Highlights from AHCPR's October Research Activities

Media Advisory Date: October 31, 1997

The U.S. Department of Health and Human Service's Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

HMO Copayments for Emergency Care Don't Delay People from Seeking Treatment for Heart Attack Symptoms

Some health maintenance organizations (HMOs) have begun requiring copayments for emergency care in order to reduce inappropriate and expensive visits to the emergency department. But these copayments seem not to dissuade persons with heart attack symptoms from seeking emergency care, reports an AHCPR-funded study. Researchers examined ambulance and hospital records from 1989 through 1994 for 602 HMO patients whose employers' plans required a copayment and 729 patients whose plans had no copayment requirement. They found that the time of onset of heart attack symptoms to hospital arrival was the same (2.25 hours) for privately insured HMO patients who paid fixed copayments for emergency care of $25 to $100 and patients enrolled in the same HMO with no copayment. But copayment requirements may result in longer delays in seeking emergency care for patients with less easily recognized conditions or higher copayments or deductibles for emergency services, caution researchers.

["Absence of association between insurance copayments and delays in seeking emergency care among patients with myocardial infarction," David J. Magid, M.D., M.P.H., Thomas D. Koepsell, M.D., M.P.H., Nathan R. Every, M.D., M.P.H., and others, in the June 12, 1997, New England Journal of Medicine 336 pp. 1722-1729.]

Needless Lab Testing in the ICU Remains a Problem

Unnecessary laboratory testing in hospital intensive care units (ICUs) continues to be a problem, according to an AHCPR-supported study. Researchers found that too much blood drawn for these tests can lead to anemia and the need for blood transfusions during the ICU stay. The patient's severity of illness and diagnosis when admitted to the ICU primarily determined the number of blood samples drawn. However, even after accounting for these and other patient differences, many ICUs still had significant variations in their blood-drawing practices. The amount of blood drawn per patient during an ICU stay ranged from 240 mL to 944 mL. These losses could be reduced by 25 percent to 38 percent with use of blood conservation devices. ICUs should focus on conserving blood and eliminating excessive testing to reduce the risk of hospital-caused anemia and resulting transfusions, concludes William A. Knaus, M.D., of the University of Virginia. He and coinvestigators evaluated laboratory blood sampling of 17,440 patients admitted to 42 ICUs in the United States.

["Evaluating laboratory usage in the intensive care unit: Patient and institutional characteristics that influence frequency of blood sampling," by Jack E. Zimmerman, M.D., Michael G. Seneff, M.D., Xiaolu Sun, M.D., and others in Critical Care Medicine 25(5), pp. 737-748, 1997.]

Hospital Costs Triple for Newborns with Syphilis

The number of U.S. babies being born with syphilis contracted from their mothers has risen sharply, with most cases occurring in urban minority groups. The mean cost of caring for these newborns ($11,000) is more than three times that of newborns without syphilis and results in a 7.5-day-longer hospital stay. A maternal history of injected drug use adds another 7.7 days at a cost of $3,936. Based on the number of reported cases of congenital syphilis from 1991 to 1994, the average annual cost of treating these infants is about $18.4 million (1995 dollars). Programs that combine prenatal care with maternal treatment for substance use may be cost-effective, suggests the Low Birthweight Patient Outcomes Research Team (PORT), which conducted the study with AHCPR support. The team, led by Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham, used Medicaid reimbursement data to compare the cost of caring for 114 newborns with congenital syphilis with the cost of caring for 2,906 infants without syphilis at Harlem Hospital in New York City in 1989.

["The hospital cost of congenital syphilis," by David A. Bateman, M.D., Ciarin Phibbs, Ph.D., , Theodore Joyce, PhD., and Margaret C. Heargarty, M.D., The Journal of Pediatrics 130(5) May 1997]

Male and Female Physicians Have Very Different Patterns of Communication with Their Pediatric Patients

Female physicians spend 29 percent longer time with and engage in 41 percent more encouraging and reassuring exchanges with children than male physicians. This doesn't mean that female physicians are more popular, however. Although girls prefer female doctors, boys still would rather see male physicians, finds an AHCPR-supported study. This is similar to adults, who also prefer physicians of their own sex. On the other hand, more parents prefer female over male physicians (56 percent vs. 44 percent). Both male and female physicians spend more time with boys than girls (26 vs. 22 minutes and 33 vs. 30 minutes, respectively). It's not clear whether such communication differences established during childhood form the basis of physician-patient communication differences as adults, according to the California researchers who conducted the study. They videotaped communication between 212 children (aged 4-14 years), parents, and physicians during health visits at a university-based pediatric practice.

["Gender differences in physician-patient communication," by Jane Bernzweig, Ph.D., John I. Takayama, M.D., M.P.H., Ciaran Phibbs, Ph.D., and others in the June 1997 Archives of Pediatric and Adolescent Medicine 151, pp. 586-591.]

Other articles in Research Activities include findings on:

• Ethnicity and substance abuse during pregnancy.
• Preferred dialysis centers for treating children.
• Enzyme markers of preterm delivery risk.
• Treatment that reduces the risk of heart failure death.
• Maintaining patient confidentiality over the Internet.
• Recovery time from pneumonia.
• Persons at higher risk for chronic back-related disability.
• Strategies for cervical, colon, and breast cancer screening.
• Hospital-insurer bargaining: Who usually wins?
• Ethnic differences in continuity of care.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).