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Glance, L.G., Osler, T.M., and Dick, A.W. (2002). "Rating the quality of intensive care units: Is it a function of the intensive care unit scoring system?"; and "Identifying quality outliers in a large, multiple-institution database by using customized versions of the simplified acute physiology score II and the mortality probability model II0." (AHRQ grant K08 HS11295). Critical Care Medicine 30(9), pp. 1976-1982, 1995-2002.
Intensive care units (ICUs) use mortality measures, adjusted for patient severity of illness, to benchmark their performance. The first study demonstrates that three severity of illness scales: the APACHE II, Simplified Acute Physiology Score (SAPS) II, and the Mortality Probability Model (MPM) II0, exhibit fair to moderate agreement in identifying ICUs that are quality outliers, that is, either provide far worse or far better care than other ICUs. However, the finding that most ICUS in this study were judged to be high-performing units by all three scoring systems limits the usefulness of these models in their present form for benchmarking, conclude the researchers. They calculated standardized mortality ratios for each ICU at 32 hospitals. Patient outcomes were identified in the Project IMPACT outcomes database created by the Society of Critical Care Medicine, using the APACHE II, SAPS II, and MPM II0. In the second study, the researchers assessed whether customized versions of the SAPS II and the MPM II0 agreed on which ICUs were outliers within a multiple-center database of 54 hospitals. Although both customized models showed good discrimination and good calibration, there was only moderate agreement on which hospitals were quality outliers. Seventeen of the 54 hospital ICUs were categorized differently, depending on which of the two screening systems was used.
Li, X., Stanton, B., Feigelman, S., and Galbraith, J. (2002, September). "Unprotected sex among African-American adolescents: A three-year study." (AHRQ grant HS07392). Journal of the National Medical Association 94(9), pp. 789-796.
Face-to-face discussions about use of condoms to prevent sexually transmitted diseases such as HIV can reduce unprotected sex among black adolescents over the long- term, according to this study. The researchers used trained adult leaders to use discussions, games, and multimedia formats to discuss use of condoms to reduce HIV risk among small groups of black, inner-city youths aged 9 to 15 years (total of 383). Following this primary series, the youths were invited to attend six monthly face-to-face booster sessions after the six-month followup, which reinforced good decisionmaking, communication, and condom use after the followup, as well as annual booster sessions at 15 and 27 months. After only 1 and 2 years of followup, there was no significant difference in cumulative failure to use a condom by the counseled and non-counseled youths. However, cumulatively over the 3-year period, youths who received the counseling reported significantly lower rates of failure to use a condom.
Newgard, C.D., Martens, K.A., and Lyons, E.M. (2002). "Crash scene photography in motor vehicle crashes without air bag deployment." (AHRQ National Research Service Award fellowship F32 HS00148). Academic Emergency Medicine 9, pp. 924-929.
Variables obtained through motor vehicle crash (MVC) photographs are associated with anatomic injury patterns, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment. As a result, these photographs may provide a useful means of communicating objective information from the crash scene to the clinician in a timely manner, concludes this article. The researchers used photographs of vehicles involved in MVCs taken by emergency personnel from 12 fire departments serving two hospitals over 22 months and collected outcome information for 559 patients from medical charts. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries but increased odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with longer hospital stays and higher charges.
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Current as of January 2003
AHRQ Publication No. 03-0015