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Highlights of AHCPR's June Research Activities

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Media Advisory: June 12, 1998

The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

New Model Projects 11 Percent Fewer Deaths in 20 Years if U.S. Smokers Stopped Smoking

If all adult smokers in the United States quit smoking today, in 20 years the overall U.S. death rate would drop by 11 percent, says an AHCPR-supported study. Men would account for 58 percent of deaths avoided by year 20, women for 41 percent. These figures are based on a model developed by Louise B. Russell, Ph.D., of Rutgers University's Institute of Health, and colleagues who estimated the probability of survival for each adult in a nationally representative sample of over 11,000 U.S. adults followed from baseline (1971-1975) to 1987. They first calculated the subject's survival probability as a function of other risk factors: diabetes, smoking, high blood pressure, and elevated serum cholesterol. They found that projected deaths closely matched observed deaths 12 years after baseline. The researchers then kept risk factors the same but changed smokers to nonsmokers to calculate projected overall deaths 20 years after baseline.

["Modeling all-cause mortality: Projections of the impact of smoking cessation based on the NHEFS," Dr. Russell, Jeffrey L. Carson, M.D., William C. Taylor, M.D., and others, in the April 1998 American Journal of Public Health 88, pp. 630-636. ]

Physicians Can Identify Women with Incontinence by Asking a Few Simple Questions

Many older women suffer from urinary incontinence that can interfere with their ability to enjoy activities ranging from social interactions to travel. However, often they are too embarrassed to mention the problem to their doctors. Primary care physicians can take the lead and identify incontinence by asking women a few simple questions, says an AHCPR-supported study. Researchers found that a positive answer to a question of whether accidental urine loss interferes with day-to-day activities is a good predictor of incontinence severe enough to affect a woman's quality of life. This and a few other simple questions could substitute for two lengthy standard questionnaires currently used to identify the problem. The study found that symptoms elicited from the questionnaires completed by 384 incontinent women correlated with symptoms identified by a few simple questions asked by physicians at 21 primary care practices.

["Relationship between patient reports of urinary incontinence symptoms and quality of life measures," Deirdre Robinson, M.D., Katherine F. Pearce, M.D., John S. Preisser, Ph.D., and others, in the February 1998 Obstetrics & Gynecology 91(2), pp. 224-228.]

Hospital Report Cards Can Help Hospitals Improve Quality

Hospital report cards that document which hospitals have better-than or worse-than-expected outcomes for particular medical treatments, can help hospitals improve the quality of care for these conditions, concludes an AHCPR-supported study. Patrick S. Romano, M.D., M.P.H., and colleagues at the University of California-Davis School of Medicine surveyed the response of California hospital chief executive officers (CEOs) to the 1996 California Hospital Outcomes Project (CHOP) report. It compares California hospital outcomes for heart attack (acute myocardial infarction, AMI) patients. About three-quarters of the CEOs found the CHOP report to be somewhat helpful in improving the quality of care for AMI patients in their hospitals. One-third of hospitals took specific quality improvement actions as a result of the CHOP report. For example, some developed or refined AMI clinical pathways, improved use of thrombolytic therapy, or reassigned medical staff to improve AMI outcomes. Hospital quality managers suggested improvements in the CHOP report, including making it more timely, linking processes of care to patient outcomes, and then identifying what hospitals with good outcomes are doing differently.

["The California hospital outcomes project: How useful is California's report care for quality improvement?" Julie A. Rainwater, Ph.D., Dr. Romano, and Deirdre M. Antonius, in the January 1998 Journal on Quality Improvement 24(1), pp. 31-39.]

Specific Factors Identify Asthmatics Most at Risk for Relapse After Emergency Room Treatment

About one-fourth of adult asthmatics relapse within 10 days of visiting the emergency room (ER) for asthma episodes. By two months, approximately 45 percent have relapsed, according to a study funded in part by AHCPR. The study found that these asthma patients had made three or more ER visits in the prior six months, had difficulty performing work or other activities due to their asthma in the prior month, and/or had discontinued hospital-based treatment for the ED asthma episode within 24 hours without having achieved at least 50 percent of their peak expiratory flow (ability to breathe out). Researchers say that these three risk factors for relapse may help to identify patients with poorly controlled asthma who probably need more intensive and comprehensive management. Patients with none of the three risk factors had a 1 percent probability of relapse within eight weeks as compared with 38 percent of patients with one risk factor, 63 percent of patients with two risk factors, and 100 percent of patients with three risk factors.

["Prediction of relapse within eight weeks after an acute asthma exacerbation in adults," by Madeline McCarren, Ph.D., Michael T. McDermott, M.D., and Robert J. Zalenski, M.D., M.A., and others, in the Journal of Clinical Epidemiology 51(2), pp.107-118, 1998.]

Other articles in Research Activities include findings on:

  • Impact of physician conversation on patient satisfaction.
  • Effectiveness of prostate cancer video on patient knowledge.
  • Changes in performance of carotid endarterectomy.
  • Computer program for emergency room trauma support.
  • Correlation of fat-indicating protein with birthweight.
  • Impact of prenatal support services on birth outcomes.
  • Suggested changes in routine thyroid function tests.
  • Regulating managed care financial incentives to physicians.
  • Medical technology coverage by managed care organizations.
  • Impact of cultural beliefs on treatments of Latinos with adult-onset diabetes.
  • Physician-patient discussion of advance directives.
  • Role of physicians in improving health care quality.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (

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