Anderson, J. and Holbrook, T.L. (2007). "Quality of well-being profiles followed paths of health status change at micro- and meso-levels in trauma patients." (AHRQ grant HS07611). Journal of Clinical Epidemiology 60, pp. 300-308.
The authors of this study used the Quality of Well-Being Scale (QWB) and its elements to document paths of change in health status over time among trauma patients. They analyzed data from 787 Trauma Recovery Project patients who completed preinjury and injury day data and followed 574 of them up to 6 months after hospital release. Means analyses found significant variation on first day of hospitalization versus 6-month recovery scores by injury site.
Patients with head injury were worse off than patients with long bone and pelvic injuries at first, but became better off 6 months after release from the hospital. These effects were traced to specific symptom/problem complexes and functional limitations. Along with preference-weighted scores, QWB individual components may be used to describe the specific ways that patient groups differ from one another, conclude the researchers.
Aragon, S.J., Flack, S.A., Holland, C.A., and others (2006, Fall). "The influence of patient-centeredness on minority and socioeconomically disadvantaged patients' trust in their physicians: An evidence-based structural equation modeling investigation." (AHRQ grant T32 HS00032). Journal of Health Disparities Research and Practice 1(1), pp. 63-74.
This study used a two-factor multigroup structural equation modeling design to determine the effect of physician patient-centeredness on patient trust among predominantly minority and disadvantaged patients from an inner city medical practice. The model fit well. Physician patient-centeredness significantly influenced patient trust, explaining 82 percent of its variability. When physician patient-centeredness increased by 1 unit, the predicted value for patient trust increased by 1.043 units. Patient-centered physician behaviors also increased patients' confidence in and likelihood of recommending their physician.
Arora, S., Geppert, C.M., Kalishman, S., and others (2007, February). "Academic health center management of chronic diseases through knowledge networks: Project ECHO." (AHRQ grant HS15135). Academic Medicine 82(2), pp. 154-160.
This paper describes an innovative academic health center (AHC)-led program of health care delivery and clinical education for the management of complex, common, and chronic diseases in underserved areas. The authors use hepatitis C virus (HCV) as a model.
The program, Project Extension for Community Healthcare Outcomes (ECHO), involves a partnership of academic medicine, public health offices, corrections departments, and rural community clinics dedicated to providing best practices and protocol-driven health care in rural areas. Telemedicine and Internet connections enable specialists in the program to comanage patients with complex diseases, using case-based knowledge networks and learning loops. Project ECHO partners present HCV-positive patients during weekly 2-hour telemedicine clinics, where partners gain expertise in HCV and collaborate with multiple university specialists in comanaging their patients.
Asplin, B.R., and Magid, D.J. (2007, March). "If you want to fix crowding, start by fixing your hospital." (AHRQ grant HS13007). Annals of Emergency Medicine 49(3), pp. 273-274.
Hospitals that have had the most success alleviating emergency department (ED) crowding are those that have recognized the hospital-wide nature of patient flow problems and designed initiatives to move admitted patients out of the ED more efficiently, note the authors of this editorial. They assert that the problem of crowded EDs is driven by delays in moving admitted patients to staffed inpatient hospital beds.
Many stakeholders in the emergency care system are calling for the end of inpatient boarding in the ED. The Institute of Medicine, for example, has recommended that hospitals and the regulatory bodies that govern them end the practice. The key challenge now is to make this recommendation a reality.
Binns, H.J., Lanier, D., Pace, W.D., and others (2007, February). "Describing primary care encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey." (AHRQ grant HS01004). Annals of Family Medicine 5(1), pp. 39-47.
This study compared clinical encounters in 20 primary care research networks with those of the National Ambulatory Medical Care Survey (NAMCS) using the Primary Care Network Survey (PRINS) clinician interview and
patient record. Overall, 89 percent of PRINS clinicians were physicians and all NAMCS clinicians were physicians. Over half (53 percent) of PRINS physicians specialized in pediatrics compared with 20 percent of NAMCS clinicians. Large proportions of PRINS visits involved preventive care and were made by children, minorities, and those without private health insurance. A diagnostic or other assessment was performed for 99 percent of PRINS visits and 76 percent of NAMCS visits. A preventive or counseling/education service was provided at 64 percent of PRINS visits and 37 percent of NAMCS visits.
Reprints (AHRQ Publication No. 07-R046) are available from the AHRQ Publications Clearinghouse.
Chandler, S.M., Garcia, S.M., and McCormick, D.P. (2007, March). "Consistency of diagnostic criteria for acute otitis media: A review of the recent literature." (AHRQ grant HS10613). Clinical Pediatrics 46(2), pp. 99-108.
Clinicians use various criteria to diagnose acute otitis media (AOM). Better agreement on the definition of AOM using American Academy of Pediatrics (AAP) criteria could facilitate a more accurate clinical diagnosis. It could also provide standardization of research and patient care practices, suggest the authors of this commentary. They used AAP guidelines to review the consistency of AOM diagnosis in clinical trials from 1994 to 2005. Overall, 81 percent of the 88 studies required at least 1 of the 3 AAP diagnostic criteria. Only 20 percent of the studies met all three AAP criteria for AOM diagnosis. The authors found no association between the number of criteria met and study quality or industry sponsorship.
Curtis, J.R., Westfall, A.O., Allison, J., and others (2007, March). "Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users." (AHRQ grant HS10389). Archives of Internal Medicine 167, pp. 591-596.
Osteoporosis (severe loss of bone mass) due to long-term glucocorticoid treatment is widely undertreated. A Web-based intervention that incorporated performance audit and feedback and case-based continuing medical education had no significant effect on the quality of osteoporosis care for this group of patients. Following the intervention, 78 intervention physicians versus 75 control physicians had similar rates of bone mineral density testing (19 vs. 21 percent) and osteoporosis medication prescribing (32 vs. 29 percent). However, physicians with greater exposure to the intervention had higher rates of glucocorticoid-induced osteoporosis management.
Dean, G.E., D. Scott, L.D., and Rogers, A.E. (2006, June). "Infants at risk: When nurse fatigue jeopardizes quality care." (AHRQ grant HS11963). Advances in Neonatal Care 6(3), pp. 120-126.
Nurse fatigue may play a role in errors in the neonatal intensive care unit (NICU). Several case studies of NICU nurses detail back-to-back night shifts, excessive work hours, little sleep, and struggling to stay awake when errors occurred. The researchers asked six NICU nurses, who participated in a larger study of nurse fatigue and patient safety, to complete a log of their sleep, mood, work hours, errors, and vigilance each day for 28 days. The nurses ranged in age from 22 to 66 years.
The NICU nurses obtained less than 6 hours and 20 minutes of sleep on workdays 50 percent of the time. They reported a total of six errors during the 28-day period, three related to procedures and three to medication administration. Analysis of nurse logbooks suggested that fatigue may have been a contributing factor in at least two of the six errors.
DeVoie, J., Fryer, G.E., Straub, A., and others (2007, January). "Congruent satisfaction: Is there geographic correlation between patient and physician satisfaction?" (AHRQ grant HS01465). Medical Care 45(1), pp. 88-94.
There is a strong correlation between physician and patient satisfaction among doctors and patients who live and work in geographic proximity to one another, concludes this study. The researchers analyzed 3 rounds of data from Community Tracking Study (CTS) Household and Physician Surveys from 1996 to 2001 in 60 communities.
Patient and physician satisfaction varied by region, but was closely correlated between physicians and patients living in the same CTS sites. Physician career satisfaction was more strongly correlated with patient overall health care satisfaction than any of the other aspects of the health care system. Patient trust in the physician was also highly correlated with physician career satisfaction.
Dormuth, C.R., Glynn, R.J., Neumann, P., and others (2006, June). "Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or
asthma." (AHRQ grant HS10881). Clinical Therapeutics 28(6), pp. 964-978.
When a public drug insurance plan in British Columbia, Canada, phased in copayments and
coinsurance plus deductible policies, far fewer elderly patients with asthma or chronic obstructive pulmonary disease used inhaled medications for their conditions. Patients with new diagnoses of asthma or chronic obstructive pulmonary disease were 25 percent less likely to begin treatment with inhaled steroids when covered by the copayment or coinsurance plus deductible policies than when they had full coverage.
Chronic users of inhaled steroids were 47 percent more likely to cease drug treatment when they were covered by the copayment policy and 22 percent more likely to cease treatment when covered by the coinsurance plus deductible policy than when they had full coverage. Overall, during the study period from 1997 to 2004, use of inhaled steroids declined 12 percent, inhaled anticholingergics 12 percent, and inhaled beta-agonists nearly 6 percent.
Egan, B.M., Lackland, D.T., Igho-Pemu, P., and others (2006, December). "Cardiovascular risk factor control in communities—update from the ASH Carolinas-Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network." (AHRQ grant HS10871 and HS10875). Journal of Clinical Hypertension 8(12), pp. 879-886.
This paper describes the collaboration among the American Society of Hypertension (ASH) Carolinas—Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network to improve cardiovascular risk factor control in communities. This collaboration provides a model for other ASH chapters and health delivery groups to partner in delivering continuing medical education programs focused on cardiovascular risk factor management, recruiting practices into the network, and developing and maintaining a centralized patient database. Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control.
Garbutt, J.M., DeFer, T.M., Highstein, G., and others (2006). "Safe prescribing: An educational intervention for medical students." (AHRQ grant HS11898). Teaching and Learning in Medicine 18(3), pp. 244-250.
Two 1-hour, small group interactive educational sessions can reduce medication prescribing errors by medical students. Researchers assessed 28 third-year medical students' knowledge of, attitudes toward, and behaviors regarding safe prescribing. The students thought that their training in safe prescribing was inadequate. At the time of the study, they began writing medication orders, but all their orders had to be reviewed and countersigned by a resident before they attended the two educational sessions. The sessions taught them how to write complete, legible, unambiguous medication orders.
The researchers asked the students to transcribe 10 verbal medication orders for patients onto an order sheet a few days before and 11 weeks after the educational sessions. There were 84 opportunities to make a prescribing error in the 10-order transcription test. Following the educational sessions, the average number of error-free orders increased fivefold from 0.82 to 4.54 per student and the average number of errors and dangerous errors per student decreased from 13.96 to 7.36 and from 4.75 to 2.68, respectively.
Holman, R.C., Stoll, B.J., Curns, A.T., and others (2006, November). "Necrotising enterocolitis hospitalizations among neonates in the United States." Paediatric and Perinatal Epidemiology 20, pp. 498-506.
During 2000, there was 1 necrotising enterocolitis (NEC), hospitalization per 1,000 live births, with about 1 in 7 NEC hospitalizations ending in death, according to a study providing the first national estimate of NEC hospitalizations among newborns. Researchers analyzed hospital discharge records for neonates with an NEC diagnosis and in-hospital death or routine discharge data from the 2000 Kids' Inpatient Database of AHRQ's Healthcare Cost and Utilization Project.
An estimated 4,463 NEC-related hospitalizations occurred among neonates in the United States in 2000, resulting in a hospitalization rate of 109.9 per 100,000 live births. The rate of NEC hospitalizations was highest among black neonates.
The median hospital stay was 49 days. The in-hospital fatality rate was 15.2 percent.
Neonates who underwent a surgical procedure during hospitalization were more likely to have a longer stay and to die than those who did not undergo surgery. Low-birthweight (LBW) neonates with NEC were more likely than LBW neonates hospitalized for other conditions to be very LBW, black, and male.
LBW neonates with NEC also had higher hospital charges and longer stays, and were more likely to die during hospitalization than LBW infants hospitalized for other problems.
Reprints (AHRQ Publication No. 07-R027) are available from the AHRQ Publications Clearinghouse.
James, P.A., Li, P., and Ward, M.M. (2007, March). "Myocardial infarction mortality in rural and urban hospitals: Rethinking measures of quality of care."(AHRQ grant HS15009).
Annals of Family Medicine 5(2), pp. 105-111.
Heart attack patients in rural hospitals have higher mortality rates than those in urban hospitals, suggesting substandard quality of care in rural hospitals. However, this study of over 12,000 adults hospitalized for heart attack found that heart attack mortality rates in rural Iowa hospitals were no higher than in urban ones, after controlling for unmeasured confounding patient factors. Yet unadjusted mortality rates for the urban and rural hospitals were 6.4 and 14 percent, respectively. Current risk-adjustment models may not be sufficient to assess hospitals that perform different functions within the health care system, conclude the researchers.
Kelley, E. (2007). "All or none measurement: Why we know so little about the comprehensiveness of care." International Journal for Quality in Health Care 19(1), pp. 1-3.
There are major advantages to the use of "all or none" measurement as one of a range of tools for reporting on local and national health care quality, notes the author of this editorial. Like all summary measures, this approach provides a rapid "dashboard" look at performance, but is limited in its ability to provide specific guidance on improving care.
This approach usefully broadens the focus beyond individual measures to better approximate the experience of patients with given conditions. However, more work is needed to refine this approach to keep it consistent with evidence-based guidelines. Also, more consensus building is needed on what is important to measure for given conditions.
Reprints (AHRQ publication no. 07-R058) are available from the AHRQ Publications Clearinghouse.
Lemus, F.C., Freeman Jr., D.H., Bajaj, M., and Freeman, J.L. (2007). "Uncontrolled diabetes in southeast Texas communities: Use of hospital discharge data to assess a healthy people 2010 goal." (AHRQ grants HS16381 and HS11618). Texas Public Health Association Journal 58(4), pp. 7-11.
One goal of the Healthy People 2010 is to reduce hospitalization for uncontrolled diabetes among nonelderly adults to 5.4 hospital admissions per 10,000 persons. Using Texas hospital discharge data and 2000 U.S. Census population counts, only one southeast Texas community was at the Healthy People goal. There were also disparities between whites and blacks and lower-than-anticipated hospitalization rates among Hispanics/Latinos. The use of Texas hospital discharge data with the Healthy People 2010 goal for uncontrolled diabetes demonstrates a method for communities to better assess, measure, and make decisions about the quality of care provided to their population groups. It also allows them to evaluate how access to this health care affects these groups.
Meredith, L.S., Cheng, W.J., Hickey, S.C., and Dwight-Johnson, M. (2007, January). "Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression." (AHRQ grant HS08349). Psychiatric Services 58(1), pp. 72-78.
Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who have less severe depression. This study used a scenario of a patient with major depression to examine factors associated this approach among 167 primary care clinicians from 46 practices of 7 managed care organizations across the United States.
Overall, 20 percent of clinicians were inclined to use watchful waiting for the patient in the scenario. Clinicians were significantly more likely to choose this approach if they had more psychotherapy knowledge and perceived the treatment of the patient's medical illness to be more important than treatment of the mental illness. Clinicians were less likely to choose this approach if they perceived lack of availability of mental health professionals as a barrier.
Mittal, V., Rosen, J., Govind, R., and others (2007). "Perception gap in quality-of-life ratings: An empirical investigation of nursing home residents and caregivers." (AHRQ grant HS11976). The Gerontologist 47(2), pp. 159-168.
Caregivers perceive quality of life to be lower than nursing home residents do across a variety of domains, according to this study. Caregiver demographics do not directly predict the perception gap. However, satisfaction with work, pay, and promotion were significant predictors, and satisfaction with a supervisor was a marginally significant predictor of the perception gap. As satisfaction with these job dimensions increased, the perception gap decreased. Thus, job-satisfaction dimensions, rather than caregiver characteristics, are appropriate predictors of the perception gap. The findings were based on interviews with caregivers and nursing home residents on 11 quality-of-life domains.
Platt, R. (2007, January). "Speed bumps, potholes, and tollbooths on the road to panacea: Making
best use of data." (AHRQ grant HS10391). Health Affairs 26(2), pp. w153-w155.
Electronic health databases promise to transform both the assessment of health care delivery and the understanding of treatments' safety and effectiveness, note the authors of this commentary. They assert that to achieve these goals, it will be necessary to recognize limits on inferring causality; protect confidentiality while allowing important societal gain; and link health data back to the individual patients. It will also be necessary to obtain more information from medical records; understand ways in which electronic data can misrepresent reality; and create the infrastructure, expertise, and resources to use the data.
Ralston, S., Kellett, N., Williams, R.L., and others (2007, March). "Practice-based assessment of tobacco usage in southwestern primary care patients: A Research Involving Outpatient Settings Network (RIOS Net) study." (AHRQ grant HS13496). Journal of the American Board of Family Medicine 20, pp. 174-180.
Primary care clinicians rely, perhaps erroneously, on general population-based data about risk factors to decide how much time to allocate in the brief primary care visit. Yet this study found that patients seen in primary care differ in important ways in rates and patterns of tobacco use, when compared with rates reported in population-based surveys. For example, Hispanic women smoked at more than twice the national population-based rate (25 vs. 12 percent). Youth smoked at higher rates as well, particularly young Native American men. These findings were based on data gathered on 2,442 patients during visits to 91 primary care clinicians in a practice-based research network.
Rosenthal, M.B. and Dudley, R.A. (2007, February). "Pay-for-performance: Will the latest payment trend improve care?" (AHRQ grant HS09660 and HS16117). Journal of the American Medical Association 297(7), pp. 740-744.
The current enthusiasm for pay-for-performance may represent a rare opportunity for physicians and payers to engage cooperatively in meaningful reform of an arcane payment system that for decades has held back efforts to improve care, assert the authors of this commentary. They highlight several key ways to increase the fidelity of payment incentives to the goal of improving care for all patients.
The public discourse on the use of incentives need not be limited to direct payment issues. Other approaches have included public reporting of performance or "honor roll" programs, grants or in-kind support from payers to community quality improvement initiatives, and administrative simplification programs. Providers, purchasers, and policymakers must understand both the potential benefits and the limitations of pay-for-performance and consider how it can best be designed to improve care for patients.
Rust, G. and Cooper, L.A. (2007). "How can practice-based research contribute to the elimination of health disparities?" (AHRQ grant HS13645). Journal of the American Board of Family Medicine 20, pp. 105-114.
Racial, ethnic, and socioeconomic disparities in health care and health outcomes are well documented. Disparities research is evolving, yet few studies to date have demonstrated substantial reductions in health outcomes disparities. Because patients in high-disparity groups are medically complex and their disparities are linked to complex social factors, no single intervention is likely to make a meaningful difference in reducing health disparities, note the authors of this article. They review 12 promising strategies that could substantially increase the impact of research on eliminating health disparities in the United States. These range from using diverse research teams and partnerships with communities to triangulation interventions on practice, patient, and community.
Schneeweiss, S., Solomon, D.H., Wang, P.S., and others (2006, November). "Simultaneous assessment of short-term gastrointestinal benefits and cardiovascular risks of selective cyclooxygenase 2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs." (AHRQ grant HS10881). Arthritis & Rheumatism 54(11), pp. 3390-3398.
The cyclooxygenase 2 (COX-2) inhibitor rofecoxib (Vioxx®), which was removed from the market in September 2004 due to its serious cardiac risks, and the nonselective nonsteroidal anti-inflammatory drug (NSAID) diclofenac, were deemed the most risky NSAIDs used by the elderly in a 1999-2002 study.
Researchers identified elderly Medicare-insured persons who began nonselective NSAID or selective COX-2 inhibitor therapy between 1999 and 2002. They used an estimation method to simultaneously assess the reduction in risk of gastrointestinal (GI) complications and increase in risk of acute heart attack within 6 months of being started on
rofecoxib, and several nonselective NSAIDs (ibuprofen, diclofenac, and naproxen) compared with new celecoxib (Celebrex®) users.
Within 6 months, a total of 746 patients had GI complications and 698 patients had an acute heart attack. Compared with nonselective NSAIDs, celecoxib reduced the risk of GI complications by 1.4 per 100 users, but increased the risk of heart attack by 0.3 per 100 users. Rofecoxib decreased GI complications by 1.1 per 100 users and increased the risk of heart attack by 0.3 per 100 users.
Using celecoxib as the reference drug showed a 40 percent increase in the heart attack risk for rofecoxib and sixfold increased risk with diclofenac. Naproxen had a benefit-risk balance similar to that of celecoxib.
Silber, J.H., Rosenbaum, P.R., Zhang, X., and Even-Shoshan, O. (2007, February). "Estimating anesthesia and surgical procedure times from Medicare anesthesia claims." (AHRQ grant HS09460). Anesthesiology 106(2), pp. 346-355.
The length of surgery is linked to probability of complications or deaths as well as costs. However, because obtaining procedure time usually requires costly chart review, most studies are limited to single-institution analyses. Yet this study found that anesthesia chart time can be well estimated using Medicare claims. Thus, it can facilitate studies with vastly larger sample sizes and much lower costs of data collection. The authors abstracted information on time of anesthesia induction and entrance to the recovery room (anesthesia chart time) from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania.
Slutsky, J.R. (2007, January). "Moving closer to a rapid-learning health care system." Health Affairs 26(2), pp. w122-w124.
The author of this commentary discusses activities that are necessary for developing a rapid-learning health system. She notes that recognition of the central role that patients play in the successful evolution of such a system will help ensure that the goals of the transformation are met. Understanding the trade-offs of using a less controlled form of research to inform health care decision making and making necessary investments in methodology and translation will help secure the success of continuous-learning research. Major public policy interest in promoting health information technology and in getting more value for health care spending creates a framework for moving ahead.
Reprints (AHRQ publication no. 07-R040) are available from the AHRQ Publications Clearinghouse.
Wong, S.T. (2006, December). "The relationship between parent emotion, parent behavior, and health status of young African American and Latino children." (AHRQ grant HS10004). Journal of Pediatric Nursing 21(6), pp. 434-442.
This study of low-income black and Latino families in San Francisco found that parental depression, single parent households, and more use of physical discipline such as spanking was significantly related to lower physical, emotional, and social well being of children.
Parents of 196 black and Latino children aged 1 to 5 years, who attended a nurse-managed primary care clinic responded to a Parent Behavior Checklist (by telephone or face-to-face). The checklist consisted of three scales: discipline (mainly corporal punishment—spanking), nurturing (playing together on the floor, getting books for the child, and taking walks together), and expectations.
Both groups of parents reported low use of discipline (36.7 percent of black parents and 34.5 percent of Latino parents), high amounts of nurturing (80.8 percent of blacks, 78.2 percent of Latino parents), and low rates of depressive symptoms on a 0-100 scale, with 0-32 considered low (28.3 for blacks and 26.1 for Latinos).
Children's higher functional health status was significantly related to higher family income and more nurturing. Lower functional health status was significantly related to having only one parent, more use of physical discipline, and increased parental depressive symptoms.
Woodard, D.B., Gelfand, A.E., Barlow, W.E., and Elmore, J.G. (2007). "Performance assessment for radiologists interpreting screening mammography." (AHRQ grant HS10591).
Statistics in Medicine 26, pp. 1532-1551.
Radiologists vary widely in their interpretation of mammograms. These researchers used hierarchical modeling techniques to draw inferences about the interpretive performance of individual radiologists in screening mammography. They also accounted for patient mix and radiologist attributes. They modeled at the mammogram level, and then used these models to assess radiologist performance. They modeled the false-positive rate and the false-negative rate separately using logistic regression on patient risk factors and radiologist random effects. The radiologist random effects were, in turn, regressed on radiologist attributes such a number of years in practice.
Wun, L-M., Ezzati-Rice, T.M., Diaz-Tena, N., and Greenblatt, J. (2007). "On modeling response propensity for dwelling unit (DU) level non-response adjustment in the Medical Expenditure Panel Survey (MEPS)." Statistics in Medicine 26, pp. 1875-1884.
Nonresponse is a common problem in household sample surveys. This paper summarizes research on comparing alternative approaches for modeling response propensity to compensate for dwelling unit (DU) nonresponse in the Medical Expenditure Panel Survey (MEPS). The researchers used logistic regression to model the response probability at the DU level and to create nonresponse adjustment cells. They evaluated both main effects models and models with interaction terms as well as inclusion of the base weights as a covariate in the logistic models. They also compared the variability of weights of two alternative response propensity approaches as well as direct use of propensity scores.
They conclude that using propensity scores from logistic models with interaction terms to form five classification groups for weight adjustment appears to perform best in terms of limiting variability and bias.
Reprints (AHRQ publication no. 07-R050) are available from the AHRQ Publications Clearinghouse.
Wyrich, K.W., Metz, S.M., Kroenke, K., and others (2007). "Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease."(AHRQ grant HS11635). Journal of General Internal Medicine 22, pp. 161-170.
Consensus is lacking on which health-related quality of life (HRQOL) measures are appropriate to assess and how much change on those measures depicts significant HRQOL improvement. This study used triangulation methods to identify and understand clinically important differences for the amount of change in HRQOL, reflecting both health professionals and patients' values among patients with chronic obstructive pulmonary disease (COPD). They incorporated the perspectives of an expert panel of physicians familiar with measurement of HRQOL in COPD patients, primary care COPD outpatients, and primary care physicians of these patients. With few exceptions, the Chronic Respiratory Disease questionnaire was able to detect small changes at levels reported by the patients and their primary care doctors.
Zhang, W., Ayanian, J.Z., and Zaslavsky, A.M. (2007, February). "Patient characteristics and hospital quality for colorectal cancer surgery." International Journal for Quality in Health Care 19(1), pp. 11-20.
Researchers examined characteristics of California hospitals where colorectal cancer (CRC) patients underwent CRC-related surgery. CRC patients who were Hispanic or Asian, less affluent, or with more advanced cancer were less likely to undergo CRC surgery at hospitals that conducted a high volume of CRC surgeries. They were also treated at hospitals with above average mortality rates (30 days after surgery), higher rates than hospitals that treated the less severely ill, white, or more affluent. Black patients also underwent CRC surgery at hospitals with above average mortality rates.
Among elderly Medicare beneficiaries, managed care members were more likely than fee-for-service beneficiaries to enter hospitals with high patient volume. However, adjusted mortality rates were similar for hospitals used by the two groups. Most of the racial variation in outcomes within individual hospitals stemmed from patients' clinical status.
These findings were based on analysis of a population-based cancer registry in California for a total of 38,237 patients diagnosed with stages I-III (nonmetastatic) colorectal cancer between 1994 and 1998. The researchers linked registry data to hospital discharge abstracts, U.S. census data, and Medicare enrollment data.
Zhang, L., Kao, L., Berthier-Schaad, Y., and others (2007, January). "C-reactive protein haplotype predicts serum C-reactive protein levels but not cardiovascular disease risk in a dialysis cohort." (AHRQ grant HS08365). American Journal of Kidney Diseases 49(1), pp. 118-126.
Elevated serum C-reactive protein (CRP) level is significantly associated with risk for cardiovascular disease (CVD) in both the general and dialysis patient population. This study examined the associations of CRP gene variation with longitudinal CRP measurements and incident CVD risk in a group of 504 white and 244 black dialysis patients.
Compared with the most common haplotype of the CRP gene, one haplotype predicted a lower serum CRP level over time, but no association existed between the haplotype of the CRP gene and incident CVD in this dialysis group. Serum CRP level might be a biomarker, rather than a causal factor, in CVD development. CRP variation may lead to susceptibility to inflammation, but not risk for CVD. However, replication of this research in multiple settings is needed.
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AHRQ Publication No. 07-0068
Current as of July 2007
Internet Citation:
Research Activities Newsletter. July 2007, No. 323. AHRQ Publication No. 07-0068. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/jul07/
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