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Quality of Care

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Hospital report cards can help hospitals improve their quality of care

Hospital report cards that identify which hospitals have better- and worse-than-expected outcomes for particular medical conditions can help hospitals improve quality of care for these conditions, concludes a survey of California hospital chief executive officers (CEOs) that was supported by the Agency for Health Care Policy and Research (HS08574). Three-fourths of the CEOs found the 1996 California Hospital Outcomes Project (CHOP) to be at least somewhat helpful in improving the quality of care for heart attack (acute myocardial infarction, AMI) patients at their hospitals. The CHOP report presented 30-day inpatient death rates for heart attack patients who were treated at California hospitals from 1990 to 1992.

Hospital leaders found the report most helpful for benchmarking performance, improving how doctors code patients' diagnoses, and educating physicians about medical record documentation and clinical pathways (step-by-step diagnostic and treatment procedures). One-third of hospitals surveyed took specific quality improvement actions. For instance, some were stimulated to develop or refine AMI clinical pathways, improve use of thrombolytic (clot-busting) therapy, or reassign medical staff to improve AMI outcomes.

The CHOP and similar reports could be improved by making them more timely—that is, having them reflect current hospital practices—and by linking processes of care to patient outcomes. Hospitals want to know what hospitals with good outcomes are doing differently, so that they can improve their practices, note Patrick S. Romano, M.D., M.P.H., and his colleagues at the University of California-Davis School of Medicine, who did the survey. In 1996, they mailed a questionnaire to the CEO of each hospital in the CHOP report (374 responded) and later conducted telephone interviews with a random sample of the 127 hospitals willing to provide more information.

See "The California hospital outcomes project: How useful is California's report card for quality improvement?" by Julie A. Rainwater, Ph.D., Dr. Romano, and Deirdre M. Antonius, in the January 1998 Journal on Quality Improvement 24(1), pp. 31-39.

Physicians have an important role in improving health care quality

Two new studies were published recently that have implications for improving the quality of health care. Both studies received funding from the Agency for Health Care Policy and Research.

In the first study, Roger A. Rosenblatt, M.D., M.P.H., of the University of Washington School of Medicine, and his colleagues conclude that most specialists do not assume the same degree of responsibility as do generalist physicians for the everyday health problems of elderly patients, even though a substantial percentage of these patients depend on specialists for most of their health care. This raises questions about the quality of primary care provided by specialists.

The researchers found that between 1994 and 1995 one of every six fee-for-service Medicare patients aged 65 and older in Washington State relied exclusively on specialists for outpatient care. But the specialists were less likely than generalists—such as family practitioners and general internists—to immunize these patients against influenza, a major killer of the elderly. Generalists gave flu shots to 55.4 percent of the Medicare patients who depended mostly on them for care, compared with 47.7 percent of the medical specialists' regular patients and 39.6 percent of those who depended on surgical specialists for routine care.

The researchers also found that about half of the ambulatory care visits made to generalists were made by patients who were depending on the generalists for the majority of their care. In contrast, 21 percent of all ambulatory care visits to medical specialists and 11.7 percent of visits to surgical specialists were made by patients who relied mainly on those types of physicians for most of their care. Pulmonologists, general surgeons, and gynecologists were more likely than other specialists to provide services outside their disciplines.

This study also received funding from the Robert Wood Johnson Foundation and the Health Resources and Services Administration, a component of the U.S. Department of Health and Human Services.

For more information, see "The generalist role of specialty physicians: Is there a hidden system of primary care?" by Dr. Rosenblatt, L. Gary Hart, Ph.D., Laura-Mae Baldwin, M.D., M.P.H., and others, in the Journal of the American Medical Association 279(17), pp. 1364-1370.

In the second study, Stephen B. Soumerai, Sc.D., and his colleagues suggest that hospitals could improve quality of care for heart attack patients by using local physicians respected by their peers for their knowledge of treating the condition to educate other medical staff. The goal of the study involving 37 Minnesota hospitals was to increase adherence to an American College of Cardiology/American Heart Association guideline recommending the use of three proven but underutilized, potentially life-saving drug therapies—aspirin, beta blockers, and thrombolytic drugs—in eligible patients. Adherence to the guideline has been variable, in spite of wide dissemination to hospitals and other providers.

The study found that in hospitals using local medical opinion leaders, the proportion of eligible elderly heart attack patients given aspirin or beta blockers increased by 21 percent and 33 percent, respectively, compared with other hospitals in the study. The other hospitals, which served as controls, received only written information on the use of study drugs (aspirin and beta blockers) for doctors practicing there.

Use of lidocaine—which is discouraged by the guideline—fell by 50 percent in both the experimental and control hospitals, while the proportion of patients given thrombolytic therapy stayed about the same. According to Dr. Soumerai, who is with Harvard Medical School and Harvard Pilgrim Health Care, the failure to increase thrombolytic therapy may be explained by the large number of patients who were very old, also had other severe illnesses, or presented late to the hospital, thus reducing benefits in relation to risks of the drugs.

According to AHCPR's administrator John M. Eisenberg, M.D., this study provides confirmation that while information is necessary, information alone is not sufficient to improve the quality of health care. It clearly shows that the role of professional leadership is one of the most important factors in improving health care quality.

Additional funding for this study was provided by the Harvard Pilgrim Health Care Foundation and the hospitals and health plans associated with the Healthcare Education and Research Foundation.

Details are in "Effect of local medical opinion leaders on quality of care for acute myocardial infarction: A randomized controlled trial," by Dr. Soumerai, Thomas J. McLaughlin, Sc.D., Jerry H. Gurwitz, M.D., and others, in the May 6, 1998, Journal of the American Medical Association 279(17), pp. 1358-1363.

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Special Populations

Risk of poor birth outcomes is reduced for low-income pregnant women who receive adequate support services

Adequate Medicaid-funded prenatal support services substantially improve the chances of avoiding poor birth outcomes in low-income women, concludes a study supported in part by the Agency for Health Care Policy and Research (HS07373) and conducted by the MEDTEP Minority Research Center at the University of California, San Francisco. These support services include nutrition, health education, and psychosocial services, including risk assessments, individual counseling for identified risks, referrals for needed resources or professional services, and followup. The goal is to reduce the impact of socioeconomic factors on healthy behaviors to avoid preventable clinical complications of pregnancy in low-income women.

Rick K. Homan, Ph.D., and Carol C. Korenbrot, Ph.D., examined the relationships between low birthweight and preterm birth outcomes using medical record data on maternal risks and use of prenatal visits for nearly 3,500 women in California receiving Medicaid-supported prenatal care at 27 outpatient sites. Adding information about the adequacy of prenatal support services to maternal risks and use of prenatal visits significantly increased the ability of models to predict poor birth outcomes for individual women.

Women who did not have three support service sessions (one each trimester) in at least one of the three areas (nutrition, psychosocial support, and education) had nearly twice the risk of a poor outcome compared with women who did have such sessions (low birthweight odds ratio [OR] of 1.75 and preterm birth OR of 1.79; 1 is equal odds). Moreover, there was a tendency for the relative odds of poor birth outcomes to increase as the number of support service areas in which assessments were inadequate increased. However, even after adjustment for the adequacy of support service sessions, variations in birth outcomes across provider sites and setting types persisted. This suggests the need for further adjustments for other differences among women or service delivery settings to explain variation in outcomes at different sites and practice settings, note the researchers.

Details are in "Explaining variation in birth outcomes of Medicaid-eligible women with variation in the adequacy of prenatal support services," by Drs. Homan and Korenbrot, in Medical Care 36(2), pp. 190-201, 1998.

Fears and cultural beliefs hinder treatment of Latinos with adult-onset diabetes

About 1.3 million Latinos in this country—or about 14 percent of all Latinos living in the United States—suffer from adult-onset (Type 2) diabetes, and they die twice as often from the disease as non-Hispanic whites.

Low socioeconomic status, lack of insurance, and hesitation to visit a physician are barriers that prevent many Lationos from getting effective treatment for diabetes. Diabetes also may be due to genetic predisposition, age, diet, obesity, family history of diabetes, and a sedentary lifestyle—all of which are risk factors for development of diabetes.

Type 2 diabetes affects the circulatory system and is frequently associated with conditions such as hardening of the arteries, kidney failure, and vision loss. Often, Latinos who are diabetic are unaware of their condition until complications arise. Many of the complications of diabetes can be prevented with patient education and appropriate treatment. However, for Latinos, emotional barriers and cultural beliefs often get in the way of effective treatment, according to researchers at the Midwest Latino Health Research, Training, and Policy Center, University of Illinois at Chicago. The study was led by Aida L. Giachello, Ph.D., and supported by the Agency for Health Care Policy and Research (HS07376).

For Latinos with diabetes, fatalism ("I will get well if God wishes it"), fear of insulin therapy, cultural reluctance to place individual medical needs over the needs of the family, and faith in and use of folk remedies such as garlic, cactus, and aloe create barriers to adequate treatment. It is often helpful to acknowledge and ultimately work around deeply rooted cultural practices rather than attempt to contradict them directly, suggests the study's lead author, Rebecca B. Lipton, Ph.D.

The researchers conducted three focus groups in 1994 with health care practitioners from Chicago-area primary care facilities about issues faced by their Latino patients. The focus groups revealed that communication between Latino patients and their physicians was often hindered by low reading levels, lack of proficiency in English, and an excessive respect for physicians that prevented first-generation patients in particular from asking questions about their treatment or clarifying medical instructions. Emotional barriers to adequate treatment were often more important than financial concerns, even among low-income patients. It was difficult to convince patients to follow a prescribed diet, particularly when the plan conflicted with the use of traditional folk remedies. Moreover, unless they felt ill, many patients felt no need to see the doctor or to follow any medical recommendations.

The researchers suggest that getting the family involved, having Spanish-speaking staff and low-literacy materials available, involving the doctors (instead of only dietitians) in diabetes education, and personalizing the doctor-patient relationship could improve diabetic care for Latinos.

See "Attitudes and issues in treating Latino patients with Type 2 diabetes: Views of healthcare providers," by Dr. Lipton, Lee M. Losey, M.A., Dr. Giachello, and others, in the January/February 1998 issue of The Diabetes Educator 24(1), pp. 67-71.

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AHCPR awards $7.6 million in grants designed to improve health care quality

The Agency for Health Care Policy and Research recently awarded eight grant awards designed to improve the quality of U.S. health care. Overall funding will total $7.6 million over 5 years. In announcing the projects, AHCPR Administrator John M. Eisenberg, M.D., pointed out that the projects will help us build a better science base for measuring and improving quality of care. They will provide new ways to measure quality and offer comparative information to help physicians and providers improve health care outcomes.

AHCPR has a number of ongoing and upcoming quality initiatives. The Agency is poised to announce a series of grants designed to determine the impact of different features of health plans on outcomes and on the quality of care provided to patients with chronic illnesses. AHCPR has launched several quality-related projects in FY 1998 that will inform health care decisions. In addition, AHCPR recently funded a report on innovations in value-based purchasing, showing how a number of major corporations, businesses, and health coalitions are using their market power to negotiate on quality as well as cost.

Earlier this year, AHCPR launched the Consumer Assessment of Health Plans (CAHPS®) survey, a survey kit that can be used by employers, managed care plans, and others to obtain consumers' views of the care they are receiving. The Medicare program is adopting CAHPS® for its managed care enrollees, and the Office of Personnel Management will adopt CAHPS® for use by the Federal Employees Health Benefits Program.

The newly funded projects are:

  • Pressure Ulcer Rates in Describing Nursing Home Quality. Principal investigator: Dan R. Berlowitz, M.D., M.P.H., Boston Medical Center, Boston, MA; grant HS09768; total funding: $697,679. This study will examine the development of pressure ulcers in nursing home patients and create a model to predict their occurrence. The model then will be used to adjust for patient risk while evaluating different methods of describing nursing home performance. Ultimately, these results will help provide information on the quality of care provided in nursing homes and how it can be improved.
  • Measuring and Improving Quality: Carotid Endarterectomy. Principal investigator: Mark R. Chassin, M.D., M.P.H., Mount Sinai School of Medicine, New York, NY; grant HS09754; total funding: $2,467,604. This project will investigate quality of care for carotid endarterectomy, a surgical procedure performed to prevent stroke in patients with lesions in their carotid arteries. The study will assess appropriate use, develop measures of appropriateness, and then create an intervention designed to improve appropriateness.
  • Patient-Based Quality Assessment for Chronic Disease. Principal investigator: Sheldon Greenfield, M.D., New England Medical Center Hospitals, Inc., Boston, MA; grant HS09756; total funding: $576,844. This study will compare disease-specific measures of quality for patients with three chronic conditions (asthma, diabetes, and lower back pain) with general measures of quality (such as HEDIS 3.0 and CAHPS®) reported by the population being served in the health plan. The researchers will determine whether these disease-specific measures are more sensitive than general measures in discriminating quality among health plans. They also will examine whether comprehensive profiles of health plans can be created across disease conditions. If these measures are found to be valid, they could be used as measures for comparing health plans.
  • Understanding Clinical and Administrative Outcomes. Principal investigator: Jeremy Holtzman, M.D., M.S., University of Minnesota, Minneapolis, MN; grant HS09735; total funding: $263,458. This study will examine whether patients' postoperative symptoms could be used as possible outcomes indicators for two Medicare groups: patients being treated for stomach pain after having gallbladder surgery and patients with pain or difficulty walking after having hip surgery. The study will determine how severity of illness impacts symptom relief, whether good symptomatic outcomes (such as less postoperative pain) correlate with a better process of care, whether better symptomatic outcomes (i.e., better mobility) predict subsequent utilization of services, and whether symptomatic and functional outcomes can be inferred from utilization data. If service utilization is found to be an acceptable surrogate for symptomatic outcomes (i.e., better or worse postoperative status), then utilization data could be used in lieu of more costly administrative data.
  • Validation of Quality Measures for Hip Replacement. Principal investigator: Jeffrey Katz, M.D., Brigham and Women's Hospital, Boston, MA; grant HS09775; total funding: $472,306. This project will create quality indicators for elective total hip replacement, using information from medical record reviews and hospital and patient surveys. Currently, there are no validated measures of quality for total hip replacement. This research also will develop a cumulative index of quality, which could have implications for other surgical and medical interventions.
  • Predicting Risk for Hysterectomy Complications. Principal investigator: Evan Robert Meyers, M.D., M.P.H., Duke University Medical Center, Durham, NC; grant HS09760; total funding: $254,550. This project will create predictive models that can be used by physicians and patients when making decisions about surgery. Hysterectomy is associated with considerable unexplained variations in use and complications, especially among minorities. Methods for estimating and adjusting risk and severity are necessary to make comparisons of performance among providers who may be treating patients with conditions of greater severity and higher risk.
  • Quality Improvement for Newborns with Jaundice. Principal investigator: R. Heather Palmer, M.B., B.Ch., S.M., Harvard School of Public Health, Boston, MA; grant HS09782; total funding: $2,449,037. Jaundice in the first few days of life can be a signal of serious, even devastating illness. The American Academy of Pediatrics has issued an evidence-based clinical guideline to help providers identify infants with jaundice and prevent them from progressing to serious illnesses. Different strategies for implementing the guideline will be tested in loosely structured managed care settings. This common form of managed care is very different from the tightly structured HMO systems in which quality improvement has most often been studied.
  • Quality Improvement in Nursing Homes. Principal investigator: Francois Sainfort, Ph.D., University of Wisconsin, Madison, WI; grant HS09746; total funding: $397,332. Very little is known about the influence of either organizational structure or culture on quality of care in nursing homes. This project will examine the impact of quality improvement activities in 100 Wisconsin nursing homes. The findings will be useful to nursing homes that are attempting to implement a quality improvement philosophy within their facilities.

AHCPR offers a new information service

The Agency for Health Care Policy and Research is establishing a new electronic mailing list for people who are interested in receiving press releases and other announcements about Agency activities. If you would like to subscribe, please send an E-mail with your name, your organization or affiliation, and your E-mail address to Nancy Comfort in AHRQ's Public Affairs office at Once the electronic mailing list has been created, you will receive an E-mail message to confirm your interest and explain how the list will work.

Final reports now available from NTIS

The following grant final reports are now available from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator (PI), his or her affiliation, the grant number and project period, and provides a description of the project.

Advance Directives, Proxies, and Electronic Medical Records. William M. Tierney, M.D., Indiana University, Indianapolis, IN. AHCPR grant HS07632, project period 4/1/93 to 3/31/97.

For 1,051 chronically ill outpatients, the researchers performed a controlled trial of reminders to discuss advance directives (ADs) and prospective studies of the effects of completed AD forms, placed in patients' electronic medical records, on emergency department (ED) and inpatient care. Physicians receiving reminders to discuss ADs had seven times as many end-of-life care discussions and completed seven times as many ADs as physicians who did not receive reminders, with no effects on patient satisfaction. In 2 years of observation, enrolled patients had 1,547 ED visits, (118 with completed ADs). AD patients had higher total charges (corrected for illness severity). There was no correlation between AD preferences and whether the service was received. During 2 years, there were 924 admissions for 410 enrolled patients (72 with completed ADs). Patients with ADs had higher miscellaneous charges and fewer surgeries. However, in both the ED and hospital, conditions that should trigger AD use (terminal illness and cognitive impairment) were rare. The presence of an AD was associated with increased ED charges but no consistent inpatient effects over a 2-year period. The researchers conclude that computer reminders can increase discussions of end-of life care and completion of AD forms.

Abstract, executive summary, final report, and appendixes A-D and F (NTIS accession no. PB98-126766; 264 pp, $54.00 paper, $23.00 microfiche) are available from the National Technical Information Service.

Chiropractic in the United States: Training, Practice, and Research. Daniel Cherkin, Ph.D., Group Health Cooperative of Puget Sound, Seattle, WA. AHCPR grant HS07915, project period 8/1/93 to 7/31/97.

In view of the growing popularity of chiropractic care, it is important for health care providers, insurers, policymakers, and people with back pain to understand the current capabilities and limitations of chiropractic care. This report reflects a collaboration among scholars, researchers, and practitioners from both the medical and chiropractic communities. It provides an unbiased overview of what is and is not known about the profession and practice of chiropractic. The report contains information on the history and development of chiropractic, training and licensure of practitioners, insurance coverage for chiropractic services, chiropractic's role in the Nation's health care system, and the benefits and risks associated with spinal manipulation. It includes a discussion of future chiropractic research priorities and policy issues.

The research report (NTIS accession no. PB98-111693; 140 pp, $36.00 paper, $17.00 microfiche) is available from the National Technical Information Service.

Consumer Choice and the Rural Hospital. Gordon H. DeFriese, Ph.D., University of North Carolina, Chapel Hill, NC. AHCPR grant HS06745, project period 7/1/93 to 6/30/96.

This national study of the organizational factors and consumer perceptions of small, sole community hospitals sought to identify factors that could account for patterns of consumer "outshopping" in small hospital service markets in the United States. The study includes data from three separate but interrelated primary sources: (1) a mailed survey of administrators of operating hospitals and converted facilities; (2) a telephone survey of a national sample of 100 residents from each of the 100 communities in which these facilities were located; and (3) a national mailed survey of up to 15 physicians practicing in each of these communities. The study asked physicians to rate a number of factors which consumers could and should be asked to evaluate regarding the quality of health care they have received. Data from the study show that proximity to these small rural hospitals—and not preference for the facilities—is of greater importance in explaining the intention and the willingness of consumers to use these facilities. Rural physicians generally considered the care provided in these facilities to be "fair" or "good" and indicated that they would seek care from these hospitals for themselves and their families.

Abstract, executive summary, final report, and appendixes A and B (NTIS accession no. PB98-126592; 74 pp, $27.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

HIV Outcomes Study. Martin F. Shapiro, M.D., Ph.D., University of California, Los Angeles, CA. AHCPR grant HS06775, project period 4//1/91 to 12/31/94.

This study examined the consequences and correlates of symptomatic illness in HIV. It demonstrated for the first time that better access to care is cross-sectionally and prospectively associated with better health outcomes, poor access is associated with a higher rate of hospitalization, and sick, indigent populations are not well represented in HIV clinical trials. The study reported on strategies to collect quality-of-life data late in such populations, and it developed improved methods to assess diarrhea, constitutional symptoms, access to care, and quality of life in patients with HIV. The study showed that constitutional symptoms profoundly influence health status, suggesting that interventions to diminish the number and severity of such symptoms may prove beneficial to health.

Abstract, executive summary, and final report (NTIS accession no. PB98-126816; 24 pp, $23.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

Simplified vs. Standard Cardiopulmonary Resuscitation (CPR) Instruction. Knox H. Todd, M.D., M.P.H., Emory University School of Medicine, Atlanta, GA. AHCPR grant HS08766, project period 7/1/96 to 6/30/97.

The researchers conducted two separate prospective, randomized, controlled trials testing the hypothesis that 34 minutes of video self-instruction (VSI) training in adult cardiopulmonary resuscitation results in comparable or better CPR performance than the current community standard—the American Heart Association "Heartsaver" course. Subjects for the two studies included a group of incoming freshman medical students and representatives from the congregation of a black church. In both studies, subjects were randomly assigned to video self-instruction or the American Heart Association "Heartsaver" CPR course. Beginning 2 months after training, each subject was tested for the ability to perform CPR in a simulated cardiac arrest setting. Blinded observers assessed CPR performance using explicit criteria. VSI trainees displayed comparable or superior overall performance compared with traditional trainees. Among incoming medical students, 20 of 47 (43 percent) of traditional trainees were judged "not competent" in performing CPR compared with only 8 of 42 (19 percent) of VSI trainees. For black churchgoers, 23 of 50 (40 percent) of VSI trainees were judged competent or better in performing CPR, compared with only 8 of 50 (16 percent) of traditional trainees. These findings show that one half hour of video self-instruction can produce CPR of comparable quality to that achieved by traditional training methods. Video self-instruction is a simple, quick, and inexpensive alternative to traditional CPR instruction and may be used to extend CPR training to currently undeserved populations, conclude the researchers.

Abstract, executive summary, and final report (NTIS accession no. PB98-126774; 30 pp, $23.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

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Research Briefs

Cunningham, W.E., Hays, R.D., Ettl, M.K., and others (1998, March). "The prospective effect of access to medical care on health-related quality-of-life outcomes in patients with symptomatic HIV disease." (AHCPR grant HS06775). Medical Care 36(3), pp. 295-306.

Public hospital patients with HIV infection have substantially worse access to medical care than patients with other chronic diseases. Better access to care may help improve their health-related quality of life (HRQL), according to this study, which found that HIV-infected patients with moderately good physical health and poor or moderately good mental health who had good access to care at the beginning of the study (baseline) had significantly better physical and mental health outcomes 3 months later than those with poor access to care. The researchers analyzed the health status and access to care of 282 HIV-infected patients at two public Los Angeles Hospitals who participated in the HIV Medical Outcomes Study and 2,471 patients with other chronic diseases who participated in the Medical Outcomes Study. The researchers cite the need for programs to improve the affordability of services and also the availability of routine, urgent, and specialty services.

Dillingham, T.R., Pezzin, L.E., and MacKenzie, E.J. (1998, March). "Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputees." Archives of Physical Medicine and Rehabilitation 79, pp. 279-287.

Trauma is an important cause of amputation in the United States, especially among young, working age individuals, who frequently suffer significant disability as a result. A new study by AHCPR researcher Liliana E. Pezzin, Ph.D., and her colleagues from Johns Hopkins University shows that the leading causes of traumatic amputation are injuries involving machinery (40 percent), power tools and appliances (28 percent), firearms (9 percent), and motor vehicle crashes (8 percent). The researchers used Maryland hospital discharge data from 1979 through 1993 to examine patterns of trauma-related amputations over time. They found a substantial decline in rates of both major and minor amputations over the 15-year study. However, hospital stays became significantly shorter, declining by 40 percent. In addition, only 15 percent of patients with major (often multiple) amputations were discharged to inpatient rehabilitation; 60 percent of these patients were discharged directly home. The researchers call for studies to examine the impact of shorter hospital stays and low rates of discharge to inpatient rehabilitation on the long-term outcomes of trauma-related amputees.

Reprints (AHCPR Publication No. 98-R062) are available from the AHCPR Publications Clearinghouse.

Dillingham, T.R., Pezzin, L.E., and Lauder, T.D. (1998, March). "The relationship between muscle abnormalities and symptom duration in lumbosacral radiculopathies." American Journal of Physical Medicine & Rehabilitation 77, pp. 103-107.

The electrodiagnostic literature has long held that paraspinal muscles (PSM) tend to show electromyographic (EMG) abnormalities early on in a lumbosacral radiculopathy (LSR) and that more distal muscles become abnormal later in the disease process. But there is no correlation between abnormal PSM and symptom duration, according to Dr. Pezzin and her colleagues. They used a multivariate logit analysis of 139 patients (retrospectively identified) with electrodiagnostically confirmed LSRs to test this hypothesis. They found that symptom duration was also nonsignificant for the remaining five lower limb muscles analyzed. The authors conclude that the probability of having EMG abnormalities is not related to symptom duration.

Reprints (AHCPR Publication No. 98-R063) are available from the AHCPR Publications Clearinghouse.

Revicki, D.A., Sorensen, S., and Wu, A.W. (1998). "Reliability and validity of physical and mental health summary scores from the medical outcomes study HIV health survey." (AHCPR grant HS06727). Medical Care 36(2), pp. 126-137.

As the life expectancy of patients with HIV disease and AIDS increases, there is concern about tradeoffs between survival benefits and the adverse effects of treatment. These researchers derived two summary indicators reflecting physical health and mental health domains of health-related quality of life from the 10 scales in the HIV Health Survey. Evidence from three independent samples indicated that the Physical Health Survey (PHS) and Mental Health Survey (MHS) scores had excellent reliability and good discriminant validity. The summary scores varied by severity of HIV disease and discriminated asymptomatic from later-stage HIV patients. Clinician ratings of patients' functional status were moderately correlated with the summary scores. The researchers conclude that the PHS and MHS may be very useful health outcome measures for clinical trials of HIV/AIDS treatments.

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AHCPR Publication No. 98-0034
Current as of June 1998

The information on this page is archived and provided for reference purposes only.


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