EHC Program Inside Track Newsletter

Issue 26, August 2014

Highlighting important news and developments from AHRQ’s Effective Health Care Program

In this issue:

New AHRQ Center Supports Increased Use of Evidence To Improve Care

The Agency for Healthcare Research and Quality (AHRQ) has established the new Center for Evidence and Practice Improvement (CEPI) to support one of its recently announced priority areas: improving health care quality by accelerating implementation of findings from patient-centered outcomes research (PCOR).

The new Center realigns the functions of two AHRQ Centers— the Center for Outcomes and Evidence and the Center for Primary Care, Prevention, and Clinical Partnerships.

The new Center will unify the Agency's efforts and investments to accelerate practice improvement through the increased use of medical evidence and evidence-based information tools. CEPI will solicit input from external partners and work with the U.S. Department of Health and Human Services (HHS) to ensure that evidence is communicated, understood, and used by health care professionals, as well as patients and families, to improve the health care system for everyone.

CEPI consists of five divisions:

Evidence-based Practice Center Program
U.S. Preventive Services Task Force Program
Division of Decision Science and Patient Engagement
Division of Health Information Technology
Division of Practice Improvement

The Center will also house the National Center for Excellence in Primary Care Research, which serves as the principal source of funding for primary care practice research in HHS.

To learn more about CEPI, please visit www.ahrq.gov/cpi/centers/cepi.

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Resources Spotlight: New CME/CE Activities

Four free continuing medical education/continuing education activities based on AHRQ-funded research are available on a new Agency Web page. They are—

Both of these resources explore how screening can impact patient outcomes and give information to help health care providers and patients make the best possible decisions. The video features AHRQ-supported researcher Dr. Roger Chou, associate professor of medicine at Oregon Health & Science University and director of the Pacific Northwest Evidence-based Practice Center. Additional AHRQ resources on hepatitis C testing include a clinician research summary that outlines the clinical bottom line, a patient summary of treatment approaches, a slide set for clinicians to share the evidence with colleagues and students, and the full research review.

First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness

This monograph compares first- and second-generation antipsychotic medications in adults with schizophrenia, schizophrenia-related psychoses, or bipolar disorder. The activity, based on a comparative effectiveness review (CER) from AHRQ's Effective Health Care (EHC) Program, reviews evidence comparing the effectiveness and side effects of individual drugs and provides questions for patients and health care providers to consider before choosing a treatment. Previous materials related to this subject include a patient summary of antipsychotic medications for adults, a clinician research summary that outlines the clinical bottom line of this CER, an educational slide set for clinicians to share the evidence with colleagues and students, and the full research review.

Child Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Maltreatment

This streaming video explores the effectiveness of interventions used to treat children who experience trauma resulting from maltreatment. While several interventions show promise, the video explores major research gaps and highlights the need for collaborative clinical trials supported by a multisite research network. This video is based on AHRQ's 2013 evidence report Child Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Maltreatment.

Each activity is accredited for a variety of health care professionals. More activities will be available soon.

Illustration of a male doctor and a female patient facing each other. The doctor is holding a clipboard and has a stethoscope around his neck. The text reads: Have you or one of your colleagues found out EHC Program materials helpful in your medical practice? Would you like more information? If so, we would love to hear from you. Email us at EHC_Outreach@ahrq.hhs.gov.

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More Resources From the Effective Health Care Program

Funding Opportunity To Accelerate Use of Recommended System Practices

AHRQ seeks to award cooperative agreements to as many as three Centers of Excellence on Comparative Health Systems as part of its dissemination of PCOR. A funding opportunity announcement (FOA) seeks applications to improve the uptake of PCOR findings among health care organizations and their clinicians. The FOA— Comparative Health System Performance in Accelerating PCOR Dissemination (U19) – also aims to compare the performance of these systems to each other and to the performance of more traditional forms of delivery system. Deadline for applications is October 17. The goal is to provide a better understanding of health care delivery systems in order to better target PCOR dissemination so that systems can more quickly adopt high-performance practices and improve patient outcomes.

AHRQ Report Provides Important Reassurances About the Safety of Commonly Used Vaccines

Serious adverse events resulting from vaccines routinely used in the United States are rare, according to an AHRQ research report that provides the most comprehensive review to date of published studies on the safety of routine vaccines. The report cited strong scientific evidence related to several common concerns about vaccines. Among the report findings: there is not a link between measles, mumps, and rubella (MMR) vaccines and autism; there is not a link between pneumonia and influenza vaccines and cardiovascular or cerebrovascular events in the elderly; and there is not a link between MMR; diphtheria, tetanus, and pertussis (DTaP); tetanus and diphtheria (Td); Haemophilus influenzae type b (Hib); and hepatitis B vaccines and childhood leukemia. Given the lack of available evidence, meanwhile, more research is needed on whether several routinely recommended vaccines are associated with serious conditions such as multiple sclerosis (MS), transverse myelitis, and acute disseminated encephalomyelitis (ADEM). These findings are available in the research review Safety of Vaccines Used for Routine Immunization of Adults (Including Pregnant Women) and Children.

Cardiac Troponin Elevations Linked With a Worse Prognosis for Kidney Disease Patients

According to the latest research review from AHRQ, in patients with chronic kidney disease (CKD), higher levels of the protein cardiac troponin are associated with a worse prognosis for those with and without suspected acute coronary syndrome (ACS). For dialysis patients without suspected ACS, increased troponin T or I, which is a measurement of heart enzymes, is a strong predictor of death. However, there is insufficient evidence to conclude whether elevated troponin provides strong incremental predictive value over and above carefully assessed clinical risk factors for coronary artery disease and mortality. These findings are available in the research review Cardiac Troponins Used as Diagnostic and Prognostic Tests in Patients With Kidney Disease.

Now Available in E-book: User's Guide on Developing Patient Registries

Registries for Evaluating Patient Outcomes: A User's Guide: 3rd Edition, an AHRQ EHC Program publication, is now available in e-book format. This user's guide provides information on the design, implementation, analysis, interpretation, and evaluation of registries for patient outcomes. Download the user's guide for free or access the guide in e-book file formats, designed to be read with e-book readers (e.g., Nook, Kindle, iPad), from the EHC Program.

Behavioral Interventions Beneficial for Children With Autism Spectrum Disorder

New research suggests that behavior-focused therapies have positive results for some children with autism spectrum disorder (ASD), according to an updated research review from AHRQ. The quality of research studies on these therapies has improved since AHRQ's 2011 review of studies on ASD, which found that many, but not all, young children who receive early intervention with intensive, long-term, applied behavior analysis (ABA)-types of approaches showed improvements in cognitive and language skills as compared to children receiving other interventions. Therapies focusing on social skills showed some positive effects on social behaviors for older children in small studies. Studies examining the effects of cognitive behavioral therapy (CBT) on anxiety report positive results in older children with average intelligence. Identifying which interventions show promise for which specific children with ASD is an important area for future research. It will also be important to gain a better understanding of which interventions work across different types of treatment settings. These findings are available in the research review Therapies for Children with Autism Spectrum Disorder: Behavioral Interventions Update.

New Journal Supplement on Methods for Studying Rare Diseases

A new AHRQ-sponsored journal supplement that explores innovative research methods for studying health outcomes in rare diseases is now freely available online from AHRQ and the Journal of General Internal Medicine (JGIM). The supplement includes more than 15 articles on important research being done in the United States and abroad to improve methods for studying health outcomes in people with rare and complex diseases, who are part of a patient community that is increasingly recognized in primary care and in health policy discourse. Topics include integrating stakeholder involvement in assessing health outcomes; economic, regulatory, ethical, legal, and social issues related to the study of rare disease health outcomes; emerging data sources and novel analytic methods for observational research; and studying patients' health outcomes in clinical trials. Articles are intended for researchers, clinicians, health policy makers, and other stakeholders. The supplement was developed through AHRQ's new Center for Evidence and Practice Improvement. Articles can be downloaded for free from AHRQ.

New Technical Brief on Decision Aids for Adult Advance Care Planning

According to a technical brief developed on the state of practice and current research for decision aids for adult advance care planning (ACP), numerous decision aids are widely available but not represented in the empirical literature. Of the 16 published studies testing decision aids as interventions for adult ACP, most were proprietary or not openly available to the public. Decision aids tend to be constructed for the general population or for disease-specific conditions for narrower decision choices. An important concern is designing decision aids that are responsive to diverse philosophical perspectives and flexible to change as people gain experience with their personal illness courses. Future directions for effort include further research, training of ACP facilitators, dissemination and access, and the potential opportunities that lie in social media or other technologies. These findings are available in the technical brief Decision Aids for Advance Care Planning.

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Current as of August 2014

Internet Citation: EHC Program Inside Track Newsletter: Issue 26, August 2014. August 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/insidetrack/26/index.html