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Final reports now available from NTIS

The following grant final reports are now available from the National Technical Information Service (NTIS). Each description of a grant final report identifies the principal investigator and his or her affiliation, the grant number, project period, project objective, and methods used. Findings and other information are presented in the individual reports.

Economic Effects of Rural Hospital Closure. Michael E. Samuels, Dr.P.H., University of South Carolina, Columbia, SC. AHCPR grant HS07252, project period 6/1/95 to 11/30/96.

The effects of hospital closure during the period 1984 to 1988 on small rural counties were studied using a telephone survey of local county officials and a multivariate analysis of economic indicators. The counties studied (n=103) were matched with three control counties (n=309) based on economic similarity. Absence of physicians, low profitability and inability to compete were seen as causing hospital failure. Hospital closure was perceived as more disruptive in smaller counties. Just under one-third of responding counties took some action to prevent or ameliorate closure. Nearly three of four rural counties made some use of the hospital facility after closure; continued use of the hospital facility mitigated the economic effects of closure. Counties that lost all hospital capacity as a result of closure were more likely to lose physicians than were other closure counties. These analyses suggested that closure suppressed economic growth. In closure counties, rates of increase in total personal income, earned income, non-farm earned income, and non-mine earned income were lower than in control counties 5 years after closure. Unemployment and labor force differences between closure and control counties were greatest in the third year after closure.

Abstract, executive summary, and final report are available from the National Technical Information Service, NTIS accession no. PB97-148829; 158 pp, $35.00 paper, $14.00 microfiche.

Employer Provided Health Insurance and Job Lock. Mark C. Berger, Ph.D., University of Kentucky Research Foundation, Lexington, KY. AHCPR grant HS08188, project period 7/1/94 to 6/30/96.

Job lock can occur when workers postpone job changes because they fear losing employer-provided health insurance. If this type of job lock is prevalent, then the overall quality of matches between workers and employers is reduced, and in general, workers are less productive. The researchers used 1987 and 1990 data from the Survey of Income and Program Participation to examine whether job lock affects mobility of wages. They found no statistically significant evidence that job lock affected job tenure or wages in either 1987 or 1990. They also studied the consequences of error in the measurement of health insurance status, the effects of dual husband-wife employer-provided health insurance coverage on labor market outcomes, and the use of various models to estimate the length of time with health insurance coverage.

Abstract, executive summary, and final report are available from the National Technical Information Service, NTIS accession no. PB97-144794; 151 pp, $31.00 paper, $14.00 microfiche.

HMO Research Network National Conference. Andrew F. Nelson, M.P.H., Group Health Foundation, Minneapolis, MN. AHCPR grant HS09319, project period 5/1/96 to 4/30/97.

The 1996 Research Network Conference was held June 7-8, 1996, in Bloomington, MN, and hosted by the Group Health Foundation of Health Partners in Minnesota. Participants were career researchers working in one of the ten research organizations that make up the HMO Research Network (Group Health of Puget Sound, Harvard Pilgrim Health Plan, Henry Ford Health System, Kaiser Permanente of Colorado, Kaiser Permanente of Georgia, Kaiser Permanente of Hawaii, Kaiser Permanente of Northern California, Kaiser Permanente Northwest, Kaiser Permanente of Southern California, and Group Health Foundation of HealthPartners). A major purpose of the conference was to facilitate networking among the researchers to address/resolve common issues and problems.

Abstracts of papers and list of attendees are available from the National Technical Information Service, NTIS accession no. PB97-153811; 98 pp, $25.00 paper, $14.00 microfiche.

Randomized Trial of the Shared Decisionmaking Program for Benign Prostatic Hyperplasia. Michael J. Barry, M.D., Massachusetts General Hospital, Boston, MA. AHCPR grant HS06540, project period 8/1/91 to 7/31/95.

These investigators had previously developed a multimedia educational program for men with benign prostatic hyperplasia (BPH), and in this study they evaluated its ability to improve treatment decisions. They conducted a prospective randomized trial of a computer- and interactive video-based Shared Decisionmaking Program (SDP) among men with BPH seen in three urological practices and followed for 1 year. Control subjects received an informational brochure. Results were based on 104 men randomized to the SDP and 123 controls. Outcome measures included the distribution of treatments selected (prostatectomy, pharmacologic treatment, or "watchful waiting"), a test of knowledge about BPH, two measures of decision satisfaction, two measures of BPH severity from the patient's perspective, three measures of overall health status, and a measure of desire for autonomy in decisionmaking. The distribution of treatment decisions did not differ significantly between groups. However, SDP subjects had significantly better scores than control subjects on the measures of BPH knowledge, satisfaction with the decisionmaking process, and general health perceptions and physical functioning. This study showed that the Shared Decisionmaking Program for BPH improves some aspects of the quality of patients' treatment decisions.

Abstract, executive summary, final report, and appendix are available from the National Technical Information Service, NTIS accession no. PB97-154025; 51 pp, $21.50 paper, $10.00 microfiche.

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Burke, H.B., Goodman, P.H., Rosen, D.B., and others (1997, February). "Artificial neural networks improve the accuracy of cancer survival prediction." (AHCPR grant HS06830). Cancer 79, pp. 857-862.

This study compared the cancer-specific 5-year survival prediction accuracy for breast and colorectal cancer of the TNM cancer staging system with that of artificial neural network statistical models. The TNM staging system uses tumor size, number of positive regional lymph nodes, and distant metastases to predict cancer survival. The study found that artificial neural networks (a class of statistical methods) improve the accuracy of the TNM staging system for predicting survival of patients with breast cancer and colorectal cancer. When the researchers used data from the American College of Surgeons' Patient Care Evaluation and the National Cancer Institute's Surveillance, Epidemiology, and End Results breast carcinoma data sets to compare the systems, artificial neural networks (ANN) were significantly more accurate in predicting 5-year and 10-year survival of these cancer patients. Adding commonly collected demographic and anatomic variables further increased the accuracy of the ANN's predictions of breast and colorectal cancer survival.

Gelberg, L. and Siecke, N. (1997). "Accuracy of homeless adults' self-reports." (AHCPR grant HS06696). Medical Care 35(3), pp. 287-290.

Homeless persons are quite accurate when reporting the number of times they have visited a health clinic, but they do not report accurately the number of such visits made during a specific time frame, according to face-to-face interviews with 349 homeless persons in both downtown and suburban areas of Los Angeles. About 49 percent of the homeless persons interviewed—who had made at least one visit to the clinic over the course of a year—underreported the total number of visits they had made compared with 28 percent of the general population. Likewise, 57 percent of respondents underreported the number of visits made in a 3-month timeframe. In the general population, 7 percent of respondents reported that they had made a medical visit in the past year that could not be confirmed compared with 17 percent in this study of the homeless. Thus, homeless persons are less accurate in recalling medical use information than the general public, but it is a difference of degree and not necessarily of magnitude. However, homeless persons may not accurately report complex information or socially undesirable information such as drinking problems.

Katz, D.A., Bates, D.W., Rittenberg, E., and others (1997, January). "Predicting Clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea." (AHCPR grant HS07107). Journal of General Internal Medicine 12, pp. 57-62.

Clostridium difficile accounts for substantial illness among hospitalized patients and is the most common cause of antibiotic-associated colitis. The number of laboratory tests to detect a cytotoxin produced by C. difficile in hospitalized patients with diarrhea could be reduced by use of selective criteria, according to these researchers. They prospectively studied 609 adult inpatients who received testing for C. difficile cytotoxin during a 3-month period in 1994. When the researchers used lack of prior antibiotic use and at least one symptom predictor (significant diarrhea or abdominal pain) to identify low-risk patients, the misclassification rate was 2.8 percent for assay results. Use of this rule to identify low-risk patients potentially could have averted 29 percent of all cytotoxin assays.

Nau, D.P., Ried, L.D., and Lipowski, E. (1997, January). "What makes patients think that their pharmacists' services are of value?" (AHCPR grant HS08221). Journal of the American Pharmaceutical Association NS37(1), pp. 91-98.

Patients who receive comprehensive pharmaceutical care perceive their pharmacist to be of more benefit and perhaps more value to them, compared with patients whose pharmacists provide only medication information, according to this cross-sectional survey of 198 asthma patients. The researchers used data on patients enrolled in an independent practice association (IPA)-model HMO to examine the relationship between the level of care provided by community pharmacists and patients' perceptions of pharmacists' ability to help them manage their asthma therapy and prevent problems with their condition. The study showed that asthma patients who receive at least a basic level of outcomes monitoring (pharmacist assesses patient's medication use and disease control on a regular basis) better rate their pharmacists' ability to help manage their asthma therapy, compared with pharmacists who provide only medication information. In this study, 52 percent of patients rated their pharmacist as very good to excellent at helping them manage their asthma therapy; 42 percent of patients rated their pharmacist as very good to excellent at helping them prevent problems.

Peek, C.W., Henretta, J.C., Coward, R.T., and others (1997, March). "Race and residence variation in living arrangements among unmarried older adults." (NRSA fellowship F32 HS00086). Research on Aging 19(1), pp. 46-68.

This study found that unmarried elderly persons are five times more likely to live alone if they have no unmarried children compared with elderly persons who have two or three unmarried children. The researchers interviewed 704 elderly unmarried persons obtained from a random sample of elderly persons in rural and urban areas of North Florida. Differences in age, sex, education, Medicaid coverage, and health status (except for a recent hospital stay) had little influence on living arrangements. Black unmarried elderly persons were more likely than their white counterparts to live with children, relatives other than children, and nonrelatives. They also were more apt to have always lived with a child and to have formed a household with a child. Despite this greater social support, rural black elderly persons were still more apt to live alone than their urban counterparts, who were considerably more apt to have formed a household with a child. According to the researchers, the close proximity of children to elderly parents in rural areas is a potential source of support that may offset the need of rural elders to co-reside with children. Finally, receiving formal care services increased the chances of living alone, suggesting that formal help provides the social "scaffolding" necessary to permit an elderly person to live alone.

Young, Y., Brant, L., German, P., and others (1997, March). "A longitudinal examination of functional recovery among older people with subcapital hip fractures." (AHCPR grant HS06658). Journal of the American Geriatric Society 45, pp. 288-294.

The rate of functional recovery from surgery to repair a hip fracture is not constant over time and varies among patients. Postsurgical functioning among disoriented but not demented patients continues to deteriorate over time compared with nondisoriented patients and is most profound in those 85 years of age and older. The type of surgical procedure performed is not significantly associated with postsurgical functional recovery. However, among patients in this study, poor prefracture functioning and an unsteady gait predicted poor functional recovery. These factors cannot be altered once the fracture occurs. Some risk factors for poor recovery are modifiable, however, and may help guide treatment and placement decisions following fracture. These include postsurgical disorientation, lengthy hospital stay, and discharge to an institution instead of home. These findings are based on a 1-year prospective study in which the researchers reviewed medical charts and interviewed 312 community-dwelling older adults at 2, 6, and 12 months following surgery at 1 of 7 Baltimore area hospitals.

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AHCPR Publication No. 97-0055
Current as of June 1997

The information on this page is archived and provided for reference purposes only.


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