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Branas, C.C., Mackenzie, E.J., and ReVelle, C.S. (2000, June). "A trauma resource allocation model for ambulances and hospitals." (AHRQ grant HS09326). Health Services Research 35(2), pp. 489- 507.

These researchers used Maryland hospital discharge and vital statistics data on severely injured patients to develop a spatial injury profile based on patient ZIP codes. They then formulated the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH), which can help trauma systems improve the survival rates of their most severely injured patients. TRAMAH was created as a unique combination of mixed-integer programming and an "iterative switching" heuristic.

Lenert, L.A., Sherbourne, C.D., Sugar, C., and Wells, K.B. (2000, July). "Estimation of utilities for the effects of depression from the SF-12." (AHRQ grant HS08349). Medical Care 38 (7), pp.763-770.

Utilities for health conditions, including major depression, have a theoretical relationship to health-related quality of life (HRQOL). Because of the complexity of utility measurement and the existence of large numbers of completed studies with HRQOL data but not utility, it would be useful to be able to estimate utilities from measurements of HRQOL. The researchers used clinical interview data to compare differences in utilities and global physical and mental HRQOL at 1- and 2-year followup in 140 depressed primary care patients who did and did not experience remission. Remission of depression resulted in health status improvement, as measured by the SF-12 (a short health status instrument), the equivalent of a gain of 0.11 quality-adjusted life years over 2 years. The authors conclude that utilities for changes in health status can be modeled from the SF-12 scales.

Morales, L.S., Reise, S.P., and Hays, R.D. (2000). "Evaluating the equivalence of health care ratings by whites and Hispanics." (AHRQ grant HS09204). Medical Care 38(5), pp. 517-527.

Some concerns have been raised about the validity of care satisfaction surveys among culturally and linguistically diverse patient populations. This study finds that health care rating scales apparently do measure actual differences in satisfaction with care between non-Hispanic white and Hispanic survey respondents. The researchers analyzed survey responses from 5,508 white patients and 713 Hispanic patients on assessment of 9 different aspects of medical care they received. Hispanics were significantly more dissatisfied with care than whites. Of the nine areas of care, two were significantly different: reassurance and support offered by doctors and staff and quality of examinations received. However, summary satisfaction scores were similar for whites and Hispanics. The authors conclude that, despite some differences in item functioning, valid satisfaction-with-care comparisons between whites and Hispanics are possible. Any disparities in satisfaction ratings should not be summarily attributed to measurement bias but should be viewed as possibly arising from actual differences in experiences with care.

Myers, E.R., McCrory, D.C., Nanda, K., and others (2000, June). "A mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis." (AHRQ contract 290-97-0014). American Journal of Epidemiology 151(12), pp. 1158-1171.

These authors developed a model that approximates the age-specific incidence of cervical cancer. It also provides a tool for evaluating the natural history of human papillomavirus (HPV) infection and cervical cancer carcinogenesis, as well as the effectiveness and cost-effectiveness of primary and secondary prevention strategies. The authors used states for HPV infection, low- and high-grade squamous intraepithelial lesions (SIL), and cervical cancer stages I through IV to simulate the natural history of HPV infection in a cohort of women ages 15 to 85. They obtained age-specific incidence for HPV, as well as regression and progression rates for HPV and SIL. The base case model resulted in a lifetime risk of cervical cancer of 3.67 percent and a life-time risk of cervical cancer mortality of 1.26 percent, with a peak incidence of 81/100,000 at age 50. Lifetime risk of cancer was most sensitive to the incidence of HPV and the probability of rapid progression of HPV to high-grade lesions.

Probst, J.C., Samuels, M.E., Hussey, J.R., and others (1999, Fall). "Economic impact of hospital closure on small rural counties, 1984-1988: Demonstration of a comparative analysis approach." (AHRQ grant HS07252). Journal of Rural Health 15(4), pp. 375-390.

This study demonstrated the use of a comparative analysis approach for estimating the economic effects of hospital closure on small rural counties. The researchers compared the experiences of 103 small rural counties in which a hospital closed between 1984 and 1988 with a matched group of counties in which no hospitals closed. Three scales examined population and economic characteristics in the year before closure; two scales measured change throughout a 3-year period preceding closure; and two scales measured change throughout a 5-year period prior to closure. Comparative analysis suggested that earned income in closure counties (excluding farming and mining income) was lower than in comparison counties subsequent to closure and that labor force growth also shrank. These results tend to confirm rural hospitals as economic centers. They also justify fears of rural residents that a community hospital closure will reduce new industries' willingness to locate in the community.

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Current as of July 2000
AHRQ Publication No. 00-0045

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