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Authors: Szilagyi PG, Shenkman E, Brach C, et al.
Date: 2003.
Title: Children with special health care needs enrolled in SCHIP: patient characteristics and health care needs.
Publication: Pediatrics 112(6 Pt. 2):508-20.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO17).

Authors: Brach C, Lewit EM, VanLandeghem K, et al.
Date: 2003
Title: Who's enrolled in SCHIP? Findings from the Child Health Insurance Research Initiative (CHIRI™).
Publication: Pediatrics 112(6):499-507.
Abstract: Available on PubMed®
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO15).

Authors: Elixhauser A, Weinick R, Betancourt J, et al.
Title: Differences in use of hospital procedures for Hispanics and non-Hispanic whites with cerebrovascular disease.
Publication: Ethn Dis 12(1):29-37.
Date: 2002
Abstract: Disparities in procedure use between racial/ethnic groups in the U.S. have been identified, yet differences between Hispanic and non-Hispanic white patients have been studies less frequently. The purpose of this study was to assess the in-hospital use of diagnostic and therapeutic procedures among Hispanics and non-Hispanic whites with transient cerebral ischemia or cerebrovascular disease. This study uses California and New York HCUP State Inpatient Databases for 1996. Hispanics had higher rates of non-invasive diagnostic testing (head CT scan, head and neck ultrasound, echocardiogram and head MRI). The odds of invasive diagnostic testing (cerebral arteriogram) and therapeutic procedures (carotid endarterectomy) were significantly lower for Hispanics. Most findings remained unchanged in logistic regression models with patient and hospital characteristics. Adding a measure of the concentration of Hispanic patients in the hospital eliminated differences or greatly reduced the level of disparity between Hispanics and non-Hispanic whites. Racial/ethnic differences in diagnostic procedure use may reflect poor communication and cultural/linguistic barriers between patients and providers, where diagnostic testing is used to compensate for an uninformative patient history.

Authors: Fleishman J, Hellinger F.
Title: Trends in HIV-Related Inpatient Admissions and Deaths: A Seven-State Study.
Publication: Journal of Acquired Immune Deficiency Syndromes 28(1):73-80.
Date: 2001
Abstract: Reports of declining HIV-related inpatient utilization since the introduction of combination antiretroviral therapy have typically been based on data from a single institution or locality. This study examines trends in HIV-related inpatient admission rates from 1993 through 1997, using a negative binomial analysis of comprehensive data from seven states. We used comprehensive hospital discharge data from seven states, from the State Inpatient Database of the Healthcare Costs and Utilization Project. HIV-related inpatient admission rates rose between 1993 and 1995, but then showed sharp and steady declines starting in late 1995. This general pattern was observed for all seven states, and did not differ by patients' gender or race/ethnicity. Admission rates were highest for black males and lowest for white females. The rate at which HIV-related admissions ended in the death of the patient also declined steadily after 1995. The inpatient death rate for women was lower than that for men, but racial/ethnic differences in death rates were not significant. These results confirm and extend previous reports of reduced HIV-related inpatient utilization subsequent to the advent of combination antiretroviral therapy.

Authors: Hellinger F, Fleishman J.
Title: Location, Race, and Hospital Care for AIDS Patients: An Analysis of Ten States.
Publication: Inquiry 38:319-30.
Date: Fall 2001
Abstract: This study is the first statewide comparison of hospital utilization and inpatient mortality rates for persons with Acquired Immune Deficiency Syndrome (AIDS). Data from 120,772 hospital discharge abstracts for all AIDS-related admissions in 10 states (California, Colorado, Florida, Iowa, Kansas, Maryland, New Jersey, New York, Pennsylvania, and South Carolina) in 1996 were combined with data on the number and the racial and ethnic characteristics of all persons living with AIDS (PLWAs) in each state. These data were used to derive population-based estimates of the utilization of hospital services per PLWA and of inpatient mortality rates in each state. Multivariate analyses examined sources of variation in inpatient length of stay and inpatient mortality. The primary finding of this study is that hospital utilization rates and inpatient mortality rates for persons with AIDS vary substantially across states and among racial and ethnic groups within states even after adjusting for severity of illness. Blacks and Hispanics had longer hospital stays and were more likely to die in the hospital than whites. State-level policies, such as home and community-based waiver programs and enhanced HIV reimbursement rates, significantly affected hospital use.

Authors: Centers for Disease Control (Tierney E) and Agency for Health Care Research and Quality (Elixhauser A).
Title: Major Cardiovascular Disease (CVD) During 1997—1999 and Major CVD Hospital Discharge Rates in 1997 Among Women with Diabetes—United States.
Publication: Morbidity and Mortality Weekly Report 50(43):948-54.
Date: 2001
Abstract: Cardiovascular disease (CVD) is the leading cause of death among all women. The risk for death from CVD among women with diabetes is two to four times higher than that for women without diabetes. The excess risk for death as the result of CVD among persons with diabetes is better understood than the excess risk for CVD morbidity. To estimate national CVD prevalence and CVD hospital use among women with diabetes, CDC and AHRQ analyzed data from the 1997-99 National Health Interview Survey (NHIS) and the 1997 Nationwide Inpatient Sample. Findings indicate that the age-adjusted prevalence of major CVD for women with diabetes is twice that for women without diabetes and that the age-adjusted major CVD hospital discharge rate for women with diabetes is almost four times the rate for women without diabetes. These findings underscore the need to reduce risk factors associated with CVD among all women with diabetes through focused public health and clinical efforts.

Authors: Centers for Disease Control (Tierney E) and Agency for Health Care Research and Quality (Elixhauser A).
Title: Hospital Discharge Rates for Nontraumatic Lower Extremity Amputation by Diabetes Status—United States, 1997
Publication: Morbidity and Mortality Weekly Report 50(43):954-8
Date: 2001
Abstract: Lower extremity amputation (LEA) is a costly and disabling procedure that disproportionately affects persons with diabetes. One of the national health objectives for 2000 was to reduce the LEA rate from a 1991 baseline of 8 per 1,000 persons with diabetes to a target of 5 per 1,000 persons with diabetes. Review of 1996 data indicated an LEA rate of 11. To estimate the national rates of hospital discharges for LEA among persons with and without diabetes and to assess the excess risk for LEA among persons with diabetes, CDC and AHRQ analyzed data from the 1997 Nationwide Inpatient Sample and the 1997 National Health Interview Survey (NHIS). This report indicates that the age-adjusted rates of hospital discharges among persons with LEA who had diabetes were 28 times that of those without diabetes.

Authors: McNamara R, Powe N, Thiemann D, Shaffer T, et al.
Title: Specialty of Principal Care Physician and Medicare Expenditures in Patients with Coronary Artery Disease: Impact of Comorbidity and Severity.
Publication: American Journal of Managed Care 7:261-66.
Date: 2001
Abstract: To explore differences in expenditures for elderly patients with acute and chronic coronary artery disease according to the specialty of the principal care physician, a total of 250,514 patients with coronary artery disease (ICD-9 codes 410-414) were drawn from a national 5 percent random sample of 1992 Medicare beneficiaries. Patients were classified by the physician type with the highest number of Medicare Part B outpatient claims into a cardiologist group and a generalist group. The outcome was mean total expenditures, stratifying (1) by comorbidity as measured by the modified Charlson Index and (2) by severity defined as the proportion of patients with acute myocardial infarction or unstable angina. Those patients in the cardiologist group had lower comorbidity and higher severity than those in the generalist group. Overall mean expenditures were significantly higher for the cardiologist group than for the generalist group ($7,658 vs $6,047; P < .001 ). These differences in mean expenditures were evident at each level of comorbidity. However, when stratified by severity of diagnosis, differences were seen pre-dominantly in those, with acute diagnoses. Expenditures were higher when cardiologists were the principal care physicians treating patients with acute disease ($15,378 vs $12,260; P < .001) compared with chronic disease where the expenditures were similar ($4,856 vs $4,745; P = .53).

Authors: Palmer CS, Schmier J, Snyder E, Scott B.
Title: Patient preferences and utilities for "off-time" outcomes in the treatment of Parkinson's disease.
Publication: Quality of Life Research 9(7):819-27.
Date: 2000
Abstract: The purpose of this study was to derive patient preferences and utilities for outcomes associated with treatment of motor fluctuations, or 'off-time', for patients with Parkinson's disease (PD). Visual analog scale and standard gamble approaches were used with 60 patients to determine patient preferences and utilities for 10 health state descriptions. Health state descriptions were categorized according to two factors: disease severity, and proportion of the day with 'off-time'. The results of this study indicated patients with PD would likely seek treatment that would minimize the amount of 'off-time' experienced per day, and that patients were relatively risk averse.

Authors: Elixhauser A, Leidy NK, Halpern M.
Title: Cost and outcome implications for prevention.
Publication: In: Weiss KB, Buist AS, Sullivan SD. Asthma's Impact on Society: The Social and Economic Burden. New York: Marcel Dekker, Inc.
Date: 2000
Abstract: This chapter examines the health and economic implications of interventions aimed at the primary prevention of asthma. Research into these areas is a relatively recent phenomenon; many of the conclusions about the effectiveness of preventive interventions are speculative. This chapter provides alternative typologies of prevention for asthma and provides a conceptual framework for evaluating the costs and outcomes of interventions for the primary prevention of asthma.

Author: Hellinger FJ, Fleishman JA.
Title: Estimating the national cost of treating people with HIV disease: Patient, payer, and provider data.
Publication: Journal of Acquired Immune Deficiency Syndrome 24(2):182-8.
Date: 2000
Abstract: Existing estimates of the national cost of treating all people with HIV disease use data from a sample of people with HIV disease to extrapolate the cost of treating all people with HIV disease (patient-based approach). This study derives estimates using two novel approaches (i.e., payer-based and provider-based) and compares these with existing estimates. The data sources include the Health Insurance Association of American and the American Council of Life Insurance 1996 HIV survey, the 1996 State Inpatient Databases (SID) maintained by the Agency for Healthcare Research and Quality, and the IMS America Ltd. survey of independent and chain drugstores. The authors found that the cost of treating all people with HIV disease in 1996 was between $6.7 and $7.8 billion, and the average annual cost of treating a person with HIV disease was between $20,000 and $24,700. They concluded that analysts should derive estimates of the cost of treating people with HIV disease using several different approaches.
Availability: AHRQ Publication No. 00-R058 is available from the AHRQ Publications Clearinghouse.

Authors: Palmer CS, Niparko JK, Wyatt JR, et al.
Title: A prospective study: cost-utility of the multichannel cochlear implant.
Publication: Archives of Otolaryngology 125(11):1221-28.
Date: 1999
Abstract: Cochlear implants can benefit individuals with advanced hearing loss insufficiently aided by hearing aids. This study determined the cost per QALY gained with implantation of a multichannel cochlear implant. Health utility and cost data were prospectively collected over 12 months in adults with severe to profound hearing loss. Results indicated a very favorable cost/QALY for those who received an implant compared with those who did not.

Authors: Elixhauser A, Halpern M.
Title: Economic evaluations of pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1206-13.
Date: 1999
Abstract: The total cost of cancer care in the United States is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8 percent of the total) and gastric cancer comprises $1.8 billion (1.3 percent). The authors have reviewed published studies presenting economic analysis of treatment or followup for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although the authors identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated, relying on charge data or simple multipliers (e.g., average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs are included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and take advantage of administrative data from large populations.

Authors: Elixhauser A., Leidy N, Meador K, et al.
Title: The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy.
Publication: Epilepsy Research 37:13-24.
Date: 1999
Abstract: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. For the study, 138 patients were recruited from 3 epilepsy centers in the U.S. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Moods States, POMS). Memory performance scores were weakly correlated with perceived cognitive functioning (r = 0.22, p<0.01). Perceived cognitive functioning was strongly correlated with mood (r = -0.75, p<0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (p<0.02); however, the explained variance for RBMT and POMS combined (R2=0.58) was only slightly higher than the predictive value for the POMS score alone (R2=0.56). Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.

Authors: Harris-Kojetin L, Fowler F, Schnaier J, et al.
Title: The use of cognitive testing for developing and evaluating CAHPS® survey items.
Publication: Med Care 37(3 Suppl):MS10-MS21.
Date: 1999
Abstract: The main goal of the Consumer Assessments of Health Plans (CAHPS®) survey is to develop an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees about their experiences. The CAHPS® project benefits from the complementary strengths of psychometric and cognitive testing. The authors found that cognitive testing was integral in developing and refining the CAHPS® instrument. The cognitive testing findings contributed to an improved instrument that should capture consumers' health care and plan experiences with less response error than one not subjected to such testing.

Authors: Leidy N, Elixhauser A, Rentz AM, et al.
Title: Telephone validation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89).
Publication: Epilepsia 40(1):97-106.
Date: 1999
Abstract: This study assesses the psychometric properties of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) administered via telephone and to compare these properties with data gathered through self-administration. Results of this study indicate telephone interview is a viable option for evaluating health-related quality of life (HRQL) in persons with epilepsy and support the reliability and validity of the QOLIE-89 regardless of method of administration.

Authors: Leidy NK, Elixhauser A, Vickrey B, et al.
Title: Seizure frequency and the health-related quality of life of adults with epilepsy.
Publication: Neurology 53:162-66.
Date: 1999
Abstract: This article compares the health-related quality of life (HRQL) of a non-surgical sample of adults with epilepsy to that of age and gender-equivalent norms, and analyzes the relative importance of seizure frequency, time since last seizure, gender, and comorbidity on HRQL in the epilepsy sample. The study, using data from 139 adults with epilepsy from 3 U.S. centers, found that seizure-free adults can attain HRQL levels comparable to those of the general population. As seizure frequency increases, patients report more impaired HRQL, regardless of time since last seizure, gender, and comorbid status. Potential for difficulties in HRQL should be considered in clinical assessment and in evaluating treatment outcomes.

Authors: Schmier J, Elixhauser A, Halpern M.
Title: Health related quality of life evaluations in pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1998-2004.
Date: 1999
Abstract: This review addresses the state of the literature on health-related quality of life (HRQL) assessment among patients with cancers of the pancreas and stomach. The authors first briefly review the epidemiology of these cancers. They examine the concept of HRQL and the degree to which it has been measured among these patient groups. The impact of gastric and pancreatic cancers on HRQL is described, including the domains that these conditions are most likely to impact. The effect of different treatments on HRQL is considered, including surgical procedures, pharmacological and non-pharmacological therapies, and procedures for symptom palliation. Based on their findings and on the limited quantity and quality of the body of literature, the authors make suggestions for further research in the area.

Author: Hellinger F.
Title: Cost and financing of care for persons with HIV disease: An overview.
Publication: Health Care Financing Review 19(3):5-18.
Date: 1998
Abstract: This article explores the impact of new combination drug therapies on the cost and financing of human immunodeficiency virus (HIV) disease. Evidence indicates that the proportion of costs attributable to drugs has increased significantly since the diffusion of new combination drug therapies, and that the proportion of costs attributable to hospital inpatient care has decreased. The absence of timely data is the major difficulty in analyzing the impact of recent changes. Only two studies have examined costs since the diffusion of new combination drug therapies, and there are no recent studies of the insurance status of persons with HIV disease.

Authors: Kitzmiller J, Elixhauser A, Carr S, et al.
Title: Assessment of costs and benefits of management of gestational diabetes mellitus.
Publication: Diabetes Care (21 Suppl):B123-130.
Date: 1998
Abstract: The purpose of this pilot study was to perform a cost-identification analysis of care of gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs); the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby; and newborn care (outcome costs). Reimbursed average charges in the Northern California managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in Northern California, Southern California, and New England, using prospectively collected data. Based on their analysis, the authors conclude that cost analysis should be included in the clinical trials of the management of GDM.

Author: Fraser I.
Title: Research on health care organizations and markets—The best and worst of times.
Publication: Health Services Research 32(5):669-78.
Date: 1997
Abstract: This article contains reflections from four short papers commissioned by AHCPR in January 1997 to identify central managed care research questions in the areas of health care markets, access, chronic illness, and long term care.
Availability: AHCPR Publication No. 98-R019 is available from the AHRQ Publications Clearinghouse.

Author: Elixhauser A, Kitzmiller JL, Weschler JM.
Title: Short-term cost benefit of pre-conception care for diabetes.
Publication: Diabetes Care 19(4):384.
Date: 1996
Abstract: This analysis revises previous estimates on the cost-benefit of preconception care for women with diabetes, which had been performed from a societal perspective. Taking the perspective of the third party payer (excluding long-term care costs and non-medical costs such as special education), preconception care for women with diabetes results in cost savings of $480 per enrollee. This indicates that significant benefits of preconception care accrue during pregnancy and during the initial hospitalization of mother and infant.

Authors: Sullivan S, Elixhauser A, Luce B, et al.
Title: National Asthma Education and Prevention Program Working Group report on the cost-effectiveness of asthma care.
Publication: American Journal of Respiratory and Critical Care Medicine 154:S84-S95.
Date: 1996
Abstract: The cost effectiveness of asthma care is the first topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group characterized the role of health economics in understanding optimal asthma management strategies. The report first reviews methods for economic evaluation of the medical technologies, with a particular focus on cost-effectiveness analysis. Next, the report explores the nature and usefulness of several key asthma outcome measures, including clinical and symptom measures, measures of lung function, measures of functional status, and measures of health services utilization and cost. The working group also conducted a review of the literature on cost effectiveness of asthma patient education programs, pharmaceutical therapy, and a variety of alternative and adjunct interventions. The report concludes with recommendations for a standardized approach for economic evaluation study designs (e.g., common asthma outcomes, long-term followup, and studies with patients of different ages, socioeconomic statuses, and severity levels) and for an expansion in the number of such standardized asthma studies and cost-effectiveness analyses.

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