Closing the Quality Gap Series: Improving Health Care and Palliative Care for Advanced and Serious Illness: Structured Abstract

AHRQ Report Examines Effect of Quality Improvement Interventions on Palliative Care

Patient education and self-management can help reduce pain in patients with advanced and serious illnesses, according to a new AHRQ report on the impact of quality improvement interventions on outcomes. The authors, affiliated with the AHRQ-supported Johns Hopkins University Evidence-based Practice Center in Baltimore, MD, also reviewed the evidence for the impact of quality improvement strategies on quality of life, patient and family satisfaction, health care utilization, and other outcomes. Select to access the report, Improving Health Care and Palliative Care for Advanced and Serious Illness. Closing the Quality Gap: Revisiting the State of the Science . The report is part of the Closing the Quality Gap: Revisiting the State of the Science series and builds on an earlier AHRQ series of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Select to access the full list of completed AHRQ evidence reports.

Closing the Quality Gap: Revisiting the State of the Science

Improving Health Care and Palliative Care for Advanced and Serious Illness

October 2012

In 2004, AHRQ launched a collection of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, to bring data to bear on quality improvement opportunities. These reports summarized the evidence on quality improvement strategies related to chronic conditions, practice areas, and cross-cutting priorities.
This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of the Science. This report reviews the evidence on the effectiveness of health care and palliative care interventions to improve outcomes for patients with advanced and serious illness.
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Structured Abstract

Objective: To systematically review the evidence on the effectiveness of health care and palliative care interventions to improve outcomes for patients with advanced and serious illness.
Data Sources: We searched MEDLINE®, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through 2011. We identified additional studies from reference lists of eligible articles and relevant reviews, as well as from technical experts.
Review Methods: We developed questions in collaboration with technical experts. We excluded retrospective and uncontrolled studies. Two investigators independently screened search results and abstracted data from eligible studies. We adapted previous frameworks to categorize included studies (e.g., by improvement target, setting). Because many studies did not report effect sizes and almost all studies were small (<200 a="a" able="able" all="all" also="also" and="and" be="be" between="between" calculated="calculated" category.="category." checked="checked" compared="compared" control="control" describe="describe" did="did" differences="differences" direction="direction" each="each" for="for" group="group" improvement="improvement" in="in" intervention="intervention" larger="larger" literature="literature" not="not" of="of" opposite="opposite" order="order" other="other" outcomes="outcomes" p="p" percentage="percentage" quantitatively="quantitatively" report="report" results="results" significant="significant" smaller="smaller" studies.="studies." studies="studies" that="that" the="the" there="there" to="to" we="we" were="were" with="with"> Results: We included 90 studies described in 96 articles. Of the 23 studies targeting continuity, coordination, and transitions, 33 percent of studies that evaluated quality of life as an outcome, 67 percent that evaluated patient satisfaction, and 31 percent that evaluated health care utilization (admissions and length of stay) found a statistically significant improvement with the intervention. Of the 21 studies targeting pain, almost all focused on patient education and self-management; 48 percent of them found a statistically significant improvement with the intervention. Findings for larger (>100) and smaller (≤100) studies were similar. For distress, only 29 percent of the seven included studies found a statistically significant impact. Of the 20 studies in communication and decisionmaking, only 22 percent of studies addressing patient or family satisfaction found a statistically significant improvement for this outcome, compared to 73 percent for the outcome of health care utilization. We found only two studies within hospice programs, both of which found a statistically significant improvement in at least one outcome; nine studies were in nursing homes, 78 percent of which demonstrated a significant improvement with the intervention.
In terms of types of quality improvement, for the target of continuity, studies including patient-centered quality improvement types, such as education and self-management, had the strongest evidence of effectiveness on patient- and family-centered domains such as satisfaction and quality of life. Studies of provider-focused interventions (e.g., education, reminders) were more likely to have an impact on health care utilization. Only one of five studies addressing multiple targets and focusing on facilitated relay of clinical data to providers demonstrated a statistically significant improvement in either quality of life or satisfaction. In terms of consultative and integrative interventions, for the target of communication and decisionmaking, three-quarters of consultative interventions showed a statistically significant improvement with the intervention, compared to half of integrative interventions. The literature was too heterogeneous and effect sizes were too infrequently reported for quantitative synthesis. There was moderate strength of evidence for the target of continuity, coordination, and transitions and the outcome of patient and caregiver satisfaction but low strength of evidence for other outcomes. For the target of pain, there was moderate strength of evidence for pain as an outcome. For the target of communication and decisionmaking, there was moderate strength of evidence for the outcome of health care utilization but low strength of evidence for other outcomes.
Conclusions: We found that evidence was strongest (moderate strength of evidence) for interventions for pain, and for the targets of communication and decisionmaking and continuity for selected outcomes. While a few high- and medium-quality, well-designed health care and palliative care interventions have been conducted to improve outcomes for patients with advanced and serious illness, this report highlights the continued presence of variable findings, quality deficiencies, vaguely defined interventions, and variable outcome measurement tools and reporting in much of this intervention literature. The evidence has a number of gaps, including few studies in the hospice setting or pediatrics. Future research needs include techniques for improving recruitment and retention to assure adequate sample size, better development and description of interventions, and further development and standardization of outcome measures and tools.

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Closing the Quality Gap: Revisiting the State of the Science Series: Improving Health Care and Palliative Care for Advanced and Serious Illness

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Evidence-based Practice Center: Johns Hopkins University EPC

Current as of October 2012

Internet Citation:

Closing the Quality Gap: Revisiting the State of the Science Series: Improving Health Care and Palliative Care for Advanced and Serious Illness. Structured Abstract, October 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/gappallcaretp.htm

Evidence Report Series by Number

The following list provides complete titles of released reports and technical reviews in reverse numerical order. For a topic index of current evidence reports and category listing, go to EPC Evidence Reports at: http://www.ahrq.gov/clinic/epcindex.htm.
Evidence Reports / Technical Reviews

Evidence Reports

210. Screening and Diagnosing Gestational Diabetes Mellitus
209. Multigene Panels in Prostate Cancer Risk Assessment

208. Closing the Quality Gap: Revisiting the State of the Science Series
  The Patient-Centered Medical Home
  Quality Improvement Interventions to Address Health Disparities
  Bundled Payment: Effects on Health Care Spending and Quality
  Public Reporting as a Quality Improvement Strategy
  Medication Adherence Interventions: Comparative Effectiveness
  Quality Improvement Measurement of Outcomes for People With Disabilities
  Improving Health Care and Palliative Care for Advanced and Serious Illness
  Prevention of Healthcare-Associated Infections 207. Allocation of Scarce Resources During Mass Casualty Events
206. Enabling Patient-Centered Care Through Health IT
205. Diagnosis and Management of Febrile Infants (0–3 Months)

204. An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer
203. Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management
202. Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention
201. Enabling Medication Management Through Health Information Technology (Health IT)
200. Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease

199. Health Literacy Interventions and Outcomes: An Updated Systematic Review
198. Management of Acute Otitis Media: Update
197. Alcohol Consumption and Cancer Risk: Understanding Possible Causal Mechanisms for Breast and Colorectal Cancers
196. Assessment of Thiopurine Methyltransferase Activity in Patients Prescribed Azathioprine or Other Thiopurine-based Drugs
195. Inhaled Nitric Oxide in Preterm Infants

194. Complementary and Alternative Therapies for Back Pain II
193. Alzheimer's Disease and Cognitive Decline
192. Lactose Intolerance and Health
191. Vaginal Birth After Cesarean: New Insights
190. Enhancing Use and Quality of Colorectal Cancer Screening

189. Exercise-induced Bronchoconstriction and Asthma
188. Impact of Consumer Health Informatics Applications
187. Treatment of Overactive Bladder in Women
186. Family History and Improving Health
185. Diagnosis and Management of Ductal Carcinoma in Situ (DCIS)

184. Treatment of Common Hip Fractures
183. Vitamin D and Calcium: Systematic Review of Health Outcomes
181. Outcomes of Community Health Worker Interventions
180. Outcomes of Genetic Testing in Adults with a History of Venous Thromboembolism

179. Clinical Utility of Cancer Family History Collection in Primary Care
177. Complementary and Alternative Medicine in Back Pain Utilization
176. Maternal and Neonatal Outcomes of Elective Induction of Labor
175. Barriers and Drivers of Health IT Use for the Elderly, Chronically Ill, and Underserved

174. Management of Chronic Hepatitis B
173. Integration of Mental Health/Substance Abuse and Primary Care
172. HER2 Testing to Manage Patients with Breast or Other Solid Tumors
171. Diagnosis and Treatment of Erectile Dysfunction
170. Effectiveness of Weight Management Programs in Children and Adolescents

169. Bariatric Surgery in Women of Reproductive Age: Special Concerns for Pregnancy
168. Outcomes of Maternal Weight Gain
167. Effectiveness of Assisted Reproductive Technology
166. Diabetes Education for Children With Type 1 Diabetes Mellitus and Their Families
165. Hydroxyurea for the Treatment of Sickle Cell Disease

164. Utility of Monitoring Mycophenolic Acid in Solid Organ Transplant Patients
163. Carbohydrate and Lipid Disorders and Relevant Considerations in Persons with Spinal Cord Injury
162. Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes
161. Prevention of Fecal and Urinary Incontinence in Adults (Archived)
160. Impact of Gene Expression Profiling Tests on Breast Cancer Outcomes

159. Collection and Use of Cancer Family History in Primary Care (Archived)
158. Effectiveness and Safety of Vitamin D in Relation to Bone Health (Archived)
157. Treatment of Primary and Secondary Osteoarthritis of the Knee (Archived)
156. Antiretroviral (ARV) Drug Resistance in the Developing World (Archived)
155. Meditation Practices for Health: State of the Research (Archived)

154. Management of Uterine Fibroids: An Update of the Evidence (Archived)
153. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries (Archived)
152. Cardiac Resynchronization Therapy and Implantable Cardiac Defibrillators in Left Ventricular Systolic Dysfunction (Archived)
151. Nurse Staffing and Quality of Patient Care (Archived)
150. Hereditary Nonpolyposis Colorectal Cancer: Diagnostic Strategies and Their Implications (Archived)

149. Effectiveness of Continuing Medical Education (Archived)
148. The Uses of Heparin To Treat Burn Injury (Archived)
147. The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control (Archived)
146. Testing for Cytochrome P450 Polymorphisms in Adults With Non-Psychotic Depression Treated With Selective Serotonin Reuptake Inhibitors (SSRIs) (Archived)
145. Genomic Tests for Ovarian Cancer Detection and Management (Archived)

144. Comparison of Endovascular and Open Surgical Repairs for Abdominal Aortic Aneurysm (Archived)
143. Management of Small Cell Lung Cancer (Archived)
142. Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure (Archived)
141. Pediatric Anthrax: Implications for Bioterrorism Preparedness (Archived)
140. Tobacco Use: Prevention, Cessation, and Control (Archived)

139. Multivitamin/Mineral Supplements and Prevention of Chronic Disease (Archived)
138. Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer (Archived)
137. Cancer Care Quality Measures: Symptoms and End of Life Care (Archived)
136. Value of the Periodic Health Evaluation (Archived)
135. Management of Eating Disorders (Archived)

134. B Vitamins and Berries and Age-Related Neurodegenerative Disorders (Archived)
133. Cesarean Delivery on Maternal Request (Archived)
132. Costs and Benefits of Health Information Technology
131. Telemedicine for the Medicare Population—Update (Archived)
130. Management of Adnexal Mass (Archived)

129. Diagnosis and Management of Work-Related Asthma (Archived)
128. Diagnosis, Prognosis, and Therapy of Impaired Glucose Tolerance and Impaired Fasting Glucose (Archived)
127. Acute Stroke: Evaluation and Treatment (Archived)
126. Effects of Soy on Health Outcomes (Archived)
125. Manifestations and Management of Chronic Insomnia in Adults (Archived)

124. Update on Acute Bacterial Rhinosinusitis (Archived)
123. Post-Myocardial Infarction Depression (Archived)
122. Knowledge and Access to Information on Recruitment of Underrepresented Populations to Cancer Clinical Trials (Archived)
121. Use of Spirometry for Case Finding, Diagnosis, and Management of Chronic Obstructive Pulmonary Disease (COPD) (Archived)
120. Management of Menopause-Related Symptoms (Archived)

119. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes (Archived)
118. Effects of Omega-3 Fatty Acids on Child and Maternal Health (Archived)
117. Effects of Omega-3 Fatty Acids on Eye Health (Archived)
116. Effects of Omega-3 Fatty Acids on Mental Health (Archived)
115. Effects of Omega-3 Fatty Acids on Organ Transplantation (Archived)

114. Effects of Omega-3 Fatty Acids on Cognitive Function with Aging, Dementia, and Neurological Diseases (Archived)
113. Effects of Omega-3 Fatty Acids on Cancer (Archived)
112. The Use of Episiotomy in Obstetrical Care: A Systematic Review (Archived)
111. Wound-Healing Technologies: Low-Level Laser and Vacuum-Assisted Closure (Archived)
110. End-of-Life Care and Outcomes (Archived)

109. Sexuality and Reproductive Health Following Spinal Cord Injury (Archived)
108. Melatonin for Treatment of Sleep Disorders (Archived)
107. Preventing Violence and Related Health-Risking Social Behaviors in Adolescents (Archived)
106. Cardiac Resynchronization Therapy for Congestive Heart Failure (Archived)
105. Measuring the Quality of Breast Cancer Care in Women (Archived)

104. Celiac Disease (Archived)
103. Pharmacological and Surgical Treatment of Obesity (Archived)
102. Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General Populations and Cancer Patients and Survivors (Archived)
101. Economic Incentives for Preventive Care (Archived)
100. Criteria to Determine Disability Related to Multiple Sclerosis (Archived)

99. Community-Based Participatory Research (Archived)
98. Islet Transplantation in Patients with Type 1 Diabetes Mellitus (Archived)
97. Pharmacological Treatment of Dementia (Archived)
96. Regionalization of Bioterrorism Preparedness and Response (Archived)
95. Training of Hospital Staff To Respond to a Mass Casualty Incident (Archived)

94. Effects of Omega-3 Fatty Acids on Cardiovascular Disease (Archived)
93. Effects of Omega-3 Fatty Acids on Cardiovascular Risk Factors and Intermediate Markers of Cardiovascular Disease (Archived)
92. Effects of Omega-3 Fatty Acids on Arrhythmogenic Mechanisms in Animal and Isolated Organ/Cell Culture Studies (Archived)
91. Health Effects of Omega-3 Fatty Acids on Asthma (Archived)
90. Strategies for Improving Minority Healthcare Quality (Archived)

89. Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis (Archived)
88. Effectiveness of Antimicrobial Adjuncts to Scaling and Root-Planing Therapy for Periodontitis (Archived)
87. Literacy and Health Outcomes (Archived)
86. Total Knee Replacement (Archived)
85. Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke (Archived)

84. Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus (Archived)
83. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease (Archived)
82. Pharmacologic Management of Heart Failure and Left Ventricular Systolic Dysfunction: Effect in Female, Black, and Diabetic Patients, and Cost-Effectiveness (Archived)
81. Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics (Archived)
80. Results of Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women (Archived)

79. Diffusion and Dissemination of Evidence-based Cancer Control Interventions (Archived)
78. Best-Case Series for the Use of Immuno-Augmentation Therapy and Naltrexone for the Treatment of Cancer (Archived)
77. Management of Treatment-Resistant Epilepsy (Archived)
76. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects (Archived)
75. Effect of the Supplemental Use of Antioxidants Vitamin C, Vitamin E, and the Coenzyme Q10 for the Prevention and Treatment of Cancer (Archived)

74. The Effect of Health Care Working Conditions on Patient Safety (Archived)
73. Criteria for Determining Disability in Infants and Children: Short Stature (Archived)
72. Criteria for Determining Disability in Infants and Children: Failure to Thrive (Archived)
71. Vaginal Birth After Cesarean (VBAC) (Archived)
70. Criteria for Determining Disability in Infants and Children: Low Birth Weight (Archived)

69. Management of Bronchiolitis in Infants and Children (Archived)
68. Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism (Archived)
67. Management of Allergic Rhinitis in the Working-Age Population (Archived)
66. Systematic Review of the Current Literature Related to Disability and Chronic Fatigue Syndrome (Archived)
65. Management of Neonatal Hyperbilirubinemia (Archived)

64. S-Adenosyl-L-Methionine (SAMe) for Depression, Osteoarthritis, and Liver Disease (Archived)
63. Utility of Blood Pressure Monitoring Outside of the Clinic Setting (Archived)
62. Diagnosis and Treatment of Worker-Related Musculoskeletal Disorders of the Upper Extremity (Archived)
61. Management of Cancer Symptoms: Pain, Depression, and Fatigue (Archived)
60. Management of Chronic Hepatitis C (Archived)

59. Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems (Archived)
58. Autopsy as Outcome and Performance Measure (Archived)
57. Diagnosis and Treatment of Parkinson's Disease: A Systematic Review of the Literature (Archived)
56. Management of Clinically Inapparent Adrenal Mass (Archived)
55. Diagnosis, Natural History, and Late Effects of Otitis Media with Effusion (Archived)

54. Management of Allergic and Nonallergic Rhinitis (Archived)
53. Management of Prolonged Pregnancy (Archived)
52. Criteria for Determining Disability in Speech-Language Disorders (Archived)
51. Training Clinicians for Public Health Events Relevant to Bioterrorism Preparedness (Archived)
50. Endoscopic Retrograde Cholangiopancreatography (Archived)

49. Effectiveness and Cost-Effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke (Archived)
48. Cardiovascular Effects of Epinephrine in Hypertensive Dental Patients (Archived)
47. Systems to Rate the Strength of Scientific Evidence (Archived)
46. Impact of Cancer-Related Decision Aids (Archived)
45. Management of Chronic Neuropathic Pain Following Traumatic Spinal Cord Injury (Archived)

44. Management of Chronic Asthma (Archived)
43. Making Health Care Safer: A Critical Analysis of Patient Safety Practices
42. Defining and Managing Chronic Fatigue Syndrome (Archived)
41. Ayurvedic Interventions for Diabetes Mellitus: A Systematic Review (Archived)
40. Mind-Body Interventions for Gastrointestinal Conditions (Archived)

39. Management of Newly Diagnosed Patients with Epilepsy: A Systematic Review of the Literature (Archived)
38. Surgical Treatment of Coexisting Cataract and Glaucoma (Archived)
37. Management of Dental Patients Who Are HIV Positive (Archived)
36. Diagnosis and Management of Dental Caries (Archived)
35. Management of Cancer Pain (Archived)

34. Management of Uterine Fibroids (Archived)
33. Diagnosis and Management of Specific Breast Abnormalities (Archived)
32. Treatment of Degenerative Lumbar Spinal Stenosis (Archived)
31. Prediction of Risk for Patients with Unstable Angina (Archived)
30. Uses of Epoetin for Anemia in Oncology (Archived)

29. Use of Epoetin for Anemia in Chronic Renal Failure (Archived)
28. Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring (Archived)
27. Treatment of Pulmonary Disease Following Cervical Spinal Cord Injury (Archived)
26. Evaluation of Technologies for Identification of Acute Cardiac Ischemia in the Emergency Department (Archived)
25. Efficacy of Interventions to Modify Dietary Behavior Related to Cancer Risk (Archived)

24. Telemedicine for the Medicare Population (Archived)
     Telemedicine for the Medicare Population: Pediatric, Obstetric, and Clinician-Indirect Home Interventions (Supplement) (Archived)
23. Criteria for Weaning From Mechanical Ventilation (Archived)
22. Prevention of Venous Thromboembolism After Injury (Archived)
21. Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects (Archived)
20. Garlic: Effects on Cardiovascular Risks and Disease, Protective Effects Against Cancer, and Clinical Adverse Effects (Archived)

19. Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (Archived)
18. Management of Preterm Labor (Archived)
17. Management of Acne (Archived)
16. Anesthesia Management During Cataract Surgery (Archived)
15. Management of Acute Otitis Media (Archived)

14. Management of Chronic Hypertension During Pregnancy (Archived)
13. Determinants of Disability in Patients with Chronic Renal Failure (Archived)
12. Management of New Onset Atrial Fibrillation (Archived)
11. Treatment of Attention-Deficit/Hyperactivity Disorder (Archived)
10. An Evaluation of Beta-Blockers, Calcium Antagonists, Nitrates, and Alternative Therapies for Stable Angina (Archived)

9. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis (Archived)
    Diagnosis and Treatment of Uncomplicated Acute Sinusitis in Children (Supplement) (Archived)
8. Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients (Archived)
7. Treatment of Depression—Newer Pharmacotherapies (Archived)
6. Prevention and Management of Urinary Tract Infections in Paralyzed Persons (Archived)
5. Evaluation of Cervical Cytology (Archived)

4. Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer (Archived)
3. Pharmacotherapy for Alcohol Dependence (Archived)
2. Rehabilitation for Traumatic Brain Injury (Archived)
    Rehabilitation for Traumatic Brain Injury in Children and Adolescents (Supplement) (Archived)
1. Systematic Review of the Literature Regarding the Diagnosis of Sleep Apnea (Archived)

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Published Technical Reviews

17. Nutritional Research Series
   Volume 1: Application of Systematic Review Methodology to the Field of Nutrition
   Volume 2: Issues and Challenges in Conducting Systematic Reviews to Support Development of Nutrient Reference Values: Workshop Summary
   Volume 3: Reporting of Systematic Reviews of Micronutrients and Health: A Critical Appraisal
   Volume 4: Effects of Eicosapentanoic Acid and Docosahexanoic Acid on Mortality Across Diverse Settings: Systematic Review and Meta-Analysis of Randomized Trials and Prospective Cohort
   Volume 5: Comparison of Translational Patterns in Two Nutrient–Disease Associations

16. Updating Systematic Reviews (Archived)
15. Consumer-Oriented Strategies for Improving Health Benefit Design: An Overview (Archived)
14. A Critical Analysis of Care Coordination Strategies for Children With Special Health Care Needs (Archived)
13. Empirical Evaluation of the Association Between Methodological Shortcomings and Estimates of Adverse Events (Archived)

12. Criteria for Distinguishing Effectiveness From Efficacy Trials in Systematic Reviews (Archived)
11. Developing a Methodology for Establishing a Statement of Work for a Policy-Relevant Technical Analysis (Archived)
10. Strategies To Support Quality-based Purchasing (Archived)
9. Closing the Quality Gap:
   Volume 1: A Critical Analysis of Quality Improvement Strategies
   Volume 2: Diabetes Mellitus Care
   Volume 3: Hypertension Care
   Volume 4: Antibiotic Prescribing Behavior
   Volume 5: Asthma Care
   Volume 6: Healthcare-Associated Infections
   Volume 7: Care Coordination

8. Meta-regression Approaches: What, Why, When, and How? (Archived)
7. Determinants of Increases in Medicare Expenditures for Physicians' Services (Archived)
6. Current Validity of AHRQ Clinical Practice Guidelines (Archived)
5. Measures of Patient Safety Based on Hospital Administrative Data—The Patient Safety Indicators (Archived)

4. Refinement of the HCUP Quality Indicators (Archived)
3. Diagnosis of Attention-Deficit/Hyperactivity Disorder (Archived)
2. Treatment of Headache (Archived)
1. Colorectal Cancer Screening (Archived)

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Current as of November 2012

Internet Citation:

Evidence-based Report Series. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epc/epcseries.htm