1. Carlson, Elizabeth A.

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You may be familiar with the Agency for Healthcare Research and Quality (AHRQ), a section of the U.S. Department of Health and Human Services, but you may not have gone to the Web site lately ( A vast array of information related to healthcare excellence (as the banner states) is available via this Web site. The information is based on research findings and literature reviews. Experts in the various fields conduct focused studies, review the current available research and literature, and present an evaluation of the subject on the basis of the evidence available. The subjects are numerous and wide ranging. Located on the home page are the entry points divided into the following categories: clinical information; funding opportunities; research findings; specific populations; consumers and patients; data and survey; and quality and patient data.


As you scan the list of entry points, let me highlight a few that are less well known. Under Clinical Information you can access evidenced-based care; outcomes and effectiveness; effective healthcare technology assessment; preventive services; clinical practice guidelines; and the national guideline clearinghouse.


Within this grouping, one area to highlight is the Effective Healthcare Technology Assessment. The fact that the government-sponsored technology assessment programs may not be widely known, but the information available is very useful when the introduction of new technologies or new medical interventions is under consideration or being pilot tested. This site is an excellent resource to see whether the proposed technology has been evaluated and what objective information is available. As seen below, the impetus for this evaluation is to inform coverage decisions for Medicare and Medicaid, but all can benefit.


The technology assessment program at the Agency for Healthcare Research and Quality (AHRQ) provides technology assessments for the Centers for Medicare & Medicaid Services (CMS). These technology assessments are used by CMS to inform its national coverage decisions for the Medicare program as well as provide information to Medicare carriers.


AHRQ's technology assessment program uses state-of-the-art methodologies for assessing the clinical utility of medical interventions. Technology assessments are based on a systematic review of the literature, along with appropriate qualitative and quantitative methods of synthesizing data from multiple studies. (


A wide range of technologies has been evaluated and is available for review. As an example, two of the nine reports released in 2007 include Remote Cardiac Monitoring and Decompression Therapy for the Treatment of Lumbosacral Pain. The research and literature used are cited and "graded" as to their pertinence and quality. Populations that benefit or would not benefit from the therapy are defined. The evaluation presented is comprehensive and data based. Not only are you able to view what has been evaluated but you are also able to see what technology is currently in progress. The reviews are available to be downloaded in a variety of formats.


This is an excellent site to recommend to colleagues and coworkers, especially someone who likes to adopt new technology or is the person who regularly brings innovative ideas and articles or advertisements on the "latest" medical device. These early adopters are great resources and interested in seeing what is new and how it has been assessed.


Progressing on to the National Guideline Clearinghouse, you access evidence-based clinical practice guidelines. This site is an excellent resource and includes U.S. Food and Drug Administration advisories. A feature I particularly find useful is the ability to browse on the basis of the following classifications: Disease/Condition, Treatment/Intervention, Measures/Tools, Organization, Guideline Index, Guidelines In Progress, or Guideline Archive. This enables me to go directly to a certain treatment or intervention or to see what a selected organization recommends.


In the previous issue (March/April 2008) a toolkit for diabetes was reviewed. The Web site ( is an excellent resource for the toolkits that have been produced under the AHRQ Partnerships in Implementing Patient Safety (PIPS) grant program. This site can be accessed through the AHRQ home page as well. These partnerships with the AHRQ are with varied organizations and groups including researchers and clinicians at medical centers, community hospitals, outpatient settings, healthcare systems, community colleges, the Joint Commission, and local, state, and national public health organizations. The projects have produced a variety of evidence-based tools, including training materials, medication guides, and checklists, that are easily adapted to other institutions and care settings. The tools were developed in the field and are designed to be implemented by multidisciplinary users. Because public funding is used to support these projects, access to the end product is freely available.


Select Quality and Patient Safety, then Medical Errors and Patient Safety, and you arrive at resources targeted to patients and family members, as well as others to healthcare providers, that present clear ways patients can help in reducing errors both at home or while in the hospital. This is an excellent resource to refer nonhealthcare inquirers to if they are concerned about medication errors, safety issues while hospitalized, how to prepare for a doctor visit, what to bring, ask, how to communicate, and similar types of issues.


The PIPS home page indicates 17 toolkits, which is somewhat misleading in that there appear to be many more than 17 toolkits, but upon closer reading, numerous categories are available and the same toolkits can be found in more than one category. This is interesting because it allows you to see how similar resources have been adapted or developed for a wide range of settings. In many instances, there are links to other groups working on the same or similar content. An example of how the same content can be accessed through numerous categories is Preventing Deep Vein Thrombosis and Venous Thromboembolism. This content appears as both a section into itself and subsections under Medication Safety-General, Work Processes, and Medication Education and Simulation.


Another example is under Infection and is a study that looked at central-catheter infection and ventilator-associated pneumonia in the intensive care unit (ICU). Although the title implies a limited usefulness, further investigation reveals tools that are much more broadly applicable than on first blush. An infection control surveillance survey is present that is used by the Hospital Corporation of America in all of its facilities to collect information about hospital ICU infection control measurement, reporting, and practices. In addition, a Safety Attitude Survey is available to assess perceived patient safety climate in ICUs. Although some of the questions are directly used for assessing ICU-based concerns, the survey is easily adaptable to other patient care settings. Surveillance guides for central-catheter infections and ventilator-associated pneumonia are also available and again can be adapted to meet surveillance needs for other concerns. What is nice is that these tools can be used to guide the development of similar tools, avoiding the need to begin from a blank slate.


A quality improvement section is present containing templates for Pre-Work Report, Implementation Plan and Progress Report, and Meeting Agenda Tool. Once again, you can use these as guidelines to get started on a particular track or use them as a reminder of what needs to be addressed and considered as you undertake similar quality improvement plans.


The last tools to mention that are found under Infection are entitled Statistical Process Control. Preprogrammed spreadsheet templates are available for data collection of process and outcomes data. The Web site tells you, "These templates are pre-programmed for easy minimal data entry and charting of control charts for quality improvement." Once again, it certainly offers something from which to work without needing to re-create the wheel. In addition, the documents provided include the Excel files and the PowerPoint tutorial.


Not all categories are discussed here because you will find similar content in each category and subcategory. In my return visit to this site, I have noted that content is added on a regular basis so it is worth your while to return to this site regularly and see what new content is available for use in your practice.


One last area to comment upon is the left-hand column of the AHRQ home page entitled Special Interest. Topics include State and Local Policy Makers, Nursing Research, PDA Applications, and How AHQR Helps People. The PDA Applications offer a few downloadable resources. Under the Nursing Research subcategory, you must select Research Activities: Online Newsletter to access the most current work reported.


In summary, I found this Web site to be very useful and easy to maneuver and recommend it to you.