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AHCPR announces second conference on evidence-based practice
The Agency for Health Care Policy and Research will host "Translating Evidence into Practice
'98," July 27-29, 1998, at the Renaissance Washington Hotel, Washington, DC. This second
annual conference on evidence-based practice is being sponsored by AHCPR's Center for
Practice and Technology Assessment.
Conference participants will explore how health care research informs practitioner and consumer
decisionmaking and health policy development. Sessions will cover methodologies for
synthesizing knowledge into products, strategies to enhance evidence-based practice, and
implementation methods to achieve quality outcomes.
If you are interested in presenting at the annual conference, please send your one-page abstract to:
Margaret Coopey, Agency for Health Care Policy and Research, Center for Practice and
Technology Assessment, 540 Gaither Road, Suite 6000, Rockville, MD 20850.
For more information, please contact Ms. Coopey at (301) 427-1618, or by fax at (301)
427-1639. You can request registration information online by E-mailing your name and address to
firstname.lastname@example.org; please indicate AHCPR-98 as the subject. Registration materials will be
mailed as soon as they are available.
AHSR's 15th annual meeting scheduled for June 1998
The Association for Health Services Research (AHSR) will hold its 15th annual meeting at the
Washington Hilton and Towers, Washington, DC, June 21-23, 1998. This year's theme is
"Health Services Research: Implications for Policy, Delivery, and Practice."
The conference will feature over 100 plenary and concurrent sessions on access, quality, ethics
and privacy, health insurance, Medicare, Medicaid, children's health, market structure, health
professions, and international comparisons. The conference will be of particular interest to health
services researchers and users of health services research, including providers, policymakers, and
For a complete conference agenda and registration information, visit AHSR's Web site at
http://www.ahsr.org or call (202) 223-2477.
Agency seeks nominations for its National Advisory
The Agency for Health Care Policy and Research is seeking nominations to fill seven positions on
its National Advisory Council for Health Care Policy, Research, and Evaluation (NAC) which are
or will become vacant late this spring. The Council was established by law to advise the Secretary
of Health and Human Services and AHCPR's Administrator on the Agency's efforts to enhance
the quality, appropriateness, and effectiveness of health care services, as well as access to such
services. The council has 17 non-Federal members who are appointed by the HHS Secretary and
5 ex-officio representatives from Federal agencies that are not engaged in conducting or
supporting health care research. The Council meets in the Washington, DC, metropolitan area
approximately three times a year.
The Agency is seeking nominations for four individuals who have expertise in health services
research, two experienced medical practitioners, and one consumer representative. Council
members generally serve 3-year terms, and appointments are staggered to permit an orderly
rotation of members. Individuals selected by the Secretary to serve on the Council will be
expected to attend their first meeting in the fall of this year.
Organizations and individuals may nominate one or more qualified candidates for membership on
the Council. AHCPR is seeking broad representation on the Council. Thus, you are encouraged to
nominate appropriately qualified women, minority candidates, and physically handicapped
individuals. Nominations should include a copy of the candidate's resume or curriculum vitae and
indicate that the nominee is willing to serve as a member of the Council. Successful candidates
will be asked to provide detailed information concerning their financial interests, consultant
positions, and research grants and contracts to permit evaluation of possible sources of conflict of
Nominations must be received no later than April 30, 1998.
Select for more information about the Council.
AHCPR funds new studies
The following small project research grants and conference grants were funded recently by the
Agency for Health Care Policy and Research. Readers are reminded that the results of studies
usually are not available until after the project is completed or nearing completion.
Small Project Grants
Childhood injuries evaluated in the office setting
Project director: Emalee G. Flaherty, M.D.
Organization: Children's Memorial Hospital
Project number: AHCPR grant HS09811
Period: 3/1/98 to 2/28/99
Developing a demographic based resource allocation model
Project director: David M. Ward, Ph.D.
Organization: Medical University of South Carolina
Project number: AHCPR grant HS09809
Period: 2/1/98 to 1/31/99
Disclosing financial incentives: A pilot study
Ethics consultation in U.S. hospitals: A national survey
Project director: Tracy E. Miller, J.D.
Organization: Mount Sinai School of Medicine
New York, NY
Project number: AHCPR grant HS09810
Period: 2/1/98 to 1/31/99
Project director: Ellen E. Fox, M.D.
Organization: American Medical Association
Project number: AHCPR grant HS09808
Period: 4/1/98 to 3/31/99
Taxonomy of patient requests and physician responses
Project director: Richard L. Kravitz, M.D.
Organization: University of California, Davis
Project number: AHCPR grant HS09812
Period: 3/1/98 to 2/28/99
Addressing tobacco in managed care
Project director: Barbara Lardy, M.P.H.
Organization: American Association of Health Plans
Project number: AHCPR grant HS09807
Period: 2/1/98 to 7/31/98
Comparing outcomes across plans, networks, and providers
Project director: David R. Nerenz, Ph.D.
Organization: Henry Ford Sciences Center
Project number: AHCPR grant HS09805
Period: 1/1/98 to 12/31/98
Pharmacoeconomics: Identifying the issues
Project director: Marilyn Dix Smith, Ph.D.
Organization: Association for Pharmacoeconomics and
Project number: AHCPR grant HS09806
Period: 2/1/98 to 7/31/98
Attention AHCPR-funded researchers: Recently you received a letter from John Eisenberg, M.D.,
AHCPR's Administrator, about the importance of widely disseminating findings from projects
supported in whole or in part by an AHCPR grant or contract. Please be sure to contact your
project officer as soon as you are notified that an AHCPR-supported article has been accepted for
publication. We thank you for your help.
Final reports now available from NTIS
The following grant final reports are now available from the National Technical Information
Service (NTIS). Each listing identifies the project's principal investigator (PI), his or her
affiliation, the grant number, and project period and provides a description of the project. Select for ordering information.
Assessing Oral Health Outcomes: Measuring Health Status and Quality of Life. Gary D.
Slade, D.D.P.H., Ph.D., University of North Carolina, Chapel Hill. AHCPR grant HS09254,
project period 9/30/95 to 9/29/97.
This project supported a conference conceived to evaluate existing measures of quality of life
related to oral health and to recommend new directions for their use in oral health outcomes
research. The 2-day conference was held in Chapel Hill, NC, in June 1996, and included
background papers, poster-discussion sessions, small group discussions, and reactor papers. The
presenters analyzed 11 oral-health-related quality-of-life instruments and evaluated their potential
for use in health outcomes research. They concluded that more widespread use of these
instruments in long-term followup studies is needed, and that the instruments need further
development before they can be used in some special population subgroups.
Abstract and final
report are available from the National Technical Information
Service (accession no.
PB98-116668; 26 pp, $19.50 paper, $10.00 microfiche).
Measuring the Effectiveness of Clinical Management Systems. R. Heather Palmer, B.Ch.,
M.B., M.D., M.S., Harvard University, Boston, MA. AHCPR grant HS06469, project period
9/30/90 to 9/29/94.
The researchers developed and tested a patient survey to obtain factual reports of patients'
experiences in receiving specific sequences of health care from health plans in the prior year. From
these data, they created quarterly reports of clinical performance indicators describing care given
by a plan for five diagnostic sequences of care (blood test, x-ray, imaging test, biopsy, or surgical
referral), two therapeutic sequences (medications and advice concerning self-care), and preventive
care and for the plan's responses to patients' complaints about care. Surveys were mailed with
telephone followup in four ambulatory care sites in two large health plans; a 63 percent response
rate was achieved for 3,160 general medical patients who were oversampled for those with
chronic diseases and those with surgical referrals. Accuracy of patients' reports was verified using
data abstracted from medical records. Sensitivity of patient reports for detecting events in the
medical record ranged by item of care from 64 to 85 percent and specificity from 79 percent to 97
percent. Patient reports for timing of events were more sensitive and less specific. Patient reports
of receiving confusing information predicted dissatisfaction with care. These findings suggest that
patient reports are a promising source of indicators of clinical performance in health plans.
Abstract and executive summary are available from the National
Technical Information Service
(accession no. PB98-116726; 28 pp, $19.50 paper, $10.00 microfiche).
Northwest Health Policy Research Conference. Aaron Katz, M.D., University of
Seattle. AHCPR grant HS09531, project period 5/1/97 to 10/31/97.
In June 1997, 250 health care professionals, researchers, and policymakers gathered in Seattle for
the 1-day, inaugural Northwest Health Policy Research Conference. Keynote speakers
emphasized the need for better communication and more effective collaboration between the
health policy and research communities. The attendees also discussed and debated the role of the
news media in translating research findings into the public and policy arenas. Workshop sessions
provided an opportunity for policymakers to hear directly about research studies relevant to health
policy issues and for researchers to hear about the research concerns of the policy community.
The conference was a constructive step toward better understanding of the differing agendas,
language, and timing that form barriers to effective use of health services research findings in the
Abstract, executive summary, monograph, and appendix are available from
the National Technical Information Service (accession no.
PB98-116627; 30 pp, $19.50
paper, $10.00 microfiche).
Testing a Decision Aid for the Management of Injuries. John R. Clarke, M.D., Medical
College of Pennsylvania, Philadelphia. AHCPR grant HS06740, project period 4/1/91 to
A rule-based artificial intelligence expert system, called TraumaAID, was tested by having experts
compare the patient care protocols it generated for the initial definitive management of 97
consecutive patients with penetrating thoraco-abdominal injuries against their actual care in a
Level 1 trauma center. The comparisons were done retrospectively using case narratives not
identified as to origin. The management plans generated by the TraumaAID program were rated
more acceptable and preferred in the aggregate than the actual care given at the trauma center,
even when judged by providers who had given the care. The problems of integrating multiple
protocols for the management of multiple simultaneous patient problems has been solved
satisfactorily in a generalizable way that can be used for other decision aids. Validation by experts
was a poor gold standard and impractical. The project produced data that should allow testing of
objective, automated methods of evaluating the process of medical care.
summary, and final report are available from the National Technical
(accession no. PB98-116734; 52 pp, $21.50 paper, $10.00 microfiche).
Using Information Systems to Improve the Efficiency and Quality of Care. David W.
M.D., M.S.C., Brigham and Women's Hospital, Boston, MA. AHCPR grant HS08297, project
period 7/1/94 to 6/30/97.
This study focused on three related questions: (1) How effective are automated information
systems for improving the use of ancillary tests; (2) What are some effective methods and clinical
situations in which patient-specific information and probabilities can be given actively to providers
to improve quality; and (3) How can an automated information system help an organization
monitor quality of care? The findings showed that: (1) a display of charges did not affect the
number of clinical laboratory tests or radiologic examinations performed, although for clinical
laboratory tests there was a trend toward decreased utilization; (2) background work showed that
many clinical laboratory tests currently performed could be eliminated using reminders for
redundant tests or structured ordering with feedback (few radiographs are redundant); (3)
reminders for redundant tests were effective, although not all redundant tests are identified under
the current system; (4) development of structured ordering is feasible; (5) direct paging of
physicians with critical laboratory results is well accepted and substantially improves time to
notification about results; and (6) computerized systems can help perform routine quality
measurement tasks and ask physicians key questions during the provision of routine care.
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Asch, D.A., Jerdziewski, M.K., and Christakis, N.A. (1997). "Response
rates to mail
surveys published in medical journals." (NRSA training grant T32 HS00009). Journal of
Clinical Epidemiology 50(10), pp. 1129-1136.
Several mail survey techniques are associated with higher response rates than others to surveys
published in medical journals.
For instance, this study shows that the mean response rate among mail surveys published in
medical journals was about 60 percent. However, response rates varied according to subject
studied and techniques used. Written reminders provided with a copy of the survey and telephone
reminders were each associated with response rates about 13 percent higher than surveys that did
not use these techniques. Other techniques, such as anonymity and financial incentives, were not
associated with higher response rates, found the researchers.
They abstracted 178 manuscripts published in 1991, representing 321 distinct mail surveys, to
determine response rates and survey techniques.
Bradley, E.H., Blechner, B.B., Walker, L.C., and Wetle, T.T. (1997).
"Institutional efforts to
promote advance care planning in nursing homes: Challenges and opportunities." (NRSA
training grant T32 HS00052). Journal of Law, Medicine & Ethics 25, pp.
Nursing homes are complying with the requirements of the Patient Self Determination Act
(PSDA) of 1991 to provide written information to individuals at the time of admission concerning
their rights under State law to refuse or accept treatment and the right to complete an advance
directive. However, instituting the broader concepts of patient autonomy and enhanced advance
care planning remains problematic, conclude these researchers. They examined institutional efforts
to promote advance care planning in nursing homes since passage of the PSDA by retrospectively
reviewing the medical records of a sample of 600 residents admitted to large Connecticut nursing
homes in two metropolitan areas during the years 1990 (pre-PSDA) and 1994 (post-PSDA).
Analysis showed that nursing homes have developed and extensively use advance care planning
forms. But such forms would be most valuable in promoting patient autonomy if they stimulated
more comprehensive discussions of residents' wishes for future medical treatment,
Harpole, L.H., Khorasani, R., Fiskio, J., and others (1997, December).
evidence-based critiquing of orders for abdominal radiographs: Impact on utilization and
appropriateness." (AHCPR grant HS08927). Journal of the American Medical Informatics
Association 4(6), pp. 511-521.
Abdominal radiographs (KUBs) are performed frequently, yet they often provide little clinical
information. In this 1995 study, physicians using a computer order entry (POE) system were
provided with real-time comments about the appropriateness of KUBs, including circumstances in
which they would yield little clinical information. Results showed that physicians were reluctant to
cancel radiographs that were likely to be of low clinical yield when presented with evidence-based
messages in real time. Physicians were more amenable, however, to changing to the suggested
view(s) when presented with suggestions to change the ordered test to an alternate examination.
Thus, providers were willing to substitute but not forgo imaging once the decision to order a
KUB had been made. To substantially reduce the number of inappropriate radiographic exams,
stronger incentives or interventions may be required, conclude the researchers.
Hemingway, H., Nicholson, A., Roberts, R., and Marmot, M. (1997).
"The impact of
socioeconomic status on health functioning as assessed by the SF-36 questionnaire: The
Whitehall II study." (AHCPR grant HS06516). American Journal of Public Health 87(9),
The researchers correlated socioeconomic status (SES)—measured by six levels of
grades—and the eight scale scores of the Medical Outcomes Study short form 36 (SF-36)
Health Survey in the Whitehall II study of British civil servants. They administered a questionnaire
containing the SF-36 to 5,766 men and 2,589 women aged 39 though 63 years. In men, all scales
except vitality showed lower scores with lower employment grades. Among women, a similar
inverse relationship was observed between employment and scores on the physical functioning,
pain, social functioning, and general health perception scales. Scores on every scale were lower
among women and men without access to a car (another marker of SES), even after adjusting for
employment grade. After adjusting for age, men without disease in the lowest employment grades
(5 and 6) were 2.5 times as likely to be in the lowest quartile of physical functioning compared
with men in the highest grades (1 and 2). In men with disease, the corresponding odds ratio was
nearly 2. In addition, age-related decline in physical functioning was more marked among men in
the lowest employment grade. This study of comparatively young, white collar, and
high-functioning individuals did not reflect the extremes of SES; thus the effect of SES on
physical functioning in the general population may be larger.
Lau, J., Ioannidis, J.P., and Schmid, C.H. (1997, November).
"Quantitative synthesis in
systematic reviews." (AHCPR grants HS07782 and HS08532). Annals of Internal
Medicine 127(9), pp. 820-826.
The purpose of most meta-analyses essentially is to try to answer four basic questions. Are the
results of the different studies similar? To the extent that they are similar, what is the best overall
estimate? How precise and robust is this estimate? Finally, can dissimilarities be explained? This
article provides some guidance in understanding the key technical aspects of the quantitative
approach to these questions. The researchers focus on the quantitative synthesis of reports of
randomized, controlled, therapeutic trials. Reliable meta-analysis requires consistent, high-quality
reporting of the primary data from individual studies, note the researchers. They caution that
meta-analysis is not a "magic" solution to the problem of scientific evidence and cannot replace
Neggers, Y.H., Goldenberg, R.L., Tamura, T., and others (1997,
November). "Plasma and
erythrocyte zinc concentrations and their relationship to dietary zinc intake and zinc
supplementation during pregnancy in low-income African-American women." (AHCPR
Low Birthweight PORT contract 290-92-0055). Journal of the American Dietetic
Association 97(11), pp. 1269-1274.
Evidence suggests that zinc deficiency during pregnancy may contribute to fetal malformation and
other poor fetal outcomes. This study shows that 25 mg of supplemental zinc given to pregnant
women whose dietary intake of zinc is 13 mg per day significantly increases plasma zinc levels
beginning at 26 weeks compared with pregnant women who do not receive zinc supplements.
Previous studies found no increase in plasma zinc with a total (dietary plus supplemental) zinc
intake of 25 or 30 mg a day during pregnancy. It is possible that there is a threshold level of
dietary zinc intake beyond which the relationship between total zinc intake (through diet and
supplements) and plasma zinc level can be detected, suggests the Low Birthweight Patient
Outcomes Research Team. The researchers conducted a randomized, double-blind trial to
evaluate the effect of zinc supplementation (daily dose of 25 mg) or a placebo until delivery in 580
low-income black women receiving prenatal care in the clinics of the Jefferson County Health
Department in Alabama. Women were randomly assigned to the placebo (286) or
zinc-supplemented group (294) at 14 to 23 weeks of pregnancy, and all were provided with
prenatal multivitamin/mineral tablets without zinc.
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AHCPR Publication No. 98-0014
Current as of February 1998