Fiscal Year 1998
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.
Childhood Injuries Evaluated in the Office Setting. This study is examining instruments for assessing pediatric office management of injuries in children and recognition, reporting and management of suspected child abuse by pediatricians in the office setting. This effort is focusing on three goals: (1) determining the incidence of suspected child abuse injuries seen in an office setting, (2) determining management and scope of childhood injuries seen in an office setting, and (3) testing the feasibility of the research design and instruments for a nationwide study. Principal Investigator: Emalee Flaherty, Children's Memorial Hospital, Chicago, IL. (Grant No. R03 HS09811) (03/01/98-02/28/99)
Study of Functional Outcome After Trauma in Adolescents. This project is determining the degree of disability, quality of life, and psychological well-being after trauma in adolescents aged 12-17 years. This study is also examining risk factors for functional limitation after major trauma in adolescents. The Quality of Well-being Scale (Child Questionnaire), and the Functional Disability Score will be used in this study. Principal Investigator: Troy Holbrook, University of California-San Diego, La Jolla, CA. (Grant No. R01 HS09707) (09/30/98-09/29/03)
Effectiveness of the National Health, Lung and Blood Institute (NHLBI) Guidelines on Childhood Asthma Outcomes. This research is: (1) determining the ability of a busy, pediatric emergency room complying with NHLBI Guidelines for management of acute childhood asthma and factors associated with emergency rooms non-compliance, (2) determining the effect of complying with NHLBI Guidelines on the rate of asthma relapse, treatment, and the functional status of children admitted to the treatment sites, and (3) evaluating the role of an observation unit in management of acute childhood asthma. Principal Investigator: Philip Scribano, Connecticut Children's Medical Center, Hartford, CT. (Grant No. R03 HS09825) (09/30/98-09/29/00)
Youth Partners in Care: Quality Improvement in Depression. This study is a randomized control trial of an intervention for treatment of adolescent and young adult depression within managed primary care settings. Intervention effects will be assessed, compared to usual care, quality of care, satisfaction with care, clinical symptoms and daily functioning, service use and cost, and parental psychological distress. Depression in youth interferes with functioning during a critical developmental period and is associated with adverse outcomes, such as suicide, risk for drug and alcohol problems, and adult depression. Principal Investigator: Joan Asarnow, University of California-L.A., Los Angeles, CA. (Grant No. R01 HS09908) (08/01/98-07/31/03)
Quality of Care for Children with Special Needs in Managed Care. This research is assessing the effect of selected organizational features of nine different managed care organizations (MCOs) on the processes and outcomes of care for children with special health care needs (CSHCN). MCO organizational features included in the research are: (1) characteristics of the provider network, (2) use of prior authorization procedures for specialty referrals, (3) presence and type of disease management programs, and (4) ownership status of the managed care organization. Quality of care will be assessed for children with asthma, diabetes, and for CSHCN with varying conditions aggregated by their functional status. Principal Investigator: Elizabeth Shenkman, University of Florida, Gainesville, FL. (Grant No. U01 HS09949) (07/01/98-06/30/01)
Asthma Care Quality in Varying Managed Medicaid Plans. This study is identifying features of managed care organizations (MCO) that are associated with the quality of care for children with asthma insured by Medicaid. The MCO features to be studied include payment mechanisms, provider profiles and incentives, and disease management programs, as well as features of care measured at the individual patient level such as accessibility, continuity, and self-care practices. Quality measures will include change over time in asthma-related quality of life, hospitalization and emergency department visits, and anti-inflammatory medication use. Principal Investigator: Tracy Lieu, Kaiser Foundation Research Institute, Oakland, CA. (Grant No. U01 HS09935) (07/01/98-06/30/99); Harvard Pilgrim Health Care, Brookline, MA (07/01/99-03/31/01)
Improving Quality of Care for Newborns with Jaundice. Studies of hospital readmissions and emergency department use in the first several weeks of life have established that jaundice is the most common single diagnosis and the most common "preventable" cause of high cost health services use. This five-year project is testing the impact of a collaborative quality improvement intervention on adherence to the American Academy of Pediatrics Guidelines for Jaundice Management. Researchers are using the Consumer Assessment of Health Plans Survey to examine the effects of the quality survey management improvement initiative on parents' views of health care. Principal Investigator: R. Heather Palmer, Harvard School of Public Health, Boston, MA. (Grant No. R01 HS09782) (05/01/98-04/30/03)
Impact of Managed Care Organization (MCO) Policy on Quality of Pediatric Asthma Care. This study is: (1) determining the impact that transition from fee-for-service to managed care has on quality of treatment, quality of life, and health outcomes for indigent children with asthma; and (2) determining the impact that exposure to specific managed care organization policies have on processes and outcome indicators of care for pediatric asthma patients. The findings are expected to shed new light on how restrictive MCO policies affect quality and outcomes for children with asthma. Principal Investigator: Bruce Stuart, University of Maryland at Baltimore, Baltimore, MD. (Grant No. U01 HS09950) (09/30/98-09/29/01)
State Children's Health Insurance Program (SCHIP) Evaluation Strategy Workshop. Through a contract, AHCPR co-sponsored the May 1998 American Academy of Pediatrics Workshop, in collaboration with the Maternal and Child Health Bureau of the Health Resources and Services Administration, the National Institute of Child Health and Human Development, Pfizer Pediatric Health and the Friends of Children Corporate Fund. A SCHIP Evaluation Tool was developed with indicators to measure the impact of SCHIP on assessing three domains on quality of health care access, process, and outcomes. The tool will: (1) provide concrete indicators to assist legislators, members of Congress and other policy makers in understanding the goal of SCHIP; (2) be useful to the States in improving the quality of their SCHIP on a continuous basis; and (3) provide these data and information to legislators on the impact of SCHIP on the health status of previously uninsured children.
Cost, Use and Access
Does Primary Care Access Decrease Respiratory Emergency Department Visits? This study is examining the relationship between emergency department utilization for respiratory problems by parents enrolled in a Medicaid managed care organization and characteristics of their primary care providers, including children with asthma, otitis media, and other respiratory disorders. Principal Investigator: Robert A. Lowe, University of Pennsylvania, Philadelphia, PA.(Grant No. R01 HS09261) (06/01/98-05/31/00)
Low Birth Weight in New York City: The Role of Context and Segregation. This research is examining the impact of residential segregation on concentrated poverty, access to prenatal care, and individual perinatal risk factors among women who gave birth in New York City. The purpose is to understand the role residential segregation plays in the black/white low birth weight gap. A multi-level analysis will be used to determine individual, neighborhood, and borough effects on low birth weight under different levels of residential segregation in New York. Principal Investigator: Kim Jaffee, Syracuse University, Syracuse, NY. (Grant No. R03 HS10061) (09/01/98-08/31/99)
Health, Health Insurance and Welfare Dynamics. This study is investigating the relationship between transitions from welfare dependence and health insurance coverage. This effort will also help policy-makers simulate how changes in the private health insurance market will affect Medicaid caseloads. The results are intended to: (1) help improve projections of Medicaid expenditures and caseloads, and (2) help project work participation by those on public assistance. Principal Investigator: Krista M. Perreira, University of California-Berkeley, Berkeley, CA. (Grant No. R03 HS09884) (08/01/98-07/31/99)
Factors that Influence Children's Health Care Utilization. This study is testing an innovative model of nurse-managed primary care settings for low-income minority children. This effort will be the first of a series of studies examining the impact of nurse-managed clinics on health care utilization. The study's research questions include: (1) Are sociodemographic and financial factors (e.g., age, sex, race/ethnicity, family income, family structure) associated with children's health status? (2) Are specific family factors such as a parent's behavior, family environment, and/or a parent's depressive symptoms associated with children's (aged 1-5) health status? and (3) What is the effect of child health status on child health utilization? Principal Investigator: Sabrina T. Wong, University of California-S.F., San Francisco, CA. (Grant No. R03 HS10004) (09/30/98-09/29/99)
Building the Field of Child Health Services Research
Ambulatory Pediatric Association Child Health Services Research Conference. The project convened a one-day Child Health Services Research Conference to precede the Annual Meeting of the Pediatric Academic Societies in New Orleans ( May 1998). A key issue identified during this conference was a need to improve junior faculty development in health services research. The conference addressed general topics such as the overview of child health services research, quality, measures, data sources, research settings, and effectiveness and cost-effectiveness research regarding children. Principal Investigator: James Perrin, Ambulatory Pediatric Association, Mclean, VA. (Grant No. R13 HS09815) (04/01/98-09/30/98)
Child Health Services Research Training Program. This project is supporting and expanding an ongoing training program for pediatric health services research within the Children's Hospital in Boston. This program offers a diverse range of applied health services research opportunities across the continuum of care, including tertiary care centers, community hospitals, pediatric practices, neighborhood clinics, and HMOs. Areas of research have included: (1) quality improvement, (2) quality measurement, (3) community systems, and (4) evaluation of changes in the health care system. Principal Investigator: Donald Goldmann, Children's Hospital, Boston, MA. (Grant No. T32 HS00063) (09/30/94-06/30/03)
Community-based Health Services Research Curriculum. This Institutional Training Innovation Incentive Award Program is developing a curriculum on performing effectiveness research in community settings for the National Research Service Award (NRSA) Health Services Research Fellows at Children's Hospital, Boston. NRSA fellows will work in partnership with community health centers, payers, public health, schools, and other community settings. The organization's first step is to establish a process to include a needs assessment to identify key curricular elements. The goal is to develop a series of cases, as well as an Annual Community-Based Health Services Research Conference for faculty, fellows, and community partners. Principal Investigator: Charles J. Homer, Children's Hospital, Boston, MA. (Grant No. R25 HS09792) (07/01/98-06/30/01)
Faculty Development Awards
Faculty Development for General Pediatrics Faculty Teaching in Community-Based Settings. An Interagency Agreement between AHRQ and the Health Resources and Services Administration's Bureau of Health Professions supported the Ambulatory Pediatric Association's (APA) Primary Care Pediatrics Research Awards. The APA 1998 award recipients and funded projects were: (1) Andrew Aligne, M.D., Rochester General Hospital, "Passive Smoking and Children: An Analysis of NHANES III to Determine Outcomes Associated with Childhood Exposure to Environmental Tobacco Smoke," and (2) Shale Wong, M.D., Children's Hospital Denver, "Prescribing Patterns and Factors Influencing Choice of Antibiotic for Otitis Media."
For more information, 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