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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 (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.

Ambulatory Pediatric Association Child Health Services Research Conference. James Perrin, M.D., Ambulatory Pediatric Association, McLean, VA. AHRQ grant HS09815, project period 4/1/98-9/30/98.

This report describes a conference convened in 1998 by the Ambulatory Pediatric Association to provide a forum for introducing junior investigators to key issues in child health services research.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104035; 12 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Assessing Health Data Needs in a Changing Environment. William D. White, M.A., Ph.D., University of Illinois, Chicago. AHRQ grant HS09526, project period 6/1/97-5/31/99.

These researchers explored the validity of a tool widely used in business applications, value chain analysis, as a conceptual framework for considering improvements in health data system design. They found that important limitations exist in applying value chain concepts to health care, particularly in identifying appropriate sequences of activities for analysis. However, their research suggests that linking value chain analysis with decision theoretic analysis could have implications for improving the design of health care data systems.

Abstract and executive summary, NTIS accession no. PB2001-105018; 10 pp. ($12.00 paper, $12.00 microfiche) are available from NTIS.

Benefits of Carotid Endarterectomy in Patients with Contralateral Occlusion. Rhonda Pindzola, M.S., Ph.D., University of Pittsburgh, Pittsburgh, PA. AHRQ grant HS09021, project period 9/1/96-8/31/00.

The objective of this study was to assess the usefulness of cerebrovascular blood flow measurements in making treatment decisions for patients with blockages of the carotid artery, a significant risk factor for stroke.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102654; 24 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Cardiac Arrhythmia Patient Outcomes Research Team (PORT). Mark Hlatky, M.D., Stanford University, Stanford, CA. AHRQ grant HS08362, project period 8/1/94-11/30/00.

The principal goal of the Cardiac Arrhythmia PORT was to identify the best strategies to prevent sudden cardiac death among patients with known heart disease. The researchers documented substantial increases over time in specialized testing and use of implantable cardiac defibrillators (ICDs) in arrhythmia patients. They found that the drug amiodarone and ICDs each improved survival. Patients from the community who were treated with an ICD had better quality of life, but costs were $20,000 higher over 2 years, compared with patients treated with amiodarone who did not receive an ICD. The ICD was generally cost effective compared with amiodarone therapy among patients who had experienced an episode of ventricular tachycardia or fibrillation and potentially cost effective in patients with severe heart damage. The researchers identified cost-effective management strategies for the most severely ill patients and established benchmarks for assessing the value of investigational tests and procedures for the larger population of at-risk patients.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104029; 42 pp. ($25.50 paper; $12.00 microfiche) are available from NTIS.

Changing Physician Behavior. Jan Temple, M.Ed., Ph.D., Medical University of South Carolina, Charleston. AHRQ grant HS10088, project period 1/24/00-1/23/01.

The purpose of this workshop was to foster a dialogue between peer review organizations and academic continuing medical education (CME) for the enhancement of physician practice patterns and to encourage collaboration and partnerships in delivery of effective physician education. The workshop focused on theory and models of change that best impact physician behavior. The program included factors that affect commitment to change, effective educational interventions, new directions in physician education, findings from a recent study on the role of CME in peer review organizations, and the value of partnership in enhancing quality health care.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105906; 28 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Computer-Based Documentation and Provider Interaction. Kevin Johnson, M.D., Johns Hopkins University School of Medicine, Baltimore, MD. AHRQ grant HS10363, project period 9/30/99-9/29/00.

These researchers investigated the impact of computer-based documentation (CBD) on parent and provider satisfaction with the pediatric health care encounter, the duration of the encounter, and parent-provider interaction during the encounter. The project involved children younger than 18 months being seen for well-baby care. Parents and providers in the intervention group used CBD, and those in the control group used paper-based documentation. Visits were 5 minutes longer, on average, with CBD. There were no differences between the two groups in overall satisfaction, but there was a strong correlation between provider satisfaction and the perceived helpfulness of CBD. Statements of partnership and an open-ended questioning style occurred more often in the CBD group. There were no other differences in communication style between the two groups.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105021. AHRQ grant HS10363, 18 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Differences in Quality of Care. Arnold Epstein, M.D., Harvard Medical School, Boston, MA. AHRQ grant HS07098, project period 9/30/94-9/29/99.

The researchers focused on the differences in use of cardiac procedures among women, minorities, and the poor. They reviewed medical charts for over 5,000 Medicare patients, aged 65-75, who underwent coronary angiography in five States (Alabama, California, Georgia, New Jersey, and Pennsylvania) during 1991-1992. They evaluated the appropriateness of coronary artery bypass graft (CABG) surgery and percutaneous transluminal angioplasty (PTCA) for patients who underwent cardiac catheterization. Rates of both CABG surgery and PTCA were higher among whites than blacks. Rates of CABG surgery also were significantly higher for men and for people from non-poor households. The researchers examined underuse by race, sex, and income but found significant differences only by race.

Abstract and executive summary, NTIS accession no. PB2001-104027; 16 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

ED Triage Instrument to Predict Resource Needs and Outcomes. Richard C. Wuerz, M.D., Brigham and Women's Hospital, Boston, MA. AHRQ grant HS10381, project period 9/30/99-9/29/00.

The Emergency Severity Index (ESI) triage algorithm facilitates quick triage of emergency department (ED) patients at presentation into five levels based on resources needed and urgency. The researchers developed a standard training program in ESI triage with a set of 20 cases. In seven EDs representing varied regions of the country, they trained nurses to use the ESI flow chart, tested them on the training cases, recorded their triage of ED patients in parallel with a research nurse, and demonstrated excellent agreement. The researchers used ESI distributions to describe case mix at these different EDs and validated the ESI against inpatient admissions, ED length of stay and resource intensity, and 60-day all-cause mortality.

Abstract and executive summary, NTIS accession no. PB2001-105903; 20 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Evaluation of Safety Data Reporting in Randomized Trials. Joseph Lau, M.D., New England Medical Center, Boston, MA. AHRQ grant HS10345, project period 9/30/99-9/29/00.

This project focused on the reporting of safety information in published reports from randomized controlled trials across several medical disciplines. The researchers surveyed safety reporting in 192 randomized drug trials involving 130,074 patients in seven medical areas. The quality and quantity of safety reporting varied across medical areas, study design, and settings, but they were largely inadequate. The severity of clinical adverse events was adequately defined in only 39 percent of trial reports. Only 46 percent of the reports stated the frequency of specific reasons for discontinuation of study treatment due to toxicity. The amount of space allocated to safety results was 0.3 page, similar to the space devoted to contributor names and affiliations.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104028; 18 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Family Linkages Supporting Hyperbilirubinemia Guidelines. Charles Homer, M.D., M.P.H., Children's Hospital, Boston, MA. AHRQ grant HS09390, project period 9/30/96-9/29/00.

These researchers developed and implemented a computer-based decision support system to enhance management of infants who have jaundice and evaluated its impact on clinicians' knowledge of and adherence to practice guidelines. The system links disparate sources of medical information across multiple sites using the Internet. The research was carried out in three sites receiving the intervention and three matched sites not receiving it. Performance on several review criteria—obtaining a maternal history and assessing for a family history of hemolytic disease—improved at intervention sites. No meaningful differences in emergency department laboratory testing occurred. More infants in primary care intervention sites received at least one bilirubin test after the intervention. Knowledge about the evaluation and treatment of newborn jaundice increased significantly among all study participants between the pre- and postintervention period.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102809; 52 pp. ($27.00 paper, $12.00 microfiche) are available from NTIS.

Health Insurance of Older Americans. Jeanette Rogowski, Ph.D., RAND, Santa Monica, CA. AHRQ grant HS07048, project period 4/1/95-3/31/99.

The near elderly are a vulnerable population group with high expected medical expenses but few affordable sources of health insurance other than employers. Severing the employment relation, whether voluntarily or involuntarily, places older workers at risk of being uninsured or of paying high prices for their health insurance. Public polices aimed at increasing access to affordable insurance for the near elderly can decrease the rate of being uninsured among early retirees, but this may encourage retirement from the workforce. The size of the retirement effect is influenced by the cost of the health insurance and differs between partial and full retirement. Women and men also have different labor force responses to postretirement health insurance. These differences must be taken into account in order to accurately forecast the effects of public policies that increase access to affordable insurance for the near elderly.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105020; 24 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Impact of Dispatching Nontraditional EMS Resources. Terri A. Schmidt, M.D., Oregon Health Sciences University, Portland, OR. AHRQ grant HS09836, project period 9/30/98-9/29/00.

The goal of this project was to develop criteria to help dispatchers distinguish callers who need an emergency response from those who can be appropriately served by alternative resources. The researchers compared the disposition of 911 calls with chief complaints of a fall, bleeding, back pain, trauma, or "sick" that were assigned the lowest severity level with EMS and hospital charts. They reviewed 532 cases; 56 involved back pain, 158 involved a fall, 48 were for a laceration, 197 involved "sick" patients, and 73 were for trauma. More than half of the calls involved females (319), and the average age of callers was 52. About 25 percent of callers had an EMS critical event, and 29 had an ED critical event (CE). Callers older than 50 were more likely to have a CE. There was no association between the answers to specific questions and the likelihood of a CE, and no group of callers had a high likelihood of not needing an EMS response.

Abstract, executive summary, and final report, NTIS accession no. PB2001-103511; 26 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Investigation of Patient Outcomes Related to Interdisciplinary Discharge Planning Collaboration. William Corser, Ph.D., University of Wisconsin, Madison. AHRQ grant HS10792, project period 6/15/00-6/14/01.

The researchers examined the relationship between professionals' ratings of their inpatient discharge planning collaboration (IDPC) and patient characteristics with the rates of postdischarge outcomes experienced by a sample of elderly veterans. There were significant relationships between levels of IDPC and the rates of emergency room visits and falls experienced by veterans. Variables such as age, length-of-stay, comorbidity burden, admission diagnosis, unit of discharge, and level of social functioning had a significant influence on the rates of certain outcomes. This study provided the first indication of how interdisciplinary health care collaboration may influence the postdischarge outcomes experienced by elderly patients in contemporary practice settings.

Abstract and executive summary of dissertation, NTIS accession no. PB2001-102807; 18 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Linking Health Services Research with Health Policy. Mary Wakefield, Ph.D., George Mason University, Fairfax, VA. AHRQ grant HS10087, project period 1/1/00-12/31/00.

In June 2000, a small conference of rural health services researchers, health policymakers, and journalists was convened to consider how to make better use of ongoing rural research findings in the formulation of public policy. The conference and a subsequent report focused specifically on what the rural research community of scholars and institutions could do to make its growing body of knowledge about rural health services more useful to public policymakers.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104793; 42 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

Making Coverage Decisions About Emerging Technologies. Nancy V. Chockley, M.B.A., National Institute for Health Care Management, Washington, DC. AHRQ grant HS09849, project period 2/1/99-1/31/00.

This report describes a 1-day conference held in 1999 on ways to make research more accessible and useful to private plans and public programs in making coverage determinations about emerging procedures and technologies.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104789; 26 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Medical Care Use and Costs for Adults with Sleep Apnea. Dennis G. Fryback, Ph.D., University of Wisconsin, Madison. AHRQ grant HS08281, project period 7/1/94-12/31/96.

Sleep-disordered breathing is a problem with high prevalence as shown by the Wisconsin Sleep Cohort Study (WSCS) of working adults, affecting 9 percent of women and 24 percent of men. It is one suspected cause of hypertension, and it is associated with increased trauma in auto accidents, psychological disorders, and other conditions. The researchers examined whether undiagnosed sleep-disordered breathing is associated with lower health status and increased use and costs of outpatient medical care services and prescription medicines. Administrative medical records over 3 years were obtained from four HMOs for 686 members of the population-based WSCS. Individuals with the undiagnosed condition showed a dose-response decrement in six of eight SF-36 health status scales, with scores equivalent to or worse than those associated with many chronic conditions. Controlling for age and body mass index, both men and women with undiagnosed sleep-disordered breathing had statistically significant higher annual prescription drug costs, and men with the condition used more outpatient services than men who did not have the condition, while women used more services overall.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102563; 42 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

National Congress on Childhood Emergencies, 2000. Jane Ball, Dr.P.H., Children's Research Institute, Washington, DC. AHRQ grant HS10084, project period 1/1/00-12/31/00.

This is the final report of a national conference on childhood emergencies with emphasis on quality improvement and research.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102808; 28 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Online Commentary Use and Antimicrobial Prescribing. Rita Mangione-Smith, M.D., University of California, Los Angeles. AHRQ grant HS10187, project period 7/1/99-9/30/00.

Online commentary is talk that describes what a physician is seeing, feeling, or hearing during the physical examination of a patient. Earlier research has suggested that this technique might help physicians reduce inappropriate antibiotic prescribing. The researchers examined the relationship between online commentary use and physicians' prescribing decisions. The study involved 10 physicians and 306 parents who were attending sick visits for their children between October 1996 and March 1997. Physicians who used "no problem" online commentary (e.g., "her ears look perfect") prescribed antibiotics less often than physicians who used "problematic" online commentary. In viral cases, when physicians thought parents expected antibiotics, "no problem" online commentary was used exclusively in 79 percent of cases where physicians resisted the pressure to prescribe antibiotics versus 29 percent of cases where physicians acquiesced to parental pressure to prescribe.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102806; 32 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

Ownership, Status, Market Concentration, and Hospital Pricing. Gary J. Young, J.D., Ph.D., Boston University, Boston, MA. AHRQ grant HS09568, project period 9/30/97-9/29/99.

The traditional control of nonprofit hospitals by the communities they serve has been offered as a justification for restraining antitrust enforcement of mergers involving nonprofit hospitals. In this project, the researchers used a panel data set to examine empirically the relationship between market concentration and price growth for three types of nonprofit hospitals: independent (or stand alone) facility, member of a local hospital system, and member of a nonlocal hospital system. All three types of nonprofit hospitals exercised market power in the form of higher prices, and hospitals that were members of non-local systems were more aggressive than independent hospitals or members of local hospital systems in exercising market power.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104616; 22 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Pharmacy-Based Patient Monitoring in an IPA HMO. L. Douglas Ried, PH.D., University of Florida, Gainesville. AHRQ grant HS08221, project period 4/1/95-10/31/97.

The researchers pilot-tested a pharmacy-based, patient monitoring protocol designed to modify the relationship between providing pharmaceutical care and medication use outcomes among patients of community-based pharmacy practitioners. Much of the improvement in outcomes predicted for those with moderate to severe asthma was realized. Anecdotal reports and trends indicate that the care of patients was successful, and patients were satisfied with their care.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104788, AHRQ grant HS08221; 52 pp. ($27.00 paper, $12.00 microfiche) are available from NTIS.

Program of Rural Health Demonstration Activities. Keith J. Mueller, Ph.D., University of Nebraska Medical Center, Omaha. AHRQ grant HS08610, project period 9/30/94-9/30/00.

The purpose of this project was to facilitate implementation of managed care health plans in rural areas by having university-based research and technical experts work with local communities. Over the 5-year project, the external environment, including Medicaid and Medicare policies, changed from pressure to adopt managed care plans to departure of managed care plans from service areas. The project emphasis shifted to one of helping local health care providers be more influential regarding the terms of contracts they signed and in improving the health of residents of their communities. Through direct participation in local rural provider networks, assistance in planning and market analysis, and educational activities, the project team helped local providers gain greater control of health care financing.

Abstract and executive summary, NTIS accession no. PB2001-105022; 28 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Research Agenda Conference on Pediatric Quality of Care. Alice Hersh, M.S., Association for Health Services Research, Washington, DC. AHRQ grant HS09323, project period 8/1/96-7/31/97.

The national invitational conference, "Improving Quality of Health Care for Children: An Agenda for Research," was called to identify the key research issues and questions that should be included in a research agenda on quality improvement in children's health services.

Abstract and executive summary, NTIS accession no. PB2001-105023; 36 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

Scoring Methods and Measurement Properties of Health Status Measures. Kitty S. Chan, Johns Hopkins University, Baltimore, MD. AHRQ grant HS10166, project period 7/1/99-12/31/00.

Summative scoring is a popular method of scoring multi-item scales, but item response theory (IRT) has been suggested as a more attractive scoring alternative. Using data from studies of asthma, end-stage renal disease, and previously injured subjects, as well as a random sample of the general U.S. population, the effect of IRT and summative scoring on the measurement precision and responsiveness of the 10-item SF-36 physical functioning scale were compared. Results suggest that IRT can provide improvements in score precision and instrument responsiveness, but these benefits may not apply to other health status instruments and experimental conditions.

Abstract and executive summary of dissertation, NTIS accession no. PB2001-102805; 16 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Staffing, Case Mix, and Quality in Nursing Homes. Christine Kovner, Ph.D., New York University, New York, NY. AHRQ grant HS09814, project period 4/1/98-9/30/99.

The goal of this invitational conference was to define issues and problems in the delivery of care in nursing homes. Attendees identified research priorities and developed a research agenda focused on care delivery, nurse staffing levels, and quality of care in nursing homes.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105019; 16 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Thrombolytic Predictive Instrument Clinical Trial. Harry Selker, M.D., M.P.H., New England Medical Center, Boston, MA. AHRQ grant HS08212, project period 6/1/94-5/31/98.

A 22-month randomized controlled clinical effectiveness trial was conducted to test whether the electrocardiography-based Thrombolytic Predictive Instrument (TPI), with its patient-specific predictions of treatment outcomes printed on the electrocardiogram (ECG) test header, facilitates thrombolytic and overall reperfusion therapy for acute myocardial infarction (AMI). In the emergency departments (EDs) of 28 urban, suburban, and rural U.S. hospitals, 1,197 patients with AMI with ECG ST elevation were randomized to control or TPI groups, and nonrandomized patients with AMI were included in a registry. Among 732 patients presenting with inferior AMIs, the TPI caused relative increases of about 10 percent in the use of thrombolytic therapy (TT), its use within 1 hour, and overall reperfusion by either TT or primary percutaneous transluminal coronary angioplasty (PTCA). For all AMIs, the TPI reversed the baseline lower treatment rates among women, with relative increases of 21 percent. When there was telephone consultation with an off-site physician, there were relative increases of 32 to 35 percent. Use of the TPI in the ED should increase the use and timeliness of TT and overall reperfusion therapy, especially for groups potentially more likely to be missed and in settings where physician input is by remote consultation.

Abstract, executive summary, and final report, NTIS accession no. PB2001-104790; 50 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

Strategies for Care of the Very Low Birthweight Infant. Nigel S. Paneth, M.D., Michigan State University, East Lansing. AHRQ grant HS08385, project period 9/30/96-9/29/00.

The late consequences of intensive care of very low birthweight infants (VLBW), less than 1,500 g at birth, are not well established. The researchers examined five large population-based cohorts of VLBW infants (United States, Canada, Holland, Germany, and Jamaica) assessed at school age to establish the nature and frequency of neurodevelopmental disabilities, quality of life, and the relation of these to variations in intensiveness of neonatal care. All cohorts showed high rates of disabling cerebral palsy (DCP), mental retardation, school problems, and behavioral difficulties. Among infants weighing less than 1,000 g at birth, a remarkably similar pattern of behavioral disorder—including hyperactivity/attention deficit, thought disorders, and social problems—was found internationally. Mechanical ventilation, when associated with hypocapnia, was associated with elevated risk of DCP in the United States. Management of infants born at 23-26 weeks gestational age differed sharply across cohorts, with near universal mechanical ventilation in the United States but selective ventilation in Holland; mortality was lower in the United States, but DCP rates were much higher. Perceived quality of life in VLBW survivors was found to depend upon the reporter (physician, patient, teen survivor) in Canada and on method of ascertainment in Holland. Management of the VLBW infant continues to raise ethical dilemmas that cannot be resolved by physicians alone.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105904; 26 pp. ($23.00 paper, $12.00 microfiche) are available from NTIS.

Study of Functional Outcome After Major Trauma. Troy L. Holbrook, Ph.D., University of California, San Diego. AHRQ grant HS07611, project period 8/1/93-7/31/99.

The Trauma Recovery Project (TRP) is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma in adults aged 18 and older, including quality of life, functional outcome, and psychologic sequelae, e.g., depression and posttraumatic stress disorder (PTSD). Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The researchers enrolled 1,048 eligible trauma patients triaged to four trauma center hospitals in the San Diego Trauma System. Functional outcome after trauma was measured using the Quality of Well-Being (QWB) scale, a sensitive index to the well end of the functioning continuum (range 0=death to 1,000=optimum functioning). Followup contact at any of the study time points was achieved for 926 (88 percent) subjects. At 12 months followup, there were very high levels of functional limitation, with no improvement at 18 months. This study demonstrated a prolonged and profound level of functional limitation after major trauma at 12- and 18-month followup.

Abstract, executive summary, and final report, NTIS accession no. PB2001-105549; 24 pp. ($25.50 paper, $12.00 microfiche) are available from NTIS.

Validating Guidelines for the Treatment of Patients with Acute Myocardial Infarction. Barbara J. McNeil, M.D., Ph.D., Harvard Medical School, Boston, MA. AHRQ grant HS08071, project period 9/1/94-8/31/00.

The researchers used data from the Cooperative Cardiovascular Project to study experiences of patients in the hospital and on discharge after an acute myocardial infarction (AMI). Patients were hospitalized in one of seven States (California, Florida, Massachusetts, New York, Ohio, Pennsylvania, or Texas) between January 1, 1994 and July 31, 1995. These data were supplemented by information from the Veterans Administration, risk plans caring for Medicare enrollees, surveys from the American Hospital Association, surveys of hospital managers and physicians, and surveys of a sample of patients from this cohort. The researchers found marked underuse of necessary angiography for patients who had suffered an AMI.

This occurred in virtually all comparison groups examined, though it was highest (largest percentage of underuse) in patients in managed care settings and those with comorbid conditions, particularly chronic renal insufficiency. Treatment in a rural hospital or one that lacked angiography capability also predicted underuse.

Abstract, executive summary, and final report, NTIS accession no. PB2001-102666; 54 pp. ($27.00 paper, $12.00 microfiche) are available from NTIS.

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