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Media Advisory: May 14, 1998
The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health
care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.
HMO Coverage May Alter Treatment Choices and Hospital
Stays for Women With Breast Cancer
A woman's chance of surviving breast cancer is similar whether she has breast-conserving surgery
(BCS) followed by radiation or modified radical mastectomy (MRM). But women who belong to a health
maintenance organization (HMO) are less likely to have BCS instead of MRM. They also are likely to have
hospital stays that are 1 or 2 days shorter than women with other private insurance, says an AHCPR-supported study. BCS costs considerably more than MRM due to expensive follow-up radiation therapy.
Principal investigator Jack Hadley, Ph.D., and Georgetown University Medical Center colleague, Jean M.
Mitchell, Ph.D., analyzed hospital discharge abstract data on nonelderly women with breast cancer from 5 states for 1988 and 1991.
["Breast cancer treatment choice and mastectomy length of stay: A comparison of HMO and other privately
insured women," Jack Hadley, Ph.D., and Jean M. Mitchell, Ph.D., Winter 1997/98 Inquiry 34, pp. 288-301.]
Half the Cases of Early Childhood Asthma Are Due to Secondhand Cigarette Smoke
Exposure to secondhand cigarette smoke is responsible for about half of the cases of early childhood
asthma, chronic bronchitis, and wheezing, according to an AHCPR-supported study. It shows that children 2
months to 5 years of age, who were exposed to household smoke of 20 or more cigarettes a day were twice as
likely to develop asthma as children who were not exposed to smoke. Also, children 2 months to 2 years of
age with such exposure were nearly 2.5 times more likely to develop chronic bronchitis and nearly 3 times
more likely to have 3 or more episodes of wheezing than unexposed children. Those 2 months to 5 years of
age with prenatal exposure from their mothers' smoking were nearly twice as likely to develop asthma.
These findings are based on data from the Third National Health and Nutrition Examination Survey,
compiled between 1988 and 1994, which included reports on household smoking and maternal smoking
["The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months
through 5 years of age in the United States," Peter J. Gergen, M.D., M.P.H., Jean A. Fowler, M.S., Kurt R.
Maurer, Ph.D. and others, Pediatrics Electronic Pages 101(2) (http://www.pediatrics.org)]
Laboratory Testing and Antibiotic Therapy Are Often at Odds
with Expert Advice About Lyme Disease
Lyme disease (LD) is caused by the tickborne bacteria Borrelia burgerorferi, but tick bites rarely
result in LD. However, tick bites are a common reason for people in endemic areas to seek medical care. It
takes two weeks or longer for antibodies to B. burgdorferi to show up in the blood, but half of patients who
seek care for a tick bites in Lyme-infested areas have a blood test performed right away. Most receive
prophylactic antibiotics regardless of whether they have the blood test or regardless of the test's outcome,
incurring potentially unnecessary medical costs. AHCPR-funded researchers studied the use patterns of
serological testing and antibiotic therapy in 1995 for 232 patients with tick bites, LD, or suspected LD in
primary care practices on Maryland's Eastern Shore in 1995, an area endemic for LD. They found that
blood testing for LD did not appear to influence treatment of patients diagnosed as having LD. About half
of patients who sought care for a tick bite had a blood test performed at the initial visit but did not have the
follow-up "convalescent" assay needed to verify LD. Fifty-five percent of patients received antibiotic
therapy, but in most cases antibiotics were prescribed before blood test results were available.
["Tick bites and Lyme Disease in an endemic setting: Problematic use of serologic testing and prophylactic
antibiotic therapy," by Alan D. Fix, M.D., M.S., G. Thomas Strickland, M.D., Ph.D., and John Grant, M.D.,
M.P.H., in the January 21, 1998, Journal of American Medical Association 279(3), pp. 206-210.]
Concerns About Side Effects May Make Doctors Reluctant to
Vaccinate Young Children
Doctors who are concerned about the side effects of vaccinations—and to a lesser degree potential
litigation—are less likely to vaccinate young children, according to a study funded by AHCPR. One third
of physicians surveyed overestimated the risk for serious adverse effects related to diphtheria-tetanus-pertussis (DTP) vaccines, and 13 percent overestimated the risks of measles vaccines in 1995. Among
doctors most concerned about possible litigation, 22 percent said they were unlikely to recommend the third
dose of DTP for a child with a fever of 39.4 degrees C (102.9 degrees F) and no other symptoms after the
second DTP dose compared with only 12 percent of doctors with little concern about vaccine-related
lawsuits. Programs are needed to educate doctors about vaccine safety and lawsuit protection, says Richard
Kent Zimmerman, M.D., M.P.H., of the University of Pittsburgh. He and colleagues surveyed by telephone a
random sample of 1,236 primary care doctors who frequently saw young children.
["Physician concerns about vaccine adverse effects and potential litigation," Richard K. Zimmerman, M.D.,
M.P.H., James J. Schlesselman, Ph.D., Tammy A. Mieczkowski, M.A., and others, January 1998 Archives of
Pediatric and Adolescent Medicine 152, pp. 12-19.]
Other articles in Research Activities include findings on:
- Treadmill testing of ER chest pain patients.
- Rural adolescent pregnancy.
- Impact of patient race on obstetric practices.
- High costs of twins and other multiple births.
- Use of ER by blacks with asthma.
- Differences by race and sex in use of hospital procedures.
- Low- and high-cost antibiotics and pneumonia outcomes.
- Cost effectiveness of preventing AIDS-related infections.
- Treatment delays following critical laboratory reports.
- Factors that increase the risk of recurrent stroke.
- Need for blood transfusions in elderly surgery patients.
- Benefit of heparin in reducing catheter-related infections.
- Hospitalizations among HMO patients with chronic disease.
- Factors influencing elderly choices about Medigap insurance.
- Hospital cost shifting from government to private payers.
- Critical research role of academic medical centers.
- Challenges of managed care to health services researchers.
- State of research within managed care plans.
- Racial differences in the need for and use of long-term care.
- Impact of health on job mobility.
For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).