Highlights from AHCPR's March Research Activities

Media Advisory Date: April 4, 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.

Women Are More Apt to Die Following Coronary Angioplasty Than Are Men

Women are more likely than men to die in the hospital following a coronary angioplasty despite the success of the procedure, according to a study funded by AHCPR. Although angioplasty was nearly 90 percent successful in opening blocked arteries for both men and women, women had a 1.6 times greater risk of dying compared with men. In addition, more women (5.3 percent) than men (4.5 percent) had to undergo bypass surgery or suffered a heart attack following angioplasty. Researchers from the Northern New England Cardiovascular Disease Study Group examined prospectively collected data on 12,232 patients undergoing angioplasty between 1989 and 1993. They found that women undergoing angioplasty tended to be older and were more likely to be hypertensive and diabetic. However, even after accounting for these factors, women's risk of death while hospitalized was still nearly twice as high as men.

["Differences in outcomes between women and men associated with percutaneous transluminal coronary angioplasty," by David J. Malenka, M.D., Gerald T. O'Connor, Ph.D., Hebe Quinton, M.S., and others, Circulation 94(Suppl. II), pp. 99-104]

Both Hospital and Market Factors Affect a Rural Hospital's Likelihood of Survival or Organizational Change

Rural community hospitals who find themselves in financial trouble are often forced to choose between closure and a shift away from acute inpatient care to a structure that provides nonacute health care services. These services include primary care clinics, long-term care facilities, or speciality hospitals. Conversions are more likely when the community's per capita income and demand for health care are high, competition from other hospitals is substantial, and hospitals have established strategies to provide alternative forms of health care, according to a study supported by AHCPR. Jeffrey A. Alexander, Ph.D., of the University of Michigan and his colleagues studied 2,780 community hospitals at risk for conversion from 1984 to 1991 as well as hospitals that emerged during the study period as newly formed organizations. They found that closeness of a rural hospital to a competitor, poor financial and operational performance, and smaller size put the hospital at risk for both closure and conversion. Hospitals that were components of a multihospital center had an increased likelihood of conversion, while investor-owned hospitals were at a higher risk of closure.

["Determinants of profound organizational change: Choice of conversion or closure among rural hospitals," by Dr. Alexander, Thomas A. D'Aunno, Ph.D., and Melissa J. Succi, The Journal of Health and Social Behavior 37, pp.238-251, 1996]

Women Receive More Health Care Services if They Have an Internist as Their Primary Care Doctor

Women who have an internist as their primary care doctor have more tests, receive more ancillary services and referrals to specialists, and spend significantly more on outpatient care than women whose primary care doctor is an obstetrician/gynecologist (OB/GYN) or family/general practitioner, according to an AHCPR-supported study. These findings are based on analysis of data from the 1987 National Medical Expenditure Survey. Researchers aren't sure whether the discrepancy is due to overtreatment by internists or undertreatment by OB-GYNs, or whether women who want more health care services choose internists as their primary care physicians. Researchers, including Carolyn Clancy, M.D., Director of AHCPR's Center for Outcomes and Effectiveness Research and Acting Director of AHCPR's Center for Primary Care Research, conclude that more research is needed to address the ongoing debate about which type of doctors should provide primary care to women.

["Cost Differences Among Women's Primary Care Physicians," by Barbara A. Bartman, M.D., M.P.H., Dr. Clancy, Ernest Moy, M.D., and Patricia Langenberg, Ph.D., in the Winter 1996 issue of Health Affairs 15(4), pp.177-182]

Study Questions Advisability of Shifting Care of Elderly Heart Attack Patients from Cardiologists to Primary Care Doctors

Elderly heart attack patients who are admitted to a hospital by a cardiologist are 12 percent less apt to die within one year than similarly ill patients admitted by a primary care physician. An AHCPR-supported study concludes that cardiologists are more likely to use cardiac procedures and medications known to improve survival. Elizabeth R. DeLong, Ph.D., of Duke University Medical Center and her coinvestigators studied detailed clinical data from the Cooperative Cardiovascular Project on 8,241 Medicare patients hospitalized for heart attack from June through December 1992. They found that compared with patients of primary care physicians, patients admitted by cardiologists underwent more coronary angiography (49 percent vs. 18-36 percent), revascularization procedures (22 percent vs. 7-14 percent), stress testing (14 percent vs. 9-11 percent), nuclear imaging (19 percent vs. 7-15 percent), and echocardiography (55 percent vs. 40-52 percent). Also, 6 percent more of patients admitted by cardiologists were considered eligible for thrombolytic (clot-busting) therapy.

["Outcomes of acute myocardial infarction according to the specialty of the admitting physician," by James G. Jollis, M.D., Dr. DeLong, Eric D. Peterson, M.D., M.P.H., and others, in the December 19, 1996 issue of the New England Journal of Medicine 335, pp. 1880-1887]

Other articles in Research Activities include findings on:

• Doctor-patient communication and malpractice suits.
• Which intensive care patients receive do-not-resuscitate orders.
• Effect of patients' desires on receipt of life-sustaining treatment.
• New medication's reduction of complications after coronary angioplasty.
• Canadian versus U.S. mortality rates after coronary bypass surgery.
• Family support and control of diabetes in the elderly.
• Suicidal thoughts among elderly primary care patients.
• Prostate cancer screening debate.
• Predictors of pregnancy loss following amniocentesis.
• Systems for managed care contracting with hospitals.

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).