Highlights from Recent AHCPR Research Findings

Media Advisory Date: October 8, 1996

The 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 July/August, 1996, issue of AHCPR's Research Activities.

Rural Hospital Downsizing Failed to Improve Financial Performance

Rural hospitals that downsized in an attempt to improve financial performance in the 1980s did not succeed in their efforts, according to a study conducted by University of Michigan researchers. About 15 percent of rural hospitals downsized during the mid and late 1980s by selling, shutting down, or restructuring ownership of a hospital unit or service. However, these hospitals did not perform any better financially than hospitals that did not downsize.

Stephen S. Mick, Ph.D., and Christopher G. Wise, Ph.D., analyzed survey responses of 797 chief administrators of rural hospitals about their service mix, financial strategies, and personnel during fiscal years 1982-83 and 1987-88, as well as secondary data from the American Hospital Association and other databases. The found that by FY 1987-1988, total profit margins had declined for both hospitals that had downsized and those which had not, but no statistical significance had emerged. In fact, hospitals that downsized actually had a significantly poorer current liquidity ratio by FY 1987-88.

"Downsizing and Financial Performance in Rural Hospitals," Health Care Management Review, 21(2), pp. 16-25, 1996.

Cancer Surgery Becomes More Common among Elderly Patients

Although older persons are still less likely to undergo surgery for cancer than younger persons, the gap is narrowing, according to a new AHCPR-supported study. Researchers found that the age discrepancy diminished for certain cancer surgeries from 1973 through 1991. These increased cancer surgeries are due in part to the greater robustness of today's elderly, who are better able to tolerate the stresses of surgery.

During the past two decades the likelihood of surgical treatment for cancers of the uterus, colon, rectum, ovary, and breast increased more quickly among persons 65 years of age and older than younger ones. Even the oldest elderly now receive surgery for these common cancers. However, the age gap did not narrow for surgeries for cancer of the lung, stomach, and pancreas. Researchers at the Johns Hopkins University School of Hygiene and Public Health, who led the study, formulated their analysis using population-based National Cancer Institute data for nine U.S. regions.

"Temporal and Regional Variability in the Surgical Treatment of Cancer among Older People, March 1996," Journal of the American Geriatrics Society, pp. 559-564.

Amount of HIV in the Blood Signals Time until Aids Onset

The amount of time that it will take for persons infected with the human immunodeficiency virus (HIV) to develop Acquired Immunodeficiency Syndrome (AIDS) can be predicted by the amount of viral RNA in their blood. Researchers, led by Joseph Lau, M.D., of Tufts University School of Medicine, found that asymptomatic persons who have 100,000 HIV particles per milliliter of blood (viral load) are at risk of developing AIDS in less than three years, while persons with 500,000 particles per milliliter may develop AIDS in less than one year. In contrast, patients with a viral load of 50,000 have at least two years and may have up to eight years before developing AIDS.

CD lymphocyte cell count has been the standard indicator of HIV disease progression. However, since CD counts are usually normal in asymptomatic patients, knowing their HIV load will aid physicians to make better therapy decisions. If a patient's viral load continues to increase under current medication, the physician will be alerted to change medication. But for persons with advanced HIV disease, CD cell count may be better than viral load for predicting long-term outcomes.

"Predictive Value of Viral Load Measurements in Asymptomatic Untreated HIV-1 Infection: a Mathematical Model," AIDS, 10(3), pp.255-262, 1996.

Latinas and Black Women are Less Likely Than Other Women To Undergo Prenatal Tests to Detect Fetal Defects

Expectant Latinas and black women are much less likely to undergo amniocentesis and chorionic villus sampling to detect fetal defects than are white and Asian women, regardless of their occupation and education. In a study, conducted by researchers at the University of California, San Francisco, black women were one-third less likely; Latinas, were one-fourth less likely, and Asian women, were nearly twice as likely as white women to undergo prenatal testing.

"This suggests that attitudes toward prenatal testing, pregnancy termination, and/or raising a disabled child may differ across these racial-ethnic groups, transcending socioeconomic strata," comments Eugene Washington, M.D., M.Sc. of UCSF. "Alternatively, these women may not be receiving adequate, clearly understandable, and culturally sensitive information regarding the possible outcomes of testing or not testing." Dr. Washington and coinvestigators suggest that efforts be made to provide these women with such information.

"Racial-ethnic Differences in Prenatal Diagnostic Test Use and Outcomes: Preferences, Socioeconomics, or Patient Knowledge?," May 1996, Obstetrics & Gynecology 87, pp. 675-682.

Other Findings

Other articles in Research Activities include findings on:

• Deciding when to admit chest pain patients to the ICU.
• Short-term survival of heart attack patients.
• Admission to nursing homes: who gets in?
• Does insurance status affect hospital treatment?
• Impact of fewer minority physicians on care for minority patients.
• Which physicians are leaving rural health care and why.
• Hospital costs for stroke.
• Effects of Medicaid on nursing home quality of care.
• How to motivate urban black teenagers to use condoms.
• Treatments for Pneumocystis carinii pneumonia.
• Complications of AIDS-related medications.
• Risk of retinal detachment following cataract surgery.
• Surgery for spinal stenosis: a good idea?
• What determines women's satisfaction with prenatal care.
• The high state costs of trauma care.
• Insurance coverage of new medical technologies.
• Free vaccines for providers: Will more children be immunized?

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864.