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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.

Records of all 750,000 documents archived at the National Technical Information Service—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. Also, all items in the database from 1997 to the present now can be downloaded from the NTIS Web site.

Editor's Note: In addition to these final reports, you can access information about these projects from several other sources. Most of these researchers have published interim findings in the professional literature, and many have been summarized in Research Activities during the course of the project.

To find information presented in back issues (1995-2002) of Research Activities, select Search Research Activities. To search for information, enter either the grant/contract number or principal investigator's name in the query line. A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.

Clinical Decision Rules for Pediatric Pneumonia. E. Melinda Mahabee-Gittens, Children's Hospital Medical Center, Cincinnati, OH. AHRQ grant HS11038, project period 9/30/01-9/29/02.

This project involved identification of clinical characteristics that best identify children with pneumonia on chest x-ray. Subjects were 2 to 59 months of age; they presented to an ER with cough and at least one of the following symptoms: difficulty breathing, chest or abdominal pain, and/or fever. The project enrolled 510 children, 44 of whom had pneumonia on chest x-ray. The following clinical characteristics were identified: combination of age greater than 12 months, a respiratory rate of at least 50, and an oxygen saturation rate less than 96 percent; in younger children (less than 12 months), nasal flaring identified children with lower respiratory symptoms who had radiographic pneumonia.

To order the abstract and executive summary (NTIS accession no. PB2003-102309; 11 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Combining Different Data Sources to Assess Treatments. Christopher H. Schmid, Ph.D., New England Medical Center Hospital, Boston, MA. AHRQ grant HS10064, project period 9/30/98-9/29/02.

The researchers compiled a database of 11 trials of angiotensin-converting enzyme (ACE) inhibitors for nondiabetic renal disease to evaluate the relative efficacy of meta-regression using study-level summary and individual patient-level data for detecting modifiers of treatment effect. They conclude that putting together such databases is a large and expensive task, but it can lead to important clinical insights and may be worth the investment.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104247; 54 pp, $31.50 paper, $14.00 microfiche), select NTIS.

Consumer Activation: Research in Practice. Ravi Singh, Foundation for Accountability, Portland, OR. AHRQ grant HS10975, project period 1/15/02-1/14/03.

This project provided support for a national 1-day conference held in Washington, DC, in 2002. Participants included representatives of patient advocacy and consumer organizations. The topic was methods to translate research findings into practice and engage consumers more effectively in their own health care.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-103366; 84 pp, $34.00 paper, $14.00 microfiche), select NTIS.

Effect of Medicaid Prescription Drug Copayment Policy on Health Outcomes and Expenditures in a Dually Enrolled Dialysis Population. Neil Jordan, Ph.D., University of Minnesota, Minneapolis. AHRQ grant HS10791, project period 7/1/00-3/31/02.

This project examined the effects of Medicaid prescription drug copayments on the use and expenditures for other medical services, particularly for patients with chronic illnesses. The sample included 13,756 patients from 30 States who were continually dually enrolled in fee-for-service Medicare and Medicaid during 1995. Results showed that patients living in States with sliding scale drug copayments had fewer hospital days and lower expenditures than patients who did not have drug copayments. Flat rate copayments were negatively associated with hospital use, but copayment policy was not significantly related to ER visits or mortality. Illness severity measures, demographic characteristics, and other Medicaid program characteristics were strong predictors of resource use and medical expenditures. The study found no evidence that nominal cost sharing for prescription drugs leads to higher resource use, mortality, or medical expenditures in low-income dialysis patients.

To order the abstract, executive summary, and dissertation (NTIS accession no. PB2003-104573; 220 pp, $54.50 paper, $26.50 microfiche), select NTIS.

Epistemology and Ethics of Quality Improvement. Joanne Lynn, M.D., RAND, Santa Monica, CA. AHRQ grant HS10961, project period 7/1/01-6/30/02.

This project provided support for a research conference held in December 2001. The conference goals were to articulate the major arguments about the nature of the knowledge that can be gained from quality improvement (QI) efforts and standards for assessing the validity of the knowledge; examine the potential risks, benefits, and harms of QI and determine what levels of benefit are necessary and what levels of risk are acceptable in performing QI work; identify privacy concerns and informed consent considerations that arise from QI work; and identify priority areas for research on the conceptual, ethical, and empirical dimensions of QI, especially in areas that relate to protection of human subjects.

To order the abstract, executive summary, and final report (NTIS accession no. PB2002-101587; 34 pp, $29.50 paper, $14.00 microfiche), select NTIS.

Evaluation of a Guideline-Based Decision Support System. David F. Lobach, M.D., Ph.D., Duke University, Durham, NC. AHRQ grant HS10814, project period 9/30/00-9/29/02.

Computerized decision support systems may enhance the use of clinical practice guidelines in clinical settings. The goal of this randomized controlled trial was to evaluate the impact of a Web-based, interactive guideline presentation system on compliance with guideline recommendations and physician education. The study involved second- and third-year medicine residents in the acute care clinic and general inpatient medicine wards at the VA hospital in Durham, NC. Compliance with guideline recommendations was measured using chart audits, and knowledge acquisition was assessed through topic-specific pre- and postintervention tests. Participants were surveyed to obtain their opinions about guidelines and the usefulness of the system. Time pressures in the clinic, technical barriers, and political considerations affected use and implementation of the system, such that rates of use were too low to permit evaluation. The survey revealed that residents had favorable attitudes regarding guidelines. The researchers conclude that guideline-based practice is acceptable to medicine residents, but the systems used to implement guidelines need to be integrated with practice workflow and be time-efficient for clinicians to use.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104245; 30 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Guideline Standardization. Richard N. Shiffman, M.D., Yale University School of Medicine, New Haven, CT. AHRQ grant HS10962, project period 7/1/01-6/30/02.

This project provided support for the Conference on Guideline Standardization, which was held in April 2002, to identify a set of key guideline components necessary to assess guideline validity and to facilitate practical application. A panel of 23 experts identified 44 items as necessary for reporting in clinical practice guidelines. Items achieving a median rank of 7 or higher with a low disagreement index were included in a proposed checklist that was found by reviewers to be comprehensive and useful for guideline development.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-102313; 10 pp, $14.00 paper, $14.00 microfiche), select NTIS.

Health Care Markets, Managed Care, and Hospital Performance. Glenn A. Melnick, Ph.D., RAND, Santa Monica, CA. AHRQ grant HS09211, project period 9/30/95-9/29/99.

This project involved multiple studies that examined the interaction among health care markets, managed care, and hospital performance in the United States between 1989 and 1997. Examples of findings include the following. Hospitals in high managed care penetration areas display a significantly lower rate of cost growth, but this depends on the level of hospital competition. Evidence suggests that greater levels of managed care penetration are associated with lower levels of uncompensated care delivery, after controlling for hospital market structure. In California, increased hospital competition reduced the rate of growth in hospital costs and revenues over a significantly longer time period than demonstrated in previous studies.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104253; 44 pp, $29.50 paper, $14.00 microfiche), select NTIS.

Health and Productivity Feasibility Study. R. W. Whitmer, M.B.A., Health Enhancements Research Organization, Birmingham, AL. AHRQ grant HS10099, project period 5/1/00-4/30/01.

This project provided support for a small conference for corporate medical directors, human resource and finance executives, and government research leaders to discuss the general topic of health and productivity. The conference was held in Colorado Springs in March 2000.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-106086; 22 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Integrating Research on Spirituality and Health and Well-Being into Service Delivery. Charles T. Kaelber, M.D., Ph.D., International Center for the Integration of Health and Spirituality, Rockville, MD. AHRQ grant HS14033, project period 3/17/03-3/16/04.

This project provided support for a conference held in April 2003 in Bethesda, MD. The objectives were to identify research findings associating religious and spiritual variables to a broad spectrum of physical, mental, and social health outcomes; identify future research questions in this area; and encourage further research on this topic.

To order the abstract, executive summary, and proceedings (NTIS accession no. PB2003-106536; 164 pp, $47.50 paper, $20.00 microfiche), select NTIS.

International Conference for Health Policy Research, 2001. William B. Smith, Ph.D., American Statistical Association, Alexandria, VA. AHRQ grant HS12074, project period 12/6/01-12/5/02.

This project provided support for a conference on methodological issues in health services and outcomes research that was held December 2001 in Boston. Conference topics included hierarchical models, longitudinal data, causal inference, techniques for assessing quality of care, profiling providers, techniques for inferring disparities, decisionmaking, data mining, and survey design.

To order the abstract, executive summary, and appendix (NTIS accession no. PB2003-104250; 14 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Kansas Rural Practice Research Network. Ken J. Kallail, Ph.D., University of Kansas Medical Center, Kansas City. AHRQ grant HS11201, project period 9/30/00-9/29/02.

This project provided support for development of the Kansas Rural Practice Research Network, a collaboration between the Kansas University School of Medicine, the Great Plains Health Alliance, the Kansas Academy of Family Physicians, the Kansas chapter of the American College of Physicians, and 17 primary care practices located in rural medically underserved communities with 3,000 or fewer residents. It includes 31 physicians, 7 nurse practitioners, and 8 physician assistants.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-102311; 14 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Knowledge Systems for Better Care. Suzanne Fletcher, M.D., International Clinical Epidemiology Network, Philadelphia, PA. AHRQ grant HS12064, project period 1/28/02-1/27-03.

The project provided support for three workshops: (1) Knowledge Systems for Better Care, which focused on the use of emerging technologies and new knowledge systems to address adverse health care outcomes; (2) Shared Decisionmaking: Integration Sociocultural and Patients' Perspectives in Health Care, which focused on health care disparities associated with socioeconomic position, race, ethnicity, and sex; and (3) Measuring and Preventing Adverse Outcomes in Health Care, which focused on methods for measuring adverse outcomes.

To order the abstract and executive summary (NTIS accession no. PB2003-104574; 146 pp, $41.50 paper, $20.00 microfiche), select NTIS.

Long-term Care Research and Service Delivery. David Helms, Ph.D., Academy for Health Services Research and Health Policy, Washington, DC. AHRQ grant HS12057, project period 9/30/01-9/29/02.

This project provided support for a conference focused on issues related to the increasing complexity of long-term care, including the growing demand for services, rising consumer expectations about quality, the changing capacity of families to provide care, and problems with the interface between acute health care and rehabilitative services.

To order the abstract, executive summary, and conference proceedings (NTIS accession no. PB2003-104246; 124 pp, $38.00 paper, $20.00 microfiche), select NTIS.

Outcomes of Instability on Discharge in Urban Hospitals. Ethan Halm, M.D., Mount Sinai School of Medicine, New York, NY. AHRQ grant HS09973, project period 9/30/98-9/29/02.

The researchers used data from three observational cohort studies to develop condition-specific criteria for measuring instability on discharge in community-acquired pneumonia, hip fracture, and asthma. They also examined associations between instability on discharge and post-hospital outcomes. Of the 680 pneumonia patients studied, 19.1 percent left the hospital prior to becoming stable. Instability on discharge was associated with higher risk-adjusted rates of death or readmission and failure to return to usual activities. For 559 hip fracture patients, 17 percent had serious clinical issues on discharge, and 41 percent had new impairments; both were associated with worse functional mobility. The analyses of instability on discharge among asthma patients has not yet been completed.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-106085; 48 pp, $24.50 paper, $14.00 microfiche), select NTIS.

Peer Counseling Intervention for Vulnerable Rural Elderly. Lee Sennott-Miller, Ph.D., University of Arizona, Tucson. AHRQ grant HS07741, project period 9/1/94-8/31/98.

This research tested the ability of trained age-related peers to facilitate change in health knowledge and behavior for elderly Hispanic and white rural residents. After a survey of 841 community members 60 and over in a former mining town near the Mexican border, eight Hispanic and white older men and women visited 275 of those surveyed over 15 months. Both ethnicity and contact/no contact had significant effects on the increase in questions answered correctly post-test. In general, knowledge increased as contacts increased, but improvement was not uniform across groups. For behavior, visits by health peers had an effect, but the amount of contact was not a factor. Effects varied among the groups indicating the presence of interaction. Hispanics were least successful in making changes. The research demonstrates that trained counterparts of elderly community members, using a non-intensive, informally delivered cognitive intervention can increase levels of knowledge about self-health care and foster appropriate behavior changes for better health.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-106087; 30 pp, $26.50 paper, $14.00 microfiche), select NTIS.

PBRN Characterization and NAMCS by Patient Report. Kurt C. Stange, M.D., Ph.D., Case Western Reserve University, Cleveland, OH. AHRQ grant HS11176, project period 9/30/00-9/29/02.

The goal of this project was to expand the infrastructure of a successful primary care practice-based research network by increasing the network's research capacity. This was accomplished by involving additional practices and populations from an integrated health care system, developing an electronic information infrastructure for the network, and establishing an Internet-based learning exchange to foster planning, communication, and implementation of research findings and quality improvement initiatives among participating practices. The Rainbow Pediatric Practice Network was established and the Practice-to-Practice Web site was developed and implemented.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104248; 38 pp, $29.50 paper, $14.00 microfiche), select NTIS.

Quality and Cost Containment in Pediatric Intensive Care. John M. Tilford, Ph.D., Arkansas Children's Hospital, Little Rock. AHRQ grant HS09055, project period 9/1/95-8/31/99.

The mission of many children's hospitals is to provide care without concern for race or insurance status. In light of recent findings of differences in medical treatment according to race and insurance status for adult populations, this study examined whether such variations occurred in the setting of the pediatric intensive care unit (PICU). Data were collected on clinical and demographic measures, resource use, and outcomes for 5,749 patient admissions to the ICUs at three children's hospitals. Models to predict resource use and outcomes after controlling for differences in patient severity were developed to assess variations by race, sex, and insurance status. The primary hypothesis underlying this research project was that findings based on adult populations may not generalize to the PICU. The findings support this hypothesis. The study produced no evidence that therapies or outcomes differ by race or insurance status after controlling for illness severity.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-10442; 26 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Regional Community Health Center Practice-Based Research Network. George S. Rust, M.D., M.P.H., Morehouse School of Medicine, Atlanta, GA. AHRQ grant HS11217, project period 9/30/00-9/29/02.

The Southeast Regional Clinicians' Network (SERCN) is a practice-based research network that includes health care professionals employed by 146 federally funded community health centers (CHCs) in eight Southeastern States. These health centers serve roughly 1.8 million people who are medically underserved, 84 percent of whom are poor, and 45 percent of whom are uninsured. During 2000, there were over 5 million medical encounters from a diverse population of medical users (45 percent black, 14 percent Hispanic, 0.8 percent American Indian/Alaska Native, 0.5 percent Asian, and less than 1 percent other). The network has concentrated on improving health outcomes related to high-impact, high-disparity conditions such as asthma and hypertension. This project involves conducting the National Ambulatory Medical Care Survey in a sample of participating network sites, as well as conducting tests to validate data collected routinely in community health center MIS systems.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104251; 14 pp, $26.50 paper, $14.00 microfiche), select NTIS.

Reliability and Efficacy of Telemedicine in Routine Pediatric Practice. Kenneth M. McConnochie, M.D., University of Rochester, Rochester, NY. AHRQ grant HS10753, project period 9/30/00-9/29/02.

The goal was to examine the usefulness of telemedicine links for increasing access to quality health care. Participants were children who were seen in a hospital-based primary care facility because of illness and were examined by an experienced pediatrician. Patients were then randomly assigned to receive either a telemedicine or in-person duplicate exam. Patients needing skilled palpation or x-rays were excluded. Among the 492 valid cases, 54 (11 percent) had a disagreement between the two exams on primary diagnosis. Disagreement was marginally more common among cases randomized to telemedicine than to in-person exam.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104249; 52 pp, $31.50 paper, $14.00 microfiche), select NTIS

Surf*Net. Theodore G. Ganiats, M.D., University of California, San Diego, La Jolla, CA. AHRQ grant HS11223, project period 9/30/00-9/29/02.

This project involved a survey of clinicians and patients in the San Diego Unified Network for Research in the Family Medicine (Surf*Net) Practice-Based Research Network. Data were collected on 49 clinicians and 1,319 patient encounters involving a random sampling of their patients over 22 weeks from February 2002-July 2002. Surf*net provides care to a larger number of blacks than most practice-based research networks, but Surf*Net patients are more likely than patients in other networks to have private insurance, more likely to be in capitated care, and less likely to be self-pay. The study demonstrated the ability of Surf*Net to collect data using an extensive but simple design.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104252; 22 pp, $26.50 paper, $14.00 microfiche), select NTIS

Synthesis of Health Services Research for Policymakers. Jason Lee, Ph.D., Academy for Health Services, Washington, DC. AHRQ grant HS10947, project period 3/1/01-2/28/02.

This project provided support for a small working conference on ways to increase the policy relevance of health services research. A group of health policy experts and health services researchers discussed synthesizing, translating, and disseminating research findings focused on several current policy debates, including adding a prescription drug benefit to the Medicare program and private employer responses to health care inflation.

To order the abstract, executive summary, and final report (NTIS accession no. PB2003-104243; 110 pp, $38.00 paper, $20.00 microfiche), select NTIS

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