Chronic Illness and CareDiabetes- Report describes quality of care and outcomes for women with diabetes. This report, prepared by AHRQ and the Centers for Disease Control and Prevention, presents measures for quality of care and outcomes for women with diabetes. It highlights where the American health care system excels with regard to diabetes care and where the greatest opportunities for improvement lie. For example, women with diabetes were less likely than women without diabetes to have their blood pressure controlled or to have had a dental visit in the preceding 12 months. Among younger women (64 or younger), women with diabetes were significantly more likely than women without diabetes to have only public health insurance. On the other hand, women with diabetes were much more likely than women without diabetes to have received an annual flu vaccination and to have ever received a vaccination for pneumonia. Women with Diabetes: Quality of Health Care, 2004-2005 (AHRQ Publication No. 08-0099)* (Intramural). Also go to Women at High Risk for Diabetes: Access and Quality of Health Care, 2003-2006 (AHRQ Publication No. 11-0002)*, available at http://www.ahrq.gov/populations/womendiab2010 (Intramural).
- Having a chronic disease like diabetes may be a barrier to receipt of recommended preventive care among women. Researchers used data from three nationally representative surveys to examine the quality of care received by women with diabetes and the impact of socioeconomic factors on receipt of clinical preventive services and screening for diabetes-related conditions. They found that use of diabetes-specific preventive care among women is low, and that women aged 45 and younger and those with low educational levels were the least likely to receive recommended services. Also, women with diabetes were less likely than other women to receive a Pap smear, and those who were poor and minority were less likely than more affluent and white women to receive the pneumonia vaccine. Owens, Beckles, Ho, et al., J Women's Health 17(9):1415-1423, 2008 (AHRQ Publication No. 09-R018)* (Intramural).
Mental/Behavioral Health- Psychological distress may cause women to delay getting regular medical care. The stress of juggling work and family roles may lead some women to delay or skip regular preventive care, such as routine physicals, mammograms, and other screening tests. In this study of 9,166 women aged 18-49, over 13 percent of them reported experiencing signs of psychological distress, including feeling nervous, hopeless, restless, fidgety, or depressed. These distressed women were more likely to delay getting health care than women who did not have distress symptoms (27 percent vs. 22 percent, respectively). Bonomi, Anderson, Reid, et al., Arch Intern Med 169(18):1692-1697, 2009 (AHRQ grant HS10909).
- Nearly two-thirds of mothers with depression do not receive adequate treatment for their condition. Nearly 10 percent of the 2,130 mothers in this study reported experiencing depression. More than one-third of those with depression did not receive any treatment for their condition, 27.3 percent received some treatment, and just 35 percent received adequate treatment for depression. Mothers who received treatment were more likely than other mothers to be age 35 or older, white, and have some college education, and they were less likely to be in the paid workforce. Witt, Keller, Gottlieb, et al., J Behav Health Serv Res online at http://jbhsr.fmhi.usf.edu/toc/36.html 2009
 (AHRQ grants T32 HS00063, T32 HS00083).
- Nearly half of homeless women are in need of mental health services. Researchers conducted face-to-face interviews with 821 homeless women in the Los Angeles area, and found that nearly half of the women had a mental distress score indicating the need for further evaluation and possible clinical intervention. Sixty-seven percent of the women were black, 17 percent were Hispanic, and 16 percent were white. Black women reported the lowest overall mental distress scores; nearly twice as many white women as Hispanic or black women reported childhood or recent physical or sexual assault. Austin, Andersen, and Gelberg, Women's Health Issues 18:26-34, 2008 (AHRQ grant HS08323).
Other- Routine osteoporosis screening recommended for all women over age 65. In an update to its 2002 recommendation, the AHRQ-supported U.S. Preventive Services Task Force now recommends that all women age 65 and older be routinely screened for osteoporosis. The Task Force also recommends that younger women who are at increased risk for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass, and parental history of fractures. U.S. Preventive Services Task Force, Ann Intern Med 154(5):356-364, 2011 (AHRQ contract 290-02-0024).
- Medicare reimbursement for bone density scans varies by diagnosis codes and Medicare carrier. Researchers analyzed Medicare claims data from 1999 to 2005 for a 5 percent national sample of enrollees with part A and part B coverage who were not in HMOs to analyze denial of Medicare coverage for bone density (DXA) scans. They found that although Medicare reimbursement for DXA is covered as part of the "Welcome to Medicare" exam and for certain indications (e.g., screening for estrogen-deficient women and conditions that lead to bone loss), DXA claims were denied from 5 to 43 percent of the time. Variations in reimbursement were related to diagnosis code submitted, place of service, local Medicare carrier, and several other factors. Curtis, Laster, Becker, et al., J Clin Densitom 11(4):568-574, 2008 (AHRQ grant HS16956).
- Osteoporosis and low bone density affect many postmenopausal women. Osteoporosis increases bone fragility and susceptibility to fracture; each year in the United States, about 1.5 million people experience a fracture related to osteoporosis. These three documents present information about osteoporosis and low bone density. Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis presents a review of the evidence comparing the efficacy and safety of agents used to treat low bone density (AHRQ Publication No. 08-EHC008-1). Fracture Prevention Treatments for Postmenopausal Women with Osteoporosis: Clinician's Guide presents information for doctors and other providers on the effectiveness and safety of various treatments for preventing fractures in postmenopausal women (AHRQ Publication No. 08-EHC008-3). Osteoporosis Treatments that Help Prevent Broken Bones: A Guide for Women After Menopause describes the effectiveness, side effects, and costs of the various treatments for low bone density (AHRQ Publication 08-EHC008-2A).* These publications are also available on the AHRQ Web site at http://effectivehealthcare.ahrq.gov/.
- Preventive care for patients with lupus could be improved. Infections and cancer are two of the leading cause of death in patients with lupus, making it particularly important for women with lupus to get cancer screening and immunizations to prevent infections. According to this study, women with lupus do get key tests and vaccinations at rates similar to the general population, but patients who are younger or have less education are not as likely to receive preventive services. Yazdany, Tonner, Trupin, et al., Arthritis Res Ther 12:R84, 2010 (AHRQ grant HS13893).
- Lupus involves higher health care costs and leads to lower work productivity. In this study of 812 individuals diagnosed with systemic lupus erythematosus (SLE), researchers found that direct health care costs for each person were $12,643, and their employment rate dropped from 76.8 percent of individuals at the time of diagnosis to 48.7 percent at study enrollment. The majority of study participants (92.6 percent) were female, since lupus mostly affects women. Panopalis, Yazdany, Gillis, et al., Arthritis Rheum 59(12):1788-1795, 2008 (AHRQ grant HS13893).
- Socioeconomic status is related to physical and mental health outcomes of women with lupus. Researchers examined data on 957 patients with lupus to assess symptoms, physical functioning, and signs of depression, as well as neighborhood and socioeconomic status (SES). The majority of patients were female (91 percent) and white (66 percent). Three factors were associated with increased disease activity: lower education level, lower income level, and poverty status. There was a significant association between lower SES, worse functioning, and increased depressive symptoms. Patients who were poor and lived in high poverty neighborhoods had a depression rate of 76 percent, compared with 32 percent for patients who were not poor and did not live in high poverty areas. Trupin, Tonner, Yazdany, et al., J Rheumatol 35(9):1782-1788, 2008 (AHRQ grant HS13893).
- Women are more likely than men to be affected by mycobacterial pulmonary disease. Nontuberculosis mycobacteria (NTM) disease is an important cause of disease and death, most often in the form of progressive lung disease. According to this study, the prevalence of pulmonary NTM disease in women was 6.4 per 100,000 vs. 4.7 per 100,000 for men in 2005-2006. The researchers also found higher rates of NTM disease in those aged 51 and older and in residents of the Western, more urban part of Oregon. Cassidy, Hedberg, Saulson, et al., Clin Infect Dis 49(12):e124-e129, 2009 (AHRQ grant HS19552).
- Childhood sexual abuse is one of several factors associated with obesity in women. Researchers analyzed information collected between 2003-2006 from 867 women (392 heterosexual, 475 lesbian), aged 35 to 64 to identify factors associated with obesity. They found increased odds of obesity among lesbians (58 percent greater) and women who reported childhood sexual abuse by a family member (42 percent greater), compared with women who were not obese; women who had a history of a mental health diagnosis were also more likely to be obese. Reduced odds for obesity were found in those having a household income greater than $75,000 per year or a bachelor's degree. Smith, Markovic, Danielson, et al., J Women's Health 19(8):1525-1532, 2010 (AHRQ grant HS17587).
- Weight-loss surgery can lead to dramatic weight loss, but it remains a high-risk procedure. In this commentary, AHRQ director Carolyn Clancy, MD, discusses the pros and cons of bariatric surgery for women, including the necessary lifestyle changes that must be made. She also examines the important role of nurses in helping women achieve success with bariatric surgery. Clancy, Women's Health 12(1):21-24, 2008 (AHRQ Publication No. 08-R061)* (Intramural).
- Booklets help women know which medical tests are needed to stay healthy at any age. Two booklets from AHRQ show at a glance what the U.S. Preventive Services Task Force recommends for screening tests and preventive services, as well as what constitutes a healthy lifestyle and healthy behaviors. Women: Stay Healthy at Any Age is available in English (AHRQ Publication No. 10-IP002-A) and Spanish (AHRQ Publication No. 10-IP002-B). Women: Stay Healthy at 50+ is also available in English (AHRQ Publication No. 11-IP001-A) and Spanish (AHRQ Publication No. 08-IP001-B).* These publications are also available online at http://www.ahrq.gov/clinic/prevenix.htm (Intramural).
Health Impact of Violence Against Women- Intimate partner violence is associated with higher health care costs. This study examined total health care costs for a group of women over an 11 year period and compared costs for women who experienced intimate partner violence (IPV) with those who did not. IPV resulted in $585 higher annual health care costs during the period of abuse, and these costs remained significantly higher for 3 years after the abuse ended. By the 4th year, differences were not statistically significant, and by the 5th year, costs for the IPV and non-IPV groups were similar. Fishman, Bonomi, Anderson, et al., J Gen Intern Med 25(9):920-925, 2010 (AHRQ grant HS10909).
- Awareness of decision points shared by abused women informs counseling sessions. Focus groups were held with 41 women, and an additional 20 women were interviewed; all of the women were undergoing counseling for domestic violence. Researchers identified five turning points that could be used by counselors to motivate women to leave their abusers. The turning points were when (1) they realized that the violence might spill over onto children or other family members; (2) the abuse intensified so they feared for their lives; (3) they realized that support and assistance were available to them; (4) they became fatigued from continually losing hope that their situation would change; and (5) they discovered their abuser was unfaithful. Chang, Dado, Hawker, et al., J Women's Health 19(2):251-259, 2010 (AHRQ grant HS13913).
- Young women are at highest risk for domestic violence. According to this study, overall rates of domestic violence are declining, but women in their mid-20s to early 30s are most vulnerable to becoming victims of abuse. Given these findings, the researchers suggest that women in this vulnerable age group who use college health clinics, family planning services, or obstetrical services be screened for domestic violence. Rivara, Anderson, Fishman, et al., Violence Vict 24(5):627-638, 2009 (AHRQ grant HS10909).
- Study documents the intergenerational nature of intimate partner violence. In this analysis of telephone interviews of 1,288 abused women in Seattle, WA, researchers found that children whose mothers saw domestic abuse during their childhoods were also at risk for witnessing abuse. Just over 56 percent of the women reported that their children had never seen domestic violence firsthand. However, because mothers were answering questions on their children's behalf, they could have been mistaken about what their child had or had not seen. The researchers note that mothers who witnessed abuse as children may view violence as normal and thus may not shield their children from it. Cannon, Bonomi, Anderson, and Rivara, Arch Pediatr Adolesc Med 163(8):706-708, 2009 (AHRQ HS10909).
- Violence and sexual abuse in childhood are linked to a higher risk for sexually transmitted infections in women. These researchers investigated how different forms of violence experienced by women across the lifespan are associated with sexually transmitted infections (STI). They found that having an STI was associated with experiencing both childhood sexual abuse and intimate partner violence. Women who experienced both types of violence were much more likely to have been diagnosed with an STI during their current relationship than women who had not suffered abuse. Williams, Larsen, McCloskey, Violence Vict 35(6):787-798, 2011 (AHRQ grant HS11088).
- Women who suffer abuse are more likely than those who have never been abused to use mental health services. Researchers surveyed 3,333 women aged 18 to 64 in the Pacific Northwest and found that mental health service use was highest when the physical or emotional abuse was ongoing. However, women who had experienced abuse recently (within 5 years) or remotely (more than 5 years ago) still accessed mental health services at higher rates than women who were never abused. Women who were physically abused also used more emergency, outpatient, pharmacy, and specialty services. Women who were experiencing ongoing physical abuse had annual health care costs that were 42 percent higher than women who never suffered abuse. Bonomi, Anderson, Rivara, and Thompson, Health Serv Res 44(3):1-16, 2009. See also Bonomi, Anderson, Rivara, et al., J Gen Intern Med 23(3):294-299, 2008 (AHRQ grant HS10909).
- Abused women are more likely to rely on condoms than pills for birth control. A survey of 25 women in the Boston, MA, area found that a high rate of women who were victims of domestic violence did not use any form of birth control. Of the 115 women who reported being abused in the past year, 17 percent did not use birth control, compared with 11 percent of the women who were not abused. Abused women most often used condoms (33 percent) to prevent pregnancy, while women who were not abused most often used birth control pills (46 percent). Williams, Larsen, and McCloskey, Violence Against Women 14(12):1382-1396, 2008 (AHRQ grant HS11088).
- Duration and severity of domestic abuse predict whether women will seek medical and legal help. Researchers in Seattle conducted phone interviews with 1,509 women who said they had experienced physical, sexual, or psychological abuse since reaching the age of 18. Those who were sexually or physically abused were more likely to seek medical care and legal assistance than those who reported only psychological abuse. The longer the abuse had continued, the more likely the woman was to seek help. Women who were psychologically abused were more inclined to seek legal assistance rather than medical services. Duterte, Bonomi, Kernic, et al., J Womens Health 17(1):85-95, 2008 (AHRQ grant HS10909).
- Women who are victims of abuse have worse health than other women, even years after abuse has stopped. Thirty-four percent of women surveyed in a large health plan had suffered from physical and/or sexual intimate partner violence during their adult lifetime, and it took an enormous toll on their health. Their depression and physical symptoms persisted for many years after the abuse had stopped, according to this study. The researchers analyzed survey results from 3,429 women who were asked about their history of abuse and their mental, social, and physical health. Although 34 percent of the women had suffered from sexual and/or physical abuse, only 5 percent reported abuse within the previous year. For the others, it had been a median of 19 years since the last episode of abuse. Bonomi, Anderson, Rivara, and Thompson, J Women's Health 16(7):987-997, 2007. See also Rivara, Anderson, Fishman, et al., Am J Prevent Med 32(2):89-96, 2007 (AHRQ grant HS10909)
- Hispanic women who are abused while pregnant report high levels of stress. Researchers surveyed 210 pregnant Latinas in Los Angeles in 2003-2004 to assess intimate partner violence, adverse social behavior, post-traumatic stress disorder (PTSD), depression, and other life situations. Nearly half (44 percent) of the women reported abuse and high levels of social undermining by their partners (criticism, anger, insults) and stress. Women who were abused were more likely to be depressed (41.3 percent) or to have PTSD (16.3 percent) compared with women who were not abused (18.6 percent and 7.6 percent, respectively). Rodriguez, Heilemann, Fielder, et al., Ann Fam Med 6(1):44-52, 2008 (AHRQ grant HS11104).
Health Care Costs and Access to CareCosts- Heart disease, cancer, and mental illness are among the most costly conditions for women. In 2008, the cost of treating women for heart disease was $43.6 billion, putting it at the top of the list of the most expensive conditions for women. Cancer came in second at $37.7 billion, followed by mental disorders at $37.3 billion. Other costly conditions included osteoarthritis, high blood pressure, and high cholesterol. These statistics were derived from an analysis of data from AHRQ's Medical Expenditure Panel Survey (http://www.meps.ahrq.gov/mepsweb). (Intramural)
- Women who receive food stamps spend more on health care and are more likely to be overweight or obese. Researchers analyzed State-level data on food stamp program (FSP) characteristics and Medical Expenditure Panel Survey data to estimate the link between FSP participation and weight and health care expenditures of nonelderly adults. They found that women who receive food stamps are nearly 6 percent less likely to be normal weight and nearly 7 percent more likely to be obese as women who do not receive food stamps. Also, participation in the FSP leads women to devote $94 extra per year to health care. Meyerhoefer and Pylypchuk, Am J Agric Econ 90(2):287-305, 2008 (AHRQ Publication No. 08-R072)* (Intramural).
Access to Care- Researchers examine health care disparities among homeless women. This study found that white, non- Hispanic women are more likely than black or Hispanic women to report unmet health care needs and that women suffering from drug abuse, violence, or depression were most in need of care. Teruya, Longshore, Andersen, et al., Women's Health 50(8):719-736, 2011 (AHRQ grant HS08323).
- Women are more likely than men to seek emergency department care. Americans aged 18 and older made more than 98 million trips to hospital emergency departments (EDs) in 2008 for problems including broken bones and heart attacks. This represents 78 percent of the nearly 125 million ED visits that year. Women were more likely than men to use the ED in 2008 (26 percent higher use, 476 visits vs. 378 visits per 1,000 people, respectively). Low income, older, and rural Americans also were more likely than others to seek care in a hospital ED. Go to Emergency Department Visits for Adults in Community Hospitals, 2008, available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb100.jsp Plugin Software Help (Intramural).
- Women are vulnerable to coverage and care gaps when their husbands transition to Medicare. Some near-elderly women (aged 62 to 64) experience disruptions in their insurance coverage as their husbands turn 65 and transition to Medicare, according to this study. Women whose coverage was interrupted had a 71 percent increased probability of changing their normal care provider or clinic, and they were much more likely to delay filling a prescription or take less medication than prescribed because of cost. Many women in this age group have one or more chronic conditions, and disjointed care could lead to adverse consequences in this group. Schumacher, Smith, Liou, and Pandhi, Health Serv Res 44(3):946-964, 2009 (AHRQ grant T32 HS00083).
Health Care Quality and Safety- Many black mothers are skeptical about the relationship between infant sleep position and SIDS. Black infants are twice as likely as white infants to die from SIDS, and they are also twice as likely to be put to sleep on their stomachs, despite American Academy of Pediatrics recommendations that infants sleep on their backs to reduce the risk of sudden infant death syndrome. Researchers conducted 13 focus groups with 73 black mothers of infants, as well as 10 individual interviews, to examine perceptions about SIDS among black parents. They found that the mothers perceived the link between sleep position and SIDS to be implausible, SIDS to be random and unpreventable, and parental vigilance to be the key to SIDS prevention. Moon, Oden, Joyner, and Ajao, J Pediatr 157:92-97, 2010 (AHRQ grant HS16892).
- Having a strong social network plays a critical role in health status. Researchers administered a 22-item survey to 1,074 women to examine whether a multidimensional, social support instrument originally developed for older Chinese and Koreans could be used for meaningful comparisons across four ethnic groups of women (black, white, Hispanic, and Chinese). Social support items in the survey were divided among three categories: tangible support, informational support, and financial support. Using the survey results, the researchers derived a valid and reliable eight-item social support instrument that is available in English, Spanish, and Chinese. Wong, Mordstokke, Gregorich, and Perez-Stable, J Cross Cult Gerontol 25:45-58, 2010 (AHRQ grant HS10856).
- Case study sets the stage for a discussion of error disclosure in U.S. hospitals. A case of wrong-site surgery for skin cancer serves as a framework for discussion of medical error and its disclosure to the patient by the surgeon and the hospital. The author reviews the state of error disclosure in U.S. hospitals, summarizes the barriers to disclosure and some possible solutions, and discusses recent developments in disclosure undertaken by Federal agencies, universities, and national quality organizations. Gallagher, Acad Med 84(8):1135-1143, 2009 (AHRQ grant HS16097).
- Use of electronic health records in labor and delivery units can improve the quality and safety of care. Researchers examined 250 paper-based and 250 electronic health record (EHR) labor and delivery notes in a busy university hospital labor and delivery unit. They found that the paper-based notes were substantially more likely to be missing key clinical information compared with the EHR. Information most likely to be missing included data on contractions (10 percent for paper vs. 2 percent for EHR), membrane status (64 vs. 5 percent), bleeding (35 vs. 2 percent), and fetal movement (20 vs. 3 percent). When workflow was examined, both computer-related and direct patient care activities increased significantly after EHR implementation. Eden, Messina, Li, et al., Am J Obstet Gynecol 199:307.e1-307.e9, 2008 (AHRQ grant HS15321).
- Male-female disparities found in risk for workplace injury. In this study of male-female and racial disparities in individual workplace injury and illness risk over time, white men had the highest risk of injury relative to other groups. But, among women, black women had the highest risk of injury. Environmental hazards were associated with elevated injury risk, but no association was found between the level of physical demand and risk of physical injury. Berdahl, Am J Public Health (12):2258-2263, 2008 (AHRQ Publication No. 09-R020)* (Intramural).
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