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Cohen-Mansfield, J., and Lipson, S. (2002). "Medical decisions for troubled breathing in nursing home residents." (AHRQ grant HS09833). International Journal of Nursing Studies 39(5), pp. 557-561.
Troubled breathing is an end-of-life symptom for many elderly nursing home residents, who typically suffer from a high rate of respiratory problems. These authors examine the decisionmaking process involved in choosing medical treatments to be considered for these residents. Researchers interviewed five physicians at a suburban nursing home about how they decided to treat 20 residents who had experienced troubled breathing within the past 24 hours or were unable to make decisions at the time of troubled breathing because of cognitive impairment. Diagnostic tests and medication were the usual treatments. Although doctors were generally satisfied with the decision process (families were involved in decisions in 45 percent of cases), they would have wanted less treatment and more symptomatic relief for 30 percent of the residents if they were in the resident's condition (for example, comfort care or no hospitalization).
Denkers, M.R., Biagi, H.L., O'Brien, M.A., and others (2002). "Dorsal root entry zone lesioning used to treat central neuropathic pain in patients with traumatic spinal cord injury." (AHRQ contract No. 290-97-0017). Spine 27(7), pp. E177-E184.
Up to 94 percent of people suffer from pain at some point after a spinal cord injury, up to 70 percent suffer from chronic pain, and from 5 to 37 percent have pain that is quite severe or disabling as a result of the injury. These authors reviewed studies to evaluate the effectiveness and safety of dorsal root entry zone lesioning in treating central neuropathic pain of patients 13 years of age and older with traumatic spinal cord injury. Ten of 11 studies found that at least half of the patients attained more than 50 percent pain relief or experienced no pain-related activity limitation and no need for narcotics. However, all of the studies poorly defined patient eligibility criteria, had no control groups, and used inadequate reporting of adverse effects. The researchers conclude that the evidence is weak for the use of dorsal root entry zone lesioning to relieve central neuropathic pain in patients with traumatic spinal cord injury.
Frank, C., Fix, A.D., Pena, C.A., and Strickland, G.T. (2002, April). "Mapping Lyme disease incidence for diagnostic and preventive decisions, Maryland." (AHRQ grant HS07813). Emerging Infectious Diseases 8(4).
Mapping Lyme disease by ZIP code rather than county will improve decisions regarding diagnoses, personal and community interventions, and cost-effective use of Lyme disease vaccine, conclude these researchers. They analyzed all cases of Lyme disease reported to the Maryland Department of Health and Mental Hygiene with a known date of onset from 1993 through 1998 based on residential ZIP code rather than county. They identified areas of high incidence on the upper Eastern Shore of the Chesapeake Bay and in counties north and east of Baltimore City. The latter places, especially, are not visible when mapping Lyme disease on the county level. For example, when analyzed by counties, focal high incidence along Gunpowder River and Deer Creek was diluted by adjacent areas of lower incidence among the comparatively urban northern inner suburbs of Baltimore City. These foci were aligned along the larger rivers and creeks in an environment that is ideal for transmission of the disease. In contrast, Maryland's upper Eastern Shore, a rural area in the Coastal Plain with an ideal tick habitat, has uniformly high Lyme disease.
Hallstrom, A.P. (2002). "Should time from cardiac arrest until call to emergency medical services (EMS) be collected in EMS research?" (AHRQ grant HS08197). Critical Care Medicine 30, pp. S127-S130.
Whether or not data on the time from cardiac arrest until a call is made to emergency medical services (EMS) should be collected in EMS research depends on several factors, notes this author. He conducted a simulation study to quantify the impact that such data might have on estimates of the relationship between time from a person collapsing to defibrillation and probability of survival. He found that in the absence of bias (for example, faulty witness recall of the time that it took from collapse until the call was placed), an underestimate of the slope on the order of 20 to 30 percent might be expected. However, in the presence of bias, the impact on the slope estimate is unpredictable. The most likely bias (distraught family members who tend to overestimate how long it takes EMS to arrive) would tend to cause an overestimate of the slope. Thus, the author suggests that, unless the time from collapse to placing the 911 call can be obtained accurately and without bias, it is probably not worthwhile to do so, especially given the considerable costs involved in collecting such data.
Jiang, H.J., and Begun, J.W. (2002). "Dynamics of change in local physician supply: An ecological perspective." Social Science & Medicine 54, pp. 1525-1541.
The remarkable increase in physician supply over the past three decades did not alleviate physician maldistribution by geographic area or specialty. Physicians continue to be concentrated in the suburbs and in more affluent sections of urban areas. These researchers used an ecological framework to explain the growth of a particular physician population (for example, surgical specialists) in a given metropolitan statistical area by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity; competition within the same physician population; and interdependence between different physician populations. Regression analysis of changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994, based on the explanatory factors, revealed that the population ecology framework was useful in explaining dynamics of change in the local physician workforce. For example, both hospital consolidation and managed care penetration positively affected growth of physician generalists but suppressed the growth of specialists.
Reprints (AHRQ Publication No. 02-R063) are available from the AHRQ Publications Clearinghouse.
Putnam, K.G., Buist, D.S., Fishman, P., and others (2002, May). "Chronic disease score as a predictor of hospitalization." (AHRQ grant HS10391). Epidemiology 13(3), pp. 340-346.
The Chronic Disease Score (CDS)—which is based on health maintenance organization (HMO) records of dispensed medications and patient age and sex—predicts hospitalizations in a wide group of health care delivery systems used by about one-third of the U.S. population, concludes this study. The researchers used the CDS to predict hospitalizations during the year after October 1, 1995, among 29,247 women aged 45 years and older. The overall risk of hospitalization was 12 percent. Among four CDS versions, the risk of hospitalization ranged from 4 percent for the lowest CDS decile to 27-29 percent for the highest decile. All four versions of the CDS predicted subsequent-year hospitalization about equally. However, based on the statistics used to evaluate the scores, the Clark-TC weights that predicted total health care cost, performed slightly better than the others. These findings suggest that CDS comorbidity metrics can be applied to multi-HMO studies to control for potential confounding.
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Current as of July 2002
AHRQ Publication No. 02-0034