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Farley, D.O., Short, P.F., Elliott, M.N., and others (2002, August). "Effects of CAHPS® health plan performance information on plan choices by New Jersey Medicaid beneficiaries." (AHRQ grant HS09204). Health Services Research 37(4), pp. 985-1007.

These researchers randomly assigned newly enrolled New Jersey Medicaid beneficiaries to a group that received the Consumer Assessment of Health Plans Study (CAHPS®) report (which provides consumer assessments of care in various health plans) and standard enrollment materials or a control group that received only the standard materials. Results showed that receipt of the CAHPS® report along with the standard plan enrollment materials did not affect plan choice. However, only half of the Medicaid enrollees said they received and read the CAHPS® report, and there was an HMO with dominant Medicaid market share but low CAHPS® performance scores. Individuals who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS® scores, on average, than the beneficiaries in the control group. The researchers conclude that health plan performance information can influence Medicaid plan choices, but the challenge is to get enrollees to actually read the information.

Fleishman, J.A., Spector, W.D., and Altman, B.M. (2002). "Impact of differential item functioning on age and gender differences in functional disability." Journal of Gerontology: Social Sciences 57B (5), pp. S275-S284.

People who are limited in their ability to perform basic daily activities—for example, bathing, eating, shopping, or managing finances—are functionally disabled. Individual functional disability is often measured by asking a person about their difficulty in performing certain tasks. However, estimates of group differences in functional disability may be biased if items exhibit differential item functioning (DIF). Comparisons of disability across sociodemographic groups need to take DIF into account, conclude these investigators. They analyzed responses of 5,750 adults, who received help with at least one of 11 daily living tasks, to the 1994/1995 National Health Interview Survey Disability Supplement. Nine items manifested significant DIF by age or sex; DIF was especially large for shopping and money management. Without adjusting for DIF, middle-aged people were less disabled than elderly men, and women were less disabled than men among nonelderly people. However, after adjusting for DIF, middle-aged people did not differ from elderly people, and differences between men and women within age groups were not significant.

Reprints (AHRQ Publication No. 03-R001) are available from the AHRQ Publications Clearinghouse.

Friedman, B., De La Mare, J., Andrews, R., and McKenzie, D.H. (2002, Fall). "Practical options for estimating cost of hospital inpatient stays." Journal of Health Care Finance 29(1), p. 1-13.

Analysts often estimate the cost of hospital services by applying cost/charge (c/c) ratios from Federal or State data sources to the charges provided on hospital discharge records. However, a number of sources of discharge data do not permit the disclosure of hospital identities. This study supports a practical policy option of releasing group c/c ratios attached to discharge records when identity must be masked. The researchers compared several sources of c/c data for use in the restricted environment using accounting data from four State systems and from files of the Federal Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration or HCFA). In one analysis, they grouped hospitals by selected characteristics. They found that c/c varied by State and characteristics. Some CMS and State measures tracked each other closely. A wider analysis of hospital-specific data for 51 States and territories offered a separate test and extension of the initial results.

Matsumura, S., Bito, S., Liu, H., and others (2002, July). "Acculturation of attitudes toward end-of-life care: A cross- cultural survey of Japanese Americans and Japanese." AHRQ grant HS07370). Journal of General Internal Medicine 17, pp. 531-539.

In Japan, doctors rarely disclose a fatal diagnosis, especially cancer, to the patient, and the family takes the lead in health care decisionmaking. Also, the concept of advance care planning is unfamiliar in Japan. Japanese Americans have adopted some American attitudes toward end-of-life care, while retaining some traditional Japanese attitudes. The researchers analyzed responses to questionnaires in English and Japanese from 539 English-speaking Japanese Americans (EJA), and 340 Japanese-speaking Japanese Americans (JJA) living in Los Angeles and from 304 Japanese living in Japan (JJ). A majority of each group wanted the family to make decisions about life-sustaining treatments (75 percent of EJA, 57 percent of JJA, and 69 percent of JJ). In contrast to EJA and JJA, about one-third of JJ preferred to withhold the terminal prognosis from the patient. Almost all respondents wanted family members to be informed of the diagnosis.

Schneeweiss, S., Maclure, M., Soumerai, S., and others (2002). "Quasi-experimental longitudinal designs to evaluate drug benefit policy changes with low policy compliance." (AHRQ grants HS09855 and HS10881). Journal of Clinical Epidemiology 55, pp. 833-841.

A causal relationship between drug benefit policy change and an increase in adverse outcomes can be tested by comparing the experience of a group of patients affected by the policy versus the (counterfactual) experience of the same patients if the policy had not been implemented. Because counterfactual experiences cannot be observed, it must be assumed that the counterfactual experience is correctly described by extrapolating from the same group's previous experience. However, results from nonrandomized comparisons of specific subgroups defined by their reaction to a new policy in the middle of followup should be interpreted with caution, concludes this study. The null hypothesis of no policy effect can be empirically tested using quasi-experimental longitudinal designs with repeated measures. If compliance to a policy is low, results may be biased toward the null, but a subgroup analysis of those who comply may be biased by treatment selection. Using the example of reference drug pricing in British Columbia, these authors discuss assumptions for causal interpretations of such analyses and provide supplementary analyses to assess and improve the validity of findings.

Weinberger, M., Murray, M.D., Marrero, D.G., and others (2002, August). "Issues in conducting randomized controlled trials of health services research interventions in nonacademic practice settings: The case of retail pharmacies." (AHRQ grant HS09083). Health Services Research 37(4), pp. 1067-1077.

Health services researchers often conduct randomized controlled trials (RCTs) in academic or other clinical settings in which the investigator has a reasonable degree of control over factors essential to conducting a well-designed RCT. However, health services researchers should conduct RCTs in a variety of nonacademic practice settings to increase the generalizability of their findings and better reflect the true impact of interventions. Pragmatic problems, although significant, can be successfully overcome, assert these researchers. They conducted an RCT to evaluate the effectiveness of an intervention to increase pharmacists' involvement in caring for customers at 36 retail drug stores in Indianapolis. Major modifications in research design were necessitated by factors such as corporate restructuring, heightened sensitivity to patient confidentiality, and difficulties in altering employees' behavior. They overcame these barriers by conducting research that was consistent with corporate goals, involving appropriate corporate administrators and technical personnel early in the process, and remaining flexible.

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Current as of November 2002
AHRQ Publication No. 03-0010

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