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Ball, J.K., and Elixhauser, A. (1996,
differences between blacks and whites with colorectal cancer."
Medical Care 34(9), pp. 970-984.
Blacks have a 59 percent to 98 percent higher odds of dying in
the hospital from colorectal cancer than whites, possibly because
of the less aggressive treatment that blacks receive for this
form of cancer. According to a recent study conducted by AHCPR
researchers, whites are more likely than blacks to be
hospitalized while colorectal cancer is still localized. Blacks,
however, are more often not hospitalized until the cancer is
advanced, and they are less likely to receive major therapeutic
procedures for this condition. These findings suggest that this
type of cancer is unmanaged or poorly managed in black patients,
according to the authors. They found that blacks hospitalized
with primary tumor were 41 percent less likely than whites to
receive a major colorectal therapeutic procedure when the cancer
had not yet spread (no metastasis) and therefore was more
treatable and 27 percent less likely to receive major therapy
when the tumor had metastasized. Blacks were nearly twice as
likely to die in the hospital with primary tumor and 1.7 times as
likely to die in the hospital with cancer-related sequelae such
as nutritional problems. Blacks were more likely than whites
overall—458.6 vs. 380.2 discharges per 1,000—to be
hospitalized with evidence of progressive cancer and, when
evidence of metastasis was present, complications of radiation or
chemotherapy, all conditions that capture the effects of
unmanaged or poorly managed cancer. These racial differences
existed even after allowances were made for differences in
patient demographics, insurance status, other clinical factors,
and provider characteristics. These findings are based on a study
of over 20,000 black and white patients hospitalized with
colorectal cancer, using discharge data from 500 hospitals
participating in the Hospital Cost and Utilization Project (HCUP)
Reprints (AHCPR Publication No. 96-R131) are
available from the AHCPR Publications
Hallstrom, A.P., Cobb, L.A., Yu, B.H. (1996,
"Influence of comorbidity on the outcome of patients treated for
out-of-hospital ventricular fibrillation." (AHCPR grant HS08197).
Circulation 93(11), pp. 2019-2022.
Persons who suffer cardiac arrest with ventricular
fibrillation (VF, an irregular heart beat) outside of the
hospital have a better chance of surviving if they are younger,
someone sees them collapse, and they quickly receive
cardiopulmonary resuscitation (CPR) and early defibrillation. A
person's coexisting (comorbid) medical conditions are an
additional important but often overlooked predictor of
out-of-hospital VF survival. The researchers constructed a
comorbidity index of a history of 10 chronic conditions and
recent (within 2 days) symptoms in 282 victims of out-of-hospital
VF, which was strongly associated with outcome. However, the
index, when combined with previously identified VF survival
predictors, could account for only one-fourth of the variation in
patient outcomes. Much of the difference in survival among these
patients remains unexplained, according to the researchers.
Chronic conditions included diabetes, hypertension, previous
heart attack or angina, lung disease, gastrointestinal disorders,
and cancer. Symptoms within 2 days of heart attack included chest
pain, dizziness, indigestion, dyspnea, nausea, and fatigue. The
comorbidity index was significantly lower in patients who
survived compared with those who died (0.87 vs. 1.08) and was
weakly but significantly correlated with age.
Handler, A., Rauge, K., Kelly, M.A., and
A. (1996, March). "Women's satisfaction with prenatal care
settings: A focus group study." (AHCPR grant HS07376).
Birth 23(1), pp. 31-37.
To assess the effects of ethnicity on satisfaction
with prenatal care, the researchers convened eight small focus
groups comprising 50 low-income Mexican-American, Puerto Rican,
black, and white women in Chicago, IL. The majority of the women
had several children, did not work, and did not have more than a
high school education. Despite their diverse ethnic backgrounds,
the women valued the same qualities in prenatal care. They wanted
providers who communicated with and respected them and were
technically competent. The women valued continuity of care with
the same provider, a clean and friendly setting, short waiting
times, and sufficient time with their providers. Only 16 percent
of the women thought it was very important to have a caregiver
from the same ethnic background as themselves. Nearly all of the
women (94 percent) thought it was very important that their
caregivers explain what they were doing and answer all of their
questions. The women expressed some negativity toward
foreign-trained or foreign caregivers, but this seemed to have
more to do with concerns about training and communication skills
than the caregivers' ethnicity.
Morise, A.P., Diamond, G.A., Detrano, R., and
others (1996, April-June). "The effect of disease-prevalence adjustments
on the accuracy of a logistic prediction model." (AHCPR grant
HS06065). Medical Decision Making 16(2), pp.
Logistic prediction models, which can estimate the
probability of a patient outcome, can aid in clinical
decisionmaking. Since not all practitioners or institutions
develop their own models using local populations, published
models need to be transportable to populations far removed from
the population from which the model was derived. The accuracy of
the model is degraded when it is transported to populations with
outcome prevalences different from those of the derivation
population, and the resulting errors from its use can have major
clinical implications. The authors developed a logistic
prediction model with respect to the noninvasive diagnosis of
coronary disease based on 1,824 patients who underwent exercise
testing and coronary angiography.
They designed the model to adjust only for differences in
prevalence. When they applied the adjusted algorithm to three
geographically remote populations, calibration improved 87
percent, while discrimination fell by 1 percent. The researchers
conclude that adjustment with a mathematical correction algorithm
can reduce clinical errors in the accuracy of logistic prediction
models used in nonderivative populations.
Stanton, B.F., Li, X., Ricardo, I., and
others (1996, April).
"A randomized, controlled effectiveness trial of an AIDS
prevention program for low-income African-American youths."
(AHCPR grant HS07392). Archives of Pediatric and Adolescent
Medicine 150, pp. 363-372.
Targeting discussions about condom use to prevent AIDS and other
sexually transmitted diseases (STDs) to small groups of urban
black adolescent friends increases their use of condoms up to 6
months later. Use of friendship groups appears to help motivate
this behavioral change. But to sustain this protective behavior
beyond 6 months requires "booster" interventions, according to
these authors. They recruited 383 black urban youths from nine
community recreation centers in a large Eastern U.S. city and
assessed the youths' use of condoms before and after
participation in eight sessions designed to encourage condom use.
The 206 intervention youths were organized into 76 already-formed
friendship groups to reinforce messages about condom use. Prior
to the sessions, 36 percent of the youths were sexually
experienced, and by 1 year later, 49 percent were sexually
active. The 177 control youths participated in discussion groups
but not necessarily with friends, and personal decisionmaking and
protection motivation were not emphasized. Six months later, 85
percent of intervention youths versus 61 percent of control
youths reported condom use. However, after 12 months the
differences in condom use were no longer apparent.
Wolinsky, F.D., and Stump, T.E. (1996). "A
measurement model of the medical outcomes study 36-item
short-form health survey in a clinical sample of disadvantaged,
older, black and white men and women." (AHCPR grant HS07632).
Medical Care 34(6), pp. 537-548.
The Medical Outcomes Study 36-Item Short-Form Health Survey
(SF-36) has become the functional health status measure of
choice in outcomes studies. However, its use has been limited to
young, healthy, and socioeconomically advantaged populations.
This study examined the validity of its use in a clinical sample
of disadvantaged, older adults with significant coexisting
medical conditions such as hypertension and heart disease. The
authors performed confirmatory factor analysis on data obtained
from baseline face-to-face interviews with 1,051 patients who
were at risk for acute deterioration of their clinical condition
due either to their age alone (75 years or older), or to their
age (50 to 74 years old) combined with major coexisting medical
problems. They found that some changes in the SF-36 are needed if
it is to be applied routinely to disadvantaged, older, sicker
adults. For example, they recommend including health optimism as
an additional factor to the current eight factors.
Current as of September 1996