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Media Advisory: March 8, 1999
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 January/February issue of AHCPR's Research Activities.
Publicizing Bypass Surgery Outcomes Has Not Prompted Doctors or Hospitals to Deny Surgery to Higher Risk Elderly Patients
Since 1990, the New York State Department of Health has published annual mortality risk profiles of hospitals and surgeons performing coronary artery bypass surgery. There has been a concern that providers would be less likely to perform the procedure on high-risk patients who could potentially jeopardize their success rates with poor outcomes. But apparently these "cardiovascular scorecards" have not prompted New York surgeons or hospitals to deny this procedure to elderly patients at higher risk of poor outcomes. According to a recent study supported by AHCPR, bypass surgery outcomes in New York State have improved much faster than the national average since initiation of the profiling program, despite the increasing number of bypass patients with higher preoperative risk profiles. Elizabeth R. DeLong, Ph.D. and Eric Peterson, M. D., M.P.H., F.A.C.C., and their colleagues at the Duke University Medical Center used Medicare data to examine trends in bypass surgery in and out of New York State between 1987 and 1992 and U.S. Department of Health and Human Services Public Health Service compared the results to the national average. Between 1987 and 1992, the percentage of New Yorkers who received bypass surgery out of state actually declined, from 12.5 percent to 11.3 percent. An elderly patient's likelihood of receiving bypass surgery in New York has increased significantly since the profiling began in 1992. In addition, during the study period, 30-day mortality rates following bypass surgery, unadjusted for patient risk factors, declined by 33 percent for New York Medicare patients compared with 19 percent nationwide.
["The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly," by Drs. Peterson and DeLong, James G. Jollis, M.D., F.A.C.C., and others, in the October 1998 Journal of the American College of Cardiology, 32(4), pp. 993-999.]
Computerized Guidelines Reduce Prescribing by Hospital Doctors of an Expensive and Overprescribed Antibiotic
Overprescribing of vancomycin, a broad-spectrum antibiotic which is effective against many types of bacteria, for hospitalized patients has resulted in vancomycin-resistant bacteria as a major health threat in hospitals throughout North America and Europe. There is no established antibiotic therapy for certain vancomycin-resistant bacteria, and it is possible that this bacteria may be found among staphylococci, the most common infection causing pathogen among hospitalized patients. David W. Bates, M.D., M.Sc., and colleagues at Brigham and Women's Hospital tested a computerized order-entry system at the hospital to determine whether this approach would reduce the prescribing of vancomycin. The AHCPR-supported study found that the physicians who used the system, reduced their use of the antibiotic by 30 percent overall. They wrote 32 percent fewer prescriptions for vancomycin, had 28 percent fewer patients for whom they either initiated or renewed an order for vancoymcin, and prescribed vancomycin therapy for a 36 percent shorter period of time than physicians who did not use the system.
["Reducing vancomycin use utilizing a computer guideline," Kaveh G. Shojania, M.D., Deborah Yokoe, M.D., Richard Platt, M.D., and others, in the December 1998 Journal of the American Medical Informatics Association 5(6), pp. 554-562.]
Even a Small Amount of Choice in Health Plans Might Improve Public Confidence in Health Insurance
Compared with working-age people who are able to choose in which health plan to enroll, workers who do not have plan choice are substantially more dissatisfied with their coverage, says an AHCPR-supported study. Workers without choice are also more likely to have more negative opinions about managed care in general. Atul A. Gawande, M.D., of the Harvard School of Public Health, and his colleagues analyzed telephone survey responses from a random sample of 778 working-age people conducted in 1997. Almost 40 percent of those who did not have a plan choice gave their plan an average to failing grade—nearly double the proportion of those who chose their plan. The researchers found that respondents with two choices gave their health plan a much better rating that people who had only one choice. However, having more than two choices did not significantly improve health plan grades.
["Does dissatisfaction with health plans stem from having no choices?" by Dr. Gawande, Robert J. Blendon, Sc.D., Mollyann Brodi, Ph.D., and others, in the September 1998 Health Affairs 17(5), pp. 184-194.]
Inappropriate Emergency Room Visits May Stem from Social Rather than Medical Needs
The problems of emergency department overuse and inappropriate use and their associated costs are commonly addressed by trying to improve access to primary care. However, while access to medical care is a critical part of this problem, it may not be the sole solution. A recent AHCPR-supported study found that people who come to EDs four or more times per year typically are seeking safety, security, comfort, food, and understanding, not medical care. The study, conducted by Ruth E. Malone, R.N., Ph.D., of the Institute for Health Policy Studies, University of California, San Francisco, found that 70 percent of heavy ED users are homeless, and most have complex, chronic, medical and psychosocial problems. They usually have no family or are estranged from their families, and most suffer from one or more chronic illnesses, such as alcoholism, opiate addiction, diabetes, hypertension, chronic pulmonary diseases, and/or mental disorders.
["Whither the almshouse? Overutilization and the role of the emergency department," by Dr. Malone, in the October 1998 Journal of Health Politics, Policy and Law 23(5), pp. 795-832.]
Other articles in Research Activities include findings on:
- Expanded Medicaid prenatal services and birth outcomes.
- Importance of heart failure in bypass surgery deaths.
- Improved neonatal intensive care.
- Use of incentives and feedback to increase cancer screening.
- Use of implantable defibrillators for heart attack patients.
- Effects of reducing Medicare coverage for prescription drugs.
- Rural childhood immunization rates.
- Effects of ownership type on nursing home outcomes.
- Effects of case mix on validity of hospital report cards.
- Community factors affecting rural hospital survival.
- Differences in hospitalizations for back and neck problems.
- Cost trends for HIV care.
For additional information, contact AHCPR Press Office: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).