This issue of CHP/PCOR's quarterly newsletter, which covers news from the winter 2006 quarter, includes articles about:

• a comprehensive review of worldwide anthrax cases from 1900 to 2005, conducted by CHP/PCOR researchers, which found that timely diagnosis and antibiotic treatment, along with pleural fluid drainage, are key to anthrax patients' survival;
• an early-stage research project in which CHP/PCOR core faculty member Grant Miller is collaborating with an NGO in Bangladesh to study whether villagers' traditional cooking practices are contributing to life-threatening respiratory infections;
• assertions by two CHP/PCOR health policy experts that health-savings accounts -- the cornerstone of President Bush's healthcare agenda -- won't save much money and won't address the fundamental problems of the U.S. healthcare system;
• the Agency for Healthcare Research and Quality's release of the Pediatric Quality Indicators, developed by CHP/PCOR researchers and collaborators. This is the first set of data-analysis tools specifically designed to help hospitals monitor their quality of care for hospitalized children; and
• a roundup of CHP/PCOR's 7th annual retreat, which featured panel discussions on improving healthcare quality, conducting health services research in developing countries, and health systems comparisons across industrialized nations.

This issue of CHP/PCOR's quarterly newsletter, which covers news from the fall 2005 quarter, includes articles about:

• a study concluding that the implantable cardioverter defibrillator -- one of the most expensive medical devices on the market -- is worth its high cost, in appropriate patients, because it prevents sudden cardiac deaths;
• the evolution and broad application of the Quality Indicators, a set of practical tools developed by CHP/PCOR researchers that are used by hundreds of U.S. hospitals, medical groups, health insurers, state health agencies and business coalitions to screen for quality problems;
• a study finding that the Internet can be a valuable tool to help patients with stigmatized illnesses (such as mental illness) find information about and seek treatment for their illness;
• CHP/PCOR-hosted seminars on global health themes, given by Jack Chow of the World Health Organization -- who discussed combating malaria, TB and HIV/AIDS -- and Dean Jamison of the NIH's Fogarty International Center, who discussed evaluating countries' performance on health; and
• a prestigious national award won by two CHP/PCOR trainees at the annual meeting of the Society for Medical Decision Making.

This paper compares the relative efficiency of health care providers in managing patients with severe chronic illnesses over fixed periods of time. To minimize the contribution of differences in severity of illness to differences in care management, we evaluate performance over fixed intervals prior to death for patients who died during a five-year period, 1999-2003. Medicare spending, hospital bed and full-time equivalent (FTE) physician inputs, and utilization varied extensively between regions, among hospitals located within a given region, and among hospitals belonging to a given hospital system. The data point to important opportunities to improve efficiency.

This issue of CHP/PCOR's quarterly newsletter, which covers news from the summer 2005 quarter, includes articles about:

• our new core faculty member Grant Miller, a Harvard-trained health economist with an interest in improving health in developing countries;
• a discussion with center director Alan Garber on key issues and challenges facing the Medicare program;
• the fourth meeting of the Patient Safety Consortium, a group of more than 100 U.S. hospitals taking part in CHP/PCOR research on patient safety culture;
• core faculty member Jay Bhattacharya's research on HIV patients' perceptions of their lifespan as examined through viatical settlement transactions; and
• a research project on technology coverage decisions in the U.S. vs. the U.K., undertaken by Stirling Bryan, a U.K.-based Harkness Fellow in Health Care Policy who is spending the next academic year at CHP/PCOR.

The Patient Safety Consortium included a group of 26 diverse hospitals in or near California. In 2001 and 2002, many consortium hospitals were surveyed using the Patient Safety Climate in Healthcare Organizations (PSCHO) tool to present quantitative measures of hospital safety climate and qualitative reports on safety practices over 2 years. Investigators engaged in discussions with consortium hospitals to elicit reports about their patient safety activities. Overall quantitative measures of safety climate remained approximately the same over the 2 years, although in some specific survey areas climate appeared to improve. Hospitals reported a range and mix of patient safety activities. While considered an essential enabler of safety, cultural change takes time. Significant hospital efforts appear to be underway, and attention to a number of lessons from past patient safety efforts may benefit future undertakings.

Background: Low rates of technology utilization in hospitals with high proportions of black inpatients may be a remediable cause of healthcare disparities.

Objectives: Our objective was to determine how differences in technology utilization among hospitals contributed to racial disparity and if temporal reduction in hospital procedure rate variation resulted in decreased racial disparity for these technologies.

Methods: We identified 2,348,952 elderly Medicare beneficiaries potentially eligible for 1 of 5 emerging medical technologies from 1989-2000 and determined if these patients had received the indicated procedure within 90 days of their qualifying hospital admission. Initial multivariate regression models adjusted for age, race, sex, admission year, clinical comorbidity, community levels of education and income, and academic/urban hospital admission. The inpatient racial composition of each patient's admitting hospital and time-race interactions were added as covariates to subsequent models.

Results: Blacks had significantly lower adjusted rates (P 0.001) compared with whites for tissue replacement of the aortic valve, internal mammary artery coronary bypass grafting, dual-chambered pacemaker implantation, and lumbar spinal fusion. Hospitals with > 20% black inpatients were less likely to perform these procedures on both white and black patients than hospitals with 9% black inpatients, and racial disparity was greater in hospitals with larger black populations. There were no temporal reductions in racial disparities.

Conclusions: Blacks may be disadvantaged in access to new procedures by receiving care at hospitals that have both lower procedure rates and greater racial disparity. Policies designed to ameliorate racial disparities in health care must address hospital variation in the provision of care.