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Media Advisory Date: June 18, 1999
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.
Practice Patterns for Hysterectomy Changed During the Early 1990s
Although the United States has the highest hysterectomy rate in the world, with more than half a million procedures performed annually in the early 1990s, hysterectomy rates have declined steadily since the 1980s, according to an AHCPR-supported study. There also have been changes in the surgical technique, including the reintroduction of supracervical hysterectomy (SCH), which leaves the cervix in place. The study found that the national rate for total abdominal hysterectomies (TAH) decreased from 25.7 per 10,000 women in 1991 to 20.5 in 1994. At the same time, the national rate of SCHs increased from 0.16 to 0.41 in 1994. Although the rate of SCH has more than doubled, it is clear that the TAH technique continues to be dominant. The total hospital charges for TAH dropped from $2.37 billion in 1991, to $2.27 billion in 1994. In contrast, the total hospital charges for SCH essentially doubled from $23.6 million to $47.4 million during the same period, largely due to the increase in the use of the procedure. However, because the rate of use of SCH is so much lower that the increase has a nominal impact on national health care spending.
["Abdominal hysterectomy practice patterns in the United States," by E. Scott Sills, M.D., Jyot Saini, M.D., Claudia Steiner, M.D., and others, in the International Journal of Gynecology and Obstetrics 63, pp. 277-283, 1998.]
High Costs of Caring for a Disabled Family Member May Negatively Affect Receipt of Needed Care for Other Family Members
Generally, having a disabled family member is associated with increased health care use and expenditures for the entire family. Regardless of the severity of the disability, a recent AHCPR-supported study found having a disabled family member increased the overall family health spending compared with families without any disabled members. As the severity rose, so did costs, so that families with a member with limitations in activities of daily living (such as feeding themselves and using the toilet) on average spent about three times as much as families without a disabled member spent for health care. Out of pocket medical expenses for families with a disabled member were 2.5 times higher (11.2 percent vs. 4.1 percent) than families without a disabled member. This disparity affected poor families harder. The study found that adults in a poor family with a disabled member are 16 percent less likely to visit a doctor compared with adults in high-income families.
["The case of disability in the family: Impact on health care utilization and expenditures for nondisabled members," by Barbara M. Altman, Ph.D., Philip F. Cooper, Ph.D., and Peter J. Cunningham, Ph.D., in the Milbank Quarterly 77(1), pp. 1-37, 1999.]
Some Latino Children Are More Likely to Have Asthma than Others
Asthma is the most common chronic illness affecting Latino children, but Puerto Rican children are affected the most. They have an 11.5 percent rate of asthma, compared with 5.2 percent of Cuban American children and 2.7 percent of Mexican American children. This is probably due to a combination of unique genetic and sociocultural factors, concludes an AHCPR-supported review of the relevant literature. For example, Puerto Rican children have a smaller airway size, more severe inflammatory reactions, and lower birthweight than other Latino children. The inflammatory reaction and resulting airway constriction that are typical of asthma are sparked by exposure to indoor allergens and irritants such as cockroaches, pets, mold, smoke, as well as outdoor ones like pollen and pollution. These exposures, along with respiratory infections, have been implicated in the development and worsening of asthma. Puerto Rican mothers, especially teenage mothers, have a much higher rate of smoking than Cuban American or Mexican American mothers. Also Puerto Rican families also are more likely to treat asthma with folk or home remedies unlike Mexican American families who are more
likely to treat asthma with conventional medicines. Also, Puerto Ricans also are more likely to lack the family support structures of Mexican Americans and the higher education of Cuban Americans, which may enable these Latinos to better manage this condition, according to the authors.
["Elevated asthma morbidity in Puerto Rican children: A review of possible risk and prognostic factors," Marialena Lara, M.D., M.P.H., Hal Morgenstern, Ph.D., Naihua Duan, Ph.D., and Robert H. Brook, M.D.,in the February 1999 Western Journal of Medicine 170, pp. 75-84.]
International Variations in Cataract Surgery Practices May Be Due in Part to Slower Diffusion of New Technology in Europe
Cataract surgery is widely accepted as an effective way to improve the vision of patients with cataracts. However, cataract surgery procedures and the rate of related complications vary widely in North America and Europe, according to a recent study supported in part by AHCPR. Researchers examined cataract surgery practices and related complications at sites in four countries known for high-quality health care systems: Spain, Denmark, Canada and the United States. They found that the transition to the latest cataract technique, phacoemulsification, was most comprehensive in the United States and only recently initiated in Spain, and that the transition from general to local anesthesia also was less complete in Spain. Some two-thirds of cataract surgeries in Manitoba, Canada and the United States were done with the new procedure, one-third in Denmark, and only 3 percent in Barcelona, Spain. More than 96 percent of cataract extractions in North America were done under local anesthesia, while general anesthesia was used for 38 percent of extractions in Barcelona. Researchers attribute the variations in clinical practice to slower diffusion of medical technology in Europe as compared with North America.
["Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain," by Jens Christian Norregaard, M.D., Ph.D., Peter Bernth-Petersen, M.D, Ph.D., and Lorne Bellan, M.D., and others, in the January 1999 Ophthalmology 106, pp. 42-48.]
Other articles in Research Activities include findings on:
- Impact of insurance changes on loss or access to care.
- Pros and cons of using hospitalists to care for patients.
- Hospital care for asthma patients.
- Psychotropic drug use in nursing homes.
- Outcomes and costs of first and recurrent stroke patients.
- Reducing redundant hospital laboratory tests.
- Improving primary care treatment of depression.
- Developing better depression treatment for minorities.
- Reflection of hospital readmissions on care quality.
- Impact of state programs on rural children's immunizations.
- Implementing rural Medicaid managed care programs.
- Outcomes of very premature newborns.
For additional information, contact the AHCPR Press Office, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).