News and Updates for Healthcare Professionals

AHRQ offers continuing education (CE) and continuing medical education (CME) videos and articles on a range of health care topics including patient safety and patient-centered outcomes research findings. The CE/CME activities summarize reviews of evidence on the effectiveness and safety of treatments and strategies for improving patient care. These resources provide health care providers with skills and information to support individual decision making and patient management.

The term insomnia is variously defined to describe a symptom and/or a disorder. It involves dissatisfaction with sleep quantity or quality and is associated with one or more of the following subjective reports: difficulty initiating sleep, difficulty maintaining sleep, or early morning waking with inability to return to sleep.

Detailed plan sets course for advancing scientific discoveries and human health.

A new online report provides an easy-to-read overview of recent National Institutes of Health-funded research advances and initiatives in Alzheimer’s disease and related dementias. Issued by the National Institute on Aging (NIA) at NIH, the annual report — 2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Cure — discusses research momentum under the National Plan to Address Alzheimer’s Disease, describes research opportunities, and summarizes scientific advances in several areas:

• Understanding the biology of Alzheimer’s, related dementias, and the aging brain
• Identifying genetic influences on risk for late-onset Alzheimer’s, the most common form
• Detecting the earliest Alzheimer’s-related brain changes, including further development of biomarkers to track the onset and progression of Alzheimer’s
• Understanding gender and racial differences in the impact of Alzheimer’s
• Stepping up translational research enabling the design and testing of new drugs
• Testing in clinical trials potential new therapies to prevent, delay or treat Alzheimer’s
• Finding better ways to support caregivers

The report includes searchable tables of NIA-funded clinical trials that are testing promising interventions for Alzheimer’s disease, mild cognitive impairment, age-related cognitive decline, delirium and dementia-related psychiatric conditions and symptoms—agitation, apathy and depression.

The CDC has released draft guidelines on prescribing opioids for chronic pain days after the National Center for Health Statistics reported a 16.3% jump in opioid overdose-related deaths in 2014. The guidelines, which don’t apply to pain associated with serious diseases or end-of-life care, call for primary care providers to be more conservative when prescribing pain drugs, such as prioritizing physical therapy and other non-opioid treatments. When opioids are needed, prescribers should use the minimum effective dose and short-acting versions of the drugs.

By: Richard Frank, Assistant Secretary for Planning and Evaluation at HHS

New CDC data shows the overall number and rate of drug overdose deaths increased notably between 2013-2014, driven in large part by continued increases in heroin deaths and an emerging increase in deaths involving illicit synthetic opioids. These new data reaffirm that we have not seen the peak of the opioid abuse and overdose epidemic and highlights the need for continued action to prevent opioid misuse and dependence to save lives.

Drug overdose death rates have never been higher. Data shows 18,893 overdose deaths involving opioid pain relievers in 2014, which is an increase of 16%, or 2,658 deaths, compared to 2013 data. Prescription opioid-related overdose deaths are increasing in part because deaths involving synthetic opioids, such as fentanyl and tramadol, increased by 79% from 2013-2014, totaling 5,544 deaths in 2014. Heroin-related deaths have more than tripled since 2010. Heroin-related death rates increased 28% from 2013-2014, totaling 10,574 deaths in 2014. Heroin is often cut with fentanyl – with or without the user’s knowledge – in order to increase its effect.

The opioid epidemic touches all of us. HHS Secretary Sylvia Burwell’s home state of West Virginia, for example, has the highest drug overdose death rate of any state in the country. These statistics reflect what we’re seeing across America, in communities large and small and among people from all walks of life – a rising tide of opioid abuse and overdose.

The U.S. Preventive Services Task Force (USPSTF or Task Force) has released its “Fifth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”

In 2015, the USPSTF continued to fulfill its mission of improving the health of all Americans by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help primary care clinicians and patients to decide together whether a preventive service is right for each patient’s needs.

In this annual report, the USPSTF has prioritized evidence gaps related to women’s health. Research in these areas would generate much needed evidence for important new recommendations to improve the health and health care of women in the United States.

Variation in the BDNF gene may affect brain’s regulation of appetite, study suggests.

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for abnormal blood glucose and type 2 diabetes mellitus. To view the recommendation and the evidence on which it is based, please go to
http://www.uspreventiveservicestaskforce.org. A fact sheet that explains the final recommendation in plain language is also available. The final recommendation statement can also be found in the October 27, 2015 online issue of Annals of Internal Medicine.

NIH-funded study examines medical, care costs in last five years of life.

By: Jamie Roberts, Gaithersburg, Maryland

I’m a nurse and a patient—and I’m tired of hearing from my doctors that although they know what’s wrong with me, they don’t have many ideas for how to fix it. I was having continuing problems with a gastrointestinal (GI) bleed, and when my doctors suggested a risky procedure as a Hail Mary, I finally asked: “What’s the evidence for it?”

That’s why I’m excited about the Precision Medicine Initiative (PMI), announced by President Obama earlier this year. The core of the initiative is a plan to recruit a 1 million national research group of people, known as a cohort, to provide genetic, environmental and lifestyle data. Researchers will be able to use the data collected to make diagnoses and develop treatments that target individuals’ personal conditions.

Whether or not a treatment for my condition is found, I’m excited about this journey.

The recommendations and opinions of health care professionals play an important role in motivating and encouraging behavior change by their patients. Behavioral counseling interventions (BCIs) to promote healthy behaviors can significantly reduce leading causes of disease and death in the United States such as heart disease, cancer, stroke, diabetes, and lung disease. Recommendations for delivery of these interventions in primary care have been and continue to be an important part of the U.S. Preventive Services Task Force (USPSTF) portfolio of clinical preventive services recommendations. However, research on effective BCIs can be more challenging to understand and integrate into recommendations for primary care than other clinical preventive services such as screening or use of preventive medications. Researching and evaluating the effectiveness of behavioral counseling interventions can also be challenging. AHRQ recently sponsored a special supplement to the September 2015 issue of the
American Journal of Preventive Medicine (AJPM), titled Evidence-Based Behavioral Counseling Interventions as Clinical Preventive Services: Perspectives of Researchers, Funders, and Guideline Developers. The supplement addresses research design and reporting characteristics needed by BCI researchers, and present other perspectives on the evidence needed for integration of BCIs into primary care to include the feasibility dissemination and implementation.

For more information about AHRQ’s Practice Improvement efforts visit the National Center for Excellence in Primary Care Research at http://www.ahrq.gov/professionals/systems/primary-care/index.html.

More patients are getting the right treatment at the right time for their health condition, but progress remains modest for patients with chronic diseases such as diabetes and asthma, according to AHRQ’s recently released
Chartbook on Effective Treatment. Overall, about half of the 46 measures of effective treatment showed improvement. Nine of those measures reached optimal performance, including two related to effective treatment for heart disease—providing percutaneous coronary intervention to heart attack patients within 90 minutes and prescribing certain classes of drugs to treat heart disease upon hospital discharge. Meanwhile, four measures worsened over time, including two measures related to effective management of diabetes and one measure of regular use of medications to prevent asthma attacks. Research summaries for clinicians on management of diabetes and management of heart and blood conditions are available from AHRQ’s Effective Health Care program.

HHS Secretary Sylvia M. Burwell today announced six new members to serve on the Advisory Council on Alzheimer’s Research, Care, and Services. The Council was established in 2011 and convenes quarterly to continue development and progress on the National Plan to Address Alzheimer’s Disease by HHS, Veterans Affairs, the Department of Defense, and the National Science Foundation to address the disease. The new members will replace the members whose terms had expired and those that retired in September and will advise the secretary on federal programs that affect people with Alzheimer’s disease and related dementias, and they will serve overlapping four-year terms.

The American Board of Medical Specialties (ABMS) has announced that it will provide an extra incentive for physicians participating in AHRQ’s EvidenceNOW: Advancing Heart Health in Primary Care initiative. ABMS issued a press release on October 5 noting that physicians who are board certified by one of 20 of the 24 ABMS member boards may now receive maintenance of certification credit for participating in EvidenceNOW. The goal of EvidenceNOW is to help clinicians in small primary care practices systematically implement the latest evidence to help prevent heart attacks and stroke. Through seven regional cooperatives, EvidenceNOW will provide quality improvement services for approximately 1,750 practices with more than 5,000 primary care professionals serving approximately 8 million people.

For more information about AHRQ’s Practice Improvement efforts, visit the National Center for Excellence in Primary Care Research at http://www.ahrq.gov/professionals/systems/primary-care/index.html.

Materials synthesizing valuable insights and lessons learned from three AHRQ-funded grant initiatives on the transformation of primary care practices into patient-centered medical homes (PCMHs) are now available on the
AHRQ Web site: http://www.ahrq.gov/professionals/systems/primary-care/tpc/index.html.

These materials can be used by those considering primary care transformation and those who are interested in understand the primary care transformation process:

• Transforming Primary Care Practice (TPC) grants evaluated the process that primary care practices undergo as they transform into PCMHs. Materials related to this grant initiative include short profiles summarizing each project, a
  journal supplement in the Annals of Family Medicine, an annotated bibliography of the more than 50 peer-reviewed articles resulting from this grant initiative, and a
  summary report synthesizing findings across the 14 grants.
• Estimating the Costs of Supporting Primary Care Practice Transformation grants explored the costs of implementing and sustaining transformative primary care practice redesign, including the direct costs of primary care transformation, such as staff time and equipment, and indirect costs, such as overhead and forgone revenue. Many studies also estimated the costs of attaining and maintaining PCMH recognition. Materials developed for this grant initiative include
  short profiles summarizing each project and a
  practical guide for measuring the costs of primary care transformation.
• Infrastructure for Maintaining Primary Care Transformation (IMPaCT) grants provided funding to State-level initiatives that provided a quality improvement infrastructure for primary care through primary care extension agents. Each of the four “model” IMPaCT States developed collaborations with three or four “partner” States to share the successful infrastructure they had developed. Materials developed for this grant initiative include
  short profiles summarizing key aspects of each project, success stories highlighting unique accomplishments of each grant in its partner States, and a
  summary report.

For more information about AHRQs Practice Improvement efforts visit the National Center for Excellence in Primary Care Research at
http://www.ahrq.gov/professionals/systems/primary-care/index.html.

Health and Human Services Secretary Sylvia M. Burwell today announced $685 million in awards to 39 national and regional health care networks and supporting organizations to help equip more than 140,000 clinicians with the tools and support needed to improve quality of care, increase patients’ access to information, and reduce costs. The Transforming Clinical Practice Initiative is one of the largest federal investments designed to support doctors and other clinicians in all 50 states through collaborative and peer-based learning networks.

By Joanne Lynn

Marcy Houle’s father was once abruptly discharged from a hospital to a nursing home that lost him! He went without water for so long that he developed renal failure. Those are just a couple of the calamities that Marcy encountered in caring for her parents, as described in her book, The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare. Co-author and geriatrician Dr. Elizabeth Eckstrom spells out how family caregivers might limit the harms. What’s missing? Effective anger! What happened is intolerable. But we need useful strategies that mobilize political force to insist upon change!

The problems in the care of the elderly are not “errors” in the usual sense of mistakes. In fact, they are baked right into our current delivery system. It was not simply that a nurse or aide slipped up on some critical step. Instead, all the nurses and aides and everyone else are working in a system that is so dysfunctional that actions that cause pain or neglect are not even called out as errors. Consider the profound error of simply not knowing what matters most to patients and their loved ones. Consider that patients have to use the emergency room, because that’s all we offer when things go badly, not on-call physicians or substitute caregivers who can deal with problems at home. Consider that we don’t have home-delivered meals for many elderly persons in need in most of the country; the wait lists often take more than 6 months, because we have not chosen to fund the Older Americans Act adequately. This is unacceptable! How can we complain effectively? Each family somehow believes that its situation is just bad luck or “how things are.” People have no benchmark by which to set expectations, so they accept the errors, suffering, and impoverishment that so often come with disabilities in old age.

Let’s change that. Let’s start raising the issues everywhere that we can: in the newspapers, in the candidate debates, when your Congressional representatives are in town, and in social media. Let’s build some highly reliable, person-centered elder care systems in our communities and see what it really costs. Let’s figure out how family caregivers can become politically powerful.

We’ve started an initiative to get family caregiver issues on the party platforms in all the states that generate party platforms. You can join the Family Caregiver Platform Project effort. It takes very little time and gets leaders talking. Go to http://caregivercorps.org to sign up. Tell them your stories, and fire up the anger. What else can you think of? We need other leverage points that would focus the pent-up frustration of millions of family members who have already witnessed the misery of ordinary elder care. That is a story that we can all absorb and tell others, and then we can go out and insist that our care system change. If we are lucky, we will all grow old. So it’s our future, too, not just our parents’!

Read more about refusing to tolerate errors in eldercare in our blog at MediCaring.org

A panel at the Institute of Medicine urges communication between clinicians and patients to help reduce diagnostic errors.

Read the full article here:
Most Americans will be misdiagnosed at least once

The U.S. Preventive Services Task Force released today a final recommendation statement on behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women. To view the recommendation and the evidence on which it is based, please go to
http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions. A fact sheet that explains the final recommendation in plain language is also available. The final recommendation statement can also be found in the September 22 online issue of Annals of Internal Medicine.

To succeed in patient engagement, healthcare providers must embrace mobile. But how to prioritize the various innovative trends in mobile technology? What works, and what does not? In this new whitepaper, we share the latest research and the most successful mobile use cases:

A comprehensive guide for healthcare executives on:

• Hospital Apps and their Role in Patient Engagement.
• The State of Wearables in Healthcare – Time to Make a Move?
• 6 Proven Steps to Develop an Efficient Mobile Use Case.

Make informed decisions and build a successful mobile strategy for your organization!

By: Don Dean, Spartanburg, South Carolina

One tumor is a difficult thing to face. Imagine having nearly 100.

Like my father, aunt, uncle and other relatives, I have a very rare hereditary condition where a mutation in what is called the MET gene causes cancerous tumors to continuously grow in my kidneys. Since my first visit to the National Institutes of Health in 1992, I’ve had to have one kidney removed and nearly 100 tumors excised from the other.

I lost my father and other relatives to this disease, but thanks to new advances in medicine, that doesn’t have to be my fate.

What I did not know at the time was that I was to be part of cutting edge science and medical care that’s become known as Precision Medicine. Precision medicine refers to treatments, therapies, and care tailored to individual patients. By looking at people’s specific genes and lifestyles, doctors and scientists, like those at NIH, can get the right treatment to the right person.

Health and Human Services Secretary Sylvia M. Burwell today kicked off a two-day intensive convening of representatives from all 50 states and Washington, DC focused on preventing opioid overdose and opioid use disorder. During her remarks, the secretary announced that HHS will move to expand access to medication-assisted treatment (MAT) by revising the regulations related to the prescribing of buprenorphine to treat opioid dependence. She also announced $1.8 million in awards to rural communities to expand access to naloxone – a drug that reverses an opioid overdose.

Read more about today’s announcement

The United States Surgeon General today issued a call to action to address major public health challenges such as heart disease and diabetes. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities articulates the health benefits of walking while addressing the fact that many communities unacceptably lack safe and convenient places for individuals to walk or wheelchair roll.

Read more about today’s announcement

The video of the symposium may be viewed on the Altarum Institute website.

On this Web page you will also see the PowerPoint presentations plus resources from the prior symposia.

The event recording is now on-demand, should you like to view it.
Use the link below to enter the webcast at any time.
WEBCAST LINK: http://event.on24.com/wcc/r/1029976/9D6A71170580605842F055BF91549D85

In Case You Missed It

You can also view recordings of our most recent webinars by clicking them below:

• April 30, 2015: “Harnessing the Power of Your EHR for Quality Improvement”
• February 26, 2015: “Introducing AHRQ’s Expanded Practice Facilitation Training Curriculum”
• January 29, 2015: “Engaging patients as partners in care: How practice facilitators can support patient engagement”
• December 18, 2014: “Supporting Leaders to Promote Quality and Patient Safety: How practice facilitators can work with practice leadership to support a culture of safety and quality”
• October 21, 2014: “Training practice facilitators to help primary care practices improve use of health information technology”
• August 14, 2014: “Case Studies of Exemplar Primary Care Practice Facilitation Training Programs”

If you have comments or questions, please contact us at PracticeFacilitation@mathematica-mpr.com.