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September 17, 2004, Issue No. 147

AHRQ News and Numbers

From 1993 to 2002, the number of hospital discharges for chronic obstructive pulmonary disease increased from 461,000 to 619,000. Average length of stay decreased from 7.2 to 5.1 days. Average total charges per discharge increased from $10,500 to $15,400. [Source: Agency for Healthcare Research and Quality, HCUP Nationwide Inpatient Sample, 1993-2002, HCUPnet.]

Today's Headlines:

  1. Many chronically ill patients don't tell their doctors that they limit use of prescription drugs because of cost
  2. Four AHRQ-funded articles in September/October issue of Health Affairs
  3. AHRQ study demonstrates benefits of organizing children's asthma care
  4. AHRQ study finds proper pain management still lacking in nursing homes
  5. New evidence report summary on community-based participatory research available
  6. Coming soon—new AHRQ Patient Safety E-Newsletter
  7. AHRQ in the professional literature

1.  Many Chronically Ill Patients Don't Tell Their Doctors That They Limit Use of Prescription Drugs Because of Cost

A new AHRQ-funded study shows that about two-thirds of chronically ill adults who cut back on their medications because of the cost don't tell their doctors in advance. The researchers found that most patients who failed to talk with their clinicians about medication costs said that none of their providers asked them about possible problems paying for their treatments. Patients also reported that they didn't think their clinicians would be able to help them with this problem or that they were too embarrassed to discuss issues related to cost. Most patients who did discuss the cost of prescription drugs with their clinicians found their clinicians to be helpful, and they received a variety of forms of assistance such as free samples or a change in their regimen to a less-expensive or generic alternative. The study, led by John D. Piette, Ph.D., and his colleagues from the Center for Practice Management and Outcomes Research at the VA Ann Arbor Healthcare System, was published in the September 13 issue of the Archives of Internal Medicine. Select to read our press release and select to read the abstract on PubMed®.

2.  Four AHRQ-Funded Articles in September/October Issue of Health Affairs

Four articles supported by AHRQ in the September/October issue of Health Affairs examine trends in insurance coverage for children and in spending on drugs for Medicare beneficiaries. The first article, "Tracking Changes in Eligibility and Coverage Among Children, 1996-2002" by AHRQ researchers led by Tom Selden, Ph.D., found that dramatic progress has been made in the provision of public health insurance for children. The study found that the percentage of children who were eligible for free or highly subsidized health insurance rose from 29 percent in 1996 to 47 percent in 2002, primarily due to the enactment of the State Children's Health Insurance Program (SCHIP). Select to read the abstract on PubMed®.

The second article, "SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare?" led by Andrew Dick, M.D., of the University of Rochester School of Medicine and Dentistry, found consistent evidence that these programs improved access to and satisfaction with health care in Florida, Kansas, and New York. Select to read the abstract on PubMed®.

The third article, "Children's Health Care Coverage: A Quarter-Century of Change," led by Peter Cunningham, Ph.D., of the Center for Studying Health System Change, found that the percentage of children without health insurance of any type increased sharply between 1977 and 1987, but by 2001 had dropped to nearly what the rate was in 1977. Select to read the abstract on PubMed®.

The final article, "Looking Inside the Nation's Medicine Cabinet: Trends in Outpatient Drug Spending by Medicare Beneficiaries, 1997 and 2001," led by John F. Moeller, Ph.D., formerly with AHRQ, and colleagues found that Medicare drug spending increased by nearly 72 percent between 1997 and 2001 when adjusted for inflation—from $31.5 billion a year to $54 billion. Select to read the abstract on PubMed®.

3.  AHRQ Study Demonstrates Benefits of Organizing Children's Asthma Care

Children treated for asthma under a "planned care method" experienced significantly fewer days during which they had difficulty breathing and needed less treatment with oral steroids than comparable children assigned to standard primary care. The study, funded by AHRQ and NIH's National Heart, Lung, and Blood Institute, and led by Paula Lozano, M.D., at Group Health Cooperative in Seattle, was published in the September issue of Archives of Pediatrics and Adolescent Medicine. Select to read the abstract on PubMed®.

4.  AHRQ Study Finds Proper Pain Management Still Lacking in Nursing Homes

Despite a number of advances in pain management over the past decade and some success in changing attitudes and controlling pain in hospitals, a recent AHRQ-sponsored study found that effective pain management remains a serious problem in nursing homes, where patients are more likely to have dementia, sensory impairments, and other disabilities that make it more difficult to assess and manage their pain. Nursing home residents with poorly managed pain tend to have sleep deprivation, poor nutrition, depression, anxiety, agitation, decreased activity, delayed healing, and an overall lower quality of life. The study, led by Katherine Jones, R.N., Ph.D., while at the School of Nursing at the University of Colorado Health Sciences Center, was published in the August issue of The Gerontologist. Select to read the abstract on PubMed®.

5.  New Evidence Report Summary on Community-Based Participatory Research Available

AHRQ released a new evidence-based report summary on community-based participatory research (CBPR)—an approach to health, social sciences, and environmental research meant to increase the value of studies for both researchers and the community studied and particularly for academics and public health professionals struggling to address the persistent problems of health care disparities in a variety of populations. The authors of the evidence review sought answers to the following questions—What defines community-based participatory research? How has CBPR been implemented to date with regard to the quality of research methodology and community involvement? What is the evidence that CBPR efforts have resulted in the intended outcomes? What criteria and processes should be used for review of CBPR in grant proposals? Select to read the summary. A print copy of the summary and the report are available by sending an E-mail to

6.  Coming Soon—New AHRQ Patient Safety E-Newsletter

Starting this fall, AHRQ will be publishing a new online resource—AHRQ's Patient Safety E-Newsletter. AHRQ will publish the E-Newsletter periodically to make important patient safety news and information available to you in a timely fashion. The E-Newsletter will feature concise descriptions of information from AHRQ's published research as well as new initiatives, upcoming meetings, and award announcements. If you would like more in-depth information, there will be Web links to more detailed material. Please tell your colleagues about our new newsletter.

7.  AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.

Lobach DF, Arbanas JM, Mishra DD, et al. Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients. Medinfo 2004 1142-6. Select to access the abstract on PubMed®.

Pronovost PJ, Wu AW, Sexton B. Acute decompensaton after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 2004 Jun 15;140(12):1025-33. Select to access the abstract on PubMed®.

Basu J, Friedman B, Burstin H. Managed care and preventable hospitalization among Medicaid adults. Health Serv Res 2004 Jun;39(3): 489-509. Select to access the abstract on PubMed®.

Mittman BS. Creating the evidence base for quality improvement collaboratives. Ann Intern Med 2004 Jun 1;140(11):897-901. Select to access the abstract on PubMed®.

Cashen MS, Dykes P, Gerber B. eHealth technology and Internet resources: barriers for vulnerable populations. J Cardiovasc Nurs 2004 May-Jun;19(3):209-14. Select to access the abstract on PubMed®.

Herschman KB, Xie SX, Feudtner C, et al. How does an Alzheimer's disease patient's role in medical decision making change over time? J Geriatr Psychiatry Neurol 2004 Jun;17(2):55-60. Select to access the abstract on PubMed®.

Contact Information

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Current as of September 2004


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