OHSU

Past Projects

Agency for Healthcare Research and Quality (AHRQ)-Funded Projects

Robert Wood Johnson Foundation-Funded Projects

Institute of Medicine-Funded Projects

Other Projects


 

Agency for Healthcare Research and Quality (AHRQ)-Funded Projects

 

Comprehensive EPC Comparative Effectiveness Reviews for Effective Health Care

Principal Investigator: Jeanne-Marie Guise, MD, MPH

Co-investigators: Mark Helfand, MD, MPH, MS, FACP; David I Buckley, MD, MPH; Roger Chou, MD, FACP; David H. Hickam, MD, MPH; Somnath Saha, MD, MPH; Amy Cantor, MD, MPH; Erika Cottrell, PhD, MPP; Pam Curtis, MS; Rochelle Fu, PhD; Dan Hartung, PharmD, MPH; Christen O'Haire, PhD; Beth Smith, DO; Amy Starmer, MD, MPH; Annette Totten, PhD; Jessica Weiss, MD

Research staff: Elaine Graham, MLS; Ian Blazina, MPH; Christina Bougatsos, MPH; Susan Carson, MPH; Tracy Dana, MLS; Cathy Gordon, MPH; Gwen Hampsten, AS; Lia LaBrant, MD; Carole Most, WHCNP; Pua Motu'apauaka, BS; Erika Nakamoto, MS; Robin Paynter, MLS; Basman Rahman, MPH; Rose Relevo, MS, MLIS; Maya Rowland, MPH; Martha Schechtel, RN; Samantha Slaughter-Mason, M:H; Arpita Tiwari, MPH; Jesse Wagner, MA; Ngoc Wasson, MPH; Leah Williams, BA. Student assistants: Lindsay Alley; Inger Appanaitis; Hannah Gaskins, Alexander Ginsburg, Rachel Hampton, Jamie Jones, Bryce Lambert, Aileen McAteer, Shaun Ramirez, Katie Reitel, Gabriel Valles, Sasha Walia, Dylan Waller

Project Period: 10/26/09-10/25/12
Funding: Agency for Healthcare Research and Quality (ARRA 2009)
Description: The Oregon EPC was designated one of eight comprehensive comparative effectiveness review centers, with American Recovery and Reinvestment Act funding from AHRQ. Our cross-cutting area of concentration was care delivery, management, and coordination; prevention; and behavioral interventions. Known locally as the Comprehensive Comparative Effectiveness Center ("CERC"), the project conducted evidence and comparative effectiveness reviews; topic identification, development, and refinement; future research needs studies, and methods projects. Reviews included Screening for Hepatitis C Virus Infection in Adults, Treatment Strategies for Hepatitis C Virus Infection in Adults, Pressure Ulcer Treatment Strategies, Pressure Ulcer Risk Assessment and Prevention, and Outpatient Care Management for Adults with Medical Illness and Complex Care Needs. Future research needs projects dealth with Reducing the Risk of Primary Breast Cancer in Women, Vaginal Birth After Cesarean, Outpatient Case Management, and Treatment of Hepatitis C Virus Infection. The topic identification project was on Prevention in Women's Health. Methods projects included Engaging Stakeholders to Identify and Prioritize Research Needs; work groups on future research needs, topic refinement, strength of evidence, and non-financial conflicts of interest; and worked examples on topic refinement and searching. The Capstone paper was entitled, Improving Narrative Synthesis in Evidence Reviews.

Telemedicine Workshop - Planning, Research, Evidence Report, and Organization

Principal Investigator: William R. Hersh, MD
Co-investigators: David H. Hickam, MD, MPH
Project Period: 4/30/04-9/1/05
Funding: Agency for Healthcare Research and Quality

Description: The Oregon EPC updated an evidence report on telemedicine for the Medicare population and prepared white papers and background papers for a workshop to inform Centers for Medicare and Medicaid Services staff about the viable uses of telemedicine services.

Management of Menopause-related Symptoms

Principal Investigator: Heidi D. Nelson, MD, MPH
Co-investigators: Elizabeth Haney, MD, Linda L. Humphrey, MD, MPH, Jill Miller, MD, Anne Nedrow, MD, Christina Nicolaidis, MD, MPH, Kim Vesco, MD
Project Period: 5/17/04-4/30/05
Funding: Agency for Healthcare Research and Quality

Description: The Oregon EPC produced an evidence report on menopause-related symptoms and treatment of such symptoms, including both the benefits and harms of treatments.

Publication:

Evidence Report: Management of Menopause-Related Symptoms

Nedrow A, Miller J, Walker M, Nygren P, Huffman L, Nelson HD. Complementary and Alternative Therapies for the Management of Menopause-Related Symptoms: Systematic Evidence Review. Archives of Internal Medicine. 2006; in press.

Nelson HD, Vesco KK, Haney E, Fu R, Nedrow A, Miller J, Nicolaidis C, Walker M, Humphrey L. Nonhormonal Therapies for Menopausal Hot Flashes: Systematic Review and Meta-Analysis. JAMA. 2006; 295: 2057-2071.

The Effect of Healthcare Working Conditions on Patient Safety

Principal Investigator: David H. Hickam, MD, MPH
Co-Investigators: Adrianne Feldstein, MD, MS, Paul Gorman, MD, Leslie N. Ray, RN, PhD, Sherrie Schuldheis, PhD, RN
Project Period: 9/28/01-3/27/03
Partner: Center for Primary Care, Agency for Healthcare Research and Quality

Project Description: The Oregon EPC produced an evidence report that examined workplace characteristics in four domains (physical environment, work flow, workforce staffing, and organizational culture) in both healthcare and other industries to assess their impact on patient safety.

Publication:

Evidence Report: The Effect of Healthcare Working Conditions on Patient Safety

Vaginal Birth after Cesarean Section

Principal Investigator: Jeanne-Marie Guise, MD, MPH
Co-Investigators: Marian S. McDonagh, PharmD, Jason Hashima MD, MPH, Dale F. Kraemer, PhD, Karen B. Eden, PhD, Michelle Berlin, MD, MPH
Project Period: 9/4/01-3/3/03
Partners: American Academy of Family Physicians, American College of Obstetricians and Gynecologists

Project Description: Investigators examined and assessed the medical literature to identify maternal and child health outcomes for VBAC candidates, including those for whom labor is induced or augmented. They looked at variation in outcomes by factors such as demographics, non-modifiable risk factors, obstetric factors, gestational age, indication for previous cesarean, geographic location, obstetric provider, and healthcare system characteristics.

Publications:

Evidence Report: Vaginal Birth after Cesarean Section

Guise JM, McDonagh M, Osterweil P, Nygren P, Chan BKS, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with prior caesarean. British Medical Journal, in press.

Guise JM, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M. Safety of vaginal birth after cesarean: A systematic review. Obstetrics and Gynecology. 2004; 103(3): 420-429.

Hashima JN, Eden KB, Osterweil P, Nygren P, Guise JM. Predicting vaginal birth after cesarean delivery: A review of prognostic factors and screening tools. American Journal of Obstetrics and Gynecology. 2004; 190: 547-55.

Eden KB, Hashima JN, Osterweil P, Nygren P, Guise JM. Childbirth preferences after cesarean birth: A review of the evidence. Birth. 2004; 31(1): 49-60.

Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke

Principal Investigator: Marian McDonagh, PharmD
Co-investigators: Joan Ash, PhD, Barry S. Russman, MD
Project Period: 3/30/01-8/31/02

Project Description: The Oregon EPC produced a technology assessment on the use of hyperbaric oxygen therapy for brain injury, cerebral palsy, and stroke. The report also examined how short-term outcomes are viewed and valued differently by patients and/or caregivers, advocates of HBOT, and the traditional medical community.

Publications:

Evidence Report: Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke.

McDonagh MS, Carson S, Russman B. Hyperbaric oxygen therapy for traumatic brain injury: A systematic review of the evidence, Archives of Physical Medicine and Rehabilitation, in press.

Effectiveness and Cost-effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke

Principal Investigator: Richard T. Meenan, PhD, MPH
Co-Investigators: Roger Chou, MD, Somnath Saha, MD, MPH, Karleen Swarztrauber, MD, MPH, Mark Hornbrook, PhD
Project Period: 8/1/00-1/31/02
Partner: American Academy of Neurology

Project Description: The Oregon EPC prepared an evidence report on the effectiveness and cost-effectiveness of various imaging strategies for evaluating and managing new stroke patients: transthoracic echocardiography, transesophageal echocardiography, carotid ultrasound, magnetic resonance imaging, and cerebral angiography.

Publication:

Evidence Report: Effectiveness and Cost-effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke

Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring

Principal Investigator: Heidi D. Nelson, MD, MPH
Co-Investigators: Nancy Carney, PhD, Dale F. Kraemer, PhD, Cynthia D. Morris, PhD, MPH, Susan Carson, MPH, Mark Helfand, MD, MPH
Project Period: 7/9/99-12/30/01
Partner: National Institutes of Health Consensus Development Conference, National Institute of Arthritis and Musculoskeletal and Skin Diseases

Project Description: For use at a National Institutes of Health Consensus Development Conference, the Oregon EPC produced an evidence report on the effectiveness of various strategies for diagnosing and monitoring postmenopausal women with osteoporosis. Investigators addressed the role of risk factors in identifying high risk women, the advantages and disadvantages of techniques for bone measurements to identify risk of fracture, the effectiveness of bone measurement tests for monitoring response to treatment, the role of markers of bone turnover in identifying women at risk of bone loss, the appropriateness of diagnostic or laboratory tests for evaluating patients with osteoporosis for secondary causes, and the costs and cost-effectiveness of various diagnostic strategies for identifying women with osteoporosis.

Publications:

Evidence Report: Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring

Kraemer DF, Nelson HD, Bauer DC, Helfand M. Economic comparison of diagnostic approaches for evaluating osteoporosis in older women. Osteoporosis International; published on line 5/12/05.

Actinic Keratoses

Principal Investigator: Mark Helfand, MD, MPH
Co-Investigators: AnnaLisa Gorman, MD, Neil A. Swanson, MD
Project Period: 10/16/00-5/21/01
Partner: Centers for Medicare and Medicaid Services

Project Description: The Oregon EPC prepared a technology assessment on actinic keratoses (precancerous skin lesions) for use by the Centers for Medicare and Medicaid Services (CMS) for a coverage decision. The report looked at whether different management strategies or methods of removal of the lesions lead to different outcomes. It also examined if there are characteristics of the lesions that are more likely to progress to squamous cell cancer or groups of patients at higher risk of this progression.

Publication:

Final Report: Actinic Keratoses

Telemedicine for the Medicare Population

Principal Investigator: William R. Hersh, MD
Co-Investigators: Merwyn R. Greenlick, PhD, Dale F. Kraemer, PhD, Patricia K. Patterson, RN, PhD, W. Paul Nicol, MD
Project Period: 5/24/99-4/27/01

Project Description: The Agency for Healthcare Research and Quality requested a report on telemedicine interventions used by those over age 65 as the Centers for Medicare and Medicaid Services looked at coverage decisions related to telemedicine. The Oregon EPC examined three areas: store-and-forward, self-monitoring/testing, and clinician-interactive services as their use related to diagnosis, outcomes, patient and/or clinician satisfaction, access to care, and cost. A supplemental report looked at pediatric, obstetric, and clinician-indirect home interventions.

Publications:

Evidence Report: Telemedicine for the Medicare Population

Supplemental report: Telemedicine for the Medicare Population: Pediatric, Obstetric, and Clinician-Indirect Home Interventions

Hersh WR, Helfand M, Wallace J, Kraemer D, Patterson P, Shapiro S, Greenlick M. Clinical outcomes resulting from telemedicine interventions: A systematic review. BMC Medical Informatics and Decision Making. 2001, November 26; 1:5

Hersh W, Helfand M, Wallace J, Kraemer D, Patterson P, Shapiro S, Greenlick M. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. Journal of Telemedicine and Telehealth. 2002; 8:197-209.

Rehabilitation for Traumatic Brain Injury

Principal Investigator: Randall M. Chesnut, MD
Co-Investigators: Hugo du Coudray, PhD, Patricia K. Patterson, RN, PhD, N. Clay Mann, PhD, Melanie Zimmer-Gembeck, PhD, Nancy Carney, PhD
Project Period: 10/1/97-1/15/99
Partners: National Institutes of Health Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury, Brain Injury Association

Project Description: The Oregon EPC examined issues related to rehabilitation for adults with traumatic brain injury, including early rehabilitation in the acute care setting and the intensity of such rehabilitation, cognitive rehabilitation, supported employment, and coordination of care. The findings of the evidence report were presented at the NIH Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury in October 1998. The EPC also prepared a supplemental report on rehabilitation for traumatic brain injury in children and adolescents.

Publications:

Evidence Report: Rehabilitation for Traumatic Brain Injury

Supplemental Report: Rehabilitation for Traumatic Brain Injury in Children and Adolescents

Chesnut RM, Carney N, Maynard H, Mann NC, Patterson P, Helfand M. Summary report: evidence for the effectiveness of rehabilitation for persons with traumatic brain injury. Journal of Head Trauma and Rehabilitation. 1999;14:176-88.

Carney N, Chesnut RM, Maynard H, Mann NC, Patterson P, Helfand M. Effect of cognitive rehabilitation on outcomes for persons with traumatic brain injury: A systematic review. Journal of Head Trauma and Rehabilitation. 1999;14:277-307.

Patterson PK, Maynard H, Chesnut RM, Carney N, Mann NC, Helfand M. Evidence of case management effect on traumatic-brain-injured adults in rehabilitation. Care Management Journals. 1999; 1:87-97.

Preventing Violence and Other Health-risking Social Behaviors in Adolescents

Principal Investigator: Nancy Carney PhD
Co-Investigators: Hugo du Coudray, PhD, Carolyn di Guiseppi, MD, MPH, Melanie Zimmer-Gembeck, PhD, Peggy Nygren, MA
Project Period: 4/9/01-4/30/03
Partner: National Institutes of Health Consensus Development Program, through the Office of Medical Applications of Research

Project Description: The Oregon EPC prepared 7 systematic reviews examining specific primary and secondary prevention programs aimed at reducing violent behavior and health-risking sexual behavior in adolscents. The reports focused on the following programs:

1. Primary Prevention: School Based Violence Prevention Programs
2. Secondary Prevention: School Based Violence Prevention Programs
3. Big Brothers Big Sisters Programs
4. Home visiting Programs
5. Life Skills Training Programs
6. Iowa Strengthening Families Program
7. Multidimensional Therapeutic Foster Care Programs

Please contact the EPC for copies of these reports.

Evaluation of Study Design-related Bias in Assessing the Risk of Serious Complications from Medical and Surgical Interventions

Principal Investigator: Roger Chou, MD, MPH
Project Period: 3/15/04-12/15/04

Project Description: Adequate assessment of harms data in systematic reviews requires valid criteria for judging the quality of harms assessment. The Oregon EPC has received funding to assess design-related bias in studies reporting complications or harms from medical and surgical interventions. Using data from studies of carotid endarterectomy and nonsteroidal anti-inflammatory drugs, investigators will develop and test the validity of a novel quality-rating tool.

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Robert Wood Johnson Foundation-Funded Project

 

Assessment of Self-Care Manuals

Principal Investigator: Merwyn R. Greenlick, PhD
Co-Investigators: Nancy Carney, PhD, Donald F. Austin, MD, MPH, Judith H. Hibbard, DrPH
Project Period: 10/1/98-3/31/00

Project Description: The Oregon EPC systematically reviewed the evidence to see if the dissemination of self-care manuals alters observed or self-reported outcomes, including patient behavior, utilization, and medical care costs.

Final Report: Assessment of Self-Care Manuals

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Institute of Medicine-Funded Projects

Screening for Skin Cancer

Principal Investigator: Mark Helfand, MD, MPH
Co-Investigator: Karen B. Eden, PhD
Project Period: 11/15/98 - 8/5/99

Project Description: The Oregon EPC conducted a systematic review of skin cancer screening for the Institute of Medicine in conjunction with a project to review extending Medicare coverage for preventive services. The report examined published data on the effectiveness of screening for skin cancer by a physician, including the accuracy of the tests used for screening, the diagnostic yield of screening in the general population, and evidence that treatment of cancers found by screening improves outcomes.

Publications:

Final Report: Screening for Skin Cancer

Helfand M, Mahon S, Eden K, Frame PS, Orleans CT. Screening for skin cancer. American Journal of Preventive Medicine, 2001;20(3S):47-58.

Screening for Thyroid Cancer

Principal Investigator: Mark Helfand, MD, MPH
Co-Investigator: Karen B. Eden, PhD
Funding Agency: Institute of Medicine
Project Period: 12/1/97 - 3/30/98

Project Description: As part of a review by the Institute of Medicine and the National Research Council on exposure of the American people to Iodine-131 from Nevada nuclear-bomb tests in the 1950s, the Oregon EPC conducted a systematic review on screening for thyroid cancer to assess whether individuals exposed to higher dosages of I-131 might have a high risk of developing thyroid cancer later in life and if early detection and intervention for thyroid cancer could be useful for those persons.

Publications:

Final Report: Screening for Thyroid Cancer

Eden K, Helfand M, Mahon S. Screening high-risk populations for thyroid cancer / thyroid disease.

Medical and Pediatric Oncology. 2001; 36:583-591.

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Other Funding

Interventions to Increase Mammography Screening

Principal Investigator: Susan Carson, MPH
Project Period: 11/27/00-3/31/01

Project Description: The Oregon EPC received funding from the Oregon/Southwest Washington Affiliate of the Susan G. Komen Breast Cancer Foundation to conduct a systematic review of interventions that increase mammography screening.

Publication:

Final Report: Interventions to Increase Screening for Breast Cancer

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