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Media Advisory Date: December 3, 1996
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 October issue of AHCPR's Research
Activities, a monthly publication that reports the
results of studies supported
Adjusting Capitation Rates May Not Prevent Discrimination Against
Chronically Ill Children
Capitation of risk-adjustment methods, which adjust capitated
rates to compensate managed care
plans for increased costs associated with chronic medical
problems, are one approach being
used to eliminate the financial incentive to discriminate against
children with chronic conditions.
However, children with chronic health problems—such as
asthma and diabetes—would probably remain at risk for
discrimination in a competitive health care market even under
risk-adjusted rates, according to a study conducted by Elizabeth
J. Fowler, Ph.D., and Gerard F.
Anderson of Johns Hopkins University. Regardless of the
capitation adjustment method used, this
study found significant underpayment to providers of care to
["Capitation adjustment for pediatric populations,"
Pediatrics July 1996 98(1), pp. 10-17.]
Costs of Outpatient Care Are Cut In Half When A Patient Sees
A Primary Care Physician First
Health maintenance organizations typically require patients to
contact their primary care
physicians first for any new medical problem. This first-contact
approach to health care can save
more than half of outpatient expenditures, concludes an
AHCPR-supported study conducted by
Christopher B. Forrest, M.D., Ph.D., and Barbara Starfield, M.D.,
M.P.H., of The Johns Hopkins
School of Public Health. The study found that consulting a
primary care clinician first instead of a
specialist or other source of care reduced overall outpatient
expenditures 53 percent, expenses for
acute illnesses by 62 percent, and expenses for preventive care
by 20 percent. Overall, increasing
the current level of first-contact care just 10 percent would
save at least $1.1 billion per
year (1993 dollars).
[The effect of first-contact care with primary care clinicians on
ambulatory health care
expenditures," Journal of Family Practice, July 1996, pp.
Earlier Referral To Hospice Care May Benefit Terminally Ill
Earlier referral to hospice care may improve the quality of
remaining life of terminally ill elderly
patients, yet many enter hospice care when they have a only few
weeks left to live. According to
an AHCPR-supported study, entering hospice care earlier also
would allow these patients to
receive Medicare-covered noncurative medicine and support
services that would not be covered
in the hospital, say researchers Nicholas Christakis, M.D.,
Ph.D., and Jose J. Escarce M.D., of the
University of Pennsylvania. Although earlier referral of
patients to hospice care would increase
Medicare costs for such care, these savings might be more than
offset by the savings realized
through reducing more expensive hospital costs.
["Survival of Medicare patients after enrollment in hospice
programs," The New England
Journal of Medicine 335(3), pp.172-178, 1996.]
Increased Risk of Preterm Birth Among Pregnant Black Women May
Be Due in Part to
Higher Rate of Vaginal Infections
Black women have two to three times more preterm births than
white women, and the gap
appears to be increasing. A study funded by AHCPR suggests that
the disparity may be linked to
a higher incidence of vaginal infections in black women. Results
of a multivariate analysis
conducted by Robert L. Goldenberg, M.D., of the University of
Alabama at Birmingham,
indicates that black women were two to six times more likely than
white women to have
vaginal infections that are associated with preterm births. They
Chlamydia trachomatis (16 percent vs. 5 percent),
Neisseria gonorrhoeae (2.5
percent vs. 0.4 percent), Bacteroides sp. (25 percent vs.
14 percent), and bacterial
vaginosis (23 percent vs. 9 percent). Other physical, behavioral,
characteristics of the women did not explain the large racial
difference in preterm births.
[Bacterial colonization of the vagina during pregnancy in four
ethnic groups," American
Journal of Obstetrics and Gynecology 174(5),
Other articles in Research Activities include
- Cost of home-based care for ventilator-assisted persons.
- Mixed feelings of emergency room (ER) personnel toward frequent
- Effectiveness of oral rehydration therapy for acute
gastroenteritis in children.
- Use of electrostimulation to recover muscle strength after stroke.
- How neonatal intensive care could be avoided for some normal
- How to change physicians' willingness to treat patients with AIDS.
- Impact of computerized reminders on in-hospital preventive
For additional information, contact AHCPR Public Affairs:
Karen Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864.