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Agency for Healthcare Research Quality

Elixhauser, Anne

Authors: Steiner CA, Elixhauser A, and Schnaier J.
Title: The Healthcare Cost and Utilization Project: An Overview.
Publication: Effective Clinical Practice 5(3):143-51.
Date: 2002.
Abstract: Healthcare Cost and Utilization Project (HCUP)—a family of databases including the State Inpatient Databases (SID), the Nationwide Inpatient Sample (NIS), the Kids' Inpatient Database (KID), and the outpatient databases State Ambulatory Surgery Data (SASD) and State Emergency Department Data (SEDD). Multistate, inpatient (SID, NIS, KID) and outpatient (SASD, SEDD) discharge records on insured and uninsured patients. Partnership between the Agency for Healthcare Research and Quality (AHRQ) and public and private statewide data organizations. Selected data elements from inpatient and outpatient discharge records, including patient demographic, clinical, disposition and diagnostic/procedural information; hospital identification (ID); facility charges; and other facility information. Varies by database: NIS 1988-2000; SID 1995-2000; KID 1997 and 2000; SASD 1995-2000; and SEDD in pilot phase. Future data years anticipated for all datasets and back years for SID and SASD. UNITS OF ANALYSIS: Patient (in states with encrypted patient identification), physician, market, and state. Quality assessment, use and cost of hospital services, medical treatment variations, use of ambulatory surgery services, diffusion of medical technology, impact of health policy changes, access to care (inference), study of rare illness or procedures, small area variations, and care of special populations. Largest collection of all-payer, uniform, state-based inpatient and ambulatory surgery administrative data. Lacks clinical detail (e.g., stage of disease, vital statistics) and laboratory and pharmacy data. Ability to track patients across time and setting varies by state. Access available to all users who sign and abide by the Data Use Agreement. Application kits available at HCUPnet, an online interactive query tool, allows access to data without purchase (
Topics: Hospitals, Methods.

Authors: Romano P, Elixhauser A, McDonald K, Miller M.
Title: HIM's Role in Monitoring Patient Safety.
Publication: J AHIMA 73(3):72-4.
Date: 2002.
Abstract: The AHRQ Patient Safety Indicators (PSIs) were developed to focus on potentially preventable instances of harm to patients, such as surgical complications and other iatrogenic events. The PSIs are based solely on hospital administrative data, such as data from the Healthcare Cost and Utilization Project (HCUP), which rely upon diagnosis and procedure information that is coded using the International Classification of Diseases—9th revision—Clinical Modification (ICD-9-CM). HIM professionals can make a major contribution to the national effort to monitor and prevent medical errors through their application and ongoing refinement of ICD-9-CM. Several steps can be taken by HIM professionals to improve ICD-9-CM coding to better identify patient safety events, including (1) introduce more specific complication codes, (2) encourage clearer coding of iatrogenic conditions using available codes, (3) address the variability in medical record documentation, and (4) collaborate with local quality improvement leaders to investigate cases that arouse concern. The administrative data that HIM professionals generate have long been used for reimbursement. More recently these data have been used for research and quality assessment and they hold promise for identifying patient safety problems. However, to fulfill this promise, the quality of the data must continue to improve. HIM professionals will be at the forefront in helping to improve the usefulness of administrative data, thereby addressing the national challenge of reducing medical errors.
Topics: Hospitals, Quality.

Authors: Jiang HJ, Elixhauser A, et al.
Title: Care of Women in U.S. Hospitals, 2000.
Publication: HCUP Factbook No. 3.
Date: 2002.
Abstract: Based on HCUP Nationwide Inpatient Sample (NIS) data, this report provides an overview of hospital care for women and compares hospital stays for women and men. It also includes statistics on obstetric care in hospitals. Six out of the top 10 conditions for nonobstetric hospital stays pertain to the circulatory system, making up 18 percent of all stays for women and 23 percent for men. Depression is the most common reason for nonobstetric hospitalization among women ages 18-44. For two cardiac conditions—heart attack and hardening of the arteries of the heart—hospital stays for women are less likely to involve heart procedures than those for men. Hypertension is the most common co morbidity among nonobstetric patients. Among patients covered by Medicaid or uninsured, the percentage of nonobstetric hospital stays for ambulatory care sensitive (ACS) conditions is higher for women than for men. Two out of five obstetric stays are attributed to women with Medicaid or no insurance. Women with private insurance are more likely to have Cesarean sections than women uninsured or covered by Medicaid.
Topics: Hospitals, Women.
Availability: AHRQ Publication No. 02-0044, available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Weinick R, Betancourt J, et al.
Title: Differences in use of hospital procedures for Hispanics and non-Hispanic whites with cerebrovascular disease.
Publication: Ethnicity and Disease 12(1):29-37.
Date: 2002.
Abstract: Disparities in procedure use between racial/ethnic groups in the U.S. have been identified, yet differences between Hispanic and non-Hispanic white patients have been studies less frequently. The purpose of this study was to assess the in-hospital use of diagnostic and therapeutic procedures among Hispanics and non-Hispanic whites with transient cerebral ischemia or cerebrovascular disease. This study uses California and New York HCUP State Inpatient Databases for 1996. Hispanics had higher rates of non-invasive diagnostic testing (head CT scan, head and neck ultrasound, echocardiogram and head MRI). The odds of invasive diagnostic testing (cerebral arteriogram) and therapeutic procedures (carotid endarterectomy) were significantly lower for Hispanics. Most findings remained unchanged in logistic regression models with patient and hospital characteristics. Adding a measure of the concentration of Hispanic patients in the hospital eliminated differences or greatly reduced the level of disparity between Hispanics and non-Hispanic whites. Racial/ethnic differences in diagnostic procedure use may reflect poor communication and cultural/linguistic barriers between patients and providers, where diagnostic testing is used to compensate for an uninformative patient history.
Topics: Chronic Conditions, Hospitals, Minorities.

Authors: Romano P, Elixhauser A, McDonald K, Miller M.
Title: The Role of Health Information Professionals in Monitoring Patient Safety.
Publication: American Health Information Management Association (AHIMA), 1-3.
Date: March 2002.
Abstract: Until better medical error reporting systems are implemented, existing administrative data can serve as a case-finding tool for targeted quality improvement efforts. A set of patient safety indicators (PSIs) based on hospital administrative data and ICD-9-CM codes have been developed to help focus on preventable instances of harm to patients, such as surgical complications and other iatrogenic events. These PSIs can be used as a screen for potential quality problems; however, improved coding of complications will increase their utility. Health information management professionals can make a major contribution to the national effort to monitor and prevent medical errors through their application and ongoing refinement of ICD-9-CM.
Topic: Hospitals.

Authors: Elixhauser A, Macklin S, Zodet MW, et al.
Title: Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures.
Publication: Ambulatory Pediatrics 2(6):419-37.
Date: 2001.
Abstract: This report provides an update on insurance coverage, use of health care services and health expenditures for children and youth in the United States. In addition the report provides information on variation in hospitalization for children from a new 22-state hospital discharge data source specifically designed to study children. The study uses the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP) Database for Pediatric Studies (DPS), later renamed the Kids' Inpatient Database (KID), both of which are maintained by the Agency for Healthcare Research and Quality. Children's use of health care services varies considerably by what type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may have a significant burden on low-income families. The data also show substantial differences in average length of hospitalization across states in the U.S., ranging from 2.7 to 4.0 days, and rates of hospitalization through the ED vary from 9% to 23%. Injuries are a major reason for hospitalization, accounting for 1 in 6 stays among 10-14 year olds. In the 10-17 age group, over 1 in 7 stays are due to mental disorders. Among 15-17 year olds, over one-third of all hospital stays are related to childbirth and pregnancy.
Topics: Hospitals, Children, Insurance.

Authors: Miller M, Elixhauser A, Zhan C and Meyer G.
Title: Patient Safety Indicators: Using administrative data to identify potential patient safety concerns.
Publication: Health Services Research 36 (part II): 110-32.
Date: 2001.
Abstract: This study describes the development of Patient Safety Indicators (PSIs) to identify potential in-hospital patient safety problems for the purpose of quality improvement. The data source was the 1997 Healthcare Cost and Utilization Project New York State Inpatient Database. PSI algorithms were developed using systematic literature reviews of indicators and hand searches of the ICD-9-CM code book. The prevalence of PSI events and associations with patient-level and hospital-level characteristics, length of stay, in-hospital mortality, and hospital charges were examined. PSIs were developed for 12 distinct clinical situations and an overall summary measure. The 1997 event rates per 10,000 discharges varied from 1.1 for foreign bodies left during procedures to 84.7 for birth trauma. Compared with discharge records without PSI events, discharge records with PSI events had 2-3 fold longer hospital stays, 2-20 fold higher rates of mortality in the hospital, and 2-8 fold higher total charges. Multivariate logistic regression revealed that PSI events were primarily associated with increasing age, hospitals performing more inpatient surgery, and hospitals with a higher percentage of beds in intensive care units. The PSIs provide an efficient tool to identify potential in-hospital patient safety problems for targeted quality improvement efforts. Until better error reporting systems are developed, the PSIs can serve to shed light on the problem of medical errors.
Topics: Hospitals, Quality.

Authors: Simonsen L, Morens DM, Elixhauser A, Gerber M, Van Raden M, Blackwelder WC.
Title: Effect of rotavirus vaccination program on trends in admission of infants to hospital for intussusception.
Publication: Lancet 358:1224-29.
Date: 2001.
Abstract: The effect of Rotashield vaccination use on intussusception admissions in 10 U.S. States was investigated. We analyzed electronic databases containing 100 percent hospital discharge records for 1993-99 from 10 States, where an estimated 28 percent of the birth cohort had received Rotashield. Records of infants admitted to hospital (<365 days old) with any mention of intussusception were examined (ICD-9-CM code 560·0). Excess admissions for intussusception during the period of Rotashield availability (October 1998-June 1999) were estimated by direct comparison with the corresponding period of October 1997 to June 1998 (before Rotashield was available) and with adjustment for secular trends during 1993-98 by Poisson regression. Among infants ages 45-210 days, an increase in intussusception admissions of 1 percent (one excess admission) was estimated by direct comparison and 4 percent (4·6 excess admissions) by trend comparison, (PAR range of one excess admission in 66,000-302,000). No evidence of increased infant intussusception admissions was found during Rotashield availability.
Topic: Children

Authors: Centers for Disease Control (Tierney E) and Agency for Health Care Research and Quality (Elixhauser A).
Title: Major Cardiovascular Disease (CVD) During 1997—1999 and Major CVD Hospital Discharge Rates in 1997 Among Women with Diabetes—United States.
Publication: Morbidity and Mortality Weekly Report 50(43):948-54.
Date: 2001.
Abstract: Cardiovascular disease (CVD) is the leading cause of death among all women. The risk for death from CVD among women with diabetes is two to four times higher than that for women without diabetes. The excess risk for death as the result of CVD among persons with diabetes is better understood than the excess risk for CVD morbidity. To estimate national CVD prevalence and CVD hospital use among women with diabetes, CDC and AHRQ analyzed data from the 1997-99 National Health Interview Survey (NHIS) and the 1997 Nationwide Inpatient Sample. Findings indicate that the age-adjusted prevalence of major CVD for women with diabetes is twice that for women without diabetes and that the age-adjusted major CVD hospital discharge rate for women with diabetes is almost four times the rate for women without diabetes. These findings underscore the need to reduce risk factors associated with CVD among all women with diabetes through focused public health and clinical efforts.
Topic: Chronic Conditions

Authors: Centers for Disease Control (Tierney E) and Agency for Health Care Research and Quality (Elixhauser A).
Title: Hospital Discharge Rates for Nontraumatic Lower Extremity Amputation by Diabetes Status—United States, 1997
Publication: Morbidity and Mortality Weekly Report 50(43):954-8
Date: 2001
Abstract: Lower extremity amputation (LEA) is a costly and disabling procedure that disproportionately affects persons with diabetes. One of the national health objectives for 2000 was to reduce the LEA rate from a 1991 baseline of 8 per 1,000 persons with diabetes to a target of 5 per 1,000 persons with diabetes. Review of 1996 data indicated an LEA rate of 11. To estimate the national rates of hospital discharges for LEA among persons with and without diabetes and to assess the excess risk for LEA among persons with diabetes, CDC and AHRQ analyzed data from the 1997 Nationwide Inpatient Sample and the 1997 National Health Interview Survey (NHIS). This report indicates that the age-adjusted rates of hospital discharges among persons with LEA who had diabetes were 28 times that of those without diabetes.
Topic: Chronic Conditions

Authors: Andrews R, Elixhauser A.
Title: Access to major therapeutic procedures: Are Hispanics treated differently than non-Hispanic whites?
Publication: Ethnicity & Disease 10 (Autumn):59-69.
Date: 2000.
Abstract: This study examines, for patients hospitalized with one of a wide range of conditions, whether Hispanics and non-Hispanic whites receive major therapeutic procedures at the same rates. The study examined hospital stays of Hispanic and non-Hispanic white adults using 1993 discharge abstract data from the Healthcare Cost and Utilization Project State Inpatient Databases. Data were for California, Florida, and New York, States which contain half the Hispanic population in the country. Logistic regression modeling was used to identify the effect of ethnicity on the likelihood of receiving a major therapeutic procedure separately for 63 conditions, controlling for age, gender, disease severity, health insurance, income level of patient's community and hospital characteristics. Hispanics are less likely than non-Hispanic whites to receive major therapeutic procedures for 38 percent of the 63 conditions examined and more likely for 6 percent of the conditions. This study identified many conditions with apparent variations in treatment based on patient ethnicity. Future studies should examine reasons for disparities between ethnic groups, why these disparities occur for some conditions and not others, and appropriateness of procedures received.
Topics: Hospitals, Minorities.
Availability: AHRQ Publication No. 01-R016 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Leidy NK, Halpern M.
Title: Cost and outcome implications for prevention.
Publication: In: Weiss KB, Buist AS, Sullivan SD, Asthma's Impact on Society: The Social and Economic Burden. New York: Marcel Dekker, Inc.
Date: 2000.
Abstract: This chapter examines the health and economic implications of interventions aimed at the primary prevention of asthma. Research into these areas is a relatively recent phenomenon; many of the conclusions about the effectiveness of preventive interventions are speculative. This chapter provides alternative typologies of prevention for asthma and provides a conceptual framework for evaluating the costs and outcomes of interventions for the primary prevention of asthma.
Topics: Children, Chronic Conditions, Methods.

Authors: Elixhauser A, Yu K, Steiner CA, et al.
Title: Hospitalization in the United States. HCUP Factbook No. 1.
Publication: Rockville (MD): AHRQ.
Date: 2000.
Abstract: A new report by AHRQ shows that over a third of all hospital patients are initially seen in the emergency department before being admitted. This figure includes 40 percent of all hospitalized children and 55 percent of the very old (80 and older). According to the report, which is based on 1997 data from AHRQ's Nationwide Inpatient Sample, the number one cause of hospital admission through the emergency room was pneumonia. Half of the other top 10 conditions for the admission of emergency room patients involved heart conditions. The other leading conditions for admission through the emergency department were stroke, chronic obstructive lung disease (emphysema or chronic bronchitis), asthma, and blood infection (septicemia). The report also provides statistics on the age and gender of hospitalized patients; leading reasons for hospital admission overall and by age; hospital charges; lengths of stay; in-hospital mortality; patients who leave against medical advice; and types of locations to which patients are discharged. The Nationwide Inpatient Sample—the AHRQ database used to develop the report—contains about 7 million records, making it one of the largest publicly available databases for research and policy analysis and the only one that provides information on total hospital charges for all patients, regardless of their type of insurance or other payment source. Users can preview NIS data through HCUPnet, an interactive software tool on AHRQ's Web site. HCUPnet users can query the database and select state hospital databases that participate in AHRQ's Healthcare Cost and Utilization Project (HCUP).
Topics: Hospitals.
Availability: AHRQ Publication No. 00-0031 is available from the AHRQ Publications Clearinghouse.

Authors: McCormick MC, Kass B, Elixhauser A, et al.
Title: Annual report on access to and utilization of health care for children and youth in the United States—1999.
Publication: Pediatrics 105(1 Pt 3):219-30.
Date: 2000.
Abstract: This report is the first in what is anticipated to be an annual series of reports on access to and use of health care services by America's children and youth. The report capitalizes on the existence of two national datasets, the Medical Expenditure Panel Survey (MEPS)and the Healthcare Cost and Utilization Project (HCUP), which have not been widely used by the child health services research community. As background to these new sources of data, the authors have provided a detailed description of the datasets, and reviewed some fundamental tabulations. In future years, as more data are accumulated, these reports will focus on delineation of key trends and analyses addressing policy issues.
Topics: Children, Hospitals.
Availability: AHRQ Publication No. 00-R014 is available from the AHRQ Publications Clearinghouse.

Authors: Palmer CS, Zhan C, Elixhauser A, et al.
Title: Economic assessment of the community-acquired pneumonia. Intervention trial employing Levofloxacin.
Publication: Clinical Therapeutics 22(2):250-64.
Date: 2000.
Abstract: The purpose of this study was to assess use of critical pathway designed to manage community-acquired pneumonia more efficiently than its management with conventional therapy. Economic outcomes were assessed in conjunction with a cluster-design, randomized, controlled trial. Nineteen participating Canadian hospitals were randomized to implement the critical pathway (n=9) or conventional therapy (n=10). The critical pathway included a clinical prediction rule to guide the admission decision, treatment with levofloxacin, and practice guidelines. Patient data on medical resource use, lost productivity, and quality of life were collected prospectively for more than 6 weeks after treatment. Costs were calculated from government, health care system, and societal perspectives, with imputation of missing outpatient costs and the costs of lost productivity when necessary. Bootstrapping was used to identify 95 percent CIs for the total cost per patient. The analysis included all eligible patients in the critical pathway (n=716) and conventional therapy (n=1027) arms. There were fewer hospital admissions in the critical pathway arm than in the conventional therapy arm, both overall (46.5 percent vs 62.2 percent; P=0.01) and in low risk patients (33.2 percent vs 46.8 percent; P< 0.001). Compared with conventional therapy, hospitals in the critical pathway arm had 1.6 fewer bed days per patient managed (P=0.05) and used fewer inpatient medical resources. The two study arms had similar outpatient, readmission, and lost-productivity costs, and similar quality-of-life outcomes. The critical pathway produced cost savings from all three perspectives that ranged from $457 and $994 per patient. The critical pathway employing levofloxacin resulted in cost savings compared with conventional therapy and did not compromise health outcomes.
Topics: Organizational Research.

Authors: Elixhauser A, Halpern M.
Title: Economic evaluations of pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1206-13.
Date: 1999.
Abstract: The total cost of cancer care in the United States is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8 percent of the total) and gastric cancer comprises $1.8 billion (1.3 percent). The authors have reviewed published studies presenting economic analysis of treatment or followup for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although the authors identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated, relying on charge data or simple multipliers (e.g., average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs are included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and take advantage of administrative data from large populations.
Topics: Cost, Chronic Conditions, Methods.

Authors: Elixhauser A., Leidy N, Meador K, et al.
Title: The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy.
Publication: Epilepsy Research 37:13-24.
Date: 1999.
Abstract: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. For the study, 138 patients were recruited from 3 epilepsy centers in the U.S. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Moods States, POMS). Memory performance scores were weakly correlated with perceived cognitive functioning (r = 0.22, p<0.01). Perceived cognitive functioning was strongly correlated with mood (r = -0.75, p<0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (p<0.02); however, the explained variance for RBMT and POMS combined (R2=0.58) was only slightly higher than the predictive value for the POMS score alone (R2=0.56). Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.
Topics: Chronic Conditions, Methods.

Authors: Elixhauser A, Steiner CA.
Title: Hospital Inpatient Statistics, 1996.
Publication: Rockville (MD): AHCPR.
Date: 1999.
Abstract: This publication provides descriptive statistics for U.S. hospital inpatient stays in 1996 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. National estimates are provided for all discharges by principal diagnosis and by principal procedure. Statistics are presented on the number of discharges, mean length of stay, mean charges, charges in quartiles (25th, 50th, and 75th percentiles), percent who died in the hospital, percent male, and mean age. The statistics in this publication can be used to assess the processes and outcomes of care for diagnoses and procedures in U.S. hospitals. For example, among the most frequent conditions are coronary atherosclerosis with over 1.4 million stays and pneumonia with over 1.2 million stays. Among the longest mean lengths of stay were those for short gestational age, low birth weight, and fetal growth retardation (23 days), infant respiratory distress syndrome (22 days), late effects of cerebrovascular disease (15 days) and paralysis (16 days) while the highest mean total charges were seen for organ transplantation ($191,000) and tracheostomy ($148,000). Diagnoses and procedures are categorized using the Clinical Classifications Software (CCS), a system for collapsing diagnosis and procedure codes into clinically meaningful categories.
Topics: Hospitals, Methods.
Availability: AHCPR Publication No. 99-0034 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Steiner CA.
Title: Most Common Diagnoses and Procedures in U.S. Community Hospitals.
Publication: Rockville (MD): AHCPR.
Date: 1999.
Abstract: This publication provides information on the most frequent diagnoses and procedures for hospital inpatients. It helps to answer questions such as "What are the most common reasons for hospitalization in the United States?" "Which procedures are most frequently performed?" "For what conditions is this procedure used?" and "How is this condition treated?" The analysis is based on data for U.S. hospital inpatient stays in 1996 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. For each of the 100 most frequently performed principal procedures, the authors list the 5 principal diagnoses most commonly recorded on the discharge abstract. Similarly, for each of the 100 most frequent principal diagnoses treated in hospitals, they list the 5 principal procedures most commonly performed. For each diagnosis-procedure combination, information on in-hospital mortality and mean and median length of stay and total charges is provided. This publication can be used to evaluate the variety of diagnoses associated with a given procedure and the variations in treatment for particular diagnoses. In addition, it provides information on variations in length of stay, total charges, and in-hospital mortality among diagnosis-procedure combinations.
Topics: Hospitals, Statistics.
Availability: AHCPR Publication No. 99-0046 is available from the AHRQ Publications Clearinghouse.

Authors: Leidy NK, Elixhauser A, Vickrey B, et al.
Title: Seizure frequency and the health-related quality of life of adults with epilepsy.
Publication: Neurology 53:162-66.
Date: 1999.
Abstract: This article compares the health-related quality of life (HRQL) of a non-surgical sample of adults with epilepsy to that of age and gender-equivalent norms, and analyzes the relative importance of seizure frequency, time since last seizure, gender, and comorbidity on HRQL in the epilepsy sample. The study, using data from 139 adults with epilepsy from 3 U.S. centers, found that seizure-free adults can attain HRQL levels comparable to those of the general population. As seizure frequency increases, patients report more impaired HRQL, regardless of time since last seizure, gender, and comorbid status. Potential for difficulties in HRQL should be considered in clinical assessment and in evaluating treatment outcomes.
Topics: Chronic Conditions, Methods, Women.

Authors: Paramore C, Elixhauser A.
Title: Quality of health care services in managed care organizations.
Publication: Value in Health 2(4):258-68.
Date: 1999.
Abstract: As managed care has grown to dominate the U.S. health care delivery system, questions have been raised about the impact on the quality of care provided to its enrollees. Two important aspects of health care quality are access to care and the appropriateness of care. This analysis evaluated the occurrence of preventable hospitalizations among managed care (MCO) versus fee for service (FFS) populations to compare access to and appropriateness of preventive, primary, and surgical health care services. Rates of preventable hospitalizations associated with ambulatory sensitive conditions (ASCs) were calculated based on all discharges from Massachusetts hospitals in 1995, and categorized by population characteristics including: age, sex, ethnicity, and insurance status. Multivariate logistic regression models were employed to explain the likelihood of having a preventable hospitalization. Rates of preventable hospitalizations for two of the conditions evaluated (perforated appendix and diabetes complications) were lower for MCO enrollees. For two additional indicators (immunization preventable pneumonia and low birth weight), MCO rates were no different from FFS rates. Results for pediatric asthma were inclusive. For four out of five quality indicators evaluated, individuals in Massachusetts MCOs are doing better or no worse than their counterparts in FFS plans. Until population-based data on managed care enrollees becomes available, and until such data can be linked to utilization and health outcomes information, investigations into the quality of services provided by MCOs compared to FFS plans cannot be definitive.
Topics: Hospitals, Managed Care.

Authors: Leidy N, Elixhauser A, Rentz AM, et al.
Title: Telephone validation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89).
Publication: Epilepsia 40(1):97-106.
Date: 1999.
Abstract: This study assesses the psychometric properties of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) administered via telephone and to compare these properties with data gathered through self-administration. Results of this study indicate telephone interview is a viable option for evaluating health-related quality of life (HRQL) in persons with epilepsy and support the reliability and validity of the QOLIE-89 regardless of method of administration.
Topics: Chronic Conditions, Mental Health, Methods.

Authors: Schmier J, Elixhauser A, Halpern M.
Title: Health related quality of life evaluations in pancreatic and gastric cancer.
Publication: Hepato-Gastroenterology 46:1998-2004.
Date: 1999.
Abstract: This review addresses the state of the literature on health-related quality of life (HRQL) assessment among patients with cancers of the pancreas and stomach. The authors first briefly review the epidemiology of these cancers. They examine the concept of HRQL and the degree to which it has been measured among these patient groups. The impact of gastric and pancreatic cancers on HRQL is described, including the domains that these conditions are most likely to impact. The effect of different treatments on HRQL is considered, including surgical procedures, pharmacological and non-pharmacological therapies, and procedures for symptom palliation. Based on their findings and on the limited quantity and quality of the body of literature, the authors make suggestions for further research in the area.
Topics: Chronic Conditions, Methods.

Authors: Luce B, Elixhauser A.
Title: Documenting the value of your product—Outcomes research for medical devices.
Publication: Medical Devices and Diagnostic Imaging 1999 Jan:159-68.
Date: 1999.
Abstract: The market for medical technologies is changing. This market is more austere and more demanding, and new technologies are being scrutinized more closely than ever before. This article describes the new medical marketplace and helps device manufacturers become proactive in demonstrating the value of their products. Rather than trying to catch up when the demands for information are thrust upon them, a proactive approach helps smooth the way for product development, marketing, and acceptance.
Topics: Cost, Managed Care, Markets, Medical Decisionmaking.

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