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Seven new 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 description of the project.

Center for Medical Treatment Effectiveness Programs. Barbara Tilley, Ph.D., Case Western Reserve University, Henry Ford Health Science Center, Detroit, MI. AHCPR grant no. HS07386, project period 2/1/93 to 7/31/98.

The objectives of this project were to (1) facilitate research on improving health and quality of life outcomes for minority populations; (2) assist and encourage minority investigators to conduct medical treatment effectiveness research relevant to minority populations; (3) provide technical assistance to others conducting treatment effectiveness research relevant to minority populations; and (4) involve the community in the center's activities. Patients studied were drawn from either the Henry Ford Health System (HFHS) or the surrounding community. Studies conducted by the center helped to separate treatment effects related to socioeconomic status and race. In 1993, over 390,000 patients of diverse socioeconomic status visited HFHS; 26.7 percent were black, and 42.1 percent of the black patients were members of a health maintenance organization (HMO). The center analyzed existing HFHS data and conducted pilot studies for effectiveness trials. The tertiary care component of HFHS provided in-depth data on rare conditions (e.g., diabetes-related amputations, hospitalization for asthma). Within an HMO/community setting, differences were found in the outcomes of white and black patients being treated for asthma or diabetes; the differences remained after accounting for socioeconomic status. Interventions shown to be successful in white patients were not always directly transferable to black patients.

Abstract, executive summary, and final report, (NTIS accession no. PB99-128357; 50 pp, $25.50 paper, $12.00 microfiche) are available from the National Technical Information Service.

Complements and Substitutes in the Production of Health. Michael Lee Ganz, Ph.D., Columbia University, New York, NY. AHCPR grant HS09610, project period 7/1/97 to 12/31/98.

Despite advances in medicine and public health people still behave in unhealthy ways that result in preventable morbidity and mortality. This project tried to explain this phenomenon by testing the theory of incentives to act in healthy ways. An economic model based on the competing risk model of epidemiology is presented. The effect of family health history is also explored. The findings suggest that policies directed at improving the physical and social environment may improve health via both their direct effects and their indirect effects on behaviors unrelated to the policy.

Abstract and executive summary of dissertation, (NTIS accession no. PB99-119828; 20 pp, $23.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

Health Care Access for Deaf Persons. Steven Barnett, M.D., Highland Hospital, Rochester, NY. AHCPR grant HS09639, project period 7/1/97 to 6/30/98.

The goal of this project was to evaluate the health care utilization and other health-related characteristics of a nationally representative sample of deaf adults while accounting for the age at onset of hearing loss, a predictor of linguistic and sociocultural group affiliation. Cross-sectional analyses of data from the 1990-1991 National Health Interview Surveys were linked to the National Death Index. Health-related measures of adults 19 years of age and older deafened before (prelingually) and after (postlingually) 3 years of age and those of a representative sample of the general population were compared after adjusting for sociodemographics and health status. Compared with the control population, prelingually deafened adults had fewer physician visits and were less likely to have visited a physician in the preceding 2 years; postlingually deafened adults had more physician visits and were more likely to have visited a physician in the preceding 2 years. Postlingually deafened women were less likely to have had mammography within the previous 2 years. Prelingually deafened adults were less likely to smoke. Prelingually and postlingually deafened adults appear to have different problems accessing health care services.

Abstract, executive summary, and final report, (NTIS accession no. PB99-128365; 56 pp, $27.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

Oral Health 2000 National Consortium: Grassroots Synergy. Denise S. Lebloch, Oral Health America, Chicago, IL. AHCPR grant HS09546, project period 9/1/97 to 2/28/98.

This grant supported the 1997 conference, "Synergy at the Grassroots Level," held in Atlanta, GA. The meeting was dedicated to promoting community-based and integrated strategies that evaluate project and program effectiveness. The focus was on providing participants with a strategic approach for the planning and implementation of effective community-based oral disease prevention and health promotion strategies. A framework was presented for supporting and facilitating State and local actions aimed at improving oral health.

Abstract, executive summary, and final report of conference, (NTIS accession no. PB99-119844; 46 pp, $25.50 paper, $12.00 microfiche) are available from the National Technical Information Service.

Outcomes of Dedicated AIDS Units. Linda M. Aiken, Ph.D., R.N., University of Pennsylvania, Philadelphia, PA. AHCPR grant HS08603, project period 9/30/95 to 9/29/98.

This study extended earlier research that employed comparative, multisite data and a quasiexperimental design to compare inpatient outcomes in 20 hospitals in 11 major cities throughout the United States. The data included detailed information on a consecutive sample of AIDS patients admitted to 40 units including interviews, nurses' clinical assessments, extensive medical records data, discharge summaries, and billing information. The earlier study found that dedicated AIDS units achieved increased patient satisfaction, as well as higher job satisfaction and lower burnout for nurses. This study extended the patient followup period beyond hospital discharge and found positive effects on 30-day mortality of dedicated AIDS units and, more generally, of hospitals with dedicated AIDS units. It also demonstrated that organizational characteristics which distinguish dedicated AIDS units from conventional scattered-bed units and magnet hospitals from conventionally organized hospitals are partly responsible for favorable patient outcomes, including decreased mortality. Moreover, it has more firmly established that a simple four-category scale reflecting nurses' assessments of patients' needs for assistance in basic activities of daily living is a better predicator of mortality than the two more established AIDS severity of illness measures and CD4 counts.

Abstract, executive summary, and final report, (NTIS accession no. PB99-130007; 48 pp, $25.50 paper, $12.00 microfiche) are available from the National Technical Information Service.

Ownership Type and the Behavior of Women's Health Centers. Amal J. Khoury, M.P.H., Johns Hopkins University, Baltimore, MD. AHCPR grant HS09328, project period 9/1/96 to 8/31/98.

Using data from the 1994 National Survey of Women's Health Centers, this research examined the association between ownership type and the behavior of centers in terms of community benefits and management practices. The researchers compared 296 nonprofit and 108 for-profit centers. Overall, nonprofit centers provided more community benefits than for-profit centers. The nonprofit centers served more uninsured women, provided more clients with reduced rates, located more often in rural areas, and were more likely to train health professionals and to provide education services at no cost to clients. Community participation in center governance was more evident at nonprofit centers. Nonprofit primary care and reproductive health centers provided a broader range of primary care services than their for-profit counterparts. Nonprofit and for-profit centers appeared equally likely to serve women on Medicaid and minority women and to provide transportation and translator services. The analysis of management practices showed that nonprofit and for-profit centers performed similarly in terms of the utilization of clinician resources and marketing and planning. The for-profit centers, however, were more involved in managed care contracting.

Abstract and executive summary of dissertation, (NTIS accession no. PB99-128340; 14 pp, $23.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

Patterns of Referral for Patients with Newly Diagnosed Diabetes in Alberta. Robert A. Reid, M.D., M.P.H., Johns Hopkins University, Baltimore, MD. AHCPR grant HS09587, project period 6/1/97 to 5/31/98.

The goals of this study were to (1) describe the patterns of referral from primary to specialty care for people with newly diagnosed diabetes, including the likelihood of referral, the pathways to specialty care, the duration of referral, and the types of specialists seen; and (2) evaluate the influence of patient and provider factors and the medical care system on the likelihood of referral and referral duration. A cohort of 4,577 patients with new-onset diabetes diagnosed in 1994 was identified using the physician claims database of the Alberta Health Care Insurance Plan; all claims were examined for 18 months following diagnosis. The results show that referral is relatively common, with 43 percent of diabetics receiving specialist care following their initial diagnosis. Although referral from a primary care provider was the most common route to specialty care (66 percent), referral from other specialists (20 percent), and patient self-referral (14 percent) were also important routes. Patients made an average of three visits to specialists; half had multiple referral episodes extending beyond a 2-week interval. Case-mix (diabetes-related morbidity and other comorbidities) was the strongest predictor of referral. Younger insulin-dependent diabetics (less than age 60) were much more likely than older patients to be referred. Other significant factors included poverty, geographic access to specialist care, and the sex and experience of the generalist.

Abstract and executive summary of dissertation, (NTIS accession no. PB99-119810; 16 pp, $23.00 paper, $12.00 microfiche) are available from the National Technical Information Service.

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