Researchers at the University of Pennsylvania’s School of Medicine have found that hospitals with high and low performance on Medicare quality measures had little difference in the rate of death for three common conditions at the hospitals, indicating that the performance measures may not accurately reflect patient outcomes. Senior author Rachel M. Werner, MD, PhD, Assistant Professor of Medicine at the University of Pennsylvania, Core Investigator with the Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center, and colleague Eric Bradlow, PhD, Professor of Marketing and Statistics at the University of Pennsylvania’s Wharton School report their findings in the December 13th issue of JAMA.

In the United States, quality of care delivered in hospitals is often variable. Because it is assumed that measuring quality of care is a key component in improving care, quality measures have an increasingly prominent role in quality improvement, according to background information in the article. These measures can provide an incentive to improve quality of the care delivered and to influence consumer choice of hospitals and health care plans. While some research has documented an association between higher adherence to care guidelines and better outcomes of patients who receive that care, to date there has been limited evidence demonstrating that hospitals that perform better on process measures also have better overall quality.

“What we would like is a kind of Consumer Reports for hospitals so that patients can find out which hospitals are better and then go to these hospitals,” said Werner. “Medicare has taken an important step toward that goal by publishing hospital performance in all acute care hospitals in the United States on their website, ‘Hospital Compare.’”

This study was conducted to determine whether these quality measures are correlated with and predictive of hospitals’ risk-adjusted death rates. The researchers analyzed data from Hospital Compare between January 1 and December 31, 2004, and compared hospital performance for heart attack, heart failure, and pneumonia with hospital risk-adjusted death rates, which were measured using Medicare Part A claims data. A total of 3,657 acute care hospitals were included in the study based on their performance reported in Hospital Compare.

Across all heart attack performance measures, the absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile versus those in the 75th percentile was 0.005 for inpatient death, 0.006 for 30-day death, and 0.012 for death at 1-year. For the heart failure performance measures, the absolute death reduction was smaller, ranging from 0.001 for inpatient death to 0.002 for 1-year death. For the pneumonia performance measures, the absolute reduction in death ranged from 0.001 for 30-day death to 0.005 for inpatient death.

“Because the differences in hospitals are so small, it is unlikely that this information will be very useful to patients,” said Werner. “This is particularly true because patients might not live close to the better hospitals. It is not helpful to know that another hospital is better if it is only a tiny bit better. And it is even less helpful if the better hospital is 50 miles farther and you are having a heart attack. But evaluating hospitals is clearly a good idea and Hospital Compare is an important start. With time, the system will get better. In the meantime, though, effort should be focused on developing new measures that are more tightly linked to the clinical outcomes patients care about.”

PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System.

Penn’s School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report’s most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors [Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.

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Research centres within the Helmholtz Association signed a cooperation agreement with the UN organisation ECLAC/CEPAL on research in urban areas of Latin America.

ECLAC/CEPAL is the UN commission for the economic development of Latin America and the Caribbean. The aim of the new Risk Habitat Megacity research initiative is to develop strategies for sustainable development in megacities and urban agglomerations by 2013. Apart from five Helmholtz Association centres (the Research Centre Karlsruhe, the Geological Research Centre Potsdam, the German Aerospace Centre, the Helmholtz Centre for Infection Research Braunschweig and the Helmholtz Centre for Environmental Research Leipzig) and two Chilean universities (Universidad de Chile and Pontificia Universidad CatГіlica), the research initiative now also involves the UN commission for Latin America (ECLAC/CEPAL). Around 40 scientists will work on the research initiative, with a budget of around 2 million euros per year. Urbanisation is very far advanced in Latin America. The urban share of the population in Latin America is higher than in Europe and much higher than in Asia and Africa. The continuing urbanisation trend brings with it new risks and new opportunities.

The figures are dramatic: according to UN estimates, 90% of future population growth will be concentrated in towns and cities. In just ten years there will be over 60 cities with more than five million inhabitants – mostly in developing countries. It is not just the cities that are increasing in size: the ecological impacts of this urbanisation process are huge. Towns and cities cover only 2% of the Earth’s surface, but use 75% of the resources. Pressing environmental problems like waste mountains and water pollution are the consequence of this development.

This is why five Helmholtz Association centres and partner organisations in Latin America are now researching these processes in greater detail. The focus of the research initiative coordinated by the UFZ in Leipzig is on “Risk Habitat Megacity”. This is because the inhabitants of these megacities are often exposed to risks through the huge social divide and as a result of technical risks like the absence of drinking water, as well as being exposed to natural risks like landslides, earthquakes and flooding – problems that will also affect Central Europe. Megacities contribute to global climate change through air pollution. Unhygienic conditions lead to a much higher risk of epidemics. The fears concerning the spread of bird flu via air travellers give an indication of the threats posed by these risk regions to people living in other regions in a globalised world. In addition, immigration pressure on European countries is growing – see the example of illegal immigrants from Africa on the EU’s southern border in the Mediterranean.

The research initiative will focus on the metropolises of Latin America. 76% of the population there is already concentrated in towns and cities. In Europe the figure is 75.5%. By contrast, in South-East Asia and Africa only 35% of the population lives in cities. This means that processes that await the towns and cities of other continents are already visible in Latin America. For instance, migration from the countryside now plays only a subsidiary role. Now most people tend to move house within the city, leading to social differentiation. In addition, there is increasing international migration. In a megacity the issues at stake are not just its size and population, but also its national significance. Because of the functions concentrated in a megacity, it also plays a decisive role in the development of the country. Lima and Buenos Aires are the focus of about half the economic power of their respective countries.

The platform for the initiative, and the first case study, is the metropolitan region of Santiago de Chile. This city suffers the typical problems of a megacity and also highlights potential solutions. Together with two universities and the UN organisation ECLAC/CEPAL, the Helmholtz researchers intend to spend the next few years looking for sustainable development pathes for Santiago and other megacities in Latin America: What are the main problems? What are the risks inhibiting sustainable development? What might the city look like in a generation’s time? The researchers intend to make particular use of the strengths of the Helmholtz Association: cooperation between natural and social scientists. Although the megacity research is in its very early stages, one thing is already certain: investigating isolated aspects is not enough on its own. Only an integrated holistic view can help solve this urgent problem faced by mankind.

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risk-habitat-megacity.ufz.de/downloads/flyer_english.pdf
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The Helmholtz Association contributes to solving major challenges facing society, science and the economy with top scientific achievements in six research areas: Energy, Earth and Environment, Health, Key Technologies, Structure of Matter, Transport and Space. With 25,000 employees in 15 research centres and an annual budget of approximately 2.2 billion euro, the Helmholtz Association is Germany’s largest scientific organisation. Its work follows in the tradition of the great natural scientist Hermann von Helmholtz (1821-1894).

The Helmholtz Centre for Environmental Research – UFZ was established in 1991 and has about 800 employees in Leipzig, Halle/S. and Magdeburg. They study the complex interactions between humans and the environment in cultivated and damaged landscapes. The scientists develop concepts and processes to help secure the natural foundations of human life for future generations.

risk-habitat-megacity

Winter pursuits are challenging, rewarding endeavors when participants are properly prepared, but winter experiences can go horribly wrong in the face of changing weather, inadequate planning and other uncertainties.

Laurie Gullion, coordinator of the Outdoor Education option at the University of New Hampshire, says people who hike and camp in winter need to have previous experience in other seasons as well as in higher, exposed elevations to test their personal preparedness and decision-making. In addition, winter backpackers should:

– Get training from a reputable organization on cold-weather first aid, camping, map and compass, and avalanche awareness.

– Go with a support group of qualified friends.

– Plan on being out overnight, even if it’s a day trip.

– Leave a trip plan with a contact person, including a time when they should contact search and rescue authorities.

– Know how to manage their clothing and gear systems to stay dry and functional.

– Consume enough calories and water to avoid dehydration, a loss of energy, and cold injuries like frostbite.

– Understand the weather to make appropriate and conservative decisions, especially about turning back or dropping quickly below tree line in the face of worsening weather.

Gullion, who has paddled, hiked and climbed in the Canadian and Scandinavian Arctic, says, “Those guidelines are appropriate for any season and every activity, but they are essential for winter experiences.”

People are used to instant communication, but in the backcountry, communication is thwarted by deep valleys, high mountains and a lack of transmission towers. “A cell phone should not only be treated as a last resort but as no option at all, and travelers should be prepared to deal with a variety of emergencies within their own party. People must enter a winter environment with the mindset and equipment that they will be able to come to their own rescue,” she says.

The UNH Outdoor Education program trains students in progressively more demanding situations to handle cold-weather camping, hiking and ice climbing. Its winter backpacking course, which Gullion teaches, includes an ascent of Mt. Washington. Students must take a 10-day summer backpacking course, and camp and hike in cooler weather before they can enroll in the winter backpacking course.

The ascent to the top of Mt. Washington is contingent upon weather conditions, with high winds, intense cold and poor visibility the factors that contribute to decisions about whether to climb or to turn back. According to Gullion, decision-making is an integral part of the UNH training program — students learn how to care for themselves, their group, and ultimately their future clients.

“Mt. Washington has some of the most severe weather in the world with a history of deaths from exposure, yet its famous Presidential Traverse is an increasingly popular challenge in winter. People on the eastern side of Mt. Washington often cannot see the prevailing weather approaching from the west,” Gullion says.

“People need to have a fitness level for hiking in snow and wind that allows them to reach the summit and come down without being so overtaxed that they lose the ability to make good decisions. Dying from hypothermia is a very real threat that has killed some winter hikers in the Presidential Range,” she says.

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The study by Brian Stemper, Ph.D., assistant professor of neurosurgery, resulted in the most comprehensively validated computer model for whiplash reported in scientific literature.

“The practical aspect of this study is that you want to set your head restraint so that it’s very close to the back of your head. Each time drivers and passengers get in a car, they should be sure the head restraint is correctly positioned to minimize injuries,” Dr. Stemper suggests.

His work is published in the journal Accident Analysis and Prevention and data from the report has been submitted to the U.S. Department of Transportation for possible use in determining safety rules for car manufacturers.

Whiplash injuries affect the soft tissues of the cervical spine (e.g., ligaments and intervertebral discs) and can be sustained in any type of crash but occur most often in low speed rear-end collisions. The injury affects more than one million people in the U.S. each year and results in symptoms of neck pain, headaches and lower back soreness. A high percentage of all patients sustaining whiplash injury report long-term pain. A 1999 Insurance Institute for Highway Safety study found that 26 percent of rear-struck vehicle drivers reported neck injuries.

Dr. Stemper has investigated cervical spine ligament stretch during whiplash by comparing increasing distances between the back of the head and the head restraint. He has developed a mathematical computer model of the head and cervical spine that can be studied under simulated rear-end collision conditions. The model provides quantifiable data on soft tissue distortions in humans.

“The process involved moving the head restraint to different positions to look at spinal ligament distortion and see how it changed with each of these configurations,” he says. “Ligament distortions were compared to previously determined failure thresholds. Our team also used previous studies and computer models to validate our work. In addition, we studied the computer response in 57 different measures of spinal motion. This data was compared to previous experimental research to be sure they were realistic.”

“We found that auto head restraints positioned less than 2.4 inches (6 cm) from the back of the head kept ligament stretch within the physiologic range – meaning that no injury would occur. However, as the restraint distance increased beyond 2.4 inches, the ligaments began to exceed failure thresholds, meaning that whiplash injury was more likely to occur,” says Dr. Stemper.

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Co researchers with Dr. Stemper on the study are Narayan Yoganandan, Ph.D., and Frank A. Pintar, Ph.D., professors of neurosurgery.

Contact: Toranj Marphetia

Medical College of Wisconsin

A study performed by the Research Laboratories of the Catholic University of Campobasso (Italy) confirms the beneficial effects that moderate consumption of alcohol has on our health. But this time it is not just cardiovascular disease that gets advantage from this: drinking in moderation reduces all-cause mortality.

The research, published on the American journal Archives of Internal Medicine, assembled 34 scientific studies conducted during the last years worldwide using the statistic procedure of meta-analysis, that allows us to match different studies to achieve general results. In this way it has been possible to examine data concerning over a million of people, for which alcohol drinking habits were associated with all-cause mortality.

The conclusions researchers from the Catholic University of Campobasso came to clearly show that drinking in moderation (a couple of wine or beer glasses a day) has beneficial effects on health. But that is not all: while the greatest part of the studies conducted on this issue have looked at cardiovascular disease, a term that includes clinical events of various severity, the study published on the Archives of Internal Medicine shows a positive effect of alcohol on an unquestionably hard parameter as overall mortality.

“Alcohol as a life insurance” Not exactly. The key word is moderation. The Italian research also confirms that excessive consumption of alcohol is absolutely harmful, and the risk of death for those who drink in excess does not decrease at all. On the contrary: the risk definitely increases.

“Our data” says Augusto Di Castelnuovo, lead author of the study “show that consumption of little amounts of alcohol leads to a reduction of mortality up to 18%. But after a certain number of glasses things radically change: who drinks too much not only loses this advantage, but increases his own risk of death in relation to the amount of alcohol consumed”.

The study shows very important differences between men and women. Whereas men report a beneficial effect after consuming 2-4 doses maximum (a dose refers to one glass of wine or beer), women should be aware: for them, the protection guaranteed from alcohol consumption disappears just after two glasses a day.

“It might be” says Licia Iacoviello, Head of the Laboratory of Genetic and Environmental Epidemiology, where the research has been performed “a fact linked to the metabolism. We know that women metabolize alcohol in a different way and the blood concentration reaches higher levels. Therefore, consuming more than two doses might lead to several harmful effects, such as liver diseases or increased risk of certain forms of tumour.”

The meta-analysis conducted by the Catholic University found that the protection given by a moderate consumption of alcohol for American men is lower than the one observed for Europeans. For women, instead, the situation is substantially the same both in USA and Europe. An explanation might be found in the different ways in consuming alcohol. Europeans are more inclined to drink wine rather than other beverages and use to do it while having meals. Two habits different from Americans’. In relation to women, the way they consume alcohol is roughly the same in both continents, thus they respond identically. However, the debate is still open and more research is needed.

Another significant data emerging from the study is related to the so called “confounding factors”. During the past years, it has been thought that the protecting effect of alcohol might be ascribed to other factors. It might be, in fact, that people enjoying alcohol drinks in moderation are more concerned about their own health: it may turn out that they are more likely to do sport or to consume healthier food.

In other words it might be that they have a better lifestyle and this could be the cause, not necessarily alcohol, that keeps them in good health.

“We’ve carefully examined this aspect” Di Castelnuovo continues. “Our data suggest that, even considering all main confounding factors (as dietary habits, physical activity or the health of people studied), a moderate consumption of alcoholic beverages keeps on showing a real positive effect.”

“The core of this study is not just about alcohol” says Giovanni de Gaetano, director of the Research Laboratories at the Catholic University “it is also the way we drink that makes the difference: little amounts, preferably during meals, this appears to be the right way. This is another feature of the Mediterranean diet, where alcohol, wine above all, is the ideal partner of a dinner or lunch, but that’s all: the rest of the day must be absolutely alcohol-free. The message carried by scientific studies like ours is simple: alcohol can be a respectful guest on our table, but it is good just when it goes with a healthy lifestyle, where moderation leads us toward a consumption inspired by quality not by quantity”.

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Contact: Antonio Mascioli

Catholic University

Mothers of young children have experienced a significant decline in the presence and availability of other women in the household over the last 120 years, according to new research by Brown University sociologist Susan E. Short. In addition to Short, the re-search team included Frances K. Goldscheider and Berna M. Torr. Their results are published in Demography.

Analyzing U.S. census data from 1880 to 2000, the researchers examined patterns of coresidence for mothers with children aged zero to five years old. They focused on the household presence of females who traditionally helped mothers with childcare, such as the women’s mothers and mothers-in-law, other female relatives and non-relatives, and older daughters.

“This work adds to current discussion of work-family balance issues and the “burden” young mothers experience while trying to balance time demands by looking beyond the young mothers’ own time-demands and the contributions made by fathers,” Short explained. “We focus on the presence and availability of other females in their households who might help out. Over the past century, the likelihood that they are there has declined. And it has declined most for women employed in non-agricultural activities.”

The findings show that at the end of the twentieth century, only about 20 percent of mothers with young children lived with another female who might help with housework and childcare, com-pared to nearly 50 percent in the late nineteenth century. The average number coresiding females in the home also declined over time.

Even when another female was present in the household, the researchers found that the availabil-ity of these coresiding women also significantly declined. For example, in 1880, 24 percent of mothers lived with a female age 10 or older that was not attending school or employed outside the home (therefore, making them more available to assist with childcare). By 2000, that number fell to only 5 percent.

The researchers then decomposed this decline into two parts — changes in living arrangements and changes in schooling or work – and found that about half the decline was due to the de-creased likelihood of living with other females and half the decline was due to increases in school or work involvement among co-resident females. The overall decline in having an older daughter around the house to help with the younger children is mostly due to the increase in the likelihood that the older daughters were attending school. The overall decline in availability of mothers and mothers-in-law is mostly due to the increased likelihood that co-resident mothers and mothers-in-law are working outside the home.

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This research grew out of a project funded by the National Institute of Child Health and Human Development. The researchers are currently exploring how the decline differs for different groups of young mothers.

Contact: Deborah Baum

Brown University

People go to emergency departments when they’ve broken a leg, been stabbed or otherwise need urgent care. But a new study from the Stanford University School of Medicine finds that 90 percent of EDs nationwide also offer preventive-care services.

The high prevalence was surprising, said M. Kit Delgado, MD, the study’s lead author and a postdoctoral scholar at Stanford’s Center for Primary Care and Outcomes Research, and it likely stems from less-than-ideal conditions.

“It’s more evidence that our health-care system is dysfunctional,” said Delgado, who is also an emergency-medicine physician at Stanford Hospital & Clinics. “Emergency departments have evolved to compensate as the ‘safety net’ for patients failed by a system unable to guarantee accessible primary care.”

Indeed, the study, to be published online in the Annals of Emergency Medicine, illustrates a dilemma faced today by many emergency departments: the desire to address underlying illnesses and unhealthy behaviors without compromising the quality of acute care, which is their primary mission.

It is the first known study to provide an overall picture of the scope of preventive care in U.S. emergency departments, measuring the availability of 11 such services – including influenza vaccinations, counseling for tobacco addiction and screening for HIV – in 277 randomly sampled EDs from 46 states. The median number of preventive services offered was four.

At 66 percent, screening for domestic violence was the most common, though the study points out that it probably should have been higher. The Joint Commission, the major accrediting agency for U.S. health-care organizations, mandates hospitals and clinics to have policies and procedures for this type of screening. The figure suggests that many EDs may not be in compliance.

At 19 percent, HIV screening was the least common service. The U.S. Centers for Disease Control and Prevention released guidelines in 2006 recommending HIV tests be done at EDs.

There is some incentive for EDs to offer preventive services. “Basically, it’s about how ‘an ounce of prevention is worth a pound of cure,’ and we try to do all we can for patients,” said Robert Norris, MD, chief of emergency medicine at Stanford Hospital, who was not involved in the study. “One thing that is notable about emergency medicine is that we are often presented with teachable moments. So, for example, people who come in with an alcohol-related injury – we can discuss with them why this happened and how much worse the consequences could have been, and then help to get them set up in a treatment program.”

Stanford Hospital’s ED is ahead of the curve, providing about a half-dozen innovative preventive services, including:
The award-winning nurse callback program, which helps discharged patients to coordinate follow-up appointments and get access to primary or specialty care.
A public insurance enrollment program (run in collaboration with San Mateo and Santa Clara counties) that has enabled thousands of children to get insurance.
“Farewell to Falls,” a free, home-based fall-prevention program for older adults that was recognized in 2007 by the Home Safety Council and National Council on aging.

In addition, doctors and nurses in the ED screen patients for domestic violence and alcohol abuse and offer intervention services through ED social workers.

But echoing a major finding of the study, Norris said that cost is a key factor determining which and how many preventive services can be offered at Stanford’s ED. “When you’re in a resource-constrained environment, you have to pick and choose,” he said.

For example, Delgado cited two key factors that discourage EDs from offering HIV tests: One, they add to unreimbursed costs, and two, studies have shown that, if mandated, they can result in longer waiting times for patients.

Sixty-four percent of ED directors expressed concern that preventive services would increase patients’ length of stay, leading to overcrowding.

While three-quarters of ED directors surveyed do not oppose offering preventive services, the same number worries that doing so could financially hurt their departments. The government and insurance companies do not reimburse emergency departments for the cost of most preventive services, Delgado said. “Our findings imply that more widespread dissemination of ED preventive services will likely be contingent on improved reimbursement,” the authors write in the study.

Delgado referred to recent reports in the Journal of the American Medical Association and from the U.S. Department of Health and Human Services that find patients with poor access to primary care, even those with insurance, are the largest rising segment of the patient population showing up at EDs.

Unsurprisingly, a system to link emergency department patients with primary care providers topped the wish list among directors, followed closely by a system to cover uninsured patients with some form of medical insurance.

The authors conclude that more research is needed on the cost-effectiveness of ED preventive services, as well as on their effect on patient flow, to help determine the best way to invest ED resources.

Ultimately, however, emergency departments are not well-designed for providing preventive care, Delgado said.

“The goal for health-care reform should go beyond increasing access to health insurance to ensuring that primary care is actually accessible,” he said. “This would free up ED resources to handle rising volumes of patients for acute care visits and would ensure that benefits from prevention efforts are sustained over the long run.”

Notes:
Other Stanford co-authors are Colleen Acosta, MPH; Ewen Wang, MD; Matthew Strehlow, MD; and Yash Khandwala. Carlos Camargo Jr., MD, DrPH, of Harvard Medical School, is the senior author.

The study was supported with a training grant from the Agency for Health Care Research and Quality Training and a mentored research award from the National Institutes of Health.

Source:
John Sanford
Stanford University Medical Center

The use of seatbelts and helmets by television characters while riding in cars, bicycles or motorcycles is significantly lower than the actual usage of these safety measures by Americans, according to new research from UAB (University of Alabama at Birmingham). And the researchers in UAB’s Center for Injury Sciences say the television industry should do better.

In findings published in the December issue of Injury Prevention, the team reports that seatbelt use was depicted in 62 percent of individuals in television programs. Actual use by Americans is 80 percent. The prevalence of motorcycle helmet use was 47 percent in television against 60 percent of actual use. Television showed only 9 percent bicycle helmet use as opposed to actual use of 40 percent.

“There is no doubt that seatbelt and helmet use reduce the likelihood of death or serious injury from vehicle crashes,” said Gerald McGwin, Ph.D., associate director for research at the Center for Injury Sciences and one of the study authors. “Since Americans watch more than four hours of TV per day, how safety behaviors are depicted on television can have tremendous influence on public perception of seatbelt and helmet use.”

McGwin says that television commercials do a much better job of presenting safe behaviors than television programming. Seatbelt use is depicted in 86 percent of individuals in commercials, motorcycle helmet use 100 percent and bike helmet use 84 percent.

The researchers examined the 20 most popular TV programs on the four major U.S. television networks over a four-week period in the summer of 2005. These programs are viewed by approximately 15 million individuals, with the top programs seen by 30 million people.

“The ability of television programs to influence behavior should not be underestimated,” McGwin said. “We suggest that programmers have a responsibility to promote safe transportation behaviors by the characters in their shows.”

McGwin also pointed out that many U.S. television shows are exported to other countries where seatbelt and helmet usage vary widely.

Unintentional injuries are the leading cause of death among Americans under age 40 and the fifth leading cause overall. Motor vehicle injuries account for 42 percent of injury related death. Seatbelt use has been shown to reduce the risk of death by at least 50 percent. Motorcycle helmets have been shown to reduce the risk of head injury by 72 percent and risk of death by 29 percent. Bicycle helmets have a similar injury risk reduction.

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A study of settlement decisions in workers’ compensation claims for low back pain has found almost no relationship between the rating of the disability’s severity when the claim was settled and reported pain and disability 21 months later.

Findings were counterintuitive: Claimants with higher disability ratings, which suggest higher severity and less ability to work, fared better than those with lower ratings.

The study shows that “administrative decisions made at the end of the workers’ compensation claim process about the ability of someone to work after back injury has very little predictive validity,” said Dr. Norton Hadler, a professor of medicine and microbiology/immunology in the University of North Carolina at Chapel Hill’s School of Medicine.

Hadler is a co-author of the paper, which was published in the December issue of the Journal of Pain, with colleagues from St. Louis University and the University of Florida. It was based on administrative records in Missouri of workers’ compensation claims for low back pain.

Workers’ compensation is an important part of America’s health-care system, accounting for 3 percent of an employer’s gross income, Hadler said.

“Clearly, the rating schemes for workers’ compensation are inconsistent, and that fact is stirring enormous pots across the country,” Hadler said. “If the outcomes from Missouri generalize, then there is a need to reform how disability is determined.”

Another paradoxical finding showed that white claimants faired no better than blacks, even though previous reviews found that blacks were much less likely than whites to be diagnosed with a herniated disk or to have back surgery, had less money spent on their care and received lower disability ratings and smaller settlements.

“It’s one of the more perverse observations in our study,” said Hadler. “African-Americans were much less likely to be operated on, but the care that the whites got, even though it looks like more care, because it’s surgery and it’s more expensive, didn’t do anything for them.”

For their study, the researchers interviewed 580 black and 892 white workers’ compensation claimants an average of 21 months after claim settlement to assess how well they were functioning and to determine the contribution of impairment, race and socioeconomic status to their disability ratings.

Hadler said that workers’ compensation claims for low back pain represent only 20 to 30 percent of all claims filed but consume a majority of the workers’ compensation budget.

The article concludes that “the pattern of results suggests that race/ethnicity and other sociodemographic factors influence medical decision making and … the outcomes of medical care.” Furthermore, the flaws in the system “are not distributed evenly” but “are visited disproportionately” on minorities and persons of lower socioeconomic status.

Study collaborators were Drs. John T. Chibnall and Raymond C. Tait from Saint Louis University School of Medicine and Dr. Elena M. Andresen of the University of Florida. Tait was the study’s principal investigator and lead author of the article. It is the fifth article that the quartet have published over the last two years.

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A George Institute road safety study has revealed an alarmingly high rate of mobile phone use amongst Australian drivers. Published in the Medical Journal of Australia, the survey conducted in NSW and WA found that 60% of drivers use a mobile phone whilst behind the wheel, resulting in crashes and negligent driving.

Almost 3 million drivers across the two states use a phone while driving. Men, younger drivers and metropolitan residents were found to be the worst offenders. In addition to talking on the phone 12% of drivers admit to writing text messages, while among young drivers, over 30% write text messages while on the road. Young drivers were almost five times more likely than older drivers to use a phone while driving.

“The Australian public are not getting the message that mobile phone use whilst driving is a dangerous activity. The risk of a crash increases four-fold when using a mobile phone, irrespective of whether you are using a hand-held or a hands-free device. Based on the results of our study an estimated 45,000 drivers have crashed while using a mobile phone, and over the past year more than 145,000 drivers have experienced a ‘near miss’ due to talking on the phone,” said Dr Suzanne McEvoy, Senior Research Fellow at The George Institute.

Although the use of hand-held mobile phones while driving is illegal, almost 40% of drivers continue to use a hand-held phone while driving. Seventy percent of drivers felt that they were unlikely to be caught by police for using a hand-held phone while driving.

“Drivers are aware of the law against hand-held mobile phones, but believe that enforcement is quite low. These data clearly demonstrate the need to enhance enforcement of this legislation. However, given that hands-free devices do not necessarily reduce the risk, drivers should limit all phone use while driving” Dr McEvoy added.

Research by The George Institute into the broader issues of driver distraction, shows that drivers are engaged in a distracting activity once every six minutes. During a given driving trip, 72% of drivers will report a lack of concentration, 69% will adjust in-vehicle equipment, 58% are distracted by outside events, objects or people and 40% will talk to passengers, all of which account for thousands of driver errors and crashes each year. In fact, one in every five crashes in this study was caused by driver distraction.

The most common adverse effects of mobile phone use while driving were taking eyes off the road, slowing down, lack of concentration, failing to indicate, lane drift and sudden braking.

“Action is urgently needed to reduce crashes caused by mobile phone use and driver distraction. Policies that include increased driver awareness and innovative enforcement practices are essential to decrease the occurrence of these behaviours and reduce adverse outcomes,” said Dr McEvoy.

Young drivers are consistently over-represented in crash statistics, and were also found to be much more frequently distracted while driving. Compared to older drivers, this group perceived distracting behaviours to be less hazardous, yet they were significantly more likely to report a crash resulting from distraction.

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This study was funded by the Motor Accidents Authority of New South Wales (MAA).

The George Institute for International Health is an internationally-recognised health research body, undertaking high impact research across a broad health landscape. The Institute is centrally involved with Australian community health issues in Aboriginal health, ethnic community health, road safety and injury, mental health, ageing, healthcare access, clinical practice in Australian hospitals and health policy development.

It is also a leader in the clinical trials, health policy and capacity-building areas. Its research has a direct, practical impact on a wide range of healthcare, health policy, safety and socio-cultural issues facing Australians.

The Institute is affiliated with The University of Sydney, Sydney South West Area Health Services, and collaborates in its research with other prestige research institutes, clinical authorities and policy centres around the world.

Contact: Emma Orpilla

Research Australia