| July 8, 2014, Issue #431 AHRQ StatsMore than 20 million Americans, or approximately 8 percent of the population under age 65, were uninsured for the entire four-year period from 2008 through 2011. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #424: The Long-Term Uninsured in America, 2008-2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65.) Today's Headlines:AHRQ-Funded Study Finds Little Benefit From Corticosteroid Injections for Common Cause of Spine-Related Pain The addition of a corticosteroid to epidural injections of an anesthetic does not enhance pain reduction in patients with lumbar spinal stenosis, a common cause of lower back and leg pain, according to a new AHRQ-funded study. The findings, released in an abstract and article published in the July 3 issue of New England Journal of Medicine, come from the first major clinical trial comparing epidural injections of anesthetic with and without corticosteroids for spinal stenosis. Researchers funded by AHRQ studied patients six weeks after treatment and found those whose lidocaine anesthetic was supplemented with a corticosteroid experienced minimal to no additional benefit compared with patients who received injections of anesthetic alone. Epidural injection of anesthetic with corticosteroid is a common treatment for lumbar spinal stenosis. It is estimated that more than 2.2 million lumbar epidural steroid injections are given each year to Medicare patients. Rates and associated costs of the procedure have increased nearly 300 percent over the last two decades. "This study raises questions about the benefits of combining corticosteroids with an anesthetic for patients with lumbar stenosis, and it will help patients and their physicians make better informed decisions about treatment options," AHRQ Director Richard Kronick, Ph.D., said in an AHRQ press release about the study. Save the Date: December Dissemination and Implementation Conference, Call for Abstracts Underway Mark your calendars for the 7th Annual Conference on the Science of Dissemination and Implementation, and note the opportunity to submit abstracts. The conference is scheduled for December 8 and 9 at the Bethesda North Marriott Hotel and Conference Center in Bethesda, Maryland. The conference theme, "Transforming Health Systems to Optimize Individual and Population Health," reflects the opportunity, excitement and charge to the field in 2014 to integrate evidence-based practices and service delivery. The call for abstracts is underway. The submission deadline is August 8; submitters will be notified of acceptance by September 8. The conference is co-hosted by the National Institutes of Health and AcademyHealth and co-sponsored by AHRQ, the Patient-Centered Outcomes Research Institute, the Robert Wood Johnson Foundation and the Department of Veterans Affairs. Additional information is available on the registration website. National Quality Strategy Priorities in Action Features Nationally Recognized Programs That Promote Patient-Centered Care The latest edition of National Quality Strategy Priorities in Action features Better Health Greater Cleveland, a collaborative of more than 700 primary care providers from 12 health care systems, health plans, employer groups and community organizations that joined to improve health care in northeast Ohio while reducing costs. The collaborative has been successful in reducing emergency room visits by 60 percent and achieving more than $50 million in savings. Care transformation efforts by the collaborative promote National Quality Strategy priorities such as promoting the most effective prevention and treatment practices and making quality care more affordable through the levers of public reporting, learning and technical assistance, measurement and feedback and health information technology. The Priorities in Action also features the Reginald S. Lourie Center for Infants and Young Children, a nationally recognized pioneer, incubator and disseminator of evidence-based treatments involving early childhood development, prevention and intervention. The National Quality Strategy, first published in March 2011, was mandated by the Patient Protection and Affordable Care Act of 2010. It is led by AHRQ on behalf of HHS. AHRQ's Web M&M Probes Safety and Security Risks of Patient Wandering The current issue of AHRQ Web M&M features a Spotlight Case about a 74-year-old man with a history of congestive heart failure secondary to alcoholic dilated cardiomyopathy who was admitted to a hospital for management of alcohol withdrawal. After several days of aggressive treatment, the patient was improving and was being managed on the medical-surgical floor. Initially he experienced confusion due to alcohol withdrawal, but by his sixth day in the hospital, his mental status was clear and he was expected to be discharged. That morning, feeling "cooped up," he left the hospital grounds without informing any of the health care providers on his floor. About an hour later, he returned to his room with a fractured arm. After the radiology results were revealed to him, he acknowledged that he had fallen while he was off the floor, and the institution began to consider a policy regarding patients leaving the unit. Also featured is an audio conversation with Dave deBronkart – also known as e-Patient Dave – co-founder and co-chair of the Society for Participatory Medicine, about engaging patients in their care and allowing patients to access their medical records. The Perspective section of the issue features an article by Helen Haskell, M.A., of Mothers Against Medical Error, describing the evolution of the patient advocacy movement. | AHRQ in the Professional Literature Donnelly JP, Baddley JW, Wang HE. Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother. 2014 Mar;58(3):1451-7. Epub 2013 Dec 16. Select to access the abstract on PubMed®. Smith MW, Davis Giardina T, Murphy DR, et al. Resilient actions in the diagnostic process and system performance. BMJ Qual Saf. 2013 Dec;22(12):1006-13. Epub 2013 Jun 27. Select to access the abstract on PubMed®. Meddings J. Interventions to reduce urinary catheter use: it worked for them, but will it work for us? BMJ Qual Saf. 2013 Dec;22(12):967-71. Epub 2013 Sep 19. Select to access the abstract on PubMed®. Stuart B, Davidoff A, Erten M, et al. How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction. Health Serv Res. 2013 Dec;48(6 Pt 1):1960-77. Epub 2013 Jun 6. Select to access the abstract on PubMed®. Goyal MK, Dowshen N, Mehta A, et al. Pediatric primary care provider practices, knowledge, and attitudes of human immunodeficiency virus screening among adolescents. J Pediatr. 2013 Dec;163(6):1711-1715.e6. Epub 2013 Sep 29. Select to access the abstract on PubMed®. Jeffs L, Law MP, Straus S, et al. Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process. BMJ Qual Saf. 2013 Dec;22(12):1014-24. Epub 2013 Jul 12. Select to access the abstract on PubMed®. Knight M. The effect of hospital organizational characteristics on postoperative complications. J Patient Saf. 2013 Dec;9(4):198-202. Select to access the abstract on PubMed®. Denham CR, Classen DC, Swenson SJ, et al. Safe use of electronic health records and health information technology systems: trust but verify. J Patient Saf. 2013 Dec;9(4):177-89. Select to access the abstract on PubMed®. Howren MB, Christensen AJ, Hynds Karnell L, et al. Influence of pretreatment social support on health-related quality of life in head and neck cancer survivors: results from a prospective study. Head Neck 2013 Jun;35(6):779-87. Select to access the abstract on PubMed®. Contact Information Please address comments and questions about the AHRQ Electronic Newsletter to Jeff Hardy at: (301) 427-1802 or Jeff.Hardy@ahrq.hhs.gov. |
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