Highlights From AHCPR's November Research Activities

Media Advisory Date: January 15, 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.

Benefits and Costs Weighed for Speciality Versus Primary Care for Stroke Patients

Stroke patients who are treated by neurologists may pay more, but they often experience better outcomes, according to a recent study supported by AHCPR. Researchers analyzed claims data for a random 20 percent sample of Medicare patients admitted to the Duke University Medical Center between January 2 and September 30, 1991. Three months following the stroke, patients treated by neurologists had a 31 percent lower death rate than patients with nonhemorrhagic stroke treated by internists and a 36 percent lower death rate than those treated by family physicians. Patients cared for by neurologists also appeared to be more functional after their hospital stay and were more likely to be sent home or discharged to inpatient rehabilitation facilities rather than to a nursing home. Neurologists were 34 percent more expensive than family physicians and 22 percent more expensive that internists or other specialists.

"What role do neurologists play in determining the costs and outcomes of stroke patients?," by Janet Mitchell, Ph.D., David J. Ballard, M.D., Ph.D., Jack Whisnat, M.D., and others in the November 1996 issue of Stroke 27, pp. 1937-1943.

Women and the Elderly Are Less Apt than Others to Receive Life-Saving Drugs for Heart Attacks

Women and the elderly who experience heart attacks are less likely than men younger than age 65 to be treated with clot-dissolving drugs (thrombolytics), beta blockers, and aspirin to reduce complications and death. Researchers at Harvard Medical School reviewed the medical records of nearly 2,500 patients admitted to 37 Minnesota hospitals for suspected heart attack in 1992 and 1993. They found that patients 75 years or older were significantly less apt to be treated with these medications, especially thrombolytics, than those aged 64 years or younger. Women were less likely than men to be treated with aspirin and thrombolytics (odds ratio of 0.7; 1 is equal odds), as well as beta blockers.

"Adherence to national guidelines for drug treatment of acute myocardial infarction," by Thomas McLaughlin, Sc.D., Stephen B. Soumerai, Sc.D., and Donald Williamson, Sc.D., and others, Archives of Internal Medicine, 15, pp.799-805, 1996.

Uterine Fibroids Are More Common Among Black Women Than White Women Undergoing Hysterectomies

Uterine fibroids (leiomyomas) are more common among black women than white women, according to a study funded by AHCPR. Kristen H. Kjerulff, Ph.D., and her colleagues at the University of Maryland School of Medicine, found that 89 percent of 409 black women and 59 percent of 836 white women who underwent hysterectomies at 28 Maryland hospitals had leiomyomas. Researchers were not able to explain the racial difference in the development of leiomyomas, but they say that weight may play a role. Of the women in this study, 67 percent of black women and 41 percent of white women were substantially overweight (20 percent or more) compared with 49 percent of black women and 33 percent of white women in the general population.

"Uterine leiomyomas: Racial differences, in severity, symptoms, and age at diagnosis," by Dr. Kjerulff, Patricia Langenberg, Ph.D., Jeffrey D. Seidman, M.D., and others, in the July 1996 Journal of Reproductive Medicine 41, pp. 483-490.

Marketplace Demand for Specialists Declines

Physician specialists may be having difficulty finding employment, while primary care colleagues are being heavily recruited. A review of physician recruitment ads in key specialty and general medical journals in select years from 1984 through 1995 found steep declines in the number of advertised positions for specialists over the past five years with the exception of pediatric specialists. There were four specialist ads for one every for a generalist in 1990, but by 1995 this ratio had shrunk to two to one. California and Washington researchers who conducted the study attribute the decline partly to the managed care health plans and capitated payment systems that use fewer specialists.

"Changes in marketplace demand for physicians," by Sarena D. Seifer, M.D., Barbara Troupin, M.D., M.B.A., and Gordon D. Rubenfield, M.D., in the September 4, 1996, Journal of the American Medical Association, 276(9), pp. 695-699.

Other articles in Research Activities include findings on:

• Aspects of primary care that affect survival.
• Why programs to prevent preterm births have failed.
• Impact of educational videos on patients' treatment decisions.
• How to reduce coronary care unit costs for chest pain patients.
• Why neurologists have more success with stroke patients than generalists.
• Elderly attitudes that contribute to nursing home use.
• Efficiency of Medicaid providers in managing chronic diseases.
• Benefits of surgery for sciatica and spinal stenosis.
• Lack of health insurance among Mexican Americans.

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