Highlights from AHCPR's April Research Activities

Media Advisory Date: May 5, 1997

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 most recent issue of AHCPR's Research Activities.

Public Disclosure of Hospital and Physician CABG Mortality Rates Has Little Effect on the Type of Patients They Treat

New York hospitals and surgeons have not been turning away risky coronary artery bypass graft (CABG) surgery patients since the state began publicly disclosing mortality rates for this procedure in 1990, according to a study supported by AHCPR. Researchers analyzed New York State registry data on CABG surgery for 31 hospitals and 87 patients from 1990 to 1992. After adjusting for patient risk status, researchers found that the mortality rate following CABG surgery for all high-risk patients (predicted death rate of at least 7.5 percent) was slightly lower than for other patients (2.94 percent vs. 3.02 percent). In general, hospitals and surgeons with the lowest risk-adjusted mortality rates for all cases also had the lowest mortality rates for high-risk cases. In fact, 16 of 31 hospitals had mortality rates for their high-risk patients that were lower than the overall statewide mortality rate of 2.99 percent. Also, over half of the surgeons who performed many bypass surgeries (200 or more a year) had mortality rates for high-risk patients that were as low as the statewide rate.

["Assessment of coronary artery bypass graft surgery performance in New York," by Edward Hannan, Ph.D., Albert L. Siu, M.D., M.S.P.H., Dinesh Kumar, M.S., and others, in Medical Care 35(1), pp.49-56, 1997.]

Adverse Drug Events Cost an Average Teaching Hospital $5.6 Million a Year

Dangerous and often life-threatening reactions to medications affect 6.5 percent of hospitalized patients, and 28 percent of these reactions are preventable. These adverse drug events (ADEs) may result in prolonged hospital stays and higher charges. Researchers supported by AHCPR compared use of medical resources by patients who experience by ADEs with similar non-ADE patients in treated in the same unit of two tertiary care hospitals over a six- month period. They found that a single ADE is associated with $2,595 in additional costs to a hospital, and a preventable ADE can account for nearly twice that amount ($4, 685). This translates into $5.6 million per year for an average 700-bed teaching hospital. Of that amount, $2.8 million is for preventable ADEs. Researchers conclude that the substantial cost associated with ADEs, not including other costs associated with injuries to patients and malpractice costs, justify an investment in efforts to prevent them.

["The costs of adverse drug events in hospitalized patients," David W. Bates, M.D., M.Sc., Nathan Spell, M.D., David J. Cullen, M.D., M.Sc., in the January 22/29 Journal of American Medical Association 227(4), pp.307-311.]

Study Says Patient Preference Is a Factor in Decisions to Perform Hysterectomy at The Same Time as Ovary Removal

When a woman has surgery to remove both ovaries because of a suspicious mass, she is typically given a hysterectomy at the same time, even when the frozen tissue sections suggest that the mass is benign. According to an AHCPR-supported study, the benefits of doing the surgeries concurrently outweigh the risks. The study shows that performing concurrent hysterectomy would prevent about 71 future deaths by averting cancer, as well as future uterine-surgery related deaths, at a cost of five immediate deaths from the hysterectomy. Alternatively, uterine preservation ultimately culminates in 49 cervical cancer cases with 22 subsequent deaths, and 228 uterine cancer cases with 44 deaths. Concurrent hysterectomy results in cost savings of about $1,913 per patient at age 45 and $4,112 at age 55. These findings were based on a decision analysis comparing both approaches in theoretical groups of 10,000 45-year-old women undergoing surgery for benign masses. However, researchers conclude that patient preferences should play a key role in determining appropriateness of the procedure because medical outcomes and economic consequences only marginally favor its use.

["Concurrent hysterectomy at bilateral salpingo-oophorectomy: Benefits, risks, and costs" by Christopher M. Grover, Miriam Kupperman, and A. Eugene Washington, in Obstetrics and Gynecology 88(6), pp. 907-913]

State Programs for Preadmission Screening of Nursing Home Applicants May Not Be Cost Effective

State nursing home preadmission screening (PAS) programs are designed to screen out individuals who do not need nursing home care. But, according to a study supported by AHCPR, few nursing home applicants are denied admission by state PAS programs. The study found that four states denied admission to only 1 percent of applicants per year, and nine states had denial rates ranging from 2 to 6 percent. Other states were unable to report denial rates. Researchers collected primary care data on PAS programs from state officials in two separate surveys in 1989 (covering 1987 to 1989) and 1992 (covering the 1990 to 1992 period). The low rate of denials suggests that PAS programs may have little direct effect in diverting people from nursing homes and thereby reducing unnecessary Medicaid costs. As a result, PAS programs may not be cost effective for states to operate, conclude researchers.

["State variations and trends in preadmission screening programs," Charlene Harrington, Ph.D. and Michael Curtis, Ph.D., in the December 1996 issue of Journal of Applied Gerontology 15(4), pp. 414-432.]

Other articles in Research Activities include findings on:

• Use of life-sustaining therapies.
• Diagnostic techniques and therapies for low back pain.
• Double-reading of mammograms.
• Effectiveness of implantable cardioverter defibrillators.
• Potential of prenatal magnesium sulfate to reduce cerebral palsy.
• Impact of symptoms on prognosis of men with benign prostatic hyperplasia.
• How doctors decide when to hospitalize and discharge pneumonia patients.

For additional information, contact AHCPR Public Affairs: Karen J. Migdail, (301) 427-1855 (KMigdail@ahrq.gov) or Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).