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Agency for Healthcare Research Quality


Authors: Darr A, Harrison MI, Shakked L, Shalom N.
Title: Physicians' and nurses' reactions to electronic medical records: managerial and occupational implications.
Publication: J Health Organ Manag 17:349-59.
Date: 2003
Abstract: Available on PubMed®

Authors: Basu J, Friedman B, and Burstin H.
Title: Primary Care, HMO Enrollment and Hospitalization for ACS Conditions: A New Approach.
Publication: Med Care 40(12) 1260-69.
Date: 2002
Abstract: The study tests the association of primary care availability, HMO enrollment, and other person and location variables with potentially preventable hospitalization for adults in New York State, comparing preventable admissions to other types of admissions. The study population is all hospital stays of New York residents in the age group 20-64 hospitalized either in New York or in three contiguous states: New Jersey, Pennsylvania, or Connecticut using 1995 statewide discharge files from the Healthcare Cost and Utilization Project (HCUP) maintained by the Agency for Healthcare Research and Quality. A multinomial logit model uses the individual discharge as the unit of analysis. ACS admissions are compared with "marker" admissions (urgent but non-ACS), and "referral sensitive" surgeries (more discretionary), controlling for severity of illness. Higher primary care density was associated with a lower likelihood of ACS admission, compared with marker admissions, and without increasing referral-sensitive admissions. The study also supports the hypothesis of ACS admissions being less likely for private HMO enrollees than for other insured adults. This result was not found for Medicaid HMO enrollees, even by comparison to other Medicaid enrollees. A key policy-relevant result is the negative association of primary care physicians per capita with the likelihood of ACS admissions, without an offsetting association with resource costs via referral-sensitive admissions. This type of analysis could be strengthened in several ways for a defined population when better data on individual patients and several time periods are used.

Authors: Friedman B., Basu J.
Title: Health Insurance, Primary Care, and Preventable Hospitalization of Children in a Large State.
Publication: American Journal of Managed Care 7(5):473-81.
Date: 2001
Abstract: The study analyzes variations of the admission rate to hospitals of children with ambulatory care-sensitive (ACS) conditions, testing the relationship to insurance coverage, HMO enrollment, availability of primary care, severity of illness, distance to hospital, and a number of other factors. Hypotheses are derived from basic considerations of demand and use of primary care and preventive services, and then tested with a weighted linear regression model of the ACS admission rate for children residing in each county of New York. The principal data are all hospital discharges for New York resident children admitted to hospitals in New York, Pennsylvania, New Jersey, or Connecticut in 1994. The data and methodology are noteworthy for including out-of-area hospital admissions. One key result is a substantial negative association of the ACS rate with private HMO coverage. There are also sizable negative effects of the availability of primary care services in physician offices and distance traveled. Large differences related to racial and ethnic composition of the population are found, independent of other determinants. There was a positive association with the proportion of admissions for all conditions covered by Medicaid or self-pay. Severity of illness and use of emergency departments were controlled. There was no independent effect of a location in New York City. The results are consistent with smaller-scale studies, suggesting that improved health insurance for children could reduce hospital admissions. Contracting with HMOs also appears to be attractive. Independently, programs to increase the availability of primary and preventive services could substantially reduce ACS admissions. Some disparities remain that deserve more detailed attention at a local level.

Authors: Luce BR, Zangwill KM, Palmer CS, et al.
Title: Cost-effectiveness analysis of an intranasal influenza vaccine for the prevention of influenza in healthy children.
Publication: Pediatrics 108(2):e24.
Date: 2001
Abstract: This study determined the potential cost-effectiveness of intranasal influenza vaccine among young, healthy children. The analysis included prospectively collected 2-year clinical trial data supplemented with data from the literature. Results indicated that routine use of intranasal influenza vaccine among healthy children may be cost-effective and cost-effectiveness may be maximized by using group-based vaccination approaches.

Author: Friedman B, Jee J, Steiner C, et al.
Title: Tracking the State Children's Health Insurance Program with hospital data: National baselines, State variations, and some cautions.
Publication: Med Care Res Rev 56(4):440-55.
Date: 1999
Abstract: State and Federal agencies are concerned with the impact of the State Children's Health Insurance Program (SCHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 States to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of SCHIP. A few cautions and limitations are discussed. An unexpected result in the explorations was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-95. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across States are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.
Availability: AHRQ Publication No. 00-R009 is available from the AHRQ Publications Clearinghouse.

Authors: Elixhauser A, Halpern M, Schmier J, et al.
Title: Health care cost-benefit and cost-effectiveness analysis from 1991 to 1996: An updated bibliography.
Publication: Med Care 36(5 Suppl):MS1-MS9.
Date: 1998
Abstract: This article updates, through 1996, a previously published bibliography of health care cost-benefit and cost-effectiveness analyses that described the literature from 1979 to 1990. A systematic search of MEDLARS databases was conducted for all articles falling under the medical subject headings "cost-benefit analysis" (which includes cost-effectiveness analysis) and "costs and cost analysis," as well as any article with the term "cost" in the title or abstract. Publications were subdivided into two major categories: reports of studies and "other" publications. Reports of studies and "other" publications were classified into approximately 250 different topic areas. Studies were further classified by parameters such as study type, publication vehicle, and medical function. This article describes the results of this classification and describes trends during 1991 to 1996 as compared with 1979 to 1990. The entire bibliography is reproduced in Appendix A.

Author: Elixhauser A, Halpern M, Schmier J, et al.
Title: Health Care CBA and Cost-effectiveness analysis from 1991 to 1996: An Updated Bibliography
Publication: Med Care 36(5 Suppl):MS1-9, MS18-147.
Date: 1998
Abstract: This issue provides a bibliography of cost-benefit and cost-effectiveness analysis literature 1991 to 1996, a classification of all articles by topic area, and a summary of the types of CBA/Cost-effectiveness analysis in health care since 1979.

Authors: Kitzmiller J, Elixhauser A, Carr S, et al.
Title: Assessment of costs and benefits of management of gestational diabetes mellitus.
Publication: Diabetes Care 1998 Aug;(21 Suppl):B123-130.
Date: 1998
Abstract: The purpose of this pilot study was to perform a cost-identification analysis of care of gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs); the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby; and newborn care (outcome costs). Reimbursed average charges in the Northern California managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in Northern California, Southern California, and New England, using prospectively collected data. Based on their analysis, the authors conclude that cost analysis should be included in the clinical trials of the management of GDM.

Authors: Spector W, Fortinsky R.
Title: Pressure ulcer prevalence in Ohio nursing homes: Clinical and facility correlates.
Publication: Journal of Aging and Health 10(1):62-80.
Date: 1998
Abstract: This article examines pressure sore risk factors in a large sample of nursing home residents in Ohio in 1994. The study finds that many nursing home residents remain at great risk of developing pressure sores. After controlling for clinical factors, residents in rural facilities were less likely to have a pressure sore.
Availability: AHCPR Publication No. 98-R027 is available from the AHRQ Publications Clearinghouse.

Author: Elixhauser A, Kitzmiller JL, Weschler JM.
Title: Short-term Cost Benefit of Pre-conception Care for Diabetes.
Publication: Diabetes Care 19(4):384.
Date: 1996
Abstract: This analysis revises previous estimates on the cost-benefit of preconception care for women with diabetes, which had been performed from a societal perspective. Taking the perspective of the third party payer (excluding long-term care costs and non-medical costs such as special education), preconception care for women with diabetes results in cost savings of $480 per enrollee. This indicates that significant benefits of preconception care accrue during pregnancy and during the initial hospitalization of mother and infant.

Author: Spector W, Reschovsky J, Cohen J.
Title: Appropriate placement of nursing home residents in lower levels of care.
Publication: Milbank Quarterly 1996;74(1):139-60.
Date: 1996
Abstract: This article discusses why clinically inappropriate residents in nursing homes continue to be placed there, updates and improves estimates of the number of persons who based on clinical criteria may be place in lower levels of care, discusses other factors that should enter into estimates of appropriate placement, and the reasons why potential savings that these estimates suggest may be difficult to achieve.
Availability: AHCPR Publication No. 96-R067 is available from the AHRQ Publications Clearinghouse.

Authors: Sullivan S, Elixhauser A, Luce B, et al.
Title: National Asthma Education and Prevention Program Working Group report on the cost-effectiveness of asthma care.
Publication: American Journal of Respiratory and Critical Care Medicine 154:S84-S95.
Date: 1996
Abstract: The cost effectiveness of asthma care is the first topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group characterized the role of health economics in understanding optimal asthma management strategies. The report first reviews methods for economic evaluation of the medical technologies, with a particular focus on cost-effectiveness analysis. Next, the report explores the nature and usefulness of several key asthma outcome measures, including clinical and symptom measures, measures of lung function, measures of functional status, and measures of health services utilization and cost. The working group also conducted a review of the literature on cost effectiveness of asthma patient education programs, pharmaceutical therapy, and a variety of alternative and adjunct interventions. The report concludes with recommendations for a standardized approach for economic evaluation study designs (e.g., common asthma outcomes, long-term followup, and studies with patients of different ages, socioeconomic statuses, and severity levels) and for an expansion in the number of such standardized asthma studies and cost-effectiveness analyses.

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