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Press Release Date: Friday, April 17, 1998
HHS' Agency for Health Care Policy and Research (AHCPR) today is
announcing eight grant awards designed to improve the quality of U.S.
health care. Overall funding will total $7.6 million over five years.
"These research projects will help us build a better science base
for measuring and improving quality of care," said HHS Secretary Donna
E. Shalala. "They will provide new ways to measure quality and will
offer comparative information that will help physicians and providers
improve health care outcomes."
In his budget proposal for FY 1999, President Clinton is requesting
$15 million to enable AHCPR to fund additional quality-related research.
"These projects and more like them will provide the scientific
foundation for this Administration's efforts to improve the quality of
health care for all Americans," said AHCPR Administrator John M.
Eisenberg, M.D. "These projects provide new insights and understanding
about our complex health care system."
AHCPR is poised to announce a series of grants designed to
determine the impact of different features of health plans on outcomes
and on the quality of care provided to patients with chronic illnesses.
The agency has launched several quality-related projects in FY 1998 that
will inform health care decisions. AHCPR recently funded a report on
innovations in value-based purchasing, showing how a number of major
corporations, businesses and health coalitions are using their market
power to negotiate on quality as well as cost.
Earlier this year, AHCPR launched the Consumer Assessment of Health
Plans survey (CAHPS®), a survey kit which can be used by employers,
managed care plans and others to obtain consumers' views of the care
they are receiving. The Medicare program is adopting CAHPS® for its
managed care enrollees and the Office of Personnel Management will adopt
CAHPS® for use by the Federal Employees Health Benefits Program.
Grants announced today are:
Pressure Ulcer Rates in Describing Nursing Home Quality. Principal
investigator: Dan R. Berlowitz, M.D., M.P.H., Boston Medical
Center, Boston, Mass.; Grant #HS09768. Total funding: $697,679.
This study will examine the development of pressure ulcers and
create a model to predict their occurrence. The model then will be
used to adjust for patient risk while evaluating different methods
of describing nursing home performance. Ultimately, these results
will help provide information on the quality of nursing homes and
how it can be improved.
Measuring and Improving Quality: Carotid Endarterectomy. Principal
investigator: Mark R. Chassin, M.D., M.P.H., Mount Sinai School of
Medicine, New York, N.Y.; Grant # HS09754. Total funding:
This project will investigate quality of care in carotid
endarterectomy, a surgical procedure performed to prevent stroke in
patients with lesions in their carotid arteries. The study will
assess appropriate use, develop measures of appropriateness and
then create an intervention designed to improve appropriateness.
Patient-based Quality Assessment for Chronic Disease. Principal
investigator: Sheldon Greenfield, M.D., New England Medical Center
Hospitals, Inc., Boston, Mass.; Grant #HS09756. Total funding:
This study will compare disease-specific measures of quality for
patients with three chronic conditions (asthma, diabetes and lower
back pain) with general measures of quality (such as HEDIS 3.0 and
CAHPS®) reported by the population being served in the health plan.
It will determine whether these disease-specific measures are more
sensitive than general measures in discriminating quality among
health plans. The research also will examine whether comprehensive
profiles of health plans can be created across disease conditions.
If these measures are found to be valid, they could be used as
measures for comparing health plans.
Understanding Clinical and Administrative Outcomes. Principal
investigator: Jeremy Holtzman, M.D., M.S., University of Minnesota,
Minneapolis, Minn.; Grant # HS09735. Total funding: $263,458.
This study examines whether patients' post-operative symptoms could
be used as possible outcomes indicators for two Medicare groups:
patients being treated for stomach pain after having gallbladder
surgery and patients with pain or difficulty walking after having
hip surgery. The study will identify: how severity of illness
impacts symptom relief; whether good symptomatic outcomes (such as
less post-operative pain) correlate with a better process of care;
whether better symptomatic outcomes (i.e., better mobility) predict
subsequent utilization of services; and whether symptomatic and
functional outcomes can be inferred from utilization data. If
service utilization is found to be an acceptable surrogate for
symptomatic outcomes (i.e., better or worse post-operative status),
then utilization data could be used in lieu of more costly
Validation of Quality Measures for Hip Replacement. Principal
investigator: Jeffrey Katz, M.D., Brigham and Women's Hospital,
Boston, Mass.; Grant # HS09775. Total funding: $472,306.
This project will create quality indicators for elective total hip
replacement, using information from medical record reviews and
hospital and patient surveys. Currently, there are no validated
measures of quality for total hip replacement. This research also
will develop a cumulative index of quality, which could have
implications for other surgical and medical interventions.
Predicting Risk for Hysterectomy Complications. Principal
investigator: Evan Robert Meyers, M.D., M.P.H., Duke University
Medical Center, Durham, N.C.; Grant # HS09760. Total funding:
This project will create predictive models that can be used by
physicians and patients when making decisions about surgery.
Hysterectomy is a procedure with a high level of unexplained
variation in use and complications, especially among minorities.
Methods for estimating and adjusting risk and severity are
necessary to make comparisons of performance among providers who
may be treating patients with conditions of greater severity and
Quality Improvement for Newborns with Jaundice. Principal
investigator: R. Heather Palmer, M.B., B.Ch., S.M., Harvard School
of Public Health, Boston, Mass.; Grant # HS09782. Total funding:
Jaundice in the first few days of life can be a signal of serious,
even devastating illness. The American Academy of Pediatrics has
issued an evidence-based clinical guideline to identify infants
with jaundice and prevent them from progressing to serious
illnesses. Different implementation strategies of this guideline
will be tested in loosely structured managed care settings. This
common form of managed care is very different from the tightly
structured HMO systems in which quality improvement has most often
Quality Improvement in Nursing Homes. Principal investigator:
Francois Sainfort, Ph.D., University of Wisconsin, Madison, Wis.;
Grant # HS09746. Total funding: $397,332.
Very little is known
about the influence of both organizational structure and culture on
quality of care in the nursing home field. This project will
examine the impact of quality improvement activities in 100 nursing
homes in Wisconsin. This research will be of use to nursing homes
seeking to implement a quality improvement philosophy within their
For additional information, please contact AHCPR Press Office:
Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).