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July 11, 2001, Issue No. 30

AHRQ News and Numbers

Seven of the top ten procedures billed to Medicaid are related to pregnancy, childbirth, and newborn infant care. [Source: Agency for Healthcare Research and Quality, Procedures in U.S. Hospitals, 1997.]

Today's Headlines:

  1. CHIRI™ presentation on disenrollment/enrollment in SCHIP
  2. More statistics from Hospital Procedures in the United States, 1997
  3. Organ donor grant award
  4. Article in JAMA on factors influencing families' consent to donate organs
  5. Three articles in JAMA on quality improvement
  6. Article in NEJM on the ecology of medical care
  7. Priorities in prevention
  8. Patient safety meeting in Nashville
  9. Highlights from the most recent edition of our monthly newsletter
  10. AHRQ in the professional literature

1.  CHIRI™ Presentation on Disenrollment/Enrollment in SCHIP

AHRQ issued a press release on June 9 announcing findings from AHRQ's Child Health Insurance Research Initiative (CHIRI™), which showed that many children in Kansas and Oregon switch between State Child Health Insurance Programs (SCHIP) and Medicaid. Also, many SCHIP enrollees remained in the program for relatively short periods of time. These findings suggest the need to increase coordination between SCHIP and Medicaid and raise concerns about the continuity of care children receive. The findings were presented at the annual meeting of Child Health Services Researchers, in Atlanta. Select to access the AHRQ Press Release and the findings.

2.  More Statistics from Hospital Procedures in the United States, 1997

AHRQ issued a press release on June 12 on additional statistics from Hospital Procedures in the United States, 1997, showing that one of every four hospital stays—nearly 9 million admissions a year—involve the use of a diagnostic imaging test, surgery, or other medical procedure for heart and circulatory system problems. The four most common cardiovascular procedures for adults are:

  • Cardiac catheterization, a test in which a fine tube is inserted through a blood vessel into the heart to check its condition (3.9 million patients).
  • Echocardiogram, an ultrasound procedure used to examine the valves, function, and size of the heart (641,000 patients).
  • Coronary artery bypass graft (CABG) surgery (739,000 patients).
  • Percutaneous transluminal coronary angioplasty (PTCA), used for restoring normal blood flow to plaque-narrowed cardiac arteries (608,000 patients).

Select to access the AHRQ Press Release and the fact book.

3.  Organ Donation Grant Award

AHRQ issued a press release on July 5 announcing the award of a 2-year, $100,000 grant to study how to improve the way organ transplant centers serve living organ donors. Building on their previous research, Rebecca P. Winsett, Ph.D., and colleagues at the University of Tennessee in Memphis will evaluate existing organizational and operational structures at transplant centers with high volumes of living donation. They will also interview living donors to determine their experiences with existing operations, and they will design models for care and postsurgical support for those who elect to become living donors. Select to access the AHRQ Press Release.

4.  Article in JAMA on Factors Influencing Families' Consent to Donate Organs

AHRQ issued a press release on an article in the July 4 issue of the Journal of the American Medical Association (JAMA) by AHRQ grantee Laura Siminoff entitled, "Making Requests and Getting Answers: Factors Influencing Families' Consent for Donation of Solid Organs for Transplantation." The article is based on what may be the largest, most comprehensive study to date on the factors influencing families' consent to donate. The article focuses on why families, when asked to donate their brain-dead family members' organs, agree or do not agree to donate. The findings indicate that family members often do not have complete or accurate information about the donation process, but when they do, they generally want to donate family members' organs. Other findings support the CMS (formerly HCFA) regulation stipulating that only professionals trained in organ donation procedures should approach the families about organ donation. Select to access the AHRQ Press Release.

5.  Three Articles in JAMA on Quality Improvement

AHRQ issued a press release about three articles on quality improvement featured in the June 13 issue of the Journal of the American Medical Association (JAMA). The articles are:

  1. "Improving Quality Improvement Using Achievable Benchmarks of Care (ABC) Feedback" (Catarina Kiefe, University of Alabama at Birmingham). This article gives the results of a randomized controlled trial (RCT) in Alabama on the ABC method vs. standard performance feedback methods for physicians managing patients with type 2 diabetes. The physicians using ABC outperformed the comparison group in improving their rates of followup care by as much as 57 percent.
  2. "Validation of Clinical Prediction Rules for Stroke: Results from the National Registry of Atrial Fibrillation," (Brian Gage, Washington University School of Medicine). This study describes CHADS2, a new tool for predicting stroke in patients experiencing atrial fibrillation, the irregular and very rapid beating of the heart's atrial chambers. The study found that CHADS2 is important because it can accurately distinguish moderate- to high-risk patients who can then be given warfarin to prevent possible stroke from low-risk patients who need only aspirin, which is only half as likely to cause bleeding.
  3. "End-of-Life Discussions and Preferences Among Persons with HIV," (Neil Wenger, UCLA). This study investigated whether advanced care planning for end-of-life patients with HIV is taking place. Researchers participating in AHRQ's HIV Cost and Services Utilization Study (HCSUS) showed that half of HIV-infected patients are likely to face end-of-life decisions without advance planning and that most such patients are black, Latino, and/or undereducated.

Select to access the AHRQ Press Release.

6.  Article in NEJM on the Ecology of Medical Care

AHRQ issued a press release on an article in the June 28 issue of the New England Journal of Medicine by AHRQ grantee Larry Green, M.D., Director of the Robert Graham Center, David Lanier, M.D. of AHRQ's Center for Primary Care Research, and others, entitled, "The Ecology of Medical Care Revisited." The authors update the 1961 work of White, Williams, and Greenberg on "The Ecology of Medical Care," which provides a framework for thinking about the organization of health care, medical education, and research. They conclude that despite many changes in the American health care system since 1961, including the advent of managed care, the proportion of patients using health care services in the United States has remained remarkably consistent. Select to access the AHRQ Press Release.

7.  Priorities in Prevention

The nonprofit group Partnership for Prevention released on June 22 a study that reveals which preventive health services save more lives for fewer dollars. The study—funded by the Centers for Disease Control and Prevention and based on the recommendations of the AHRQ-sponsored U.S. Preventive Services Task Force (USPSTF)—prioritized 30 preventive health services recommended for average patients based on the services' health benefits and cost-effectiveness. Screening for colon cancer and tobacco cessation counseling top the list. Two articles about the study appear in the July 2001 issue of the American Journal of Preventive Medicine. David Atkins, M.D., M.P.H., is a coauthor on both articles.

8.  Patient Safety Meeting in Nashville

The User Liaison Program, a component of AHRQ's Office of Health Care Information, held a national workshop on June 11 to inform State policymakers about the extent to which medical errors affect the health care delivery system and to share with States strategies and tools that are being used to improve patient safety. State officials were encouraged to bring with them other stakeholders such as providers, purchasers, and health system administrators.

9.  Highlights from the Most Recent Edition of Our Monthly Newsletter

The new issue of Research Activities is in the mail. The key articles are:

  1. Hormone replacement therapy may improve mental function for some postmenopausal women.
  2. Tissue prostheses may be better than mechanical ones for elderly patients undergoing aortic valve replacement.
  3. Primary care residents' practice style predicts their referral of patients to specialty care.
  4. Market pressures prompt children's hospitals to develop new relationships with doctors and other health care organizations.

Select to look at these articles and others.

10.  AHRQ in the Professional Literature

  1. Tilford JM, Simpson PM, Yeh TS, et al. Variation in therapy and outcome for pediatric trauma patients. Crit Care Med 2001 May; 29(5):1056-61.
  2. Glasgow RE, Bull SS. Making a difference with interactive technology: considerations in using and evaluating computerized aids for diabetes self-management education. Diabetes Spect 2001 Spring; 14(2):99-106.
  3. Walter LC, Covinsky KE. Cancer screening in elderly patients. A framework for individualized decision making. JAMA 2001 June 6; 285(21):2750-56.
  4. Iriart C, Emerson EM, Waitzkin H. Managed care in Latin America: the new common sense in health policy reform. Soc Sci Med 2001 Apr; 52(8):1243-53.
  5. Eisenberg JM. Putting research to work: reporting and enhancing the impact of health services research. Health Serv Res 2001 Jun; 36(2):xi-xvii.
  6. Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001 Jun 20; 285(23):2987-94.

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Current as of July 2001


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