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Asada, Y. (2005, April). "Medical technologies, nonhuman aids, human assistance, and environmental factors in the assessment of health states." (AHRQ grant HS13116). Quality of Life Research 14, pp. 867-874.

Researchers have developed various health state measures, which focus on functionality and general symptoms, to quantify a variety of possible health states between full health and death. A person's functionality and general symptoms can be assessed either with or without medical technologies (for example, a pacemaker), nonhuman aids (for example, a wheelchair), human assistance (meaning the help of another person), and accommodating environmental factors (for example, a barrier-free environment). This paper explores the implications these distinctions have for the construction and application of health status measures. The author concludes that it is reasonable to include medical technologies and nonhuman aids in health assessment, but not human assistance or accommodating environmental factors.

Clarke, P., Evans, S.H., Shook, D., and Johanson, W. (2005). "Information seeking and compliance in planning for critical care: Community-based health outreach to seniors about advance directives." (AHRQ grant HS09232). Health Communication 18(1), pp. 1-22.

This study, a field experiment in three States, investigated factors that encourage older adults to explore critical-care choices such as preferences for life-sustaining treatment and end-of-life decisions and to complete an advance directive. Researchers developed a program that offered a detailed guide to critical-care choices and telephone counseling. Results indicated that cognitive variables such as participants' sense of their vulnerability in the future and having confidence in their ability to prepare now for future care helped determine which older adults requested a guide. Compliance in completing an advance directive, however, depended solely on their pattern of reading the guide and talking about critical care. Neither information seeking nor completing an advance directive correlated with participants' actual health status.

Crampton, P., Davis, P., Lay-Vee, R., and others (2005). "Does community-governed nonprofit primary care improve access to services? Cross-sectional survey of practice characteristics." (AHRQ grant HS00003). International Journal of Health Services 35(3), pp. 465-478.

This study's findings support the shift from private, for-profit primary care practices to nonprofit community-governed primary care practices in New Zealand and elsewhere. Researchers used data from a nationally representative cross-sectional survey of general practitioners to compare certain characteristics of community-governed nonprofit and private for-profit primary care practices in New Zealand. Community-governed nonprofit practices charged lower patient fees per visit and employed more Maori and Pacific Islanders as staff members, thus reducing financial and cultural barriers to health care access compared with for-profit practices. Nonprofit practices also provided a different range of services and were more likely than for-profit practices to have written policies on quality management, complaints, and critical events, and to carry out locality service planning and community needs assessments.

Crawford, M.A., Harrington, T.M. Russell, T.V., and others (2005, July). "Practice extenders and PDA-based counseling for smoking and unhealthy diet." Annals of Family Medicine 3(S2), pp. S41-S43.

In this study, 8 family physicians in 5 Alabama practices delivered personal digital assistant (PDA)-based behavioral smoking and obesity interventions to more than 200 adult patients during routine clinic visits over a 9-month period. PDA value-added features included an automatic body mass index calculation and behavior modification tips to personalize each intervention. Patients who indicated readiness to change at the "assess" step were informed of the availability of practice extender services to "assist" them and "arrange" interventions to support their efforts to change unhealthy behaviors. The authors indicate that a PDA-based behavior change intervention and referral system has the potential to be successfully implemented in the clinical setting.

Flanders, S.A., Kaufman, S.R., and Saint, S. (2005, June). "Hospitalists as emerging leaders in patient safety: Targeting a few to affect many." (AHRQ grant HS11540). Journal of Patient Safety 1(2), pp. 78-82.

An increasingly large number of hospitalized patients are cared for by a relatively small cadre of physicians known as hospitalists. The authors of this article suggest that hospitalists have the potential to emerge as leaders in patient safety and propose a consortium of nine regional hospitalist programs as a way to enhance patient safety. The Hospitalists as Emerging Leaders in Patient Safety (HELPS) Consortium of Southeastern Michigan is a first-of-its-kind program designed to identify proven patient safety practices and facilitate their widespread dissemination to consortium members. The authors discuss the HELPS Consortium structure, barriers to translating patient safety research into practice, and challenges to implementing this project.

Kelleher, T.B., Mehta, S.H., Bhaskar, R., and others (2005, July). "Prediction of hepatic fibrosis in HIV/HCV co-infected patients using serum fibrosis markers: The SHASTA index." (AHRQ grant HS07809). Journal of Hepatology 43, pp. 78-84.

Chronic hepatitis C is characterized by slowly progressive liver fibrosis. Among patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), serum testing for hyaluronic acid (HA), albumin, and aspartate aminotransferase can accurately stage mild and advanced liver fibrosis, according to this study. The researchers compared serum fibrosis biomarkers in 95 people infected with both HIV and HCV who had indications of liver fibrosis on liver biopsy. Fibrosis scores of F3 or greater were found 27 times more often in people with HA levels greater than 86 ng/ml and 5.5 times more often in people with HA levels 41-86 ng/ml.

Ko, M., Edelstein, R.A., Heslin, K.C., and others (2005, September). "Impact of the University of California, Los Angeles/Charles R. Drew University medical education program on medical students' intentions to practice in underserved areas." (AHRQ grant HS14022). Academic Medicine 80(9), pp. 803-808.

According to this study, a medical education program can have a positive effect on medical students' goals to practice in underserved areas. The researchers examined the relationships between participating in the University of California, Los Angeles/Charles R. Drew University (UCLA/Drew) Medical Education Program, a comprehensive, inner-city-based program, and medical students' intentions to practice in underserved areas. Compared with students in the UCLA School of Medicine, UCLA/Drew students were more likely to report intention to work in underserved communities at graduation.

Kralewski, J., Dowd, B.E., Kaissi, A., and others (2005, July). "Measuring the culture of medical group practices." (AHRQ Contract No. 290-00-0017). Health Care Management Review 30(3), p. 184-193.

There is growing agreement that the culture of medical group practices is one of the most important factors influencing the cost and quality of care. Yet, efforts to understand and manage these cultures have been limited by the lack of a measurement instrument. This paper presents an instrument that successfully differentiates the cultures of different types of practices. To develop the instrument, the investigators used questionnaires to collect practice culture statements from primary care physicians. A process involving 500 physicians in 267 medical group practices in 22 States was eventually refined into 39 statements that correlated with 9 cultural dimensions of group practices. A test of the instrument found that it successfully identified differences in medical group cultures.

Meyerhoefer, C.D., Ranney, C.K., and Sahn, D.E. (2005, August). "Consistent estimation of censored demand systems using panel data." American Journal of Agricultural Economics 87(3), pp. 660-672.

Analysis of data for policy purposes is often hampered by the arduous econometric techniques required to extract vital information. Many approaches provide a way to obtain consistent estimates of disaggregated demand models, but these approaches are designed for cross-sectional data, which suffer from a number of shortcomings. Chief among these shortcomings are the limited ability to control for heterogeneous preferences and the lack of significant real price variation. This article presents a method for consistently estimating large, theoretically plausible, longitudinal censored demand systems using a generalized method of moments framework.

Parsons, S.K., Shih, M.C., Mayer, D.K., and others (2005, August). "Preliminary psychometric evaluation of the Child Health Ratings Inventory (CHRIs) and disease-specific impairment inventory-hematopoietic stem cell transplantation (DSII-HSCT) in parents and children." (AHRQ grant HS06897). Quality of Life Research 14, pp. 1613-1635.

The Child Health Ratings Inventory (CHRIs) generic health-related quality of life (HRQL) instrument and its Disease Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT) module is a promising measure of HRQL after pediatric HSCT, conclude the authors of this article. Although parent and child reports were moderately correlated and revealed complementary results, the unique perspectives of both raters provide a more complete picture of HRQL. A total of 122 children who underwent HSCT completed the questionnaire and 74 parents completed a parallel version of it. The instrument satisfactorily discriminated among several clinically important groups: those early in the transplant process (less than 6 months), those later in the process (more than 12 months), and those with different provider-assigned clinical severity ratings.

Robinson, J.D., and Heritage, J. (2005, July). "The structure of patients' presenting concerns: The completion relevance of current symptoms." (AHRQ grant HS10922). Social Science & Medicine 61, pp. 481-493.

This article uses conversation analysis to examine the problem-presentation phase of 302 visits between primary care physicians and patients with acute problems such as recent injuries or infection. The authors analyze how physicians inquire about patients' health status and how patients present their health problems, focusing on how both physicians and patients recognize and negotiate the completion of this part of their interaction. They argue that physicians and patients mutually orient to the presentation of current symptoms as a point of transition between the problem-presentation phase of the visit that the patient controls and the information-gathering phase that the physician controls. Physicians can use this as a resource to help them distinguish complete from incomplete presentations.

Rost, K., Dickinson, L.M., Fortney, J., and others (2005, June). "Clinical improvement associated with conformance to HEDIS-based depression care." (AHRQ grant HS08349). Mental Health Services Research 7(2), pp. 103-112.

Employers have indicated that they are prepared to negotiate with health care plans to improve the quality of care for depression if a valid indicator of depression treatment quality can be developed. Such an indicator needs to measure the proportion of people in need of treatment who will receive high-quality care and predict clinical improvement.

Researchers constructed an administrative database indicator derived from Health Plan Employer Data and Information Set (HEDIS) criteria for antidepressant medication management, and tested it in 230 employed patients in 5 health plans. Seven percent of these patients were positive on the indicator, meaning that they met the criteria of having started antidepressant medication, were continuing to take antidepression medication, and receiving follow-up visits. Conformance to indicator criteria in this population was associated with 23 percent lessening of depression severity over 1 year. The authors conclude that calculating depression indicators for the population in treatment can be done with pre-existing administrative databases. Calculating depression indicators for the population in need is more cumbersome, but may be needed to provide a valid indicator for employer purchasers.

Shiffman, R.N., Dixon, J., Brandt, C., and others (2005). "The guideline implementability appraisal (GLIA): Development of an instrument to identify obstacles to guideline implementation." (AHRQ grant HS10962). BMC Medical Informatics and Decision Making 5(23), available online at

Clinical practice guidelines do not always succeed in persuading clinicians to use the best clinical practices. These researchers developed and validated a tool to evaluate the implementability of clinical guidelines, the Guideline Implementability Appraisal (GLIA). They identified indicators of implementability from the research literature to develop a GLIA that includes 31 items, arranged into 10 dimensions. Dimensions range from guideline validity and executability to novelty/innovation and effect on process of care. They conclude that GLIA may be used by guideline developers to remedy defects in their guidelines or by guideline implementers to devise implementation strategies.

Wosinska, M. (2005, August). "Direct-to-consumer advertising and drug therapy compliance." (AHRQ grant HS11600). Journal of Marketing Research 42, pp. 323-332.

A patient's noncompliance with drug regimens can render treatment ineffective. Drug companies have limited ability to directly influence patients' compliance with therapy which has generated an interest in direct-to-consumer advertising (DTCA) to improve compliance. Contrary to many drug industry surveys, the author of this paper found the impact of DTCA was small in economic terms, the effect spilled over to other drug brands, and, in certain cases, the effect may have decreased average compliance rates. The findings were based on a study of prescription claims data for 19,618 patients with cholesterol problems who began their cholesterol-lowering therapy during a 4-year study period. The researchers compared cholesterol-lowering prescription data with monthly brand-level advertising expenditures.

Zhao, J.H., Brunner, E.J., Kumari, M., and others (2005, July). "APO polymorphism, socioeconomic status, and cognitive function in mid-life." (AHRQ grant HS06516). Social Psychiatry and Psychiatric Epidemiology 40, pp. 557-563.

The aim of this study was to investigate the association of the common apolipoprotein E gene (APOE) variants with cognitive function and cognitive decline in adult mid-life and explore the possibility that APOE genotype mediates the link between socioeconomic status (SES) and cognitive function. The researchers obtained data on the cognitive function and APOE genotype from 6,004 middle-aged British civil servants participating in the Whitehall II study. SES based on civil service employment grade was strongly related to cognitive function. There was no association between APOE genotype and employment grade. There were marginal associations between APOE-E4 genotypes and semantic fluency and relative decline as the group aged. The authors conclude that APOE-E4 has little influence on cognitive decline in mid-life, whereas SES is a strong determinant.

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AHRQ Publication No. 06-0013
Current as of November 2005

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