff views different areas of patient safety. The survey, Medical Office Survey on Patient Safety Culture, captures opinions from all levels of staff on important dimensions that relate to patient safety and quality issues, communication about error, communication openness, information exchange with other settings, office processes and standardization, organizational learning, staff training, teamwork, and work pressure and pace. It includes survey forms and a user's guide that explains the survey process, discussing such topics as overall project planning, data collection procedures and analysis and report creation. The easy-to-use survey toolkit provides:

Easy-to-understand survey questions that take approximately 10-15 minutes to complete;
Ability to gain knowledge of how all staff, from administrators and clerical staff to clinicians, view patient safety culture within the medical office;
Ability to track changes in patient safety culture over time and evaluate improvement efforts;
Access to a survey users' group for sharing success stories and implementation strategies;
Data to compare your office's findings to others; and
Contact information for obtaining free technical assistance related to questions on survey administration, data collection, and analysis.

The new survey is an expansion of AHRQ's successful Hospital Survey on Patient Safety Culture. Select to access the tools.

3. AHRQ Issues Recommendations for Safeguarding Children During Public Health Emergencies

AHRQ released two new tools designed to protect and care for children who are in a hospital or a school during a public health emergency. The first tool, Pediatric Hospital Surge Capacity in Public Health Emergencies, consists of guidelines to assist pediatric hospitals in converting from standard operating capacity to surge capacity and help community hospital emergency departments provide care for large numbers of critically ill children. Steps address needs such as communications, staff responsibilities, triaging, stress management, and security concerns when handling mass numbers of children with either communicable respiratory diseases or communicable food borne or waterborne illnesses. The second tool, School-Based Emergency Preparedness: A National Analysis and Recommended Protocol, is a national model for school-based emergency response planning. It provides guidance on the recommended steps for both creating and implementing a school-based emergency response plan. Steps outlined include performing needs assessments, conducting site surveys, developing training modules for school staff, and informing parents of the plan, as well as steps relating to building security and safety, preparation for large-scale emergencies, sheltering-in-place and lockdown, evacuation, relocation, and communications. Included with the guidance is a model school-based emergency response plan developed by the Brookline, Massachusetts, school district in cooperation with the Center for Biopreparedness, the division of Harvard Medical School that prepared both sets of guidelines under contract to AHRQ.

Select to read our press release. Print copies are available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

4. AHRQ Commentary on Transformation of Health Care at the Front Line

An AHRQ commentary co-authored by Patrick H. Conway, M.D., M.Sc., and Carolyn M. Clancy, M.D., titled, "Transformation of Health Care at the Front Line," was published in the February 18 issue of JAMA. The commentary outlines an approach to transforming health care at the front line with clinicians and patients. The authors conclude that four critical steps are needed: (1) an investment in the key drivers (quality measurement and payment; health information technology: comparative effectiveness and quality improvement collaboratives); (2) clinicians to actively engage in the process of developing solutions to improve care at the front line; (3) an increase in the current payment system's focus on payment for high-quality, efficient care, to reward achievement of improved patient outcomes over episodes of care, and to minimize the opportunity for unintended negative consequences; and (4) a champion for transformation of care at the front line who can convene stakeholders and build the requisite capacity and infrastructure. A reprint copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

5. Triggers and Targeted Injury Detection Systems Expert Panel Meeting Summary

AHRQ released a report that will guide Federal research efforts around targeted injury detection systems (TIDS). Using triggers to detect adverse events in real time, so that they can be prevented before the patient is harmed, is an important step toward a safer health system. The report, Triggers and Targeted Injury Detection Systems Expert Panel Meeting Conference Summary contains concrete action items to guide Federal agencies in supporting TIDS research and implementation to improve patient safety and quality of care. Action items include continued research to explore methods of integrating triggers/TIDS harm identification and mitigation into existing health information technology and workflow as well as development of a standardized implementation tool for triggers/TIDS. The report also includes:

A literature review summarizing published work to date in the trigger/TIDS research domain;
Seven brief articles submitted by the expert panelists, summarizing their research and implementation work to date; and
A glossary to build a common understanding of trigger related terms.

The report reflects the culmination of input from researchers and key stakeholders representing diverse disciplines, health care organizations, and Federal agencies. Its aim is to develop and improve existing methods of detecting triggers that lead to adverse events and injuries, and to address the challenges involved in implementing TIDS in a variety of care settings. Select to access the report.

6. New AHRQ Evidence Report on Management of Chronic Hepatitis B Produced for NIH Conference Is Available

AHRQ released a new evidence report on combining evidence of the natural history of chronic hepatitis B and the effects and harms of antiviral drugs on clinical, virological, histological, and biochemical outcomes. The report, Management of Chronic Hepatitis B, was requested and funded by the National Institutes of Health's (NIH) Office of the Medical Applications of Research, for a State-of-the-Science Conference held on October 20-22. AHRQ's Minnesota Evidence-based Practice Center conducted the systematic literature review and prepared the report. The researchers found that no one treatment improved all outcomes and there was limited evidence on comparative effects. The NIH consensus panel recommends routine screening for hepatitis B of newly arrived immigrants to the United States from countries where the hepatitis B virus prevalence rate is greater than two percent. Screening will facilitate the provision of medical and public health services for infected patients and their families and provide public health data on the burden of disease in immigrant populations. The screening test should not be used to prohibit immigration. The consensus panel also said the most important research needs representative future companion studies to define the natural history of the disease and large randomized controlled trials of single and combined therapies, which measure the effects on clinical health outcomes.

Select to access the AHRQ report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

7. U.S. Preventive Services Task Force Recommends High-Intensity Behavioral Counseling to Prevent Sexually Transmitted Infections

The U.S. Preventive Services Task Force released a new recommendation supporting high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs. The Task Force could not find enough evidence to assess the balance and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. According to the CDC, an estimated 19 million new STIs occur in the United States each year, almost half among people from 15 to 24 years of age. Common STIs include chlamydia, hepatitis B, hepatitis C, herpes, HIV and syphilis. Despite advances in screening, diagnosis and treatment of STIs, they remain an important cause of death in the United States. Direct medical costs are estimated at $15 billion annually. High intensity behavioral counseling is delivered through multiple sessions and includes education, skill training, or support for changes in sexual behavior that promote risk reduction or risk avoidance. Counseling may be delivered in primary care settings or in other areas of the health system and may be greatly improved by strong linkages between the primary care setting and the community. The recommendation and materials for clinicians are available on the AHRQ Web site.

8. Register for AHRQ Webcast on Improving Performance on the CAHPS® Health Plan Survey

On March 31, from 2:00 p.m.-3:30 p.m. ET, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) User Network is presenting a free Webcast on strategies for improving performance on the CAHPS® Health Plan Survey. This event will highlight the usefulness of two important tools: the National CAHPS® Benchmarking Database and the new Web-based CAHPS® Improvement Guide.

9. New MEPS Statistical Brief Examines the Level of Health Expenditures over Time

A new analysis by AHRQ's Steven B. Cohen, Ph.D., and William Yu, M.A., found that the top 10 percent of Americans in terms of the cost of treating their health problems, accounted for about 64 percent of medical care spending in 2005 and 2006. About 45 percent of the 12 million people in this top 10 percent were age 65 or older, and 36 percent were between 45 and 64 years of age. The AHRQ researchers also found that roughly 81 percent were non-Hispanic whites, 11 percent were non-Hispanic blacks, 7 percent Hispanics, under 2 percent Asian or Pacific Islanders, and women comprised about 60 percent of the overall group. Of those under 65 years of age, approximately 65 percent had private health insurance, 33 percent had public-only insurance, and 2.5 percent were uninsured in 2006. The researchers further found that about 35 percent were high income, 26 percent middle income, 16 percent poor, 13 percent low income, and 9.5 percent were near poor. The analysis focused on community-dwelling people. AHRQ's Medical Expenditure Panel Survey (MEPS), the basis for this analysis, does not include people in nursing homes or other institutions.

Select to access Statistical Brief #236, The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2005-2006.

10. HHS Measure Inventory Has Updated Features

The HHS Measure Inventory accessible through the National Quality Measures Clearinghouse™ (NQMC) Web site has been enhanced with additional browse and search features. Users now have the ability to browse the HHS inventory by HHS division, topic or condition, domain, and care setting, perform an advanced search of the content using keywords or filters, and generate a table representing the total number of measures in terms of two measure categories (e.g., HHS division by topic or condition, topic or condition by domain). Once the table is generated, users can access detailed measure results by selecting a measure total within the table. Users will also notice that when viewing measure results, "cross links" have been included for those measures that are in both the HHS Measure Inventory and represented in NQMC. NQMC is continuing this effort to establish cross links as appropriate—i.e., when measures included in the HHS Measure Inventory are submitted to NQMC and accepted for inclusion.

11. 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.

Hsia RY, MacIsaac D, Palm E, Baker LC. Trends in charges and payments for nonhospitalized emergency department pediatric visits, 1996-2003. Acad Emerg Med 2008 Apr; 15(4):347-54. Select to access the abstract in PubMed®.

Calderon JL, Fleming E, Gannon MR, et al. Applying an expanded set of cognitive design principles to formatting the Kidney Early Evaluation Program (KEEP) Longitudinal Survey. Am J Kidney Dis 2008 Apr; 51(4 Suppl 2):S83-S92. Select to access the abstract in PubMed®.

Gregory KD, Korst LM, Fridman M, et al. Vaginal birth cesarean: Clinical risk factors associated with adverse outcome. Am J Obstet Gynecol 2008 Apr; 198(4):452.e1-452.e12. Select to access the abstract in PubMed®.

Perry TT, Vargas PA, Bufford J, et al. Classroom aeroallergen exposure in Arkansas Head Start centers. Ann Allergy Asthma Immunol 2008 Apr; 100(4);358-363. Select to access the abstract in PubMed®.

Chander G, Josephs J, Fleishman JA, et al. Alcohol use among HIV-infected persons in care: results of a multi-site survey. HIV Med 2008 Apr; 9(4):196-202. Select to access the abstract in PubMed®.

Lorch SA, Millman AM, Zhang X et al. Impact of admission-day crowding on the length of stay of pediatric hospitalization. Pediatrics 2008 Apr; 121(4):e718-e730. Select to access the abstract in PubMed®.

Boyington JE, Carter-Edwards L, Piehl M, et al. Cultural attitudes toward weight, diet, and physical activity among overweight African American girls. Prev Chon Dis 2008 Apr; 5(2):A36. Select to access the abstract in PubMed®.

Ohl ME, Landon BE, Cleary PD, et al. Medical clinic characteristics and access to behavioral health services for persons with HIV. Psychiatri Serv 2008 Apr; 59(4):400-7. Select to access the abstract in PubMed®.

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Current as of March 2009

Internet Citation:

AHRQ Electronic Newsletter, March 16, 2009, Issue #272. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews272.htm