This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Balas, E.A., Austin, S.M., Ewigman, B.G., and
"Methods of randomized controlled clinical trials in health
services research." (AHCPR grant HS07268). Medical Care 33(7),
The authors analyzed the methodologies employed by health
services researchers who conduct randomized controlled clinical
trials to evaluate the cost, quality, and effectiveness of health
care services. They created and validated a streamlined quality
evaluation tool and used it to analyze 101 trials from the
Columbia Registry of Controlled Clinical Trials. Of a possible
score of 100, the trials received an average score of 54.8.
Significant quality deficiencies showed up in sample size,
description of case selection, data on possible adverse effects,
analysis of secondary effect variables, and retrospective
analysis. The researchers found their quality evaluation tool to
be useful as a checklist that could prompt investigators to
provide pertinent information when designing a trial and
reporting its results.
Bombardier, C., Melfi, C.A., Paul, J., and
"Comparison of a generic and a disease-specific measure of pain
and physical function after knee replacement surgery." (AHCPR
grant HS06432). Medical Care 33(4), pp.
Both generic and disease-specific health status instruments are
commonly used to assess patients' outcomes. According to this
Total Knee Replacement Patient Outcomes Research Team (PORT)
study, these instruments are complementary, and both are needed
to fully assess patient outcomes. The PORT researchers used a
sample of patients 67 to 99 years of age who had undergone knee
replacement surgery 2 to 7 years earlier. They compared patients'
scores on a generic health-related quality-of-life (HRQOL) SF-36
measure with their scores on the Western Ontario and McMaster
Universities (WOMAC) Osteoarthritis Index. The distribution of
scores in pain, physical function, and overall score were
consistently higher on the WOMAC than on the SF-36, indicating
less disability from arthritis than from other conditions after
knee surgery in this elderly population. The WOMAC index was
better able to discriminate persons with more or less severe knee
problems, whereas the SF-36 discriminated better among persons
with varying levels of overall health status and coexisting
Glanz, M., Klawansky, S., Stason, W., and
others (1995, June).
"Biofeedback therapy in poststroke rehabilitation: A
meta-analysis of the randomized controlled trials." (AHCPR
poststroke guideline development contract 282-91-0085).
of Physical Medicine and Rehabilitation 76, pp.
Approximately 150,000 individuals die each year as a result of
strokes, and 60 percent of stroke survivors suffer some degree of
long-term disability. Evidence for the efficacy of rehabilitative
efforts for stroke patients has been lacking. These researchers
pooled results of a meta-analysis of randomized controlled trials
of biofeedback therapy to assess its efficacy in poststroke
rehabilitation. Biofeedback was applied to a paretic (weak or
paralyzed) limb of patients in the rehabilitative phase of their
illness. Patients in both treatment and control groups received
standard physical therapy. According to the researchers, results
do not support the efficacy of biofeedback in restoring the range
of motion of hemiparetic joints, that is, joints on one side of
the body that are weak or paralyzed. The researchers caution,
however, that their findings are based on relatively few studies
with small individual sample sizes and that the studies
themselves raise questions in terms of population homogeneity and
the randomization process used.
Guadagnoli, E., Cleary, P.D., and McNeil, B.J.
influence of socioeconomic status on change in health status
after hospitalization." (AHCPR grant HS06341). Science and
Medicine 40(10), pp. 1399-1406.
An association between socioeconomic status (SES) and health
status has been well established. Poorer, less educated patients
experience higher rates of serious illness, spend more time in
bed because of illness, and report fewer health care visits than
higher SES patients. A recent study found that hospitalization
has little effect on gaps in health status that exist between
high and low SES patients. The researchers used hospital records
and a posthospitalization questionnaire to examine the influence
of SES on the health status of 1,962 patients recently discharged
from six university-affiliated teaching hospitals following stays
for chest pain and four types of surgery (coronary artery bypass
grafting, total hip replacement, gallbladder removal, and
prostatectomy). They found that on admission to the hospital,
lower SES patients were less able to function (activities of
daily living, social activities, and work performance) compared
with higher SES patients. Yet afterwards, both high and low SES
patients with chest pain improved minimally compared with
prehospital functioning, and their degree of improvement did not
vary significantly by education or income level. Unlike patients
with chest pain, most surgical patients improved in functioning
following hospitalization, but differences in improvement between
highest and lowest income groups were small to moderate.
Melfi, C., Holleman, E., Arthur, D., and Katz,
"Selecting a patient characteristics index for the prediction of
medical outcomes using administrative claims data." (AHCPR grant
HS06432). Journal of Clinical Epidemiology 48(7), pp.
Different indexes have been developed to provide a common
classification scheme for patient characteristics—such as
severity, comorbidities, resource needs, and stability—for
administrative databases to study the outcomes of medical care.
These authors examined the utility of four indexes to predict
length of hospital stay and 30-day mortality for patients
undergoing total knee replacement surgery between 1985 and 1989.
They compared the Deyo-adapted Charlson Index, the Relative
Intensity Score derived from Patient Management Categories
(PMCs), the Patient Severity Level derived from PMCs, and the
number of diagnoses (up to five) listed in the Medicare claims
data. They found that all of the indexes were an improvement over
the baseline models of length of stay and mortality. The Relative
Intensity Score and Patient Severity Level indexes resulted in
the greatest improvement in measures of model fit; the number of
diagnoses (Medicare claims data) performed well and did not
suffer from problems associated with miscoding on claims data.
Morishita, L., Boult, C., Ebbitt, B., and
others (1995, June).
"Concurrent validity of administering the geriatric depression
scale and the physical functioning dimension of the SIP by
telephone." Journal of the American Geriatric Society 43(6), pp.
The Sickness Impact Profile (SIP) and the Geriatric Depression
Scale (GDS), which measure health status and symptoms of
depression, respectively, have been used extensively to assess
older persons. Usually, these instruments are administered in
person, but home interviews are expensive and sometimes
frightening to older adults. Interviews away from home are
complicated and time-consuming. As a result, there is growing
interest in administering these instruments by telephone. This
study, cosponsored by the Agency for Health Care Policy and
Research and the National Institute of Aging, compared telephone
and in-person interviews using these instruments in a sample of
patients recruited from a university-based geriatrics clinic in
1994. When interviewed in person, more than one-third of the
sample reported that their general health was "fair" or "poor."
In person, the subjects' mean GDS score was 5.7 (not depressed),
and their mean SIP score for physical functioning was 11.1
(moderately impaired). The concurrent validity of administering
the GDS by telephone was 90 percent compared with 96 percent for
the SIP. The mean interview time required for administering the
GDS and the SIP was 13.4 minutes in person and 11.5 minutes by
telephone. The researchers conclude that telephone administration
of health status measures among community-dwelling older adults
is more convenient and less expensive than in-person interviews,
but it may be less useful in older persons with significant
hearing, physical, or cognitive impairment.
Osuch, J.R., Anthony, M., Bassett, L.W., and
June). "A proposal for a national mammography database: Content,
purpose, and value." American Journal of Radiology 164,
Marietta Anthony, Ph.D., a former AHCPR staff member now with the
U.S. Food and Drug Administration, and colleagues propose a
national mammography database. They suggest using a centralized,
computerized method of data collection consisting of two parts: a
national mammography audit and a system for monitoring and
tracking patients. The audit would collect and analyze medical
audit data of individual mammography practices at a national
level as a critical step in improving the interpretive component
of mammography. The monitoring and tracking component would be a
centralized system that provides women and physicians with a
recruitment and followup mechanism to optimize participation in
mammography services. However, the researchers point out that
unique scientific, legal, and fiscal concerns must be addressed
before establishment of this database. For example, the onus
would be placed on practices to provide the data, track patients,
and report on outcomes over a 1-year followup period.
AHCPR Publication No. 96-0010
Current as of October 1995