Funded Grants Submitted by Nurses: 1980-2005 (continued)
Principal Investigator: Janie L. Canty, M.S.N., R.N.
Institution: Institution Name Unavailable
Grant No: R03 HS07547 (Dissertation)
Title: Adolescents Life Change Events, Hope and Self-Care Agency
Summary: The descriptive correlational study investigated relationships among life change events, hope and self-care agency in inner-city adolescents. The sample included 202 male and female adolescents from 13 to 19 years of age, volunteers from two public high schools in Miami, Florida. A major finding of the study was the significant positive correlation found between hope and self-care agency. The magnitude and significance of the correlation remained the same when life change events was introduced as a control variable. The study also demonstrated that there was no correlation found between life change events and self-care agency. However, when hope was introduced as a control variable, there was a significant correlation found between life change events and the adolescents' valuing of health, one of six self-care agency subscales.
Availability: NTIS Final Report Accession Number: PB94204260
Principal Investigator: Patricia A. Carney, R.N.
Institution: University of Washington
Grant No: R03 HS07988 (Dissertation)
Title: HIV Prevention in Primary Care: an Objective Assessment
Summary: Unannounced standardized patients (SPs) (lay individuals trained to replicate a clinical encounter consistently) were used to evaluate the frequency, content, time spent, and cost related to HIV risk factor determination, education and counseling provided by 22 family nurse practitioners and family physicians. Whether any of the above factors varied by type and gender of provider and gender of 'patient' was explored. Results indicate that even when prompted by the patient with a concern about AIDS, most study variables were performed between 9 and 60 percent of the time, leaving room for improvement in both family physicians and family nurse practitioners. No providers assessed sexual practices and none followed the U.S. Preventive Services Task Force Guidelines on HIV preventive educational practices. Providers performed higher in providing education about HIV testing than the educational content about risk factor reduction. No differences were identified in how time was spent and the cost of visit by type of provider. Some differences were discovered, particularly in time and cost factors, by gender of health care provider. Time spent and cost factors did not vary by gender of SP.
Availability: NTIS Final Report Accession Number: PB94210747XSP
Principal Investigator: Patricia A. Caulfield-Wall, B.Sc.N., R.N.
Institution: University of Toronto
Grant No: R03 HS08481 (Dissertation)
Title: Impact of Advance Care Directives on Terminal AIDS Care
Summary: This study examined care in the terminal phases for those with AIDS who are unable to participate in decisions about their care. The research questions were: From the perspectives of (a) substitute decision-makers (b) physicians and (c) nurses, (1) were the patient's desires for terminal care expressed and, if so, in what form? (2) (a) was there concordance between the care desired and the care actually provided? (b) if there was not concordance, why not? (c) what might be done in the future to enhance concordance? (3) (a) were the respondents satisfied with how the patient's desires were incorporated into their care? (b) if respondents were not satisfied, why note? (c) what might be done in the future to enhance satisfaction? The population will be substitute decision-makers and providers for people who have died in hospital as a result of AIDS in Toronto.
Principal Investigator: Chyi-Kong Chang, M.S.N.
Institution: University of Illinois
Grant No.: R03 HS10843 (Dissertation)
Title: Measuring Patient-perceived Nursing Care Quality
Summary: The purpose of the study is to continue to establish a valid and reliable instrument to measure adult patients' views of nursing care quality during their stay in an acute care hospital. The Patient -Perceived Nursing Care Quality (PNCQ) questionnaire was developed through extensive literature review, content analysis of published instruments, patient interviews, content validation from patients and health care professionals, pretests, and a pilot study. Three dimensions underlying perceived nursing care quality are proposed: care of perceived needs, perceived professional competency in managing care, and care of physical environment. Two scales measure patient perceptions regarding the consistency of nursing care quality: quality (poor, fair, good, and very good) and frequency (once or twice, some of the time, most of the time, and all of the time). Specific aims are to examine internal consistency and test-retest reliability and to examine construct validity, criterion-related validity, discriminance validity, and convergent and discriminant validity. A cross-sectional design with repeated measures on a subsample of patients will be used. The study sample will include adult patients who will be discharged to home from eight medical or surgical units of two acute care hospitals in one large Midwestern city; 75 patients who meet inclusion criteria will be randomly selected from each unit (n 600). Consenting patients will be called 5 to 26 days after discharge. A subsample of 12 patients from each unit (n = 96) will be reinterviewed in 2 weeks to examine stability.
Principal Investigator: Sung-Hyun Cho, M.P.H., R.N.
Institution: University of Michigan
Grant No.: R03 HS11397 (Dissertation)
Title: Nurse Staffing and Adverse Patient Outcomes
Summary: A public concern pertaining to patient safety is that hospitals may currently be providing inadequate nurse staffing, consequently jeopardizing the quality of patient care. Recently, several studies have examined the relationship between nurse staffing and patient outcomes. Whereas these studies have produced empirical findings supporting this relationship, this study examines the cost-benefits of increasing nurse staffing as well as the nurse staffing-patient outcomes relationship. The specific aims of this study are: (1) to examine hospital characteristics that affect nurse staffing; (2) to examine the effects of nurse staffing on the occurrence of adverse events; (3) to assess the consequences of adverse events on morbidity, mortality and medical costs during hospitalization; and (4) to estimate increased nursing labor costs incurred for increasing nurse staffing and decreased medical care costs due to decreases in adverse events as the benefits of increasing nurse staffing.
A cross-sectional study design will be conducted using two existing databases of California acute care hospitals. Nurse staffing will be measured by six indicators, including nursing intensity-adjusted nursing hours per patient day worked by registered nurses, all nursing personnel, and agency or contract personnel, skill mix, overtime index, and labor productivity. Adverse events include adverse drug events, patient falls, pressure ulcers, and nosocomial infections. These adverse events will be detected by using the International Classification of Diseases, 9th Revision diagnosis codes. Morbidity attributed to adverse events will be indirectly measured by prolonged length of stay. Analyses will employ multiple regression, logistic regression, or mixed models, depending on the dependent variables. Patient characteristics will be controlled for to isolate the effects of nurse staffing on patient outcomes. The cost benefit analysis from the hospital perspective will examine whether the benefits of increasing nurse staffing are greater than its costs. This study will provide guidelines for determining appropriate nurse staffing levels in hospitals with differing characteristics, such as patient population and types of care provided.
Principal Investigator: Marilyn Chow, D.N.Sc., R.N.
Institution: California Nurses Association
Grant No: R13 HS07280 (Conference)
Title: Innovation, Effectiveness and Outcomes of Health Care Services
Summary: The 1993 Western Regional Invitational Conference was designed to disseminate information to invited regional nursing leaders regarding health care effectiveness initiatives and to create an opportunity for participants to examine opportunities, strategies and challenges for regional collaboration in nursing to develop, disseminate and evaluate clinical innovations with the potential to improve the quality and effectiveness of nursing practice and health care. The conference participant objectives were: (1) analyze the impact of clinical effectiveness initiatives and guideline development on the profession of nursing and nurses' individual roles and settings; (2) evaluate setting/role specific sources of data for effectiveness analysis and identify opportunities to strengthen clinical administrative nursing data bases; (3) examine linkages between quality, effectiveness and health care reimbursement; (4) analyze strategies for improving nursing practice effectiveness through innovation utilization; and (5) evaluate risks and benefits of individual and organizational participation in a regional innovation dissemination and utilization network.
Availability: NTIS Final Report Accession Number: PB94196870XSP
Principal Investigator: Virginia Cleland, Ph.D., R.N.
Institution: University of California
Grant No: R01 HS06437 (Research Project)
Title: Pay Structure for Nursing: Inducements and Costs
Summary: The Differentiated Pay Structure (DPS) model determines a nurse's base pay on the basis of education, position, and expertise level, adjusting that base for part-time employment, differentials for non-business hours, and single payment bonuses to reward longevity. Using computer simulations, the model was tested with personnel and payroll data from two urban hospitals. When the full model was applied, one hospital would save 2.1 percent and the other, 23.7 percent in nursing pay costs. By using the DPS model, administrators can compensate those behaviors valued by employers and can avoid the costly practice of across-the-board increases to all employees.
Availability: NTIS Final Report Accession Number: PB94210408XSP
Principal Investigator: Margaret Compton, M.S.N.
Institution: Institution Name Unavailable
Grant No: R03 HS06964 (Dissertation)
Title: Perception Drug Preference and Pain in Drug Users
Summary: The objective of the research was to develop an understanding of the experience of pain for drug abusers. It was posited that their perceptual style predicts their pain experience as well as their drug of choice. Utilizing a descriptive survey design, relationships among perceptual style, drug preference and pain perception were explored. Perceptual style in a convenience sample of 122 male substance abusers was described using Vando's (1969) Reducing Augmenting Scale and electrodermal response. Pain perception was determined by tolerance to a cold pressor trial. Descriptive analyses revealed high rates of electrodermal non-responsivity and cold-pressor pain intolerance. Reducing-Augmenting Scale score correlated to drug preference for the electrodermally responsive subsample only and not at all to pain perception. Electrodermal responsivity did not correlate to drug preference or pain perception. Drug preference related to subject histories of anxiety and drug treatment, and both pain perception and drug preference were associated with current drug-using status.
Availability: NTIS Final Report Accession Number: PB94206455XSP
Principal Investigator: Joann G. Congdon, Ph.D.
Institution: University of Colorado Health Sciences Center
Grant No.: R18 HS10926 (Research Grant)
Title: American Society for Microbiology 102nd General Meeting
Summary: The process of selecting a quality nursing home requires that consumers have access to useful, meaningful, and appropriate information about nursing home quality. The purpose of the investigation is to develop and evaluate information strategies to assist consumer use of quality factors in making nursing home choices. Specific aims include: 1) determine what information consumers use, need, and value in selecting a nursing home; 2) determine what information health care providers use, need, and value in discussing nursing home choices with consumers; 3) determine what information currently in the public domain can be used to assess nursing home quality from consumer and provider viewpoints; 4) crate a prototype report card incorporating information from Aims 1, 2, and 3 that can be used to assist consumers when choosing a nursing home; 5) examine consumer and provider responses to the prototype report card, specifically: the quality indicators, usefulness, completeness, cultural appropriateness, and format, and 6) examine whether consumer and provider responses to the prototype report card differ by urgency (timing) of the nursing home selection process. In Aims 1 and 2, a descriptive qualitative design will employ ethnographic interviews and analytic techniques with a sample of 68 newly admitted older nursing home residents, family members, and healthcare providers in eight rural and urban nursing homes. A descriptive comparative design in Aim 3 will determine the reliability and validity of available quality information. After combining data analysis result of Aims 1,2, and 3, one or more prototype reports cards will be developed (Aim 4) and evaluated with 50 consumers and providers in eight rural and urban, vulnerable older persons and families. The significance of this study is the integration of qualitative and quantitative approaches to determining the most useful and relevant indicators of nursing home quality for report card development. Use of systematic consumer quality information will motivate and inform consumers to use quality indicators as a decision tool. Identifying information enabling consumers to make value-based nursing home choices will also be useful for other healthcare settings in the continuum of long-term care.
Principal Investigator: William Corser, M.S.N.
Institution: University of Wisconsin
Grant No.: R03 HS10792 (Dissertation)
Title: Patient Outcomes Related To Discharge Planning Collaboration
Summary: The aim of this study is to investigate the relationship between hospital professionals' ratings of their interdisciplinary discharge planning collaboration (IDPC) and the occurrence of post-discharge outcomes later experienced by a sample of elderly hospital patients. The specific objective is to investigate the relationship between 44 professionals' ratings of their recent level of IDPC and other patient characteristics, and six post-discharge clinical and utilization outcomes experienced by a sample of 225 elderly patients.
Principal Investigator: Marie J. Cowan, Ph.D.
Institution: University of California, Los Angeles
Grant No.: R01 HS10734 (Research Project)
Title: Care Management by Nurse Practitioner/Hospitalist Team
Summary: This project will test an intensive intervention using hospitalists collaborating with nurse practitioners who also engage in post-discharge followup, with patients in a general medical unit of an academic medical center.
Principal Investigator: Jolie Crowder, Ph.D., R.N.
Institution: American Health Quality Foundation
Grant No.: R13 HS14387 (Small Conference Grant)
Title: 2003 Annual Session: Celebrating 30 Years of Quality
Summary: Not available.
Principal Investigator: Regina Cunningham, M.A., M.S.N., R.N.
Institution: University of Pennsylvania
Grant No.: R03 HS13124 (Dissertation)
Title: Nursing Interventions and Outcomes Post Prostatectomy
Summary: Prostate cancer is the most frequently diagnosed malignant solid tumor in U.S. males and the second leading cause of male cancer-related death. In concert with the increased incidence of prostate cancer, the number of prostatectomies performed in the United States has escalated over the past few decades. The trend towards increasingly limited hospitalization has led to earlier discharge of this population, requiring patients to manage complex post-surgical issues in the home setting. Preliminary studies have indicated that selected clinical outcomes can be improved in this population when Advanced Practice Nurses (APN) provide care following discharge; however, reasons for this have not been clearly explicated. The proposed descriptive quantitative study will explore this issue by examining how the process of APN care provided to men following prostatectomy affects selected clinical outcomes. A recently completed clinical trial examining the effects of APN interventions in men with clinically localized prostate cancer who have undergone radical prostatectomy, provides a unique opportunity to investigate this issue. The proposed secondary analysis has two specific aims. The first of these is to determine the level of consistency between interventions recorded in the Documentation Logs maintained by APNs during the parent study and core elements of the Agency for Healthcare Research and Quality Clinical Practice Guidelines (CPGs) on three intermediate clinical outcome variables of interest (pain, depressive symptoms, and incontinence). Documentation logs will be examined, subject to content analysis, coded, and compared to core elements of established CPGs. The level of consistency (i.e., "consistent," "partially consistent," "not consistent") between documented interventions and core CPG elements will be established. The second specific aim will determine if APN interventions that are "consistent" or "partially consistent" with core elements of CPGs result in better intermediate clinical outcomes (i.e., less pain, fewer depressive symptoms, less incontinence). Regression techniques that control for age, race, level of education, number of preoperative symptoms, and Gleason score, will be used to determine if higher levels of consistency resulted in differential outcomes. The three intermediate outcome variables will be investigated at two different post-operative time points. Pain outcomes will be evaluated at four weeks post surgery, and pain, depressive symptom, and incontinence outcomes will be studied at eight weeks following surgical intervention.
Principal Investigator: Jacqueline S. Dienemann, Ph.D., R.N.
Institution: Georgetown University
Grant No: R03 HS10731 (Small Research Project)
Title: Domestic Violence Assessment and Intervention
Summary: This project has three specific aims: 1) To test the validity and reliability of the Domestic Violence Survivor Assessment (DVSA) tool using a sample of 250 survivors identified at an urban, suburban or rural health system; 2) To identify preferences for clinician interventions of domestic violence survivors who are primarily motivated to change by family preservation, self preservation or resolution preservation using qualitative analysis of 9 focus across three sites; 3) To achieve consensus of multidisciplinary clinicians through a modified delphi, of a DV clinical pathway incorporating the 1996 Clinical Screening and Intervention Guidelines of the US Prevention Services Task Force and an updated literature review for immediate and followup interventions sensitive to survivor's primary motivation to change.
Principal Investigator: Nancy Donaldson, D.N.Sc., M.S.N., R.N.
Institution: University of California San Francisco
Grant No.: R01 HS11954 (Research Project)
Title: Unit Level Nurse Workload Impacts on Patient Safety
Summary: The aims of this proposed two-year descriptive correlational study build on the established integrity and capacity of the California Nursing Outcomes Coalition (CalNOC) to engage California acute care hospitals in voluntarily using ANA nursing quality indicators for reporting standardized nurse staffing, patient safety, and quality indicators in a collaborative research, repository development, and benchmarking project. For the purposes of this study, it is posited that the daily unit-level configuration of nurse staffing and workload may buffer patients from the effects of error and resulting injury or compromise patient safety when variance in these factors exceeds a staff's adaptive capacity and breaches a unit-level margin of safety. The aims of this study are grounded in the knowledge that the potential to compromise patient safety through human error is inherent in nursing practice and medical care. In collaboration with CalNOC's Statewide voluntary-convenience sample of medical-surgical acute care units from 77 hospitals, this study will break new ground in tracing daily unit-level direct care nurse staffing, in 100 patient care units over a two-month period, to examine associations between the structure of hospital nurse staffing and authoritative indicators of patient outcomes and safety commonly tracked by acute care hospitals, as well as regulatory and accreditation agencies—falls, pressure ulcers, restraint prevalence, and significant clinical events. Staffing measures to be studied include hours of direct care per patient day, skill mix of nurse caregivers, percent of contacted or agency staff, ratio of required to actual hours of care, and RN years of post-licensure experience. This study recognizes and quantifies the impact of patient turnover, a key factor in nurse staffing workload, and integrates it into multiple regression analyses examining associations between nurse staffing and outcomes. Of equal importance, this study will advance staffing measurement by tracing and analyzing the impact of variation in staffing and patient turnover, exploring the impact of variance on patient safety and outcomes.
Principal Investigator: Nancy Donaldson, D.N.Sc., M.S.N., R.N.
Institution: Association of California Nurse Leaders
Grant No.: U18 HS13704 (Cooperative Agreement)
Title: CALNOC Partners to Reduce Patient Falls Project
Summary: The primary aim of the CalNOC Partners for Quality TRIP To Reduce Patient Falls Project, a four-year quality improvement demonstration project, is to use evidence from the reported literature and the California Nursing Outcomes Coalition statewide repository to reduce the incidence of patient falls and severity of fall-related injury in California Hospitals. The proposed project builds on the established infrastructure and capacity of the California Nursing Outcomes Coalition (CalNOC). CalNOC engages California acute care hospitals in voluntarily reporting standardized nurse staffing, patient falls, and fall-related injuries, as well as other quality indicators, in a collaborative repository development and benchmarking project using American Nurses Association's quality indicators. CalNOC, described in publications that are presented in appendix A (Donaldson, Brown, Aydin, and Burnes Bolton, 2002; Brown, Donaldson, Aydin, and Cadson, 2001), is the largest of the American Nurse's Association (ANA) nursing quality measurement research and development project and a major contributor of data to the ANA's National Database for Nursing Quality Indicators (NDNQI). The proposed demonstration project expands and advances CalNOC's efforts to use its quality benchmarking infrastructure as a vibrant network to expedite the transfer of evidence-based knowledge into practice as the basis for improving patient care quality and safety. Reducing patient falls in acute care hospitals in California may be viewed as a first step in reducing patient falls nationally. Analysis of 13 quarters of CalNOC prospective hospital-generated patient falls risk assessment, incidence, and injury data reveals wide variation in fall rates, ranging from less than 1.0 to 13.0+ per 1,000 patient days and nearly 50 percent of patients with unknown or undocumented risk assessment status. A majority of CalNOC sites (76 percent) report using "home grown" fall risk assessment tools with unknown predictive validity. We believe these findings may be representative of processes of care nationwide and present a clear professional mandate to reduce patient falls in acute care hospitals by translating evidence-based knowledge of falls risk assessment and the efficacy of fall prevention interventions into nursing practice.
Principle Investigator: Toni Ebeling, B.S.N., M.S.N.
Institution: Hancock County Health Services
Grant No.: P20 HS15396 (Research Project)
Title: EMR Planning to Improve North Iowa Health Care
Summary: This planning project is led by Hancock County Memorial Hospital in partnership with Belmond Medical Center, Ellsworth Municipal Hospital, Franklin General Hospital, Regional Health Services of Howard County, Kossuth Regional Health Center, Mercy Medical Center-New Hampton, Mitchell County Regional Health Center, and Palo Alto County Health System. Through this project, these nine small, rural, north Iowa medical centers will follow a six-step planning process with the assistance of a medical informatics consultant and a rural healthcare information technology (HIT) consultant to design a three-year plan to implement an integrated electronic health record (EHR) system for their hospitals and 21 affiliated physician health organization clinics. They will also collaborate with Mercy Medical Center-North Iowa, a closely affiliated secondary referral center, and nine county public/community health agencies to develop compatible HIT infrastructures, standardized protocols, and procedures for effectively and securely exchanging patient information. The project has two major goals: 1) To complete a successful system-wide, patient-centered planning process led by physicians, nurses, and other clinicians across these organizations in collaboration with administrators, information system staff, and expert consultants. 2) To produce a comprehensive, achievable three-year EHR implementation plan that will: a) effectively, confidentially, and securely exchange patient information within and across the partners' diverse healthcare settings--acute care, outpatient, clinic, home health, hospice, and long-term care; b) increase evidence-based care practices; and c) lead to significant, measurable, and sustainable improvements in patient safety and quality of care, as well as increased organizational and financial efficiencies.
Principal Investigator: B. J. Ensign, F.N.P.
Institution: University of Washington
Grant No.: K08 HS11414 (Clinical Investigator Award)
Title: Measuring Quality of Care for Homeless Adolescents
Summary: Homeless youth are widely acknowledged as being a particularly medically vulnerable population in the US. Homeless youth are at high risk for negative outcomes from various environmental stressors, individual coping mechanisms, and poor access to appropriate primary health care. The multidimensional health problems of homeless youth are known. Factors related to monitoring and improving quality of primary health care for this population are not well documented. This project proposes to conduct research to document the factors necessary for monitoring access and quality of primary health care for homeless youth. The present study of monitoring the quality of health care for homeless youth will be a mixed-method study. It begins with a qualitative component, consisting of narrative interviews with street-based and service-based homeless youth to document their understandings of illness, health care, and experiences with seeking health care. It then includes focus groups with homeless youth to record their perspectives about appropriate process and outcome measures of quality of health care. This is complemented by national expert consensus on appropriate process and outcome measures of quality health care using a modified Delphi technique. Finally, the research will include a pilot testing study of existing youth health-related quality of life instruments that are deemed appropriate to this population based on results of the previous research components. The resulting data will assist in local and national health care monitoring and planning for this vulnerable population.
Principal Investigator: Carroll Estes, Ph.D., R.N.
Institution: University of California
Grant No: R01 HS06860 (Research Project)
Title: Unlicenced Homecare Structure and Performance
Summary: Home care is one of the fastest growing and potentially most important sectors of the health care industry in the present era of rising costs and cost containment. In addition to Medicare certified providers (CPs) of home care, there is a larger sector of uncertified providers (UPs) about which little is known. Project aims were to address four sets of questions: (1) What are the organizational characteristics (structure) of UPs in three sites and how do UPs 'perform' in terms of access, and quality financing; (2) How do UP and CP structure and performance differ; (3) What are the interrelationships among access, quality and financing; (4) What are issues, incentives and barriers concerning licensure and certification. The project identified the universe of uncertified home care providers in 3 SMSAs: San Francisco/Oakland, CA, Philadelphia, PA, and Houston, TX. Telephone interviews were conducted with 291 UPs and 105 key informants (who are policymakers and health industry leaders). Study findings indicate that most UPs are licensed and tax status predicts differences in their performance (e.g., access and quality).
Availability: NTIS Final Report Accession Number: PB95192159, PB95148367, PB5192142
Principal Investigator: Carroll Estes, Ph.D., R.N.
Institution: University of California
Grant No: R01 HS04042 (Research Project)
Title: Correlates of Long-term Care Expenditures and Service Utilization
Summary: This study examined the Medicaid and income eligibility policy choices made by state governments since 1978, and assessed the consequences of these policies on Medicaid service cost and utilization. Research questions examined included: (1) Have the policies adopted resulted in trade-offs of one subpopulation (e.g. high risk vs. low risk) against another, or one services area (e.g. hospitals vs. nursing homes) against another? (2) Have the policies adopted been effective in their primary purpose? And (3) Have they produced unanticipated cost shifts or other adverse effects?
Availability: NTIS Final Report Accession Number: PB86103991
Principal Investigator: Shirley Farrah, Ph.D., R.N.C.
Institution: University of Missouri-Columbia
Grant No.: R13 HS14116 (Small Conference Grant)
Title: Transferring Geriatric Research into Practice
Summary: Not available.
Principal Investigator: Emily Feinberg, R.N., M.Sc.
Institution: Harvard University
Grant No: R03 HS10207 (Dissertation)
Title: Children's Health Insurance Coverage in Massachusetts
Summary: Using data from the state's Children's Medical Security Plan (CMSP) administrative and claims files and information obtained from a telephone survey of CMSP participants, the research aims to: 1) determine the relationship between insurance status, unmet health need, and health service utilization among CMSP enrollees; 2) assess the impact of enrollment in CMSP on indicators of access to health care; and 3) determine the extent to which crowd out is occurring among CMSP enrollees.
Principal Investigator: Lucie L Ferguson, B.S.N., M.P.H.
Institution: University of Virginia Charlottesville
Grant No.: R03 HS10796 (Dissertation Grant)
Title: Racism, Racial Identity and Blood Pressure
Summary: Deaths from cardiovascular disease account for the greatest disparity in mortality between blacks and whites, and hypertension is a major risk factor for cardiovascular disease. This project focuses on hypertension in black adults aged 45-64 years. Several conceptual models have been developed to describe the relationship between race/racism/racial identity and health status. However, no studies have tested the relationship between these race variables and physical health. Therefore, the overall aim of this project is to determine whether racial identity and racism can predict hypertensive or normotensive status in a sample of black adults using a modified version of the conceptual framework developed by King and Williams. Specifically, the research questions are: (1) How are responses to racism and racial identity correlated?, and (2) Can we use responses to racism and racial identity to predict normotensive or hypertensive status in blacks, controlling for known risk factors and demographic variables?
Principal Investigator: Sandra Ferketich, Ph.D., R.N., F.A.A.N.
Institution: University of New Mexico
Grant No: R18 HS06801 (Research/Demonstartion)
Title: Multilevel Practice Model for Rural Hispanics
Summary: The primary purpose of this project was to test the effectiveness of the CMLNP model using a quasi -experimental research design that employs measures of process, outcome and impact. In order to achieve this purpose a three level, community-based nursing care delivery model, The Comprehensive Multi-level Nursing Practice Model (CMLNP), will be refined and implemented among Mexican Americans in four rural Arizona communities through La Programa de Enfermeria para la Salud (Nursing for Health Program) and La Programa de Enfermeria para la Salud is designed to improve the health of Mexican American, child bearing women and their families and Mexican American individuals, of both sexes, who are 65 years or older or approaching 65 years of age. The three model levels include (a) PERSONAL PREVENTIVE NURSING, which involves illness and wellness care provided to Mexican American individuals and families by a 3 member nursing team (including a family nurse practitioner, community heath nurse and traditional ethnic healer) through a neighborhood nursing center, (b) ORGANIZED INDIGENOUS CAREGIVING, which involves systematically organized "neighbors helping neighbors" through a modified block nursing program involving trained lay outreach workers, and (c) COMMUNITY EMPOWERMENT which involves a community intervention which is based on the locality development approach.
Principal Investigator: Judith Fifield, R.N., Ph.D.
Institution: University of Connecticut
Grant No.: U18 HS11068 (Research Project)
Title: Better Pediatric Outcomes Through Chronic Care
Summary: This 3-year, multi-site intervention study focuses on the translation of effective and affordable methods to bring a chronic care model to the primary care of poor, minority, inner-city children with asthma who are at great risk of the worst outcomes for the leading chronic disease of children. The specific aims are to: 1); Develop a method to deliver peer-driven, patient-linked Guideline prompts at the point of care using affordable information technology; 2)Evaluate the effect of a peer-driven, patient-linked Guideline prompt system on the process and outcomes (symptom control, health-related-quality-of life, emergency department and hospitalizations for asthma) of pediatric asthma care; and 3) Evaluate the additional effect on patient outcomes of a family-focused, supportive educational intervention delivered by a community health worker.
Principle Investigator: Elizabeth Floersheim, J.D., R.N.
Institution: Rural Healthcare Quality Network
Grant No.: R01 HS15188 (Research Project)
Title: A Rural HIT Cooperative to Promote Clinical Improvement
Summary: The Rural Healthcare Quality Network (RHQN) of Washington State and American Institutes for Research (AIR) have joined forces to demonstrate the value of HIT in improving the quality of emergency and inpatient care in rural hospitals by facilitating the adoption of national clinical guidelines and their adaptation to rural settings. This project will conduct a quasi-experimental evaluation of a Rural Health Information Technology Cooperative (RHITC), based in network computing, designed to improve the practice patterns of physicians and nurses in two clinical areas that are particularly relevant to rural hospital practice: emergency department (ED) stabilization of acute myocardial infarction (AMI) patients and inpatient care of patients with community-acquired pneumonia (CAP). The project's broad goal is to demonstrate the value and foster the widespread deployment of HIT to promote rural clinical best practices and overcome barriers to the adoption of quality-improvement innovations in rural hospitals. The project's specific objectives are to: 1. Design and implement the RHITC intervention: (a) identify rural best clinical practices for AMI and CAP, based on national guidelines; and (b) develop appropriate HIT interventions to achieve standardized adoption of these best practices in each of the hospitals exposed to the intervention. 2. Network and hospital-level evaluation: Examine (a) how the characteristics of rural hospitals impede or facilitate the adoption of the HIT intervention; and (b) how the intervention influences hospital culture and performance. 3. Staff-level evaluation: Determine the impact of the HIT intervention on physician, mid-level practitioner, and nurse knowledge, attitudes, behavior, and practice culture in rural hospitals. 4. Patient-level evaluation: Examine the associations between the use of the HIT intervention by hospital staff and quality of hospital care and utilization of hospital services. 5. Disseminate the results: Disseminate the HIT intervention model for use by small rural hospitals nationwide.