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Research Briefs

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Adegoke, O.J., Blair, A., Shu, X.O., and others (2004). "Agreement of job-exposure matrix (JEM) assessed exposure and self-reported exposure among adult leukemia patients and controls in Shanghai." (AHRQ grant HS11640). American Journal of Industrial Medicine 45, pp. 281-288.

Workers' self-report is a suitable way to assess occupational exposure to potentially toxic substances, concludes this study. The investigators evaluated agreement between selected self-reported occupational exposures to benzene, other organic solvents, pesticides, and electromagnetic fields and job-exposure matrix (JEM) exposure assessment (probability of exposure to specific agents using job titles and/or descriptions) in a case-control study of 486 leukemia patients and 502 healthy controls in Shanghai. Agreement between self-reported exposures and JEM assessment (the "gold standard") was good.

Blewett, L.A., Parente, S.T., Finch, M.D., and Peterson, E. (2004). "National health data warehouse: Issues to consider." (AHRQ grant HS10091). Journal of Healthcare Information Management 18(1), pp. 52-58.

A national data warehouse that links public and private data could be used to monitor trends in health care costs, use of services, quality of care, adherence to quality guidelines, and changes in treatment protocols, conclude these authors. They note, however, that the development of the data warehouse would require overcoming a number of political and technical challenges to gain access to private insurance data. They outline recommendations from a national conference sponsored by AHRQ on the private sector's role in quality monitoring and provide an operational outline for the development of a national private-sector health data warehouse.

Carney, P.A., Elmore, J.G., Abraham, L.A., and others (2004, June). "Radiologist uncertainty and the interpretation of screening." Medical Decision Making 24, pp. 255-264.

Male radiologists who have more years of interpreting mammograms and read a higher volume of mammograms exhibit less intense reactions to the uncertainty that is inherent in the interpretation of mammograms. However, radiologists' reactions to uncertainty do not appear to affect interpretive performance, according to this study. The investigators used a mailed survey to assess demographic and clinical characteristics of radiologists and reactions to uncertainty associated with practices. Responses were linked to radiologists' actual interpretive performance data obtained from three regionally located mammography registries.

Carder, P.C., and Hernandez, M. (2004). "Consumer discourse in assisted living." (AHRQ grant HS09886). Journal of Gerontology: Social Sciences 59B(2), pp. S58-S67.

Assisted living is a type of residential long-term care that is becoming an increasingly popular alternative for older people who need assistance with personal care and health monitoring. Consumer discourse used by assisted living practitioners, gerontologists, and public agency personnel characterizes this setting as one where older people act as rational and informed shoppers, seeking the goods and services that best meet their personal preferences. This paper relies on theories of consumer studies to explain strategies used by assisted living practitioners to promote consumer choice and independence while minimizing potential risks. Data include field notes, participation in manager-training programs, and interviews with residents and family members during a 2-year period.

Centers for Education and Research on Therapeutics (CERTs) Risk Assessment Workshop Participants (2003). "Risk assessment of drugs, biologics, and therapeutic devices: Present and future issues." (AHRQ grant HS12084). Pharmacoepidemiology and Drug Safety 12, pp. 653-662.

The current U.S. system for detecting adverse effects of therapeutics (drugs, devices, and biological products) is suboptimal, assert these authors. Their report presents the results of an expert workshop on assessing therapeutic risks. The workshop's focus was on the post-approval phase and procedures in the United States, but relevant international issues and attendees were included. Workshop participants delineated substantial deficiencies in the current U.S. system for risk assessment of therapeutics. Improving the system will involve research into methods to enhance risk assessment, refinement and consolidation of data-handling systems, education of health care workers, allocation of financial resources, and building of constituencies.

Chen, S.C., Bayoumi, A.M., Soon, S.L., and others (2004). "A catalog of dermatology utilities: A measure of the burden of skin diseases."(AHRQ training grant T32 HS00028). Journal of Investigative Dermatology Symposium Proceedings 9, pp. 160-168.

Utilities represent a measure of the burden a disease places on a particular individual. Utilities are quality of life measures that reflect the strength of individuals' preferences or values for a particular health outcome. These authors introduce the concept of utilities to the dermatology community and present a catalog of dermatology utilities obtained from direct interviews with 236 patients. They present utilities for 17 diagnostic categories ranging from acne and hives to lymphoma and melanoma and discuss the underlying reasons for the significant disease burden that these utilities represent. For example, the burden of blistering diseases was high and comparable to that of kidney disease.

Cheng, E.M., Siderowf, A., Swarztrauber, K., and others (2004). "Development of quality of care indicators for Parkinson's disease." (AHRQ grant K08 HS00004). Movement Disorders 19(2), pp. 136-150.

To date, there have been no large-scale efforts to measure the quality of Parkinson's disease (PD) care because of a lack of quality indicators for reviewing the PD care process. This paper presents a set of quality indicators for PD care. Following a review of the medical literature, the authors drafted 79 potential indicators. An expert panel of seven specialists in movement disorders rated each indicator and agreed on 71 quality indicators. Applying thresholds for impact on patient outcomes, room for improvement, and overall utility, the panel narrowed these down to 29 quality indicators of PD care. The indicators span assessment of functional status, assessment and treatment of depression, coordination of care, and medication use.

Feldman, P.H., and McDonald, M.V. (2004). "Conducting translation research in the home care setting: Lessons from a just-in-time reminder study." (AHRQ grant HS10542). Worldviews on Evidence-Based Nursing 1, pp. 49-59.

This article examines issues in implementing evidence-based practice in home health care, a decentralized setting that lacks strong peer contact or on-site support and supervision compared with hospitals, clinics, and nursing homes. The authors demonstrate that translational research on the effectiveness of an E-mail reminder (by itself or augmented with other reminders) to nurses about treatment of heart failure or cancer pain patients can be successfully conducted in the home health care setting. They also point to the value of assessing different levels of intensity of interventions in a single study, looking at process measures and patient outcomes, and conducting a cost-effectiveness analysis. To encourage broader adoption of translation strategies, additional incentives from purchasing or regulatory agencies may be needed.

Franks, P., Lubetkin, E.I., Gold, M.R., and others (2004, May). "Mapping the SF-12 to the EuroQol EQ-5D index in a national U.S. sample." (AHRQ grant HS13770). Medical Decision Making 24, pp. 247-254.

The SF-12 component summary scale scores can be transformed to a preference scale score exhibiting adequate performance characteristics in a large, national sample, concludes this study. The investigators examined responses of 1,500 adults in the 2000 Medical Expenditure Panel Survey that included the SF-12 health status questionnaire and the EQ-5D Index of health state preferences. The performance of the predicted EQ-5D seemed adequate for group comparison purposes for which the SF-12 was developed. The mapped SF-12 yielded usable preference-scaled scores, with some caution for the lowest health states. Researchers seeking to minimize respondent burden in primary data collection, while generating data useful for health profiles and cost-effectiveness analyses, may find that use of the SF-12 suffices.

Glance, L.G., Dick, A., Osler, T.M., and Mukamel, D. (2004). "Judging trauma center quality: Does it depend on the choice of outcomes?" (AHRQ grant HS11295). Journal of Trauma Injury, Infection and Critical Care 56, pp. 165-172.

Trauma center quality should be judged based on patients' functional status as well as survival, concludes this study. The researchers found that the trauma care quality of 15 of 27 hospitals studied was categorized differently when their performance was benchmarked using survival versus functional outcome. The investigators used data from the National Trauma Database on adult patients who sustained a blunt trauma (but without head or spinal cord injury) in 1999. They developed a model that would allow trauma centers to compare their performance with one another and with a national norm in terms of functional outcomes. They compared the probability of good functional outcome using this model with survival rates using a different model. The researchers then compared the performance of 27 hospitals based on the number of survivors and the number of survivors with good functional outcomes.

Guise, J., Berlin, M., McDonagh, M., and others (2004, March). "Safety of vaginal birth after cesarean: A systematic review." (AHRQ grant K08 HS11338). Obstetrics and Gynecology 103(3), pp. 420-429.

Researchers conducted a comprehensive review of research studies to determine the risks and benefits associated with repeat c-section and attempted vaginal birth after cesarean (VBAC). They analyzed 20 studies involving more than 55,500 women with prior cesarean delivery and found the studies to be flawed or limited. They found no direct evidence for the relative benefits and harms of VBAC, although several studies provided indirect evidence. The researchers were unable to determine the relative increased risk for a patient choosing a trial of labor compared with repeat cesarean, regardless of the ultimate delivery route. They make several recommendations for future studies comparing VBAC with elective repeat cesarean.

Krueger, P.M., Huie, S.A., Robers, R.G., and Hummer, R.A. (2004). "Neighborhoods and homicide mortality: An analysis of race/ethnic differences." (AHRQ grant HS13996). Journal of Epidemiology and Community Health 58, pp. 223-230.

Homicide was the 15th leading cause of death in the United States in 2000, and the majority of those deaths were among young black and Hispanic men. According to this study, residents living in poverty-stricken neighborhoods had a 50 percent higher risk of homicide death than residents of neighborhoods with less inequality or poverty. Those living in areas where 15 percent or more of their neighbors lived in poverty had a 21 percent higher risk of homicide death. The findings support economic deprivation, social disorganization, and acculturation theories of homicide differences and suggest that both neighborhood and individual risk factors play a role. They cite the need for public health policies that focus on both individual and neighborhood factors to reduce homicide risks in vulnerable populations.

Lyles, R.H., Lin, H., and Williamson, J.M. (2004). "Design and analytic considerations for single-armed studies with misclassification of a repeated binary outcome." (AHRQ grant HS11452). Journal of Biopharmaceutical Statistics 14(1), pp. 229-247.

In clinical studies, misclassification or mismeasurement due to the use of an imperfect surrogate outcome measure is a common problem that is known to produce potentially significant bias in estimated treatment effects. In this study, the investigators consider the case of a single-armed (noncomparative) study of the effectiveness of antibiotics to combat acute otitis media. Both initial misclassification at screening and a regression phenomenon impacting the error-prone followup outcome measure contributed to bias in the typical treatment effect estimate.

McIntosh, W.A., Alston, L.T., Booher, J.R., and others (2003). "Time spent with patients and charges to patients for specialty consultations using telemedicine." (AHRQ grant HS08247). Telemedicine Journal and e-Health 9(4), pp. 345-350.

These authors modeled time spent with patients and estimated costs using data from a university medical center on 184 telemedical consultations to determine the cost of teleconsultations. More time was spent with patients if payment was through private insurance, more specialists were involved in the consult, or the specialist had practiced medicine longer. Consultations took less time if the specialist was a neonatologist or if the specialist recently completed medical training, and charges were lower when a neonatologist was involved. Estimated charges to patients were higher when consults took more time, multiple specialists were involved, the patient was female, the consultation involved endocrinology or dermatology, or the patient came from a rural community.

M'ikanatha, N.M., Lautenbach, E., Kunselman, A.R., and others (2003). "Sources of bioterrorism information among emergency physicians during the 2001 anthrax outbreak." (AHRQ grant HS10399). Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 1(4), pp. 259-265.

An electronic Health Alert Network, composed of broadcast faxes, electronic mail, and the Web, is a potentially efficient mechanism for public health agencies to disseminate bioterrorism recommendations to physicians. Health Alerts are perceived as highly credible and appear to be able to convey important information, according to the results of a survey of emergency physicians in Pennsylvania in 2001. For the survey, physicians were asked about their sources of information on bioterrorism during the anthrax outbreak. Although physicians received bioterrorism information from various sources, they most often cited Health Alerts, medical journals, and the Web as primary sources.

Marshall, M.N., Romano, P.S., and Davies, H.T. (2004). "How do we maximize the impact of the public reporting of quality of care?" (AHRQ grant HS10985). International Journal for Quality in Health Care 16(S), pp. i57-i63.

Many developed countries are beginning to see the public reporting of comparative information about the quality of health care as an important way to improve accountability, stimulate quality improvement, and empower members of the public to make informed health care choices. The authors of this paper make recommendations about the importance of understanding the macro- and micro-environment within which public reporting takes place, actively addressing the unintended consequences of public reporting, and engaging the public and media. They describe lessons they think are common to all countries attempting to produce and disseminate health care quality reports.

Potter, P., Boxerman, S., Wolf, L., and others (2004, February). "Mapping the nursing process: A new approach for understanding the work of nursing." (AHRQ grant HS11983). Journal of Nursing Administration 34(2), pp. 101-109.

This article describes an observational investigation of a single registered nurse (RN) and patient care technician (PCT) team over a 10-hour period. Human factors engineering analysis identified the activities performed by the RN and PCT during 1-minute intervals during the work shift. The nurse was shadowed to observe how and to what extent the five steps of nursing process (assessment, diagnosing or problem identification, planning, intervention, and evaluation) were completed. The goal was to develop a new method for mapping the nursing process—a cognitive pathway—to better understand the work of nursing. The pathway also provides an analytical tool for examining how disruptions to the nursing process may contribute to errors within the acute care environment.

Rosen, M.P., Jarvik, J.G, and Swan, S. (2004, February). "Expect the unexpected: Thoughts, insights, and musing about research in radiology." (AHRQ grant HS09499). Academic Radiology 11(2), pp. 206-212.

In this paper, the authors present an informal discussion of their individual experiences in radiological research, including mistakes made along the way. They detail the top ten mistakes they made in clinical non-funded research and lessons they learned from the mistakes. They also recount experiences accumulated during 10 years of working on randomized controlled trials and all that can go wrong while conducting such trials. Finally, they make several recommendations to radiology researchers focused on dealing with institutional review boards, interactions with colleagues and funding agencies, data collection, and the clinical environment.

Schmid, C.H., Cappelleri, J.C., and Lau, J. (2004). "Bayesian methods to improve sample size approximations." (AHRQ grant HS10064). Methods in Enzymology 383, pp. 406-427.

Determining the sample size necessary to have a high probability of obtaining a statistically significant result is a key component of study design. Although the standard calculations aim for sufficient power to account for sampling variation, they assume fixed values of the parameters and ignore the usually substantial prior uncertainty associated with them. In this article, the authors incorporate this uncertainty in a Bayesian analysis to improve sample size approximations.

Tebb, K.P., Shafer, M., Wibbelsman, C.J., and others (2004). "To screen or not to screen: Prevalence of C. trachomatis among sexually active asymptomatic male adolescents attending health maintenance pediatric visits." (AHRQ grant HS10537). Journal of Adolescent Health 34, pp. 166-168.

This study estimated the prevalence of Chlamydia trachomatis (CT) among sexually active, asymptomatic, multiethnic adolescent males attending preventive health maintenance visits at pediatric clinics within a large health maintenance organization. First-void urine samples of sexually active 14- to 18-year-old males were screened for CT. The CT infection rate was 4 percent. This finding indicates the need to increase research efforts to find ways to identify at-risk populations, suggest the researchers. They advise implementing CT screening of sexually active asymptomatic adolescent males as part of routine health care.

Walter, L.C., Davidowitz, N.P., Heineken, P.A., and Covinsky, K.E. (2004, May). "Pitfalls of converting practice guidelines into quality measures." (AHRQ grant K02 HS00006). Journal of the American Medical Association 291(20), pp. 2466-2470.

The Department of Veterans Affairs (VA) measures quality of care at all of its sites by assessing adherence rates to performance measures, which generally are derived from evidence-based practice guidelines. However, there are problems with converting practice guidelines into performance measures that are meant to identify poor quality of care. The authors of this paper suggest a more balanced perspective on the use of performance measures to define quality by delineating conceptual problems with the conversion of practice guidelines into quality measures. They use a case study of colorectal cancer screening at one VA facility to illustrate pitfalls in using adherence rates to guideline-based measures to assess quality of care.

Wolraich, M.L., Lambert, E.W., Bickman, L., and others (2004, February). "Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder." (AHRQ grant HS09905). Developmental and Behavioral Pediatrics 25(1), pp. 41-47.

These investigators compared the ratings by teachers and parents of attention-deficit hyperactivity disorder (ADHD) among elementary school children with a high risk of ADHD according to teacher ratings. Followup parent interviews and information from teachers were obtained on 243 children. Before screening, health care professionals had diagnosed ADHD in 40 percent of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms such as inattention, hyperactivity or impulsive behavior, and performance impairment. The recommendation of multiple informants significantly decreased the prevalence of ADHD in this group, pointing to the need for clear guidelines for dealing with these inconsistencies.

Wyrwich, K.W. (2004). "Minimal important difference thresholds and the standard error of measurement: Is there a connection?" (AHRQ grant HS11635). Journal of Biopharmaceutical Statistics 14(1), pp. 97-110.

Several recently published studies have examined the relationship between the magnitude of the standard error of measurement (SEM) and established thresholds for a minimal clinically important difference (MCID) or a minimal important difference (MID) for change scores on health-related quality of life (HRQOL) or health status measures. These investigators reviewed studies linking the minimal important difference standard, determined by a relevant anchor-based procedure, and the SEM. They used study methodologies for establishing a relevant anchor and for estimating the reliability of the HRQOL or health status measure to calculate the SEM.

Yawn, B.P., Ammar, K.A., Thomas, R., and Wollan, P.C. (2003, November). "Test-retest reproducibility of heart rate recovery after treadmill exercise." (AHRQ grant HS10239). Annals of Family Medicine 1(4), pp. 236-241.

Slowed heart rate recovery (HRR) of less than 12 beats per minute in the first minute after an exercise stress test has been suggested as a useful addition to the criteria currently used to assess exercise stress test results. However, preliminary data from this study suggest that HRR appears to have limited short-term test-retest stability or reproducibility. Therefore, it might not be a reliable addition to current results of exercise stress tests. The findings were based on a retrospective comparison of medical record information on 90 patients undergoing two exercise stress tests separated by 18 weeks or less. Individual patient's HRR was markedly variable from the first to second stress test.

Zhou, K.H., Fielding, J.R., and Ondategui-Parra, S. (2004). "What is evidence-based medicine?" (AHRQ grant HS13234). Academic Radiology 11, pp. 127-133.

In this review article, the authors present the definition and useful concepts of evidence-based medicine (EBM) in radiology. They describe the principles and major steps of practicing EBM in radiology. They also provide useful literature and resources related to meta-analysis, such as AHRQ and the Cochrane Collaboration, which initiated the research and practice in EBM. Finally, they summarize statistical methods for evaluating radiologic diagnostic performances derived from meta-analysis.

Current as of July 2004
AHRQ Publication No. 04-0080

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