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AHRQ Effective Health Care ProgramMarch 26, 2009, Issue #52
Message from AHRQ Director
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 site to sign up for updates. Also, please go to the AHRQ Web site, and check out AHRQ's standing program and training award announcements.
—Carolyn M. Clancy, M.D., Director, AHRQ
Today’s Headlines:
1. Special AHRQ-funded journal issue features health IT commentary by AHRQ director and health IT experts
2. Register now for free Web conference on “Improving Patient Safety: Implementing Re-Engineered Hospital Discharges” on March 31
3. Free Web conference series on e-prescribing and medication management starts March 31
4. AHRQ releases new survey to assess medical office safety culture
5. AHRQ director testifies on the quality of health care in the United States
6. AHRQ commentary on “Transformation of Health Care at the Front Line”
7. AHRQ's National Advisory Council seeks public comments on comparative effectiveness program
8. AHRQ researchers urge doctors to be more conservative when prescribing drugs
9. New report on ambulatory computerized provider order entry now available
10. New survey indicates clinical pharmacy services continue to be underused in emergency departments
11. New health IT system allows for shared access to patient information and improved care
12. Latest issue of WebM&M is available online
13. AHRQ in the patient safety and health IT professional literature—some useful citations
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1. Special AHRQ-Funded Journal Issue Features Health IT Commentary by AHRQ Director and Health IT Experts
A special March-April issue of Health Affairs features a commentary by AHRQ Director Carolyn M. Clancy, M.D., and P. Jon White, M.D., AHRQ’s director for health information technology (health IT) titled “Investing in Health Information Infrastructure: Can It Help Achieve Health Reform?” In the article, Drs. Clancy and White encourage policymakers and stakeholders to pursue key short-term steps for which the health IT and quality improvement potential is clear—data sharing that leads to care coordination, multi-player pilot projects, and policy interoperability. Making investments in these areas will lay the groundwork needed to create a high-quality, high-value health system in the future. Over the long-term, the authors predict a substantial national investment in health IT will be needed to achieve and sustain a high-value health system. In another article, titled “Information Gap: Can Health Insurer Personal Health Records Meet Patients' and Physicians' Needs?" Teresa Zayas Cabán, Ph.D., senior manager of health IT at AHRQ, and other authors discuss the potential benefits and challenges of health insurers' personal health records (PHR) for enrollees while offering possible solutions that may lead to more widespread adoption of insurer PHRs. The Health Affairs issue explores the benefits, challenges, and potential risks of transforming the health care system through the use of IT. The special issue features articles on electronic health records, PHRs, electronic prescribing, computerized physician order entry systems, privacy and security, health IT systems, and regional health information organizations. Select to access an abstract of the commentary by Drs. Clancy and White; an abstract of the article coauthored by Dr. Zayas-Caban; and the Health Affairs press release.
2. Register Now for Free Web Conference on “Improving Patient Safety: Implementing Re-Engineered Hospital Discharges” on March 31
Hospital executives, clinicians, and patient safety officers and advocates are invited to join AHRQ and Brian Jack, M.D., Associate Professor of Family Medicine at Boston University, to learn how to re-engineer their own hospital discharge process and reduce readmissions. This free event, from 2:00 p.m. to 3:15 p.m., EDT, on March 31, will highlight Dr. Jack’s AHRQ-sponsored toolkit, the Re-Engineered Hospital Discharge (or Project RED), which features the use of a nurse discharge advocate who follows 11 discrete, mutually reinforcing action steps shown to improve the discharge process and decrease hospital readmissions. During the Web conference, Dr. Jack will provide an overview of Project RED and focus on sharing practical tips for implementing the toolkit in hospitals nationwide. In addition, Dr. Jack will present information on a current AHRQ-supported project to create a "virtual" discharge advocate in an effort to deliver Project RED at a lower cost. In a recent study, Dr. Jack explains that patients who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information. Select to register for the Web conference and for more information on Project RED.
3. Free Web Conference Series on E-Prescribing and Medication Management Starts March 31
The AHRQ National Resource Center for Health Information Technology is hosting a series of three, free 90-minute Web conferences on the role of health IT in medication management, from prescribing to adherence. The first in the series, titled “A National Web Conference on E-Prescribing and Medication Management,” will explore the potential impact of health IT on prescribing and will be held on March 31, from 3:30 p.m. to 5:00 p.m., EDT. Featured presenters are Douglas Bell, M.D., Ph.D., of the University of California at Los Angeles and the RAND Corporation, Santa Monica, CA; David R. Mehr, M.D.,of the University of Missouri, Columbia, MO; and Ken Majkowski, Pharm.D., of SureScripts LLC, Alexandria, VA. Speakers will present a conceptual model of the medication management process, with an emphasis on prescribing and key areas for improvement; discuss the tradeoffs involved in providing prescribing decision support when the accuracy of recommendations is mixed; explore the operational challenges of generating good patient histories and medication lists; discuss experiences working with PHR medication lists and medication reconciliation; discuss utilizing pharmacy fill data and claims data not only to populate patient lists but also to inform providers about their patients’ behavior; and, discuss ways of impacting meaningful use within the prescribing process. Select to register for this event. Detailed registration information for upcoming events will be announced in future issues of this e-newsletter.
4. 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 errors, communication openness, information exchange among health care 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 new survey is an expansion of AHRQ’s successful Hospital Survey on Patient Safety Culture. Select to access the tool.
5. AHRQ Director Testifies on the Quality of Health Care in the United States
On March 18, AHRQ Director Carolyn M. Clancy, M.D., testified before the Senate Finance Committee's health subcommittee about the state of health care quality in America. Dr. Clancy defined health care quality as “getting the right care to the right patient at the right time—every time,” and addressed escalating health care costs, progress in reducing disparities, and quality measurement. Focusing efforts on performance, transparency, and innovations will help clearly identify areas of improvement in health care as well as accelerate the pace of improvement, which is essential to sustainable health care reform, Dr. Clancy noted. She also stressed the importance of health IT as the foundation that support quality measurement and improvement, care coordination, and provides clinicians and patients the information necessary to optimize care. Select to view Dr. Clancy’s complete testimony.
6. 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.
7. AHRQ's National Advisory Council Seeks Public Comments on Comparative Effectiveness Program
The National Advisory Council for Healthcare Research and Quality is seeking public comment at a public meeting on Friday, April 3, on the comparative effectiveness program funded by AHRQ. At the meeting, the Council, which advises the AHRQ Director and the Secretary of HHS on priorities for a national health services research agenda, will discuss the American Recovery and Reinvestment Act and its investment in the AHRQ comparative effectiveness research program. The Recovery Act provides $1.1 billion for comparative effectiveness research: $300 million for AHRQ; $400 million for NIH and $400 million for HHS’ Office of the Secretary. Select to access the agenda. The Council will meet at the AHRQ Conference Center, 540 Gaither Road, Rockville, Maryland, 20850, beginning at 9:00 a.m., E.D.T.
8. AHRQ Researchers Urge Doctors to be More Conservative When Prescribing Drugs
Physicians should be more conservative in their drug prescribing practices and more skeptical about the benefits of drugs that don’t have a proven track record, according to AHRQ researchers. Authors Gordon D. Schiff, M.D., of Center for Patient Safety Research and Practice at the Brigham and Women’s Hospital, Boston, MA, and William L. Galanter, M.D., Ph.D., of the University of Illinois, Chicago, IL, suggest 25 principles that will help clinicians become more careful, cautious, evidence-based prescribers. The principles suggest that clinicians: 1) think beyond drugs when treating patients, such as recommending physical therapy, exercise, changes in diet, counseling, and stress reduction techniques; 2) practice more strategic and judicious prescribing methods; 3) educate patients about potential adverse effects of drugs; 4) learn about new drugs and new indications from unbiased sources and from colleagues with reputations for conservative prescribing; 5) learn how to work with patients and promote conservative therapies; and 6) think beyond short-term effects of drugs and consider longer-term benefits and risks. Although medical and pharmacy curricula and journals are rich with information about drugs and treatment of specific disease, the fundamentals for prescribing drugs are absent or underemphasized in current medical and pharmacy education. By following the principles, clinicians can develop excellent prescribing skills and, as a result, patients could be spared the risk or expense of unnecessary or harmful drug therapy. The commentary, titled “Promoting More Conservative Prescribing,” was published in the February 25 issue of JAMA. Select to access a press release issued by the Brigham and Women’s Hospital.
9. New Report on Ambulatory Computerized Provider Order Entry Now Available
AHRQ’s National Resource Center for Health Information Technology has released a new resource that summarizes key findings from grantees who have implemented ambulatory computerized provider order entry and clinical decision support (CDS) tools in outpatient practices. CDS capabilities integrated within ambulatory electronic health records and order entry systems provide clinicians with real-time support on a range of information related to diagnosis and treatment. They also provide tools aimed at improving patient care and reducing medical errors and costs. In addition, decision support may add rules to check for drug-drug interactions, allergies, medication contraindications, and renal and weight-based dosing, further enhancing the ability to reduce medical errors. The new report features lessons learned from health IT grantees about leadership, implementation and training, clinician adoption, and postimplementation considerations. Select to access the report.
10. New Survey Indicates Clinical Pharmacy Services Continue to be Underused in Emergency Departments
Although AHRQ researchers found that 30 percent of emergency medicine residency programs use some form of clinical pharmacy services, most of these programs did not take full advantage of the skills and services available from a clinical pharmacist present in the emergency department. For example, only a few emergency departments reported having clinical pharmacists provide drugs therapy recommendations, cost-effectiveness advice, or patient counseling. The value of clinical pharmacists in emergency departments is increasing and their presence in emergency medicine residency programs is an important way to increase their use in all emergency departments. The role of clinical pharmacists, such as modifying inventory according to formulary status, providing drug or toxicology information, and reporting adverse drug events, can improve the quality of care provided to patients, increase medication safety, and lead to cost savings. Eight percent of the survey respondents reported that a dedicated pharmacist was available in the emergency department 24 hours a day; 22 percent reported partial coverage; and, 70 percent report no coverage. The study, led by Jillian M. Szczesiul, Pharm.D., of Allegheny General Hospital, Pittsburgh, PA, and Rollin J. Fairbanks, M.D., of the University of Rochester, New York, resulted from AHRQ’s Partnerships in Implementing Patient Safety (PIPS) program. Findings of the study, “Survey of Physicians Regarding Clinical Pharmacy Service in Academic Emergency Departments,” are published in the March 15 issue of the American Journal of Health-System Pharmacy. Select access an abstract of the study and to access information on the PIPS project.
11. New Health IT System Allows for Shared Access to Patient Information and Improved Care
AHRQ’s National Resource Center for Health Information Technology has published a new entry in its Health IT Implementation Stories series. AHRQ health IT researchers at Lincoln Health Center, Mattoon, IL, discuss how an ambulatory electronic medical record (EMR) software application is helping prevent serious medical errors from occurring by providing better patient care and improving the way the health care system shares critical information. The new system provides shared access to computerized patient health information across hospital services, home health organizations, hospices, and physician practices. Before the system was installed, hospital staff could not access any patient records during clinic off-hours, despite the fact that the emergency room treats patients on a 24/7 basis. Clinicians who treated patients in the emergency room during these times were not able to access critical patient information such as current medications or health history. As part of the new EMR system, each patient has a "problem list," to let emergency staff know if they have high cholesterol, joint problems, or any other diagnosis that clinicians may need to know. Select to access the story and to access a recent AHRQ Healthcare 411 podcast featuring the lead researcher on this project. To access any of AHRQ's podcasts and special reports or to sign up for a free subscription to the series and receive notice of all future AHRQ podcasts, visit our Healthcare 411 series main page.
12. Latest Issue of WebM&M Is Available Online
The February/March issue of AHRQ WebM&M is now available online. The Perspectives on Safety section focuses on health literacy and safety. The section features Dean Schillinger, M.D., of the University of California, San Francisco, CA, an expert on health literacy and improving care for vulnerable populations. In an accompanying perspective piece, Michael Wolf, Ph.D., and Stacy Cooper Bailey, of Northwestern University, Evanston, IL, describe the role of health literacy and clear health communication in patient safety. The Spotlight Case features Christopher Fee, M.D., of University of California San Francisco (UCSF) Medical Center, and examines issues surrounding transitions in patient care to and from the emergency department. The second case features Timothy Cutler, Pharm.D., of UCSF School of Pharmacy and the University of California Davis Medical Center, and discusses a case study in which medication reconciliation was effective in diagnosing a medication error. In the third case, Hedy Cohen, R.N., of the Institute for Safe Medication Practices, Horsham, PA, describes strategies for maintaining safety when instituting new medication administration policies. Physicians and nurses can receive free CME, CEU, or trainee certification by taking the Spotlight Quiz. You can easily share AHRQ WebM&M cases by using the “Email a colleague” feature.
13. AHRQ in the Patient Safety and Health IT Professional Literature—Some Useful Citations
We are providing the following hyperlinks to abstracts of journal articles describing AHRQ-funded research. If you are having problems accessing the abstracts because of firewalls or specific settings on your individual computer systems, you should ask your technical support staff for possible remedies.
Handley MA, Shumway M, Schillinger D. Cost-Effectiveness of Automated Telephone Self-Management Support with Nurse Care Management Among Patients with Diabetes. Ann Fam Med. 2008 Nov-Dec;6(6):512-8. Select to access the abstract. Hinman AR, Davidson AJ. Linking Children's Health Information Systems: Clinical Care, Public Health, Emergency Medical Systems, and Schools. Pediatrics. 2009 Jan;123 Suppl 2:S67-73. Select to access the abstract. Zhan C, Elixhauser A, Richards CL Jr, Wang Y, Baine WB, Pineau M, Verzier N, Kliman R, Hunt D. Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections from Medicare Claims: Sensitivity and Positive Predictive Value. Med Care. 2009 Mar;47(3):364-9. Select to access the abstract. AHRQ's Patient Safety and Health Information Technology E-Newsletter Contact:
Please address comments and questions regarding the newsletter to Salina Prasad at salina.prasad@ahrq.hhs.gov; (301) 427-1864.
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