AHRQ Electronic Newsletter, Issue #287

February 26, 2010, Issue #287
AHRQ News and Numbers

Nearly 58 percent of the surgeries performed in hospitals were done as outpatient procedures. Outpatient surgery charges for hospitals totaled $55.6 billion, compared with $259 billion for inpatient surgeries. [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #86: Hospital-Based Ambulatory Surgery, 2007.

Today’s Headlines:

Today’s Headlines:

1. New AHRQ funding opportunity announcement for comparative effectiveness delivery system research released

2. Seeking public comment on CHIPRA Children's Health Care Quality Measures through March 1

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

4. AHRQ announces interest in research on health care-associated infections in ambulatory care settings

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

6. New AHRQ evidence report on colorectal cancer screening use is available

7. AHRQ introduces new online technical tutorial series with first module on HCUP sample design

8. AHRQ releases 2007 hospital emergency department data

9. New AHRQ evidence report and tools to identify and run alternate care facilities is available

10. New AHRQ evidence report on lactose intolerance and health is available

11. Register for AHRQ User Group Meeting for Surveys on Patient Experience and Patient Safety Culture

12. New program brief on community-based participatory research is available

13. AHRQ in the professional literature

1. New AHRQ Funding Opportunity Announcements for Comparative Effectiveness Delivery System Research Released

AHRQ issued three funding opportunity announcements (FOAs) under the American Recovery and Reinvestment Act of 2009. The first FOA, ARRA OS Recovery Act 2009 Limited Competition: Comparative Effectiveness Delivery System Evaluation Grants (R01) is seeking applications to conduct rigorous comparative evaluations of alternative system designs, change strategies, and interventions that have already been implemented in health care and are likely to improve quality and other outcomes. AHRQ anticipates funding between 6 and 10 awards that together total $7 million. Applicants may receive no more than $500,000 annually for up to three years. Deadline to submit an application is March 18. The second FOA,
Accelerating Implementation of Comparative Effectiveness Findings on Clinical and Delivery System Interventions by Leveraging AHRQ Networks (R18) is seeking applications that promote the increased implementation and widespread use of findings from comparative effectiveness research that have been demonstrated to improve the prevention, diagnosis, management, or treatment of a clinical condition or to otherwise improve care quality, improve access to care, reduce disparities, or improve population-based measures of health outcomes. AHRQ anticipates funding up to 10 awards that together total $13 million. Applicants may receive no more than $5 million annually for up to three years. Deadline to submit an application is March 24. The third FOA, Research Demonstration and Dissemination Grant is seeking applications to conduct demonstrations of (1) broad strategies and/or specific interventions for improving care by redesigning care delivery, or (2) strategies and interventions for improving care by redesigning payment. The demonstrations will aim to achieve major improvements in care quality (including clinical outcomes and other dimensions), improve access to care, reduce disparities, or improve population-based measures of health outcomes. The demonstration will address issues related to HHS priorities, including those of Medicare and Medicaid. AHRQ anticipates making three to six awards, which will not exceed $5 million in total funding; typical awards may be smaller than this amount. A total of $12 million is available to fund applications under this FOA. Deadline to submit an application is March 23.
http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-012.html

http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-014.html

http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-10-013.html


2. Seeking Public Comment on CHIPRA Children's Health Care Quality Measures Through March 1

HHS Secretary Sebelius is seeking public comments as required by CHIPRA on the initial, recommended core set of children's health care quality measures. The deadline to submit comments is March 1. Select to access background information with a description of the process used to identify the core set and details on the recommended measures. Select to read the December 29 Federal Register notice.

http://www.ahrq.gov/chip/chipraact.htm#Core

http://www.gpo.gov/fdsys/pkg/FR-2009-12-29/html/E9-30802.htm


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, know 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 in to 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 was published in the February 4 issue of the British Medical Journal. Select to access the abstract in PubMed®.

http://www.ncbi.nlm.nih.gov/pubmed?term=sustaining+reductions+in+catheter+related+bloodstream&TransSchema=title


4. AHRQ Announces Interest in Research on Health Care-Associated Infections in Ambulatory Care Settings

AHRQ has recently issued a special emphasis notice focused on addressing health care-associated infections (HAIs) within ambulatory care settings—non-acute, non-residential settings including practitioner offices, clinics, outpatient departments of hospitals, large or small group practices, community health centers, emergency departments, ambulatory surgery centers, dialysis centers, home care, dental offices, mental health centers, occupational health centers, school health facilities, nursing homes and inmate health facilities. This notice provides the following research priorities for investigator-initiated applications for fiscal year 2010: 1) development, implementation and demonstration of the prevention of HAIs; 2) determination of the efficacy, effectiveness, and costs of preventive interventions; and 3) population level studies on the patient risk factors, sources and disease genotypes of antibiotic resistant organisms that can result in HAIs. AHRQ anticipates awarding approximately $10 million in HAI-related grants in fiscal year 2010, which ends September 30. Select to learn more about the Special Emphasis Notice and select to read the announcement.

http://grants.nih.gov/grants/guide/pa-files/PA-09-070.html


5. 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 (HAIs). 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.

http://grants.nih.gov/grants/guide/pa-files/PA-10-089.html


6. New AHRQ Evidence Report on Colorectal Cancer Screening Use Is Available

Despite national recommendations supporting screening for colorectal cancer—a disease that kills an estimated 50,000 Americans a year—screening is still underused, especially by low-income people, the uninsured, Asians and Hispanics, foreign-born people, and/or those with limited English-language skills according to a new AHRQ evidence report. The reviewers, led by Debra J. Holden, Ph.D., found some increase in screening using colonoscopy, but rates of screening by sigmoidoscopy and fecal occult blood testing are decreasing. The reviewers also looked for evidence on strategies for encouraging colorectal cancer screening and found that some, such as contacting people to remind them to get screened, increased screening. Other strategies, including using printed matter and videos messages, either did not increase rates or produced mixed results. However, it is not clear that any specific set of interventions will increase screening rates nationally. The reviewers found no studies of how colorectal cancer screening has been effectively monitored, nor did they find any that systematically measured its quality. The report, Enhancing the Use and Quality of Colorectal Cancer Screening, was prepared by AHRQ’s RTI-UNC Evidence-Based Practice Center for the NIH State-of-the Science Conference on Enhancing the Use and Quality of Colorectal Cancer Screening held on February 2-4. Select to access the report (PDF File, 226 pages, PDF Help). A print copy is available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.

http://www.ahrq.gov/downloads/pub/evidence/pdf/crcuse/crcuse.pdf


7. AHRQ Introduces New Online Technical Tutorial Series With First Module on HCUP Sample Design

AHRQ is offering a new online training course on Healthcare Cost and Utilization Project (HCUP) Sample Design as the first technical course in a new HCUP Online Tutorial Series. The sampling course assists users in understanding the sampling strategy of the three HCUP nationwide databases: the Nationwide Inpatient Sample (NIS), the Kids’ Inpatient Database (KID), and the Nationwide Emergency Department Sample (NEDS). The HCUP Online Tutorial Series provides HCUP data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data. The courses are designed to answer technical questions related to HCUP data and programs. Modules on loading and checking HCUP data and producing national and regional estimates will be released later this year. For new HCUP users, the HCUP Overview Course is very helpful. For more information, contact HCUP User Support at hcup@ahrq.gov.

http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp

http://www.hcup-us.ahrq.gov/overviewcourse.jsp


8. AHRQ Releases 2007 Hospital Emergency Department Data

AHRQ's Healthcare Cost and Utilization Project (HCUP) released 2007 data for its Nationwide Emergency Department Sample, the largest emergency department database in the US. It can be used to generate statistics on hospital emergency department visits by patients with various types of coverage as well as the uninsured, can help researchers and others find answers to questions about issues such as the access to and use of hospital emergency departments by Americans as a whole and policy-relevant groups like the low-income and uninsured, quality and effectiveness of care, charges, and impact of policy changes. For example, the data show that in 2007, the uninsured accounted for nearly one-fifth of the 122 million emergency department visits, Medicaid and Medicare each accounted for about a fifth, and the rest were made by privately insured patients. However, Medicare patients accounted for half of all cases severe enough to require hospital admission. Select for more information about the Nationwide Emergency Department Sample.

http://www.hcup-us.ahrq.gov/nedsoverview.jsp


9. New AHRQ Evidence Report and Tools to Identify and Run Alternate Care Facilities Is Available

AHRQ released an updated evidence report that explains how to select and operate alternate care facilities—locations that can easily and quickly be equipped to augment or replace health care services when hospitals and other traditional care sites are inoperable or overwhelmed. The report, Disaster Alternate Care Facilities: Selection and Operation, includes input from planning and preparedness experts in public, private, and government sectors who have real-world experience in standing up and running alternate care facilities. The report supports two Web-based interactive tools that provide user-customized plans to implement key components discussed in the report: site selection and the transfer of patients. The tools are: Disaster Alternate Care Facility Selection Tool and Alternate Care Facility Patient Selection Tool. The resources were developed for AHRQ through a contract with Denver Health with support from the Health Resources and Services Administration.

http://www.ahrq.gov/prep/acfselection/dacfrep.htm

http://www.ahrq.gov/prep/acfselection/dacfrep.htm

http://www.ahrq.gov/prep/acfselection/pselectmatrix/(S(k5wcuf45taqwbeex2r24lmji))/Default.aspx


10. New AHRQ Evidence Report on Lactose Intolerance and Health Is Available

AHRQ released a new evidence report that found insufficient evidence on how dairy-free diets affect long-term gastrointestinal and bone health. Researchers found minimal data suggesting that adults with milk intolerance and lactose malabsorption had greater odds of fractures and worse bone outcomes. They also found limited and low quality evidence that treatment with lactose reduced milk products may result in clinical improvements in select gastrointestinal symptoms in select individuals diagnosed with lactose intolerance or lactose malabsorption. Researchers, led by Timothy J. Wilt, M.D., M.P.H, of AHRQ’s Minnesota Evidence-based Practice Center, concluded that a majority of individuals diagnosed with lactose intolerance can likely tolerate up to 12 grams of lactose (1 cup of milk) at a given sitting with no symptoms, especially if consumed with other foods. Therefore, most individuals (either self or clinically diagnosed) can consume a sufficient amount of dairy products daily to meet minimum recommendations without incurring gastrointestinal symptoms. However, as the dose is increased above 12 grams, intolerance in individuals becomes more prominent, with doses of 24 grams usually yielding appreciable symptoms. The report, Lactose Intolerance and Health, prepared for the NIH Consensus Development Conference: Lactose Intolerance and Health, February 22-24, 2010, also found insufficient evidence that probiotics or colonic adaption improves symptoms. Select to access the report (PDF File)
(PDFHelp). A print copy is available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.

http://www.ahrq.gov/downloads/pub/evidence/pdf/lactoseint/lactint.pdf


11. Register for AHRQ User Group Meeting for Surveys on Patient Experience and Patient Safety Culture

AHRQ is sponsoring a free joint meeting on April 20-21 for users of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys and the AHRQ Surveys on Patient Safety Culture. Learn how health care organizations are using the CAHPS surveys and the Surveys on Patient Safety Culture to assess and improve patient experience and patient safety. The meeting will be held at the Hyatt Regency Hotel, Baltimore, MD. Pre-conference sessions designed for new survey users, as well as more advanced users, will be held on April 19. Select for more information and to register.

https://www.cahps-sopsugm.org/ugm/ugmoverview.aspx


12. New Program Brief on Community-Based Participatory Research Is Available

AHRQ has released a new publication, AHRQ Activities Using Community-Based Participatory Research to Address Health Care Disparities, highlighting research that has successfully followed the model of Community-Based Participatory Research designed to establish structures to increase the value of research for both researchers and the communities participating in the studies. Select to access the program brief.

http://www.ahrq.gov/research/cbprbrief.htm


13. 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.

Marín HA, Ramírez R, Wise PH, et al. The effect of Medicaid managed care on prenatal care: the case of Puerto Rico. Matern Child Health J 2009 Mar; 13(2):187-97. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/18484174

Radwin LE, Cabral HJ, Wilkes G. Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system. Res Nurs Health 2009 Feb; 32(1):4-17. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/18814304

Auble TE, Hsieh M, Yealy DM. Differences in initial severity of illness between black and white emergency department patients hospitalized with heart failure. Am Heart J 2009 Feb; 157(2):306-11. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/18814304

Lee I, Fishman NO, Zaoutis TE, et al. Risk factors for Fluconazole-resistant Candida glabrata bloodstream infections. Arch Intern Med 2009 Feb 23; 169(4):379-83. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/19237722

Patkar NM, Curtis JR, Teng GG, et al. Administrative codes combined with medical records based criteria accurately identified bacterial infections among rheumatoid arthritis patients. J Clin Epidemiol 2009 Mar; 62(3):321-7, 327.e1-327.e 7. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/18834713

Stucky ER, Dresselhaus TR, Dollarhide A, et al. Intern to attending: assessing stress among physicians. Acad Med 2009 Feb; 84(2):251-7. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/19174680

Olfson M, Cherry DK, Lewis-Fernández R. Racial differences in visit duration of outpatient psychiatric visits. Arch Gen Psychiatry 2009 Feb; 66(2):214-21. Select to access the abstract in PubMed®.
http://www.ncbi.nlm.nih.gov/pubmed/19188544


Contact Information
Please address comments and questions regarding the AHRQ Electronic Newsletter to Nancy Comfort at Nancy.Comfort@ahrq.hhs.gov or (301) 427-1866.