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AHCPR Funds New Studies

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Media Advisory Date: September 30, 1996

Appropriate and effective use of right heart catheterization, home care of infants with neonatal chronic lung disease, medical and surgical superspecialization, and the effect of the market structure on HMOs are among the topics to be studied in a series of new grants awarded by the Agency for Health Care Policy and Research.

"The findings of this research will go a long way to improve the quality of care provided to millions of Americans," according to AHCPR Administrator Clifton R. Gaus, Sc.D. "The variety of these topics reflects the wide gaps in information that exist within the health care system," added Dr. Gaus.

The following are descriptions of the 12 new grants, listing the principal investigator, first-year funding, and project period.

Right Heart Catheterization: Appropriate/Effective Use
Case Western Reserve University, Cleveland, Ohio; Alfred F. Connors, Jr., M.D.; $372,595 (1996); (7/1/96-6/30/98)

This study explores: 1) variation in the use of right heart catheterization (RHC) in seriously ill patients; 2)effectiveness of RHC in terms of survival, quality of life, and satisfaction with care; 3)cost of RHC; and 4) appropriateness of use of RHC.

Superspecialization of Medical and Surgical Subspecialists
University of Pennsylvania, Philadelphia, PA; Jose Escarce, M.D.; $271,721 (1996); (6/1/96-5/31/98)

This study will examine the patterns and determinants of superspecialization among medical and surgical subspecialists.

Community-Based Pharmaceutical Care: A Controlled Trial
Indiana University, Indianapolis, IN; Morris Weinberger, M.D.; $590,656; (1996); (6/1/96-5/31/00)

The Investigator will develop algorithms to facilitate pharmaceutical care for the treatment of asthma. A randomized, controlled trial, with 460 patients in a pharmacy intervention group and two control groups will be undertaken. The pharmacy intervention group will be provided with patient-specific clinical information, displayed on their computer workstations, when filling prescriptions. Outcomes to be studied include cost and quality of life.

Assessing Pediatric Quality of Life in a Clinical Trial
University of New Mexico, Albuquerque, NM; Robert D. Annett, Ph.D.; $36,329 (1996); (6/1/96-5/31/98)

This study examines the relationship between a disease-specific pediatric quality of life measure (the PQLQ) and 1) current asthma symptom severity as measured in the Childhood Asthma Management Program (CAMP), 2) sociodemographic variables as measured in the CAMP study, and 3) the general multidimensional measures of quality of life utilized in the CAMP study. Additionally, it will try to determine the best clinical and psychosocial predictors of disease-specific quality of life (PQLQ).

The project will address two issues not reported by the few existing pediatric asthma measures: severity and its impact on quality of life or the impact on the family's socioeconomic status.

Facilitating Home Care of Neonatal Chronic Lung Disease
Bowman Gray School of Medicine, Winston-Salem, NC; Thomas Michael O'Shea, M.D.; $266,967 (1996); (7/1/96-6/30/01)

This study will measure the outcomes and costs of two interventions that facilitate home care of infants with chronic lung disease. The interventions to be tested are: 1) a multi-disciplinary (neonatologist, nurse, and social worker) center-based care consisting of home visits and visits by the patients to the outpatient department; or 2) follow-up care coordinated by a center-based nurse, by way of telephone contact, and by community-based providers of primary medical care. Advancing therapies have improved the survival rate of low birth weight babies, resulting in a significant number of infants with complex care needs after discharge from the hospital.

Adoption of Cancer Pain Guidelines in Managed Care
Education Development Center, Inc., Newton, MA; Mildred Z. Solomon, Ed.D.; $581,087 (1996); (6/01/96-5/31/00)

Researchers will conduct a randomized controlled study of cancer patients and their providers in managed care clinics to determine the effectiveness of a two-tiered (organizational and individual) dissemination strategy of the AHCPR-sponsored guideline on the Management of Cancer Pain.

Cardiac Procedure Use: A Prospective Cohort Study
Brigham and Women's Hospital, Boston, MA; Thomas H. Lee, M.D., MSC; $654,677 (1996);(7/1/96-6/30/99)

The project will evaluate the reasons for the racial and gender differences in the use of cardiac tests and procedures. The cohort will be identified at the time of emergency room admission with chest pain, and will be followed for all procedures, both invasive and noninvasive, for one year.

Effects of Health Care Market Structure on HMOs
Georgetown University, Washington, DC; Jack Hadley, M.D.; $307,437; (7/01/96-6/30/97)

The study will analyze the impact of the recent growth and concentration of HMOs on employers, health insurance coverage decisions, health care premiums, and employees' health insurance choices.

Selective Cervical Spine Radiography In Blunt Trauma
University of California, Los Angeles, CA; William R. Mower, M.D., M.E., M.S.; $621,570 (1996); (8/1/96-7/31/98)

To determine whether it is possible to reduce radiographic cervical spine imaging by demonstrating that clinical criteria can reliably exclude cervical spine injury in "no risk" blunt trauma victims without misidentifying any injured patient.

Understanding Health Values of HIV-Infected Patients
University of Cincinnati Medical Center, Cincinnati, OH; Joel Tsevat, M.D., M.P.H.; $160,160 (9/1/96-8/31/97)

Researchers will strive to gain an understanding of the health values of 100 HIV-infected patients through focus groups and interviewing, and then will develop and test a conceptual model of their health values.

Impact of Prospective Drug Use Review on Health
Pennsylvania State University, University Park, PA; Frank M. Ahern, Ph.D.; $183,154 (8/1/96-7/31/98)

This study seeks to compare two different models of outpatient prospective drug utilization review programs in the state of Pennsylvania, one of which allows active participation of the pharmacist in the process and the other which does not. The aims of the research are to 1) conduct a descriptive epidemiological analysis of psychotropic drug use, prescribing patterns, and yield of prospective drug utilization review (ProDUR) interventions, and compute estimates of drug-related outcome measures; and 2) evaluate the independent effects of two different ProDUR procedures on health outcomes.

AHCPR UI Guidelines: Application in Nursing Homes
University of Rochester, Rochester NY; Nancy M. Watson, Ph.D.; $201,635 (6/1/96-5/31/99)

The project will evaluate the impact of the Agency for Health Care Policy and Research-sponsored Clinical Practice Guideline for Urinary Incontinence in Adults in the nursing home setting.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 or Salina Prasad, (301) 427-1864.

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