Research Briefs

Caughey, A.B., Washington, A.E., and Kuppermann, M. (2008, March). "Perceived risk of prenatal diagnostic procedure-related miscarriage and Down syndrome among pregnant women." (AHRQ grant HSD07373). American Journal of Obstetrics & Gynecology 198, pp. 333.e1-333.e8.

Invasive prenatal diagnostic tests, such as chorionic villus sampling (CVS) and amniocentesis are used to detect Down syndrome and other fetal chromosomal abnormalities. This study suggests that women's perceived risk of outcomes of these procedures (such as procedure-related miscarriage) may vary based on factors not necessarily related to their actual risk. For example, among women younger than age 35, the perceived risk of carrying a Down syndrome-affected fetus was higher in women who had not attended college, or had poor self-perceived health status. Latinas, women with an annual income less than $35,000, and those who had difficulty conceiving had higher perceived procedure-related miscarriage risk. The findings were based on a survey of 1,081 English-, Spanish-, or Chinese-speaking women receiving prenatal care in San Francisco.

Clancy, C. (2008, March). "Forging a new path to medication safety with emergency pharmacists." Journal of Patient Safety 4(1), pp. 1-2.

To help reduce the risk of adverse drug events in hospital emergency departments (EDs), a small but growing number (79 in 2006, up from 49 in 2004) of hospitals are employing a pharmacist in their ED. In addition to traditional pharmacist responsibilities, an ED clinical pharmacy specialist actively participates in clinical consultations before drugs are ordered and administered. Two new initiatives are underway to assist pharmacists and hospitals in getting support for and implementing emergency pharmacist programs, according to Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ). The first, based on research conducted by Rollin Fairbanks, M.D., will connect teams of ED pharmacists with pharmacists interested in developing these programs. The second initiative, found at www.emergencypharmacist.org, contains a tool kit to help hospitals implement an ED pharmacist program. The tool kit was created by Dr. Fairbanks, whose work was supported by AHRQ. It includes a job description for an ED pharmacist, downloadable slide presentations describing the position, the role of the ED pharmacist, its justification and implementation, and other relevant literature.

Clancy, C.M. (2008, March). "SCIP: Making complications of surgery the exception rather than the rule." AORN Journal 87(3), pp. 621-624.

Deaths due to postoperative complications are not simply a hazard of surgery. Rather, they often are due to health care providers not following basic steps that have been proven to eliminate infections and other major postoperative complications, notes Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ). In a recent paper, she describes the Surgical Care Improvement Project (SCIP), a multiyear national campaign, whose goal is to use collaborative efforts by private and public players in the surgical care arena to reduce surgical complications 25 percent by the year 2010. SCIP focuses on areas in which the incidence and cost of complications are particularly high. These include surgical site infections (SSIs), adverse cardiac events, and venous thromboembolism (VTE, blood clots in the veins). For example, each of the 780,000 cases of SSIs per year increases hospital charges by $4,768. >The SCIP partnership of 10 national organizations, including AHRQ and the Centers for Disease Control and Prevention, has prompted preventive interventions to reduce SSIs, but there is limited adherence to these practices.

Reprints (AHRQ Publication No. 08-R060) are available from the AHRQ Publications Clearinghouse.

Clement, J.P., Valdmanis, V.G., Bazzoli, G.J., and others (2008). "Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion." (AHRQ grant HS13049). Health Care Management Science 11, pp. 67-77.

Technical inefficiency is associated with poorer quality of patient outcomes, concludes this study. It also found that the majority of study hospitals could improve both their technical efficiency and patient care outcomes. Using hospital data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Inpatient Database (HCUP SID) and the American Hospital Association Annual Survey for 2000, the researchers sought to determine the relationship between hospital technical efficiency and quality of patient outcomes. Technical efficiency was measured by numbers of staffed beds, full-time equivalent (FTE) registered nurses and licensed practical nurses, as well as other FTEs. Quality of patient outcomes was measured by desirable patient care outputs (patient stays) and undesirable outputs (five risk-adjusted mortality inpatient quality indicators for heart attack, congestive heart failure, stroke, gastrointestinal hemorrhage, and pneumonia). The analytic method selected for the study was data envelopment analysis (DEA) under assumptions of strong and weak disposability of outputs.

Cohen, S.B., Makuc, D.M., and Ezzati-Rice, T.M. (2007). "Health insurance coverage during a 24-month period: A comparison of estimates from two national health surveys." Health Services Outcomes Research Methodology 7, pp. 125-144.

National estimates of health insurance status are essential inputs to inform policymakers' assessments of the population's access to medical care. While these estimates are generally annually based, the authors of this study compared estimates over a 2-year period from the Medical Expenditure Panel Survey (MEPS) and from the National Health Interview Survey (NHIS) linked to the MEPS files. They found that the two approaches did not differ significantly on national estimates of the percentage of persons continuously insured; however, the MEPS longitudinal estimate of the percentage continuously uninsured was higher than the NHIS-MEPS linked estimate. In addition, the MEPS longitudinal estimate of the discontinuously insured was lower than that derived from the NHIS-MEPS linked data. These differences are partly due to the two surveys using different time periods, different lengths of time, and different lengths of recall. The authors conclude that the estimates from these two sources provide a relatively consistent picture of health coverage rates over time in the United States.

Reprints (AHRQ Publication No. 08-R029) are available from the AHRQ Publications Clearinghouse.

Col, N.F., Ngo, L., Fortin, J.M., and others (2007, September-October). "Can computerized decision support help patients make complex treatment decisions? A randomized controlled trial of an individualized menopause decision aid." (AHRQ grant HS13329). Medical Decision Making 27, pp. 585-598.

A computerized decision aid (DA), which conveys individualized information about the risks and benefits of menopause treatments based on women's individual symptoms, lifestyle, medical history, and clinical variables (such as bone density and cholesterol level) reduced women's conflicts about their treatment decisions and enhanced their care satisfaction. The summary report generated by the computer for the patient and individual clinician listed the patient's menopausal symptoms and quantified her risks for coronary heart disease, breast cancer, and hip fracture (with and without hormone treatment). The DA reduced decisional conflict 2 weeks after the clinic appointment by 0.70 points on a 1 to 5 point scale and 0.09 for the control group. Women in the DA group were also significantly more satisfied with their care than women in the control group.

Cosby, K.S., Roberts, R., Palivos, L., and others (2008, March). "Characteristics of patient care management problems identified in emergency department morbidity and mortality investigations during 15 years." (AHRQ grant HS11552). Annals of Emergency Medicine 51(3), pp. 251-261.

The authors of this paper characterized the types of cases referred to a physician review committee of an urban hospital's emergency department (ED) and identified the phase of work in which problems were detected and specific factors that affected the quality of patient care. Overall, they retrospectively reviewed 636 cases and classified problems into 1 of 4 major categories depending on the phase of work in which each occurred. In descending order of frequency, 71 percent of problems were identified in diagnosis, 44 percent in disposition, 42 percent in treatment, and 4 percent in public health. More than half the cases fell into at least two categories. Problems in specific clinical tasks were the most common contributing factor (99 percent), with patient factors (61 percent) and teamwork factors (61 percent) of equal weight. The data demonstrate that these cases are often complex and not the result of the failure of any single individual or process at any one moment in time.

Dougherty, D. and Conway, P.H. (2008, May). "The '3 T's' road map to transform US health care: The 'how' of high-quality care." Journal of the American Medical Association 299(19), pp. 2319-2321.

This article describes the "3T's" roadmap to translate research into quality care delivery in many settings for many types of patients. The authors point out that basic science and its translation into clinical research (translation 1 or T1) are only the beginning of the journey toward high-quality, effective, and safe care delivery along the road map. Next, translation 2 (T2) activities focus on creating more patient-specific evidence of clinical effectiveness to identify the right treatment for the right patient in the right way at the right time, and to translate practice guidelines into practice. Translation 3 (T3) activities address the "how" of health care delivery so that evidence-based treatment, prevention, and other interventions are delivered reliably to all patients in all settings of care and improve health care for individuals and populations.

Reprints of the article (AHRQ Publication No. 08-R054) are available from the AHRQ Publications Clearinghouse.

Elmore, J.G. and Brenner, R.J. (2007, August). "The more eyes, the better to see? From double to quadruple reading of screening mammograms." (AHRQ grant HS10591). Journal of the National Cancer Institute 99(15), pp. 1141-1143.

From 10 to 20 percent of women diagnosed with breast cancer had lesions that were visible but overlooked on their most recent mammogram and another 10 to 20 percent had lesions that were misinterpreted. These missed cancers represent lost opportunities for an early diagnosis. This, in turn, may have legal ramifications for the radiologists who miss them. A delay in breast cancer diagnosis is one of the most common reasons for malpractice lawsuits against American physicians. Double reading of mammograms by radiologists has been advocated to reduce the proportion of missed cancers and to at least partly offset the wide variations in radiologists' interpretations of mammograms. Computer-aided detection (CAD) has also been advocated as a digital "second reader," but its high recall rates have not prompted widespread support. The push for an improved cancer detection rate by double or quadruple reading needs to be balanced against the potential for higher recall and false-positive rates. To increase recall rates beyond 5 percent will result in many more biopsy referrals and false positives, with only modest improvement in cancer detection, caution the researchers. They also point out that the pool of U.S. radiologists interested in breast imaging is shrinking, while the demand for it continues to grow as women age.

Hohenhaus, M.H., McGarry, K.A., and Col, N.F. (2007). "Hormone therapy for the prevention of bone loss in menopausal women with osteopenia: Is it a viable option?" (ARHQ grant HS13329). Drugs 67(16) pp. 2311-2321.

Researchers examined various treatment standards from national medical organizations and found inconsistent guidance on when osteopenia should be treated. They found little data supporting treating osteopenia to forestall its progression into osteoporosis. Thus, women with osteopenia and their doctors do not have clear evidence to answer the clinical questions of what the risk factor is for a fracture, how often bone scans should be done if watchful waiting is elected, and what therapy is the best if the risk for fracture is high. Hormone therapy was a popular choice for preventing fragility fractures for women with osteoporosis, but it also increases the risk of blood clots, breast cancer, and cardiovascular disease. The authors state that evidence is insufficient to recommend using osteoporosis treatments for women with osteopenia unless they have suffered a fracture due to fragile bones. They suggest that treatment decisions should be based on weighing net benefits against anticipated risks, taking into account the woman's age, risk profile, and the presence of estrogen-responsive menopausal symptoms.

Kao, L.S. and Thomas, E.J. (2008). "Navigating towards improved surgical safety using aviation-based strategies." (AHRQ grant HS115440). Journal of Surgical Research 145, pp. 327-335.

To reduce medical errors and patient harm, health care has increasingly adapted safety practices from the aviation industry. The authors reviewed research on a number of strategies adapted from aviation to improve surgical safety, including behavioral marker systems, crew resource management (CRM), and training and competency assessment using simulators. The existing behavioral marker systems were considered to be early in development, incomplete, and not psychometrically validated. CRM encompasses team building, briefing strategies, situation awareness, and stress management. However, given the difficulties in the rigorous evaluation of these programs, novel trial designs and research methodologies may need to be developed. With the development of a variety of simulators, simulation has shown usefulness in the training and assessment of technical skills and teamwork in critical situations. The authors also discussed the strategies of incident reporting and human factors analysis. They concluded that challenges remain in establishing the validity of aviation-based strategies for surgical care, given differences between the two industries and a lack of rigorous research linking practices to outcomes.

Lapane, K.L., Dube, C.E., Schneider, K.L., and Quilliam, B.J. (2007, November). "Misperceptions of patients vs providers regarding medication-related communication issues." (AHRQ grant HS16394). American Journal of Managed Care 13(11), pp. 613-618.

Use of computers to electronically prescribe medications in the exam room enables clinicians to verify a patient's current medications, drug allergies, and other safety-related issues. However, e-prescribing may not change the extent to which patients and their doctors discuss medication issues. Doctors think they discuss medication issues more often than patients do, according to a new study. Researchers analyzed data from a sample of 96 providers practicing in 6 States and 1,100 of their mostly long-term patients. Patients who received electronic prescriptions were more likely than patients with paper prescriptions (54 vs. 43 percent) to report that their provider always checked the accuracy of their medication list during visits. However, a greater proportion of patients than their e-prescribing doctors reported never having discussions about medication use. For example, 83 percent of patients reported that they would never tell their physician if they did not plan on picking up a prescription, while physicians believed most patients would tell them this. Physician and patient perceptions diverged on safety issues as well. For example, one in four patients said their physicians always discussed the potential adverse effects of medications (regardless of physician e-prescribing experience) while doctors believed that they discussed this problem often or most of the time.

Lipowski, E.E. (2008, March/April). "Pharmacy practice-based research networks: Why, what, who, and how." (AHRQ grant HS16844). Journal of the American Pharmacists Association 48(2), pp. 142-152.

Pharmacy practice research that leads to improvements in the medication use process is needed, conclude the authors of this article. They reviewed proceedings from a national conference and the medical literature on pharmacy practice innovations that can lead to widely adopted advances in the safe and effective use of medication. The data suggest that only those interventions that can be reliably implemented by typical practitioners in a wide range of practice settings can produce lasting benefits for considerable numbers of patients. Teamwork between and among disciplines is needed for new insight and novel approaches to delivering pharmaceutical products and services. The authors conclude that practice-based research networks provide a model for building a synergy among pharmacists and other stakeholders to devise improvements that provide sustainable and system-wide improvements in medication use.

Lockley, S.W., Barger, L.K., Ayas, N.T., and others (2007, November). "Effects of health care provider work hours and sleep deprivation on safety and performance." (AHRQ grants HS15906 and HS12032). Joint Commission Journal on Quality and Patient Safety 33(11), pp. 7-18.

The long hours and shifts routinely worked by hospital medical staff in the United States jeopardize worker and patient safety, as well as quality of care, concludes a comprehensive review of studies on the topic. Compared with residents working 16-hour shifts, on-call residents had twice as many attention failures when working overnight and committed 36 percent more serious medical errors. They also reported making 300 percent more fatigue-related medical errors that led to a patient's death. A resident was also more than twice as likely to crash on the commute home after an extended shift (more than 24 hours) compared with residents on 14-hour or shorter shifts. Similarly, 39 percent of all nursing shifts were longer than 12.5 hours and were associated with a threefold increased risk of making a medical error. These longer shifts also boosted the nurses' likelihood of decreased vigilance on the job, making a medical error, and suffering a potentially devastating occupational injury (such as sticking themselves with a needle full of blood infected with HIV).

Lorch, S.A., Millman, A.M., Zhang, X., and others (2008). "Impact of admission-day crowding on the length of stay of pediatric hospitalization." (AHRQ grant HS09983). Pediatrics 121, pp. e718-e730.

High hospital occupancy rates can affect the care that children receive, according to this study. The researchers investigated the association between hospital occupancy on admission workload and hospital length of stay (LOS) for common pediatric diagnoses. They studied claims data (1996-1998) on over 69,000 respiratory and 49,000 nonrespiratory pediatric admissions (ages 1-17) in Pennsylvania and New York. The effect of admission-day occupancy on LOS was only apparent for children with respiratory conditions, and was greatest when the occupancy rate was greater than 60 percent. When the admission-day occupancy rate increased from 60 percent to 100 percent, the models used by the researchers predicted an extra 25 hospital days per 100 typical children admitted with respiratory conditions and a 16 percent increase in the likelihood of a prolonged hospital stay. The researchers offered the explanation that medical professionals treat the more acutely ill patients first, thus delaying treatment of children with less complex problems. This explanation was supported by their finding that the increased likelihood of a prolonged stay was focused on children with less complicated diagnoses who nevertheless required complex management and treatment.

McCloskey, L.A., Williams, C.M., Lichter, E., and others (2007, August). "Abused women disclose partner interference with health care: An unrecognized form of battering." (AHRQ grant HS11088). Journal of General Internal Medicine 22, pp. 1067-1072.

Intimate partner violence (IPV) includes not only physical and sexual assault and psychological battering, but also a pattern of coercive behaviors, such as interfering with a woman's health care. Researchers found that among women surveyed at 8 Boston area clinics, of 276 women who had been physically abused in the past year, 17 percent reported that a partner interfered with their health care. Women who had less than a high school education were three times more likely to be victimized in this way. Also, women who were born outside the United States and those who visited the clinic with a man were twice as likely to have their partner interfere with their health care. In addition, partner interference nearly doubled the odds of women having poor health.

Ness, R.B., Soper, D.E., Richter, H.E., and others (2008, February). "Chlamydia antibodies, Chlamydia heat shock protein, and adverse sequelae after pelvic inflammatory disease: The PID evaluation and clinical health (PEACH) study." (AHRQ grant HS08383). Sexually Transmitted Diseases 35(2), pp. 129-135.

Women who have been exposed to Chlamydia trachomatis, evidenced by C. trachomatis elementary bodies (EB), have lower rates of pregnancy and higher rates of recurrence of pelvic inflammatory disease (PID) after an initial episode of mild to moderate PID, concludes this study. In models including both EB and Chlamydia heat shock protein 60 (Chsp60), a high EB titer continued to be significantly related to a reduced rate of pregnancy and higher rates of recurrent PID. In contrast, associations between Chsp60 and pregnancy or PID recurrence were all insignificant. Some think that Chlamydia induces post-PID infertility and other problems due to immune reactions to Chsp60. However, this study's findings suggest that the role of Chsp60 antibodies in the etiology of PID sequelae remains unclear. The researchers examined Chlamydia antibodies, Chsp60, and adverse sequelae after PID among 443 women with mild to moderate PID, whom they followed for a mean of 84 months.

Resnick, B., Galik, E., Pretzer-Aboff, I., and others (2008). "Testing the reliability and validity of self-efficacy and outcome expectations of restorative care performed by nursing assistants." (AHRQ grant HS13372). Journal of Nursing Care Quality 23(2), pp. 162-169.

The researchers sought to determine the reliability and validity of two measures, the Nursing Assistant Self-efficacy for Restorative Care (NASERC) Scale and the Nursing Assistant Outcome Expectations for Restorative Care (NAOERC) Scale. They anticipated that self-efficacy-based interventions with nursing assistants (NAs) can increase their confidence and time spent in restorative care activities and thereby improve their job attitude and retention. The 386 NAs recruited from Maryland nursing homes filled out the two scale questionnaires as well as others on knowledge of restorative care, job satisfaction, and self-esteem. Each of the participants was also observed for 15 minutes to measure their actual performance of restorative care. The hypothesized relationships between self-efficacy and outcome expectations with performance of restorative care activities were not supported by the study results. The researchers believe that self-efficacy expectations were inflated, given that the mean score on knowledge of restorative activities was 55 percent. Successful implementation of restorative activities may not take place until the NAs understand what is meant by restorative care and can accurately evaluate their self-efficacy and outcome expectations.

Schneider, E.S., Nadel, M.R., Zaslavsky, A.M., and McGlynn, E.A. (2008, April). "Assessment of the scientific soundness of clinical performance measures." (AHRQ grant HS09473). Archives of Internal Medicine 108(8), pp. 876-882.

Performance measures used to assess both health care plans and ambulatory care performance of physician groups remain controversial because of concerns that measures with poor validity will lead physicians to provide inappropriate care, especially when incentives are attached to the measures. Few evaluations of the scientific soundness of measure specifications have been published. The researchers decided to assess the soundness of a clinical performance measure of colorectal cancer screening introduced in 2004 by the National Committee for Quality Assurance by comparing results from three different data sources: administrative data, a hybrid of administrative and medical records data, and survey data. They conducted a field test of 5 health plans that enrolled 189,193 individuals eligible for colorectal cancer screening. The percentage of enrollees screened varied by data source across the five health plans, with administrative data ranging from 27.3 percent to 47.1 percent, hybrid data varying from 38.6 percent to 53.5 percent, and survey data ranging from 53.2 percent to 69.7 percent. The researchers determined that administrative data underestimated colorectal cancer screening because of its between-plan bias and survey data overestimated screening because of nonresponse bias. They concluded that the hybrid data approach was the most accurate.

Setoguchi, S., Stevenson, L.W., and Schneeweiss, S. (2007, August). "Repeated hospitalizations predict mortality in the community population with heart failure." (AHRQ grant HS10881). American Heart Journal 154(2), pp. 260-266.

From 30 to 50 percent of patients diagnosed with heart failure die within a year after they are first hospitalized for the problem. Researchers found that each hospitalization for heart failure progressively boosts the risk of dying from the condition. For example, median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest weakened the impact of the number of heart failure hospitalizations on death. Researchers followed 14,374 patients hospitalized for heart failure for nearly 2 years. A total of 7,401 died during the study period. After adjusting for age, sex, and major coexisting medical conditions, the number of heart failure hospitalizations clearly was a strong predictor of death.

Shahinian, V.B., Kuo, Y-f., Freeman, J.L., and others (2007, December). "Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer." (AHRQ grant HS11618). Journal of Clinical Oncology 25(34), pp. 5359-5365.

Androgen deprivation therapy, which reduces testosterone levels, was previously used to relieve the discomfort of metastatic prostate cancer. Now, it is being widely used for localized prostate cancer, despite lack of evidence for its benefit in this situation. At present, whether a man receives androgen deprivation therapy depends on who his urologist is, not the state of the cancer or his characteristics, concludes a new study. Researchers examined the treatment of 82,375 men with prostate cancer, who were diagnosed from January 1, 1992, through December 31, 2002, and the 2,080 urologists who cared for them. Overall, 34.4 percent of men received androgen deprivation therapy, 5.2 percent underwent surgery to remove one or both testicles, and 29.2 percent received gonadotropin-releasing hormone agonists. Patients of urologists who were not academically affiliated, who had a larger patient panel size, or who had graduated less recently, were significantly more likely to receive androgen deprivation therapy, regardless of their cancer stage. Also, patients of nonacademically affiliated urologists were significantly more likely to receive primary androgen deprivation therapy for localized prostate cancer.

Tang, Z., Weavind, L., Mazabob, J., and others (2007, September). "Workflow in intensive care unit remote monitoring: A time-and-motion study." (AHRQ grant HS15234). Critical Care Medicine 35(9), pp. 2057-2063.

One approach to the national shortage of critical care specialists to care for patients in the intensive care unit (ICU) is remote monitoring of ICU patients by these specialists. Three factors may affect the quality and efficiency of remote clinicians' work: workflow interruption of remote clinicians, usability of the clinical information system (CIS), and collaboration with bedside caregivers. Researchers examined the characteristics of remote clinicians' workflow by observing 6 physicians for 47 hours and 7 registered nurses for 39 hours in a facility that remotely monitored 132 beds in 9 ICUs. Clinicians had access to a CIS that integrated real-time physiologic, laboratory, and imaging data of ICU patients with current medications and interventions. Physicians spent 70 percent, 3 percent, 3 percent, and 24 percent of their time on patient monitoring, collaboration, system maintenance, and administrative/ social/personal tasks, respectively. For nurses, the time allocations were 46 percent, 3 percent, 4 percent, and 17 percent, respectively. Nurses spent another 30 percent of their time maintaining health records. Physicians' workflows were interrupted 2.2 times per hour and nurses' workflows were interrupted 7.5 times per hour.

Trivedi, A.N., Rakowski, W., and Ayanian, J.Z. (2008, January). "Effect of cost sharing on screening mammography in Medicare health plans." (AHRQ grant T32 HS000020). New England Journal of Medicine 358(4), pp. 375-383.

Researchers reviewed data from the Medicare Health Plan Employer Data and Information Set to look at the relationship between cost sharing and screening mammograms from 2002 to 2004. They found that while just 3 of the 174 Medicare health plans studied required co-payments of $10 or more or coinsurance of more than 10 percent in 2001, 21 did so in 2004. Along with the increase in co-payments and coinsurance requirements came a decrease in screening mammograms. For 366,475 Medicare enrollees, 69.2 percent of women whose plans required cost sharing received breast-cancer screenings, while 77.5 percent of fully covered women were screened. Although every demographic group studied was negatively affected by cost sharing, black women and women with lower incomes and educational levels often were insured by plans that required cost sharing for mammography.

Yorita, K.L., Holman, R.C., Sejvar, J.J., and others (2008, February). "Infectious disease hospitalizations among infants in the United States." Pediatrics 121(2), pp. 244-252.

Agency for Healthcare Research and Quality researcher Claudia A. Steiner, M.D., M.P.H., and colleagues from the Centers for Disease Control and Prevention examined 2003 data from the Kids' Inpatient Database (produced by the Healthcare Cost and Utilization Project) and found that more than 40 percent of infant hospitalizations are caused by infectious diseases. Lower respiratory tract infections account for nearly 60 percent of those hospital stays with a hospitalization rate of 4,135 per 100,000 live births. Infections of the kidney, urinary tract, and bladder placed a distant second for causing hospital stays with a rate of 533.4 hospitalizations per 100,000 live births. Hospitalization rates for infectious diseases were higher for boys than girls, black and Hispanic infants, and lowest for Asian/Pacific Islander infants. These hospital stays commonly last 3 days and cost $2,235. In 2003, infants with infectious diseases in the United States spent more than 1 million days in the hospital at a cost of more than $3 billion.

Reprints (AHRQ Publication No. 08-R049) are available from the AHRQ Publications Clearinghouse.

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