Research Briefs

Abdolrasulnia, M., Collins, B.C., Casebeer, L., and others (2004, September). "Using email reminders to engage physicians in an Internet-based CME intervention." (AHRQ grant HS11124). BMC Medical Education 4(17), online at www.biomedcentral.com.

E-mail course reminders may enhance recruitment of physicians to interventions designed to reinforce guideline adoption, concludes this study. Over a 45-week period, 445 recruited physicians received up to 33 E-mail contacts announcing and reminding them of an online continuing medical education (CME) activity to reinforce chlamydia screening. Of these physicians, 47 percent logged on and completed at least one module. The first 10 E-mails were the most effective in engaging community-based physicians to complete the intervention.

Ariza, A.J., Binns, H.J., and Christoffel, K.K. (2004, September). "Evaluating computer capabilities in a primary care practice-based research network." (AHRQ grant HS11248). Annals of Family Medicine 2(5), pp. 418-420.

This 2001 survey of the computer capabilities of 40 practices in the Pediatric Practice Research Group (PPRG) found wide variability in the computer hardware and software used. All practices in the group used IBM-compatible systems. Of these, 45 percent used stand-alone desktops, 40 percent had networked desktops, and about 15 percent used laptops and minicomputers. They used a variety of software packages, with most practices having software for patient care documentation (82 percent), patient accounting (90 percent), business support (60 percent), and management reports and analysis (97 percent). The main obstacles to expanding use of computers in patient care were insufficient staff training (63 percent) and privacy concerns (82 percent).

Atkins, D., Siegel, J., and Slutsky, J. (2005, January). "Making policy when the evidence is in dispute." Health Affairs 24(1), pp. 102-113.

Developing good health policy involves consideration of much more than clinical evidence, according to these AHRQ staff members. They summarize common factors underlying recent health care policy debates and outline a series of questions that can help disentangle questions of evidence from those of values. The questions focus on identifying the most important outcomes, evaluating the quality of evidence, and assessing the trade-offs involved. The authors then use four recent policy debates—prostate-specific antigen screening, high-dose chemotherapy for breast cancer, antibiotic therapy for otitis media, and newborn hearing screening—to illustrate how this approach can help clarify areas of agreement and disagreement of the opposing sides. Reprints (AHRQ Publication No. 05-R033) are available from the AHRQ Publications Clearinghouse.

Baine, W.B., and Kazakova, S.V. (2005). "An analysis of administrative data found that proximate clinical event ratios provided a systematic approach to identifying possible iatrogenic risk factors or complications." Journal of Clinical Epidemiology 58, pp. 162-170.

These investigators developed and tested a method to generate hypotheses about iatrogenic risk factors and complications from administrative data on 30,998 elderly patients hospitalized for the first time for depression. They calculated proximate clinical events—for example, principal diagnoses and procedures in hospitalizations within 90 days of the index depression admission—and the ratio of how many events happened before and after the index admission to identify possible risk factors associated with depression and complications associated with its management. For example, admission for a broken hip was more than 60 percent more common after a depression admission than in the preceding 3 months, most likely due to dizziness (and related falls) associated with use of antidepressants. Reprints (AHRQ Publication No. 05-R028) are available from the AHRQ Publications Clearinghouse.

Barker, F.G., and Amin-Hanjani, S. (2004, September). "Changing neurosurgical workload in the United States, 1988-2001: Craniotomy other than trauma in adults." (AHRQ grant HS11637). Neurosurgery 55(3), pp. 506-518.

The neurosurgical caseload for craniotomy other than trauma in adults increased 50 percent between 1988 and 2001, from 70,800 to 105,300 admissions. These surgeries include most open and closed intracranial operations, such as those for intracranial aneurysms, intracerebral hematomas, cerebrospinal fluid shunts, and cranial tumors. Based on an analysis of Nationwide Inpatient Sample (NIS) data, elective admissions increased and in-hospital mortality rates decreased. Length of hospital stay decreased during the first half of the study period and then stabilized. Defining the reasons for these changes in neurosurgical workload will require further research.

Battles, J.B., Wilkinson, S.L., and Lee, S.J. (2004). "Using standardized patients in an objective structured clinical examination as a patient safety tool." Quality and Safety in Health Care 13 (Suppl. 1), pp. i46-i50.

Standardized patients (SPs) are individuals who have been trained to portray a medical case in a consistent manner. They are now the gold standard for measuring the competence and clinical practice of physicians and other health professionals. SPs are commonly used in performance assessment as part of an objective structured clinical examination (OSCE). These authors describe how the use of SPs in an OSCE could be a patient safety tool based on cases related to postdonation information in the blood collection process. This information accounts for the majority of errors reported to the U.S. Food and Drug Administration. Reprints (AHRQ Publication No. 05-R027) are available from the AHRQ Publications Clearinghouse.

Bonomi, A.E., Holt, V.L., Thompson, R.S., and Martin, D.P. (2005). "Ascertainment of intimate partner violence in women seeking legal protection." (AHRQ grant HS10909). American Journal of Preventive Medicine 28(1), pp. 52-58.

Three brief questions can reasonably identify women who have experienced severe intimate partner violence (IPV) and are seeking legal protection, according to this study. A total of 448 urban women reporting IPV to police or the court system completed surveys at 8 weeks (baseline) and 5 and 10 months after the incident to assess IPV. The investigators compared three questions about physical and psychological abuse to the Conflict Tactics Scale, version 2, in this group of women. The physical abuse question at baseline detected 93 percent of abused women, and the two psychological abuse questions detected 94 percent. These questions should be tested in real-world settings as a tool for initiating conversations with women about abuse.

Boon, H.S., Cherkin, D.C., Erro, J., and others (2004, October). "Practice patterns of naturopathic physicians: Results from a random survey of licensed practitioners in two U.S. states." (AHRQ grant HS08194). Complementary and Alternative Medicine 4(14).

This study compared the practice patterns of naturopathic physicians in Washington State and Connecticut. The researchers interviewed 170 practitioners, of whom 99 recorded data on 1,817 patient visits. Almost 75 percent of naturopathic visits were for chronic complaints, most frequently fatigue, headache, and back symptoms. Complete blood counts, serum chemistries, lipids panels, and stool analyses were ordered for 4 to 10 percent of visits. All other diagnostic tests were ordered less often. The most commonly prescribed naturopathic therapeutics were botanical medicines, vitamins, minerals, homeopathy, and allergy treatments. The mean visit length was about 40 minutes.

Coster, W.J., Haley, S.M., Ludlow, L.H., and others (2004, December). "Development of an applied cognition scale to measure rehabilitation outcomes." (AHRQ grant HS14386). Archives of Physical Medicine and Rehabilitation 85, pp. 2030-2035.

These investigators prospectively studied 477 patients receiving rehabilitation services for neurologic, orthopedic, or complex medical conditions at four post-acute care rehabilitation settings to develop an applied cognition scale to measure rehabilitation outcomes. They administered applied cognition items from the new Activity Measure for Post-Acute Care, the Medical Outcomes Study 8-item Short Form Health Survey, and an additional setting-specific measure for inpatient rehabilitation. The majority of items (46/59) could be located along a single continuum. The results support the possibility of constructing a meaningful outcome measure to address cognitive functioning.

Dutta, A.P., Daftary, M.N., Oke, F., and others (2005, January). "Geriatric education in U.S. schools of pharmacy: A snapshot." (AHRQ grant HS11673). Consultant Pharmacist 20(1), pp. 45-52.

Geriatric education in pharmacy schools has not increased proportionally with the expected increase in the geriatric population in the United States, according to this 2003 survey of schools of pharmacy in the United States. All 42 of the responding schools had some form of geriatric education incorporated into their curriculum. However, the depth and breadth of the geriatric curriculum did not seem to be much different from results obtained by a 1985-1986 survey. The authors advise schools of pharmacy to make geriatric education a priority.

Flaherty, E.G., Jones, R., Sege, R., and The Child Abuse Recognition Experience Study Research Group (2004). "Telling their stories: Primary care practitioners' experience evaluating and reporting injuries caused by child abuse." (AHRQ grant HS10746). Child Abuse & Neglect 28, pp. 939-945.

Two themes emerged from a focus group discussion on experience with child abuse injuries among six Chicago area primary care physicians: the importance of a physician's own past experience in identifying and reporting suspected child abuse and the responsibility physicians experience as they try to assess possible abuse within the time constraints of an office visit. The physicians mentioned the following obstacles to decisionmaking about suspected child abuse: lack of knowledge about child abuse, their previous experience with child protective services, and the additional time required to evaluate and report suspected abuse. They felt rapid availability of expert consultation would improve comfort with their decisions.

Fletcher, K.E., Davis, S.Q., Underwood, W., and others (2004). "Systematic review: Effects of resident work hours on patient safety." (AHRQ grant HS11540). Annals of Internal Medicine 141, pp. 851-857.

The Accreditation Council for Graduate Medical Education mandated new work hour rules for all residency programs in July 2003. However, evidence on patient safety is insufficient to inform the process of reducing resident work hours, according to this study. The investigators systematically reviewed studies that assessed interventions (for example, float systems or other cross-coverage systems or unspecified schedule changes) designed to counteract the effects of extended work hours, fatigue, and sleep deprivation on an outcome related to patient safety. They found that introducing such interventions had an unclear effect on selected patient safety indicators. Some indicators changed, while others improved or worsened.

Fried, M.P., Satava, R., Weghorst, S., and others (2004). "Identifying and reducing errors with surgical simulation." (AHRQ grant HS11866). Quality and Safety in Health Care 13(Suppl.1), pp. i19-i26.

These investigators describe a study in which they are assessing whether the integration of a comprehensive endoscopic sinus surgery simulator (ES3) training program into the residency curriculum will have long-term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified intraoperatively and on the simulator. Through a Web-based database, individual performance can be compared against a national standard. The information gained can help usher in the next generation of surgical simulators to improve patient safety.

Goodman, H.S., Manski, M.C., Williams, J.N., and others (2005, February). "An analysis of preventive dental visits by provider type, 1996." Journal of the American Dental Association 136, pp. 221-228.

Sociodemographic factors are associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner, according to this study. For example, survey respondents were more likely to receive preventive care from a dental hygienist than a dentist if they were white, aged 18 or older, and female; had dental insurance, a higher income, and more education; and resided in small metropolitan areas. These elements should be considered when planning for future dental work force needs, suggest the authors. Their findings were based on analysis of data from the 1996 Medical Expenditure Panel Survey. Reprints (AHRQ Publication No. 05-R030) are available from the AHRQ Publications Clearinghouse.

Green, L.A., Fryer, G.E., Froom, P., and others (2004, October). "Opportunities, challenges, and lessons of international research in practice-based research networks: The case of an international study of acute otitis media." (AHRQ grant HS07035). Annals of Family Medicine 2(5), pp. 429-433.

The opportunity to study naturally occurring variation in treatment prompted collaboration among primary care research networks in the United Kingdom, the Netherlands, and North America to study treatment of acute otitis media. These authors describe the project and practical lessons learned from it. For example, international research, particularly in practice-based research networks, requires additional effort, administrative skill, and patience and will take longer than expected. Strong, trusting relationships among coinvestigators can be the basis of overcoming much adversity and can be cultivated through conference calls, meetings, and social engagements.

Grossberg, R., Zhang, Y., and Gross, R. (2004). "A time-to-prescription-refill measure of antiretroviral adherence predicted changes in viral load in HIV." (AHRQ grant HS10399). Journal of Clinical Epidemiology 57, pp. 1107-1110.

A time-to-prescription-refill measure is a valid measure of antiretroviral therapy adherence and should be incorporated into clinical practice and adherence research, according to these researchers. They observed time from a prescription to refill for 110 HIV-infected individuals on a stable, highly active antiretroviral regimen for at least 3 months at one medical center. The viral load decreased by 0.12 log c/mL for each 10 percent increase in pharmacy-based time-to-refill defined adherence as compared with 0.05 log c/mL for the self-reported adherence measure. Also, those classified as having good adherence using the pharmacy-based measure had greater viral load reductions than those who had poor adherence (2.4 log c/mL vs. 1.5 log c/mL).

Karsh, B.T. (2004). "Beyond usability: Designing effective technology implementation systems to promote patient safety." (AHRQ grant HS13610). Quality and Safety in Health Care 13, pp. 388-394.

Many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, or general dissatisfaction by end users. This author reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The author reviews the literature on diffusion of innovations, technology acceptance, organizational justice, participative decisionmaking, and organizational change, as well as strategies for promoting successful implementation.

Kim, M., Zaslavsky, A.M., and Cleary, P.D. (2005, January). "Adjusting pediatric Consumer Assessment of Health Plans Study (CAHPS®) scores to ensure fair comparison of health plan performances." (AHRQ grant HS09205 and contract 290-01-0003). Medical Care 43(1), pp. 44-52.

Patient characteristics (casemix) are not under the control of health plans, but they affect plan ratings in surveys such as the Consumer Assessment of Health Plans Study (CAHPS®). Plan scores on the pediatric CAHPS® survey should be adjusted for plan differences in casemix, specifically, child health status, parent age, and parent education, concludes this study. The investigators analyzed responses to the pediatric CAHPS® 2.0 surveys from 50,583 Medicaid beneficiaries and 43,579 privately insured individuals. They found that parent age and education and child health status and race were important casemix adjustment variables for pediatric CAHPS® surveys.

Kuo, W.H., Wilson, T.E., Weber, K.M., and others (2004). "Initiation of regular marijuana use among a cohort of women infected with or at risk for HIV in the Women's Interagency HIV Study (WIHS)." (Cosponsored by AHRQ, NIH, and CDC). AIDS Patient Care and STDs 18(12), pp. 702-713.

Among HIV-infected women, the incidence of weekly marijuana use is associated with only one marker of HIV disease stage (wasting syndrome). Also, use of highly active antiretroviral therapy (HAART) is associated with a lower initiation rate of weekly marijuana use, according to this study. The researchers calculated the incidence rate for initiating weekly marijuana use and correlates of use among 2,059 HIV-positive and 569 HIV-negative women recruited from six sites in 1994 and 1995 (baseline) and followed through 2000. Within 5.5 years of the baseline visit, 15 percent began weekly marijuana use. While undetectable viral load was associated with lower incidence of weekly marijuana use and wasting syndrome with a higher incidence, CD4 cell count was not associated with the incidence rate of weekly marijuana use.

Larson, E., Bratts, T., Zwanziger, J., and Stone, P. (2004). "A survey of IRB process in 68 U.S. hospitals." (AHRQ grant HS13114). Journal of Nursing Scholarship 36(3), pp. 260-264.

Current institutional review board (IRB) review processes are cumbersome and nonstandardized, and review time varies widely, according to the results of this survey of IRB processes at 68 U.S. hospitals participating in a multicenter study. About 34 percent of the hospitals required that the principal investigator listed on the application be from within the institution, 27 percent required evidence of human subjects research training, and 10 percent required a conflict of interest statement. Time from submission of the IRB application to approval averaged 45.4 days, with a range from 1 to 303 days.

Linkin, D.R., Fishman, N.O., Patel, J.B., and others (2004, September). "Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae in a neonatal intensive care unit." (AHRQ grant HS10399). Infection Control and Hospital Epidemiology 25(9), pp. 781-783.

There have been many reports of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in neonatal intensive care units (NICUs). Low gestational age and exposure to third-generation cephalosporins are risk factors for colonization or infection with (ESBL)-producing Enterobacteriaceae during an outbreak in a NICU, concludes this study. The researchers performed a case-control study among neonates in a NICU in 1998, who had Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca isolates to determine risk factors for the isolates demonstrating ESBL-mediated resistance. They also searched the literature for studies that evaluated clinical risk factors for colonization or infection with ESBL-producing organisms in a NICU population.

Mendeloff, J., Ko, K., Roberts, M.K., and others (2004, December). "Procuring organ donors as a health investment: How much should we be willing to spend?" (AHRQ grant HS09694). Transplantation 78(12), pp. 1704-1710.

These authors examined the benefits and costs that accrue when a cadaveric organ donor is procured. Costs were estimated on a quality-adjusted life year (QALY) basis. They calculated the average number of kidney, heart, and liver transplants that a typical cadaveric donor generates. Using the published literature, they estimated for each organ type the average number of QALYs that transplants add and the average medical costs they generate. The researchers multiplied per organ benefits and costs by the number of organs from the typical donor. They found that the typical donor generates about 13 QALYs at an added medical cost of about $214,000, or approximately $16,000 per QALY. Most analysts agree that a figure of $100,000 per QALY is reasonable. At that value, the benefit obtained from one added donor would be $1.3 million, while the medical costs would be $214,000.

Nemoto, E.M., Yonas, H., Kuwabara, H., and others (2004). "Identification of hemodynamic compromise by cerebrovascular reserve and oxygen extraction fraction in occlusive vascular disease." (AHRQ grant HS09021). Journal of Cerebral Blood Flow & Metabolism 24, pp. 1081-1089.

Both cardiovascular reserve (CVR) and oxygen extraction fraction (OEF) have been proven capable of identifying a subgroup of patients at increased stroke risk. However, the results of this study suggest that OEF alone may not be adequate to identify the true spectrum of patients at increased stroke risk. The researchers studied 12 symptomatic patients with carotid occlusion by xenon-computed tomography after intravenous acetazolamide administration for CVR, followed within 24 hours by positron emission tomography for OEF. CVR and OEF showed a significant negative linear relationship in stage II hemodynamic compromise. However, 37.5 percent of the hemispheres showed compromised CVR but normal OEF and were associated with subcortical white matter infarction.

Newgard, C.D., Lewis, R.J., and Kraus, J.F. (2005, January). "Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes." (AHRQ grant F32 HS00148). Annals of Emergency Medicine 45(1), pp. 43-50.

Steering wheel deformity is a factor in serious thoracic and abdominal injury in drivers and front seat passengers, concludes this study. The investigators analyzed data on serious thoracic or abdominal injury among 42,860 individuals 16 years of age and older who were involved in motor vehicle crashes while seated in the driver or front passenger seat. Overall, 1.3 percent had serious thoracic injuries, and 0.4 percent suffered serious abdominal injuries. Increasing steering wheel deformity was associated with a 28 percent increase in serious thoracic injury in drivers for each 5-cm increase in deformity and a 45 percent increase in serious abdominal injury in front seat passengers but not in drivers.

Orlando, M., Tucker, J.S., Sherbourne, C.D., and Burnam, M.A. (2005, January). "A cross-lagged model of psychiatric problems and health-related quality of life among a national sample of HIV-positive adults." (AHRQ grant HS08578). Medical Care 43(1), pp. 21-27.

This is the first study to demonstrate a reciprocal relationship between psychiatric symptoms and physical aspects of quality of life among HIV-positive adults. The researchers studied four components of health-related quality of life (HRQOL): general health, lack of pain, physical functioning, and role functioning and psychiatric symptoms of depressive and anxiety disorders among 2,431 HIV-positive adults at baseline and about 8 months later. Patients with more initial depressive symptoms showed increased pain and declining general health perceptions over the 8-month period. Those who initially had higher general health perceptions, no pain, and good physical functioning exhibited significantly decreased symptoms of either depressive or anxiety disorder or both.

Rosen, J., Mulsant, B.H., Bruce, M.L. and others (2004, October). "Actors' portrayals of depression to test interrater reliability in clinical trials." (AHRQ grant HS11976). American Journal of Psychiatry 161(10), pp. 1909-1911.

Training and testing materials for raters participating in multicenter clinical trials on depression could be developed by using trained actors to portray depressive psychopathology without the risk of disseminating the clinical information of actual patients, concludes this study. For the study, actors portrayed depressed patients using scripts derived from depression rating scale assessments obtained at three points during treatment. Four experienced raters viewed videotapes of two patients and two actors and guessed who the actors were. The raters could not distinguish actors and patients better than chance.

Rutitzky, L.I., Hernandez, H.J., Yim, Y.S., and others (2005). "Enhanced egg-induced immunopathology correlates with high IFN-y in murine schistosomiasis: Identification of two epistatic genetic intervals." (AHRQ grant T32 HS00060). Journal of Immunology 174, pp. 435-440.

Schistosomiasis is a serious parasitic disease responsible for over 200 million human infections and 200,000 deaths each year. This study of murine schistosomiasis revealed at least three genetic regions influencing the levels of granulomatous inflammation (liver fibrosis was not specifically analyzed) and SEA-elicited IFN-y response. The researchers performed a multipoint parametric linkage analysis on a cohort of mice to examine whether the observed differences in the type of immune response or extent of liver immunopathology were linked to any particular genomic intervals. The findings clearly indicate, as is the case in humans, that the control of murine immunopathology is polygenic.

Schleinitz, M.D., Olkin, I., and Heidenreich, P.A. (2004, December). "Cilostazol, clopidogrel or ticlopidine to prevent sub-acute stent thrombosis: A meta-analysis of randomized trials." (AHRQ grant T32 HS00011). American Heart Journal 148(6), pp. 990-997.

These researchers conducted a meta-analysis of all trials that compared two or more oral anti-thrombotic agents—clopidogrel plus aspirin, ticlopidine plus aspirin, and cilostazol and aspirin—in patients undergoing coronary stent placement to determine which treatment optimally prevents adverse cardiac events in the 30 days following stent placement. They found that neither clopidogrel plus aspirin nor cilostazol plus aspirin could be statistically distinguished from ticlopidine plus aspirin for the prevention of adverse cardiac events in the 30 days after stenting. They conclude that a randomized trial including cilostazol is warranted.

Sedman, A., Harris, M., Schulz, K., and others (2005, January). "Relevance of the Agency for Healthcare Research and Quality patient safety indicators for children's hospitals." Pediatrics 115(1), pp. 135-145.

For this study, researchers applied patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality to children's hospitals to determine which PSIs would be appropriate for use in that setting. They concluded that PSIs can be relevant as quality screening tools for children's hospitals. Some—such as foreign body left in during a procedure, infection attributable to medical care, and decubitus ulcer—seem to be appropriate for pediatric care and may be directly amenable to system changes. Two of the indicators—namely, failure to rescue and death in low-mortality diagnostic groups—are inaccurate for the pediatric population and should not be used to estimate quality of care or preventable deaths in children's hospitals. Reprints (AHRQ Publication No. 05-R034) are available from the AHRQ Publications Clearinghouse.

Shwartz, M., Pekoz, E.A., Ash, A.S., and others (2005, January). "Do variations in disease prevalence limit the usefulness of population-based hospitalization rates for studying variations in hospital admissions?" (AHRQ grant HS09832). Medical Care 43(1), pp. 4-11.

Differences in disease prevalence can limit the usefulness of population-based hospitalization rates for studying variations in hospital admissions, concludes this study. The authors examined 1997 Medicare data on both inpatient admissions and outpatient visits of elderly patients in each of 71 small areas in Massachusetts for 15 medical conditions. They used Bayesian analysis to estimate area-specific population-based hospitalization rates, disease-based hospitalization rates (DHRs), and disease prevalence. For 11 of the 15 conditions, 5 or more of the 14 areas that were ranked in the top and bottom deciles by population-based hospitalization rates were more likely than not to be at least 2 deciles less extreme when ranked by DHRs.

Solomon, L.S., Hays, R.D., Zaslavsky, A.M., and others (2005, January). "Psychometric properties of a group-level Consumer Assessment of Health Plans Study (CAHPS®) instrument." (AHRQ grant HS09205). Medical Care 43(1), pp. 53-60.

The Consumer Assessment of Health Plans Study (CAHPS®) survey for use with medical groups (G-CAHPS) provides an assessment of selected aspects of care that are important to consumers and could be a useful complement to the plan-level CAHPS® survey, according to this study. The researchers tested a draft G-CAHPS in 75 interviews with adults in three areas and pretests in four groups of adults in two cities. They then surveyed random samples of patients from medical groups and practice sites in California, Knoxville, St. Louis, and Denver. Data supported the reliability and validity of three multi-item measures to differentiate access, office staff service, and patient-clinician communication among medical groups. Measures related to specialty care and preventive counseling did not differentiate among medical groups.

Srivastava, R., Norlin, C., James, B.C., and others (2005, January). "Community and hospital-based physicians' attitudes regarding pediatric hospitalist systems." (AHRQ grant HS11826). Pediatrics 115(1), pp. 34-38.

According to this study, attitudes about hospitalist systems differ between physician groups and are influenced by practice characteristics. A total of 313 physicians with admitting privileges at a tertiary-care, pediatric teaching hospital responded to a 2002 survey about attitudes regarding hospitalists. Community physicians more often characterized inpatient care as an inefficient use of time (45 vs. 25 percent), but they were less likely to think that hospitalists would improve the quality of care (49 vs. 68 percent) or increase patient satisfaction (10 vs. 30 percent). Being a community physician and admitting patients at more than one hospital were associated with less favorable attitudes.

Titler, M.G. (2004). "Overview of the U.S. invitational conference 'Advancing quality care through translation research'." (AHRQ grant HS14141). Worldviews on Evidence-Based Nursing Third Quarter (Suppl.), pp. S1-S5.

This article provides an overview of an October 2003 conference, "Advancing Quality Care Through Translation Research." Translation research examines factors that influence adoption of evidence-based practices by individuals and organizations to improve health care. Papers from the conference are included in the journal supplement. They discuss such topics as translation studies in long-term and primary care; TRIP (translating research into practice) interventions tested, methodological issues encountered, and strategies used to resolve these issues; and quality of the evidence and impact on the adoption of a specific evidence-based practice.

Twiggs, J.E., Fifield, J., Jackson, E., and others (2004). "Treating asthma by the guidelines: Developing a medication management information system for use in primary care." (AHRQ grant HS11068). Disease Management 7(3), pp. 244-260.

The researchers discuss how they developed, implemented, and assessed an automated asthma medication management information system (MMIS) in primary care settings within a pediatric asthma disease management program. MMIS collects detailed asthma medication data on patients; evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control, and guideline-recommended severity-appropriate medications; and produces a patient-specific "curbside consult" feedback report. MMIS was successful, producing a valid feedback report for 83 percent of visits.

Watson, N.M. (2004). "Advancing quality of urinary incontinence evaluation and treatment in nursing homes through translational research." (AHRQ grant HS11064). Worldviews on Evidence-Based Nursing Third Quarter (Suppl.), pp. S21-S25.

This article describes ongoing research to improve the evaluation and treatment of urinary incontinence (UI) in nursing homes through "A Model for Use of the Urinary Incontinence Guideline in U.S. Nursing Homes." The model proposes nurse practitioners (NPs) as consultants to nursing homes to perform the basic UI evaluation and treatment in order to reduce UI, minimize complications, and increase cost savings attributable to UI reduction. They used a pre- and post-comparison using four control and four experimental NP caseloads followed for 16 weeks post-UI onset. Findings are not yet available.

White, A.A., Wright, S.W., Bianco, R., and others (2004, October). "Cause-and-effect analysis of risk management files to assess patient care in the emergency department." (AHRQ grant HS11563). Academic Emergency Medicine 11(10), pp. 1035-1041.

This paper describes a method to identify common causes of adverse outcomes in an emergency department. The investigators analyzed 74 risk-management files opened by a malpractice insurer between 1995 and 2000 to identify potential causes of adverse outcomes. About 50 percent of cases were related to injuries or abdominal complaints. A contributing cause was found in 92 percent of cases. The most frequent contributing causes included failure to diagnose (45 percent), supervision problems (31 percent), communication problems (30 percent), patient behavior (24 percent), administrative problems (20 percent), and documentation (20 percent).

Whitehall II Study (AHRQ grant HS06516): Bartley, M., Martikainen, P., Shipley, M., and Marmot, M. (2004). "Gender differences in the relationship of partner's social class to behavioral risk factors and social support in the Whitehall II study." Social Science & Medicine 59, pp. 1925-1936.

Kivimaki, M., Head, J., Ferrie, J.E., and others (2005, January). "Working while ill as a risk factor for serious coronary events." American Journal of Public Health 95(1), pp. 98-102.

Kivimaki, M., Ferrie, J.E., Head, J., and others (2004). "Organizational justice and change in justice as predictors of employee health." Journal of Epidemiology and Community Health 58, pp. 931-937.

Singh-Manoux, A., Ferrie, J.E., Chandola, T., and Marmot, M. (2004). "Socioeconomic trajectories across the life course and health outcomes in midlife: Evidence for the accumulation hypothesis?" International Journal of Epidemiology 33, pp. 1072-1079.

Stafford, M., Martikainen, P., Lahelma, E., and Marmot, M. (2004). "Neighbourhoods and self rated health: A comparison of public sector employees in London and Helsinki." Journal of Epidemiology and Community Health 58, pp. 772-778.

These five studies examined data from the large, long-term Whitehall II study of British civil servants. The first study analyzed associations between a person's or spouse's (or partner's) socioeconomic position and a set of risk factors for prevalent chronic diseases. The second study found that employees who took no sick days during a 3-year period were twice as likely to suffer serious coronary events as those who took sick leave. According to the third study, the extent to which people were treated with justice in the workplace seemed to predict their health independently of established stressors at work. The fourth study concluded that the health effects of socioeconomic disadvantage accumulate over the life course. The fifth study revealed that neighborhood socioeconomic context was associated with workers' health in both London and Helsinki.

Wilson, I.B., Landon, B.E., Ding, L., and others (2005, January). "A national study of the relationship of care site HIV specialization to early adoption of highly active antiretroviral therapy." (AHRQ grant HS10227). Medical Care 43(1), pp. 12-20.

In 1996, use of highly active antiretroviral therapy (HAART) varied widely by site of care. HIV specialization, total patient volume of more than 20,000 visits a year, and educational level of the zip code in which the site was located were associated with higher rates of HAART use. These results persisted after adjustment for physician HIV expertise. The findings are based on analysis of a national probability sample of people receiving care for HIV in 1996 who participated in the HIV Cost and Services Utilization Study.

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