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February 28, 2003, Issue No. 90
AHRQ News and Numbers
Part-time workers (those working less than 35 hours per week) were more likely than full-time workers to be uninsured in 2001. Approximately 61 percent of part-time workers had job-related insurance, compared with 79 percent of full-time workers. [Source: Agency for Healthcare Research and Quality, MEPS, Statistical Brief No. 11: The Health Insurance Status of U.S. Workers, 2001, February 2003 (PDF File,307 KB; PDF Help).]
- Program to reduce disparities in kidney dialysis appears to be effective
- Article on patients' and physicians' attitudes regarding the disclosure of medical errors
- Second year of national survey data details children's access to necessary medical care
- Study shows declining trend in emergency department payments
- AHRQ Web M&M mentioned in Wall Street Journal
- AHRQ's new National Quality Measures Clearinghouse™ launched
- Guidelines added to the National Guideline Clearinghouse™
- AHRQ in the professional literature
1. Program To Reduce Disparities in Kidney Dialysis Appears To Be Effective
An editorial in the February 26 issue of JAMA by AHRQ's Drs. Kaytura Aaron and Carolyn Clancy notes that a new study funded by CMS showed that appropriate collection and use of racial and ethnic data are essential to evaluate progress in minimizing inequalities in health care. While blacks and men continue to be less likely to receive "adequate dialysis" than whites and women, the differences have become smaller. The study, led by Dr. Ashwini Sehgal, and published in the February 26 JAMA, analyzed data from 1993-2000 on 58,700 kidney failure patients, nearly half of whom were 65 or older, participating in a CMS project to improve dialysis treatment. In 1993, 46 percent of white patients and 36 percent of black patients received the correct amount of dialysis, compared to 87 percent and 84 percent, respectively, in 2000. The study also found that in 1993, 54 percent of female patients and 31 percent of male patients received the correct amount of dialysis, compared with 91 percent and 82 percent, respectively, in 2000. The reasons for these disparities are not clear. Select to access the abstract of the study on PubMed® and the editorial.
2. Article on Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors
An article published in the February 26 issue of JAMA features a new AHRQ-funded study involving focus groups of patients and physicians discussing hypothetical medical errors. The study reveals that the current response to medical error disclosure might not meet patients' desire for information or the needs of patients and physicians for emotional support. The study, led by Thomas G. Gallagher, M.D., from the University of Washington School of Medicine in Seattle, and colleagues analyzed the transcripts from focus groups of patients and physicians to determine attitudes about medical error disclosure based on a hypothetical situation. Select to access the abstract on PubMed®.
3. Second Year of National Survey Data Details Children's Access to Necessary Medical Care
In 2001, nearly 25 percent of children under age 18 had not been to a doctor's office or visited a clinic during the previous 12 months, according to data reported by their families as part of AHRQ's Medical Expenditure Panel Survey. Of the 75.8 percent of children who did receive care, 91.9 percent were reported to have had no problems receiving the care their parents or doctors believed necessary. While a high percentage of Hispanic children were reported to have no problems receiving necessary care (88.4 percent), this percentage remains lower than percentages for black (91.7 percent) and white children (92.7 percent). These data are similar to data collected in 2000, the first year specific health care measures for children were added to MEPS. Select to access a new statistical brief (PDF File, 634 KB; PDF Help).
4. Study Shows Declining Trend in Emergency Department Payments
An AHRQ-funded study published in the March issue of Annals of Emergency Medicine shows an overall declining trend in emergency care payments, with the most significant payment decline noted among the privately insured. Based on data from AHRQ's MEPS, researchers found that from 1996 to 1998, the rate of payment for emergency department charges declined from 60.3 percent to 53 percent. In 1998, of $30.6 billion charged for emergency care, only $16.2 billion was paid, compared with $17 billion paid out of $28.1 billion charged in 1996. The study, led by Rita K. Cydulka, M.D., of Case Western Reserve University in Cleveland, indicates that the ability to recover losses from uninsured patients by cost shifting to other payers is becoming more difficult, largely because managed care has eliminated the financial margin previously used for this purpose. The problem likely will become worse, since the number of uninsured patients is increasing. Select to access the abstract on PubMed®.
5. AHRQ Web M&M Mentioned in Wall Street Journal
AHRQ's new Web M&M online patient safety journal was mentioned in the Wall Street Journal on February 20. Select to access the Web site of the online journal, which encourages anonymous reporting of cases involving medical errors. The article also quoted Dr. Dan Stryer, acting director of AHRQ's Center for Quality Improvement and Patient Safety, who noted that voluntary medical error reporting systems won't be effective unless they ensure confidentiality and free up health care workers from fear of prosecution.
6. AHRQ's New National Quality Measures Clearinghouse™ Launched
AHRQ recently launched its Web-based National Quality Measures Clearinghouse™. The NQMC contains the most current evidence-based quality measures and measure sets available to evaluate and improve the quality of health care. The site is designed to be a one-stop shop for physicians, hospitals, health plans, and others interested in quality measures. Users can search the NQMC for measures that target a particular disease/condition, treatment/intervention, age range, gender, vulnerable population, setting of care, or contributing organization. Visitors also can compare attributes of two or more quality measures side by side to determine which measures best suit their needs. The site also provides guidance on how to select, use, apply, and interpret a measure. Measures to be considered for inclusion in the NQMC can be submitted on an ongoing basis but must meet a set of criteria.
7. Guidelines Added to the National Guideline Clearinghouse™
Select to access what's new at the National Guideline Clearinghouse™(NGC)—a public resource for evidence-based clinical practice guidelines. Select to subscribe to the NGC Weekly Update Service, which notifies you via E-mail when new features and guidelines become available at the NGC Web site. AHRQ also has available a supply of NGC tutorials on CD-ROM. The tutorial walks you through a series of informative demonstrations and scenarios on using the NGC. The CD-ROM is available free of charge by calling the AHRQ Publications Clearinghouse at 1-800-358-9295 or by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
8. AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.
Longenecker JC, Klag MJ, Marcovina SM, et al. Small apolipoprotein(a) size predicts mortality in end-stage renal disease: the CHOICE study. Circulation 2002 Nov 19;106(21):2812-8. Select to access the abstract on PubMed®.
Mukamel DB, Weimer DL, Zwanziger J, et al. Quality of cardiac surgeons and managed care contracting practices. Health Serv Res 2002 Oct;37(5):1129-44. Select to access the abstract on PubMed®.
Lo Sasso AT, Johnson RW. Does informal care from adult children reduce nursing home admissions for the elderly? Inquiry 2002 Fall;39(3):279-97. Select to access the abstract on PubMed®.
Wilson IB, Ding L, Hays RD, Shapiro MF, et al. HIV patients' experiences with inpatient and outpatient care: results of a national survey. Med Care 2002 Dec;40(12):1149-60. Select to access the abstract on PubMed®.
Collins MM, Barry MJ, Zietman A, et al. United States radiation oncologists' and urologists' opinions about screening and treatment of prostate cancer vary by region. Urology 2002 Oct;60(4):628-33. Select to access the abstract on PubMed®.
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Current as of February 2003