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Media Advisory Date: February 15, 2000
The Agency for Healthcare Research and Quality (AHRQ) 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 AHRQ's Research Activities.
Primary Care Physicians Should Counsel Parents of Young Children About Drowning Prevention
Drowning is the second most common cause of accidental death among U.S. children aged five and younger, yet most
primary care providers (PCPs) are not counseling parents on its prevention. According to researchers at the University of California-Los Angeles, cost-consciousness is shrinking patient visit time and forcing doctors to choose which injury topics are addressed during typical immunization or well-child visits. Focusing on Los Angeles County, the UCLA team found that only one-third of PCPs counseled parents on drowning prevention. Additionally, their study revealed most parents are unaware that drowning outranks other causes of accidental death such as poisoning or injuries from firearms. In conducting the AHRQ-supported study, the UCLA group analyzed 325 responses from a random sample of pediatricians, family physicians, and pediatric nurse practitioners.
["Sink or swim: Clinicians don't often counsel on drowning prevention," by Shari Barkin, M.D., M.S.H.S., and Lillian Gelberg, M.D., M.S.P.H., in the November 1999 Pediatrics 104(5), pp. 1217-1219.]
Elderly Heart Attack Patients Who Have Multiple Health Problems May Not Receive Prompt Clot-Busting Treatment
Elderly heart attack patients with multiple health problems who most need clot-dissolving medication do not receive it as promptly as other patients. Ideally, clot-dissolving medication, also known as thrombolytic agents, should be given within an hour of onset of symptoms. In a recent study of patients admitted for a diagnosed or suspected heart attack, researchers at Harvard Medical School found treatment was delayed in those 75 or older and in those with a greater burden of coexisting health problems. The delays in administering treatment to these patients may be due to the complex clinical factors involved. For example, the elderly have a higher risk of bleeding (particularly intracranial hemorrhage) with thrombolytic agents. According to the Harvard team, quality improvement efforts should be directed at accelerating the decision process for these more vulnerable patients. Led by Thomas J. McLaughlin, Sc.D., the study focused on 776 heart attack patients arriving at 37 Minnesota hospitals in 1992-1993 and 1995-1996.
["Delayed thrombolytic treatment of older patients with acute myocardial infarction," by Dr. McLaughlin, Jerry H. Gurwitz, M.D., Donald J. Willison, Sc.D., and others, in the October 1999 Journal of the American Geriatrics Society 47(10), pp. 1222-1228.]
Hospitals Vary in How Much They Are Willing to Spend on Improving Quality of Care
American hospitals vary greatly in the amount of money they spend on improving quality of care, according to an AHRQ-supported project. The study, which focused on 16 large nonprofit U.S. hospitals found that annual expenses per hospital for continuous quality improvement (CQI) ranged from roughly $300,000 to over $4.5 million. Among these expenses were education programs, data collection, personnel costs, CQI meetings, outside consultants, and allocated overhead. Eight hospitals with mature CQI programs had higher expenditures than hospitals with no CQI program or only minimal CQI training. The findings were part of a larger study correlating CQI expenditures with patient outcomes from coronary artery bypass graft surgery and total hip replacement surgery. Conducted by researchers at the University of California, Berkeley, the study also provided benchmark estimates of benefits from CQI initiatives.
["The cost of efforts to improve quality," by David Dranove, Ph.D., Stephen S. Shortell, Ph.D., Katherine S.E. Reynolds, R.N., Robin R. Gillies, Ph.D., and others, in the October 1999 Medical Care (37)10, pp.1084-1087.]
Therapy Can Be Intensified for the Majority of Patients with Inadequate Glycemic Control
When doctors decide not to intensify therapy for diabetes patients, their reasons are sound in only half of the cases. That is the finding of researchers who looked at physician adherence to the diabetes management protocol at a hospital specialty clinic. The protocol requires advancing therapy in patients whose fasting plasma glucose or random plasma glucose exceeds certain levels. Over a three-month period, clinic doctors completed questionnaires for each patient visit, describing how well a patient's diabetes was controlled and whether therapy was advanced. In cases involving poorly controlled diabetes where therapy was not advanced, providers were asked to justify their decision. The most common reason for not advancing therapy among patients with poor control was the provider's perception that glycemic control was improving (34 percent of cases). In most cases, the physician's perception
was accurate, however control may not have improved any further. Other reasons cited were noncompliance with
medications (16 percent), dietary noncompliance (10 percent), acute intervening illness (8 percent), patient refusal to have therapy (7 percent) and recurrent hypoglycemia (3 percent). Most patients treated in the study clinic were black and had adult-onset diabetes and a high rate of diabetes-related complications.
["Diabetes in urban African-Americans: Identification of barriers to provider adherence to management protocols," by Imad El-Kebbi, M.D., David C. Ziemer, M.D., Daniel L. Gallina, M.D., and others, in the October 1999 Diabetes Care 22(10), pp. 1617-1620.]
Other articles in Research Activities include findings on:
- Patient rankings of physicians and health plans.
- Outcomes following coronary angioplasty.
- Home-based monitoring program for elderly patients with heart failure.
- Nonclinical factors influencing hospital stays for bypass surgery.
- Need for improved doctor-patient communication on medications.
- Surgical choices for bilateral knee replacement.
- Functioning and discomfort in patients with low-back pain.
- Time spent by internists vs. family physicians in confirming diagnoses.
- Factors influencing healthy adults to get flu shots.
- Benefits of screening young women for chlamydia.
- Impact of depression on functioning and quality of life.
- Nursing home adherence to Federal quality-of-care standards.
- Role of informed consumers in boosting quality of care.
- Issues affecting patient access to second medical opinions.
- Impact of strategic hospital alliances on hospital finances.
- Effects of managed care on physician income.
- Funding for research at academic health centers.
For additional information, contact AHRQ Public Affairs, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).