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Media Advisory Date: October 8, 1996
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 July/August, 1996, issue of AHCPR's Research Activities.
Rural Hospital Downsizing Failed to Improve Financial
Rural hospitals that downsized in an attempt to improve financial
performance in the 1980s did
not succeed in their efforts, according to a study conducted by
University of Michigan
researchers. About 15 percent of rural hospitals downsized
during the mid and late 1980s by
selling, shutting down, or restructuring ownership of a hospital
unit or service. However, these
hospitals did not perform any better financially than hospitals
that did not downsize.
Stephen S. Mick, Ph.D., and Christopher G. Wise, Ph.D., analyzed
survey responses of 797 chief
administrators of rural hospitals about their service mix,
financial strategies, and personnel
during fiscal years 1982-83 and 1987-88, as well as secondary
data from the American
Hospital Association and other databases. The found that by FY
1987-1988, total profit margins
had declined for both hospitals that had downsized and those
which had not, but no statistical
significance had emerged. In fact, hospitals that downsized
actually had a significantly poorer
current liquidity ratio by FY 1987-88.
"Downsizing and Financial Performance in Rural Hospitals,"
Health Care Management Review,
21(2), pp. 16-25, 1996.
Cancer Surgery Becomes More Common among Elderly Patients
Although older persons are still less likely to undergo surgery
for cancer than younger persons,
the gap is narrowing, according to a new AHCPR-supported study.
Researchers found that the
age discrepancy diminished for certain cancer surgeries from 1973
through 1991. These
increased cancer surgeries are due in part to the greater
robustness of today's elderly, who are
better able to tolerate the stresses of surgery.
During the past two decades the likelihood of surgical treatment
for cancers of the uterus, colon,
rectum, ovary, and breast increased more quickly among persons 65
years of age and older than
younger ones. Even the oldest elderly now receive surgery for
these common cancers. However,
the age gap did not narrow for surgeries for cancer of the lung,
stomach, and pancreas.
Researchers at the Johns Hopkins University School of Hygiene and
Public Health, who led the
study, formulated their analysis using population-based National
Cancer Institute data for nine
"Temporal and Regional Variability in the Surgical Treatment of
Cancer among Older People,
March 1996," Journal of the American Geriatrics Society,
Amount of HIV in the Blood Signals Time until Aids
The amount of time that it will take for persons infected with
the human immunodeficiency virus
(HIV) to develop Acquired Immunodeficiency Syndrome (AIDS) can be
predicted by the
amount of viral RNA in their blood. Researchers, led by Joseph
Lau, M.D., of Tufts University
School of Medicine, found that asymptomatic persons who have
100,000 HIV particles per
milliliter of blood (viral load) are at risk of developing AIDS
in less than three years, while
persons with 500,000 particles per milliliter may develop AIDS in
less than one year. In
contrast, patients with a viral load of 50,000 have at least two
years and may have up to eight
years before developing AIDS.
CD lymphocyte cell count has been the standard indicator of HIV
disease progression. However,
since CD counts are usually normal in asymptomatic patients,
knowing their HIV load will aid
physicians to make better therapy decisions. If a patient's viral
load continues to increase under
current medication, the physician will be alerted to change
medication. But for persons with
advanced HIV disease, CD cell count may be better than viral load
for predicting long-term
"Predictive Value of Viral Load Measurements in Asymptomatic
Untreated HIV-1 Infection: a
Mathematical Model," AIDS, 10(3), pp.255-262, 1996.
Latinas and Black Women are Less Likely Than Other Women
To Undergo Prenatal Tests to Detect Fetal Defects
Expectant Latinas and black women are much less likely to undergo
amniocentesis and chorionic
villus sampling to detect fetal defects than are white and Asian
women, regardless of their
occupation and education. In a study, conducted by researchers at
the University of California,
San Francisco, black women were one-third less likely; Latinas,
were one-fourth less likely, and
Asian women, were nearly twice as likely as white women to
undergo prenatal testing.
"This suggests that attitudes toward prenatal testing, pregnancy
termination, and/or raising a
disabled child may differ across these racial-ethnic groups,
transcending socioeconomic strata,"
comments Eugene Washington, M.D., M.Sc. of UCSF. "Alternatively,
these women may not be
receiving adequate, clearly understandable, and culturally
sensitive information regarding the
possible outcomes of testing or not testing." Dr. Washington and
coinvestigators suggest that
efforts be made to provide these women with such information.
"Racial-ethnic Differences in Prenatal Diagnostic Test Use and
Socioeconomics, or Patient Knowledge?," May 1996, Obstetrics
& Gynecology 87, pp. 675-682.
Other articles in Research Activities include findings
- Deciding when to admit chest pain patients to the ICU.
- Short-term survival of heart attack patients.
- Admission to nursing homes: who gets in?
- Does insurance status affect hospital treatment?
- Impact of fewer minority physicians on care for minority
- Which physicians are leaving rural health care and why.
- Hospital costs for stroke.
- Effects of Medicaid on nursing home quality of care.
- How to motivate urban black teenagers to use condoms.
- Treatments for Pneumocystis carinii pneumonia.
- Complications of AIDS-related medications.
- Risk of retinal detachment following cataract surgery.
- Surgery for spinal stenosis: a good idea?
- What determines women's satisfaction with prenatal
- The high state costs of trauma care.
- Insurance coverage of new medical technologies.
- Free vaccines for providers: Will more children be
For additional information, contact AHCPR Public Affairs: Karen Migdail,
(301) 427-1855 , or Salina Prasad, (301) 427-1864.