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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.
Availability: AHRQ Publication No. 02-0044, available from the AHRQ Publications Clearinghouse.

Authors: Farquhar, C.M, Steiner, C.A.
Title: The Impact of Endometrial Ablation on Hysterectomy Rates in Women with Benign Uterine Conditions in the U.S.
Publication: International Journal of Technology Assessment in Health Care 2002, 18:3
Date: Summer 2002
Abstract: This study assesses the impact of endometrial ablation on the utilization of hysterectomy in women with benign uterine conditions. Data are from the State Inpatient Database and Ambulatory Surgery Database of the Healthcare Cost and Utilization Project (HCUP) for 6 States, 1990-97. Women who underwent hysterectomy and endometrial ablation and had benign uterine conditions were extracted using ICD-9 coding. Comparative rates, length of stay, total charges, age, payer, location of hospital and teaching status of the hospital for hysterectomy and endometrial ablation were studied. The rates of hysterectomy decreased in three States (Colorado 37 percent, Maryland 18 percent, New Jersey 11 percent), were static in two States (Connecticut and New York) and increased in one State (Wisconsin, 11 percent increase). In contrast, the rates for endometrial ablation have increased in all states. The ratio of hysterectomy to endometrial ablation rates fell in each state and in two States (New York and New Jersey) the rate of endometrial ablations was equivalent to the rate of hysterectomies during the eight years studied. The total combined rate for hysterectomy and endometrial ablation for women with benign uterine conditions for each state increased by more than 10 percent with the exception of Maryland which had an increase of only 4 percent, and Colorado which had a decline of 23 percent. In the six States studied, the diffusion of endometrial ablation has had a varying impact, although overall it appears ablation is an additive rather than substitutive technology.

Authors: Farquhar C, Steiner C.
Title: Hysterectomy Rates in the United States 1990-1997
Publication: Obstetrics & Gynecology 99:229-34.
Date: 2002.
Abstract: This study assesses national hysterectomy rates, type of hysterectomy and other factors associated within the United States from 1990 to 1997. A descriptive statistical analysis of national discharge data was undertaken. Data from the Nationwide Inpatient Sample of HCUP (from which national estimates are generated based on a 20 percent stratified sample of U.S. community hospitals) were used for the 1990-97. All women who underwent hysterectomy were identified using ICD-9-CM procedure codes. Rates and type of hysterectomy, age of patients, length of stay, total hospital charges and diagnostic categories were determined. We found that the rates of hysterectomy have not changed significantly over 1990-97. Rates for hysterectomy in 1990 were 5.5 per 1,000 women and increased slightly by 1997 to 5.6 per 1,000 per women. It appears that introduction of alternative techniques for controlling abnormal uterine bleeding such as endometrial ablation have not had an impact on hysterectomy rates. The type of hysterectomy has changed, with laparoscopic hysterectomy (LAVH) accounting for 9.9 percent of cases by 1997, with a concomitant decline in abdominal hysterectomy but no substantial change in vaginal hysterectomy rates. Length of stay decreased and total charges increased for all types of hysterectomy. Vaginal hysterectomy and laparoscopic hysterectomy are associated with shorter length of stay than abdominal hysterectomy. Abdominal hysterectomy remains the most common procedure (63.0 percent in 1997).

Authors: Case C., Johantgen M., Steiner C.
Title: Outpatient Mastectomy: Clinical Payer and Geographical Influences.
Publication: Health Services Research 2001 Oct;36:5.
Abstract: This study was designed to determine: 1) the use of outpatient services for all surgical breast procedures for breast cancer, and 2) the influence of payer and state on the use of outpatient services for complete mastectomy, in light of state and federal length-of-stay, managed care legislation. All discharges from hospitals and ambulatory surgery centers for five States (Colorado, Connecticut, Maryland, New Jersey, and New York) and 7 years (1990-96) are examined using the Healthcare Cost and Utilization Project (HCUP). All women undergoing inpatient and outpatient complete mastectomy, subtotal mastectomy and lumpectomy for cancer were analyzed. Total age-adjusted rates and percent of outpatient complete mastectomy, subtotal mastectomy and lumpectomy are compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient complete mastectomy is determined from multivariate models, adjusting for clinical (age <50, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). This study determined that lumpectomy an outpatient procedure, and subtotal mastectomy is becoming primarily outpatient. Complete mastectomy, while still primarily inpatient, is increasingly outpatient in some states. While clinical characteristics remain important, the state in which a woman receives her care and whether she has an HMO payer are strong determinants of whether she receives an outpatient complete mastectomy.

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.

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: Sills E, Saini J, Steiner C, McGee M, Gretz H
Title: Abdominal hysterectomy practice patterns in the United States.
Publication: International Journal of Gynecology and Obstetrics 1998:63;277-83.
Date: 1998.
Abstract: This article describes the nationwide practice trends for two principal techniques of abdominal hysterectomy in the United States, total abdominal (TAH) and supracervical hysterectomy (SCH). The study uses data form the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project, 1991-94. The study concludes that the national rates of TAH and SCH changed significantly in the Unites States from 1991 to 1994, with TAH declining and SCH increasing. The mix of cases continues to reflect a strong preference for TAH. The data also demonstrated that SCH was more expensive.
Availability: AHCPR Publication No. 98-R053 is available from the AHRQ Publications Clearinghouse.

Authors: Harris D, Andrews R, Elixhauser A.
Title: Racial and gender differences in the use of procedures for black and white hospitalized adults.
Publication: Ethnicity and Disease 7:91-105.
Date: 1997.
Abstract: A number of studies have found that blacks and females with coronary heart disease are less likely to undergo major diagnostic and therapeutic procedures than whites and males, even after controlling for severity of illness and other indicators of physical condition. This investigation examined 78 conditions treated in acute care hospitals to identify possible variations in medical treatment by race and gender among blacks and whites. Using data from the Healthcare Cost and Utilization Project (HCUP), the study found that blacks were less likely than whites to receive major therapeutic procedures in 37 of 77 (48 percent) conditions, and females were less likely than males to receive major therapeutic procedures for 32 of 62 (52 percent) conditions. The proportion of conditions in which blacks and females were less likely to receive a major diagnostic procedure (without a major therapeutic procedure) was 21 percent and 26 percent, respectively. This study identified a number of conditions with apparent variations in medical treatment by race or gender among blacks and whites that should be targeted for more detailed investigations.
Availability: AHCPR Publication No. 98-R018 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.

Authors: Robinson G, Brach C.
Title: Managed mental health care and women: Implications of a changing delivery system.
Publication: Paper read at Changes in Mental Health Care: What Might They Mean for Women?
Date: October 2, 1996.
Abstract: This article was written to serve as the basis of discussion for the Commonwealth Fund Commission on Women's Health's symposium, Changes in Mental Health Care: What Might They Mean for Women? The public mental health system is now undergoing a radical transformation with the advent of managed care. Over the past two decades Medicaid has grown into a dominant funding source for public mental health services. States, facing budgetary pressures, are increasingly shifting Medicaid programs into managed care.

Author: Andrews R, Harris DR, Elixhauser A.
Title: Gender, race/ethnicity, and treatment of adults in hospital diagnosis
Publication: Rockville (MD): AHCPR.
Date: 1995.
Abstract: Recent studies have identified differences in treatment for a few selected diagnoses based on race and gender. The extent to which such differences exist for all diagnoses and treatments is unknown. In addition, there has been almost no research on ethnic (Hispanic/non-Hispanic) differences in treatment. This Research Note examines treatment differences by gender and race/ethnicity across a comprehensive list of diagnoses in order to foster more research in this important area.

This Research Note provides information on 100 conditions treated on an inpatient basis; descriptive statistics are presented overall and separately by gender and race/ethnicity (white, black, Hispanic, and other). This study used discharge abstract data on more than 3 million discharges from the 1986 Hospital Cost and Utilization Project, a sample of about 500 short-term, general, non-Federal hospitals in the United States. For each condition, statistics are provided on age, type of procedure, presence of complications, discharge status, disease stage, expected primary payer, length of stay, and charges. Detailed tables allow comparison of racial/ethnic groups overall and by gender on all these variables. Alcohol, drug abuse, and mental health diagnoses are used as a case study to provide an example of how these descriptive statistics can be used to design future research projects.
Availability: AHCPR Publication No. 96-0011 is available from the AHRQ Publications Clearinghouse.

Current as of February 2003

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Publications by CDOM Staff: Topic Index. Agency for Healthcare Research and Quality, Rockville, MD.


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