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Media Advisory Date: October 7, 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.
"Drive-through Deliveries" Were More Than 18 Times as Likely in 1994 as in 1990, Regardless of Payer
Consumer furor in the early 1990s over "drive-through" deliveries, 1-day hospital stays for uncomplicated vaginal birth, was aimed primarily at health maintenance organizations (HMOs). But HMOs may have been unjustly targeted because other insurers also reduced stays to 1 day after 1992 legislation changes that allowed them to negotiate directly with hospitals for discount rates, says an AHCPR-supported study. Kevin G.M. Volpp, M.D., Ph.D., of Harvard Medical School, and M. Kate Bundorf, M.B.A., M.P.H., of the University of Pennsylvania, reviewed New Jersey hospital discharge data and found that the percentage of 1-day stays increased from less that 4 percent for all payers in 1990 to 48 percent for HMO patients and 32 percent for non-HMO patients in 1994. Controlling for all other factors, the odds of an HMO patient staying 1 day for delivery were nearly twice as great as those for a non-HMO patient in 1994. Overall, however, a woman had 18 times the odds of a 1-day stay in 1994 than she did in 1990, regardless of her insurer.
["Consumer protection and the HMO backlash: Are HMOs to blame for drive-through deliveries?" by Dr. Volpp, and Ms. Bundorf, in the Spring 1999 Inquiry 36, pp. 101-109.]
Internal Medicine Residents Need Training to Enhance Their Diabetes Care
Improvements are needed in the way internal medicine residents care for patients with adult-onset (type 2) diabetes, according to an AHCPR-supported study. Researchers surveyed internal medicine residents at one large, urban hospital outpatient clinic in Atlanta, GA, about how often they performed six diabetes care services advocated by the American Diabetes Association: annual eye exam referral, annual lipid testing, urine protein screening, foot exam, blood glucose screening, and documentation of patient self-monitoring of blood glucose. They also documented actual performance of these services by using the hospital laboratory database and reviewing the charts of 140 patients seen at the clinic an average of five times during 1996. Researchers found that self-described and reported performance of all services fell short of recommended standards. For example, 60 percent of residents reported that they referred patients for an annual eye exam, 50 percent said they performed annual lipid testing, and 65 percent said they screened patients yearly for urine proteins. The record review found that 61 percent of patients had two or fewer HbA1c measurements (blood sugar indicator) in 12 months, which is less than recommended. Researchers conclude that better training in diabetes management will improve patient care and reduce the costs and complications associated with the condition.
["What do internal medicine residents need to enhance their diabetes care?" by Annette M. Bernard, M.D., M.S., Lynda Anderson, Ph.D., Curtiss B. Cook, M.D., in the May 1999 Diabetes Care 22(5), p. 661-666]
Women's Assessments of Maternity Care Can Guide Other Women Seeking such Care
Despite differing clinical conditions and demographic characteristics, women generally agree on which hospitals provide quality maternity care. Thus, their assessments may be a useful guide for pregnant women selecting doctors and hospitals for such care, according to an AHCPR-supported study. Beth S. Finkelstein, Ph.D., of Case Western Reserve University, and fellow researchers examined mailed survey responses assessing maternity care by 16,051 women who were hospitalized for labor and delivery from 1992-1994 in 18 Ohio hospitals. Women consistently scored seven or more hospitals as higher or lower than the sample mean for maternity care. They varied significantly in their scoring of different hospitals, but within each hospital, the mean scores were generally consistent over the 3 years. Patient characteristics (age, race, education, insurance status, health status, and type of delivery) explained only 2 to 3 percent of the variance in patient assessments, and adjusting for them had little effect on hospital scores.
["Patient assessments of hospital maternity care: A useful tool for consumers?" by Dr. Finkelstein, Dwain L. Harper, D.O., and Gary E. Rosenthal, M.D., in the June 1999 Health Services Research 34(2), pp. 623-640]
Injections of Heparin Seem To Be Safe and Work as Well as IV Heparin for Treating Acute Deep Venous Thrombosis
Patients who have deep venous thrombosis (blood clots in a deep vein, usually of the leg or abdomen) have typically been treated in the hospital with intravenous, unfractionated heparin, an anticoagulant. A new study indicates that subcutaneous injections of low-molecular-weight heparins (LMWH) seem to be as safe and effective as conventional intravenous heparin. Researchers performed a meta-analysis of 11 randomized controlled trials that compared LMWH with unfractionated heparin for treatment of acute deep venous thrombosis. Compared with unfractionated heparin, LMWHs reduced mortality rates by 29 percent over 3 to 6 months of patient followup. However, LMWHs did not reduce the risk of death from major bleeding complications or documented thromboembolic recurrences. For major bleeding complications, the odds ratio favored LMWHs (OR, 0.57; 1 is equal odds), but the absolute risk reduction was small and not statistically significant). For preventing thromboembolic recurrences, LMWHs seemed as effective as unfractionated heparin (OR, .85). These agents may prove highly cost effective for treating venous thrombosis, despite their current higher price ($236 more per patient for the initial course compared with IV heparin), but more research is needed, conclude researchers.
["Low-molecular weight heparins compared with unfractionated heparin for treatment of deep venous thrombosis," by Michael K. Gould, M.D., M.Sc., Anne D. Dembitzer, M.D., Ramona L. Doyle, M.D., and others, in the May 18, 1999, Annals of Internal Medicine 130(10), pp. 800-809.]
Other articles in Research Activities include findings on:
- Geographic differences in hospital quality.
- Factors affecting outcomes of spinal surgery.
- Differing attitudes toward seriously disabled newborns.
- Cancer screening differences among minority women.
- Use of ACE inhibitors by heart failure patients.
- Diabetes care provided by internal medicine residents.
- Increased rates of Lyme disease in Maryland.
- Contributions of PORTs to research.
- Quality of care similarities among HMO primary care doctors.
- Use of calcium channel blockers in heart-attack survivors.
- Rates of lower extremity amputations in the elderly.
- Effects of divorce on parent/adult child relationship.
For additional information, contact the AHCPR Press Office, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).