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Final reports now available from NTIS
The following grant final reports are now available from the National Technical Information
Service (NTIS). Each description of a grant final report identifies the principal investigator and his
or her affiliation, the grant number, project period, project objective, and methods used. Findings
and other information are presented in the individual reports.
Economic Effects of Rural Hospital Closure. Michael E. Samuels, Dr.P.H., University of
Carolina, Columbia, SC. AHCPR grant HS07252, project period 6/1/95 to 11/30/96.
The effects of hospital closure during the period 1984 to 1988 on small rural counties were
studied using a telephone survey of local county officials and a multivariate analysis of economic
indicators. The counties studied (n=103) were matched with three control counties (n=309) based
on economic similarity. Absence of physicians, low profitability and inability to compete were
seen as causing hospital failure. Hospital closure was perceived as more disruptive in smaller
counties. Just under one-third of responding counties took some action to prevent or ameliorate
closure. Nearly three of four rural counties made some use of the hospital facility after closure;
continued use of the hospital facility mitigated the economic effects of closure. Counties that lost
all hospital capacity as a result of closure were more likely to lose physicians than were other
closure counties. These analyses suggested that closure suppressed economic growth. In closure
counties, rates of increase in total personal income, earned income, non-farm earned income, and
non-mine earned income were lower than in control counties 5 years after closure. Unemployment
and labor force differences between closure and control counties were greatest in the third year
Abstract, executive summary, and final report are available from the National
Technical Information Service, NTIS accession no. PB97-148829; 158 pp, $35.00 paper,
Employer Provided Health Insurance and Job Lock. Mark C. Berger, Ph.D., University
Kentucky Research Foundation, Lexington, KY. AHCPR grant HS08188, project period 7/1/94
Job lock can occur when workers postpone job changes because they fear losing
employer-provided health insurance. If this type of job lock is prevalent, then the overall quality of
matches between workers and employers is reduced, and in general, workers are less productive.
The researchers used 1987 and 1990 data from the Survey of Income and Program Participation
to examine whether job lock affects mobility of wages. They found no statistically significant
evidence that job lock affected job tenure or wages in either 1987 or 1990. They also studied the
consequences of error in the measurement of health insurance status, the effects of dual
husband-wife employer-provided health insurance coverage on labor market outcomes, and the
use of various models to estimate the length of time with health insurance coverage.
executive summary, and final report are available from the National Technical
Service, NTIS accession no. PB97-144794; 151 pp, $31.00 paper, $14.00 microfiche.
HMO Research Network National Conference. Andrew F. Nelson, M.P.H., Group
Foundation, Minneapolis, MN. AHCPR grant HS09319, project period 5/1/96 to 4/30/97.
The 1996 Research Network Conference was held June 7-8, 1996, in Bloomington, MN, and
hosted by the Group Health Foundation of Health Partners in Minnesota. Participants were career
researchers working in one of the ten research organizations that make up the HMO Research
Network (Group Health of Puget Sound, Harvard Pilgrim Health Plan, Henry Ford Health
System, Kaiser Permanente of Colorado, Kaiser Permanente of Georgia, Kaiser Permanente of
Hawaii, Kaiser Permanente of Northern California, Kaiser Permanente Northwest, Kaiser
Permanente of Southern California, and Group Health Foundation of HealthPartners). A major
purpose of the conference was to facilitate networking among the researchers to address/resolve
common issues and problems.
Abstracts of papers and list of attendees are available from the
National Technical Information Service, NTIS accession no. PB97-153811;
98 pp, $25.00
paper, $14.00 microfiche.
Randomized Trial of the Shared Decisionmaking Program for Benign Prostatic
Hyperplasia. Michael J. Barry, M.D., Massachusetts General Hospital, Boston, MA. AHCPR
grant HS06540, project period 8/1/91 to 7/31/95.
These investigators had previously developed a multimedia educational program for men with
benign prostatic hyperplasia (BPH), and in this study they evaluated its ability to improve
treatment decisions. They conducted a prospective randomized trial of a computer- and
interactive video-based Shared Decisionmaking Program (SDP) among men with BPH seen in
three urological practices and followed for 1 year. Control subjects received an informational
brochure. Results were based on 104 men randomized to the SDP and 123 controls. Outcome
measures included the distribution of treatments selected (prostatectomy, pharmacologic
treatment, or "watchful waiting"), a test of knowledge about BPH, two measures of decision
satisfaction, two measures of BPH severity from the patient's perspective, three measures of
overall health status, and a measure of desire for autonomy in decisionmaking. The distribution of
treatment decisions did not differ significantly between groups. However, SDP subjects had
significantly better scores than control subjects on the measures of BPH knowledge, satisfaction
with the decisionmaking process, and general health perceptions and physical functioning. This
study showed that the Shared Decisionmaking Program for BPH improves some aspects of the
quality of patients' treatment decisions.
Abstract, executive summary, final report, and appendix
are available from the National Technical Information Service, NTIS
PB97-154025; 51 pp, $21.50 paper, $10.00 microfiche.
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Burke, H.B., Goodman, P.H., Rosen, D.B., and others (1997, February).
networks improve the accuracy of cancer survival prediction." (AHCPR grant HS06830).
Cancer 79, pp. 857-862.
This study compared the cancer-specific 5-year survival prediction accuracy for breast and
colorectal cancer of the TNM cancer staging system with that of artificial neural network
statistical models. The TNM staging system uses tumor size, number of positive regional lymph
nodes, and distant metastases to predict cancer survival. The study found that artificial neural
networks (a class of statistical methods) improve the accuracy of the TNM staging system for
predicting survival of patients with breast cancer and colorectal cancer. When the researchers
used data from the American College of Surgeons' Patient Care Evaluation and the National
Cancer Institute's Surveillance, Epidemiology, and End Results breast carcinoma data sets to
compare the systems, artificial neural networks (ANN) were significantly more accurate in
predicting 5-year and 10-year survival of these cancer patients. Adding commonly collected
demographic and anatomic variables further increased the accuracy of the ANN's predictions of
breast and colorectal cancer survival.
Gelberg, L. and Siecke, N. (1997). "Accuracy of homeless adults'
grant HS06696). Medical Care 35(3), pp. 287-290.
Homeless persons are quite accurate when reporting the number of times they have visited a
health clinic, but they do not report accurately the number of such visits made during a specific
time frame, according to face-to-face interviews with 349 homeless persons in both downtown
and suburban areas of Los Angeles. About 49 percent of the homeless persons interviewed—who
had made at least one visit to the clinic over the course of a year—underreported the total number
of visits they had made compared with 28 percent of the general population. Likewise, 57 percent
of respondents underreported the number of visits made in a 3-month timeframe. In the general
population, 7 percent of respondents reported that they had made a medical visit in the past year
that could not be confirmed compared with 17 percent in this study of the homeless. Thus,
homeless persons are less accurate in recalling medical use information than the general public,
but it is a difference of degree and not necessarily of magnitude. However, homeless persons may
not accurately report complex information or socially undesirable information such as drinking
Katz, D.A., Bates, D.W., Rittenberg, E., and others (1997, January).
Clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea."
(AHCPR grant HS07107). Journal of General Internal Medicine 12, pp. 57-62.
Clostridium difficile accounts for substantial illness among hospitalized patients and is the most
common cause of antibiotic-associated colitis. The number of laboratory tests to detect a
cytotoxin produced by C. difficile in hospitalized patients with diarrhea could be reduced by use
of selective criteria, according to these researchers. They prospectively studied 609 adult
inpatients who received testing for C. difficile cytotoxin during a 3-month period in 1994. When
the researchers used lack of prior antibiotic use and at least one symptom predictor (significant
diarrhea or abdominal pain) to identify low-risk patients, the misclassification rate was 2.8 percent
for assay results. Use of this rule to identify low-risk patients potentially could have averted 29
percent of all cytotoxin assays.
Nau, D.P., Ried, L.D., and Lipowski, E. (1997, January). "What makes
patients think that
their pharmacists' services are of value?" (AHCPR grant HS08221). Journal of the
American Pharmaceutical Association NS37(1), pp. 91-98.
Patients who receive comprehensive pharmaceutical care perceive their pharmacist to be of more
benefit and perhaps more value to them, compared with patients whose pharmacists provide only
medication information, according to this cross-sectional survey of 198 asthma patients. The
researchers used data on patients enrolled in an independent practice association (IPA)-model
HMO to examine the relationship between the level of care provided by community pharmacists
and patients' perceptions of pharmacists' ability to help them manage their asthma therapy and
prevent problems with their condition. The study showed that asthma patients who receive at least
a basic level of outcomes monitoring (pharmacist assesses patient's medication use and disease
control on a regular basis) better rate their pharmacists' ability to help manage their asthma
therapy, compared with pharmacists who provide only medication information. In this study, 52
percent of patients rated their pharmacist as very good to excellent at helping them manage their
asthma therapy; 42 percent of patients rated their pharmacist as very good to excellent at helping
them prevent problems.
Peek, C.W., Henretta, J.C., Coward, R.T., and others (1997, March).
"Race and residence
variation in living arrangements among unmarried older adults." (NRSA fellowship F32
HS00086). Research on Aging 19(1), pp. 46-68.
This study found that unmarried elderly persons are five times more likely to live alone if they
have no unmarried children compared with elderly persons who have two or three unmarried
children. The researchers interviewed 704 elderly unmarried persons obtained from a random
sample of elderly persons in rural and urban areas of North Florida. Differences in age, sex,
education, Medicaid coverage, and health status (except for a recent hospital stay) had little
influence on living arrangements. Black unmarried elderly persons were more likely than their
white counterparts to live with children, relatives other than children, and nonrelatives. They also
were more apt to have always lived with a child and to have formed a household with a child.
Despite this greater social support, rural black elderly persons were still more apt to live alone
than their urban counterparts, who were considerably more apt to have formed a household with a
child. According to the researchers, the close proximity of children to elderly parents in rural areas
is a potential source of support that may offset the need of rural elders to co-reside with children.
Finally, receiving formal care services increased the chances of living alone, suggesting that formal
help provides the social "scaffolding" necessary to permit an elderly person to live alone.
Young, Y., Brant, L., German, P., and others (1997, March). "A
of functional recovery among older people with subcapital hip fractures." (AHCPR grant
HS06658). Journal of the American Geriatric Society 45, pp. 288-294.
The rate of functional recovery from surgery to repair a hip fracture is not constant over time and
varies among patients. Postsurgical functioning among disoriented but not demented patients
continues to deteriorate over time compared with nondisoriented patients and is most profound in
those 85 years of age and older. The type of surgical procedure performed is not significantly
associated with postsurgical functional recovery. However, among patients in this study, poor
prefracture functioning and an unsteady gait predicted poor functional recovery. These factors
cannot be altered once the fracture occurs. Some risk factors for poor recovery are modifiable,
however, and may help guide treatment and placement decisions following fracture. These include
postsurgical disorientation, lengthy hospital stay, and discharge to an institution instead of home.
These findings are based on a 1-year prospective study in which the researchers reviewed medical
charts and interviewed 312 community-dwelling older adults at 2, 6, and 12 months following
surgery at 1 of 7 Baltimore area hospitals.
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AHCPR Publication No. 97-0055
Current as of June 1997