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Media Advisory: October 6, 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.
Survival of Extremely Small and Premature
Newborns Has Increased, but One in Four or Five
Survivors Has a Major Disability
New advances now enable about 30 to 40 percent of babies who are very small (less than
2 pounds) or very premature (26 weeks gestation or earlier) to survive. However, one of every
four or five of these babies has at least one major neurodevelopmental problem, according to
an AHCPR-supported study. The study found that the most common disability, mental
retardation, struck 14 percent of both very small and very premature infants. Cerebral palsy
affected 12 percent of premature survivors and 8 percent of very small survivors. Blindness
affected 8 percent and deafness affected 3 percent of infants in both groups. Researchers at
Michigan State University based their findings on analysis of mortality and disability data
from 42 studies of 20 groups of 4,116 extremely premature infants and 38 groups of 4,345
extremely small infants born after 1972.
["A quantitative review of mortality and developmental disability in extremely premature
newborns," by John M. Lorenz, M.D., Diane E.,Wooliever, R.N., N.N.P., James R. Jetton,
B.A., and Nigel Paneth, M.D., M.P.H., May 1998, in the Archives of Pediatric and
Adolescent Medicine 152, pp. 425-435.]
Nearly 9 Percent of Lab Tests Commonly
Performed for Hospitalized Patients Are
A large number of the clinical laboratory tests performed in hospitals appear redundant,
according to a study supported in part by the AHCPR. It found that at one hospital, 28
percent of 12 standard laboratory tests were repeated earlier than the recommended test-specific intervals expected to show a change in status. For 10 of the 12 tests, a medical chart
review revealed no clinical indication for 92 percent of repeat tests following normal initial
results. Overall, 9 percent of these 10 tests appeared unnecessary, that is they were repeated
too early to show any clinical change. For the remaining two tests (white blood cell count and
chest x-rays), nearly all the initial results in the sample were abnormal, and all repeat tests
were justified. Eliminating the redundant tests would have saved $930,000 in charges at the
study hospital. Most of the redundant tests might be eliminated using computerized reminder
systems, suggests David W. Bates, M.D., M.Sc., of Brigham and Women's Hospital in
Boston. Dr. Bates and his colleagues examined the medical records of more than 6,000 adults
discharged from a large teaching hospital during a 3-month period in 1991.
["What proportion of common diagnostic tests appear redundant," by Dr. Bates, Deborah L.
Boyle, Eve Rittenberg, M.A., and others, in the April 1998 American Journal of Medicine 104, pp. 361-368]
Replacing Local Transplant Lists with Regional
Lists May Improve Access and Matching of
Relatively few kidney transplants are shared outside the local area where the kidneys are
recovered. Thus, some end-stage rental disease (ESRD) patients put themselves on waiting
lists in more than one area. However, New York State enacted a law in 1990 prohibiting this
multiple listing, which because it is expensive, gives more affluent patients unfair access to
donor kidneys. This ban resulted in a 66 percent reduction in multiple listings for New York
patients, according to an AHCPR-supported study. However, its impact on actual kidney
waiting times was slight: only 3 weeks less for blacks and 2 weeks less for Latinos and low-income patients. Waiting times for more affluent and highly educated patients increased by 1
to 2 weeks. The researchers recommend consolidating some of the smaller local waiting lists
into larger regional lists to equalize access to kidney transplants and improve matching of
donor organs with recipients. They used waiting list files from the Organ Procurement and
Transplantation Network, Medicare files, and U.S. Census Public Use Files to estimate the
impact of the ban on multiple listing.
["The effects of New York State's ban on multiple listing for cadaveric kidney
transplantation," June 1998, by Alan J. White, Ph.D., Ronald J. Ozminkowski, Ph.D., and
Andrea Hassol, M.S.P.H., and others, in Health Services Research 33(2), pp. 205-222.]
Use of Restraints in Nursing Homes Depends In
Part on the Number of Residents and the Nurse-Resident Ratio
The 1987 Nursing Home Reform Act directed nursing homes to reduce their use of physical
restraints; it also detailed nursing home residents' rights to be free of chemical and physical
restraints used simply for discipline or convenience. As a result, the number of restraint-free
nursing homes had increased nationwide from 1 percent to 8 percent by 1995. Restraint-free
homes differ from homes that use restraints in several critical ways, according to a study
supported by AHCPR. Nicholas G. Castle, Ph.D., and Barry Fogel, M.D., of Brown
University found that restraint-free homes are 30 percent more likely to have a high ratio of
full-time equivalent (FTE) registered nurses per resident than homes that use restraints.
Restraint-free homes also have a lower average occupancy rate, 68 percent on average, as
compared with 87 percent in other facilities. They also found that restraint-free homes are
more likely to be not-for-profit facilities in urban and more competitive areas, to be smaller,
and not to be members of chains. Restraint-free homes are more likely to have special care
units but less likely to have dedicated units for the care of Alzheimer's patients.
["Characteristics of nursing homes that are restraint free," by Drs. Castle and Nicholas, in The
Gerontologist 38(2), pp. 181-188, 1998.]
Other articles in Research Activities include findings on:
- Effects of early tube feeding following bowel surgery.
- Psychiatric disorders and care satisfaction.
- Reducing postoperative delirium and its complications.
- Health plan choice among Medicaid managed care enrollees.
- Use of physician opinion leaders to improve quality of care.
- Health status of kidney transplant recipients.
- Factors that drive variations in intensive care use.
- Repeat knee replacement surgery among the elderly.
- Delays in childhood immunizations.
- Impact of malpractice laws on dental practice behavior.
- Quality of life after major traumatic injury.
- Impact of urinary incontinence on quality of life.
For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).