In The News

New AHRQ Report Reviews Promising Strategies for Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care

A new AHRQ report, Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan examines factors that may limit access to medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural primary care settings. Three innovative models of care, including the Vermont Hub and Spoke model, Project ECHO (Extension for Community Health Care Outcomes) from New Mexico, and the Office-Based Opioid Treatment with Buprenorphine (OBOT-B) Collaborative Care Model from Massachusetts, may help overcome a number of the challenges faced when implementing MAT services in rural primary care. Peer-reviewed articles and grey literature on implementing MAT for OUD were examined. The report also includes links and descriptions to nearly 250 tools and resources to support the delivery of MAT in rural primary care settings. Visit AHRQ’s Academy for Integrating Behavioral Health and Primary Care to download the report.

Other AHRQ Related Opioid Use Disorder Research

NIH to fund Centers of Excellence on Minority Health and Health Disparities

Twelve specialized research centers designed to conduct multidisciplinary research, research training, and community engagement activities focused on improving minority health and reducing health disparities will launch. The centers, to be funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, will share approximately $82 million over five years, pending the availability of funds. [ FULL ARTICLE ]

Warner’s CHRONIC Care Act Unanimously Passes Senate

The U.S. Senate unanimously passed bipartisan legislation introduced by Senator Mark R. Warner (D-VA), a member of the Senate Finance Committee, to improve health outcomes for Medicare beneficiaries living with chronic conditions. [ FULL ARTICLE ]

Federal agencies partner for military and veteran pain management research

Joint HHS-DoD-VA initiative will award multiple grants totaling $81 million. [ FULL ARTICLE ]

Managing hypertension in diabetes: a position statement from the ADA

The American Diabetes Association (ADA) has released a position statement to update the assessment and treatment of hypertension among patients with diabetes.

The position statement, published in Diabetes Care, includes advances in care since the ADA last published a statement on this topic in 2003. The ADA notes that antihypertensive therapy is shown to reduce atherosclerotic cardiovascular disease (ASCVD) events, heart failure, and microvascular complications in patients with diabetes. There have also been reductions in ASCVD morbidity and mortality in patients with diabetes since 1990, which are likely due to improvements in blood pressure control.

 

“Treatment should be individualized to the specific patient based on their comorbidities; their anticipated benefit for reduction in ASCVD, heart failure, progressive diabetic kidney disease, and retinopathy events; and their risk of adverse events,” according to the ADA. “This conversation should be part of a shared decision-making process between the clinician and the individual patient.”

The ADA has made the following recommendations:

Screening and diagnosis

  • Clinicians should measure blood pressure at every routine clinical care visit. Patients with elevated blood pressure ?140/90 mmHg should have blood pressure confirmed with multiple readings to diagnose hypertension (Grade B recommendation).
  • Hypertensive patients with diabetes should have home blood pressure monitoring to identify white-coat hypertension (Grade B recommendation).
  • Orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and periodically at follow-up, or when symptoms of orthostatic hypotension are present, and regularly if orthostatic hypotension has been diagnosed (Grade E recommendation).

Blood pressure targets

  • The systolic blood pressure goal should be <140 mmHg, and the diastolic blood pressure goal should be <90 mmHg for most individuals with diabetes and hypertension (Grade A recommendation).
  • Lower systolic and diastolic blood pressure targets may be appropriate for those with high risk of cardiovascular disease if they can be achieved without excessive treatment burden (Grade B recommendation).

Lifestyle management

  • Lifestyle intervention for those with systolic blood pressure >120 mmHg or diastolic blood pressure >80 mmHg consists of weight loss if overweight or obese; a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern; increased fruit and vegetable consumption; moderation of alcohol intake; and increased physical activity (Grade B recommendation).

Pharmacologic antihypertensive treatment

  • Patients with confirmed blood pressure ?140/90 mmHg should have timely titration of pharmacologic therapy to achieve blood pressure goals, in addition to lifestyle therapy (Grade A recommendation).
  • Patients with confirmed blood pressure ?160/100 mmHg should have prompt initiation and timely titration of 2 drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes, in addition to lifestyle therapy (Grade A recommendation).
  • Treatment should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes. These include ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, or dihydropyridine calcium channel blockers. Multiple-drug therapy is generally required to achieve blood pressure targets (Grade A recommendation).
  • An ACE inhibitor or ARB is the recommended first-line treatment for hypertension in patients with diabetes and urine albumin-to creatinine ratio  ? 300 mg/g creatinine (Grade A recommendation) or 30–299 mg/g creatinine (Grade B recommendation). If one class is not tolerated, the other should be substituted. (Grade B recommendation).
  • Serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored in patients treated with an ACE inhibitor, ARB, or diuretic (Grade B recommendation).

Full Article Here

CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients

Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.

“The Hospice Compare website is an important tool for the American people and will help empower them in a time of vulnerability as they look for information necessary to make important decisions about hospice care for loved ones,” said CMS Administrator Seema Verma. “The CMS Hospice Compare website is a reliable resource for family members and care givers who are looking for facilities that will provide quality care.”

Hospice facilities offer specialized care and support to individuals with a terminal illness and a prognosis of six months or less if the illness runs its normal course. Once a patient elects hospice care, the focus shifts from curative treatment to palliative care for relief of pain and symptom management, and care is generally provided where the patient lives. Additionally, caregivers can get support through the hospice benefit, such as grief and loss counseling. Hospice Compare helps patients and caregivers find hospice providers in their area and compare them on quality of care metrics.

Section 1814(i)(5) of the Social Security Act authorizes a quality reporting program for hospices. The Act requires hospice providers to report data to CMS on a number of quality measures selected through notice and comment rulemaking. The Hospice Quality Reporting Program (HQRP) includes both quality data from the Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (Hospice CAHPS®).

The Hospice Compare site allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on important quality metrics, such as the percentage of patients that were screened for pain or difficult or uncomfortable breathing, or whether patients’ preferences are being met. Currently, the data on Hospice Compare is based on information submitted by approximately 3,876 hospices.

The Hospice Compare website will reflect current industry best practices for consumer-facing websites and will be optimized for mobile use. For more information, please visit https://www.medicare.gov/hospicecompare/ to view the new Compare site.

For more information, visit the Hospice Quality Public Reporting webpage.