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Bailey, J.J., Berson, A.S., Handelsman, H., and Hodges, M. (2001, December). "Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction." Journal of the American College of Cardiology 38(7), pp. 1902-1911.

These researchers examined methods used to identify recent heart attack patients who are at highest risk for sudden cardiac death from heart rhythm problems and thus are most likely to benefit from prophylactic insertion of an implantable cardioverter-defibrillator. They analyzed 44 research reports to estimate prediction values for five common tests for risk of major arrhythmic events (MAEs) after heart attack: signal-averaged electrocardiography; heart rate variability; severe ventricular arrhythmia on ambulatory electrocardiography; left ventricular ejection fraction; and electrophysiology study. Sensitivities and specificities for the five tests were similar, and no one test was satisfactory for predicting risk for MAEs. However, combinations of tests in stages did stratify 92 percent of patients as either high-risk or low-risk.

Reprints (AHRQ Publication No. 02-R042) are available from the AHRQ Publications Clearinghouse.

Bierman, A.S., Lawrence, W.F., Haffer, S.C., and Clancy, C.M. (2001, December). "Functional health outcomes as a measure of health care quality for Medicare beneficiaries." Health Services Research 36(6).

The Medicare Health Outcomes Survey (HOS) is a new quality measure in the Health Plan Employer Data and Information Set (HEDIS), which is designed to assess physical and mental functional health outcomes of Medicare beneficiaries enrolled in Medicare+Choice plans. These authors discuss the rationale for the HOS measure together with methodologic challenges in its use and interpretation. In this study, the HOS measure revealed plan-level variation across all baseline measures of sociodemographic characteristics and illness burden. At the individual level, socioeconomic position as measured by educational attainment was strongly associated with functional status. The least educated beneficiaries had the highest burden of illness on all measures examined, and there was a consistent and significant gradient in health and functional status across all levels of education.

Reprints (AHRQ Publication No. 02-R037) are available from the AHRQ Publications Clearinghouse.

Brunner, E., Stallone, D., Juneja, M., and others (2001). "Dietary assessment in Whitehall II: Comparison of 7d diet diary and food-frequency questionnaire and validity against biomarkers." (AHRQ grant HS06516) British Journal of Nutrition 86, pp. 405-414.

Diet diaries are probably the most accurate self-report measurements of nutrient intake in motivated groups. A less laborious approach is to use a machine-readable pre-coded questionnaire. These authors compared the estimated nutrient intakes obtained from the two methods with one another, and with biomarkers of fatty acid and anti-oxidant vitamin intake, in a group of British civil servants. The two methods showed satisfactory agreement, together with an expected level of systematic differences, in their estimates of nutrient intake. Nutrient intakes estimated by the questionnaire proved to be well correlated with biomarker levels and within estimates from the generally more accurate daily diary collected at the same study phase. Given the moderate agreement between methods, and the similarity of the respective biomarker correlations, it may be that a combination of intake estimates from both methods has better predictive power for nutritional effects on health and disease than daily diary estimates alone.

Chapman, G.B., Brewer, N.T., Coups, E.J., and others (2001). "Value for the future and preventive health behavior." (AHRQ grant HS09519). Journal of Experimental Psychology: Applied 7(3), pp. 235-250.

Three studies examined the relationship between scenario measures of time preference and preventive health behaviors that require an upfront cost to achieve a long-term benefit. Responses to time preference scenarios showed weak or no relationship to influenza vaccination, adherence to a medication regimen to control high blood pressure, and adherence to cholesterol-lowering medication. The finding that scenario measures of time preference have surprisingly little relationship to actual behaviors places limits on the applications of time preference research to the promotion of preventive health behavior. This finding is consistent with the fact that people are often reluctant to adopt preventive health behaviors or to engage in other future-minded activities, such as investing for retirement.

Johnson, K.B. (2001, December). "Barriers that impede the adoption of pediatric information technology." (Cosponsored by AHRQ and the American Academy of Pediatrics). Archives of Pediatric and Adolescent Medicine 155, pp. 1374-1379.

Despite the presence of electronic medical records since the 1970s, between 3 and 30 percent of U.S. physicians use this technology. The poor penetration of information technology (IT) contributes to the large number of laboratory tests that are reordered because of lost results, as well as the 30 percent of treatment orders that are undocumented. According to this literature review, many barriers impede the adoption of IT by pediatric professionals. For example, situational barriers include challenges imposed by the current national health environment, financial and legal risks associated with technology purchasing and use, and access to technology. The most significant barrier is that pediatric health care practitioners may lack the knowledge or training to use IT effectively. While some barriers may be difficult to overcome, lack of knowledge about the uses of IT can be solved through education.

Keller, R.B., Griffin, E., Schneiter, E.J., and others (2002, January). "Searching for quality in medical care: The Maine Medical Assessment Foundation." (AHRQ grant HS06813). Journal of Ambulatory Care Management 25(1), pp. 63-79.

This article describes an alternative method of dealing with the challenges of cost and quality in the current health care system. The method preserves the integrity of the patient-physician relationship and cultivates cooperation among physicians in changing their own behavior. This alternative involves a quality improvement foundation (QIF), which functions at a State or regional level, to provide physicians with a supportive, nonregulatory educational resource that facilitates and disseminates a broad range of information about the use and effectiveness of local health care. The Maine Medical Assessment Foundation is a successful example of a QIF. Maine physicians have been participating in specialty study groups that provide a confidential, educational forum for physicians to learn from their peers. As a result, many participating physicians have voluntarily modified their practices, which has reduced practice variation.

Mandelblatt, J.S., Bierman, A.S., Gold, K., and others (2001, December). "Constructs of burden of illness in older patients with breast cancer: A comparison of measurement methods." (AHRQ grant HS08395). Health Services Research 36(6), pp. 1085-1107.

Burden of illness can affect disease management and treatment decisions as well as health outcomes and care costs. There are limited data comparing the performance of different measures of illness burden. These authors assessed the correlations between five previously validated measures of illness burden and global health and physical function (Charlson index, Index of Co-existent Diseases, cardiopulmonary burden of illness, patient-specific life expectancy, and disease counts) and evaluated how each measure correlated with breast cancer treatment patterns in a group of 718 older women with early-stage breast cancer. All of the measures were significantly correlated with each other and with physical function and self-rated health. After controlling for age and cancer stage, life expectancy had the largest effect on surgical treatment, followed by self-rated physical function and health. For example, women with longer life expectancy and better self-rated physical function and health were more likely to receive breast conservation and radiation than sicker women. Although several measures of illness burden were associated with breast cancer therapy, each measure accounted for only a small amount of variance in treatment patterns.

Reprints (AHRQ Publication No. 02-R044) are available from the AHRQ Publications Clearinghouse.

Marshall, G.N., Morales, L.S., Elliott, M., and others (2001). "Confirmatory factor analysis of the Consumer Assessment of Health Plans Study (CAHPS®) 1.0 core survey." (AHRQ grant HS09204 and contract 290-95-2005). Psychological Assessment 13(2), pp. 216-229.

The Consumer Assessment of Health Plans Study (CAHPS®) is currently the most widely used instrument to assess consumer evaluations of health care. The CAHPS® 1.0 Core Survey assesses both reports about specific health care experiences (for example, delays in gaining access to care) and specific health care providers and settings. It also retains the ability to measure global ratings of care received. In this study, the authors used the CAHPS® Benchmarking Database to assess the factor structure and invariance of the CAHPS® 1.0 Core Survey. The researchers conducted separate analyses with Latinos and non-Latino whites drawn from commercial and Medicaid sectors. Results showed that the 23 CAHPS® 1.0 report items measured consumer reports of experiences with 5 aspects of health plan performance: access to care, timeliness of care, provider communication, health plan consumer service, and office staff helpfulness. Four items assessed global ratings of care. Care ratings and reports of care showed marked convergence.

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Current as of March 2002
AHRQ Publication No. 02-0016

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