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Highlights From AHCPR's November Research Activities
Media Advisory Date: January 15, 1997
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
Benefits and Costs Weighed for Speciality Versus Primary Care for
Stroke patients who are treated by neurologists may pay more, but
they often experience better
outcomes, according to a recent study supported by AHCPR.
Researchers analyzed claims data
for a random 20 percent sample of Medicare patients admitted to
the Duke University Medical
Center between January 2 and September 30, 1991. Three months
following the stroke, patients
treated by neurologists had a 31 percent lower death rate than
patients with nonhemorrhagic
stroke treated by internists and a 36 percent lower death rate
than those treated by family
physicians. Patients cared for by neurologists also appeared to
be more functional after their
hospital stay and were more likely to be sent home or discharged
to inpatient rehabilitation
facilities rather than to a nursing home. Neurologists were 34
percent more expensive than family
physicians and 22 percent more expensive that internists or other
"What role do neurologists play in determining the costs and
outcomes of stroke patients?," by
Janet Mitchell, Ph.D., David J. Ballard, M.D., Ph.D., Jack
Whisnat, M.D., and others in the
November 1996 issue of Stroke 27, pp. 1937-1943.
Women and the Elderly Are Less Apt than Others to Receive
Life-Saving Drugs for Heart Attacks
Women and the elderly who experience heart attacks are less
likely than men younger than age 65
to be treated with clot-dissolving drugs (thrombolytics), beta
blockers, and aspirin to reduce
complications and death. Researchers at Harvard Medical School
reviewed the medical records
of nearly 2,500 patients admitted to 37 Minnesota hospitals for
suspected heart attack in
1992 and 1993. They found that patients 75 years or older were
significantly less apt to be
treated with these medications, especially thrombolytics, than
those aged 64 years or younger.
Women were less likely than men to be treated with aspirin and
thrombolytics (odds ratio of 0.7;
1 is equal odds), as well as beta blockers.
"Adherence to national guidelines for drug treatment of acute
myocardial infarction," by Thomas
McLaughlin, Sc.D., Stephen B. Soumerai, Sc.D., and Donald
Williamson, Sc.D., and others,
Archives of Internal Medicine, 15, pp.799-805, 1996.
Uterine Fibroids Are More Common Among Black Women Than White
Uterine fibroids (leiomyomas) are more common among black women
than white women,
according to a study funded by AHCPR. Kristen H. Kjerulff,
Ph.D., and her colleagues at the
University of Maryland School of Medicine, found that 89 percent
of 409 black women and 59
percent of 836 white women who underwent hysterectomies at 28
Maryland hospitals had
leiomyomas. Researchers were not able to explain the racial
difference in the development of
leiomyomas, but they say that weight may play a role. Of the
women in this study, 67 percent of
black women and 41 percent of white women were substantially
overweight (20 percent or more)
compared with 49 percent of black women and 33 percent of white
women in the general
"Uterine leiomyomas: Racial differences, in severity, symptoms,
and age at diagnosis," by Dr.
Kjerulff, Patricia Langenberg, Ph.D., Jeffrey D. Seidman, M.D.,
and others, in the July 1996
Journal of Reproductive Medicine 41, pp. 483-490.
Marketplace Demand for Specialists Declines
Physician specialists may be having difficulty finding
employment, while primary care colleagues
are being heavily recruited. A review of physician recruitment
ads in key specialty and general
medical journals in select years from 1984 through 1995 found
steep declines in the number of
advertised positions for specialists over the past five years
with the exception of pediatric
specialists. There were four specialist ads for one every for a
generalist in 1990, but by 1995 this
ratio had shrunk to two to one. California and Washington
researchers who conducted the study
attribute the decline partly to the managed care health plans and
capitated payment systems that
use fewer specialists.
"Changes in marketplace demand for physicians," by Sarena D.
Seifer, M.D., Barbara Troupin,
M.D., M.B.A., and Gordon D. Rubenfield, M.D., in the September 4,
1996, Journal of the
American Medical Association, 276(9), pp. 695-699.
Other articles in Research
Activities include findings on:
- Aspects of primary care that affect survival.
- Why programs to prevent preterm births have failed.
- Impact of educational videos on patients' treatment
- How to reduce coronary care unit costs for chest pain
- Why neurologists have more success with stroke patients than
- Elderly attitudes that contribute to nursing home use.
- Efficiency of Medicaid providers in managing chronic
- Benefits of surgery for sciatica and spinal stenosis.
- Lack of health insurance among Mexican Americans.
For additional information, contact AHCPR Public Affairs: Karen J.
Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864.