AHRQ in the Professional Literature

AHRQ in the Professional Literature


1. Omachi TA, Katz PP, Yelin EH, et al. Depression and health-related quality of life in chronic obstructive pulmonary disease. Am J Med 2009 Aug; 122(8): 778.e9-778.e15. Select to access the abstract on PubMed. ®

Am J Med. 2009 Aug;122(8):778.e9-15.

Depression and health-related quality of life in chronic obstructive pulmonary disease.
Omachi TA, Katz PP, Yelin EH, Gregorich SE, Iribarren C, Blanc PD, Eisner MD.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA. omachi@ucsf.edu

Abstract
BACKGROUND: Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life. METHODS: Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively. RESULTS: In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score >or=6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001). CONCLUSIONS: Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.

PMID: 19635280 [PubMed - indexed for MEDLINE]PMCID: PMC2724315Free PMC Article
http://www.ncbi.nlm.nih.gov/pubmed/19635280



2. Chen RC, Clark JA, Talcott JA. Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function. J Clin Oncol 2009 Aug 20; 27(24):3916-22. Select to access the abstract on PubMed. ®

J Clin Oncol. 2009 Aug 20;27(24):3916-22. Epub 2009 Jul 20.

Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function.Chen RC, Clark JA, Talcott JA.

Center for Outcomes Research, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA.

Comment in:

J Clin Oncol. 2009 Aug 20;27(24):3877-8.

Abstract
PURPOSE: Although it is the most powerful predictor of early prostate cancer treatment-related complications and quality-of-life (QOL) outcomes, most studies do not stratify results by baseline function. Further, reporting functional outcomes as averaged numerical results may obscure informatively disparate courses. Using levels of treatment-related dysfunction, we address these problems and present the final QOL outcomes of our prospective cohort study of patients with early prostate cancer. METHODS: We created categories for sexual, bowel, and urinary function, measured using numerical scores of the validated Prostate Cancer Symptom Indices and stratified into "normal," "intermediate" and "poor" levels of function by incorporating patient-reported symptom and distress information. We present QOL outcomes for 409 patients 36 months after radical prostatectomy, external-beam radiation therapy, and brachytherapy. RESULTS: Different levels of baseline sexual, bowel, and urinary function produced distinctive treatment-related changes from baseline to 36 months. In general, the average scale increases in dysfunction were greatest among patients with normal baseline function, although patients with normal and intermediate baseline function had similar increases in sexual dysfunction. For patients whose baseline urinary obstruction/irritation was poor, both average scale scores and most patients' level of function improved after treatment, particularly after surgery. CONCLUSION: The use of functional levels to stratify treatment-related outcomes by pretreatment functional status and to display the proportions of patients with improved, stable, or worsened function after treatment provides information that more specifically conveys the expected impact of treatment to patients choosing among localized prostate cancer treatments.

PMID: 19620493 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19620493




3. Kahn CA, Schultz CH, Miller KT, et al. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med 2009 Sep; 54(3):424-30, 430.e1. Select to access the abstract on PubMed. ®

Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1. Epub 2009 Feb 5.

Does START triage work? An outcomes assessment after a disaster.
Kahn CA, Schultz CH, Miller KT, Anderson CL.

Department of Emergency Medicine, University of California, Irvine, Orange, CA 92868, USA. ckahn@uci.edu

Comment in:

Ann Emerg Med. 2010 Jun;55(6):579-80; author reply 580-1.
Ann Emerg Med. 2009 Sep;54(3):431.

Abstract
STUDY OBJECTIVE: The mass casualty triage system known as simple triage and rapid treatment (START) has been widely used in the United States since the 1980s. However, no outcomes assessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesize that START achieves at least 90% sensitivity and specificity for each triage level and ensures that the most critical patients are transported first to area hospitals. METHODS: The performance of START was evaluated at a train crash disaster in 2003. Patient field triage categories and scene times were obtained from county reports. Patient medical records were then reviewed at all receiving hospitals. Victim arrival times were obtained and correct triage categories determined a priori using a combination of the modified Baxt criteria and hospital admission. Field and outcomes-based triage categories were compared, defining the appropriateness of each triage assignment. RESULTS: Investigators reviewed 148 records at 14 receiving hospitals. Field triage designations comprised 22 red (immediate), 68 yellow (delayed), and 58 green (minor) patients. Outcomes-based designations found 2 red, 26 yellow, and 120 green patients. Seventy-nine patients were overtriaged, 3 were undertriaged, and 66 patients' outcomes matched their triage level. No triage level met both the 90% sensitivity and 90% specificity requirement set forth in the hypothesis, although red was 100% sensitive (95% confidence interval [CI] 16% to 100%) and green was 89.3% specific (95% CI 72% to 98%). The Obuchowski statistic was 0.81, meaning that victims from a higher-acuity outcome group had an 81% chance of assignment to a higher-acuity triage category. The median arrival time for red patients was more than 1 hour earlier than the other patients. CONCLUSION: This analysis demonstrates poor agreement between triage levels assigned by START at a train crash and a priori outcomes criteria for each level. START ensured acceptable levels of undertriage (100% red sensitivity and 89% green specificity) but incorporated a substantial amount of overtriage. START proved useful in prioritizing transport of the most critical patients to area hospitals first.

PMID: 19195739 [PubMed - indexed for MEDLINE]
Does START triage work? An outcomes assessment aft... [Ann Emerg Med. 2009] - PubMed result



4. Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE II in the trauma ICU: improved risk stratification in critically injured adults. Injury 2009 Sep; 40(9):993-8. Select to access the abstract on PubMed. ®


Injury. 2009 Sep;40(9):993-8. Epub 2009 Jun 16.

Revisiting the validity of APACHE II in the trauma ICU: improved risk stratification in critically injured adults.
Dossett LA, Redhage LA, Sawyer RG, May AK.

Division of Trauma & Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 404 Medical Arts Building, Nashville, TN 37212, USA. lesly.dossett@vanderbilt.edu

Abstract
BACKGROUND: Quality and benchmarking initiatives highlight the need for accurate stratified risk adjustment. The stratification of trauma patients has relied on scores specific to trauma populations. While the Acute Physiologic and Chronic Health Evaluation (APACHE) II score has been considered "invalid" in the trauma population, we hypothesized that APAHCE II would more accurately predict outcomes in critically injured patients in whom commonly used trauma scores have inherent limitations. METHODS: A prospective cohort of critically injured patients was enrolled. Severity scores and their sub-components were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Logistic regression estimated the odds of death associated with incremental changes in severity scores and their subcomponents. RESULTS: 1019 patients were available for analysis. APACHE II was the best predictor of mortality (AUROC 0.77 versus AUROC 0.54 for ISS and 0.64 for TRISS). A unit increase in APACHE II was associated with an OR of death of 1.18 (95% CI 1.14-1.22). The components of APACHE II that contributed the most to its accuracy included temperature, serum creatinine and the Glasgow Coma Scale (GCS). CONCLUSION: Critically injured patients have physiologic derangements not accurately accounted for by commonly used trauma scores. In this subset a more general ICU scoring system is useful for risk adjustment for research, administrative and quality improvement purposes.

PMID: 19535054 [PubMed - indexed for MEDLINE]PMCID: PMC2752660 [Available on 2010/9/1]
Revisiting the validity of APACHE II in the trauma... [Injury. 2009] - PubMed result



5. Wren TA, Kalisvaart MM, Ghatan CE, et al. Effects of preoperative gait analysis on costs and amount of surgery. J Pediatr Orthop 2009 Sep; 29(6):558-63. Select to access the abstract on PubMed. ®

J Pediatr Orthop. 2009 Sep;29(6):558-63.

Effects of preoperative gait analysis on costs and amount of surgery.
Wren TA, Kalisvaart MM, Ghatan CE, Rethlefsen SA, Hara R, Sheng M, Chan LS, Kay RM.

Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. twren@chla.usc.edu

Abstract
BACKGROUND: The purpose of this study was to determine the effects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo. METHODS: A retrospective review identified all ambulatory patients with CP who had undergone lower extremity orthopaedic surgery at our hospital from 1991 to 2005 with at least a 6-month follow-up. The patients were grouped into those who had undergone GA before their index surgery (GA group, N=313) and those who had not (NGA group, N=149). The groups were compared in terms of the number of procedures during index surgery and subsequent surgeries and the direct costs associated with these surgeries. Costs were calculated in US dollars by using a standardized protocol including fees for the surgeon, anesthesia, operating room, hospital stay, physical therapy, and GA. RESULTS: Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups. CONCLUSIONS: Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID: 19700983 [PubMed - indexed for MEDLINE]
Effects of preoperative gait analysis on costs and... [J Pediatr Orthop. 2009] - PubMed result