News and Updates for Healthcare Professionals

This report considers issues related to acute and chronic pain management and substance use disorders (SUD). The guidance provided aims to achieve the application of the proper healthcare quality metrics across the U.S. healthcare system. Using the best metrics, in turn, seeks both to continue to reduce opioid deaths verifiably, to encourage the implementation of best practices of pain management, to decrease the incidence of other SUDs, and to decrease illegal drug use by those unable to obtain prescription pain medication.

Researchers have discovered a neural signature that predicts whether individuals with depression are likely to benefit from sertraline, a commonly prescribed antidepressant medication. The findings, published in Nature Biotechnology, suggest that new machine learning techniques can identify complex patterns in a person’s brain activity that correlate with meaningful clinical outcomes.

A new guide to help primary care practices manage patients taking opioids for chronic pain is highlighted in a new post by AHRQ Director Gopal Khanna, M.B.A. The new Self-Service How-To Guide helps practices implement the AHRQ-funded Six Building Blocks, a structured, systems-based approach to treating patients who use long-term opioid therapy. Clinicians and staff, quality improvement personnel, practice coaches, and clinic administrators can use the new guide to implement the Six Building Blocks in a three-stage,15-month timeline. Developing tools and resources to reduce opioid overdoses and the prevalence of opioid use disorder is a priority for the U.S. Department of Health and Human Services and AHRQ.

NIH study shows treatment recommendations impacted by patient and physician factors.

Several health literacy research tools are developed from the funding and support of the federal government. Visit our website to see how the National Institutes of Health, the U.S. Department of Education and others support health literacy research.

The ideas people have about health, the languages they use and the health literacy skills they have, reflect their cultures. Organizations can increase communication effectiveness when they recognize and address cultural differences that may contribute to miscommunication. Our website has resources to help you improve your cross-cultural communications skills.

Community organizations are incorporating health literacy strategies to contribute to the well-being of their community. Check out our website for more resources community organizations offer for your communication needs.

Also, check out the
Clear Communication Index! A research-based tool that helps you develop and assess communication materials for your intended audience.

Safety data analyzed from five NIH inpatient clinical trials

Treatment for Acute Pain: An Evidence Map

Recently, the United States Department of Health and Human Services (HHS) issued new guidance on appropriate tapering or discontinuation of long-term opioid use. The new guide, the HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics, serves as advice to clinicians who are contemplating or initiating a change in opioid dosage for a patient.

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has a rich portfolio of public health efforts to reduce the risks of developing chronic disease and to improve the health and quality of life for those living with chronic disease. This collection from Preventing Chronic Disease features 10 articles that offer insights into the development, implementation, and evaluation of population-based interventions to prevent chronic diseases and to control their effects on quality of life, morbidity, and mortality.

The NCCDPHP Program Evaluation collection shares important evaluation findings and lessons learned from public health and clinical interventions implemented by NCCDPHP, its partners, and its awardees.

Table of Contents

• Teacher Physical Education Practices and Student Outcomes in a Sample of Middle Schools Participating in the Presidential Youth Fitness ProgramLucas IR, Harris C, Lee S, Wargo J, Barnes SP, Kauh TJ, et al
• A Faith-Based Intervention to Reduce Blood Pressure in Underserved Metropolitan New York Immigrant CommunitiesYi SS, Wyatt LC, Patel S, Choy C, Dhar R, Zanowiak JM, et al
• A Change-Management Approach to Closing Care Gaps in a Federally Qualified Health Center: A Rural Kentucky Case StudyCarman AL, Vanderpool RC, Stradtman LR, Edmiston EA
• Putting the National Diabetes Prevention Program to Work: Predictors of Achieving Weight-Loss Goals in an Employee PopulationChakkalakal RJ, Connor LR, Rolando LA, Huang Y, Byrne DW, Awalt BM, et al
• Implementation of Liver Cancer Education Among Health Care Providers and Community Coalitions in the Cherokee NationMomin B, Mera J, Essex W, Gahn D, Burkhart M, Nielsen D, et al
• A Media Campaign to Increase Health Care Provider Assistance for Patients Who Smoke CigarettesJuster HR, Ortega-Peluso CA, Brown EM, Hayes KA, Sneegas K, Gopez G, et al
• Single Cigar Price and Availability in Communities With and Without a Cigar Packaging and Pricing RegulationKephart L, Song G, Henley P, Ursprung WS
• Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant ProgramYarnoff B, Bradley C, Honeycutt AA, Soler RE, Orenstein D
• A Cohort Review Approach Evaluating Community Health Worker Programs in New York City, 2015–2017Feinberg A, Seidl L, Dannefer R, Wyka K, Drackett E, Brown-Dudley L, et al
• Advancing Tobacco Control Through Point of Sale Policies, Providence, Rhode IslandPearlman DN, Arnold JA, Guardino GA, Welsh EB

In this issue of JAMA, Shrank and colleagues report a thorough review of studies published over the past decade to provide updated estimates on the proportion of US health care spending that is wasteful, defined in 6 broad categories: …

Risk factors for chronic disease are multiple and interrelated, having roots in individuals, families, and communities and requiring coordinated strategies across multiple levels and sectors to create conditions that promote and sustain optimal health.

This collection places emphasis on the fact that public health cannot reduce chronic disease rates alone, and neither can health care. Instead, this collection features 16 articles that explore a wide array of new approaches for improving systems and addressing upstream causes, sharing early outcomes and identifying changes in workflows to ease implementation and promote sustainability of improvements.

AHRQ’s Medication-Assisted Treatment for Opioid Use Disorder (MAT for OUD) Playbook serves as a comprehensive guide for implementing MAT in primary care and other ambulatory care settings. The online, interactive playbook contains the latest guidance, tools and resources to address MAT implementation.

2018 National Healthcare Quality and Disparities Report

After communicating with older adults and addressing health literacy barriers, take one last step and check your work. Ask yourself have I:

• considered their comfort with technology and online health information
• researched the health literacy issues for my older adult population

For more of these tips, visit the Clear Communication Checklist on our website.

Engaging patients in decisions about their care has been shown to contribute to positive health outcomes, but physicians and patients need tools to better guide informed conversations, according to AHRQ grantee Alex H. Krist, M.D., M.P.H.

Dr. Krist, a professor in the department of family medicine and population health at Virginia Commonwealth University (VCU) in Richmond, advocates engaging patients in care decisions that are based on the best available evidence and helping them play a more active role in creating their own care plans. His work as an AHRQ-funded primary care researcher and as a clinician and faculty member in VCU’s family medicine residency program reflects this conviction.

For example, when patients learn about the benefits and risks of screening recommendations, “they can really be active participants in managing their health and working with their care team to get the care they want,” Dr. Krist said. Engaged patients can also ask more informed questions or raise concerns about screenings for breast, prostate, and colon cancer, which collectively account for 10 percent of all U.S. primary care visits, according to Dr. Krist.

He received an AHRQ-funded grant in 2007 to create an interactive preventive health record called MyPreventiveCare that was designed to help patients better understand their care options in a manner that reflects their individual values and concerns. The health record combined information about a patient’s clinical status, family history, and health behaviors with preventive care recommendations, including those from the U. S. Preventive Services Task Force Link to Exit Disclaimer (USPSTF), of which Dr. Krist is a vice chair. Patients had access to a personalized overview of preventive services in plain language, as well as motivational messages, links to additional resources, decision aids, and reminders.

Initially implemented in eight primary care practices in Virginia, the tool helped prepare patients and clinicians for specific conversations or decisions, according to Dr. Krist. “Patients can go in and have a whole different discussion with their clinician, whether it’s a more shared decision, or whether it’s participating more in creating their treatment plans,” he said. The system is now used by nearly 50 practices in five States.

Engaging patients with multiple chronic conditions can be more challenging for physicians, however. These patients have complex needs that can be exacerbated by untreated mental health issues, social needs, or unhealthy behaviors.

That’s why Dr. Krist’s latest AHRQ-funded grant, awarded in 2019, will help primary care physicians better understand how to engage patients with multiple chronic conditions in creating their own care plans, with the larger goal of addressing the root causes of poor health.

In the project, patients will be screened for certain health risks and will work with clinicians to prioritize their health needs. When clinicians engage patients with multiple chronic conditions, patients generally identify one or two concerns that are most important to them, according to Dr. Krist. “There’s a reason they’re identifying it. Maybe it’s something they feel they have an ability to change.” Based on this information, clinicians will create a care plan that reflects patients’ preferences.

Dr. Krist is a fellow of the American Academy of Family Physicians and was elected to the National Academy of Medicine in 2018.

Everyone can benefit from communication that is clear and easy to understand. There are many resources to help healthcare organizations lower barriers for people to get and use health information. Check out our website for the “Ten Attributes of Health Literate Health Care Organizations”.

Also, check out the Clear Communication Index! A research-based tool that helps you develop and assess communication materials for your intended audience.

Today, the National Quality Forum in partnership with the Blue Cross Blue Shield Association (BCBSA) released Enhancing Access to Medication-Assisted Treatment, a practical guide that provides concrete strategies, implementation examples, tools, and resources to assist healthcare delivery systems, practitioners, and payers in expanding the use of medication-assisted treatment (MAT) to treat opioid use disorder (OUD).

In 2017 alone, the U.S. experienced over 70 thousand overdose deaths, of which 47 thousand were related to opioids. That is one opioid-related death occurring every 11.4 minutes. MAT is an evidence-based treatment for individuals affected by OUD that utilizes Food and Drug Administration (FDA)-approved medications in combination with behavioral therapies.

Although greatly underused, MAT is often more cost-effective as it has shown to reduce general health care expenditures, emergency care, and other healthcare utilization when compared to other OUD treatments that do not use medication. Building on NQF’s work in Opioid Stewardship and Technical Expert Panel review, this Guide continues efforts to address the opioid crisis by enhancing the capacity and efficiency of clinicians to treat more patients with OUD through MAT.

“With thousands of Americans struggling with an opioid addiction, it’s critical that proven, evidence-based treatments are available for them when they need it,” said Jennifer Atkins, Vice President, Network Solutions at BCBSA. “With the resources and clear pathways for implementation this Guide provides, we will be able to more effectively address this national epidemic that’s affecting an ever-growing number of Americans in communities across the country.”

A number of factors including societal stigmas, limited resources, and a lack of clinician experience and training contribute to the slow adoption of MAT by healthcare practitioners and organizations despite its demonstrated success. This valuable resource provides concrete strategies, implementation examples, tools, and resources for healthcare delivery systems, clinicians, payers, and community organizations to strengthen and put MAT programs into action. For more information, learn about how you can make a difference in the opioid crisis through the actions included in the NQF Medication-Assisted Treatment Guide.

Participants saw improvement in waist circumference, blood pressure, HDL cholesterol, LDL cholesterol, triglycerides, insulin sensitivity and fasting glucose.

Study team identified 17 variants in the ARMC5 gene that were associated with high blood pressure by analyzing genetic research databases that include those of African descent.

The Centers for Medicare and Medicaid Services (CMS) announced today that Minnesota and Nebraska have become the 23rd and 24th states who have received approval under the Trump Administration for innovative demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD).

Under the section 1115 demonstrations, Minnesota and Nebraska are approved to receive Medicaid matching funds for treatment in facilities that meet the definition of an institution for mental diseases (IMD). Since announcing a more flexible approach to these demonstrations through a November 2017 Medicaid policy announcement, the Trump Administration has accelerated efforts to help states combat the national opioid epidemic, decreasing overuse and saving lives.

“The Trump administration is committed to offering a more flexible, streamlined approach to accelerate states’ ability to expand addiction treatment services during this national crisis,” said CMS Administrator Seema Verma, “Whereas only a handful of states were approved for these demonstrations before 2017, our approach has allowed us to approve nearly 20 more demonstrations in just 18 months.” Under the Minnesota demonstration, Medicaid eligible individuals will receive enhanced mental health services through Minnesota’s Certified Community Behavioral Health Clinics (CCBHCs). Temporary expenditure authority will allow CCBHCs to integrate community health care providers to increase rates of identification, initiation, and engagement in treatment for SUD.

CMS expects the Nebraska demonstration will enhance existing substance abuse related services and offer those services to beneficiaries in more appropriate treatment locations, including residential facilities. As a result the anticipated outcome is that more patients will receive a more complete array of required treatments than before the demonstration.

States will monitor and report the impact of changes to address SUD and OUD over the course of the demonstrations. States who have already implemented their programs are beginning to report positive results. For example, Virginia experienced a 4 percent decrease in acute inpatient SUD admissions during the first 10 months of implementation, along with a 6 percent decrease in opioid use disorder inpatient admissions. During the first year, the total number of prescriptions for opioid pain medications among Medicaid beneficiaries decreased by 27 percent while the number of prescriptions for non-opioid pain relievers remained unchanged. In one year of early implementation of the Maryland demonstration, over 8,000 Medicaid beneficiaries received residential treatment services.

Expanding access to treatment for people with opioid use disorder (OUD) is one key strategy identified in CMS’s Roadmap to Address the Opioid Epidemic, which details agency efforts in combatting the opioid crisis. More than two million people suffer from OUD, yet only 20 percent of people with OUD receive treatment. These demonstrations will allow Minnesota and Nebraska to improve access to high quality, clinically appropriate treatment for OUD and other SUDs, in ways that take into account the particular challenges the opioid epidemic has caused in their respective states. Both demonstrations are approved for a five year period beginning on July 1, 2019, and ending on June 30, 2024.

For More information regarding the Minnesota and Nebraska, demonstrations please visit:

Minnesota: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/mn/mn-sud-reform-ca.pdf

Nebraska: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ne/ne-sud-demo-ca.pdf

States with previously approved demonstration approvals include Illinois, New Jersey, Louisiana, Indiana, Kentucky, Utah, Vermont, Pennsylvania, New Hampshire, Washington, North Carolina, Wisconsin, Alaska, New Mexico, Kansas, Rhode Island, Michigan, Massachusetts, Maryland, Virginia, California and West Virginia.

Notice of Funding Opportunity will award 18-month planning grants to at least 10 State Medicaid Agencies

Today, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Funding Opportunity that provides State Medicaid agencies with information to apply for planning grants that will aid in the treatment and recovery of substance use disorders (SUDs), including opioid use disorder (OUD). Fighting the opioid epidemic is one of CMS’s top priorities, and the planning grants are an important step in that effort.

The planning grants are intended to increase the capacity of Medicaid providers to deliver SUD treatment or recovery services through an ongoing assessment of the SUD treatment needs of the State; recruitment, training, and technical assistance for Medicaid providers that offer SUD treatment or recovery services; and improved reimbursement for and expansion of the number or treatment capacity of Medicaid providers. To apply, State Medicaid agencies are required to submit an 18-month proposal by August 9th to increase the capacity of Medicaid providers throughout the State and quickly deliver SUD treatment or recovery services within local communities. CMS will review all of the applications and select at least 10 proposals, with awards totaling $50,000,000.

“CMS is pulling every lever to combat the opioid epidemic, and increasing access to treatments for Americans suffering from substance use disorder is essential to addressing this issue,” said CMS Principal Deputy Administrator for Policy and Operations Kimberly Brandt. State-level innovation has been and will continue to be key in addressing the opioid crisis and this funding opportunity provides states with a significant opportunity to expand access to critical treatments for their citizens.”

CMS has a comprehensive three-pronged approach to combat the opioid crisis, which is laid out in the CMS Roadmap to Address the Opioid Epidemic and focuses on prevention, treatment, and data. The implementation of section 1003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (P.L. 115-27) and the release of this Notice of Funding Opportunity represent a key aspect of our efforts to increase access to evidence-based treatment for OUD.

The application for planning grants is the first step CMS is taking in implementing section 1003 of the SUPPORT for Patients and Communities Act. Enacted on October 24, 2018, the SUPPORT for Patients and Communities Act is a comprehensive bill that tackles multiple aspects of the epidemic including treatment, prevention, recovery and enforcement. Section 1003 authorizes CMS to conduct a 54-month demonstration project to increase substance use provider capacity, beginning with this 18-month planning phase. Upon completion of the planning phase, up to 5 states will be selected to carry out a subsequent 36-month demonstration.

The American Family Physician recently published an editorial about U.S. Preventive Services Task Force recommendations and social determinants of health, authored by Task Force vice chair Alex Krist, Task Force member Karina Davidson, and the Scientific Director of the Task Force program at AHRQ, Quyen Ngo-Metzger. The editorial, entitled “What Evidence Do We Need Before Recommending Routine Screening for Social Determinants of Health?” focuses on:

• The two Task Force recommendations that directly address social determinants of health, screening for intimate partner violence and screening for child maltreatment, and a review of other Task Force recommendations related to social needs.
• What is needed before recommending routine screening for social needs: an accurate screening test, an effective treatment, and a meaningful health outcome improvement for patients.
• What clinicians can do in the absence of evidence-base recommendations on social needs.

The editorial concluded that primary care clinicians need more evidence about their role in addressing social determinants of health, and community resources and public health support is needed to help patients with unmet social needs.