Ammar, K.A., Kors, J.A., Yawn, B.P., and Rodeheffer, R.J. (2004). "Defining unrecognized myocardial infarction: A call for standardized electrocardiographic diagnostic criteria." (HS10239). American Heart Journal 148, pp. 277-284.
Unrecognized myocardial infarctions (UMIs) are detected by surveillance electrocardiograms (ECGs). In epidemiologic studies, different sets of ECG criteria have been used to define MI, possibly contributing to significant differences in prevalence estimates and risk factor associations. The authors summarize the rationale behind the various UMI-ECG definitions and suggest an approach to develop uniform criteria. They conclude that the most cost-effective and valid method for detecting UMI in epidemiologic studies is computerized ECG analysis using major Q waves in middle-aged white men. They note the need for further studies to validate ECG-UMI criteria and identify the influence of age, sex, and race on ECG-UMI criteria.
Fryback, D.G., and Craig, B.M. (2004). "Measuring the economic outcomes of cancer." (AHRQ grant T32 HS00083). Journal of the National Cancer Institute Monographs 33, pp. 134-141.
This article provides an introduction to the nature and measurement of economic outcomes in cancer and introduces the reader to a considerable literature on measuring economic endpoints in health and medicine. Economic outcomes data are defined here as measures of resources consumed in prevention, detection, and treatment of cancer and its sequelae. The authors first discuss questions addressed by economic outcomes. Second, they present a typology of and introduction to measurement of economic outcomes. Third, they discuss important measurement issues and call for development and validation of standardized protocols and questionnaires to measure economic outcomes, especially at the patient level.
Hirdes, J.P., Fries, B.E., Morris, J.N., and others (2004). "Home care quality indicators (HCQIs) based on the MDS-HC." (AHRQ grant HS09455). The Gerontologist 44(5), pp. 665-679.
The goal of this study was to develop home care quality indicators (HCQIs) to be used by consumers, home care agencies, regulators, and policymakers to support evidence-based decisionmaking related to the quality of home care services. The investigators used data from 3,041 Canadian and 11,252 U.S. home care clients assessed with the Minimum Data Set—Home Care (MDS-HC) to evaluate a series of indicators suggested by international experts and by focus groups conducted in Canada and the United States. They retained 22 of the 73 original candidate HCQIs for the final list of recommended indicators. These HCQIs are new tools providing a first step along the path of quality improvement for home care. They can provide high-quality evidence on performance at the agency level and on a regional basis.
Hsu, E.B., Jenckes, M.W., Catlet, C.L., and others (2004 July). "Effectiveness of hospital staff mass-casualty incident training methods: A systematic literature review." (AHRQ contract 290-97-0006). Prehospital and Disaster Medicine 19(3), pp. 191-199.
Current evidence on the effectiveness of mass-casualty incident (MCI) training for hospital staff is limited, concludes this study. The researchers reviewed the existing evidence on the effectiveness of disaster drills, technology-based interventions, and tabletop exercises in training hospital staff to respond to an MCI. Of 243 potentially relevant citations, 21 met the defined criteria. The existing evidence suggests that hospital disaster drills are effective in allowing hospital employees to become familiar with disaster procedures, identify problems in different components of response (for example, incident command, communications, triage, patient flow, materials and resources, and security), and provide the opportunity to apply lessons learned to disaster response. However, the strength of evidence on other training methods is insufficient to draw recommendations.
Mandelblatt, J., Armetta, C., Yabroff, K.R., and others (2004). "Descriptive review of the literature on breast cancer outcomes: 1990 through 2000." (AHRQ grant HS08395). Journal of the National Cancer Institute Monographs 33, pp. 8-44.
Despite the recent explosion of quality of life (QOL) measures for breast cancer, routine incorporation of QOL outcomes into cancer research has been slow, and when used, outcomes have often been poorly measured. These researchers reviewed the relevant literature published from 1990 through 2000. Their review included studies that spanned all phases of breast cancer care, including primary prevention, early detection, diagnosis, local treatment, adjuvant treatment, treatment of metastatic disease, survivorship, and the dying experience. Of the 230 articles selected, most focused on survivorship followed by screening. The most frequently reported outcomes were health-related quality of life (54 percent) followed by economic analyses (38 percent) and patient satisfaction (14 percent); only 9 percent measured patient preferences. Few studies included more than 10 percent minority populations or focused on the elderly, and methodologic flaws were prevalent. Thus, more research is needed to develop practical approaches that are reliable, valid, and feasible in routine practice and applicable in diverse populations.
Martikainen, P., Lahelma, E., and Marmot, M. (2004). "A comparison of socioeconomic differences in physical functioning and perceived health among male and female employees in Britain, Finland, and Japan." (AHRQ grant HS06516). Social Science and Medicine 59, pp. 1287-1295.
Different social structural contexts and historical settings may shape the pattern of socioeconomic inequalities in health among men and women, according to this study. The researchers found that Britain, Finland, and Japan—representing liberal, social democratic, and conservative welfare State regimes—produce broadly similar patterns of socioeconomic differences in health among men. In general, men employed in higher grade non-manual work in all three countries perceive their health and physical functioning to be better than that of their manual worker counterparts. Similarly, British and Finnish women employed in lower grade jobs had consistently worse perceived health and poorer physical function than women in higher grade jobs. Yet, the same was not true for Japanese women, possibly because the Japanese conservative welfare regime is characterized by low female attachment to paid work. Few Japanese women are in the labor force, and part-time work is common. Also, they earn much lower wages than Japanese men. In contrast, Finland's social democratic welfare system is characterized by exceptionally high full-time employment among women, and universal social benefits (day care and parental leave arrangements) that enable women to combine motherhood and paid employment. In Britain, publicly funded day care facilities are modest, and female labor force participation is much lower than in Finland.
Morris, J.N., Jones, R.N., Fries, B.E., and Hirdes, J.P. (2004, November). "Convergent validity of minimum data set-based performance quality indicators in postacute care settings." (AHRQ grant HS09455). American Journal of Medical Quality 19(6), pp. 242-247.
U.S. patients who are candidates for rehabilitation are quickly discharged from acute care hospitals, where their stays have been shortened, into institutional and community-based post-acute care (PAC) settings. However, little is known about how such patients fare once discharged. This article describes an approach for quantifying quality performance measurements within two PAC settings: skilled nursing homes and home-care based PAC. It specifically describes the validation of a focused set of summary scales that reflect patient outcomes. The summary scales can be implemented practically. They were created from data collected with standardized patient assessment instruments, the Resident Assessment Instrument for Home Care, and the Minimum Data Set for Post-Acute Care.
Sherman, K.E., Sherman, S.N., Chenier, T., and Tsevat, J. (2004, November). "Health values of patients with chronic hepatitis C infection." (AHRQ grant HS10366). Archives of Internal Medicine 164, pp. 2377-2382.
Patients with hepatitis C virus (HCV) infection report a reduction in health status, but it is not known how they value their state of health. These researchers assessed health utilities directly from 124 patients with chronic HCV infection. They administered a disease-specific version of the Medical Outcomes Study 36-item Short-Form Health Survey, the Beck Depression Inventory, and three direct health value measures. They found that although quality of life is compromised in patients with chronic HCV infection, patient-derived health utilities are not strongly associated with health status or clinical measures. The utility measures they obtained from patients with HCV differ significantly from previous surrogate measures of health values. The researchers conclude that such differences could affect decision analyses and cost-effectiveness analyses of treatment interventions for individuals with HCV infection.
Tamariz, L.J., Eng, J., Segal, J.B., and others (2004). "Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review." (AHRQ contract 290-97-0006). American Journal of Medicine 117, pp. 676-684.
About half of outpatients diagnosed with deep vein thrombosis have a major risk factor for venous thrombosis, such as immobilization, trauma, or recent surgery. However, symptoms alone are not sensitive or specific for the diagnosis, and individual physical findings have limited predictive value. Clinical prediction rules have been developed to aid in diagnosis. These authors review the evidence on the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism. They conclude that the Wells prediction rule is useful in identifying patients at low risk of being diagnosed with the condition. The addition of a rapid latex D-dimer assay improved overall performance of the rule.
Tamayo-Sarver, J.H., and Baker, D.W. (2004, August). "Comparison of responses to a $2 bill versus a chance to win $250 in a mail survey of emergency physicians." (AHRQ grants HS11948 and T32 HS00059). Academic Emergency Medicine 11(8), pp. 888-892.
Attempts to conduct mail surveys of physicians are often frustrated by low response rates. Mailing a $2 bill incentive produces a better response rate with lower survey cost per participant than offering a chance to win $250, according to this study. The researchers evaluated whether or not small monetary incentives would improve physicians' responses to surveys. The investigators mailed a survey to two groups of 288 emergency physicians. Within each group of 288, half received a $2 bill and the other half received an offer that respondents would be entered into a drawing to win $250. Of the 301 physicians who participated in the survey, the $2 bill arm had a substantially higher response rate: 56 percent of those receiving it participated versus 44 percent of those receiving a chance to win $250.
Tien, P.C., Kovacs, A., Bacchetti, P., and others (2004, November). "Association between syphilis, antibodies to herpes simplex virus type 2, and recreational drug use and hepatitis B infection in the Women's Interagency HIV Study." (Cosponsored by AHRQ, NIH, and CDC). Clinical Infectious Diseases 39, pp. 1363-1370.
Liver disease has become a leading cause of death in HIV-infected men and women, in many cases due to coinfection with hepatitis B virus (HBV) or hepatitis C virus. This study found that women with a history of drug use who have or are at risk for HIV infection are more likely to be coinfected with HBV if they also have a history of genital ulcer disease, specifically genital herpes or syphilis. The researchers analyzed the seroprevalence of HBV infection among 2,132 women with or at risk for HIV infection, who were enrolled in the Women's Interagency HIV Study during the periods 1994-1995 and 2001-2002. After excluding women with evidence of past HBV vaccination, 43 percent of 1,500 HIV-infected and 22 percent of 461 HIV-uninfected women had HBV infection. Women using injection drugs were nearly three times as likely as others to be coinfected with herpes simplex virus 2, while women using other illicit drugs were nearly three times as likely as others to have a history of syphilis. The authors conclude that antibodies to genital herpes, a history of syphilis, and high-risk sexual behaviors are important risk factors for HBV infection.
Internet Citation:
Research Activities Newsletter. February 2005, No. 294. AHRQ Publication No. 05-0052. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/feb05/
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