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Media Advisory Date: September 8, 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.
Traditional Community-based Nursing Homes Are Offering More Rehabilitation Services to Residents
Growing numbers of traditional nursing homes are providing rehabilitation services to their residents, and at a fraction of the cost of hospital-based rehab, according to a new study supported in part by AHCPR. It found that half of newly admitted nursing home patients in Ohio received at least 90 minutes of physical, occupational, or speech rehabilitation therapy during 1994 and 1995, and the amount of therapy provided to each patient increased by 6.4 minutes each quarter, with the largest increase in occupational therapy. Researchers at Case Western Reserve University retrospectively examined rehabilitation services received by 52,705 newly admitted residents of all Medicaid-certified nursing homes in Ohio in 1994 and 1995. Insurers, including Medicare, may focus only on the issue of cost and increasingly use nursing homes as a major site for rehabilitation care, conclude the researchers.
["Rapid growth of rehabilitation services in traditional community-based nursing homes," Patrick K. Murray, M.D., Mendel E. Singer Ph.D., Richard Fortinsky, Ph.D., and others, in the April 1999 Archives of Physical Medicine and Rehabilitation 80, pp. 372-378.]
Women Who Have Angina and Report More Physical Symptoms Are at Increased Risk for Coronary Artery Disease
Research suggests that a smaller proportion of women with angina (crushing chest pain) have coronary artery disease (CAD) than men with angina. This may have contributed to the perception that chest pain is less serious in women. However, CAD risk is greater in certain women with angina, particularly those who have a poor cardiovascular risk profile and more physical symptoms such as shortness of breath, according to a study supported by AHCPR. Researchers from University College London and Glasgow University used the Rose
Questionnaire—the most widely used instrument to measure angina—to examine correlates of angina in men and women aged 35 to 55 years. The questionnaire asks about the type, duration, and circumstances of chest pain. The researchers also asked about the presence of 16 different symptoms for a symptom score, as well as health behaviors such as exercise and smoking. As expected, more females than males (4 percent vs. 2.4 percent) had angina. However, there was a stronger relationship between overall symptom reporting (ranging from premenstrual irritability and bloating to shortness of breath) and angina in women than men.
["Rose Questionnaire angina in younger men and women: Gender differences in the relationship to cardiovascular risk factors and other reported symptoms," by Amanda Nicholson, Ian R. White, Peter MacFarlane, and others, in the Journal of Clinical Epidemiology 52(4), pp. 337-346, 1999.]
Primary Care Physicians Spend an Average of 16 Minutes Per Visit With Their Adult Patients
Adults visited with their primary care physician (PCP) a mean of 16 minutes in 1991 and 1992. However, the length of individual visits was influenced by patient and practice characteristics, as well as procedures performed during the visit, according to an AHCPR-supported study. For instance, older patients, patients new to the practice, those referred by another physician, and those with psychosocial problems had significantly longer visits. Patients insured by health maintenance organizations or Medicaid had shorter visits (2 percent and 5 percent, respectively). Also, patients who had eye or dental problems or were pregnant also had shorter visits (16 percent vs. 6 percent). Taking into account patient-related factors when allotting time for an
individual patient's visit could improve patient scheduling, physician productivity, and patient satisfaction, conclude David Blumenthal, M.D., M.P.P., of Harvard Medical School, and colleagues. They analyzed data from the 1991-1992 National Ambulatory Medical Care Survey on 19,192 visits by adults to 686 PCPs and interviews with physicians.
["The duration of ambulatory visits to physicians," Dr. Blumenthal, Nancyanne Causino, Ed.D., Yuchiao Chang, Ph.D., and others, in the April 1999 Journal of Family Practice 48(4), pp. 264-271.]
Some Patients with Deep Venous Thrombosis Can Be Treated Safely at Home
A certain group of patients suffering from lower extremity deep venous thrombosis (DVT), or blood clot in a deep vein of a leg, can be treated safely at home, concludes a study partly funded by AHCPR. These are patients who are not at high risk for bleeding, recurrent clotting, and who do not have pulmonary embolism, limited cardiovascular reserve, or another illness that requires hospitalization. Researchers retrospectively applied these criteria to 195 patients at one hospital who were newly diagnosed with proximal lower extremity DVT to determine the proportion of patients eligible for outpatient therapy. Nine percent of patients were classified as eligible and 9 percent as possibly eligible. None of the patients treated at home developed any complications. Of the 82 percent classified as ineligible, 8 percent died or developed serious complications. Thus, the eligibility criteria had a sensitivity of 100 percent and negative predictive value of 100 percent for predicting serious complications.
["Criteria for outpatient management of proximal lower extremity deep venous thrombosis," by Roger D. Yusen, M.D., Brennan M. Haraden, M.D., Brian F. Gage, M.D., M.Sc., and others, in the April 1999 Chest 115, pp. 972-979.]
Other articles in Research Activities include findings on:
- Higher risk of patients over 80 following angioplasty.
- Disagreement among experts about use of coronary angiography.
- Factors affecting smoking behavior among deaf adults.
- Determinants of intervals between physician visits.
- Doctor/patient communication in surgical and primary care visits.
- Factors encouraging primary care treatment of depression.
- Impact of financial incentives on pediatric practices.
- Quality of care challenges for rural health.
- Role of primary care physicians in managed care.
- Pharmacy bargaining power with health insurers.
- Progress in the field of managed care research.
For additional information, contact the AHCPR Press Office, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).