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Newscast: Lead Story - Clinical Decision
Support: Improving Health Care Quality
(opening music)
Rand: This is Healthcare 411 for the week of Oct. 21, 2009.
Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare
Research and Quality, part of the U.S. Department of Health and Human Services.
I’m Debra James.
Rand: And I’m Rand Gardner. This week on Healthcare 411: hospital
admissions for fractures related to osteoporosis. Data shows these are up by 55
percent.
Debra: And medications that could reduce the risk of breast cancer. But what are
the risks?
Rand: Plus, the first segment in a three-part series on clinical decision
support. All this coming up on Healthcare 411.
[Begin PSA: Take Charge of Your Health]
Fran: Hi, I’m Fran Drescher. It took me two years to get a proper
diagnosis of uterine cancer, so here are some tips I learned the hard way: Go to
the doctor armed with lots of questions, and bring a friend with you, even right
into the examining room, to write down the answers, and get a second opinion to
do a check on your diagnosis and treatment. To get a list of questions to ask,
go to ahrq.gov. It’s your life. Be
in charge of your health.
Narrator: A message from HHS and the Cancer Schmancer Foundation.
[End PSA]
Rand: Now the numbers.
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Rand: According to recent AHRQ research, hospital admissions for patients
with hip, pelvis, and other fractures related to osteoporosis increased by 55
percent between 1995 and 2006. In fact, in 2006 alone, fractures associated with
osteoporosis accounted for about 250,000 hospitalizations and $2.4 billion in
hospital costs. Osteoporosis is a condition that causes bones to become brittle
and weak. It affects an estimated ten million Americans and those who suffer
from it can easily fracture bones. Slow to heal, these fractures can cause
debilitating pain, disability, deformities and even death.
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Debra: Breast cancer is the second most commonly diagnosed cancer in
women. There are more than 190,000 new cases each year in the U.S., and about
40,000 people die from this disease annually. The National Cancer Institute
estimates that nearly 15 percent of women born today will develop breast cancer
in their lifetimes. Although most cases of breast cancer occur in women with no
specific risk factors other than age and gender, women with a family history of
breast and ovarian cancer are at higher risk for developing the disease. That’s
why some women may choose to take risk-reducing medications to lower their
chances of developing breast cancer. But do these drugs work? And what are the
risks? Here to answer those questions is AHRQ researcher Dr. Shilpa Amin. Dr.
Amin, AHRQ just published a new comparative effectiveness report that looked at
these drugs as risk-reducing medications for breast cancer. What were the key
findings?
Dr. Amin: Recent clinical trials have demonstrated the effectiveness of
three medications - tamoxifen, raloxifene, and tibolone - to reduce the risk of
invasive breast cancer in women who didn’t already have breast cancer. Our
comparative effectiveness report found all three of these medications
significantly reduced the risk of invasive breast cancer in midlife and older
women, but their benefits and potential harms varied depending on the drug and
the patient.
Debra: Can you tell us a little about the medications reviewed?
Dr. Amin: Yes. Tamoxifen was cleared by the Food and Drug Administration
in 1998 to prevent breast cancer in women at high risk of developing the
disease. Using tamoxifen to reduce the risk of breast cancer is an accepted
medical strategy, although the drug is primarily used for treatment rather than
lowering risk. Our report compared tamoxifen with another drug called raloxifene,
which is usually used to prevent and treat osteoporosis. Raloxifene was cleared
by the FDA for breast cancer risk reduction in 2007. A third drug, tibolone, has
not been cleared by the FDA for use in the United States. But it is commonly
used in other countries to treat menopausal symptoms and osteoporosis.
Debra: So do we know that these three medications can reduce a woman’s
chance of getting breast cancer?
Dr. Amin: Yes, we do.
Debra: Are they safe?
Dr. Amin: That’s a tough question. Each drug actually has potential
harms. For example, tamoxifen increases risk for endometrial cancer,
hysterectomies, blood clots and cataracts more than the other drugs. It can also
cause side effects, such as vasomotor and vaginal symptoms, the degree to which
varies by patient. Likewise, Tibolone can also cause vaginal symptoms and also
carries an increased risk of stroke. So, this review of the latest evidence
sheds important light on the advantages and potential harms of these
medications. Taking medicine to avoid breast cancer may be a great option, but
patients and clinicians must weigh the potential harms as well as the potential
benefits when discussing their options.
Debra: Dr. Amin, thanks for joining us.
Dr. Amin: My pleasure.
Debra: More comparative effectiveness information, including the new
report, titled "Comparative Effectiveness of Medications to Reduce Risk of
Primary Breast Cancer in Women," is available online at
effectivehealthcare.ahrq.gov.
Rand: Up next, the first segment in a three-part series on clinical
decision support. What is it and how can it improve the quality of your health
care delivery?
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Rand: Clinical decision support. It’s a phrase we’re hearing more
frequently in health care, as our use of technology blends with bedside
caretaking. But what exactly is it? Computerized medication alerts? More
importantly, which clinical decision support tools work best? And how do we best
incorporate them in our clinical practice? These are just a couple of the issues
that AHRQ is researching. And we’ll explore those and more in a three-part
podcast series. Here, joining us for the first segment is AHRQ’s Director of
Health Information Technology, Dr. Jon White Welcome.
Dr. White: Thank you very much.
Rand: For those who are less familiar with the phrase, what is clinical
decision support?
Dr. White: Clinical decision support encompasses a variety of tools and
interventions such as computerized alerts and reminders, clinical guidelines,
documentation templates, diagnostic support, and other tools. It’s about getting
the right information, to the right person, at the right time, through the right
channel, and in the right format. It is a tool that helps clinicians, staff,
patients or others make informed health care decisions by providing them with
timely information. And when it’s used correctly, clinical decision support can
effectively improve patient outcomes and lead to higher-quality health care.
Rand: Ultimately, this is as much about providing the right tools for
patients, as it is about interventions that support clinicians, right?
Dr. White: Yes. We believe clinical decision support can have a huge
impact on health care. And it’s a tool for patients and clinicians. For example,
a person with a chronic condition, such as diabetes, could use a support tool to
be reminded to take their medicine or to check their blood sugar. Other tools
for clinicians can also provide high-tech help, such as alerts if two
medications might cause a harmful interaction.
Rand: So what kinds of projects are currently being worked on at AHRQ in
the area of clinical decision support?
Dr. White: AHRQ’s Health Information Technology Portfolio Clinical
Decision Support Initiative includes a variety of ongoing research projects.
AHRQ has awarded $5 million for two health information technology contracts that
are focusing on the development, adoption, implementation and evaluation of best
practices using clinical decision support. These demonstration projects focus on
the translation of clinical guidelines, and outcomes related to preventive
health care and treatment of patients with chronic illnesses.
Rand: And when do you hope to have results from these demonstration
projects?
Dr. White: Well, for clinical decision support to be meaningful and
useful, it has to be well-designed and well-implemented. We hope to have the
results of these projects by late 2010, and that these will include
recommendations, best practices and other information that can help us better
understand how to best incorporate clinical decision support into health care
delivery.
Rand: Thank you, Dr. White. That’s it for this segment on clinical
decision support. But we’ll continue our series on health information technology
in our next podcast when we’ll discuss a group of AHRQ-sponsored white papers on
clinical decision support. We’ll explore what valuable information they uncover
and how these tools can help improve the delivery of health care services.
(music)
Debra: That’s it for this week. For more information on these and other
health-related stories and topics, go to
healthcare411.ahrq.gov.
Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare
Research and Quality, part of the U.S. Department of Health and Human Services.
For Debra James, I’m Rand Gardner. Please join us for the next edition of
Healthcare 411.
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