Alagoz, O., Bryce, C.L., Shechter, S., and others (2005, December). "Incorporating biological natural history in simulation models: Empirical estimates of the progression of end-stage liver disease." (AHRQ grant HS09694). Medical Decision Making 25, pp. 620-632.
The use of standard Markov methods to model disease in groups of patients has often been replaced with the use of Monte Carlo microsimulation, which models disease in individual patients. The authors have developed a natural-history model that uses cubic splines to calibrate an individual microsimulation model. Cubic splines can predict quantitative changes in the laboratory values and clinical characteristics of patients with end-stage liver disease (ESLD) awaiting liver transplantation,.
The model was able to simulate the types of erratic disease trajectories that occur in individual ESLD patients and preserve the statistical properties of the natural history of ESLD in groups of real patients. Moreover, the model was able to predict pretransplant survival rate (87 percent at 1 year).
Carey, T.S., Howard, D.L., Goldmon, M., and others (2005, November). "Developing effective interuniversity partnerships and community-based research to address health disparities." (AHRQ grant HS10861). Academic Medicine 80(11), pp. 1039-1045.
The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill to address community-based research on health disparities. The universities strategically developed several research initiatives, building on modest early successes and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing medical research grants from U.S. Federal agencies. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration.
Chapman, W.W., Dowling, J.N., and Wagner, M.M. (2005, November). "Generating a reliable reference standard set for syndromic case classification." (AHRQ Contract No. 290-00-0009). Journal of the American Medical Informatics Association 12, pp. 618-629.
The authors generated and measured the reliability of a reference standard set with representative cases from seven broad syndromic case definitions and several narrower syndrome definitions used for biosurveillance. From 527,228 patients eligible between 1990 and 2003, they generated a set of patients potentially positive for 7 syndromes by classifying all eligible patients according to their ICD-9 primary discharge diagnoses. They selected a representative subset of the cases for chart review by physicians, who read emergency department reports and assigned values to 14 variables related to the 7 syndromes. Of the 27 syndromes generated by the 14 variables, 21 showed high enough prevalence, agreement, and reliability to be used as reference standard definitions against which an automated syndromic classifier could be compared.
Garbutt, J.M., Highstein, G., Jeffe, D.B., and others (2005, June). "Safe medication prescribing: Training and experience of medical students and housestaff at a large teaching hospital." (AHRQ grant HS11898). Academic Medicine 80(6), pp. 594-599.
Dosing errors, drug-drug-interactions, and allergic reactions are the prescribing errors most commonly associated with adverse drug events (harm due to drug errors). A study on the routine use of safe medication prescribing practices among interns, residents, and medical students at one hospital found that only 50 percent of interns always double-checked their dosage calculations, and only 55 percent always checked for impaired renal functioning and adjusted the medication accordingly. Only one in three prescribers routinely checked for potential drug-drug interactions when writing a new order, and one in four failed to check for allergies before prescribing an antibiotic. Overall, 89 percent of those surveyed reported always checking prescribing information before prescribing new drugs, 75 percent always checked for drug allergies, 59 percent double-checked dosage calculation, 56 percent checked for renal impairment, and 30 percent checked for potential drug-drug interactions. Respondents to the anonymous survey also indicated that being in a hurry (84 percent) and being interrupted (66 percent) were likely to contribute to prescribing errors.
Hepner, K.A., Brown, J.A., and Hays, R.D. (2005, December). "Comparison of mail and telephone in assessing patient experiences in receiving care from medical group practices." (AHRQ grant HS00924). Evaluation & The Health Professions 28(4), pp. 377-389.
Mail and telephone modes of data collection produce similar results for the medical group survey from the Consumer Assessment of Health Plans Study (G-CAHPS), concludes this study. The survey focuses on patient experiences in receiving care from their medical group practices. The researchers compared mail and telephone responses to the G-CAHPS survey in a sample of 880 patients from 4 physician groups. They randomly assigned patients to either telephone or mail survey, then compared response rates, missing data, internal consistency, reliability of six multi-item scales, and mean scores. A total of 537 phone surveys were completed and 343 mail surveys were completed. There were no significant differences in internal consistency by survey mode and only one significant mode difference in item and composite means by mode of administration.
Heslin, K.C., Andersen, R.M., Ettner, S.L., and others (2005, October). "Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?" (AHRQ grant HS08578). Medical Care Research and Review 62(5), pp. 583-600.
Some States have authored bills that give managed care enrollees with a serious chronic illness such as HIV disease the right to self-refer to specialists rather than getting referrals from their primary care doctor. Researchers analyzed survey data from the HIV Costs and Services Utilization Study (HCSUS) and found that at baseline (December 1996 to April 1997), 67 percent of patients had insurance that permitted self-referral to specialists. After accounting for other factors affecting the likelihood of having an HIV expert physician, patients who were able to refer themselves to a specialist were 8 to 12 percent more likely than those who weren't to have a regular doctor who mainly treated patients with HIV.
Seventy-four percent of HIV patients with self-referral insurance policies had HIV-experienced physicians compared with 66 percent of patients needing prior authorization. Blacks were less likely than whites to have an expert physician at baseline, and those with incomes between $10,000 to $24,999 were less likely to have expert physicians at followup than those in the highest income category.
Huang, S.S., Platt, R., Rifas-Shiman, S.L., and others (2005, September). "Post-PCV7 changes in colonizing pneumococcal serotypes in 16 Massachusetts communities, 2001 and 2004." (AHRQ grant HS10247). Pediatrics 116(3), pp. e408-e413.
In February 2000, heptavalent pneumococcal conjugate vaccine (PCV7) was released to provide immunity to the 7 serotypes responsible for 85 percent of pediatric invasive pneumococcal disease and 78 percent of penicillin-nonsusceptible Streptococcus pneumoniae isolates in children. This study found that pneumococcal colonization changed after the introduction of PCV7, both in serotype distribution and in patterns of antibiotic resistance. The frequency of nonvaccine strains increased, and the proportion of nonvaccine isolates that are not susceptible to penicillin tripled. This shift toward increased carriage of nonvaccine serotypes warrants vigilance, caution the researchers. Their findings were based on examination of nasopharyngeal specimens from young children during well-child or sick visits to 16 Massachusetts primary care practices during 2001 and 2004.
Levine, R.S., Briggs, N.C., Husaini, B.A., and others (2005, November). "HEDIS prevention performance indicators, prevention quality assessment and Healthy People 2010." (AHRQ grant HS18113). Journal of Health Care for the Poor and Underserved 16, pp. 64-82.
The Health Employer Data and Information Set (HEDIS) has been used to evaluate the quality of outpatient care and has profoundly influenced the way preventive care is delivered. However, critics suggest that because HEDIS focuses on a small set of indicators, it may also cause neglect of non-measured services. This study of Medicaid-insured patients at one clinic found that a focus on HEDIS-Medicaid 3.0 quality indicators in these patients would have been inconsistent with the goals and objectives of Healthy People 2010 and would have promoted patient mistrust by failing to meet patient expectations. According to recommended preventive services rated A or B by the U.S. Preventive Services Task Force, these patients had 11,504 service needs. Performance indicators from HEDIS-Medicaid 3.0 would have covered 22 percent (2,571), while the goals and objectives of Healthy People 2010 would have covered 99 percent (11,437).
Reynolds, P.P., Kamei, R.K., Sundquist, J., and others (2005, December). "Using the PRACTICE mnemonic to apply cultural competency to genetics in medical education and patient care." (AHRQ Contract No. 240-98-0020). Academic Medicine 80(12), pp. 1107-1113.
A growing number of medical school courses are focusing on physician cultural competency and skills development with ethnically diverse patient populations, as well as on genetics and genomics. The authors of this paper describe the work of the Genetics in Primary Care Faculty Development Working Group on Cultural Competency. The working group wrote a module on cultural competency and nine new clinical cases, and developed the PRACTICE mnemonic (prevalence, risk, attitude, communication, testing, investigation, consent, and empowerment) to help health care professionals integrate cultural competency skills in genetics into primary care. The PRACTICE mnemonic integrates information emerging from experts in health disparities and doctor-patient communication to build a comprehensive model for addressing the relevance of culture and ethnicity in the delivery of genetic services.
Schuster, M.A., Collins, R., Cunningham, W.E., and others (2005, September). "Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care." (AHRQ Grant HS08578). Journal of General Internal Medicine 20, pp. 807-813.
One-fourth of U.S. adults receiving care for HIV believe that their clinicians discriminated against them after they became infected with HIV, according to a study based on survey data from the HIV Cost and Services Utilization Study (HCSUS). Respondents to the survey indicated that from 1996 to 1997, they felt that a health care provider had been uncomfortable with them (20 percent), treated them as inferior (17 percent), preferred to avoid them (18 percent), or refused them service (8 percent). Whites (32 percent) were more likely than Latinos (21 percent) and blacks (17 percent) to report discrimination. Reported discrimination also varied significantly by type of health insurance. Patients with HIV who felt discriminated against also reported lower access to care, lower quality of medical care and hospital care, and less trust in doctors or clinics than those who didn't report discrimination.
Singh-Manoux, A., Hillsdon, M., Brunner, E., and others (2005, December). "Effects of physical activity on cognitive functioning in middle age: Evidence from the Whitehall II prospective cohort study." (AHRQ grant HS06516). Research and Practice 95(12), pp. 2252-2258.
This new Whitehall II study of British civil servants (aged 35-55 years) examined the association between physical activity and cognitive functioning in middle age. The researchers categorized physical activity level as low, medium, or high at phase 1 (1985-1988), phase 3 (1991-1994), and phase 5 (1997-1999). They tested cognitive functioning at phase 5, when respondents were 46-68 years old. Low levels of physical activity increased by 65 to 79 percent the risk for poor performance on a measure of fluid intelligence, with persistently low levels of physical activity being particularly harmful.
Yost, K.J., Cella, D., Chawla, A., and others (2005, December). "Minimally important differences were estimated for the functional assessment of cancer therapy-colorectal (FACT-C) instrument using a combination of distribution- and anchor-based approaches." (AHRQ grant HS09869). Journal of Clinical Epidemiology 58, pp. 1241-1251.
Several disease-specific instruments have been developed to measure health-related quality of life (HRQL) in colorectal cancer patients, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C). This study generated minimally important differences (MIDs) for FACT-C scores based on published results for two samples from the FACT-C validation study. The researchers confirmed preliminary MIDs using data from a Phase II randomized controlled clinical trial and a population-based observational study. MIDs were stable across the different patient samples. The recommended MIDs ranged from 2 to 3 points for the colorectal cancer subscale, 4 to 6 points for the FACT-C Trial Outcome Index, and 5 to 8 points for the FACT-C total score. The authors conclude that MIDs can enhance the interpretability of FACT-C scores.
Zhou, K.H., Resnic, F.S., Talos, I-F., and others (2005, October). "A global goodness-of-fit test for receiver operating characteristic curve analysis via the bootstrap method." (AHRQ grant HS13234). Journal of Biomedical Informatics 38, pp. 395-403.
A popular method for evaluating the performance of diagnostic tests is the receiver operating characteristic (ROC) curve analysis. These researchers developed a global statistical hypothesis test for assessing the goodness-of-fit for parametric ROC curves via the bootstrap. A simple log and more flexible Box-Cox normality transformations were applied to untransformed or transformed data from two clinical studies to predict complications following percutaneous coronary interventions (PCIs) and for image-guided neurosurgical resection results predicted by tumor volume, respectively. In both studies, the p- values suggested that transformations were important to consider before applying any binormal model to estimate the areas under the curve. The analysis also demonstrated and confirmed the predictive values of different classifiers for determining the interventional complications following PCIs and resection outcomes in image-guided neurosurgery.
Current as of March 2006
AHRQ Publication No. 06-0033
Internet Citation:
Research Activities Newsletter. March 2006, No. 307. AHRQ Publication No. 06-0033. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/mar06/
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