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Grant final reports available

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 description of the project.

Computer Records, Guidelines, Quality, and Efficient Care. Clement J. McDonald, M.D., Indiana University, Indianapolis. AHRQ grant HS07719, project period 7/1/94-6/30/99.

The use of practice guidelines and computer systems may improve care and reduce costs. These researchers conducted an 18-month, randomized controlled trial of computer reminders versus no computer reminders. The reminders implemented national guidelines, utilized data from the patientŐs electronic medical record, and were incorporated into a computerized order entry system. Of nearly 6,400 patients hospitalized a total of 10,000 times on the general medicine ward and attended by 200 physicians, 68 percent had at least one computer-generated reminder. Patients whose doctors received computer reminders were significantly more likely to receive orders for pneumococcal vaccination, influenza vaccination, subcutaneous heparin, and aspirin on discharge than were control patients. Additional studies involved a trial of automated standing orders and validation of an in-hospital questionnaire detailing patient symptoms and functional characteristics.

Abstract, executive summary, and final report, NTIS accession no. PB2000-105023; 38 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Medicaid Changes: Impact on At-Risk Children. Laurel K. Leslie, M.D., Children's Hospital Research Center, San Diego, CA. AHRQ grant HS09563, project period 9/30/97-9/29/99.

This research capitalized on an ongoing randomized clinical trial, the Healthy Families of San Diego (HFSD) trial, investigating the impact of paraprofessional home visitation services on 488 mother-infant pairs in San Diego County who were identified at delivery as being at high risk for possible child abuse and neglect. Families enrolled in the longitudinal trial served as a cohort to examine the impact of mandatory Medicaid managed care enrollment on access to and use of health care services by the 488 mother-infant pairs who were tracked for a 2-year period. Children without insurance had decreased access to and use of care. Medicaid managed care enrollment did not negatively impact on access, use, or continuity of care; it positively affected compliance with well-visits compared with private insurance and lack of insurance. These findings are preliminary, since data collection and analysis efforts will continue under separate funding through the end of the HFSD trial in October 2000.

Abstract, executive summary, and final report, NTIS accession no. PB2000-105025;128 pp, $36.00 paper, $17.00 microfiche are available from the National Technical Information Service.

Required Request: Determinants of Family Consent. Laura A. Siminoff, M.A., Ph.D., Case Western Reserve University, Cleveland, OH. AHRQ grant HS08209, project period 9/1/96-12/31/99.

To examine the factors affecting decisions regarding the donation of organs, tissues, and corneas, the researchers recruited 420 organ-donor-eligible families from nine acute care general hospitals in two metropolitan areas. This 4-year study collected analogous data from two sources: donor-eligible patients' families and the health care providers and relevant OPO (organ procurement organization) staff directly involved in requesting donation. Cases were identified through prospective review of all deaths at study hospitals. The study found that almost 80 percent of all eligible families were asked to donate organs, but only 46.2 percent actually agreed to donate. Major factors associated with lack of consent were older age of patients, black race, less time spent discussing donor-related issues, less time spent with the organ procurement personnel, and less positive beliefs about organ donation and transplantation prior to hospitalization. The study identifies areas that are potentially amenable to public education and in-hospital interventions.

Abstract, executive summary and final report, NTIS accession no. PB2000-105180; 40 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Understanding Health Values of HIV-Infected Patients. Joel Tsevat, M.D., M.P.H., University of Cincinnati Medical Center, Cincinnati, OH. AHRQ grant HS09103, project period 9/1/96-12/31/97.

Previous studies of health values (utilities) of HIV-infected patients have shown that they often place high value on their current state of health, indicating a strong will to live, but that such values do not correlate well with the patient's actual health status. Using a mix of focus groups (six groups with 34 HIV-infected patients, total) and in-depth individual interviews (51 additional HIV-infected patients), the researchers determined health ratings and health-related values and asked the patients to compare their lives with and prior to HIV infection. Nearly half (49 percent) said that their lives were better than when they were HIV-negative, and 29 percent said their lives were worse. Patients who felt their lives were better were more likely to be past or present users of injected drugs, single, and satisfied with life. A strong will to live was most common among patients with higher health ratings, patients who felt at peace, male patients, and patients with children.

Abstract, executive summary, and final report, NTIS accession no. PB98-142342; 72 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.

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