Fiscal Year 1996
Research on Child and Adolescent Health: New Starts
New initiatives from the Agency for Healthcare Research and Quality (AHRQ) in child and adolescent health care are summarized, focusing on improving the quality, safety, efficiency, and effectiveness of health care. Goals are described for each study.
Home care of very low birth weight infants with chronic lung disease. A randomized controlled trial is assessing and comparing the outcomes and costs of two interventions to facilitate the home care of oxygen-dependent infants with chronic lung disease. These two potential alternatives to prolonged hospitalization involve multidisciplinary center-based follow-up care versus community-based follow-up care by a nurse. Thomas O'Shea, Principal Investigator (Grant No. HS-07928) (7/1/96-6/30/01).
Strategies for care of very low birth weight infants. This study will evaluate outcomes in school-age children who were very low birth weight infants, using three population-based data sets from the Netherlands, Canada, and the United States. Recommendations will be made for the development of ethical, cost-effective, and appropriate strategies for clinical management and resource allocation. Nigel S. Paneth, Principal Investigator (Grant No. HS-08385) (9/30/96-9/29/99).
Family linkages supporting hyperbilirubin (neonatal jaundice) guidelines. This effort will develop and implement a computer-based decision-support system to help different types of providers identify and treat infants at risk for developing hyperbilirubinemia by providing better access to patient records and guidelines. More than half of all infants born in hospitals develop jaundice within 48 hours of discharge. Charles J. Homer, Principal Investigator (Grant No. HS-09390) (9/30/96-9/29/99).
Impact of prenatal Medicaid program on newborns' health. This effort will examine how the Medicaid program affects newborns' health. Specifically, it will isolate the impact of individual Medicaid program components on birth outcomes. Christopher Trenhom, Principal Investigator (Grant No. HS-09332) (9/1/96-8/31/97).
The postpartum mandate: Estimated costs and benefits. This study will evaluate the costs and health consequences of mandates requiring insurers to pay for a minimum 48-hour hospital stay for mothers and newborns after a vaginal delivery or 96-hour stay following a Cesarean section. Three related policy questions will be addressed: (1) How would the mandate affect health? (2) How much would the mandate cost? (3) Is the mandate cost-effective? Jesse Malkin, Principal Investigator (Grant No. HS-09342) (9/1/96-8/31/97).
Health Care Services Access, Use, and Costs
Patterns of referral and care for children on Medicaid. This study 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 conditions. James Perrin, Principal Investigator (Grant No. HS-09416) (9/30/96-9/29/98).
Effective organization of adolescent health services. This study will analyze how the organization of adolescent health services affects teenagers' access to care. Jonathan B. Klein, Principal Investigator (Grant No. HS-08192) (9/30/96-9/29/98).
Primary care performance for low-income children in HMOs. This effort will assess the performance of different types of managed care organizations in the organization and delivery of primary care services to children. It will take into account plan features that affect provider and consumer behavior; examine possible variations in the attainment of primary care among enrollees with different racial, ethnic, economic, and family characteristics; and contribute to the development of better tools to measure primary care from the consumer perspective. Margarita Patricia Hurtado, Principal Investigator (Grant No. HS-09339)(9/1/96-8/31/97).
Research agenda conference on pediatric quality of care. The purpose of the conference is to develop and disseminate a national research agenda on quality of care measures for children, and to prioritize issues that demand immediate and long-term attention from the research community and from policymakers. Alice Hersh, Principal Investigator (Grant No. HS-09323) (8/1/96-7/31/97).
Measures of Health Status
Design and produce sensitive instruments for valid assessment of child health status. This project will produce child health status instruments that reliably measure the health and illness profile of children ages 5 to 11. After development of the parent version and a pictorial version to obtain children's perspectives of their own health, the instrument sets will be tested systematically in geographically distinct populations with different racial and ethnic backgrounds. Barbara Starfield, Principal Investigator (Grant No. HS-08829) (8/1/96-7/31/00).
Assessing cost-effectiveness of practice guidelines to reduce asthma morbidity among children. This large, 5-year randomized clinical trial will test the cost-effectiveness of recently developed practice guideline designed to reduce asthma morbidity among children. In addition, researchers will test new educational and organizational approaches to deliver pediatric asthma care in managed care settings. The National Heart, Lung, and Blood Institute, which developed the guideline, is contributing to this study. Kevin B. Weiss, Principal Investigator (Grant No. HS-08368) (9/30/96-9/30/01).
Measuring quality of life in children with asthma. This study will examine the relationship between a general multidimensional approach and a disease-specific approach to measuring quality of life in children with asthma. The two different methods will be assessed by administering the Pediatric Quality-of-Life Questionnaire to 600 asthmatic children and their parents participating in an asthma management program. Robert D. Annett, Principal Investigator (Grant No. HS-09123)(6/1/96-5/31/98).
Medicaid managed care for asthma: Does plan type matter? This study explores potential differences in the patterns of clinical care provided to Massachusetts Medicaid asthma patients enrolled in two different delivery systems—one a modified fee-for-service plan which uses a physician gatekeeper model and is managed by the State Medicaid program, and another which is a staff model HMO with the largest Medicaid enrollment among participating HMOs in the State. Alexandra Shields, Principal Investigator (Grant No. HS-09327) (9/1/96-5/31/97).
Office systems to improve preventive care for children. This study will determine whether pediatric practices that use office systems for prevention have higher rates of immunizations and screening for anemia, tuberculosis, and lead, and if rates vary in relation to the number of system components used. Peter Margolis, Principal Investigator (Grant No. HS-08509) (9/30/96-9/29/00).
Evaluating computer decision support for preventive care. This study will expand and modify for everyday use in pediatric office practices an existing guideline-based computerized decision service for childhood preventive services. The study will evaluate the effects of the system on process of care and outcomes of patients. Stephen M. Downs, Principal Investigator (Grant No. HS-09507) (9/30/96-9/29/99).
Development of a child mental health and substance abuse agenda. AHRQ has begun to develop and carry out a health services research agenda for improving mental health and substances abuse services for children and youth provided in the general health sector.
The Efficacy of Prenatal Care for Women and Children's Health. This conference, scheduled for June 26-27, 1997, will examine prenatal care interventions and their effectiveness in enhancing both immediate and long-term health and development of women and children. Conference participants will summarize and synthesize the current research on prenatal care, develop recommendations for a research agenda that addresses gaps in the literature, and disseminate findings to health care providers, managers and policymakers. Marie McCormick, Principal Investigator (Grant No.HS-09528) (1/1/97-12/31/97).
Taking Action With Children and Families. This conference, held March 13-14, 1997, examined health services and outcomes research for children and adolescents, especially as applied to Medicaid settings. Research and demonstration projects and community-based model programs were discussed in three symposia: 1) service systems for at-risk infants and very young children; 2) community interventions to reduce asthma morbidity in elementary school children; and 3) health promotion interventions to reduce risk-taking behaviors among adolescents. Small working groups were also convened to summarize findings and recommend future initiatives in each of the three topical areas. Ardene Brown, Principal Investigator (Grant No. HS-09362) (2/1/97-1/31/98).
AHRQ's newest endeavor as a "science partner" with both public- and private-sector organizations is the Evidence-based Practice Center (EPC) program. AHRQ is funding 12 Evidence-based Practice Centers (EPCs). These centers will work closely with professional societies, health plans, and others to develop evidence reports and technology assessments. These reports will form the scientific foundation for use by AHRQ science partners in developing their own quality improvement tools. Applicants were asked to include evidence of their expertise in child health. AHRQ is already working on two pilot evidence reports that concern children. One report is on attention deficit hyperactivity disorder (ADHD), in coordination with the American Academy of Pediatrics, and the other is on valvular heart disease with the American College of Cardiology and the American Heart Association.
For additional information, including highlights of other current AHRQ research, contact:
Denise Dougherty, Ph.D.
Senior Advisor, Child Health
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: (301) 427-1868
Fax: (301) 427-1561