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Alster, K.B., and Radwin, L.E. (2004, August). "The deserved care framework for evaluating health care quality." (AHRQ grant HS11625). Home Health Care Management & Practice 16(5), pp. 332-338.
Excessively narrow definitions of health care quality do not identify certain important components of health care for clinicians, providers, or patients. On the other hand, excessively broad definitions drive up health care costs and encourage unjustified interventions. These authors propose a framework for examining health care quality in terms of what patients need, want, and deserve, and they advance the idea that deserved care is the relevant concept of care to inform health policy debates.
Baser, O., Bradley, C.J., Gardiner, J.C., and Given, C. (2003). "Testing and correcting for non-random selection bias due to censoring: An application to medical costs." (AHRQ grant HS09514). Health Services & Outcomes Research Methodology 4, pp. 93-107.
A common problem with medical cost data is censoring. Since costs accrue over time and some patients may not be followed until the endpoint of interest, their medical costs are not fully observed. This paper presents a systematic treatment of the correction for nonrandom sample selection bias of medical cost data, where the selection rule is described by a censored regression model. Data from a study on the medical cost of breast, prostate, colon, and lung cancer are used as an application of the method.
Bent, S., Shojania, K.G., and Saint, S. (2004, June).
"The use of systematic reviews and meta-analyses in infection control and hospital epidemiology." (AHRQ grant HS11540). American Journal of Infection Control 32,
Systematic research reviews adhere to a prospectively defined protocol that specifies how studies should be identified, evaluated, and statistically combined. This approach reduces the bias inherent in traditional narrative reviews, allowing authors to pick and choose the studies they discuss and the depth of their discussion. About 1,000 systematic reviews published annually focus on topics important to infection control professionals. This article discusses the essential elements of a systematic review and provides a framework for evaluating the quality of the review. It should help the infection control professional and hospital epidemiologist in determining whether the results of such reviews should change clinical practice.
Kan, H., Goldman, D., Keeler, E., and others (2003). "An analysis of unobserved selection in an inpatient diagnostic cost group model." (AHRQ grant HS11403). Health Services & Outcomes Research Methodology 4, pp. 71-91.
Models that better capture selection bias are needed to reduce overestimation of Medicare HMO enrollees' resource use. These researchers assessed unobserved selection bias in an inpatient diagnostic cost group (DCG) model similar to Medicare's Principal Inpatient Diagnostic Cost Group (PIP-DCG) risk adjustment model. They used a unique data set containing hospital discharge records for both fee-for-service (FFS) and HMO Medicare beneficiaries in California from 1994 to 1996. They found that the inpatient DCG model did not adequately adjust for biased selection in Medicare HMOs. New HMO enrollees were healthier than FFS beneficiaries, even after adjustment for the included PIP-DCG risk factors. A model developed over an FFS sample that ignored unobserved selection overestimated hospital use of new HMO enrollees by 28 percent compared with their use if they had remained in an FFS plan.
McDonagh, M., Helfand, M., Carson, S., and Russman, B.S. (2004, July). "Hyperbaric oxygen therapy for traumatic brain injury: A systematic review of the evidence."(AHRQ contract 290-97-0018). Archives of Physical Medicine and Rehabilitation 85, pp. 1198-1204.
These authors systematically reviewed the evidence for the benefits and harms of hyperbaric oxygen therapy (HBOT) for traumatic brain injury (TBI). Two fair-quality trials of patients with severe brain injury reported conflicting results. One found no difference in mortality or morbidity at 1 year between HBOT and control patients. The other found significantly lower mortality in the HBOT group at 1 year compared with controls (17 vs. 31 percent). However, this decrease in mortality was accompanied by an increase in the proportion of patients with severe disability. No study systematically assessed adverse events, and none reported adverse events in control groups. The authors conclude that the available evidence for HBOT for TBI is insufficient to establish effectiveness or ineffectiveness; they call for more high-quality studies on this topic.
Ness, R.B., Randall, H., Richter, H.E., and others (2004, August). "Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease." (AHRQ grant HS08358). American Journal of Public Health 94(8), pp. 1327-1329.
For this study, researchers correlated self-reports of condom use with recurrent pelvic inflammatory disease (PID), chronic pelvic pain, and infertility among 684 sexually active women with PID, whom they followed for a mean of 35 months. The women were enrolled in the PID Evaluation and Clinical Health (PEACH) cohort and were recruited from 13 U.S. sites between 1996 and 1999. Condom use was considered to be consistent if a woman reported use in at least 6 of the last 10 sexual encounters. Rates of recurrent PID, chronic pelvic pain, and infertility were highest among inconsistent condom users (condom use reported at 25 percent to less than 50 percent of interviews) and lowest among consistent condom users (condom use reported at 75 to 100 percent of interviews). After adjusting for other factors, consistent condom users had 50 percent less risk than inconsistent condom users of recurrent PID. Reduced risk of recurrent PID for users of other barrier methods such as diaphragms was nonsignificant. Use of oral contraceptives or medroxyprogesterone was not associated with significantly elevated or reduced risks of the PID sequelae studied.
Resnic, F.S., Zou, K.H., Do, D.V., and others (2004, August). "Exploration of a Bayesian updating methodology to monitor the safety of interventional cardiovascular procedures." (AHRQ grant HS13234). Medical Decision Making 24, pp. 399-407.
Development and implementation of appropriate methods for monitoring the safety of cardiology interventions have proven difficult. These authors propose Bayesian updating, which incorporates existing knowledge regarding adverse event rates into the estimation of risk, as a method to monitor the safety of interventional cardiovascular procedures. They use this method to retrospectively analyze the clinical outcomes of 309 patients undergoing an infrequent interventional cardiology procedure, rotational atherectomy. Their analysis demonstrates the feasibility of Bayesian updating applied to medical device safety evaluation and indicates that the method can generate stable estimates in a variety of patient risk groups.
Rovner, D.R., Wills, C.E., Bonham, V., and others (2004, July). "Decision aids for benign prostatic hyperplasia: Applicability across race and education." (AHRQ grant HS10608). Medical Decision Making 24, pp. 359-366.
Patient decision aids have not been widely tested in diverse audiences. These authors conducted interviews with 188 adults 50 years of age or older to test their knowledge about benign prostatic hyperplasia both before and after watching a videotape on the condition. The subjects were stratified by race and level of education. Contrary to expectations, results showed no difference by race or college education in knowledge gain or increase in reported readiness to decide about treatment after watching the videotape. This suggests that a well-designed decision aid may be equally effective for men of different races and education levels.
Seid, M., Sobo, E.J., Gelhard, L.R., and Varni, J.W. (2004, July). "Parents' reports of barriers to care for children with special health care needs: Development and validation of the barriers to care questionnaire." (AHRQ grant HS13058). Ambulatory Pediatrics 4(4), pp. 323-331.
This article describes the development and validation of the Barriers to Care Questionnaire (BCQ). The 39-item BCQ was developed through review of the literature, focus groups, and cognitive interviews of Spanish- and English-speaking parents of children with chronic health conditions. The authors field tested the BCQ in three samples of children with special health care needs. BCQ scores were higher (fewer barriers) for children with a primary care physician and for those who reported no problems getting care or having to forgo care. The authors conclude that the BCQ is a feasible, reliable, and valid instrument for measuring barriers to care for children with special health care needs.
AHRQ Publication No. 05-0008
Current as of October 2004