Cervical Cancer
- Despite new guidelines, most ob-gyns
continue to over-screen low-risk
women for cervical cancer.
The American Cancer Society suggests
that cervical cancer screening with Pap
tests begin within 3 years after a woman
becomes sexually active or by age 21,
whichever comes first. The ACS no
longer recommends annual screening in
women over age 30 who have had three
or more previous normal Pap tests. The
American College of Obstetricians and
Gynecologists has made similar
recommendations. Yet, 185 randomly
selected ob-gyns said that they would
begin screening girls who were not yet
sexually active at age 18. Also, 60
percent of respondents said that they
would continue annual screening in a
35-year-old woman with three or more
normal tests. Saint, Gildengorin, and
Sawaya, Am J Obstet Gynecol 192:414-21, 2005 (AHRQ grant HS07373).
- Less frequent cervical cancer screening
may be a safe option.
Current care guidelines recommend
extending the interval for Pap tests from
once a year to once every 3 years among
low-risk women with three consecutive
negative pap tests. According to this
study, the less-frequent approach is a
safe option with only minimal excess
risk of cervical cancer in women aged
30 to 64.
Sawaya, McConnell,
Kulasingam, et al., New Engl J Med
349(16):1501-9, 2003 (AHRQ
grant HS07373).
- Rural women report satisfaction with
telecolposcopy.
Women living in rural Georgia felt that
telecolposcopy saved them time and
money and said they would recommend
the procedure to a friend. The women
believed that telecolposcopy improved
the quality of their care, and they felt
better about their health after the exam.
Ferris, Litaker, and Lopez, J Am Board
Fam Pract 16:405-11, 2003 (HS08814).
- Cervical cancer rates among younger
women have decreased.
According to this study, the rate of
cervical cancer detected among women
younger than 30, incidence rates of
cervical cancer overall and squamous
cell cancer specifically declined by
nearly 1 percent per year from 1973 to
1999.
Chan, Sung, and Sawaya, Obstet
Gynecol 102(4):765-73, 2003 (AHRQ
grant HS07373).
- South Asian women should be
targeted to receive cervical cancer
screening.
Despite the high socioeconomic status
of Indian and other South Asian
women living in the United States, this
study found that one-fourth of them
had not had a Pap smear in more than
3 years. Regions with large South Asian
populations should be targeted with
messages promoting cervical cancer
screening. The message should be aimed
particularly at unmarried South Asian
women of low socioeconomic status
who have spent little time in America.
Chaudhry, Fink, Gelberg, and Brook, J
Gen Intern Med 18:377-84, 2003
(AHRQ grant HS10597).
- Telecolposcopy can enhance diagnostic
accuracy.
Researchers examined the efficacy of
telecolposcopy for women with
abnormal Pap smears or other
indications for colposcopy who were
examined by local colposcopists at rural
clinics. Images of colposcopic
examinations were transmitted to a
tertiary care center for interpretation by
an expert colposcopist and to an expert
at the rural site. The colposcopists did
not share findings with each other.
Agreement ranged from 60, 56, and 53
percent for the local colposcopists,
distant experts, and site experts,
respectively.
Ferris, Macfee, Miller, et
al., Obstet Gynecol 99(2):248-54, 2002
(AHRQ grant HS08814).
Return to Contents
Breast and Cervical/Ovarian Cancer
- Task Force recommends against
routine testing for genetic risk of breast
or ovarian cancer.
According to the U.S. Preventive
Services Task Force, primary care
physicians should only refer certain
women for genetic counseling and
DNA testing to detect the presence of
specific BRCA1 and BRCA2 gene
mutations that may be associated with
breast and ovarian cancer. Physicians
should suggest counseling and DNA
testing only for women who have
specific family history patterns which
put them at risk for these gene
mutations. Nelson, Huffman, Fu, and
Harris, Ann Intern Med 143(5):362-79; see also pages 355-61 in the same
journal (AHRQ contract 290-97-0011).
- Physician specialty influences use of
screening mammography and Pap
smears in gatekeeper plans.
The impact of gatekeeper plans—which
require a referral to see a specialist—on
cancer screening varies according to the
specialty of a woman's primary care
physician, according to this study. For
example, the use of mammography to
screen for breast cancer and Pap smears
to screen for cervical cancer among
patients of internal medicine physicians
were unaffected by enrollment in a
gatekeeper plan. On the other hand,
screening rates were increased if family
practice physicians were in gatekeeper
plans. The researchers note that different cultures of practice may
explain the study findings. Haggstrom,
Phillips, Liang, et al., Cancer Causes and
Control 15:883-92, 2004 (AHRQ
grant HS10771 and HS10856).
- Breast and cervical cancer screening
rates are higher in areas with greater
HMO market share.
After taking into account individual and
area factors, women in high HMO
market share areas were nearly twice as
likely to have recently had a
mammogram or Pap smear, according
to this study. Also, women were 58
percent more likely to have had a recent
clinical breast exam than women in
areas with low managed care
penetration. Also, there was a spillover
effect to women not enrolled in
managed care. The researchers linked
data on cancer screening from the 1996
Medical Expenditure Panel Survey with
data on HMO market share and HMO
competition in metropolitan statistical
areas. Baker, Phillips, Haas, et al.,
Health Serv Res 39(6, part I):1751-72, 2004 (AHRQ grants HS10771,
HS10856, and HS10925).
- Personalized form letters may improve
breast and cervical cancer screening
among some women.
According to this study of more than
1,500 urban low-income and minority
women, sending them a personalized
form letter with general cancer
information increases the likelihood
they will be screened for cervical and
breast cancer.
Jibaja-Weiss, Volk, Kingery, et al., Patient Educ Couns
50:123-32, 2003 (AHRQ grant
HS08581).
Return to Contents
Other Cancers
- Screening sigmoidoscopy may be less
effective for detecting colorectal cancer
in women and older people.
This study found that screening for
colorectal cancer with a 60-cm flexible
sigmoidoscope resulted in inadequate
exams for 18 percent of patients of all
ages. The percentage of inadequate
exams increased progressively with age,
from 10 percent for ages 50 to 59 to 22
percent for ages 80 or older. Inadequate
exams were more common in women of
all ages, ranging from 19 percent (ages
50-59) to 32 percent (ages 80 and
older). Women are more likely than
men to experience pain during the
exam, and they have longer colons in a
smaller abdominal cavity.
Walter, deGarmo, and Covinsky, Am J Med
116:174-8, 2004 (AHRQ grant K02
HS00006).
Return to Contents
Hysterectomy and Other Treatments for Uterine Conditions
More than 500,000 hysterectomies are
performed in the United States each
year at an annual cost of more than $5
billion. More than one-third of women
in the United States have had a
hysterectomy by age 60.
The most common reason for
hysterectomy for women of any age
continues to be fibroid tumors, which
in the mid-1990s accounted for about
one-third of all hysterectomies (nearly
two-thirds for black women). Other
reasons for hysterectomy include
endometriosis (about 18 percent),
uterine prolapse (16 percent), excessive
bleeding (5 percent), and other causes
(10 percent).
- Type of hysterectomy does not affect
sexual functioning and quality of life
2 years later.
Women who undergo supracervical
hysterectomy (cervix is left in place) or
total abdominal hysterectomy (cervix is
removed) achieve similar sexual
functioning and quality of life 2 years
after the procedure, according to this
study of 135 premenopausal women
who underwent hysterectomy in one of
four U.S. clinical centers. At 6 months
postsurgery, sexual problems had
improved dramatically in both groups,
and at 2 years the women reported few
problems in this area. Both groups also
had substantial improvement in most
other quality of life measures.
Kuppermann, Summit, Varner, et al.,
Obstet Gynecol 105(6):1309-18,
2005; see also Learman, Summitt,
Varner, et al., Obstet Gynecol 102:453-62, 2003 (AHRQ grant HS09478).
- Hysterectomy offers better outcomes
than medicine for women with
abnormal uterine bleeding.
This randomized controlled trial of
women aged 30 to 50 who had
abnormal uterine bleeding for an
average of 4 years found that those in
the hysterectomy group had greater
improvement in their symptoms and
expressed higher satisfaction with their
overall health 6 months after treatment
than women in the oral medication
group.
Kuppermann, Varner, Summitt,
et al., JAMA 291(12):1447-55, 2004
(AHRQ grant HS07373).
- Long-term outcomes are similar for
women who either have a hysterectomy
or go through natural menopause.
This is the first study to examine the
long-term impact of hysterectomy on
quality of life. The researchers found no
difference in quality of life between
women who had a hysterectomy (with
or without ovary removal) an average of
27 years earlier and women who had a
natural menopause 25 years earlier. The
study involved 801 women aged 50-96
who were interviewed between 1992
and 1996.
Kritz-Silverstein, Von
Muhlen, Ganiats, and Barrett-Connor,
Qual Life Res 13:55-62, 2004 (AHRQ
grant HS06726).
- Several factors influence women's
satisfaction with use of medication to
treat abnormal uterine bleeding.
Factors such as age, fertility status,
attitudes about uterine conservation,
and intensity of symptoms affect
premenopausal women's satisfaction
with use of oral medroxyprogesterone
acetate to control bleeding.
Richter, Learman, Lin, et al., Am J Obstet
Gynecol 189:37-42, 2003 (AHRQ grant
HS9478).
- Study finds racial differences in
treatment and outcomes of women
undergoing surgery for uterine fibroids.
The researchers examined the medical
charts of 225 women (53 percent black,
47 percent white) who underwent
abdominal myomectomy for fibroid
tumors at one medical center between
1992 and 1998. Black women were
more than twice as likely as white
women to have in-hospital
complications or a blood transfusion.
These increased complications were
largely due to differences in uterine size
and number of fibroids.
Roth, Gustilo-Ashby, Barber, and Myers,
Obstet Gynecol 101:881-4, 2003
(AHRQ grant HS09874).
- Endometrial ablation does not
substitute for hysterectomy.
Using the State Inpatient and
Ambulatory Surgery Databases of the
Healthcare Cost and Utilization Project,
investigators accessed data on women
with benign uterine conditions who
underwent hysterectomy or endometrial
ablation. In the six States studied, from
1990 to 1997, increases in endometrial
ablation rates did not mirror decreases
in hysterectomy rates. Results show
endometrial ablation was used as an
additive medical technology rather than
as a substitute for hysterectomy.
Farquhar, Naoom, and Steiner, Int J
Technol Assess Health Care 18(3):625-34, 2002. (Reprints, AHRQ
Publication No. 03-R004).*
- Study shows life satisfaction improves
after hysterectomy.
In a 1992 survey, women were asked to
rate their life satisfaction as better, the
same, or worse after menopause or
hysterectomy. Women who were 20 or
more years posthysterectomy or
postmenopause were significantly more
likely to reply "better" than women 5 or
fewer years after these events. Among
women with a hysterectomy, 53 percent
with oophorectomy and 60 percent with
ovarian conservation rated life better
after the surgery. Only 42 percent of
women who had not had a
hysterectomy rated life satisfaction as
better after menopause.
Kritz-Silverstein,
Wingard, and Barrett-Connor J Womens
Health and Gender-Based Med
11(2):181-90, 2002 (AHRQ grant
HS06726).
- U.S. hysterectomy rates stayed constant
but the type of surgery changed.
An analysis of 1990-1997 hospital
discharge data from the Nationwide
Inpatient Sample of the Healthcare Cost
and Utilization Project revealed that
over the study period, rates of
hysterectomy for benign uterine
conditions remained about the same,
abdominal hysterectomy remained the
most common procedure, and
laparoscopic hysterectomies increased
30-fold.
Farquhar and Steiner, Obstet
Gynecol 99(2):229-34, 2002. (Reprints,
AHRQ Publication No. 02-R049)*
(Intramural).
- Study reveals effects of hysterectomy on
UI.
Using the Urinary Symptom Scale for
Women, researchers interviewed 1,299
women to assess incontinence before
and after hysterectomy. Responses
indicate that UI improves for the first 2
years after surgery for most women who
have moderate or severe incontinence.
According to researchers, women who
had mild or no incontinence before
hysterectomy had a 10 percent risk of
worse or new-onset incontinence after
surgery.
Kjerulff, Langenberg,
Greenaway, et al., J Urol 167:2088-92, 2002 (AHRQ grant HS06865).
- Report describes evidence on
management of uterine fibroids.
Researchers at the Duke EPC reviewed
the available evidence on the commonly
used medical and invasive therapies for
uterine fibroids and found the overall
quality of the literature to be poor and
inconsistent. They did, however, find good evidence that use of
gonadotropin-releasing hormone
agonists prior to surgery reduces blood
loss and may facilitate certain surgical
approaches (e.g., use of laparoscopic or
vaginal approaches or use of transverse
abdominal instead of vertical incisions).
They also found that 2-year outcomes
are favorable for most women who
undergo hysterectomy.
Copies of
Evidence Report/Technology
Assessment No. 34, Management of
Uterine Fibroids (AHRQ Publication
No. 01-E051 summary and 01-E052,
full report), are available from AHRQ
(contract 290-97-0014).*
Return to Contents
Reproductive Health
AHRQ's research on reproductive
health focuses on fertility problems, use
of contraceptives, chronic pelvic pain,
and conditions that can affect fertility
and childbearing.
Pelvic inflammatory disease (PID) is
one of many health conditions that can
affect women during their reproductive
years. PID affects more than 1 million
U.S. women each year and frequently
results in infertility, ectopic pregnancy,
and chronic pelvic pain. Annual
estimated costs associated with PID and
its consequences exceed $4 billion.
- Uterine artery embolization found to
be a low-risk procedure.
Researchers examined the outcomes of
more than 3,000 women who
underwent uterine artery embolization
for fibroids. The women were treated at
72 sites across the United States.
Overall, less than 1 percent of women
suffered from major inpatient
complications; 4.8 percent suffered
from major events (mostly inadequate
pain relief ) within the first 30 days
following hospital discharge. There were
no deaths related to the procedure, but
31 women required additional surgical
intervention with 30 days of the
procedure. Worthington-Kirsch, Spies,
Myers, et al., Obstet Gynecol 106(1):52-9, 2005; see also pp. 44-51 by the
same authors in the same journal
(AHRQ grant HS09760).
- Certain factors predict chronic pelvic
pain after PID.
One-third of women with PID
subsequently suffer from chronic pelvic
pain. A study of 780 urban women
with PID found that women who
smoked, those who had previous
episodes of PID, women who were
married, and those who had low mental
health scores were more likely than
other women to experience chronic
pelvic pain. The researchers also note
that recurrent PID can cause adhesions
to form and may represent persistent,
chronic infection or inflammation, all
of which can result in chronic pelvic
pain. Haggerty, Peipert, Weitzen, et al.,
Sex Trans Dis 32(5):293-9, 2005; see
also Haggerty, Schulz, Ness, et al.,
Obstet Gynecol 102:934-9 (AHRQ
grant HS08358).
- Women who have urinary
incontinence are more likely than
those with pelvic organ prolapse to
complain of sexual problems.
Pelvic floor disorders—including
urinary incontinence (UI) and pelvic
organ prolapse—affect nearly one-third
of adult women. Researchers at Johns
Hopkins University examined the
association between pelvic floor
disorders and sexual complaints using
data collected in 1992-1993 during in-home
interviews of 1,299 women aged
30 to 50 who were scheduled to
undergo hysterectomy. Nearly 40
percent of the women had evidence of
pelvic floor disorders. UI was associated
with twice the likelihood of low libido,
vaginal dryness, and painful intercourse,
independent of a woman's age,
education, or race. In contrast, pelvic
organ prolapse was not associated with
sexual problems. Handa, Harvey,
Cundiff, et al., Am J Obstet Gynecol
191:751-6, 2004 (AHRQ grant
HS06865).
- Drug regimens for treating PID
should include metronidazole.
In a recent study of 278 women with
clinically suspected PID, researchers
frequently isolated bacteria that are
strongly associated with endometritis.
This finding prompted them to
recommend that all women with PID
be treated with drug regimens that
include the broad-spectrum antibiotic,
metronidazole. They conclude that this
approach could potentially reduce the
frequency of infertility, chronic pelvic
pain, recurrent PID, and ectopic
pregnancy after treatment. Haggerty,
Hillier, Bass, et al., Clin Infect Dis
39:990-5, 2004 (AHRQ grant
HS08358).
- Targeted chlamydia screening found to
be most effective and cost effective.
Annual screening for chlamydia of all
sexually active women aged 15 to 29,
coupled with semiannual screening of
those with a history of chlamydial
infection, is the most effective and cost-effective
screening strategy, according to
this study. Since most chlamydial
infections are asymptomatic and are
100 percent curable if caught early,
screening and early treatment are
critical. Hu, Hook, and Goldie, Ann
Intern Med 141:501-13, 2004 (AHRQ
grant T32 HS00020).
- Many women face barriers to
consistent use of oral contraceptives.
Uninterrupted use of oral contraceptive
pills is necessary for optimal
effectiveness. For some women, out-of-pocket
costs and the inconvenience of
making monthly pharmacy visits may
be barriers to consistent use of oral
contraceptives, according to this study.
Phillips, Stotland, Liang, et al., JAMA
59:36-42, 2004 (AHRQ grants
HS10771 and HS10856).
- Researchers examine effects of condom
use on recurrent PID.
In this study of 684 sexually active
women with PID, consistent condom
users had 50 percent less risk of
recurrent PID compared with
inconsistent users of condoms. Other
barrier methods, such as diaphragms
and use of oral contraceptives, had no
effect on risk of recurrent PID.
Ness, Randall, Richter, et al., J Public Health
94(8):1327-9, 2004 (AHRQ grant
HS08358).
- Research findings suggest that invasive
prenatal diagnostic testing should be
offered to all women.
Current guidelines recommend offering
noninvasive screening tests (blood tests
and/or ultrasound) to pregnant women
younger than 35 and reserving invasive
diagnostic testing (amniocentesis and
chorionic villus sampling) for women
age 35 or older and those at elevated
risk for having a child with a genetic
disorder. Two recent studies disagree.
The first study recommends that
prenatal diagnostic testing be offered to
all women, not just those at elevated
risk. The second study concludes that
prenatal diagnostic testing can be cost
effective at any age or risk level.
Caughey, Washington, Gildengorin, and
Kuppermann, Obstet Gynecol 103:539-45, 2004 (AHRQ grant HS07373);
and Harris, Washington, Nease, and
Kuppermann, Lancet 363:276-82,
2004 (AHRQ grant HS07373).
- Endometritis does not predict
reproductive problems after PID.
In a study that involved 614 women,
the researchers compared women with
endometritis, upper genital tract
infection (gonorrhea or chlamydia), or
both to women without these problems
for outcomes of pregnancy, infertility,
recurrent PID, and chronic pelvic pain.
For women with mild to moderate PID
who were treated with standard
antibiotics, endometritis and/or
infection were not associated with
reduced pregnancy, elevated infertility,
or recurrent PID.
Haggerty, Ness,
Amortegui, et al., Amer J Obstet Gynecol
188:141-8, 2003 (AHRQ grant
HS08358)
- Inpatient and outpatient PID
treatment outcomes are similar.
Researchers compared the effectiveness
of inpatient and outpatient treatment
strategies in preserving fertility and
preventing recurrence of PID, chronic
pelvic pain, and ectopic pregnancy for
women with mild to moderate PID.
After 35 months, pregnancy rates were
nearly equal between the groups. There
were no significant differences between
the proportion of women with ectopic
pregnancy, chronic pelvic pain, or PID
recurrence.
Ness, Soper, Holley, et al.,
Am J Obstet Gynecol 186(5):929-37,
2002 (AHRQ grant HS08358).
- Contraception affects risk of upper
genital tract infection.
Researchers interviewed and obtained
endometrial samples from 14- to 37-year-old females with PID to examine
the link between hormonal and barrier
contraception on the development of
UGTI. About 60 percent of the women
were age 24 or younger, and nearly 63
percent of the women were black.
Although inconsistent use of condoms
was associated with a two to three times
greater risk of UGTI, no contraceptive
method significantly reduced UGTI.
Ness, Soper, Holley, et al., Am J Obstet
Gynecol 185:121-7, 2001 (AHRQ
grant HS08358).
- Researchers evaluate use of clinical
predictors of endometritis in women
with symptoms of PID.
Adnexal tenderness (tenderness of the
ovaries and/or fallopian tubes) identifies
over 95 percent of women with PID,
but only 83 percent are identified by the
minimum criteria for diagnosing PID
suggested by the Centers of Disease
Control and Prevention. These and
other findings are based on the
characteristics of 651 women enrolled in
a multicenter randomized treatment
trial for PID, clinical and laboratory
findings, and endometrial sampling.
Peipert, Ness, Blume, et al., Am J Obstet
Gynecol 184:856-64, 2001 (AHRQ
HS08358).
Return to Contents
Health Care Access, Quality, and Costs
The many changes taking place in
health care delivery in the United States
have serious implications for women's
health. These changes include a
consolidation of the health care system,
a shift to managed care, and decreased
public funding of health care and
health-related programs. These changes
mean woman need more information
than ever before to help them make
informed health care choices for
themselves and their families.
- Physician specialty linked to patient
satisfaction among younger women.
Younger women (aged 18 to 34) are
more satisfied with their health care
when a reproductive health specialist is
the primary provider, according to this
study of more than 1,100 women who
made primary care visits in 2001. The
researchers defined reproductive health
specialists as obstetrician/gynecologists
and nurse midwives. They found
increased satisfaction with health care
coordination and comprehensiveness of
care among younger women seen by
these providers. Henderson and
Weisman, Med Care 43(8):826-33,
2005 (HS10237).
- Study finds link between State policies
and women's mortality rates for certain
diseases.
Researchers at Oregon Health &
Science University examined State
policies affecting women's health in four
areas: reproductive issues (e.g., State
requirements for private insurers to
cover cervical cancer screening),
economic issues (e.g., child support
payments), access to care (e.g., Medicaid
eligibility requirements), and ensuring
healthy communities (e.g., gun control
and aid to victims of domestic violence).
They found that Medicaid eligibility policies accounted for 66 percent of the
variation in heart disease mortality
across States. Policies related to violence
against women and gun control, family
medical support and efforts to expand
Medicaid, and tracking of
environmental health accounted for 50
percent of the variance in lung cancer
mortality. Wisdom, Berlin, and Lapidus,
Soc Sci Med 61:1776-84, 2005
(AHRQ grant T32 HS00069).
- Informal caregivers influence
hospitalization of elderly women.
The researchers analyzed data from a
sample of 420 disabled elderly women
who were receiving informal care from
family and friends. The objective was to
examine the relationship between
caregiver attributes and the women's
hospitalization experiences. Results
showed that the women were more
likely to be hospitalized but less likely to
have a delayed discharge if their
caregivers felt competent in their role.
Nearly half of the women were never
hospitalized over 3 years. Those who
were hospitalized tended to be older,
were in worse health, had more task
limitations, and had a cardiopulmonary
condition or diabetes. Wolff and Kasper,
Aging Clin Exp Res 16(4):307-13, 2004
(AHRQ grant T32 HS00029).
- Inequalities in care continue to limit
women's access to the most effective
therapies.
In this article, AHRQ's Senior Advisor
on Women's Health identifies five key
areas for advancing women's health:
research, clinical practice, policy,
curriculum development, and research
training. Studies that focus separately
on women and men are needed to
develop targeted quality measures and
other initiatives that address the unique
health care needs of women.
Correa-de-Araujo, Women's Health Issues 14:31-4,
2004 (Reprints, AHRQ Publication
No. 04-R044)* (Intramural).
- Racial disparities found in Medicare
managed care plans.
Data from the 1998 Medicare Health
Plan Employer Data and Information
Set on 305,574 elderly patients enrolled
in Medicare managed care health plans
revealed racial differences in clinical
services. For example, blacks were less
likely than whites to receive breast
cancer screening (63 vs. 71 percent).
Researchers said more than half of this
disparity was explained by
socioeconomic factors.
Schneider, Zaslavsky, and Epstein, JAMA
287(1):1288-94, 2002 (AHRQ grant
HS10803).
- Disparities in men's and women's
mental health may be sociodemographic.
Using the 12-item General Health
Questionnaire with men and women
working in three organizations in the
United Kingdom, researchers found
that women had more minor mental
health problems than men. However, in
each organization, women were
overrepresented in the lowest grades and
underrepresented in the higher grades.
Studies of differences between men and
women in mental health should take
into account their work and life
situations.
Emslie, Fuhrer, Hunt, et al.,
Soc Sci Med 54:621-4, 2002 (AHRQ
HS06516).
- Lack of prenatal coverage decreases
chances for timely care.
This study examined the relationship
between timing of insurance coverage
and prenatal care among 5,455 low-income
women. Rates of untimely
prenatal care were highest among
women who were uninsured
throughout their pregnancy or whose
coverage began after the first trimester
and were lowest among women who
obtained coverage during the first
trimester.
Egerter, Braveman, and
Marchi, Am J Public Health 92(3):423-7, 2002 (AHRQ HS07910).
- Medicare fees influence choice of breast
cancer treatment.
Investigators used data from Medicare
files, the American Hospital
Association's Annual Survey of
Hospitals, and the 1990 census to
investigate whether Medicare fees for
breast-conserving surgery (BCS) and
mastectomy (MST) affected the rate of
BCS across 799 ZIP code areas. Results
show a that a 10 percent higher BCS
Medicare fee was associated with a 7 to
10 percent higher BCS rate. A 10
percent higher MST fee was associated
with a 2 to 3 percent lower proportion
of women receiving BCS.
Hadley, Mitchell, and Mandelblatt, Med Care
Res Rev 58(3):334-60, 2001 (AHRQ
grant HS08395).
- AHRQ fact book answers questions on
hospital care for women.
Using Healthcare Cost and Utilization
Project (HCUP) data, researchers
describe the care of women in U.S.
hospitals in 2000 for the following
categories: age, charges, length of stay,
in-hospital deaths, insurance coverage,
and obstetric care.
Jiang, Elixhauser,
Nicholas, et al., Care of Women in U.S.
Hospitals, 2000, HCUP Fact Book No.
3 (AHRQ Publication No. 02-0044).*
- Researchers describe U.S. women's
health status.
Using 1996 MEPS data, this report
describes the health status of U.S.
women (perceived health, mental
health, and presence of limitations) and
their insurance status. Information is
presented on women's usual source and
type of care as a way to examine access
to care.
Altman and Taylor, Women in
the Health Care System: Health Status,
Insurance, and Access to Care, MEPS
Research Findings 17 (AHRQ
Publication No. 02-0004).*
- A new report illustrates health
disparities and gaps between men and
women.
Based on data from the MEPS
Household Component and the 1987
National Medical Expenditure Survey,
this report presents estimates of health
insurance, access to and use of care, and
health status among women of different
racial and ethnic groups in the United
States, as well as differences between
men and women.
Kass-Bartelmes, Altman, and Taylor, Disparities and
Gender Gaps in Women's Health, 1996: MEPS Chartbook No. 8 (AHRQ
Publication No. 02-0003).*
- Health plan satisfaction survey finds
small differences between the sexes.
Using the Consumer Assessment of
Health Plans Study (CAHPS®) adult
questionnaire, researchers interviewed
nearly 100,000 men and women
enrolled in 206 commercial managed
care plans nationwide about satisfaction
with their health plans. Results show
small differences by sex in satisfaction,
with no consistent pattern of one sex
being more satisfied than the other.
Health plan characteristics accounted
for the largest variation in satisfaction,
and not-for-profit plan status and lower
turnover of primary care providers were
stronger determinants of women's
satisfaction.
Weisman, Henderson,
Schifrin, et al., Women's Health Issues
11(4):401-15, 2001. (Reprints,
AHRQ Publication No. 02-R007)*
(Intramural).
- Race, income, and education influence
older women's health.
A survey of the health and functional
status of 91,314 elderly women enrolled
in Medicare managed care plans
revealed that poorer and less educated
women reported poorer health,
experienced more chronic illness, and
felt depressed or sad more of the time in
the past year than their more affluent
and educated counterparts. The
percentages of women reporting fair or
poor health were: black (46),
Hispanic/Spanish (42), American
Indian/Alaska Native (36), Asian/Pacific
Islander (28), and white (27).
Bierman, Haffer, and Hwang, Health Care
Financing Rev 22(4):187-98, 2001
(Reprints, AHRQ Publication No. 02-R006)* (Intramural).
- Survey data reveal health disparities
among older women.
Survey data were collected from 91,314
elderly women for a new quality
measure in the Health Plan Employer
Data and Information Set to assess
functional outcomes in
Medicare+Choice plans. Over half of
the women surveyed suffered from three
or more chronic conditions. Women
with low income, less education, and
minority group status were significantly
more likely than other women to suffer
from chronic diseases and limited ability
to function.
Bierman and Clancy, J
Amer Med Womens Assoc 56:155-60,
2001. (Reprints, AHRQ Publication
No. 02-R023)* (Intramural).
- Some disabled women face barriers to
screening services.
Researchers analyzed National Health
Interview Survey data with Disability,
Family Resources, and Healthy People
2000 supplements to examine the use of
screening and preventive services among
adult women with disabilities living in
the community. Women with major
lower extremity disability were much
less likely than other women to receive
Pap smears, mammograms, and
clinician inquiries about smoking.
Iezzoni, McCarthy, Davis, et al., Am J
Med Qual 16(4):135-44, 2001
(AHRQ grant HS10223).
- Researchers examine the role of ob-gyns
as primary care providers for elderly
women.
Using Medicare claims data, researchers
examined the degree to which ob-gyns
in the State of Washington offered
primary care to elderly women in 1994.
About 12 percent of visits by elderly
women to ob-gyns involved
nongynecologic diagnoses. Further,
patients who saw ob-gyns received over
15 percent of their overall health care
from an ob-gyn compared with 43
percent of total health care received by
elderly women who saw family physicians.
Fink, Baldwin, Lawson, et
al., J Fam Pract 50(2):153-8, 2001
(contract 290-93-0136).
- Nonprofit centers rate better than for-profits
in serving disadvantaged women.
Using data on 108 for-profit and 296
nonprofit women's health centers,
investigators examined the association
between center ownership and
community benefits and concluded that
nonprofit centers do a better job of
serving disadvantaged women than for-profit
centers. Nonprofit centers serve
larger proportions of uninsured women
and rural women, offer reduced rates to
more clients based on financial need,
offer a broader range of primary care
services, and provide clinicians with
more frequent training opportunities.
Khoury, Weisman, and Jarjoura, Med
Care Res Rev 58(1):76-99, 2001
(AHRQ grant HS09328).
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