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Media Advisory: June 12, 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.
New Model Projects 11 Percent Fewer Deaths in 20
Years if U.S. Smokers Stopped Smoking
If all adult smokers in the United States quit smoking today, in 20 years the overall U.S. death
rate would drop by 11 percent, says an AHCPR-supported study. Men would account for 58
percent of deaths avoided by year 20, women for 41 percent. These figures are based on a model
developed by Louise B. Russell, Ph.D., of Rutgers University's Institute of Health, and
colleagues who estimated the probability of survival for each adult in a nationally representative
sample of over 11,000 U.S. adults followed from baseline (1971-1975) to 1987. They first
calculated the subject's survival probability as a function of other risk factors: diabetes, smoking,
high blood pressure, and elevated serum cholesterol. They found that projected deaths closely
matched observed deaths 12 years after baseline. The researchers then kept risk factors the same
but changed smokers to nonsmokers to calculate projected overall deaths 20 years after baseline.
["Modeling all-cause mortality: Projections of the impact of smoking cessation based on the
NHEFS," Dr. Russell, Jeffrey L. Carson, M.D., William C. Taylor, M.D., and others, in the April
1998 American Journal of Public Health 88, pp. 630-636. ]
Physicians Can Identify Women with Incontinence
by Asking a Few Simple Questions
Many older women suffer from urinary incontinence that can interfere with their ability to enjoy
activities ranging from social interactions to travel. However, often they are too embarrassed to
mention the problem to their doctors. Primary care physicians can take the lead and identify
incontinence by asking women a few simple questions, says an AHCPR-supported study.
Researchers found that a positive answer to a question of whether accidental urine loss interferes
with day-to-day activities is a good predictor of incontinence severe enough to affect a woman's
quality of life. This and a few other simple questions could substitute for two lengthy standard
questionnaires currently used to identify the problem. The study found that symptoms elicited
from the questionnaires completed by 384 incontinent women correlated with symptoms
identified by a few simple questions asked by physicians at 21 primary care practices.
["Relationship between patient reports of urinary incontinence symptoms and quality of life
measures," Deirdre Robinson, M.D., Katherine F. Pearce, M.D., John S. Preisser, Ph.D., and
others, in the February 1998 Obstetrics & Gynecology 91(2), pp. 224-228.]
Hospital Report Cards Can Help Hospitals Improve
Hospital report cards that document which hospitals have better-than or worse-than-expected
outcomes for particular medical treatments, can help hospitals improve the quality of care for
these conditions, concludes an AHCPR-supported study. Patrick S. Romano, M.D., M.P.H., and
colleagues at the University of California-Davis School of Medicine surveyed the response of
California hospital chief executive officers (CEOs) to the 1996 California Hospital Outcomes
Project (CHOP) report. It compares California hospital outcomes for heart attack (acute
myocardial infarction, AMI) patients. About three-quarters of the CEOs found the CHOP report
to be somewhat helpful in improving the quality of care for AMI patients in their hospitals. One-third of hospitals took specific quality improvement actions as a result of the CHOP report. For
example, some developed or refined AMI clinical pathways, improved use of thrombolytic
therapy, or reassigned medical staff to improve AMI outcomes. Hospital quality managers
suggested improvements in the CHOP report, including making it more timely, linking processes
of care to patient outcomes, and then identifying what hospitals with good outcomes are doing
["The California hospital outcomes project: How useful is California's report care for quality
improvement?" Julie A. Rainwater, Ph.D., Dr. Romano, and Deirdre M. Antonius, in the January
1998 Journal on Quality Improvement 24(1), pp. 31-39.]
Specific Factors Identify Asthmatics Most at Risk for
Relapse After Emergency Room Treatment
About one-fourth of adult asthmatics relapse within 10 days of visiting the emergency room (ER)
for asthma episodes. By two months, approximately 45 percent have relapsed, according to a
study funded in part by AHCPR. The study found that these asthma patients had made three or
more ER visits in the prior six months, had difficulty performing work or other activities due to
their asthma in the prior month, and/or had discontinued hospital-based treatment for the ED
asthma episode within 24 hours without having achieved at least 50 percent of their peak
expiratory flow (ability to breathe out). Researchers say that these three risk factors for relapse
may help to identify patients with poorly controlled asthma who probably need more intensive
and comprehensive management. Patients with none of the three risk factors had a 1 percent
probability of relapse within eight weeks as compared with 38 percent of patients with one risk
factor, 63 percent of patients with two risk factors, and 100 percent of patients with three risk
["Prediction of relapse within eight weeks after an acute asthma exacerbation in adults," by
Madeline McCarren, Ph.D., Michael T. McDermott, M.D., and Robert J. Zalenski, M.D., M.A.,
and others, in the Journal of Clinical Epidemiology 51(2), pp.107-118, 1998.]
Other articles in Research Activities include findings on:
- Impact of physician conversation on patient satisfaction.
- Effectiveness of prostate cancer video on patient knowledge.
- Changes in performance of carotid endarterectomy.
- Computer program for emergency room trauma support.
- Correlation of fat-indicating protein with birthweight.
- Impact of prenatal support services on birth outcomes.
- Suggested changes in routine thyroid function tests.
- Regulating managed care financial incentives to physicians.
- Medical technology coverage by managed care organizations.
- Impact of cultural beliefs on treatments of Latinos with adult-onset diabetes.
- Physician-patient discussion of advance directives.
- Role of physicians in improving health care quality.
For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).