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AHCPR releases new hospital data
The Agency for Health Care Policy and Research recently released the 1995 Nationwide Inpatient Sample (NIS), a powerful set of data that can be used to identify and track major national trends in the cost, use, and quality of health care. The NIS is one product resulting from the Healthcare Cost and Utilization Project (HCUP-3), a Federal-State-industry partnership sponsored by AHCPR to provide data that States, private policymakers, and researchers can use to measure and evaluate the impact of variations and changes in health care delivery.
The NIS Release 4 sample is a stratified probability sample of hospitals from 19 participating States. It is designed to approximate a 20-percent sample of U.S. community hospitals. All discharges from sample hospitals are included in the NIS database. Data are provided in a set of six CD-ROMs that contains all-payer data for 1995 for approximately 6.7 million inpatient stays in more than 900 hospitals across the United States. These data can be linked back to the 1988-92, 1993, and 1994 data.
NIS data can be used to study many aspects of hospital care, for example:
- Comparing services and costs of hospital chains and individual facilities with national data.
- Determining the costs of treating specific conditions.
- Examining health care cost inflation.
- Studying time trends from 1988 to 1995.
The NIS is a dataset of extraordinary power. It can be run on desktop computers and is in ASCII format for ease of use with numerous off-the-shelf software products, including SAS and SPSS. It includes weights to produce national and regional estimates and can be linked to county-level information on the availability of medical personnel and services from the Bureau of Health Professions' Area Resource File.
The NIS captures information on uncommon conditions and procedures, such as congenital anomalies and organ transplantation, and it protects the privacy of individual patients and physicians.
The NIS Release 4 is now available from the National Technical Information Service (NTIS); the six CD-ROM set costs $160 (NTIS accession no. PB98-500440). Previous releases available through NTIS are: NIS Release 3, 1994 data on CD-ROM (PB97-500433) $160; NIS Release 2, 1993 data on CD-ROM (PB96-501325) $160; NIS Release 1, 1988-92 data on CD-ROM (PB95-503710) $300.
For more information on NIS Release 4 or other NIS information, call AHCPR at 866-290-HCUP (4287) toll-free, or via E-mail at firstname.lastname@example.org.
Editor's note: Select the January 1998 issue of Research Activities for information on a new tool that can be used to develop comorbidity measures for use with large administrative databases, such as the NIS. The tool was developed by AHCPR researchers using HCUP-3 data from California. A free reprint of the journal article "Comorbidity measures for use with administrative data" (AHCPR Publication No. 98-R013), by Anne Elixhauser, Ph.D., Claudia Steiner, M.D., M.P.H., Robert Harris, Ph.D., and Rosanna M. Coffey, Ph.D., which appeared in Medical Care 36(1), pp. 8-27, 1997, is available from the AHCPR Publications Clearinghouse.
AHCPR funds new studies
The following research and conference grants were funded recently by the Agency for Health Care Policy and Research. Readers are reminded that the results of studies usually are not available until after the project is completed or nearing completion.
Determinants of nursing home resident hospital use
Project director: Orna Intrator, Ph.D.
Organization: Brown University
Project number: AHCPR grant HS09723
Period: 7/1/98 to 6/30/00
First year funding: $180,462
Does primary care access decrease respiratory
Project director: Robert A. Lowe, M.D.
Organization: University of Pennsylvania
Project number: AHCPR grant HS09261
Period: 6/1/98 to 5/31/00
First year funding: $487,276
Impact of physician specialty on post-MI care and outcomes
Project director: John Ayanian, M.D.
Organization: Harvard Medical School
Project number: AHCPR grant HS09718
Period: 7/1/98 to 6/30/00
First year funding: $218,400
Improving quality of care for newborns with jaundice
Project director: R. Heather Palmer, M.D.
Organization: Harvard School of Public Health
Project number: AHCPR grant HS09782
Period: 5/1/98 to 4/30/03
First year funding: $79,570
Measuring and improving quality: Carotid endarterectomy
Project director: Mark. R. Chassin, M.D.
Organization: Mount Sinai School of Medicine
New York, NY
Project number: AHCPR grant HS09754
Period: 6/1/98 to 5/31/03
First year funding: $420,073
Patient-based quality assessment for chronic disease
Project director: Sheldon Greenfield, M.D.
Organization: New England Medical Center
Project number: AHCPR grant HS09756
Period: 4/1/98 to 3/31/00
First year funding: $300,789
Pressure ulcer rates in describing nursing home quality
Project director: Dan R. Berlowitz, M.D.
Organization: Boston Medical Center
Project number: AHCPR grant HS09768
Period: 4/1/98 to 3/31/00
First year funding: $347,660
Quality improvement in nursing homes
Project director: Francois Sainfort, Ph.D.
Organization: University of Wisconsin
Project number: AHCPR grant HS09746
Period: 5/1/98 to 4/30/00
First year funding: $200,496
Risk adjustment methods for hysterectomy complications
Project director: Evan R. Myers, M.D.
Organization: Duke University Medical Center
Project number: AHCPR grant HS09760
Period: 5/1/98 to 4/30/00
First year funding: $154,555
Surgical outcome rates: Identifying etiologic factors
Project director: Jeffrey H. Silber, M.D., Ph.D.
Organization: Children's Hospital of Philadelphia
Project number: AHCPR grant HS09460
Period: 3/1/98 to 8/31/01
First year funding: $558,844
Understanding clinical and administrative outcomes
Project director: Jeremy Holtzman, M.D.
Organization: University of Minnesota
Project number: AHCPR grant HS09735
Period: 7/1/98 to 12/31/99
First year funding: $172,133
Validation of quality measures for hip replacement
Project director: Jeffrey N. Katz, M.D.
Organization: Brigham and Women's Hospital
Project number: AHCPR grant HS09775
Period: 7/1/98 to 6/30/00
First year funding: $259,797
Child health services
Project director: James Marc Perrin, M.D.
Organization: Ambulatory Pediatric Association
Project number: AHCPR grant HS09815
Period: 4/1/98 to 9/30/98
Cochrane IV systematic reviews: Evidence for action
Project director: Kay Dickersin, Ph.D.
Organization: University of Maryland
Project number: AHCPR grant HS09818
Period: 5/1/98 to 2/28/99
Building bridges IV research conference
Project director: Barbara Lardy, M.P.H.
Organization: American Association of Health Plans
Project number: AHCPR grant HS09816
Period: 4/1/98 to 10/30/98
Mental health services delivery in primary and specialty care settings
Project director: Annie G. Steinberg, M.D.
Organization: Children's Seashore House
Project number: AHCPR grant HS09813
Period: 4/1/98 to 3/31/99
Northwest health policy research conference, 1998
Project director: Aaron Katz, M.D.
Organization: University of Seattle
Project number: AHCPR grant HS09817
Period: 4/1/98 to 9/30/98
NRSA annual trainees' conference, 1998 through 2003
Project director: Kevin A. Schulman, M.D.
Organization: Georgetown University
Project number: AHCPR grant HS09700
Period: 4/1/98 to 3/31/03
Staffing, case mix, and quality in nursing homes
Project director: Christine Kovner, Ph.D.
Organization: New York University
New York, NY
Project number: AHCPR grant HS09814
Period: 4/1/98 to 3/31/99
New publications now available from AHCPR and NTIS
The following publications and grant final reports are now available from the Agency for Health Care Policy and Research and the National Technical Information Service (NTIS). For final reports, each listing identifies the project's principal investigator (PI), his or her affiliation, the grant number and project period, and provides a brief description of the project.
Competition and Health Plan Premium Determination. Randall P. Ellis, Ph.D., Boston University, Boston, MA. AHCPR grant HS08159, project period 8/1/94 to 8/31/96.
This project examined how health premium cost-sharing affects the levels of health plan premiums. Detailed information was collected on State employee health plans in 35 States, with each plan offered and each rate class (e.g., single versus family coverage) contributing a distinct observation. Data were collected on 4,289 health plans. Analysis showed that premium levels seemed to respond to changes in how premiums were calculated. Two actions tended to reduce health plan premiums: increasing the share of premiums paid by employees for single and family coverage and increasing the number of plans offered. Abstract and executive summary are available from the National Technical Information Service (NTIS accession no. PB98-131337; 18 pp, $23.00 paper, $12.00 microfiche).
Consumer Health Informatics and Patient Decision-Making: Final Report (AHCPR contract 290-96-0011). Hersey, J.C., Matheson, J., and Lohr, K.N. (AHCPR Publication No. 98-N001). Rockville, MD: AHCPR, 1997.
Medical organizations are beginning to invest heavily in the development and dissemination of health informatics tools that provide patients with treatment- or disease-specific information, especially when patients are faced with choices among several options for managing their illnesses. To determine the scientific knowledge base underlying these tools, AHCPR contracted with Research Triangle Institute (RTI) to evaluate and synthesize research on their effects. Both computerized and noncomputerized tools were reviewed, including interactive computer discs, videotapes, audiotapes, brochures, and computer-generated fact sheets. RTI contacted researchers in the United States, Canada, and the United Kingdom and found surprisingly few relevant studies that varied in quality. Most studies to date have been exploratory and have not used rigorous research methods. Finally, they found no comparative studies of the cost and effectiveness of different types of tools. They conclude that informatics tools have the potential to help patient decisionmaking, but that much remains to be learned. The authors offer suggestions for researchers working in this area, such as developing stronger links between existing theories and new initiatives, carefully describing the theoretical and operational context of implementing the tools, and paying greater attention to rigorous controls, adequate sample size, and standardized measurement.
Copies of the report (AHCPR Publication No. 98-N001) are available from the AHCPR Publications Clearinghouse.
Delivering Education to Rural Health Care Providers. Michael G. Kienzle, M.D., University of Iowa, Iowa City, IA. AHCPR grant HS09322, project period 9/1/96 to 8/31/97.
Access to high-quality continuing education, electronic information resources, and decision support is lacking in the rural setting. Emerging technologies such as video conferencing and the Internet may narrow the gaps that exist between rural and nonrural settings. In April 1997, the University of Iowa hosted the conference, "Health Connections: Delivering Continuing Education to Rural Health Care Practitioners," which was attended by more than 180 participants, including physicians, nurses, educators, administrators, and technologists interested in community-based education. Plenary sessions, workshops and demonstrations addressed several areas of interest, including new educational approaches, telemedicine, the Internet, interactive video, and electronic mail, as well as agenda-setting for rural health education. Abstract, executive summary, and final report are available from the National Technical Information Service (NTIS accession no. PB98-131329; 28 pp, $23.00 paper, $12.00 microfiche).
Effects of HMO Market Structure on Firm and Consumer Behavior in the Employment-Based Health Insurance Market. Jack Hadley, Ph.D., Georgetown University, Washington, DC. AHCPR grant HS09193, project period 7/1/96 to 6/30/97.
This project involved a number of multivariate statistical analyses to address the general question of how variations in HMO market structure affect particular aspects of the employment-based health insurance market. HMO market structure was measured by two variables defined for sample employers in metropolitan statistical areas (MSAs): HMO penetration (HMO enrollment as a percentage of total population), which is a continuous measure of the prevalence of HMOs in the market; and HMO competition, which indicates whether the market has both high HMO penetration (30 percent or higher) and high HMO competition (in the first quartile of the Hirschman-Herfindahl Index of HMO concentration). The following dependent variables were analyzed: (1) the type of insurance plan offered by employers, (2) premiums charged to employers for managed care and fee-for-service plans, (3) premium-sharing between employers and workers, (4) the use of internal financial incentives by employers to influence workers' selection of an insurance plan, and (5) the effects of such incentives and HMO market structure on the proportion of workers actually selecting a managed care plan. The primary data source for the analyses was approximately 1,500 employers in the 75 largest MSAs surveyed by KPMG Peat-Marwick from 1994 to 1996. The results generally support the hypothesis that HMO market structure has a significant impact on employment-based health insurance, which is manifested through changes in the efficiency of both the health care and health insurance markets, market-level risk selection, and internal (to the employer) risk selection. Abstract, executive summary, and final report are available from the National Technical Information Service (NTIS accession no. PB98-126758; 164 pp, $41.00 paper, $17.00 microfiche).
First Annual Chicago Health Services Research Symposium. Edward F. Lawlor, Ph.D., University of Chicago, Chicago, IL. AHCPR grant HS09361, project period 12/1/96 to 3/31/97.
The "First Annual Chicago Health Services Research Symposium" was held January 30-31, 1997. The Research Center Director's Consortium served as an advisory committee in accomplishing the symposium's goal of defining selected issues, problems, and phenomena in the delivery of health services and presenting a research agenda/strategy for study. The symposium involved 350 participants representing local, State, and regional governments, academic institutions, advocacy agencies, health institutions, and trade associations from Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, and Wisconsin. Topical sessions focused on substance abuse and mental health, health economies, maternal and child health, geriatrics and long-term care, and health outcomes. Conference proceedings are available from the National Technical Information Service (NTIS accession no. PB98-126360; 174 pp, $41.00 paper, $17.00 microfiche).
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 and demonstrated for the first time that: (1) better access to care is cross-sectionally and prospectively associated with better health outcomes, (2) poor access is associated with a higher rate of hospitalization, and (3) sick, indigent populations are not well represented in HIV clinical trials. The study reported on strategies to collect quality-of-life information late in such populations and developed improved methods to assess illness, constitutional symptoms, access to care, and quality of life in HIV. The study found 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 are available from the National Technical Information Service (NTIS accession no. PB98-126816; 19 pp, $23.00 paper, $12.00 microfiche).
Managed Care and Hospital/Physician Integration. Michael A. Morrisey, Ph.D., University of Alabama, Birmingham, AL. AHCPR grant HS09183, project period 10/1/95 to 9/30/97.
The objectives of this study were to describe the different integrative structures and processes that hospitals and physicians have developed and to estimate the impact of managed care on their efforts. Data came principally from the 1,495 community hospitals responding to the 1993 Survey of Hospital-Physician Relationships conducted for the Prospective Payment Review Commission.
Three findings emerged: (1) there was very little evidence that integration efforts were related to managed care, (2) hospitals have been more aggressive in establishing internal integration efforts than external ones, and (3) hospitals have undertaken integration efforts for a variety of reasons which may have no relationship to managed care. There are at least two interpretations of these findings. The efforts at integration may be anticipatory in nature, or vertical integration may not be the best organizational form for dealing with the new health care market. The data are not well suited to differentiating between these interpretations. Future work should examine the issues longitudinally. Abstract, executive summary, and final report are available from the National Technical Information Service (NTIS accession no. PB98-126519; 36 pp, $25.50 paper, $12.00 microfiche).
Referral Process in Primary Care Settings. Barbara Starfield, M.D., M.P.H., American Academy of Pediatrics, Elk Grove, IL. AHCPR grant HS08430, project period 9/30/94 to 3/29/97.
This study examined rates, patterns, and outcomes of referrals made by 156 pediatric practitioners in 96 practices in a nationally representative, practice-based research network. Data were collected on 61,401 office visits and 1,972 referrals. The aims of the project were to: (1) describe variability in referral rates and characteristics of referrals in terms of diagnoses referred, specialties referred to, reasons for making the referral, and duration of the referral; (2) examine how referrals are coordinated across the primary-specialty care interface and identify factors related to successful coordination of a referral; (3) compare referrals made during phone conversations with parents with those made during office visit encounters; (4) determine how gatekeeping influences rates, patterns, and outcomes of referrals to specialty care; and (5) develop a multivariate prediction model of physicians' referral decisionmaking that includes patient, physician, and health system factors. Abstract, executive summary, and final report are available from the National Technical Information Service (NTIS accession no. PB98-126808; 88 pp, $29.50 paper, $12.00 microfiche).
Predicting Physicians' Medical Malpractice Experience. Derek A. Weycker, Ph.D., Wayne State University, Detroit, MI. AHCPR grant HS09340, project period 9/1/96 to 8/31/97.
This study examined the nature of medical malpractice litigation against physicians in Michigan and analyzed the determinants of their encounters with such litigation over the period 1980 to 1989. The researcher used descriptive and statistical measures to show that the distribution of malpractice claims is highly concentrated, both within a given year and over time, among a small subset of the physician population. Multivariate regression analysis was used to show that a physician's past claims experience—along with certain physician characteristics and training credentials—has substantial predictive value of his or her future claims experience. Specifically, the results indicate that physicians with at least one prior claim, regardless of the outcome of the claim, have significantly higher odds of incurring an adverse future record relative to physicians with no prior claims experience. Moreover, odds generally increase in terms of the number and size of claims as the degree of prior claims experience increases. Physicians who attend a higher ranked medical school or residency program have significantly lower odds of incurring an adverse malpractice record. Finally, the physician's sex, employment classification, location of practice, and primary specialty class are strongly associated with claims experience. Abstract, executive summary, and dissertation are available from the National Technical Information Service (NTIS accession no. PB98-116684; 256 pp, $47.00 paper, $19.50 microfiche).
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Chaisson, R.E., Gallant, J.E., Keruly, J.C., and Moore, R.D. (1998). "Impact of opportunistic disease on survival in patients with HIV infection." (AHCPR grant HS07809). AIDS 12(1), pp. 29-33.
Virtually all deaths related to the human immunodeficiency virus (HIV) that causes AIDS are due to so-called opportunistic infections that take advantage of a person's weakened immune system, which is the hallmark of the disease. The risk of opportunistic infection increases dramatically at CD4 cell counts of 200 and less. However, this study shows that most opportunistic diseases increase the risk of death independently of CD4 cell count and enhance HIV pathogenesis. It is based on a 30-month followup of 2,081 predominantly black HIV-infected patients at one urban HIV clinic. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalopathy (PML), dementia, wasting, toxoplasmosis, and cryptosporidiosis were all significantly associated with death, independent of CD4 cell count. The increased risk was greatest for lymphoma, PML, MAC, and CMV. In addition, patients who had opportunistic diseases had significantly greater monthly declines in CD4 counts than those who did not.
Cohen, R.A., Muzaffar, S., Schwartz, D., and others (1998). "Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission."(AHCPR grant HS08427). American Journal of Respiratory and Critical Care Medicine 157, pp. 156-161.
The recent resurgence of tuberculosis (TB) complicated by the AIDS epidemic has refocused attention on the need for more rapid and accurate diagnostic tests. Decisions regarding respiratory isolation and institution of therapy are still based largely on clinical grounds. But this study shows that polymerase chain reaction (PCR) assay may be a useful tool to evaluate patients for TB during the first hospital day. The researchers assessed the diagnostic yield of PCR prospectively in a blinded study of patients admitted to the hospital to rule out TB. They compared PCR results to a culture and clinical diagnosis of TB. They analyzed specimens sent for routine smear, culture, and PCR analysis. Of the 85 enrolled patients, 27 had cultures positive for TB; 12 were smear-positive. A positive PCR on at least one of two specimens collected in the first 24 hours was 85 percent sensitive and 88 percent specific for the Roche technique and 74 percent sensitive and 93 percent specific for the in-house technique. Sensitivity in smear-negative patients was 73 percent and 53 percent, respectively.
Hannan, E.L., Stone, C.C., Biddle, T.L., and DeBuono, B.A. (1997, December). "Public release of cardiac surgery outcomes data in New York: What do New York State cardiologists think of it?" (AHCPR grant HS06503). American Heart Journal 134(6), pp. 1120-1128.
In 1990, the New York State Department of Health began releasing to hospitals and the public coronary artery bypass graft (CABG) surgery outcomes for all hospitals in New York in which the procedure was performed. Since 1991, the same type of information has been publicly released on a surgeon-specific basis. Based on survey responses of 450 cardiologists practicing in New York State, the majority have not changed their well-established referral patterns in response to the reports.
A majority (67 percent) of the cardiologists found the report to be accurate in capturing differences in the performance of cardiac surgeons, whereas 33 percent found it to be inaccurate. Twenty-two percent reported that they routinely discuss the reports with their patients, and 38 responded that the information has affected their referrals to surgeons "very much" or "somewhat."
Hazuda, H.P. (1997). "Minority issues in Alzheimer disease outcomes research." (AHCPR grant HS07397). Alzheimer Disease and Associated Disorders 11(S6), pp. 156-161.
Ethnic minorities make up the fastest growing segment of the U.S. elderly population. Working with ethnic minorities poses important measurement challenges for Alzheimer disease outcomes researchers. Measurement outcomes should include cognition, symptoms (behavior, mood, and psychiatric), physical status, functioning and self-care abilities, quality of life, and family caregiver outcomes. Researchers need to use cross-cultural adaptation to the idiom, lifestyle, and daily context of the ethnic culture, whether or not there are language differences, to ensure that the version of a measurement instrument used with any given ethnic minority is cross-culturally equivalent to the original measurement instrument.
Hirth, R.A. (1997, December). "Competition between for-profit and nonprofit health care providers: Can it help achieve social goals?" (AHCPR grant HS06934). Medical Care Research and Review 54(4), pp. 414-438.
This article outlines a theory of competition between for-profit and nonprofit health care providers. The theory demonstrates conditions under which nonprofit organizations (NPOs) can help achieve social goals and explores how the nondistribution constraint imposed on NPOs regulates the competitive process. It shows that competition from NPOs can create a positive spillover effect on the performance of the for-profit sector. The theoretical arguments, which focus on patients who are poorly informed about quality, are then extended to the hospital sector where there are a variety of social programs including charity care, education, and community health programs.
These ideas serve as the basis for a literature review on hospital ownership, competition, and the provision of "social goods," as well as a critique of empirical research on the relative performance of for-profit and nonprofit providers. The article concludes with implications for policy toward NPOs in service industries and a discussion of how empirical research can inform such policy.
Jamason, P.F., Kalkstein, L.S., and Gergen, P.J. (1997). "A synoptic evaluation of asthma hospital admissions in New York City." American Journal of Respiratory and Critical Care Medicine 156, pp. 1781-1788.
Peter J. Gergen, M.D., M.P.H., of AHCPR's Center for Primary Care Research, and his colleagues evaluate weather/asthma relationships in the New York City area using a synoptic climatological methodology. This procedure isolates "air masses"—or bodies of air that are homogeneous in meteorological character—and relates them to daily counts of overnight asthma hospital admissions. Apparently, certain air masses are related to significant increases in asthma hospital admissions. The impact varies seasonally, with weather having a particularly important impact on asthma admissions during fall and winter. Air pollution has little impact on asthma during these two seasons. However, during spring and summer, the air masses associated with highest admissions are among those with high pollution concentrations. If these results can be replicated at other locations, it may be possible to develop an asthma/weather watch-warning system. Reprints (AHCPR Publication No. 98-R050) are available from the AHCPR Publications Clearinghouse.
Patrick, D.L. (1997). "Finding health-related quality of life outcomes sensitive to healthcare organization and delivery." (AHCPR grant HS06833). Medical Care 35(11), pp. NS49-NS57.
This paper was presented at the AHCPR-sponsored conference, "Outcome Measures and Care Delivery Systems," held June 20-22, 1996, in Washington, DC. It identifies health-related quality-of-life outcomes sensitive to health care organization and delivery, evaluates the state of the art in applying these outcomes, and presents a research agenda on creating and using outcomes. As the author points out, the rapid growth of managed care has increased the demand for indicators of system performance. Although generic measures already exist for assessing outcomes related to functional status and well-being, condition-specific measures are also needed to address directly the concerns of patients and providers and to detect small differences in organizational arrangements.
Reilly, C.A., Holzemer, W.L., Henry, S.B., and others (1997, November). "A comparison of patient and nurse ratings of human immunodeficiency virus-related signs and symptoms." (AHCPR training grant T32 HS00026). Nursing Research 46(6), pp. 318-323.
Effective management of the symptoms of human immunodeficiency virus (HIV) disease is important to delay disease progression to AIDS and to maintain optimal health and quality of life. Since management strategies are guided by the assessment of the symptom experience, agreement between patients' and nurses' perceptions of symptoms is central to clinical management. In this study, AIDS patients' perceptions of 41 HIV-related signs and symptoms were compared in 207 pairs of ratings by 207 patients and 103 nurses. Mean patient intensity ratings for all signs and symptoms, with the exception of anxiety, were higher than nurse ratings. This suggests that nurses' ratings poorly predicted patients' symptom experiences.
Schwartz, C.E., Coulthard-Morris, L., Cole, B., and Vollmer, T. (1997, December). "The quality-of-life effect of interferon beta-1b in multiple sclerosis." (AHCPR grant HS08582). Archives of Neurology 54, pp. 1475-1480.
Until recently, drug therapies for multiple sclerosis (MS) have been ineffective at influencing the generally debilitating course of this chronic demyelinating disease of the central nervous system. About half of the 350,000 people with MS in the United States would be eligible for interferon beta-1b. A recombinant form of the drug was given FDA approval for use in treating relapsing-remitting MS in 1993. These researchers evaluated treatment with the drug in 79 patients with MS who participated in a random allocation lottery and were followed for 12 months. During the followup year, case patients reported 10.6 months of quality-adjusted time, compared with 10.4 months for control patients. Thus, the first year of treatment did not substantially improve or detract from patients' quality of life.
Turner, B.J., Markson, L., Cocroft, J., and others (1998, January). "Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia." (AHCPR grant HS06465). Journal of General Internal Medicine 13, pp. 16-23.
Pneumocystis carinii pneumonia (PCP) has from the start been one of the most common and feared complications of human immunodeficiency virus (HIV) disease. PCP prevention appears to be more successful in clinics offering an array of HIV-focused services, according to this study of Medicaid-insured AIDS patients in New York State from 1990 to 1992. Of 1,876 HIV-infected persons, 44 percent had received PCP prophylaxis, and 38 percent had primary PCP. Those on prophylaxis had 20 percent lower odds of developing PCP. The odds of receiving prophylaxis rose with the number of HIV-focused services offered by the clinic, with three-fold higher odds for six versus two or fewer services.