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Highlights of AHCPR's November Research Activities

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Media Advisory: December 14, 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.

Short Intervals Between Pregnancies Increase the Chances of Preterm Birth

Women who conceive a second child only 13 weeks after delivery of their first child have a 20 percent chance of giving birth prematurely to their second child. Women, particularly those who are poor and young, should be advised of the potential harm to their infants of short intervals between pregnancies, concludes the Low Birthweight Patient Outcomes Research Team. Led by Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham, the researchers used data on all women who delivered babies at the university or county hospital in Birmingham to correlate pregnancy intervals with premature births. They found that as the interval between pregnancies lengthened, the chance of preterm delivery of the second child decreased, from 20 percent at less than 13 weeks, to 16 percent at 13-25 weeks, to 12 percent at 26-51 weeks, to 10 percent at 52-103 weeks and 11 percent at 104 weeks or longer.

["The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population," by Lorraine.V. Klerman, Suzanne. P. Cliver, and Robert. L. Goldenberg, in the August 1998 American Journal of Public Health 88(8), pp. 1182-1185.]

Intensive Program Improves Care Satisfaction Among Frail Elderly Patients and Their Doctors

Geriatric evaluation and management (GEM) improves satisfaction with care among elderly patients and their primary care doctors, according to a study jointly funded by AHCPR and the National Institute on Aging. GEM includes a comprehensive geriatric assessment, followed by an average of seven primary care office visits, and continuous case management by a team consisting of a geriatrician, a nurse, a social worker, and a gerontological nurse practitioner. University of Minnesota researchers randomized Medicare beneficiaries in one Minnesota county who were at high risk of repeated hospitalizations to a usual care group (274) and a GEM group (248). Based on post-care satisfaction questionnaires, twice as many GEM patients expressed a high degree of satisfaction with their care compared with usual care patients (41 percent vs. 20 percent, respectively). Patients believed that the GEM had helped them feel better and improved their understanding of their health, decreased their worries, helped them exercise more, and made taking medications easier. Physicians also reported that the GEM had provided appropriate care and was helpful to them in the care of their patients.

["Satisfaction with outpatient geriatric evaluation and management (GEM)," by Lynne Morishita, M.S.N., Lisa Boult, M..D., M.P.H., and others, in The Gerontologist, 38(3), p. 303-308, 1998.

Variations in Provider Characteristics, Procedure Use, and Cost of Care Do Not Affect Pneumonia Outcomes

Elderly patients hospitalized with community-acquired pneumonia have the same outcomes regardless of whether they are treated in urban teaching hospitals with specialists, high-technology procedures, and expensive resources, or rural hospitals with no specialists or sophisticated procedures, according to a study supported in part by AHCPR. While high-tech care provided by specialists has been shown to improve outcomes for specific illnesses, it is less clear that this approach can improve the outcomes of patients who are treated for more routine illness such as pneumonia, says Wishwa N. Kapoor, M.D., M.P.H. of the University of Pittsburgh. Kapoor and other researchers used diagnostic data from the Health Care Financing Administration to identify 21,194 Medicare patients hospitalized with pneumonia. Patients treated at urban hospitals were more likely to receive either a chest computed tomography scan or a bronchoscopy and pulmonary and infectious disease consults, and they had 15 percent higher costs than comparable patients treated in rural hospitals ane 11 percent higher costs than those treated at nonteaching hospital. Physician speciality was not independently associated with procedure use. However, a patient whose attending physicians was a general internist or medical subspecialist experienced 9 percent and 8 percent higher costs, respectively, than a patient whose attending physician was a family practitioner.

["Relationship of provider characteristics to outcomes, process, and costs of care for community-acquired pneumonia," by Jeff Whittle, M.D., M.P.H., Kuangchou Jena Lin, Ph.D., Judith R. Lave, Ph.D., and others, in Medical Care 36(7), pp. 977-987, 1998.]

Cost Effectiveness of Knee Replacement Surgery Usually Increases as Surgical Volume Increases

Knee replacement (KR) surgery is a relatively common and costly surgical procedure most often performed on elderly patients. Except for hospitals performing more than 100 knee replacement surgeries per year, the more K'S a hospital performs, the less the associated treatment costs. The study found that average treatment costs per KR surgery can be as much as 10 percent lower for hospitals that perform 76 to 100 K'S per year compared with large hospitals that perform only 1 to 12 K'S per year. For example, hospitals that performed from one to 12 K'S in 1989 had an average KR treatment cost of $10,088 compared with an average cost of $9,527 for hospitals performing 51 to 75 K'S and $9,419 for those performing 76 to 100 K'S. However, the amount of saved also depended on a hospital's size and current volume of K'S. Small hospitals that performed 25 to 50 K'S during 1989 had a cost of $9,164 compared with $9,478 for medium-sized hospitals, and $10,494 for large hospitals performing this number of procedures. The findings are based on an analysis of 1989 a national survey of hospitals and 1989 Medicare claims data.

["Does hospital procedure-specific volume affect treatment costs: A national study of knee replacement surgery," by Benjamin Gutierrez, Ph.D., Steven D. Caller, Ph.D., and Deborah A. Freud, Ph.D., in the August 1998 Health Services Research 33(3), pp. 489-511.]

Other articles in Research Activities include findings on:

  • Effects of marriage on health-related behaviors.
  • Benefits of modest gains in diabetics' blood sugar control.
  • Comparison of treatments for low back pain.
  • Approaches to preventing preterm birth.
  • Screening and treatment of prostate cancer.
  • Improvements in pediatric ICU mortality rates.
  • Circadian variations in the occurrence of cardiac arrests.
  • Participation in managed care by rural Medicaid programs.
  • Physician uncertainty and use of diagnostic tests.
  • Differences in receipt of lab tests by hospitalized men and women.
  • Physician's practice style and patient satisfaction.
  • Overcoming barriers to office-based research.

For additional information, contact AHCPR Press Office: Salina Prasad, (301) 427-1864 (

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