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Grant final reports now available from NTIS

The following grant final reports are now available for purchase from the National Technical Information Service. Each listing identifies the project's principal investigator (PI), his or her affiliation, grant number, and project period and provides a brief description of the project.

Records of all 750,000 documents archived at the National Technical Information Service (NTIS)—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. Items in the database from 1997 to the present can be downloaded. Documents from 1-20 pages are free; documents 21 pages and over are $8.95 per download.

Editor's Note: In addition to these final reports, you can access information about these projects from several other sources. Most of these researchers have published findings in the professional literature, and many have been summarized in Research Activities during the course of the project.

Select Search Research Activities to find information presented in back issues (1995-present) of Research Activities. To search for information, enter either the grant/contract number or principal investigator's name in the query line.

A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.

Achieving Optimal Outcomes in Primary Care. Emmanuel O. Quaye, M.D., Morehouse School of Medicine, Atlanta, GA. AHRQ grant HS10948, project period 6/1/01-5/31/02.

This project provided support for a conference for providers and policymakers on ways to translate evidence into practice to overcome barriers and improve primary care for target groups. Topics included: disparities related to ethnicity, sex, and geographic location in the incidence and mortality of stroke and other cardiovascular diseases; cardiovascular risk factors such as obesity, hypertension, and smoking; and disparities among providers in knowledge about those risk factors. Other risk factors and poor outcomes in vaccine preventable diseases, mental health disorders, cancer, diabetes, and obesity were addressed, as was the disproportionate rise in the incidence of HIV infection among minorities and women. Over 40 faculty and more than 400 participants from 13 States attended the conference, which resulted in the development of a working coalition committed to reducing disparities in health outcomes in the Southeast region of the United States.

Copies of the abstract and conference proceedings (NTIS accession no. PB2003-100053; 26 pp, $23.00 paper, $12.00 microfiche) are available from NTIS.

Cognitive Retraining in Survivors of Sudden Cardiac Arrest. Mary J. Sauve, D.N.S., R.N., University of California, Davis. AHRQ grant HS10701, project period 2/1/00-1/31/02.

The purpose of this pilot study was twofold: one, to determine whether two targeted cognitive rehabilitation interventions could improve memory functioning in survivors of sudden cardiac arrest; and two, to assess whether improvements in memory function as determined by standardized neuropsychological tests are accompanied by improvements in functional status as determined by self report, spouse assessments, and subject's performance on a novel task similar to those used during training. Four subjects, three men and one woman, with a mean age of 61 years underwent both the mnemonic and control learning conditions. Neuropsychological test results indicated that all but one subject increased their scores in attention and late recall achieving either normal or mildly depressed scores. However, only one subject was able to maintain these gains over the subsequent 2 to 4 months. In contrast, measures of functional status including performance on the novel task showed a sustained gain in function which was augmented by the general memory strategies used in the control condition. These preliminary results indicate that computerized training using a targeted mnemonic strategy focused on the clustering of related items is potentially useful for boosting recall memory in impaired patients.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100297; 30 pp, $23.00 paper, $12.00 microfiche) are available from NTIS.

Consumer Assessments of Health Plans Study. Lauren D. Harris-Kojetin, Ph.D., Research Triangle Institute, Research Triangle Park, NC. AHRQ grant HS09218, project period 9/30/95-4/30/02.

To help strengthen the scientific base underlying consumer surveys and reports within the health care industry, AHRQ awarded cooperative agreement grants to three consortia led by RTI, RAND, and Harvard, respectively, to pursue the Consumer Assessment of Health Plans Study (CAHPS®) major quality-based initiative to assist consumers in selecting health care plans. CAHPS® involved three main objectives: one, design surveys to measure the experiences of health plan members; two, design reports to provide feedback on survey results to consumers; and three, evaluate the implementation and impact of the CAHPS® products in real-word settings. Between September 1995 and April 2002, the consortia worked collaboratively to achieve these objectives among a variety of populations, including commercially insured adults and children, Medicaid recipients, people with chronic illnesses, people enrolled in different care delivery systems, non-English speaking enrollees, and Medicare beneficiaries. The CAHPS® final report describes the main activities and findings from over 15 projects conducted under CAHPS® to achieve these objectives.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100198; 96 pp, $29.50 paper, $12.00 microfiche) are available from National Technical Information Service.

Determinants of Patient Satisfaction with Medical Care Among Depressed Primary Care Patients. Karen Swanson, B.A., Sc.M., University of California, Los Angeles. AHRQ grant HS11407, project period 7/1/01-6/30/02.

Data for this research came from the Quality Improvement for Depression (QID) initiative, a large national four-study collaborative of 1,481 patients diagnosed with current major depression in managed care settings. The sample was 1,317 patients who answered both the baseline and 6-month questionnaires. Multivariate analysis found that both interpersonal care and technical care were positively associated with patient satisfaction. Sex was not a moderator of this relationship. Patients who were satisfied with their care at baseline were less likely to switch providers, and those who switched providers had a decrease in satisfaction at 6-month followup. There were no differences between men and women in the relationship between patient satisfaction and provider switching. Patient satisfaction was best predicted by interpersonal care.

Copies of the abstract, executive summary, and dissertation (NTIS accession no. PB2003-100063; 182 pp, $44.00 paper, $17.00 microfiche) are available from NTIS.

Diabetes and the Arts and Humanities: Planning Conference. Naj M. Wikoff, Society for the Arts in Healthcare, Washington, DC. AHRQ grant HS10953, project period 5/1/01-4/30/02.

This project provided support for a January 2002, conference to identify ways to use arts and humanities activities in the education and treatment of patients at high risk for developing or living with type 2 diabetes. Attendees included professionals in education and treatment of diabetes, cultural competency, the arts, arts programs in health care settings, research and evaluation techniques, hospital planning, government, foundations, and corporate entities, as well as patients and caregivers of people living with diabetes. Participants identified questions, arts projects, protocols, and evaluation procedures that could be of value in the education and treatment of patients with or at risk for type 2 diabetes.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100193; 41 pp, $25.50 paper, $12.00 microfiche) are available from NTIS.

Domestic Violence Assessment and Intervention. Jacqueline S. Dienemann, Ph.D., R.N., Georgetown University School of Nursing, Washington, DC. AHRQ grant HS10731, project period 9/30/99-3/30/02.

The Domestic Violence Survivor Assessment (DVSA) was tested in a sample of 119 survivors, including 91 survivor-clinician pair assessments, 5 survivor-only assessments, and 23 clinician-only assessments. The DVSA reliably identified patterns of preservation of the relationship, preservation of self, or preservation of resolution in 93 percent of cases assessed by clinicians and 66.5 percent of self-assessment cases. The self-assessment version needs revision to remove the phrase "after I left" from all responses. Significant correlations between clinician and self-assessment were found for 6 of the 11 issues with agreement ranging from 23 percent to 67 percent. The value of self-assessment, which allows survivors to view issues they face in abusive relationships, was stated by clinicians and survivors. Five survivor focus groups indicated preferences for clinicians to screen for domestic violence, offer services when intimate partner violence is suspected even if it is denied, support the victim's human dignity, allow survivors control over confidentiality, offer immediate protection in cooperation with police, document all injuries and threats while in the facility, and offer an open door for the victim to return when in need of future assistance. A clinical pathway for domestic violence was developed and validated for feasibility and scientific accuracy through a Delphi technique with 17 expert researchers and clinicians.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100052; 26 pp, $23.00 paper, $12.00 microfiche) are available from NTIS.

Fundamental Measurement for Health Services Research. William P. Fisher, Ph.D., LSU Health Sciences Center, New Orleans, LA. AHRQ grant HS10186, project period 7/1/99-12/31/00.

This study describes and demonstrates the mathematical properties of additive formulations of probabilistic conjoint measurement (PCM), which provide the necessary and sufficient conditions for fundamental measurement. PCM was applied to data from 23,767 individuals responding to AHRQ's Medical Expenditure Panel Survey to test its usefulness in measuring quality of care (QOC). The results indicate two general conclusions: PCM offers new insights into theories of QOC, and it is possible to construct fundamental measurement systems of QOC variables. Since QOC fundamental measurement systems are viable, it should be feasible to scale different QOC surveys in the same metric.

Copies of the Abstract, executive summary, and final report (NTIS accession no. PB2003-100196; 166 pp, $44.00 paper, $17.00 microfiche) are available from NTIS.

Implementation of Screening and Exams for Diabetic Retinopathy. Robert A. Goldstein, M.D., Ph.D., Juvenile Diabetes Research Foundation, New York, NY. AHRQ grant HS10929, project period 12/15/00-12/14/01.

Diabetes is the leading cause of legal blindness in the United States. Diabetic retinopathy is preventable if caught early and sight-saving treatment is given; nevertheless, many people with diabetes do not have regular eye exams. The Juvenile Diabetes Research Foundation (JDRF) convened a workshop to address this problem and discuss the barriers that prevent people with diabetes from having eye exams. Attendees heard problems and success stories of ways that health care providers and others have increased eye exams in their communities. Recommendations were made in three areas: the importance of public education, issues of access to care; and ways to improve quality of care.

Copies of the abstract and executive summary (NTIS accession no. PB2003-100059; 56 pp, $27.00 paper, $12.00 microfiche) are available from NTIS.

Maine AHRQ Rural Center. David Hartley, Ph.D., University of Southern Maine, Portland, ME. AHRQ grant HS07612, project period 9/30/94-9/29/01.

The goal of this rural managed care demonstration project was to work with several communities in northern New England to develop vertically integrated health care networks, foster risk-based contracting, provide provider and consumer education, assist in the development of appropriately scaled health information systems, and disseminate findings regionally and nationally. Over a 7-year period, these goals were accomplished to varying degrees in the two original sites and four sites that were added over the course of the project. An added positive outcome was the development of a health card in the original demonstration communities that is issued to all county residents, facilitating a standard basic health information database and the delivery of free or sliding-fee care. In the other original site, network development efforts eventually led to a collaborative telemedicine project that now serves the entire State.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100051; 83 pp, $29.50 paper, $12.00 microfiche) are available from NTIS.

Measuring Quality of Life in Economic Evaluations of Treatment for Severe Mental Illness. Anna M. Adachi-Mejia, Ph.D., Dartmouth College, Hanover, NH. AHRQ grant HS11405, project period 9/1/01-3/31/02.

Disease-specific and generic health-related quality-of-life instruments were compared using the Wisconsin Quality of Life Index (W-QLI), the SF-6D, and the EuroQol EQ-5D. Their ability to discriminate on symptom severity, the need for additional substance abuse treatment, and structured activity was compared. A convenience sample (49 individuals with severe mental illness and substance use disorder and 52 New Hampshire residents) was identified, and participants were interviewed. The W-QLI, the disease-specific instrument, was associated with the symptom-severity and need for additional substance abuse treatment criterion variables; the generic instruments, the SF-6D and EQ-5D, were not. For the rating scale values, only the friends/family category showed a statistically significant difference between groups. Based on a limited sample, this work questions a generic instrument's ability to adequately discriminate differences in outcomes pertinent to mental illness.

Copies of the abstract, executive summary, and dissertation (NTIS accession no. PB2003-100014; 208 pp, $47.00 paper, $23.00 microfiche) are available from NTIS.

Outcomes Measurement in Pediatric Burn Care: An Agenda for Research. Ronald G. Tompkins, M.D., Sc.D., American Burn Association, Chicago, IL. AHRQ grant HS10950, project period 3/1/01-2/28/02.

Medical and surgical advances over the last 25 years have dramatically decreased mortality in children with major burn injuries. Successful treatment, however, is enormously expensive, and the pediatric patient may require protracted surgical, medical, psychological, and rehabilitative interventions over many years. Relatively little is known about access to specialty care for this population, the cost and cost-effectiveness of treatment strategies, outcomes, or the impact of burn injury and medical treatment on children and their families. To address these concerns, a consensus conference was held in November 2001 to develop a national research agenda designed to define the scope and direction of pediatric burn research and outcomes measurement. Participants identified research priorities in three areas: financing and delivery of pediatric burn care, pediatric burn treatment and interventions, and psychosocial factors of the child and family. They also recommended the creation of an outcomes measurement tool for the young adult population and an outcomes tool to screen for psychosocial factors that might predict poor outcomes in the burned child.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100054; 18 pp, $23.00 paper, $12.00 microfiche) are available from NTIS.

Outcomes Research Center for Asians and Pacific Islanders. Takashi Makinodan, Ph.D., University of California, Los Angeles. AHRQ grant HS07370, project period 9/9/92-12/31/98.

The UCLA/VA/RAND MEDTEP Center for Asians and Pacific Islander (hereafter referred to as MEDTEP) completed four timely projects in the areas of physical activity, end-of-life care, self-report instruments, and birth outcomes for Asians and Pacific Islanders. MEDTEP provided an opportunity for one UCLA predoctoral fellow to receive training. Technical assistance was provided to four community-based organizations, as well as to the UCLA Asian American Studies Center. The most successful information dissemination endeavor was the community forums on quality of life through preventive medicine practice. The forums were held in five ethnic-specific communities. Finally, a nonprofit community-based organization was created, with support from Asian Pacific community leaders, for the purpose of continuing MEDTEP'S community-related activities after this project ended in 1998.

Copies of the abstract, executive summary, and final report (NTIS accession no. PB2003-100197; 54 pp, $27.00 paper, $12.00 microfiche) are available from NTIS.

Translation of the Health Brochure and Impact on the Target Reader. Holly E. Jacobson, Ph.D., University of Arizona, Tucson. AHRQ grant HS10562, project period 9/30/99-12/29/01.

This study involved the analysis of a group of health brochures in Spanish, contrasting the way this particular genre is formed and understood in the United States and Mexico. The group was made up of two subgroups: a collection of health brochures published in the United States (translated from English into Spanish), and a collection of brochures from Mexico (originally written in Spanish). These subgroups were analyzed and compared from many different angles, providing a comprehensive view of how the texts are structured and organized. Computer-based linguistic analysis revealed differences between the two text types that are attributed to the interpersonal relations and cultural and social contexts in which the two text types are embedded. Subsets of texts from both subgroups were field tested with Mexican-born, monolingual Spanish-speaking informants with the aim of assessing the impact of the two text types on readers. Responses provided a look at the brochures from the perspective of the reader and shed light on the role of the two text types in the Mexican community. The problems inherent in using translations to disseminate health information are discussed, and guidelines for the development of health brochures in Spanish are provided.

Copies of the abstract, executive summary, and dissertation (NTIS accession no. PB2003-1000060; 261 pp, $54.00 paper, $23.00 microfiche) are available from NTIS.

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