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The following grant final reports are now available for purchase from the National Technical Information Service (NTIS). 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.
Changing Markets and Hospitals: Managed Care and Strategic Alliances with Physicians. Alison Evans Cuellar, M.B.A., University of California, Berkeley. AHRQ grant HS10760, project period 6/15/00-6/14/01.
A striking development in the organization of medical care has been the formation of strategic alliances between hospitals and physicians. By 1998, 60 percent of hospitals had formed such alliances, which vary from loosely networked open configurations to exclusive fully integrated models. Hospital-physician integration likely reflects providers' responses to rapidly expanding managed care. This researcher examined the roles of transaction cost economics and market power motives for these alliances and the consequences for hospital performance, using panel data from Arizona, Florida, and Wisconsin for 1994-1998. The study revealed substantial evidence that these alliances improve market power, particularly among those types where the physicians are exclusive to the hospital and among those in less competitive hospital markets.
Abstract and executive summary of dissertation, NTIS accession no. PB2002-100391; 8 pp, $12.00, $12.00 microfiche are available from NTIS.
Continence for Women: State of the Science. Karen J. Kelly Thomas, Ph.D., Association of Women's Health, Obstetric and Neonatal Nurses, Washington, DC. AHRQ grant HS10107, project period 6/1/00-5/31/01.
The conference, Continence for Women: State of the Science, was held in Seattle, WA, June 3, 2000 as a research dissemination conference for primary care clinicians aimed at translating research into clinical practice. Conference participants discussed the prevalence of urinary incontinence, behavioral therapies for decreasing incontinence, and educational strategies for nurses in clinical practice to teach women self-care techniques that promote continence.
Abstract, executive summary, and final conference report, NTIS accession no. PB2001-109048; 18 pp, $23.00 paper, $12.00 microfiche are available from NTIS.
Financial Burden of Health Care Costs for the Elderly. Stephen Crystal, Ph.D., Rutgers University, Piscataway, NJ. AHRQ grant HS09566, project period 9/30/97-9/29/98.
Even with Medicare, out-of-pocket health care costs are substantial for older people. For many, the impact is modest; but for a subgroup of Medicare enrollees, it is large related to income, and it constitutes a significant financial burden. These researchers used Medicare Current Beneficiary Survey data to examine the characteristics of Medicare enrollees most affected by out-of-pocket health costs. They found that health care expenditures averaged 19.0 percent of income for full-year Medicare beneficiaries alive during all of 1995. Functional impairment, number of medical conditions, self-perceived health, and privately-purchased supplemental coverage were associated with higher out-of-pocket costs. HMO participation was associated with lower costs. Out-of-pocket expenditures averaged 15.2 percent of total health care expenditures. Half of these out-of-pocket payments were for prescription drugs and dental services. The researchers concluded that the burden of out-of-pocket costs is heaviest for those with chronic health conditions and without employer-subsidized supplemental coverage or Medicaid, and that the impact of Medicare reform proposals on these subgroups needs to be carefully evaluated.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100266; 20 pp, $23.00 paper, $12.00 microfiche are available from NTIS.
HMO Research Network Conference. Michael R. Vonkorff, Sc.D., Group Health Cooperative, Seattle, WA. AHRQ grant HS10951, project period 3/1/01-2/28-02.
The seventh annual HMO Research Network Conference was held April 24-25, 2001, in Seattle, WA. The HMO Research Network comprises the major public domain research centers situated in large health maintenance organizations. This national meeting provides a forum to advance the individual and collective research efforts of these organizations and enhance their ability to respond to national goals to enhance the overall quality of health care delivery systems. Objectives of the 2001 HMO Research Network Conference were to identify challenges and opportunities inherent in the conduct of research in health care delivery systems; disseminate research findings and discuss methodologic issues from studies conducted in HMOs; stimulate multisite collaborative research; contribute to the national research agenda; and identify areas in which the Network is uniquely positioned to enhance the quality and effectiveness of health care delivery.
Abstract, executive summary, and final report, NTIS accession no. PB2001-109050; 14 pp, $23.00 paper, $12.00 microfiche are available from NTIS.
Immunization Barriers: A Study of Pediatric Nurse Practitioners. Richard K. Zimmerman, M.D., M.P.H., University of Pittsburgh. AHRQ grant HS09527, project period 6/1/97-5/31/99.
These researchers studied barriers to childhood immunization. They conducted a national survey in 1997 of 252 pediatric nurse practitioners (PNPs) using computer-assisted telephone interviewing. Almost half (44 percent) of the respondents were less likely to vaccinate a child during an acute care visit compared with a routine, well-child visit; 56 percent treated the situations equally, suggesting that this is one barrier. Some PNPs were overly cautious when interpreting contraindications. Half of the respondents (49 percent) said they would be likely to refer an uninsured child to a public health vaccine clinic but were unlikely to refer an insured child. Nearly 70 percent of the PNPs who do not receive free vaccine supplies said they would be likely to refer an uninsured, poor child compared with 46 percent of those who receive free vaccine supplies.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100268; 58 pp, $27.00 paper, $12.00 microfiche are available from NTIS.
INCLEN 2000: Workshop for Improving the Quality of Care. David Fraser, M.D., INCLEN, Inc., Philadelphia, PA. AHRQ grant HS10103, project period 8/1/00-7/31/00.
INCLEN is a worldwide network of over 1,000 physicians, biostatisticians, and health social scientists who believe that fighting disease and improving health care depend on integrating the principles of epidemiology into clinical practice. Since its inception, INCLEN has trained over 500 health practitioners at 69 medical schools in 30 countries, primarily in the developing world, to a master's degree level in clinical epidemiology.
INCLEN convened a plenary session and a series of workshops that were held October 15-18, 2001 in Bangkok, Thailand. A total of 386 participants from 39 countries attended. The workshops focused on four main areas:
- Discussion of new approaches in outcomes assessment, with a focus on integrating sociocultural differences and patient perspectives.
- Addressing methodological issues in measurement of quality of health care.
- Discussion of effective methods for disseminating clinical practice guidelines.
- Description of advances in formation technology for quality measurement and monitoring.
Abstract, executive summary, and final report of workshop, NTIS accession no. PB100393; 298 pp, $56.00 paper, $23.00 microfiche are available from NTIS.
More Disease: How Major a Factor in Higher Utilization? Michael Shwartz, Ph.D., Boston University. AHRQ grant HS09832, project period 19/39/98-3/31/01.
Differences in small-area hospitalization rates have often been attributed to differences in practice style. An alternative hypothesis is that higher than expected hospitalization rates are an indicator that there is more disease. The goal of this study was to examine the correlation between 1997 small area hospitalization rates and outpatient-only treatment rates for 20 medical conditions for patients 65 and older in Massachusetts and to examine the relative importance of "practice style" vs. "more identified disease" in explaining variations in hospitalization rates. The researchers used 1997 inpatient and outpatient data obtained from the Centers for Medicare and Medicaid Services to estimate more stable rates of hospitalization. They also developed an approach to assess the relative importance of "practice style" and "more identified disease" in explaining variations in hospitalization rates. Across a number of different analyses, almost all of the correlations of hospitalization rates and outpatient-only treatment rates were positive. The hypotheses of no correlation was always rejected. It was not possible to identify either practice style or more disease as the more important factor for explaining hospitalizations.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100269; 72 pp, $27.00 paper, $12.00 microfiche are available from NTIS.
National Quality Forum: First Annual Meeting. Kenneth W. Kizer, M.D., M.P.H., National Forum for Health Care, Washington, DC. AHRQ grant HS10114, project period 9/1/00-8/31/01.
The National Quality Forum (NQF) held its first annual meeting September 7-8, 2000. The goal was to foster a sense of common purpose and develop a shared framework for quality measurement and reporting and to begin a substantive discussion of topics being undertaken by the forum. Over 140 individuals from 92 organizations participated in a mix of plenary sessions and smaller group discussions. Participant feedback suggests that future such meetings should emphasize interactive group discussions on National Quality Forum consensus topics.
Abstract, executive summary, and conference report, NTIS accession no. PB2002-100032; 38 pp, $25.50 paper, $12.00 microfiche are available from NTIS.
Patient-Based Quality Assessment for Chronic Disease. Sheldon Greenfield, M.D., New England Medical Center, Boston, MA. AHRQ grant HS09756, project period 4/1/98-9/30/00.
The goal of this project was to examine the usefulness of patient reports on quality of care by
seeking answers to the following questions: Are patient reports accurate in relation to claims data? Do disease-specific outcomes provide better discrimination between health plans than generic measures such as the SF-36? Can a patient based measure of case mix—the Total Illness Burden Index, which is patient reported and independent of diagnosis—be used to adjust quality indicators, including satisfaction, functional status, and use of services? The researchers tested these questions in a national sample of 10,360 patients in six cities using a patient survey and a well developed claims database. There were 5,188 patients who had matched survey and claims records. They concluded that patient reports can be used as "case finding," indicating the need to seek more information only if the patient answers positively. This could reduce the amount of chart review necessary. They also concluded that disease-specific outcomes are more useful than generic measures in comparing health plans. Finally, the Total Illness Burden Index can be used to adjust quality measures.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100392; 58 pp, $27.00 paper, $12.00 microfiche are available from NTIS.
Physician/Patient Preferences in Hysterectomy. Jeffrey F. Peipert, M.D., M.P.H., Women and Infants Hospital, Providence, RI. AHRQ grant HS09846, project period 4/1/99-5/31/01.
Hysterectomy is now the second most common surgery performed in women, with over one-half million hysterectomies each year in the United States. Despite the staggering number performed, there are gaps in our knowledge base regarding patient needs and preferences, physicians' interpretation of clinical indications when recommending hysterectomy or alternative medical therapies, and most importantly, how these two factors converge to influence decisions about hysterectomy. In this study, physician and patient focus groups were held to explore the perceived factors influencing decisionmaking in hysterectomy. Identified themes from the focus groups include a two-tiered hysterectomy decisionmaking process, specific physician and patient characteristics that influence the shared decisionmaking process, and a need for additional outcomes data about differences in sexual functioning after hysterectomy and other differences as they relate to the three surgical routes of hysterectomy.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100267; 26 pp, $23.00 paper, $12.00 microfiche are available from NTIS.
Setting Criteria and Agendas for Quality Improvement Research. Theodore Speroff, Ph.D., Vanderbilt University Medical Center, Nashville, TN. AHRQ grant HS10086, project period 12/01/99-5/30/01.
This report describes a conference held in December 1999 as part of the International Scientific Symposium on Improving Quality and Value in Health Care. The primary goals of the conference were to develop a conceptual framework that distinguishes quality improvement research as a discipline in health care and define standards for methodologic rigor to be applied in quality improvement research.
Abstract, executive summary, and final report, NTIS accession no. PB2002-100033; 38 pp, $25.50 paper, $12.00 microfiche are available from the NTIS.
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