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Highlights from AHCPR's October Research Findings

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Media Advisory Date: December 3, 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 October issue of AHCPR's Research Activities, a monthly publication that reports the results of studies supported by AHCPR.

Adjusting Capitation Rates May Not Prevent Discrimination Against Chronically Ill Children

Capitation of risk-adjustment methods, which adjust capitated rates to compensate managed care plans for increased costs associated with chronic medical problems, are one approach being used to eliminate the financial incentive to discriminate against children with chronic conditions. However, children with chronic health problems—such as asthma and diabetes—would probably remain at risk for discrimination in a competitive health care market even under risk-adjusted rates, according to a study conducted by Elizabeth J. Fowler, Ph.D., and Gerard F. Anderson of Johns Hopkins University. Regardless of the capitation adjustment method used, this study found significant underpayment to providers of care to high-risk children.

["Capitation adjustment for pediatric populations," Pediatrics July 1996 98(1), pp. 10-17.]

Costs of Outpatient Care Are Cut In Half When A Patient Sees A Primary Care Physician First

Health maintenance organizations typically require patients to contact their primary care physicians first for any new medical problem. This first-contact approach to health care can save more than half of outpatient expenditures, concludes an AHCPR-supported study conducted by Christopher B. Forrest, M.D., Ph.D., and Barbara Starfield, M.D., M.P.H., of The Johns Hopkins School of Public Health. The study found that consulting a primary care clinician first instead of a specialist or other source of care reduced overall outpatient expenditures 53 percent, expenses for acute illnesses by 62 percent, and expenses for preventive care by 20 percent. Overall, increasing the current level of first-contact care just 10 percent would save at least $1.1 billion per year (1993 dollars).

[The effect of first-contact care with primary care clinicians on ambulatory health care expenditures," Journal of Family Practice, July 1996, pp. 40-48.]

Earlier Referral To Hospice Care May Benefit Terminally Ill Elderly Patients

Earlier referral to hospice care may improve the quality of remaining life of terminally ill elderly patients, yet many enter hospice care when they have a only few weeks left to live. According to an AHCPR-supported study, entering hospice care earlier also would allow these patients to receive Medicare-covered noncurative medicine and support services that would not be covered in the hospital, say researchers Nicholas Christakis, M.D., Ph.D., and Jose J. Escarce M.D., of the University of Pennsylvania. Although earlier referral of patients to hospice care would increase Medicare costs for such care, these savings might be more than offset by the savings realized through reducing more expensive hospital costs.

["Survival of Medicare patients after enrollment in hospice programs," The New England Journal of Medicine 335(3), pp.172-178, 1996.]

Increased Risk of Preterm Birth Among Pregnant Black Women May Be Due in Part to Higher Rate of Vaginal Infections

Black women have two to three times more preterm births than white women, and the gap appears to be increasing. A study funded by AHCPR suggests that the disparity may be linked to a higher incidence of vaginal infections in black women. Results of a multivariate analysis conducted by Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham, indicates that black women were two to six times more likely than white women to have vaginal infections that are associated with preterm births. They are: Chlamydia trachomatis (16 percent vs. 5 percent), Neisseria gonorrhoeae (2.5 percent vs. 0.4 percent), Bacteroides sp. (25 percent vs. 14 percent), and bacterial vaginosis (23 percent vs. 9 percent). Other physical, behavioral, and socioeconomic characteristics of the women did not explain the large racial difference in preterm births.

[Bacterial colonization of the vagina during pregnancy in four ethnic groups," American Journal of Obstetrics and Gynecology 174(5), pp.1618-1621.]

Other Findings

Other articles in Research Activities include findings on:

  • Cost of home-based care for ventilator-assisted persons.
  • Mixed feelings of emergency room (ER) personnel toward frequent ER users.
  • Effectiveness of oral rehydration therapy for acute gastroenteritis in children.
  • Use of electrostimulation to recover muscle strength after stroke.
  • How neonatal intensive care could be avoided for some normal weight infants.
  • How to change physicians' willingness to treat patients with AIDS.
  • Impact of computerized reminders on in-hospital preventive care.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864.

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