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Bechtel, G.G. (2000). "Commensurate ratings of health care." (AHRQ grant HS09550). Journal of Outcome Measurement 4(3), pp. 635-666.

The goal of this research was to develop markers of consumer satisfaction with health care delivery that are comparable over different questionnaire items, population groups, and care delivery modes in the United States. These markers will assist health care providers in evaluating how they "measure up" and help consumers in their "comparative shopping" among health plans. In this paper, the author describes a method—the mean cumulative logit (MCL)—that can be used to score ratings of health care at the population level. The author demonstrates the advantages of the MCL on data from AHRQ's Consumer Assessment of Health Plans Study (CAHPS®) from the patient and provider perspectives. From both of these viewpoints, the population studied here perceived quality of health care as greater for fee-for-service plans than for managed care plans.

Friedman, D.S., Bass, E.B., Lubomski, L.H., and others (2001, March). "Synthesis of the literature on the effectiveness of regional anesthesia for cataract surgery" and "The methodologic quality of clinical trials of regional anesthesia for cataract surgery." (AHRQ Contract No. 290-97-0006). Ophthalmology 108, pp. 519-529, 530-541.

The authors of these papers systematically reviewed the research literature on regional anesthesia during cataract surgery on adults. In the first paper, they discuss evidence supporting the effectiveness of different forms of regional anesthesia and grade them by consensus as good, fair, poor, or insufficient. The authors conclude that current approaches to anesthesia management provide adequate pain control for successful cataract surgery, but the effectiveness of techniques vary. In the second paper, the researchers examine the methodologic rigor of the randomized controlled trials on regional anesthesia for cataract surgery on adults. They discuss the quality in each of five domains: representativeness, bias and confounding, intervention description, outcomes and followup, and statistical quality and interpretation. Overall they found that key outcomes often were inadequately reported, including the distribution of patient-reported pain scores and the mean surgical time. The authors conclude that greater attention to methodologic quality and detailed reporting of study results will improve interpretation of the results of clinical trials assessing regional anesthesia for cataract surgery.

Gifford, A.L., Collins, R., Timberlake D., and others (2000, December). "Propensity of HIV patients to seek urgent and emergent care." (AHRQ grant HS08578). Journal of General Internal Medicine 15, pp. 833-840.

The researchers interviewed a nationally representative group of HIV-infected adults (as part of AHRQ's HIV Cost and Services Utilization Study) with both early and advanced disease about how they would seek care for key HIV-associated symptoms. They were asked if they would go to the emergency room, talk to or visit their doctor the same day, schedule a special appointment, wait until the next scheduled appointment, or give the symptom a chance to resolve before seeing a doctor. Most patients with advanced HIV disease (78 to 87 percent) said they would seek care right away from the ER or their primary care provider. Most who had early disease (82 percent) said they would seek care right away for new respiratory symptoms, yet fewer (46 percent) would do so for headaches or white patches in the mouth (62 percent). Blacks, the poor, those with less education, and patients who were drug-dependent or had psychological symptoms were more likely to use the ER than other patients.

Lenert, L.A., Sherbourne, C.D., and Reyna, V. (2001). "Utility elicitation using single-item questions compared with a computerized interview." (AHRQ grant HS08349). Medical Decision Making 21, pp. 97-104.

Utilities are numerical ratings of the desirability of health states that reflect a person's preferences. In most studies, measurement of utilities is done through interviews conducted by a research assistant or a computer program. Paper-based questionnaires differ in that the response is measured as the answer to a single-item, open-ended question rather than the result of a forced choice or matching task; there is no graphic or verbal feedback on trade-offs; and there is no training of subjects in utility elicitation procedures prior to their answering the questions of interest. In this study, the researchers compared single-item utility elicitations for current health to computerized utility elicitations performed 1 to 2 weeks later in a sample of 149 primary care patients with symptoms of depression. Use of single-item questions resulted in less precise estimates of utilities relative to those elicited using a more complex search procedure.

Nallamothu, B.K., Saint, S., Bielak, L.F., and others (2001, March). "Electron-beam computed tomography." (AHRQ National Research Service Award training grant HS00053) Archives of Internal Medicine 161, pp. 833-838.

Electron-beam computed tomography (EBCT) is a noninvasive procedure that is being increasingly advocated as a diagnostic test for coronary artery disease (CAD). This review of studies from 1979 to 2000 on the accuracy of EBCT for diagnosing obstructive CAD found it to be reasonably accurate at detecting obstructive CAD in patients undergoing coronary angiography, with sensitivity and specificity rates comparable to those reported for traditional exercise stress testing. The authors conclude, however, that further studies are needed to determine the exact role of EBCT among current noninvasive tests for CAD.

Rodriguez, I., Kilborn, M.J., Liu, X-K., and others (2001, March). "Drug-induced QT prolongation in women during the menstrual cycle." (AHRQ grant HS10385). Journal of the American Medical Association 285, pp. 1322-1326.

Women have slower cardiac repolarization than men, which shows up as longer heart rate corrected QT intervals (QTc) on the electrocardiogram (ECG). Also, women are more prone than men to develop a particular type of heart arrhythmia known as "torsades de pointes ventricular arrhythmia" after administration of drugs that prolong cardiac repolarization (for example, drugs to correct irregular heart rhythms, such as ibutilide, and the antibiotic erythromycin). This sex difference is apparent only after puberty, however. These researchers found that menstrual cycle and sex differences existed in QTc responses to ibutilide, with the greatest increase in QTc corresponding to the first half of the menstrual cycle. These findings are based on ECG monitoring at timed intervals during and after ibutilide infusion in a group of 58 healthy adults (39 men and 20 women). Women received the medication on three separate occasions to correspond with menstrual cycle phases. The findings support a complex role for sex hormones in prolongation of cardiac repolarization, including a possible protective effect of the hormone progesterone.

Safran, C., and Goldberg, H. (2000). "Electronic patient records and the impact of the Internet." (AHRQ grant HS08749). International Journal of Medical Informatics 60, pp. 77-83.

This paper highlights the benefits of electronic patient records (EPRs) over paper-based medical records, using the successful implementation of CareWeb at Boston's Beth Israel Deaconess Medical Center as an example. The researchers describe the Internet architecture that medical informatics researchers used in implementation of CareWeb. In this case, CareWeb integrated the two existing EPRs to support care in the emergency department in a virtual environment. CareWeb can be viewed from any Web browser providing information to clinicians who may be located at many practice sites. The authors also describe how this approach can be extended beyond the boundaries of traditional care settings to help in the development of new collaborative models of "electronic health."

Stineman, M.G. (2001). "Defining the population, treatments, and outcomes of interest: Reconciling the rules of biology with meaningfulness." (AHRQ cooperative agreement HD37234 with the National Institute of Child Health and Human Development). American Journal of Physical Medicine and Rehabilitation 80, pp. 147-159.

These authors examine the relationship between environment and mental and physical functioning. They describe the 1997 draft of ICIDH-2: International Classification of Impairments, Activities and Participation as an approach to population definition and outcome assessment. They apply a new and evolving model referred to as the spheres of human-environmental integration (HEI) to expressing the relationships among the ICIDH-2 dimensions. HEI is the individual's potential for meaningful activity as determined by physical and mental capabilities in relationship to the man-made and natural worlds, societal expectations, and available resources. HEI can be expanded by reducing disabilities through medical and rehabilitation interventions and by eliminating environmental barriers, according to the authors. This dual approach views disability as a function of the environment and implies a need to integrate rehabilitation sciences with the principles of independent living.

Williams, E.S., Konrad, T.R., Scheckler, W.E., and others (2001). "Understanding physicians' intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health." (AHRQ grant HS00032). Health Care Management Review 26(1), pp. 7-19.

Traditionally, doctors have had almost complete control over their practices. However, as third parties (managed care plans, traditional insurers, and employers) exert more influence in the practice of medicine, physician job control dissipates, exposing doctors to ever-increasing stress. These authors propose and test a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health. The model suggests that higher perceived stress is associated with lower physician satisfaction levels, which in turn are related to greater intentions to quit, decrease work hours, change specialty, or leave direct patient care. Doctors experiencing burnout, anxiety, and depression seem to deal with these problems by leaving patient care in some way rather than quitting their jobs, decreasing work hours, or changing specialty. Higher levels of perceived stress result in poorer perceptions of physical health, which links with greater intentions to change specialty.

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Current as of May 2001
AHRQ Publication No. 01-0031

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