publicdata/ahrq-gov
1
0
Fork 0
Code Issues Pull requests Projects Releases Packages Wiki Activity Actions
ahrq-gov/archive.ahrq.gov/research/jul96/dept6.htm
Scott Williams 58222b51ed Initial commit
2025-02-28 14:14:25 -05:00

587 lines
No EOL
33 KiB
HTML
Raw Blame History

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<title>Research Activities, July/August 1996: Announcements</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<!-- "metadata" -->
<meta name="Title" content="Research Activities, July/August 1996" />
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, AIDS/HIV, ambulatory care, benchmark, child, cost, elderly, health cost, healthcare cost, hospital, long-term care, managed care, markets, mental health, methodology, minority health, nursing, nursing homes, outcome research, out-of-pocket spending, patient care, primary, primary care, research, rural, spending, study, Translating Research Into Practice, TRIP" />
<meta name="description" content="Online newsletter summarizing published findings from AHRQ-funded studies, new AHRQ publications and products, and funding opportunities." />
<meta name="creator" content="Agency for Healthcare Research and Quality (AHRQ)" />
<meta name="language" content="English" />
<!-- end metadata -->
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
<script>
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
ga('create', 'UA-75759936-1', 'auto');
ga(' set', 'anonymizeIp', true);
ga('send', 'pageview');
</script></head><body><!-- Google Tag Manager -->
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
<!-- End Google Tag Manager -->
<noscript>
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
</noscript>
<!-- Page Header v2.0 -->
<a name="top" id="top"></a>
<!--Begin Banner CodeS-->
<div id="ahrqbanner">
<div class="hhsportion">
<a href="#h1" class="skipnav">Skip Navigation</a>
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
</a>
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
</a>
</div>
<div class="ahrqportion">
<a href="/" title="Archive: Agency for Healthcare Research Quality">
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
<input type="hidden" name="entqr" value="0" />
<input type="hidden" name="output" value="xml_no_dtd" />
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
</form>
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home&#8212;Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | &nbsp;<img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
</div>
<div id="PrintBanner">
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
</div>
<a name="h1"></a>
<!-- End banner code -->
<!-- End of Page header -->
<!-- Content Body -->
<div id="mainContent">
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
<tr valign="top">
<td width="70%">
<!-- Center Content section -->
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
<!--DWLayoutTable-->
<tr>
<td class="crumb_link"><div id="crumbContent">
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> &gt; <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> &gt; <a href="." class="crumb_link">July/August 1996</a>
</span></p>
</div>
</td>
</tr>
<tr>
<td><h1><a name="h1" id="h1"></a> Announcements </h1>
</td>
</tr>
<tr>
<td><div id="centerContent"><div class="headnote">
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<a name="head1"></a><h2>AHCPR launches MEPS project</h2>
<p>The <a href="http://www.meps.ahrq.gov/">Medical Expenditure Panel Survey</a> (MEPS) is a vital new
resource designed to continually provide policymakers, health
services researchers, health care administrators, businesses, and
others with timely, comprehensive information about health care
use and costs in the United States and to improve the accuracy of
economic projections.</p><p>
The Agency for Health Care Policy and Research and the National
Center for Health Statistics (NCHS) are cosponsoring this new
survey, which is being conducted through contracts with Westat, a
survey research firm in Rockville, MD, and the National Opinion
Research Center (NORC), which is affiliated with the University
of Chicago.</p>
<p>MEPS collects information on the specific health services used,
the costs of these services, and how Americans pay for health
services, as well as information on health status, disability,
income, and assets. Data also are collected on the cost, scope,
and breadth of private health insurance coverage held by and
available to the U.S. population.</p><p>
MEPS is unparalleled for the degree of detail in the data
collected and the ability to link medical expenses to health
insurance information, demographic data, employment
characteristics, and health status. Moreover, MEPS is the only
national survey that provides a foundation for estimating the
impact of changes in sources of payment and insurance coverage on
different economic groups and populations of special interest
such as the poor, elderly, veterans, the uninsured, and
minorities.</p>
<p>The 1996 MEPS is the most recent in a series of medical
expenditure surveys that began in 1977 as the National Medical
Care Expenditure Survey and later became the National Medical
Expenditure Survey (NMES), which was conducted in 1987. The new
MEPS data will provide critically needed updates to the
information gathered in 1987.</p><p>
MEPS comprises four surveys: a household survey, a survey of
physicians and hospitals, a survey of employers and other sources
of health insurance, and a nursing home survey.</p>
<p><strong>Household Survey.</strong> In the MEPS household component, data
are
collected on 10,500 families and 24,000 individuals in 190
communities across the United States. The sample is drawn from a
nationally representative subsample of the households
participating in NCHS's 1995 National Health Interview Survey.
The survey design calls for several interviews over almost 30
months, which will permit estimates for each of 2 calendar years.
MEPS data can be used to explain the relationships between
changes in health status, eligibility for private and public
health insurance coverage, use of services, and payment for
care.</p><p>
<strong>Medical Provider Survey.</strong> MEPS will collect information
from 2,700
hospitals, 20,000 physicians, and 300 home health care agencies
that provided care to persons in the MEPS household survey. This
information will supplement responses obtained during the
household survey and provide data that can be used to estimate
the expenses of persons enrolled in health maintenance
organizations and other types of non-fee-for-service health
insurance plans.</p>
<p><strong>Insurance Survey.</strong> This component of MEPS covers sources of
insurance, including over 9,000 employers, 300 unions, and 400
insurers identified by the household respondents. Detailed
information is collected on the insurance held by the household
and on the plans from which the respondent made his or her
insurance choice. An additional 20,000 establishments will be
asked the same questions about available plans and their
characteristics to permit national and regional estimates of the
availability of health insurance at the workplace. State-level
estimates can be made every 5 years.</p><p>
The first of several rounds of MEPS interviewing were recently
completed, and the first installment of MEPS data will be
available for public use in the spring of 1997. MEPS data also
will be used in a series of studies to be published by AHCPR
researchers. For more information, contact Doris Lefkowitz or Joel
Cohen in AHCPR's Center for Cost and Financing Studies at (301)
427-1477 or (301) 427-1659, or via E-mail at mepspd@ahrq.gov. </p>
<a name="head2"></a><h2>New publications available from NTIS</h2>
<p>The following publications and final reports are now available
from the National Technical Information Service.</p> <p>
<strong>Continuous Twice Daily or Once Daily Amoxicillin Prophylaxis
Compared to Placebo for Children with Recurrent Otitis Media.</strong> AHCPR grant HS07383, 9/30/92 to 9/29/95. Stephen Berman,
M.D.,
University of Colorado Health Science Center, Denver, CO.</p>
<p>This randomized, double-blind clinical trial was set in a
hospital-based general pediatric clinic and a private pediatric
practice, both in Denver, CO. Participants were 158 children
(aged 3 months through 6 years) who had three documented acute
otitis media (AOM) episodes within the prior 6 months and did not
have ventilating tubes or associated anatomic defects,
immunodeficiency disorders, or allergy to penicillin. The
amoxicillin dose was 20 mg per kg per day, given either once or
twice a day. Following randomization to placebo,
amoxicillin/placebo, or amoxicillin alone, patients were followed
monthly. Overall, study subjects had 7,243 days at risk during
which time they developed 56 new AOM episodes. Among patients
enrolled for 3 months or longer, 15 (54 percent) in the placebo group,
15 (63 percent) in the once daily amoxicillin group, and 9 (60 percent) in the
twice daily amoxicillin group were otitis-free. Among patients
enrolled for 30-90 days, 22 (71 percent) in the placebo group, 20 (65 percent)
in the once daily group, and 18 (62 percent) in the twice daily group
were otitis-free. Although once-a-day dosing was equivalent to
twice-a-day dosing for amoxicillin prophylaxis, no benefit was
found for amoxicillin prophylaxis compared with a placebo control
in preventing new AOM episodes. Because of these findings and the
potential of excessive antibiotic use to promote the acquisition
of resistant pneumococci, the researchers conclude that routine
use of amoxicillin prophylaxis for AOM should be discouraged
(Abstract, executive summary, and tables 1-4; NTIS accession no.
PB96-179023, 23 pp; $19.50 paper, $10.00 microfiche).</p>
<p><strong>Development of an Adolescent Health Status Measure.</strong> AHCPR
grant
HS07045, 2/1/92 to 9/21/96. Barbara Starfield, M.D., M.P.H.,
Johns Hopkins University, Baltimore, MD.</p><p>
The purpose of this project was to develop a comprehensive health
status measure for self-administration by adolescents. The goal
was to assess the reliability and validity of the measure in
representative samples of adolescents in schools and clinic
facilities. The project was successful in accomplishing its goal
and in making available a feasible and practical tool for
assessing the health status of 11- to 17-year-olds across a
comprehensive range of domains. The six domains address
health-related characteristics, including functional status and
quality of life: they are discomfort, disorders, satisfaction
with health, achievement of social expectations (development
appropriate to age), resilience, and risks. The instrument, known
as the Child Health &amp; Illness Profile-Adolescent Edition
(CHIP-AE&#8482;), is designed for self-administration in
both community
and clinical settings (Abstract, executive summary, final
report, and appendixes A and D; NTIS accession no. PB96-182563,
107 pp; $28.00 paper, $14.00 microfiche).</p>
<p><strong>Effects of Rural Hospital Closures on the Utilization and Cost
of
Hospital Care for Medicare Beneficiaries Living in the Hospital
Market Areas.</strong> AHCPR grant HS07029, 1/1/93 to 12/31/95. Susan
DesHarnais, Ph.D., University of North Carolina, Chapel Hill.</p><p>
This study evaluated the impact of rural hospital closures on the
use and cost of care for the Medicare populations living in the
service areas of the closed hospitals from January 1, 1985 to
December 31, 1989. The investigators compared hospital
utilization and cost data for Medicare beneficiaries in market
areas where hospitals closed with data from similar areas where
no hospital closures occurred. They used an analytical technique,
SUDAAN, which accounts for correlated data due to repeated
measurements in the same market areas over time. They found that
for Medicare patients using medical, surgical, psychiatric, and
alcohol/substance abuse services, "closure status" was not a
significant variable in the model for predicting changes in the
use of hospital care; the same trends in utilization occurred in
market areas with open and closed hospitals. The researchers
found no significant differences in costs between rural market
areas with hospital closures and no closures. In urban areas,
however, they found significantly higher costs per admission
after the year of closure, compared with urban areas where
hospitals remained open (Abstract, executive summary, and final
report; NTIS accession no. PB96-185897, 26 pp; $19.50 paper,
$10.00 microfiche).</p>
<p><strong>Health Status Measure of Drug Therapy for PCP.</strong> AHCPR grant
HS07824, 9/1/93 to 8/31/95. Albert W. Wu, M.D., Johns Hopkins
University, Baltimore, MD.</p><p>
Reliability, validity, and responsiveness were examined for a
brief health status measure for acute <em>Pneumocystis carinii</em> pneumonia (PCP). Data from a 21-day clinical trial comparing
three treatment regimens for acute PCP involved 157 HIV-infected
subjects (10 percent women and 24 percent African Americans).
Scales assessing general health perceptions, physical
functioning, energy, disability, and respiratory symptoms showed
good reliability and validity. Lower scores predicted changes in
therapy. Health perception and respiratory symptom scales were
most strongly related to changes in alveolar-arterial gradient;
physical functioning and disability were also sensitive to
differences between treatments. Health status was more sensitive
than survival, treatment failure, and adverse events to
differences among treatment groups. Standard therapy was not
superior to the two alternative regimens (Abstract, executive
summary, final report, and appendixes A, B, and D; NTIS accession
no. PB96-182555, 105 pp; $28.00 paper, $14.00 microfiche).</p>
<p><strong>Lifestyle and Diabetic Amputation in Pima Indians.</strong> AHCPR
grant
HS07238, 9/30/92 to 9/30/94. Robert Nelson, M.D., Indiana
University, Indianapolis, IN.</p><p>
The investigators examined the contribution of foot risk factors,
lifestyle, and preventive care to the risk of lower extremity
amputation in diabetic Pima Indians. Based on a review of medical
records, they compared 61 cases with an incident lower extremity
amputation between 1985-1992 with three groups of randomly
selected controls that had no amputation by 1992 (183 subjects).
Eligible subjects were 25 to 85 years old, had
non-insulin-dependent diabetes mellitus, were 50 percent or more
Pima or Tohono O'odham Indian, lived in the Gila River Indian
Community, and had undergone at least one National Institutes of
Health research examination. Peripheral neuropathy, peripheral
vascular disease, foot deformity, and a prior ulcer were almost
equally associated with an increased risk of lower extremity
amputation. The risk of amputation was associated with the number
of foot conditions, male sex, complications of diabetes, poor
glucose control, age, and duration of diabetes. Preventive foot
care decreased the amputation risk by half, and patient
nonadherence to medical advice doubled the risk of amputation;
however, neither of these findings was statistically significant.
Alcohol-related medical problems and treatment had no association
to amputation risk (Executive summary and final report;
PB96-182522, 37 pp; $21.50 paper, $10.00 microfiche).</p>
<p><strong>Link Between a Total Quality Management Initiative and the
Accounting and Control System in a Healthcare Setting.</strong> AHCPR
grant HS07458, 9/1/92 to 8/31/94. Leslie K. Pearlman, M.B.A.,
Boston University.</p><p>
The purpose of this study was to investigate the relationship
between a total quality management (TQM) initiative in a health
care setting and the role of the organization's accounting and
control (A&amp;C) system in facilitating or constraining the
initiative. The goal was to provide managers with insights about
the role played by the A&amp;C system during organizational
change. The researcher studied the change process demanded by a
TQM initiative in two hospitals (Abstract and executive summary
of dissertation; PB96-182506, 12 pp; $19.50 paper, $10.00
microfiche).</p>
<p><strong>Long-Term Care for the Rural Elderly.</strong> AHCPR grant HS08125,
2/1/94
to 1/3/96. Graham D. Rowles, M.D., Ph.D., University of Kentucky,
Lexington.</p>
<p>Long-term care of the rural elderly is undergoing substantial
changes as new options are introduced and institutions adapt to
the changing circumstances of rural America. The report
summarizes a conference that provided a forum for sharing current
research, exploring innovative options for enhancing the rural
long-term care environment, assessing the implications of actual
and potential health care reform initiatives, and developing and
disseminating a research and policy agenda. The conference led to
the development of seven guiding principles for rural long-term
care: community focus of control, non-linear models of care,
client-centered philosophy of care, family-centered
decisionmaking, access to information, cooperation among
providers, and redefinition of health professional roles. Within
this framework, a series of programmatic recommendations and key
research questions were developed for five key rural
institutions: rural families, home- and community-based services,
senior centers, nursing homes, and hospitals (Abstract,
executive summary, and final report; NTIS accession no.
PB96-182514, 11 pp; $19.50 paper, $10.00 microfiche).</p><p>
<strong>Medicaid HMO Enrollee Nonurgent Emergency Room Use: Factors
Associated with Non-Emergency Care.</strong> AHCPR grant HS08934,
8/1/95
to 3/31/96. Patricia A. Butler, J.D., University of Michigan
School of Public Health, Ann Arbor.</p>
<p>Research shows that enrolling Medicaid beneficiaries in managed
care reduces emergency department (ED) use. Yet some ED use
remains, and it varies across plans. In an effort to understand
why Medicaid health maintenance organization (HMO) enrollees in
one large Colorado HMO use EDs for nonemergency care, this study
examined personal and system characteristics. This researcher
asked why a nonemergency visit was made to the ED rather than to
the primary care physician's office. A visit was more likely to
be made to a primary care physician by an enrollee who: had more
experience using the HMO (because the enrollee was older, female,
or enrolled longer in the HMO); was not disabled; lived closer to
the physician's office; spoke English as a primary language; and
expressed several health attitudes and beliefs (satisfaction with
the HMO, a perception of vulnerability to illness, knowledge of
when and how to get primary care, and a willingness to seek
care) (Abstract, executive summary, and dissertation; NTIS
accession no. PB96-176920, 145 pp; $31.00 paper, $14.00
microfiche).</p><p>
<strong>Monitoring Trends in the Financing of HIV-Related Care.</strong>
AHCPR
grant HS07847, 5/1/93 to 4/30/94. Jesse Green, M.B.A., Ph.D., New
York University Medical Center, New York, NY.</p>
<p>This project extended the grant entitled: "Consequences of
Patterns of Provider Care for AIDS" by examining the influence of
clinic service availability, accessibility, and HIV
specialization on outcomes of care. Patients in the study were
New York State (NYS) Medicaid enrollees diagnosed with AIDS in
fiscal years 1987-1992. These patients used a clinic as their
dominant site of ambulatory care either before or after AIDS
diagnosis. Patient-level data were obtained from the NYS HIV/AIDS
Research Data Base, with supplementary death information from
national sources. Information on over 66 clinic characteristics
was provided by telephone surveys that were designed with HIV
experts and completed by 179 directors of NYS clinics. A
classification of typologies of clinic care characteristics was
developed on this project among HIV specialty, general medicine,
and community-based clinics. Important tradeoffs were identified
between comprehensiveness and accessibility of care. Clinics that
offer longer hours and services facilitating accessibility to
providers appear to substantially reduce clinic patients' odds of
multiple emergency room encounters and hospitalization in the
year before AIDS diagnosis. Clinics with an array of HIV-specific
services appear to be more effective in <em>Pneumocystis
carinii</em> pneumonia prevention, and clinic experience with HIV care was
associated with improved survival among women after AIDS
diagnosis (Abstract, executive summary, and final report; NTIS
accession no. PB96-176938, 38 pp; $21.50 paper, $10.00
microfiche).</p><p>
<strong>Prenatal Care Source in Medicaid Low Birthweight Births.</strong>
AHCPR
grant HS08423, 9/1/94 to 8/31/95. Linda O. Lange, M.P.H.,
University of California, Los Angeles.</p>
<p>Using the 1988 National Maternal and Infant Health Survey&#8212;a
nationally representative, cross-sectional, linked survey of
vital records and maternal questionnaires&#8212;this study found
an
association between low birthweight and source of prenatal care
for Medicaid births. For all Medicaid births, mothers who
attended hospital clinics for prenatal care were more likely to
have a low birthweight infant than mothers attending other public
or private providers. These infants were more likely to be black
and have mothers who smoked, did not complete high school, and
did not receive WIC benefits. In separate analyses, mothers of
black infants who attended hospital clinics and, to a slightly
lesser extent, community health centers and public health
clinics, were more likely to have a low birthweight infant
compared with mothers who saw private providers. Mothers were
more likely to be smokers and have prior abortions but not to be
WIC recipients. For white births, women who attended hospital
clinics for prenatal care were more likely to have a low
birthweight infant compared with women who saw other providers.
These mothers also were more likely to be smokers and not to have
completed high school (Abstract, executive summary, final
report, and dissertation; NTIS accession no. PB96-179098, 325 pp;
$49.00 paper, $19.50 microfiche).</p><p>
<strong>Quality of Cardiac Surgical Care in Ontario, Canada.</strong> AHCPR
grant
HS08464, 8/1/94 to 7/31/96. Jack V. Tu, M.D., Harvard Medical
School, Boston, MA.</p>
<p>This research involved a comprehensive study of the quality of
cardiac surgical care in Ontario, Canada. Data from the
Provincial Adult Cardiac Care Network (PACCN) of Ontario, a
cardiac surgery registry, were used to conduct three studies. The
first study demonstrated that the overall in-hospital mortality
rate following coronary artery bypass graft (CABG) surgery in
Ontario was 3.01 percent with no hospitals having risk-adjusted
mortality rates significantly greater than expected during the
1991 to 1993 study period. The second study showed that higher
rates of CABG surgery in New York State compared with Ontario in
1993 were a function of higher rates of surgery in the elderly,
females, patients with a recent heart attack, and patients with
left main and limited coronary artery disease. The results of the
third study suggest that artificial neural network modeling
techniques do not offer any significant predictive advantages
over existing logistic regression statistical techniques for
predicting mortality after CABG surgery (Abstract and executive
summary of thesis; NTIS accession no. PB96-182498, 12 pp; $19.50
paper, $10.00 microfiche).</p><p>
<strong>Time-Insensitive Predictive Instrument Impact Trial.</strong> AHCPR
grant
HS07360, 2/9/93 to 5/31/95. Harry P. Selker, M.D., New England
Medical Center, Boston, MA.</p>
<p>Each year in the United States, approximately 3 million emergency
department (ED) patients are hospitalized for suspected acute
cardiac ischemia (acute infarction or unstable angina pectoris)
for whom the diagnosis is ruled out. In this clinical trial, the
researchers tested whether the acute cardiac ischemia
time-insensitive predictive instrument (ACI-TIPI) incorporated
into a computerized electrocardiograph could improve ED triage
for such patients. This prospective, controlled clinical trial in
10 hospitals' EDs included all patients with chest pain or other
symptoms suggesting acute cardiac ischemia. During 7 alternating
months, the ACI-TIPI's predicted probability of acute ischemia
was automatically printed, or not printed, by the
electrocardiograph on the top of patients' presenting
electrocardiograms. The trial included 10,689 patients. For
patients without cardiac ischemia, in hospitals with low cardiac
telemetry unit capacities, the ACI-TIPI reduced coronary care
unit (CCU) use by 16 percent (from 15 to 12 percent) and
increased ED discharge to home by 6 percent (from 49 to 53
percent), whereas in hospitals with high telemetry capacity,
there was no significant change. However, for patients in these
facilities seen by unsupervised residents, it reduced CCU
admission by 20 percent (from 39 to 31 percent) and increased
discharge home by 25 percent (from 45 to 56 percent). Of patients
with stable angina, at low telemetry capacity hospitals, it
reduced CCU admission by 50 percent (from 26 to 13 percent) and
increased discharges home by 10 percent (from 20 to 22 percent).
At high telemetry capacity hospitals, it did not change CCU
admission, but it reduced telemetry admission by 14 percent (from
68 to 59 percent) and increased discharge home by 101 percent
(from 10 to 21 percent). For patients with acute myocardial
infarction or unstable angina, it resulted in no change in
appropriate admission (96 percent) to CCU or telemetry at
hospitals with either low or high telemetry capacity. The trial
demonstrated that the ACI-TIPI reduced unnecessary hospital and
cardiac unit admission for ED patients without acute cardiac
ischemia, tailored to the hospital's specific cardiac bed
capacities. It did not reduce appropriate cardiac unit admission
of patients with unstable angina or acute myocardial infarction.
ACI-TIPI appears to be effective and safe for improving ED
triage (Abstract, executive summary, final report, and
appendixes A-G; NTIS accession no. PB96-182571, 437 pp; $57.00
paper, $21.50 microfiche).</p><p>
<strong>Traumatic Brain Injury in the U.S. Army: Behavioral Sequelae
and
Medical Disability.</strong> AHCPR grant HS08414, 9/1/94 to 5/7/96.
Alexander K. Ommaya, M.A., Johns Hopkins University, Baltimore,
MD.</p>
<p>This study examined the behavioral and medical consequences of
hospital admissions during fiscal years 1992 and 1993 for
traumatic brain injury (n=1,617), orthopedic/internal injury
(n=4,626), and a random sample of the active duty Army population
(n=9,997). Adverse action (disciplinary action recorded in a
soldier's personnel file), discharge from military service for
behavioral criteria, criminal conviction, and medical discharge
were compared in these groups. Individuals who were injured as a
result of fights were more likely to incur a postinjury adverse
action or behavioral or criminal discharge and less likely to
receive a medical discharge when compared with other groups. Head
injury in military personnel increased the risk for behavioral
separation by four times and increased the risk of criminal
conviction five times compared with the control group. The study
found an association between head injury and an increased risk of
behavioral problems after injury (Abstract, executive summary,
and dissertation; NTIS accession no. PB96-182548, 185 pp; $38.00
paper, $14.00 microfiche).</p>
<p class="size2"><a href=".">Return to Contents</a><br />
<a href="dept7.htm">Proceed to Next Section</a></p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
<p>&nbsp;</p>
</div>
</td>
</tr>
</table>
<!-- End of Center Content section -->
</td>
</tr>
</table>
</div>
<!-- End of Content Body -->
<!-- Footer graphic 1.2-->
<table cellspacing="0" cellpadding="0" border="0" width="100%">
<tr>
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
</tr>
</table>
<!-- Footer links section -->
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health &amp; Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
</div>
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
<!-- End of Footer links section -->
</body>
</html>
Reference in a new issue View git blame Copy permalink