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Press Release Date: December 30, 1996
The Federal Agency for Health Care Policy and Research (AHCPR) today announced the funding
of 13 new research projects: eight projects to determine how the referral of primary care patients
to medical specialists and other specialized services affects the quality and cost of health care, and
five projects to improve primary care services overall.
More than half of all Americans are now covered by managed care plans, which often require the
use of a primary care physician or gatekeeper to manage the referral of patients from primary to
specialty care. To strengthen the scientific base underpinning the referral policies of health plans,
AHCPR issued a call in early 1996 for research applications on the referral of patients to
The following eight studies, with a total estimated funding of $4.79 million, were chosen from
among the applicants. They are:
Nephrologist Care and Outcomes in Renal Insufficiency. (Grant No.:
HS09398) Principal investigator: Jerome L. Avorn, M.D., Brigham and Women's Hospital,
Boston, MA. 1996-1998. Total estimated funding: $634,179.
Determines the appropriate timing of patient referrals to a nephrologist prior to the diagnosis of
end-stage renal disease (ERSD); examines how use of a nephrologist affects the clinical course of
ESRD and outcomes; and also investigates other issues.
Specialty Care in Closed Versus Open Access HMOs. (Grant
No.: HS09414) Principal investigator: José Escarce, M.D., University of Pennsylvania,
Philadelphia, PA. 1996-1998. Total estimated funding: $707,328.
Examines the use of primary care and specialist services by patients in a closed-panel gatekeeper
HMO plan versus those in a point-of-service (POS) plan. Also examines whether
primary care physicians refer patients in the two plans at different rates and the factors influencing
the choice of specialists.
Referrals in Primary Care. (Grant No.: HS09397) Principal
investigator: Peter Franks, M.B.B.S., M.S., Highland Hospital, Rochester, NY. 1996-1998. Total
estimated funding: $469,112.
Examines variations in referral rates among primary care physicians in a large managed care
organization, characteristics of the patients, physicians, and practices associated with these
variations, and the impact of referral rate variations on costs and patient outcomes.
Unmet Needs and Use of Vision Care by Medicare Beneficiaries. (Grant
No.: HS09424) Principal investigator: Carol Mangione, M.D., University of California, Los
Angeles, CA. 1996-1998. Total estimated funding: $694,285.
Investigates how the use of specialist referrals and services may be affected by payment
organization. Focuses on the use of vision care services for Medicare patients in fee-for-service
versus capitated managed care settings.
Patterns of Referral and Care for Children on Medicaid. (Grant No.:
HS09416) Principal Investigator: James Perrin, M.D., Massachusetts General Hospital,
Boston, MA. 1996-1998. Total estimated funding: $245,892.
Focuses on the consequences of the referral of children enrolled in Medicaid to pediatric
specialists, compared with adult specialists, for common and uncommon pediatric chronic
Specialty Referrals Among California Physician Groups. (Grant No.: HS09372)
Principal investigator: Joseph Selby, M.D., Kaiser Foundation Research Institute, Oakland,
CA. 1996-1998. Total estimated funding: $725,925.
Examines the determinants of referral among 6,300 adult California managed care patients with
one of three common chronic conditions; the possible effect of plans' financial arrangements and
utilization management techniques on referral decisions; and the possible association between
referral patterns and quality of care.
Managed Care and the Primary-Specialty Care Interface. (Grant No.: HS09377)
Principal investigator: Barbara Starfield, M.D., Ambulatory Sentinel Practice Network,
Denver, CO. 1996-1998. Total estimated funding: $909,794.
Characterizes referral patterns by primary care physicians and determines how those patterns and
the coordination of referrals are influenced by financial incentives and organization controls
imposed by managed care organizations.
Analysis of Physician Referrals of Medicare Patients. (Grant No.: HS09439)
Principal investigator: Bruce C. Stuart, Ph.D., Pennsylvania State University, University Park, PA. 1996-1998. Total estimated funding: $403,397.
Characterizes patterns of physician referrals and consultations in the treatment of
noninstitutionalized elderly and disabled Medicare beneficiaries, and identifies differences in cost
and patient outcomes associated with specialist referrals for treatment of cardiovascular disease
in Medicare patients.
AHCPR also announced today the funding of five additional studies, with a total estimated
funding of $3.54 million, to improve primary care. They are:
Prevention and Competing Demands in Primary Care Practice. (Grant No.:
HS08776) Principal investigator: Benjamin F. Crabtree, Ph.D., University of Nebraska
Medical Center, Omaha, NE. 1996-1999. Total estimated funding: $879,978.
Investigates why primary care physicians do or do not provide preventive health services as part
of their practice, and the competing demands on physicians for the delivery of medical and clinical
Effective Organization of Adolescent Health Services. (Grant No.: HS08192) Principal investigator: Jonathan B. Klein, M.D., University of Rochester School of Medicine,
Rochester, NY. 1996-1998. Total estimated funding: $311,642.
Analyzes how the organization of adolescent health services affects teenagers' access to care.
State Service-Contingent Programs for Health Providers. (Grant No.: HS09165) Principal investigator: Donald E. Pathman, University of North Carolina, Chapel Hill, NC.
1996-1999. Total estimated funding: $546,766.
Evaluates the effectiveness of state service-contingent programs and the various methods they use
to reduce primary care provider shortage and maldistribution.
Health Education in an HMO: Effectiveness and Efficiency. (Grant No.: HS08641)
Principal investigator: Ronald W. Toseland, Ph.D., State University of New York, Albany,
NY. 1996-2000. Total estimated funding: $1.22 million.
Compares the short- and long-term effects of a managed care program to teach health education,
coping, and other skills to individuals who care for their frail elderly spouses, and examines the
impact of the training on caregivers' and care recipients' health care utilization and
Couples' Preference for Prostate Cancer Screening. (Grant No.: HS08992) Principal investigator: Robert J. Volk, Ph.D., University of Texas Medical Branch,
Galveston, TX. 1996-1998. Total estimated funding: $586,610.
Determines the appropriateness of prostate cancer screening from the perspective of men who
have the disease, and of their spouses. The researchers will also examine differences in
preferences among non-Hispanic white, Mexican-American, and African-American husbands and
The Agency for Health Care Policy and Research, a part of the Department of Health and Human
Services, is the lead agency charged with supporting research designed to improve the quality
of health care, reduce its cost, and enhance access to essential services. AHCPR's broad programs
of research and technology assessment bring practical, science-based information to medical
practitioners, and to consumers and other health care purchasers.
For additional information, contact AHCPR Public Affairs: Howard
Holland, (301) 427-1857; Salina Prasad, (301) 427-1864.