AHRQ Electronic Newsletter, December 9, 2014, Issue #451

December 9, 2014, Issue #451 AHRQ Stats: Osteoporosis Treatments Among U.S. women age 50 and older, the percentage using selective estrogen receptor modulators dropped from 4 percent in 2000-2001 to less than 2 percent in 2010-2011, while the use of bisphosphonates increased from 6 percent to 8 percent during the same time period. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #442: Changes in Osteoporosis Medication Use and Expenditures among Women (Age 50 and up), United States, 2000 to 2011.) Today's Headlines: New Report Says Interoperability, Data Integration Needed To Improve Individual Health Most Nursing Home Residents with Advanced Dementia Get Medications With Questionable Benefits and Substantial Costs AHRQ Report Defines Elements of High-Quality Emergency Department Discharge Process American Children Continue To Receive Antibiotics Inappropriately, AHRQ Researchers Find AHRQ Research Review Finds Utility of Pharmacokinetics and Pharmacodynamics for Antibiotic Dosing in Pneumonia Patients Unclear Register Now for December 11 Webinar on Pragmatic-Explanatory Continuum Indicator Summaries (PRECIS) Tool New Report Says Interoperability, Data Integration Needed To Improve Individual Health A new report supported by AHRQ lays out recommendations for a health information technology (IT) infrastructure that could not only achieve interoperability among electronic health records but also integrate data. Such data could include information from personal health devices, patient collaborative networks and social media, and environmental, demographic and genomic data. “Data for Individual Health” examines how health information is used and shared across the health care system and makes recommendations about the use of standards and incentives to allow information sharing. The report, supported through a partnership between AHRQ, the Office of the National Coordinator for Health Information Technology (ONC) and the Robert Wood Johnson Foundation, comes as ONC is developing a federal health IT strategic plan for a shared, nationwide interoperability roadmap to ensure that information can be securely shared across an emerging health IT infrastructure. Most Nursing Home Residents with Advanced Dementia Get Medications With Questionable Benefits and Substantial Costs According to a new AHRQ-funded study, more than half of nursing home residents with advanced dementia – a terminal illness marked by severe cognitive impairment and functional dependence – continue to receive medications that may not help them, but incur substantial financial cost. The study and abstract, “Use of Medications of Questionable Benefit in Advanced Dementia,” were published in the November 2014 issue ofJAMA Internal Medicine. An analysis of more than 5,400 residents at 460 facilities (using 2009-2010 data) found that nearly 54 percent of residents received at least one medication of questionable benefit. The average 90-day expenditure for medications with questionable benefits was $816. This accounts for 35.2 percent of the total average 90-day medication costs for residents with advanced dementia who were prescribed common medications with questionable benefits. AHRQ Report Defines Elements of High-Quality Emergency Department Discharge Process A new AHRQ report outlines a conceptual framework of the emergency department (ED) discharge process and identifies elements of a high-quality discharge process. “Improving the Emergency Department Discharge Process: Environmental Scan Report” identifies best practices, tools, strategies and approaches for addressing problem areas and criteria/outcomes for assessing their effectiveness. Developed by researchers at the Johns Hopkins University Armstrong Institute for Patient Safety and Quality, the report can be used by hospital EDs to identify: What constitutes an effective discharge process and what constitutes discharge failures. Socioeconomic or medical factors that increase a patient’s risk for a discharge failure. Intervention tools or strategies shown to improve the discharge process. Screening tools that have been used to predict hospital readmission and ED revisits. American Children Continue To Receive Antibiotics Inappropriately, AHRQ Researchers Find Inappropriate antibiotic prescribing continues for American children, despite efforts to educate providers about the risks of creating antibiotic-resistant infections, according to a new AHRQ-funded study. Researchers found that 27.3 percent of American children used at least one antibiotic each year during the 2004-2010 study period. About 69 percent of those children received antibiotics to treat common upper respiratory infections such as pharyngitis, pneumonia and ear infections. In addition, significant proportions of children received antibiotics to treat three conditions – bronchitis, sinusitis and the common cold – for which antibiotics are rarely prescribed. Researchers also found that 18.5 percent of these children used narrow-spectrum antibiotics and 12.8 percent used broad-spectrum antibiotics. AHRQ’s Eric M. Sarpong, Ph.D., and G. Edward Miller, Ph.D., conducted the study, “Narrow and Broad Spectrum Antibiotic Use Among U.S. Children,” which appeared online with an abstract November 25 inHealth Services Research. The researchers concluded that, despite encouraging reports on the declining use of antibiotics, further improvement is needed in the appropriate prescribing of antibiotics for children. AHRQ Research Review Finds Utility of Pharmacokinetics and Pharmacodynamics for Antibiotic Dosing in Pneumonia Patients Unclear A new research review from AHRQ has found that, despite the potential advantages of improving intravenous (IV) therapy antibiotic dosing using principles of pharmacokinetics and pharmacodynamics (PK/PD) in patients with hospital-acquired pneumonia, no conclusions can be drawn because of major gaps in evidence. According to the research review, “Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Nosocomial Pneumonia,” the available research is inconclusive as to whether including PK/PD measures in decisions about dosing or monitoring IV antibiotic treatment improves outcomes. Future research may include large-scale studies designed to compare PK/PD strategies in patients with hospital-acquired pneumonia. The review says two primary goals of this research should be to document the clinical impact of different dosing strategies and to determine their effects on the development of antibiotic resistance in bacteria. Register Now for December 11 Webinar on Pragmatic-Explanatory Continuum Indicator Summaries (PRECIS) Tool Register for an in-depth research methods webinar December 11 from 1:30 to 3 p.m. ET. AHRQ is hosting the webinar, which will focus on the pragmatic-explanatory continuum indicator summary (PRECIS) tool. Kevin Thorpe of the University of Toronto will discuss the development of the tool and the methods for its use by researchers to determine whether research design decisions are consistent with the research aims.Registration is open. AHRQ in the Professional Literature Maggard-Gibbons M. The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program. BMJ Qual Saf. 2014 Jul;23(7):589-99. Epub 2014 Apr 19. Select to access the abstract on PubMed®. Williams SE, Rothman RL, Offit PA, et al. A randomized trial to increase acceptance of childhood vaccines by vaccine-hesitant parents: a pilot study.Acad Pediatr. 2013 Sep-Oct;13(5):475-80. Select to access the abstract on PubMed®. Galárraga O, Genberg BL, Martin RA, et al. Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. AIDS Behav. 2013 Sep;17(7):2283-92. Select to access the abstract on PubMed®.  Zhang M, Shubina M, Morrison F, et al. Following the money: copy-paste of lifestyle counseling documentation and provider billing. BMC Health Serv Res. 2013 Oct 2;13:377.Select to access the abstracton PubMed®.  Kruger JF, Chen AH, Rybkin A, et al. Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study. BMJ Qual Saf. 2014 Nov;23(11):893-901. Epub 2014 Apr 24. [Epub ahead of print.] Select to access theabstract on PubMed®.  Skolasky RL, Riley LH 3rd, Maggard AM, et al. Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes. Contemp Clin Trials. 2013 Sep;36(1):207-17. Epub 2013 Jun 29. Select to access the abstract on PubMed®.  Harris LT, Koepsell TD, Haneuse SJ, et al. Glycemic control associated with secure patient-provider messaging within a shared electronic medical record: a longitudinal analysis. Diabetes Care. 2013 Sep;36(9):2726-33. Epub 2013 Apr 29. Select to access theabstract on PubMed®. Gawron AJ, Yadlapati R. Disparities in endoscopy use for colorectal cancer screening in the United States. Dig Dis Sci. 2014 Mar;59(3):530-7. Epub 2013 Nov 19. 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.