Current Awareness in Aging Research (CAAR) Report #66--January 11, 2001

CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:


I. Data:

1. HCFA: "Medicare+Choice rates as revised by the Benefit Improvements and Protection Act of 2000" (US Health Care Financing Administration, HTML and .exe self de-compressing .csv format). Included are: 2001 Medicare+Choice Payment Rates for March through December; 2001 Medicare+Choice Payment Rates for January and February; Historical Rates & Data; and Risk Adjustment Information, Data files, & Programs.

2. NCHS--DATA METHODOLGY REPORT: "Design and Operation of the National Hospital Discharge Survey: 1988 Redesign," by Charles F. Dennison and Robert Pokras (US National Center for Health Statistics Vital Health and Statistics Series 1, Programs and Collections Procedures No. 32, (PHS) 2001-1315, December 2000, .pdf format, 42p.).

Click on "View/download PDF" for full text.


II. Reports and articles:

3. HCFA BENEFITS IMPROVEMENT AND PROTECTION ACT ACR/PBP INFORMATION: The US Health Care Financing Administration has made electronically available (.pdf, Microsoft Word, or Microsoft Excel format) information on: Benefits Improvement and Protection Act (BIPA) of 2000; Adjusted Community Rate (ACR); Plan Benefit Package (PBP); and Summary of Benefits (SB).


A. "Nursing Home Resident Assessment: Quality of Care" (US Department of Health and Human Services Office of Inspector General Office of Evaluation and Inspections OEI-02-99-00040, January 2001, .pdf format, 29p.).


[This] report evaluates the current state of practice of implementing nursing home resident assessments. We found that generally nursing homes follow a systematic process when performing them. However, we also found that 17 percent of the fields on the assessment instrument contain information different from that found in the rest of the medical record. Furthermore, 14 percent of specific assessment protocols which should have been triggered by the overall assessment were not triggered, and one-quarter of the protocols are not addressed in the plans of care. However, for those residents who have plans of care, the plans are being followed.

B. "Nursing Home Resident Assessment: Resource Utilization Group" (US Department of Health and Human Services Office of Inspector General Office of Evaluation and Inspections OEI-02-99-00041, January 2001, .pdf format, 32p.).


[This] report is on the assessments as they pertain to resource utilization groups, which are used as a basis for billing Medicare for nursing home care. We found significant coding problems. According to our reviewers, 76 percent of the cases reviewed had discrepancies when compared to the rest of the medical record. However, these consisted of both upcoding and downcoding, which may indicate confusion or difficulties with the assessment instrument rather than deliberate miscoding. Therapy minutes and activities of daily living are keys to the differences. We recommended a number of steps which HCFA can take to address these problems, primarily by way of training and clarifying definitions and requirements.

5. _THE LANCET_ ARTICLE, NEWS, FEATURE: Note: _The Lancet_ requires free registration before providing content.

A. "Withholding and withdrawal of life support in intensive-care units in France: a prospective survey," by Edouard Ferrand, Ren Robert, Pierre Ingrand, and Francois Lemaire (_The Lancet_, Vol. 357, No. 9249, Jan. 6, 2001, HTML and .pdf format, p. 9-14).

B. "The double-edged sword of postmenopausal hormone therapy," by Kathryn Senior (_The Lancet_ News, Vol. 357, No. 9249, Jan. 6, 2001, HTML and .pdf format, p. 46).

C. "Music tunes up memory in dementia patients," by Marilynn Larkin (_The Lancet_ News, Vol. 357, No. 9249, Jan. 6, 2001, HTML and .pdf format, p. 47).

D. "Robert Butler: Championing a healthy view of ageing," by Marilynn Larkin (_The Lancet_ Feature, Vol. 357, No. 9249, Jan. 6, 2001, HTML and .pdf format, p. 48).

All of the above articles can be accessed from:

6. _BMJ_ NEWS: "Spain agrees palliative care plan," by Xavier Bosch (_British Medical Journal_, Vol. 322, No. 7277, Jan. 6, 2001, HTML format, p. 8).

7. _JAMA_ ARTICLE: "Changes in Breast Density Associated With Initiation, Discontinuation, and Continuing Use of Hormone Replacement Therapy," by Carolyn M. Rutter, Margaret T. Mandelson, Mary B. Laya, and Stephen Taplin (_Journal of the American Medical Association_ Vol. 285, No. 2, Jan. 10, 2001, HTML and .pdf format, p. 171-176).

8. _NEJM_ ARTICLE ABSTRACT: "Effects of Walking on Mortality among Nonsmoking Retired Men," by Amy A. Hakim, Helen Petrovitch, Cecil M. Burchfiel, G. Webster Ross, Beatriz L. Rodriguez, Lon R. White, Katsuhiko Yano, J. David Curb, and Robert D. Abbott (_New England Journal of Medicine_, Vol. 338, No. 2, Jan. 8, 1998, p. 94-99).

9. AARP PERIODICAL: AARP has made selected contents from the January/February 2001 issue of _Modern Maturity_ electronically available (HTML format).


III. Working Papers:

10. NBER:

A. "The Relation Between Managed Care Market Share and the Treatment of Elderly Fee-For-Service Patients with Myocardial Infarction," by Paul A. Heidenreich, Mark McClellan, Craig Frances, and Laurence C. Baker (National Bureau of Economic Research W8065, January 2001, .pdf format, 23p.).


Managed care may affect medical treatments for non-managed-care patients if it alters local market structure or physician behavior. We investigate whether higher levels of overall managed care market share are associated with greater use of recommended therapies for fee-for-service patients with acute myocardial infarction using data on 112,900 fee-for-service Medicare beneficiaries residing in one of 320 metropolitan statistical areas, with age >= 65 years, and admitted with an acute myocardial infarction between February 1994 and July 1995 from the Cooperative Cardiovascular Project. After adjustment for patient characteristics, severity of illness, characteristics of the hospital of admission, specialty of treating physicians, and other area characteristics, patients treated in areas with high levels of managed care had greater relative use of beta-blockers during hospitalization and at discharge and aspirin during hospitalization and at discharge, consistent with more appropriate care. Patients in high HMO areas may be less likely to receive angiography when compared to areas with low levels of managed care, although this result was only marginally significant. In unadjusted comparisons, patients in high HMO market share areas had lower 30 day mortality, but there were no differences in 30 day mortality when all of the control variables were included in the model. We conclude that managed care can have widespread effects on the treatment of patients and the quality of care they receive, even for patients not enrolled in managed care organizations.

Click on "PDF" at the bottom of the abstract, or submit your email address, for electronic full text.

B. "Effects of Competition under Prospective Payment on Hospital Costs among High and Low Cost Admissions: Evidence from California, 1983 - 1993," by David Meltzer and Jeanette Chung (_National Bureau of Economic Research_ W8069, January 2001, .pdf format, 51p.).


Competition and prospective payment systems have been widely used to attempt to control health care costs. Though much of the increase in medical costs over the past half-century has been concentrated among a few high-cost users of health care, prospective payment systems may provide incentives to selectively reduce expenditures on high-cost users relative to low-cost users and this pressure may be increased by competition. We use data on hospital charges and cost-to-charge ratios from California in 1983 and 1993 to examine the effects of competition on costs for high and low cost admissions before and after the establishment of the Medicare Prospective Payment System (PPS). Comparing persons above and below age 65 before and after the establishment of PPS, we find that competition is associated with increased costs before PPS in both age groups, but decreased costs afterwards, especially among those above age 65 with the highest costs. We conclude that the combination of competition and prospective payment systems may result in incentives to selectively reduce spending among the most expensive patients. This raises important issues relevant to the use of competition and prospective payment to control costs and implies at minimum the need to carefully monitor outcomes for the sickest patients under prospective payment systems in competitive environments.

Click on "PDF" at the bottom of the abstract, or submit your email address, for electronic full text.


IV. Journal Tables of Contents (check your library for availability):

11. Abstracts in Social Gerontology (Vol. 43, No. 4, December 2000) is available in the ProQuest Research Library database. Check your organization's library for the availability of this database.

12. Archives of Gerontology and Geriatrics (Vol. 31, No. 3, December 2000).

Click on "Tables of Contents and Abstracts," and then "Volume 31, Issue 3" for table of contents and abstracts.

13. Health and Social Work (Vol. 25, No. 4, November 2000) is available in the ProQuest Research Library database. Check your organization's library for the availability of this database.

14. CARL Uncover Journal Tables of Contents. Follow the instructions below to access tables of contents. CARL Uncover provides fee based document delivery services for selected journals.

A. Point your browser to:

B. click on "Search Uncover"
C. click on "Search Uncover Now"
D. Type the Journal Name in the search box and click the radio button "Journal Title Browse"
E. click on the journal name
F. click on "journal issues"
G. click on the issues identified below

International Psychogeriatrics (Vol. 12, No. 2, June 2000).

Omega: Journal of Death and Dying (Vol. 41, No. 2, 2000).

Research on Aging (Vol. 23, No. 1, January 2001). Note: This journal is available in electronic full-text in the ProQuest Research Library and EBSCO Academic Search Elite Database. Check your library for the availability of these databases and this issue.


V. Funding and Employment Opportunities:

15. UNIVERSITY OF PENNSYLVANIA POPULATION STUDIES CENTER: "The Population Studies Center (PSC) at the University of Pennsylvania has an opening for a post-doctoral fellow in the economics and demography of aging. The position is funded by the National Institute on Aging. Applicants must have a doctoral degree in demography, economics, another social science or public health. Preference will be given to candidates who have already worked in the area of aging and whose research interests are compatible with the research interests of members of the PSC. We are particularly interested in researchers with interests in medical demography, biodemography, or formal demography applied to advanced ages. We welcome applications from researchers whose research will require the facilities of our Limited Access Data Room which provides a secure computing environment. One position is open for a start date of summer 2001 or January 2002. Applicants should send a letter of intent which includes a discussion of research and career plans following postdoctoral training, a C.V., a two-page description of research plans and two letters of recommendation to:

Dr. Douglas Ewbank
Population Studies Center
University of Pennsylvania
3718 Locust Walk
Philadelphia, PA 19104

Information about the PSC and the Population Aging Research Center are available at:

Inquiries can be addressed to Douglas Ewbank at EWBANK@POP.UPENN.EDU


Jack Solock
Data Librarian--Center for Demography and Ecology and Center for Demography of Health and Aging
4470 Social Science
University of Wisconsin-Madison
Madison, WI 53706