Research Briefs

Amarasingham, R., Pronovost, P.J., Diener-West, M., and others (2007, May/June). "Measuring clinical information technology in the ICU setting: Application in a quality improvement collaborative." (AHRQ grant HS14246). Journal of the American Medical Informatics Association 14, pp. 288-294.

This study describes a new instrument to examine intensive care unit (ICU) information system effectiveness. The researchers surveyed medical directors of 19 Michigan ICUs, assessing their ICU information systems. The mean of 54 summed items on this instrument yielded the clinical information technology (CIT) index, a global measure of the ICU's information system performance on a 100 point scale. A 10-point increase in the CIT score was associated with 4.6 fewer catheter-related bloodstream infections (CRBSIs) per 1,000 central line days for ICUs that participated in a quality improvement program to reduce the rate of CRBSIs.

Banja, J., Eig, J., and Williams, M.V. (2007, May). "Discharge dilemmas as system failures." (AHRQ grant HS15882). The American Journal of Bioethics 7(3), pp. 29-37.

Health care professionals remain reluctant to improve or coordinate system processes so that predictable, safe, and timely discharges occur, note the authors of this paper. They cite three examples of how system or operational failures can contribute to ethical discharge dilemmas. A patient's projected discharge is a low priority for hospitals, yet it is critical in preparing patients and families for what will be needed at home. Second, a patient's discharge is often delayed for a simple test, consult, or transportation, many of which unnecessarily prolong the hospital stay. Third, patients are often not ready for discharge for reasons such as social or financial issues, which should be addressed before the discharge process. Hospitals should implement system-based strategies for the discharge process that engage patients and confirm their understanding of their medical condition, treatment plan, and followup after discharge.

Bonomi, A.E., Allen, D.G., and Holt, V.L. (2006, May). "Conversational silence, coercion, equality: The role of language in influencing who gets identified as abused." (AHRQ grant HS10909). Social Science & Medicine 62(9), pp. 2258-2266.

By framing questions about intimate partner violence in a specific way, time-strapped clinicians can encourage women to reveal domestic abuse. The researchers suggest that clinicians ask close-ended questions combining the three approaches outlined in the Abuse Assessment Screen and the Ongoing Abuse Screen. In the outright approach, the physician asks, "Were you physically or emotionally abused or did your partner assault you?" In the behavioral tactic approach, the physician asks, "Did your partner kick, slap, punch, or choke you?" Finally, the impact approach asks women about the impact of their partner's behavior on their life. For example, the doctor might ask, "Are you afraid of your partner?" The researchers have developed an Intimate Partner Violence assessment tool to further refine these approaches. It separates questions about physical and emotional abuse, and also asks women whether their partner's behavior has caused them feelings of sadness, shame, or hopelessness.

Brady, J., Ho, K., Kelley, E., and Clancy, C. (2007, June). "AHRQ's National Healthcare Quality and Disparities Reports: An ever-expanding road map for improvement." HSR: Health Services Research 42(3), pp. xi-xxi.

This paper describes the National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) of the Agency for Healthcare Research and Quality (AHRQ). The Agency recently released a new Web site that provides quality (and some disparities) data by State. The NHQR/NHDR State Snapshots allow each State to find out how it compares at the regional or national level for a type of care (preventive, acute, chronic), health care setting (ambulatory, hospital, nursing home, home health), or in a specific clinical area (cancer, diabetes, heart, maternal and child health, respiratory). The Agency is also poised to release a new online resource that will make national health care quality and disparities data even more accessible.

Cramer, S.C., Koroshetz, W.J., and Finkelstein, S.P. (2007, April). "The case for modality-specific outcome measures in clinical trials of stroke recovery-promoting agents."(AHRQ grant HS11392). Stroke 38, pp. 1393-1395.

Clinical trials for acute stroke recovery-promoting agents have often used composite clinical rating scales as primary outcome measures of treatment efficacy. Recent preclinical and clinical studies highlight the opportunity to administer treatments in the subacute and chronic phase of stroke to promote neurological recovery. Because different neurological deficits recover to different extents at different rates after stroke, putative stroke recovery-promoting treatments may exert differential effects on various functional aspects of stroke recovery. Thus, the authors of this paper propose that use of modality-specific outcome measures may be best suited as primary end points in clinical trials of stroke recovery-promoting agents. The use of such end points may result in a more selective labeling of stroke recovery treatments.

Fein, S.P., Hilborne, L.H., Spiritus, E.M., and others (2007, June). "The many faces of error disclosure: A common set of elements and a definition." (AHRQ grant HS11512). Journal of General Internal Medicine 22, pp. 755-761.

Error disclosure may mean different things to clinicians than it does to patients, conclude these authors. They conducted 20 focus groups that included 204 hospital administrators, physicians, residents, and nurses at 5 medical centers. The clinicians and administrators considered various forms of communication about errors to be error disclosure. The focus groups characterized full disclosure as communication that included admission of a mistake, discussion of the error, and a link from the error to harm. They described partial disclosure as communication that included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon.

Feldman, P.H., Bridges, J., and Peng, T. (2007, June). "Team structure and adverse events in home health care." (AHRQ grant HS11962). Medical Care 45(6), pp. 553-561.

Several team-level organizational variables influence adverse events in home health care services, according to this study. It found that the number of home health care episodes, number of weekend home care visits, and workload distribution were negatively associated with the occurrence of adverse events, while higher weekend home care admissions were positively associated with adverse events. Also, the Fixed-Effects score was a more accurate measure of team quality than the traditional Z-score, given that it focuses only on "team attributable" adverse events by isolating and excluding random variation from the quality score.

Fox, E., Myers, S., and Pearlman, R.A. (2007, February). "Ethics consultation in United States hospitals: A national survey." (AHRQ grant HS09808). The American Journal of Bioethics 7(2), pp. 13-25.

The authors of this paper describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. They surveyed the "best informant" within each of 600 U.S. general hospitals, stratified by bed size. They found ethics consultation services (ECSs) in 81 percent of U.S. general hospitals and in 100 percent of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to the survey was three. Most individuals performing ethics consultations were physicians (34 percent), nurses (31 percent), social workers (11 percent), or chaplains (10 percent). Yet only 41 percent had formal supervised training in ethics consultation. Also, consultation varied widely. For example, 65 percent of ECSs always made recommendations, whereas 6 percent never did.

Fried, M.P., Sadoughi, B., Weghorst, S.J., and others (2007, April). "Construct validity of the endoscopic sinus surgery simulator." (AHRQ grant HS11866). Archives of Otolaryngology and Head and Neck Surgery 133, pp.350-357.

This study assessed the discriminant validity of the endoscopic sinus surgery simulator (ES3) between various health care provider experience levels. The authors examined its use by 10 expert otolaryngologists, 14 otolaryngologist residents, and 10 medical students, who had completed the ES3's virtual reality curriculum (10 naive mode, 10 intermediate mode, and 3 advanced mode trials). The naive mode accurately distinguished the three groups at the onset of training. However, subjects were not distinguished beyond trial 5. The advanced mode did not show performance differences between groups. Expert scores were used to define benchmark criteria of optimal performance.

Gorelick, M.H., Alessandrini, E.A., Cronan, K., and Shults, J. (2007, April). "Revised pediatric emergency assessment tool (RePEAT): A severity index for pediatric emergency care." (AHRQ grant HS11359). Academic Emergency Medicine 14, pp. 316-323.

The authors of this paper developed and validated a multivariable model, using information available at the time of patient triage, to predict the level of care provided to pediatric emergency patients for use as a severity of illness measure. They retrospectively studied 5,521 children treated at 4 emergency departments (EDs) over a 12-month period. They included eight predictor variables in the final models: presenting complaint, age, triage acuity category, arrival by emergency medical services, current use of prescription medications, and three triage vital signs (heart rate, respiratory rate, and temperature). The model was validated in the sample, and the Revised Pediatric Emergency Assessment Tool (RePEAT) score accurately predicted level of care provided for pediatric emergency patients.

Grijalva, C.G., Nuorti, J.P., Arbogast, P.G., and others (2007, April). "Decline in pneumonia admissions after routine childhood immunization with pneumococcal conjugate vaccine in the USA: A time-series analysis." (AHRQ grant HS16784). The Lancet 369, pp. 1179-1186.

Since 2000, U.S. infants have been routinely immunized with a pneumonia vaccine that has markedly reduced hospitalizations for pneumonia related to Streptococcus pneumoniae among children younger than 2 years. By the end of 2004, pneumonia hospital admission rates had declined by 39 percent for children in this age group, representing about 41,000 pneumonia admissions that were prevented in 2004.

Researchers at the University's Center for Education and Research on Therapeutics analyzed data from the Nationwide Inpatient Sample, a national inpatient database of U.S. hospital admissions. They compared monthly admission rates for all-cause and pneumococcal admissions for the years after the introduction of pneumococcal conjugate vaccine (PCV7) vaccination (2001-2004) with expected rates calculated from pre-PCV7 years (1997-1999). There was no significant decline in rates of outpatient visits for pneumococcal pneumonia and unspecified pneumonia in children in this age group after the PCV7 was introduced. This suggests that the decline in hospital admissions for pneumonia was not caused by a shift to outpatient care of pneumonia.

Hahn, E.A., Cella, D., Dobrez, D.G., and others (2007, April). "The impact of literacy on health-related quality of life measurement and outcomes in cancer outpatients." (AHRQ grant HS10333). Quality of Life Research 16, pp. 495-507.

A Talking Touchscreen (TT) is valid and useful for health-related quality of life (HRQL) assessment in low literacy populations, concludes this study. The authors developed a TT that they used in a HRQL study of 214 low-literacy and 201 high-literacy adult cancer outpatients; 70 percent were racial/ethnic minorities. Patients completed three questionnaires by TT, a cancer-specific one, a general health status one, and a standard gamble utility questionnaire (which examined how highly they valued their current health state). Nearly all (97 percent) of patients rated the TT easy to use. There was no systematic literacy bias in reporting HRQL using the TT, and low literacy was not an independent risk factor for poor HRQL.

Jordon, H.S., Pine, M., Elixhauser, A., and others (2007, June). "Cost-effective enhancement of claims data to improve comparisons of patient safety." Journal of Patient Safety 3, pp. 82-90.

There seems to be little justification for abstraction of medical records to obtain data for risk-adjusting the Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), conclude the authors of this study. The PSIs are based solely on hospital administrative or claims data. To construct risk-adjustment models, the researchers used hospital discharge data from July 2000 to June 2003 from 188 Pennsylvania hospitals. They augmented the hospital claims data with clinical data abstracted from medical records. They concluded that more accurate coding of specific secondary diagnoses, which are currently undercoded, could improve the validity of risk-adjustment equations without the added cost of abstracting clinical findings from medical records.

Reprints (AHRQ Publication No. 07-R063) are available from the AHRQ Publications Clearinghouse.

Kelley, E. (2007, March). "Health, spending and the effort to improve quality in OECD countries: A review of the data." Journal of the Royal Society for the Promotion of Health 127(2), pp. 64-71.

The author of this paper used data from the Organisation for Economic Co-operation and Development (OECD) to summarize what is known about health, spending, risk factors, and quality of care in OECD countries. He notes that health has improved dramatically since the 1970s in all of the OECD countries. Likewise, all of the OECD countries are spending many times more on health per person than in 1970. However, the gains in health as well as the spending levels vary tremendously across countries. Quality of care is relatively high in some areas, such as vaccination rates. In other areas such as breast cancer survival, most, but not all, countries are making progress. Finally, in other areas, such as inpatient care for heart attack, there is wide variation in quality of care among OECD countries.

Reprints (AHRQ Publication No. 07-R065) are available from the AHRQ Publications Clearinghouse.

Kelly, P.A., Kallen, M.A., and Suarez-Almazor, M.E. (2007, May). "A combined-method psychometric analysis recommended modification of the Multidimensional Health Locus of Control scales." (AHRQ grant HS10876). Journal of Clinical Epidemiology 60, pp. 440-447.

The Multidimensional Health Locus of Control (MHLC) scales are widely used to measure beliefs about determinants of peoples' health. These authors evaluated the scales with 1,206 subjects from 3 osteoarthritis studies using a combined-method psychometric approach. The results of this large-sample evaluation of the MHLC scales corroborated earlier findings that removal of certain items improved the scales. The combined Rasch-Confirmatory Factor model approach provided better insight into scale performance problems than either method alone provided.

Lee, T.A., Fuhlbrigge, A.L., Sullivan, S.D., and others (2007, April). "Agreement between caregiver reported healthcare utilization and administrative data for children with asthma." (AHRQ grant HS08368). Journal of Asthma 44, pp. 189-194.

Administrative data and caregiver reported data don't always agree on health care use by children with asthma, according to this study. The researchers compared asthma-related hospitalizations, emergency department (ED) visits, oral steroid bursts, and outpatient visits as reported by caregiver and administrative data over 2 years. The percentage of individuals with disagreement between sources was 6.1 percent for hospitalizations, 20.2 percent for ED visits, 34.3 percent for steroid bursts, and 83.6 percent for outpatient visits. These differences could negatively affect the perceived quality of care provided by a physician. They could also reduce physicians' compensation in a pay-for-performance system when physicians are rated using administrative data, yet they provide treatment based on patient-reported information.

Lewis, J.D., Schinnar, R., Bilker, W.B., and others (2007, April). "Validation studies of The Health Improvement Network (THIN) database for pharmaco-epidemiology research." (AHRQ grant HS10399). Pharmacoepidemiology and Drug Safety 16, pp. 393-401.

The Health Improvement Network (THIN) is a new medical records database that contains records from general practices, some of which have participated or continue to participate in the General Practice Research Database (GPRD) and others that never participated in the GPRD. THIN data that are collected outside of the GPRD appear as valid as the data collected as part of the GPRD, concludes this study. The researchers used THIN data from 1986-2003 to conduct case-control studies of associations between diseases (for example, hypertension and stroke) and between diseases and drugs (for example, aspirin and colon cancer). In all cases, results obtained from the GPRD practices were similar to those obtained from the non-GPRD practices.

Longo, D.R., Hewett, J.F., Ge, B., and Schubert, S. (2006, September/October). "The long road to patient safety: A status report on Missouri acute-care hospitals." (AHRQ grant HS11885). Missouri Medicine 103(5), pp. 545-552.

A survey of Missouri acute care hospitals in 2002 and 2004 revealed modest improvement in patient safety systems, but they still fell short of national recommendations. By 2004, 8 percent of 93 hospitals improved on 40 or more of the 78 patient safety items in the survey, with the average hospital improving in 21 areas.

Despite evidence that staff fatigue increases the likelihood of medical error, by 2004 only about half of the hospitals had policies requiring that clinicians involved in the medication process work no more than 12 consecutive hours and have at least 10 hours off duty between shifts; however, about three-fourths of hospitals had fully implemented the policy of not giving demerits to personnel who made a medical error, thus advancing a no-blame work environment. Three-fourths of hospitals also provided an employee patient safety/quality improvement continuing medical education program and identified error prevention targets. In addition, 73 percent of hospitals had fully implemented policies providing for anonymous adverse event reporting, 66 percent implemented voluntary adverse event reporting, and 73 percent encouraged employees to file error reports without fear/reprisal.

Ma, J., Lee, K-V., and Stafford, R.L. (2006, November). "Changes in antihypertensive prescribing during U.S. outpatient visits for uncomplicated hypertension between 1993 and 2004." (AHRQ grant HS11313). Hypertension 48, pp. 846-852.

The drugs prescribed for uncomplicated hypertension among outpatients varied between 1993 and 2004, according to analysis of data from National Ambulatory Care Surveys in those years. Clinical prescribing guidelines seemed to affect prescribing trends, but their impact appeared short-lived. Diuretic prescriptions comprised 39 percent of antihypertensive prescriptions through 2001, but increased to 53 percent in 2003, largely due to a 72 percent increase in thiazide diuretic prescriptions in the first quarter of 2003.

At this time, the U.S. Joint National Committee (JNC) recommended that thiazide diuretics be prescribed alone or as part of combination therapy for most hypertensive patients. However, these increases were not sustained in 2004. Beta-blocker prescriptions increased modestly from 24 percent in 1993 to 33 percent in 2004. Prescription of calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors declined significantly following the sixth JNC report in 1997, which recommended diuretics and beta-blockers as preferred first-line therapies. However, prescribing of both calcium channel blockers and ACE inhibitors subsequently rebounded to pre-report levels.

Peters, E., Hibbard, J., Slovic, P., and Dieckmann, N. (2007, May). "Numeracy skill and the communication, comprehension, and use of risk-benefit information." (AHRQ contract 290-05-0013). Health Affairs 26(3), pp. 741-748.

Current health care policy emphasizes improving health outcomes and the efficacy of health care delivery by supporting informed consumer choices. At the same time, health information often involves uncertainty, and many people may lack the skills and knowledge to process this information, manage their health and health care, and make informed choices. Innumeracy, an element of poor health literacy, is associated with lower comprehension and use of important health information. After examining studies on the topic, these authors discuss what can be done to help less numerate people act more effectively and take charge of their health.

Raebel, M.A., McClure, D.L., Chan, K.A., and others (2007, February). "Laboratory evaluation of potassium and creatinine among ambulatory patients prescribed spironolactone: Are we monitoring for hyperkalemia?" (AHRQ grant HS11843). Annals of Pharmacotherapy 41, p. 193-200.

Spironolactone, used to treat heart failure, hypertension, and other chronic conditions, can cause hyperkalemia. Thus, serum potassium and creatinine evaluation is recommended for patients prescribed spironolactone. However, this study found that only three-fourths of outpatients dispensed spironolactone received recommended laboratory evaluation. Monitoring was more likely to be completed in patients prescribed other drugs that also increased hyperkalemia risk, in older patients, and in patients with diabetes. The study retrospectively studied patients at 10 HMOs who had been taking spironolactone for 1 year.

Roberts, R.J., Stockwell, D.C., and Slonim, A.D. (2007, March). "Discrepancies in administrative databases: Implications for research and practice." (AHRQ grant HS14009). Critical Care Medicine 35(3), pp. 949-950.

These authors note the divergence of critical care days and costs in Medicare beneficiaries in two distinct databases: MedPAR supplemented by the Health Care Information System (HCIS) and the Healthcare Cost Report Information System (HCRIS). Two codes in particular, the intensive care and cardiac critical care post/intermediate codes in MedPAR/HCIS were responsible for the majority of the variance in critical care days between the two databases. The authors caution that it is only through accurate data acquisition and analysis that administrative databases retain their value for informing clinical, scientific, and financial decisionmaking. They assert that every critical care provider has a role in ensuring that medical record documentation accurately reflects the care delivered at the bedside, and that their institution uses proper standards and coding of these data.

Rye, C.B., and Kimberly, J.R. (2007, June). "The adoption of innovations by provider organizations in health care." (AHRQ grant T32 HS00009). Medical Care Research and Review 64, pp. 235-278.

A variety of health care innovations have flooded health care systems worldwide, offering potentially beneficial advances in the diagnoses and treatment of disease and delivery of medical services. The direct and indirect costs of acquiring and implementing innovations are often substantial, though the potential financial benefits can be large as well. This article develops a comprehensive census of studies examining the adoption of and disengagement from innovations in health care provider organizations. The authors organize these studies into an inductively derived classification scheme. Finally, they assess the studies' strengths and weaknesses and reflect on the implications of the review for future research.

Sangl, J., Buchanan, J., Cosenza, C., and others (2007). "The development of a CAHPS instrument for nursing home residents (NHCAHPS)." Journal of Aging & Social Policy 19(2), pp. 63-82.

This paper describes a Federal initiative to develop a CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality of care and quality of life in nursing homes (known as NHCAHPS). The authors focus on development and testing of the instrument. They learned that in contrast to other CAHPS® surveys, ratings were more useful than reports because of the difficulty residents had with summarizing over time and people. Consistent with other CAHPS® surveys, the 0 to 10 response scale appeared to work well for many of the quality-of-care questions. However, a different response scale was needed for many of the quality-of-life items.

Reprints (AHRQ Publication No. 07-R064) are available from the AHRQ Publications Clearinghouse.

Sangvai, S., Cipriani, L., Colborn, K., and Wald, E.R. (2007, April). "Studying injury prevention: Practices, problems, and pitfalls in implementation." (AHRQ grant HS13523). Clinical Pediatrics 46(3), pp. 228-235.

This study examined the effectiveness of a chronic care model (CCM) approach to injury prevention in primary care settings compared with standard anticipatory guidance. Caregivers of children aged 0 to 5 years in the CCM group received focused counseling from a doctor and health assistant, educational handouts, phone followup, and access to free safety devices and automobile restraint evaluations. The researchers used home visits to observe safety practices 6 months later. Medical record review showed no difference between the CCM group and anticipatory guidance group in the number of medically attended injuries. Thus, the impact of the CCM on injury prevention in primary care could not be determined with certainty.

Schneeweiss, S. (2007, April). "Reference drug programs: Effectiveness and policy implications." (AHRQ grant HS10881). Health Policy 81, pp. 17-28.

This paper summarizes the mechanism and rationale of reference drug programs (RDPs) and presents evidence of their economic effectiveness and clinical safety. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior drug authorization programs are safer and more effective than simplistic fiscal drug policies such as fixed copayments and deductibles, asserts the author. He notes that RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior drug authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit neatly into one of the two categories.

Shaw, J.W., Johnson, J.A., Chen, S., and others (2007, May). "Racial/ethnic differences in preferences for the EQ-5D health states: Results from the U.S. valuation study." (AHRQ grant HS10243). Journal of Clinical Epidemiology 60, pp. 479-490.

Cost-utility analysis (CUA) is a form of cost-effectiveness analysis that compares the costs of health care programs with their outcomes, which are measured in terms of both quantity and quality of life. In CUA, the EuroQol Group's EQ-5D system can be used to classify a respondent's current health status and to provide a preference for that health state. This study examined differences for EQ-5D health states among blacks, whites, and Hispanics selected from the adult U.S. population. Valuations differed among the groups for 7 of the 13 health states, and these differences persisted after adjusting for other sociodemographic factors.

Snyder, R.A., Abarca,J., Meza, J.L., and others (2007, August). "Reliability evaluation of the adapted national coordinating council medication error reporting and prevention (NCC MERP) index." (AHRQ grant HS13131). Pharmacoepidemiology and Drug Safety 16(8), pp. 1006-1013.

These authors used adapted National Coordinating Council for Medication Error Reporting and Prevention Index criteria in a study undertaken to evaluate the impact of the commercial computerized provider order entry system on community hospital medication errors. They used the criteria to classify a random sample of 17 percent of 2,251 medication safety events based on event type—adverse drug event (ADE) or potential ADE—preventability, and outcome severity. The adapted Index yielded substantial agreement on event type, preventability, and severity. The authors conclude that adaptation of the Index to support classification of nonpreventable ADEs was an important improvement.

Starks, H., Back, A.L., Pearlman, R.A., and others (2007, February). "Family member involvement in hastened death." (AHRQ grant T32 HS13853). Death Studies 31, pp. 105-130.

This paper discusses four cases that highlight the positive and negative consequences of family members' participation in a hastened death—that is, when dying persons express an interest in physician-assisted suicide, or hastened death. In these cases, they often call upon family members to acquire "how to" information on approaching health care providers with a request for assistance, what medications to ask for, how to save and store medications for future potential use, and how to assure that the death is reported without prompting a legal investigation. Four cases reveal the main themes: "taking care" included mutual protection between patients and family members; "midwifing the death" without professional support left families unprepared for adverse events; "tying up loose ends" included dealing with family members' fear of legal consequences; and "moving ahead" involved a greater risk of complicated grief when families encountered complications during the dying process.

Stewart, A.L., Napoles-Springer, A.M., Gregorich, S.E., and Santoyo-Olsson, J. (2007, June). "Interpersonal processes of care survey: Patient-reported measures for diverse groups." (AHRQ grant HS10599). HSR: Health Services Research 42(3), pp. 1235-1256.

This paper describes the development of a patient-reported, multidimensional physician/patient interpersonal processes of care (IPC) survey appropriate for patients from diverse racial/ethnic groups. The researchers interviewed adult general medicine patients stratified by race/ethnicity and language to develop data. They designed items to be appropriate for diverse ethnic groups based on focus groups. The final 29-item instrument assessed several subdomains of communication, patient-centered decisionmaking, and interpersonal style. Final scales exhibited moderate to high reliability. The authors conclude that the IPC survey can be used to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes of quality improvement efforts to reduce health care disparities.

Tracy, J.I., Dechant, V., Sperling, M.R., and others (2007, April). "The association of mood with quality of life ratings in epilepsy." (AHRQ grant HS09986). Neurology 68, pp. 1101-1107.

Quality of Life in Epilepsy (QOLIE) scores, reflecting both general and specific aspects of quality of life, are strongly influenced by mood state, such as depression. Factors such as seizure control exert a more limited effect on the QOLIE, according to this study. Thus, health-related quality of life measures are needed in which mood does not play such a dominant role, conclude the researchers. They had 435 outpatients with epilepsy complete the Quality of Life in Epilepsy 31 Inventory (QOLIE-31), a depression and anxiety measure, and a social survey to determine the relative contributions of psychological, social, and seizure-related variables to QOL scores in epilepsy.

Welch, W.P., Bazarko, D., Ritten, K., and others (2007, May/June). "Electronic health records in four community physician practices: Impact on quality and cost of care." (AHRQ Contract No. 290-00-0012). Journal of the American Medical Informatics Association 14, p. 320-328.

These researchers assessed the impact of the electronic health record (EHR) on cost (that is, payments to providers) and process measures of quality of care. They obtained claims of patients from 4 community practices that implemented the EHR with 50 comparison practices without the EHR in the same counties. They examined their rate of adherence to clinical guidelines for four chronic conditions. Guideline adherence increased across practices without EHRs and slightly faster in practices with EHRs. However, measuring the impact of EHRs on cost per episode was challenging, because of the difficulty of completely capturing the long-term episodic costs of a chronic condition. Nevertheless, few practices associated with the study managed care organization had implemented EHRs in any form.

Return to Contents

AHRQ Publication No. 07-0077
Current as of September 2007

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Internet Citation:

Research Activities Newsletter. September 2007, No. 325. AHRQ Publication No. 07-0077. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/sep07/

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