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Blewett, L.A., Kane, R.L., and Finch, M. (1995/1996, Winter).
"Hospital ownership of post-acute care: Does it increase access
to post-acute care services?" (AHCPR grant HS06604).
Inquiry 32, pp. 457-467.
Patients with stroke or chronic obstructive pulmonary disease
are more likely to use a post-acute care (PAC) facility after
hospital discharge if the hospital owns the facility, it is a
teaching hospital, or the hospital serves a large proportion of
Medicare patients. However, patient characteristics—such as
whether the patient lives alone, is older, or has functional
impairments—are much more consistent predictors of PAC use.
In the other three diagnosis-related groups studied (congestive
heart failure, hip joint procedures, and hip fracture
procedures), patients discharged from hospitals that owned PAC
facilities were as likely to receive PAC as patients discharged
from hospitals that did not own PAC facilities. Almost two-thirds
of the patients studied were discharged to PAC services. Patients
discharged from hospitals that owned PAC facilities and served a
high volume of Medicare patients were more apt to receive PAC.
The researchers suggest this may be because these hospitals
benefit by reducing inpatient length of stay, where costs are
paid by Medicare on a fixed-price basis, to the PAC setting,
where services are paid for on a cost-plus basis. Also, these
hospitals may be financially dependent on Medicare and thus face
additional incentives to discharge patients sooner, leaving the
patients more in need of PAC services. This analysis was based on
data collected as part of a large-scale study on the course of
post-acute care among more than 2,500 Medicare patients in five
DRGs who were discharged from 52 hospitals in three urban areas
(Minneapolis/St. Paul, Houston, and Pittsburgh) between March
1988 and March 1989.
Escalante, A., Galarza-Delgado, D., Beardmore, T.D., and
others (1996, January). "Cross cultural adaptation of a brief
outcome questionnaire for Spanish-speaking arthritis patients."
(AHCPR grant HS07397). Arthritis & Rheumatism 39(1),
These researchers adapted a brief self-assessment
questionnaire to measure health outcomes among English- and
Spanish-speaking patients with arthritis. They translated the
items into Spanish about 8 activities of daily living, duration
of morning stiffness, and a 10-point pain scale. They tested the
questionnaire among English- and Spanish-speaking arthritis
patients from four clinical centers. Results showed that the
English-Spanish equivalence and test-retest reliability of the
questionnaire were almost perfect. Questionnaire scores compared
with an occupational therapists' evaluation also were
near-perfect in both languages. Both versions of the
questionnaire correlated well with functional class, amount of
pain, grip strength, and walking velocity. The researchers
conclude that the questionnaire is suitable for studying
Spanish-speaking subjects with arthritis in the United States and
Gaudier, F.L., Goldenberg, R.L., Nelson, K.G., and others
(1996, February). "Influence of acid-base status at birth and
Apgar scores on survival in 500-1000-g infants." (AHCPR Low
Birthweight PORT contract 282-92-0055). Obstetrics &
Gynecology 87(2), pp. 175-180.
Gestational age at delivery and birthweight are considered the
most important predictors of survival in very low birthweight
(VLBW) infants. However, the predictive value of other maternal
and neonatal risk factors, especially cord blood acid-base status
and Apgar scores, remain unclear. These researchers evaluated the
influence of acid-base status at birth and Apgar scores on the
survival of 1,073 VLBW infants during 1979 to 1991. Survival of
infants in every gestational age grouping was higher in infants
with an umbilical artery pH of 7.05 or higher compared with
infants with a pH lower than 7.05, significantly so at 27-28
weeks. There was no consistent relationship between umbilical
artery PCO2 or bicarbonate and survival. With the exception of
the 1-minute Apgar score at 23-24 weeks, the relationship of
Apgar score to survival was significant in all gestational age
periods (23 to 29 weeks or more). The only significant
relationships between any of the cord blood gases, Apgar scores,
and mortality involved low 1-minute and low 5-minute Apgar scores
and a bicarbonate less than 21 mEq/L. The researchers conclude
that 1-minute and 5-minute Apgar scores are better predictors of
survival than umbilical artery blood gases in neonates weighing
500-1,000 grams (approximately 1-3/4 to 3-1/2 pounds) at
Knaus, W.A., Harrell, F.E., LaBrecque, J.F., and others
(1996). "Use of predicted risk of mortality to evaluate the
efficacy of anticytokine therapy in sepsis." (AHCPR grant
HS07137). Critical Care Medicine 24(1), pp. 46-56.
Infection is one of the most frequent causes of morbidity and
mortality in severely ill, hospitalized patients. Although
antibiotic therapy controls or limits the growth of bacteria, a
high mortality rate persists, attributable in part to the
patients' own systemic inflammatory response to the infection.
The investigators applied an independent, sepsis-specific,
regression model to predict the risk of mortality over 28 days to
all patients with sepsis syndrome enrolled in the multicenter
clinical trial of recombinant human interleukin-1-receptor
antagonist (rhIL-1ra) therapy. Of the 893 patients, 302 received
a placebo, 298 were treated with 1 mg/kg/hr of rhIL-1ra, and 293
were treated with 2 mg/kg/hr of rhIL-1ra. Results showed a
significant increase in survival time for all patients treated
with rhIL-1ra, but patients with a predicted risk of mortality of
less than 24 percent derived little benefit. Retrospective
examination of time-to-death demonstrated that rhIL-1ra reduced
risk of death in the first 2 days for patients by 24 percent or
more. This same effect was not present in patients with a
predicted risk of mortality of less than 24 percent on entry into
the study. There was a wide distribution of individual patient
risks for 28-day mortality for all patients, as well as within
categorical subgroups, such as shock and organ system
dysfunction. The researchers conclude that individual risk or
severity assessment may be useful for evaluating the clinical
benefit of new therapeutic approaches to sepsis and for
monitoring outcomes at the bedside.
Steinberg, S.H., Strickland, G.T., Pena, C., and Israel, E.
(1996, January). "Lyme disease surveillance in Maryland." (AHCPR
grant HS07813). Annals of Epidemiology 6(1), pp. 24029.
Lyme disease (LD) is a tick-borne infection caused by the
spirochete Borrelia burgdorferi, which accounts for 90 percent of
all reported vector-borne illnesses in the United States. The
authors describe the incidence of LD reported to the Maryland
Department of Health and Mental Hygiene during 1992 at
6.5/100,000 population, ranging from 29.3 cases/100,000 on the
Eastern Shore (nearly 75 percent of all cases) to no cases in the
mountains of western Maryland. Among the 317 reported patients,
44.4 percent gave a history of tick exposure and 78.9 percent had
positive serologic test results. For the 59 percent of patients
meeting the Centers for Disease Control and Prevention
surveillance case definition, erythema migrans (EM) occurred in
69.5 percent, with arthritic (26.7 percent), neurologic (13.4
percent), and cardiac (2.1 percent) manifestations being less
frequent. Patients not meeting the case definition were
significantly more likely to have influenza-like symptoms, a
smaller rash, and arthralgia. Patients meeting the CDC criteria
were more likely to have an onset during the major transmission
season in the summer, since this was the time that most patients
with EM were detected. There was no difference in the treatment
prescribed for patients who did and did not meet the case
definition. These data show that physicians in Maryland are
treating many patients for LD who are clinically diagnosed as
having the disease and have positive serologic test results but
do not meet the CDC case definition.
Zhu, B-P, Lemeshow, S., Hosmer, D.W., and others (1996).
"Factors affecting the performance of the models in the Mortality
Probability Model II system and strategies of customization: A
simulation study." (AHCPR grant HS06026). Critical Care
Medicine 24(1), pp. 57-63.
More than a dozen statistical models have been developed to
estimate the probability of hospital mortality of intensive care
unit (ICU) patients. These models need to be evaluated in order
for them to accurately reflect mortality experience in diverse
clinical settings. The researchers examined the impact of
hospital mortality and ICU size on the performance of the
Mortality Probability Model II system for use in quality
assessment and examined the ability of model customization to
produce accurate estimates of hospital mortality to characterize
patients by severity of illness. They simulated model performance
using data assembled from six adult medical and surgical ICUs in
Massachusetts and New York and found the model to be sensitive to
differences in hospital mortality and thus useful as a quality
Selected publications are available from the National
Technical Information Service
Ordering Information. For copies of these publications, contact the
National Technical Information Service
(NTIS). Refer to the NTIS accession number when ordering.
Acute Pain Management. Guideline Technical Report, Number 1. Most of the 23 million
operations performed each year in the United States involve some form of pain control. Acute
pain management is also needed for most trauma patients and for
patients undergoing certain medical procedures. The Guideline
Technical Report presents scientific evidence tables, and
discusses the results of peer and pilot reviews of guideline
materials. (NTIS accession no. PB95-167391CEB; $44.50 bound copy; $17.50 microfiche.)
AHCPR Clinical Practice Guideline Program. Report to
Congress. This congressionally mandated report summarizes findings and
AHCPR's plans for streamlining and refining its clinical practice
guideline activities. Methods for setting priorities for
guideline topics, generating guidelines, and assessing the
quality and impact of practice guidelines are discussed. (NTIS
accession no. PB95-269148CEB; $27.00 bound copy.)
AHCPR's Program of Patient Outcomes Research and Related
Activities. Report to Congress.
This congressionally mandated report describes the progress
of activities under the Agency's Medical Treatment Effectiveness
Program, a multidisciplinary approach to addressing the complex
issues of health care delivery through outcomes research, data
development, clinical practice guidelines, and dissemination and
evaluation of research findings. (NTIS accession no.
PB95-261764CEB; $19.50 bound copy; $9.00 microfiche.)
Design of a Survey to Monitor Consumers' Access to Care, Use
of Health Services, Health Outcomes, and Patient Satisfaction.
Final Report. This book contains initial sets of questions and procedures
assessing consumer-supplied information that is useful to other
consumers. The authors describe the method and results of the
cognitive testing and how the items in the survey were chosen.
The conceptual development process and description and rationale
for the survey design also are included. (NTIS accession no.
PB95-196036CEB; $36.50 bound copy; $17.50 microfiche.)
Effective Dissemination of Clinical and Health Information.
This publication features presentations from a 1991 conference on
dissemination of clinical and health information. Topics include
disseminating evaluation findings, building network models of
information dissemination, using mass media communications to
enhance public health, designing message strategies, and using
electronic dissemination. (NTIS accession no. PB95-123956CEB;
$36.50 bound copy; $17.50 microfiche.)
Evaluation of a Comprehensive Hospital Information System.
Project Summary. This report documents the differences and similarities in
nearby hospitals, one of which has a 20-year history of
computerization. It looks at a unique information system that was
specifically designed to encourage physician data entry and
thereby capture clinical data at the source. (NTIS accession no.
PB95-269155CEB; $17.50 bound copy.)
Management of Functional Impairment Due to Cataract in Adults.
Guideline Technical Report, Number 4. Cataract surgery is the most common surgical procedure
performed on Americans age 65 and over. This report consists of
recommendations for providing the highest quality of care for
individual patients, based on an extensive review of the relevant
literature and on expert opinion. (NTIS accession no. PB94-175809CEB; $44.50 bound copy;
Maternity Care: Science, Guidelines, and Medical Practice.
Conference Proceedings. This publication contains papers and presentations from a
1991 conference that examined the findings of a 10-year study on
effective care in pregnancy and childbirth. (NTIS accession no.
PB93-213692CEB; $19.50 bound copy; $12.50 microfiche.)
Otitis Media with Effusion in Young Children. Guideline
Technical Report, Number 12. Otitis media with effusion (middle ear fluid) is one of the
most common problems in infants and young children. The
Guideline Technical Report presents recommendations based
on extensive reviews of the relevant medical and health-related
literature and on expert opinion and guideline panel consensus.
(NTIS accession no. PB95-224523CEB; $44.50 bound copy; $17.50 microfiche.) An appendix
detailing written testimony is also available. (NTIS accession no.
PB95-170015CEB; $44.50 bound copy; $17.50 microfiche.)
Physicians, Nurses, and AIDS: Findings From a National
From a social perspective, acquired immunodeficiency syndrome
(AIDS) revives longstanding issues about the willingness of
health care professionals to treat people with a contagious,
fatal, and stigmatized disease. This report presents responses to
AIDS-related questions posed to 958 physicians and 1,520
registered nurses during 1990-1991. The author compares the
responses of both groups and those from different regions in the
United States. (NTIS accession no. PB95-129185CEB; $17.50 bound
copy; $9.00 microfiche.)
Pressure Ulcers in Adults: Prediction and Prevention.
Guideline Report, Number 3. Most pressure ulcers can be prevented, and early-stage
pressure ulcers that do appear need not worsen. The Guideline
Report contains a comprehensive literature review, details the
methodology of the guideline, and presents exhaustive evidence
tables and reference lists. (NTIS accession no. PB95-167383CEB;
$36.50 bound copy; $17.50 microfiche.)
Prostate Disease: Final Report of the Patient Outcomes
Research Team. This report discusses a 5-year study (1989-1994) conducted to
better define the outcomes of health care for men with two very
common diseases of aging: benign prostatic hyperplasia
(enlargement) and early stage prostate cancer. Outcomes of care
are assessed and made available to patients, clinicians, and
policymakers. (NTIS accession no. PB95- 253811CEB; $19.50 bound
copy; $9.00 microfiche.)
Putting Research Into Practice: Report of the Task Force on
Building Capacity for Research in Primary Care.
This report describes the critical need for primary care research
and provides 10 recommendations that include national,
institutional, collaborative, and individual career strategies
for increasing support for research in primary care. (NTIS
accession no. PB93-218584CEB; $17.50 bound copy; $9.00
Understanding and Choosing Clinical Performance Measures for
Quality Improvement: Development of a Typology.
Three decades of research have yielded a scientific basis for
research and development in clinical performance measurement and
improvement. This book presents a literature review and results
of a survey on instruments that estimate how well providers
deliver appropriate clinical care. Information on a system for
analyzing the instruments' properties and uses also is included.
Attachments, (NTIS accession no. PB95-184784CEB; $27.00 bound
copy; $12.50 microfiche.)
Use of Language in Clinical Practice Guidelines.
This resource helps drafters of clinical practice guidelines
express themselves with clarity and precision. Since guidelines
not only affect clinical practice, but also may be used in
litigation, drafters should be alert to the significance of
language used. (NTIS accession no. PB93-213700CEB; $17.50 bound
copy; $9.00 microfiche.)
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AHCPR Publication No. 96-0060
Current as of June 1996