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Allison, J.J., Kiefe, C.I., Weissman, N.W., and others (1999). "The art and science of searching MEDLINE® to answer clinical questions." (AHCPR grants HS09446 and HS08843). International Journal of Technology Assessment in Health Care 15(2), pp. 281-296.

This article provides a brief tutorial on how to search the National Library of Medicine's MEDLINE® database. The authors summarize the current state of the art of searching and provide an approach to enhance search skills. For example, they suggest general principles that can be applied to the constantly appearing new search engines. They propose an idealized classification system for the results of a MEDLINE® search: Type A searches produce a few articles of high quality that are directly focused on the immediate question. Type B searches yield a large number of articles, some more relevant than others. Type C searches produce few or no articles, and those that are located are not germane. Provided that relevant, high-quality articles do exist, type B and C searches often may be improved with attention to search technique, according to the authors. They advise the searcher on how to overcome barriers to good searching, such as failure to begin with a well-built question or failure to apply proper limits to the search.

Barnett, S., and Franks, P. (1999, November). "Telephone ownership and deaf people: Implications for telephone surveys." (AHCPR grant HS09539). American Journal of Public Health 89, pp. 1754-1756.

People with hearing loss represent slightly more than 9 percent of the U.S. population, which is more than 23 million people. Of those, about 4.8 million people cannot hear or understand normal speech and instead use American Sign Language. This is the third most commonly used language in the United States, after English and Spanish. This study concludes that telephone surveys risk marginalizing prelingually deafened adults (those who lost hearing before they acquired language) due to low telephone ownership and language barriers. The researchers analyzed the Hearing Supplement of the National Health Interview Survey data from 1990 and 1991 to determine the prevalence of telephone ownership in different deaf populations. They found that, compared with the general population, prelingually deafened adults were less likely to own a telephone (adjusted odds ratio, AOR of 0.35; 1 is equal odds), whereas postlingually deafened adults (those who became deaf after they learned how to speak) were as likely as members of the general population to own a telephone (AOR of 1).

Lohr, K.N., and Carey, T.S. (1999, September). "Assessing 'best evidence': Issues in grading the quality of studies for systematic reviews." (AHCPR contract 290-97-0011). Joint Commission Journal on Quality Improvement 25(9), pp. 470-479.

Evidence-based medicine, clinical practice guidelines, quality and value of health services, and science-based decisionmaking are becoming mainstays of the health care sector. This movement toward the use of "best evidence," usually called evidence-based medicine or evidence-based practice, has spread widely in the United States and abroad during the past decade. As part of this movement, systematic reviews of clinical questions are becoming increasingly common. These systematic, evidence-based reviews are innovative in their comprehensive review of the literature, use of standard methods of presenting data, and special emphasis on the validity of research methods. These authors contend that, even in the absence of any universal evidence-grading system, those conducting systematic reviews of studies can take certain steps to ensure that their approaches to grading the quality of articles meet applicable scientific standards. To clarify issues in this area, in 1998, the Agency for Health Care Policy and Research commissioned a small project to determine how its 12 Evidence-based Practice Centers were carrying out this part of their systematic reviews (evidence reports). As part of this project, methods to grade the quality of research articles were developed and are reported in this article.

Mandelblatt, J.S., Ganz, P.A., and Kahn, K.L. (1999, August). "Proposed agenda for the measurement of quality-of-care outcomes in oncologic practice." (AHCPR grant HS08395). Journal of Clinical Oncology 17(8), pp. 2614-2622.

The Institute of Medicine recently released a report reviewing the quality of cancer care in the United States and called for further development and monitoring of quality indicators. More practice-based measures of quality cancer care are needed as we move into the 21st century, note these researchers. They reviewed methodological concerns involved in selecting quality of care measures, using breast cancer to exemplify key issues from early detection through posttreatment surveillance. They give examples of potential breast health care outcome measures, including the use of charts and tumor registries to track stages of cancer over time and rate of true-positive breast biopsies for screening and diagnosis indicators. They define criteria for measures of the quality of breast cancer care. These measures should capture a condition or aspect of a condition that has a large burden of morbidity or mortality in the target population, be sufficiently prevalent in the setting/unit of interest (for example, practice or region), be under the control of patients and providers (that is, be amenable to change), and be feasible to collect and verify in routine practice settings.

Meenan, R.T., O'Keefe-Rosetti, M.C., Hornbrook, M.C., and others (1999). "The sensitivity and specificity of forecasting high-cost users of medical care." (AHCPR National Research Service Award training grant T32 HS00069 and fellowship F32 HS00072). Medical Care 37(8), pp. 815-823.

This study demonstrates the potential of risk-assessment models to inform care management decisions by efficiently screening managed care populations for high-expense risk. Such models can act as preliminary screens for plans that can refine model forecasts with detailed surveys, suggest the authors. They analyzed 98,985 cases drawn randomly from memberships of 3 staff/group health plans. They measured risk-factor data from 1992 and measured expenses for 1993 and then compared the ability of three risk-assessment models—the Global Risk Assessment Model (GRAM), a logistic version of GRAM, and a prior-expense model—to analyze the models' ability to distinguish high and low expense-risk status. All models forecast the highest cost cases relatively well. The authors conclude that such models can inform care management decisions by efficiently screening managed care populations for high expense-risk.

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AHCPR Publication No. 99-0006
Current as of November 1999

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