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AHCPR awards 10 large grants in areas of emphasis

The Agency for Health Care Policy and Research has awarded a total of $8.98 million over a 3-year period to fund 10 new research projects that reflect the key goals in the Agency's strategic plan: improving health outcomes, strengthening quality measurement and improvement, and identifying strategies to improve access, foster appropriate use, and reduce unnecessary health care expenditures. AHCPR expects to fund additional grants by the end of fiscal year 1999. Select to access AHCPR's Strategic Plan. The newly funded projects are:

Optimal Antithrombotic Therapy in Atrial Fibrillation. Principal Investigator: Brian F. Gage, M.D., Barnes-Jewish Hospital, St. Louis, MO. AHCPR grant HS10133; funding $377,261; project period 7/1/99-6/30/02.

This study will address the shortcomings of previous data on the use of antithrombotic therapy in patients with atrial fibrillation. The underuse of warfarin in elderly patients with nonvalvular atrial fibrillation has been documented repeatedly and appears to result in part from uncertainty about the conflicting benefits and risks of anticoagulation in the very old.

Effects of a Nursing-Based Intervention in Two Emergency Departments. Principal Investigator: Lorraine C. Mion, M.S.N., Ph.D., the Cleveland Clinic Foundation, Cleveland, OH. AHCPR grant HS09725; funding $894,143; project period 6/1/99-5/31/01.

The researchers will evaluate a recently awarded Robert Wood Johnson Foundation demonstration grant based in the emergency department (ED) and aimed at maintaining frail elderly in the community setting. They will compare usual ED care and comprehensive case management with a community linkage ED intervention in terms of subsequent ED use, unplanned hospitalizations and/or nursing home use, perceived health status, satisfaction, and cost-effectiveness.

Online Commentary Use and Antimicrobial Prescribing. Principal Investigator: Rita M. Mangione-Smith, M.D., University of California, Los Angeles. AHCPR grant HS10187; funding $90,030; project period 7/1/99-9/30/00.

The objective of this study is to gain a better understanding of how physicians use online commentary (the physician's description of physical findings and observations that are related to a parent as a child is being examined/observed) in response to both explicit and perceived parental expectations for antibiotics in the pediatric outpatient setting.

Preferences for Short-Term Health States in Radiology. Principal Investigator: Francois Sainfort, Ph.D., University of Wisconsin, Madison. AHCPR grant HS10277; funding $519,062; project period 7/1/99-6/30/01.

The researchers will attempt to estimate the short-term preference-based, quality-of-life effects of imaging tests, including conventional angiograms and magnetic resonance angiograms, in patients being evaluated for suspected carotid atherosclerotic vascular disease.

Guideline to Improve Quality of Initial Pneumonia Care. Principal Investigator: Michael J. Fine, M.D., M.Sc., University of Pittsburgh School of Medicine. AHCPR grant HS10049; funding $4,944,640; project period 7/1/99-12/31/02.

The objectives of this randomized clinical trial are to reduce appropriately the number of low-risk patients who are hospitalized for the treatment of community-acquired pneumonia (CAP) and to improve the quality of initial medical management for patients with CAP treated in hospital emergency departments.

Managed Care and Quality: Children with Chronic Conditions. Principal Investigator: Frederick Connell, M.D., M.P.H., University of Washington, Seattle. AHCPR grant HS09948; funding $1,071,185; project period 7/1/99-6/30/02.

This observational study will examine how the structural characteristics, incentives, and quality assurance efforts of managed care organizations in Washington State affect the quality of care for children with chronic conditions such as asthma, diabetes, and cerebral palsy.

Nurse Staffing and Quality of Care. Principal investigator: Peter I. Buerhaus, Ph.D., R.N., Harvard University, Boston, MA. AHCPR grant HS09958; funding $691,401; project period 7/1/99-6/30/01.

The purposes of this study are to (1) test and improve the methods available for measuring hospital-level patient acuity, nurse staffing levels, and adverse nurse-sensitive events (ANSE); (2) analyze the relationship between hospital nurse staffing levels and the quality of patient care, specifically the rate of ANSE over time; and (3) assess the impact of market forces on hospital nurse staffing levels and the rates of ANSE over time.

Adult Medicaid Patients' Dental Visits in Emergency Departments. Principal Investigator: Leonard A. Cohen, D.D.S., M.P.H., University of Maryland, Baltimore. AHCPR grant HS10129; funding $139,853; project period 7/1/99-9/30/00.

This project will evaluate adult Maryland Medicaid patients' patterns of use of hospital emergency departments for the treatment of mouth pain and infections. It also will examine the impact of the elimination of adult Medicaid reimbursement to dentists for the treatment of dental emergencies on these patterns.

Fundamental Measurement for Health Services Research. Principal Investigator: William P. Fisher, Ph.D., Louisiana State University School of Nursing, New Orleans. AHCPR grant HS10186; funding $37,883; project period 7/1/99-12/31/99.

This study uses data from AHCPR's Medical Expenditure Panel Survey (MEPS) to evaluate the potential of using trade-off models for measuring health-related variables.

Timing and Predictors of Nursing Home Transfers. Principal Investigator: Richard A. Hirth, M.A., Ph.D., University of Michigan, Ann Arbor. AHCPR grant HS10118; funding $216,598; project period 7/1/99-12/31/00.

This longitudinal study will focus on measuring patient transfers from one nursing home to another and the identification of resident and facility characteristics associated with different types of transfers.

In addition to these "special emphases" projects, AHCPR has recently funded the following additional projects:

Research Project Grant

Rural response to Medicare plus choice: Change and its impact.
Project Director: Keith J. Mueller, Ph.D.
Organization: University of Nebraska, Omaha, NE
Project number: AHCPR grant HS10183
Project period: 8/1/99 to 4/30/02
First year funding: $207,431

Small Project Grants

Analyses of public policies: Coverage of HIV drugs.
Project Director: Robert J. Buchanan, M.D.
Organization: Texas A&M University, College Station, TX
Project number: AHCPR grant HS09819
Project period: 9/1/99 to 8/31/00
Funding: $31,055

Children's health insurance coverage in Massachusetts.
Project director: Emily Feinberg, M.S.C.
Organization: Harvard School of Public Health, Boston, MA
Project number: AHCPR grant HS10207
Project period: 7/1/99 to 6/30/00
Funding: $31,296

Disseminating information on the quality of HMOs.
Project director: Zhe Jin, B.A.
Organization: University of California, Los Angeles, CA
Project number: AHCPR grant HS10168
Project period: 7/1/99 to 6/30/00
Funding: $31,840

Effectiveness of influenza vaccination.
Project director: Paul Hebert, B.A.
Organization: University of Minnesota, Minneapolis, MN
Project number: AHCPR grant HS10154
Project period: 7/1/99 to 6/30/00
Funding: $32,282

Infant feeding method and Medicaid service utilization.
Project director: Aylin A. Riedel, B.A.
Organization: University of Minnesota, Minneapolis, MN
Project number: AHCPR grant HS10163
Project period: 7/1/99 to 6/30/00
Funding: $32,282

Item response theory and the MOS SF-36.
Project director: Kitty S. Chan, B.A.
Organization: Johns Hopkins School of Public Health, Baltimore, MD
Project number: AHCPR grant HS10166
Project period: 7/1/99 to 6/30/00
Funding: $31,813

Managed care contracting: Safety net provider effects.
Project director: Glen P. Mays, M.P.H.
Organization: University of North Carolina, Chapel Hill, NC
Project number: AHCPR grant HS10201
Project period: 7/1/99 to 6/30/00
Funding: $32,227

Multisited ethnography of the emergence of hospitalist medicine.
Project director: Philippa Strelitz, M.P.
Organization: University of California, San Francisco, CA
Project number: AHCPR grant HS10169
Project period: 8/1/99 to 7/31/00
Funding: $31,651

Predictors of health insurance coverage after welfare.
Project director: Julie A. Hudman, M.P.P.
Organization: Johns Hopkins University, Baltimore, MD
Project number: AHCPR grant HS10162
Project period: 7/1/99 to 6/30/00
Funding: $30,660

Conference Grants

Developing model interventions to increase consent for organ donation.
Project director: Laura A. Siminoff, Ph.D.
Organization: Case Western Reserve University, Cleveland, OH
Project number: AHCPR grant HS10074
Project period: 8/1/99 to 7/31/00
Funding: $25,000

Followup workshop on community-based quality improvement.
Project director: Virginia M. Paganelli, M.S.N.
Organization: Center for Clinical Quality Evaluation, Washington, DC
Project number: AHCPR grant HS10076
Project period: 8/1/99 to 7/31/00
Funding: $49,682

Small grant program for conference support.
Project director: Benjamin Djulbegovic, M.D., Ph.D.
Organization: University of South Florida, Tampa, FL
Project number: AHCPR grant HS10075
Project period: 8/1/99 to 7/31/00
Funding: $22,699

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