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/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes. 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.
In The News
Final Recommendation Statement: Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus
Health care costs for dementia found greater than for any other disease
October 27, 2015
NIH-funded study examines medical, care costs in last five years of life.
Precision Medicine: A Personal Journey for Answers
October 21, 2015
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.
Perspectives on Integrating Behavioral Counseling Interventions into Primary Care
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 Getting Effective Treatment, but Progress Lags for Managing Chronic Diseases
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 Burwell announces new members of Advisory Council on Alzheimer's Research, Care, and Services
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.
American Board of Medical Specialties To Offer Maintenance of Certification Credits for Physicians Participating in AHRQ EvidenceNOW Initiative
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.
AHRQ Studies Provide Insights into Primary Care Transformation
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.
HHS announces $685 million to support clinicians delivering high quality, patient-centered care
September 29, 2015
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.
Let’s Refuse to Accept Medical Errors as the Standard of Care for Frail Elders
September 30, 2015. 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’!