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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.
Deploying Idealized Design of Clinical Office Practices. Charles M. Kilo, M.D., M.P.H., Institute for Healthcare Improvement, Boston, MA. AHRQ grant HS10093, project period 2/18/00-2/17/01.
This report describes a conference held March 1, 2000, that brought together 27 leaders from the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Academy of Neurology, and others. Participants discussed resources within the academies, developed academy-specific strategies to enhance dissemination of the Idealized Design of Clinical Office Practice (IDCOP) initiative, and drafted action plans for future work. The goal IDCOP is to demonstrate that clinical office practices, with appropriate redesign, can achieve significant improvement in performance relevant to today's urgent social needs.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107460; 16 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Evaluation of a Home- and Community-based Waiver for Persons with AIDS. Jean M. Mitchell, Ph.D., Georgetown University, Washington, DC. AHRQ grant HS09560, project period 9/30/97-9/29/99.
The researchers analyzed Florida Medicaid claims data for people with AIDS from December 1993 through December 1997 to determine how participation in the home- and community-based waiver program (providing home- and community-based services in lieu of more expensive hospital-based care) affected the use of services, monthly expenditures, and survival rates. Monthly expenditures were almost $843 or 42 percent higher for nonparticipants compared with participants, and these differences persisted across demographic groups. An analysis of 1996-1997 data—a period during which combination drug therapy was available for Medicaid patients with HIV or AIDS—revealed that the selection of the waiver was not random. White men and sicker patients were more likely to participate in the waiver than other groups. Also, compared with nonparticipants, waiver participants were more likely to receive combination therapy and less likely to use inpatient care, have monthly Medicaid expenditures that were 49 percent lower, and have similar survival rates. Overall, the study concludes that the Florida Medicaid AIDS waiver (Project AIDS Care) appears to be an efficient treatment option.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107823; 33pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Impact of Infant Feeding Method on Health Services Costs and Utilization in a Medicaid Population. Aylin A. Riedel, University of Minnesota, Minneapolis. AHRQ grant HS10163, project period 7/1/99-6/30/00.
The researcher examined the relationship between the method of infant feeding (breast or formula) and health care costs and utilization among 1,374 infants enrolled in Medicaid in Colorado. Data sources included Medicaid claims for the first 12 months of the infants' lives, linked to vital statistics and WIC files. The researcher suggests that the infant feeding—health status relationship is confounded by several factors related to both the choice of feeding method and to infant health outcomes, including maternal income, education, age, marital status, and smoking status. Analysis of outpatient costs and utilization initially indicated that breastfeeding led to lower costs and utilization, even after controlling for demographic factors. However, after identification and removal from the data set of infants with preexisting illnesses, the impact of breastfeeding on health care costs and utilization disappeared. The author attributes this to the fact that infants with preexisting illnesses or more severe conditions were more likely to be placed on formula, even when breastfeeding was not contraindicated.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107824; 18 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Improve—Improving Disease Prevention in Primary Care. Leif I. Solberg, M.D., Group Health Foundation, Minneapolis, MN. AHRQ grant HS08091, project period 7/1/93-6/30/98.
The researchers examined whether an intervention emphasizing preventive services and the use of continuous quality improvement (CQI) techniques could stimulate the private primary care clinics of a managed care organization to develop and maintain systems to routinely deliver clinical preventive services. A randomized, controlled trial of an intervention, with baseline and followup measures of delivery of selected preventive services, was conducted in 44 primary care clinics affiliated with two HMOs in the Minneapolis-St. Paul area; 8 preventive services were measured by patient report and chart audit in two cross-sections of visiting patients (more than 6,000 patients surveyed at baseline and followup, with about 4,600 chart audits in each group). In the clinics randomly assigned to the intervention, two of the eight preventive services increased by modest, but statistically significant, amounts. None of the other service delivery rates increased significantly, leading the researchers to conclude that CQI techniques as used in this trial failed to have a significant effect on the delivery of preventive services.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107822; 16 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Models of Integrated Long-term Care: Rural Applications. Joyce E. Beaulieu, M.P.H., Ph.D., University of Kentucky, Lexington. AHRQ grant HS09850, project period 5/1/99-4/30/00.
This 2-day conference on integrated models of long-term care in rural areas was convened by the University of Kentucky Center for Health Services Management and Research, the Sanders-Brown Center on Aging, and the Rural Center. The purpose of the conference was to discuss current research in models that integrate payers, providers, and clients; current models being implemented; and how integrated rural programs can be implemented. An agenda for further research was developed, identifying the need for more information on the effectiveness of case-management models, contracts, and gatekeeping arrangements for rural providers and research on innovations in training and recruitment for rural nursing home staff.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107459; 24 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Outcomes Dissemination: The Maine Study Group Model. Robert B. Keller, M.D., Maine Medical Assessment Foundation, Manchester. AHRQ grant HS06813, project period 9/30/91-3/31/97.
This project involved the export of the Maine physician study group model of quality improvement to both New Hampshire and Vermont, establishing a tri-State study group initiative. The principal objectives of the 5-year project were to demonstrate the effectiveness of the specialty-oriented study group and data feedback methodology in producing changes in physician behavior; to determine, via survey research, the effect of the data feedback process on physician knowledge and attitudes; and to demonstrate that the feedback approach can be used to disseminate research findings and other clinical information. An evaluation of the program concluded that the physician study group model can be replicated in other areas in a relatively short period of time, and that physicians new to the process broadly accepted both the models and the process goals.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107480; 100 pp, $29.50 paper, $17.00 microfiche are available from the National Technical Information Service.
Outcomes Following Minor Head and Abdominal Trauma. David H. Livingston, M.D., University of Medicine and Dentistry of New Jersey, Newark. AHRQ grant HS07336, project period 8/1/94-7/31/98.
The goals of this study were to evaluate the current practice of mandatory hospitalization for observation only following two specific types of injury, minimal head injury (MHI) and minor abdominal trauma, and to develop practice guidelines that could reliably rule out significant injuries without hospitalization. The researchers evaluated 2,500 trauma patients admitted to level-one trauma centers. All patients underwent a physical examination followed by cranial or abdominal computed tomographic (CT) scanning. Patients were then admitted to the hospital and observed for the development of missed injuries. For both MHI and minor abdominal trauma, no single or combination of findings upon physical examination could predict an injury observed with CT scanning. Scanning of the cranium or abdomen had a high negative predictive value. The researchers conclude that it is safe to discharge patients who show no sign of intracranial or intra-abdominal injuries upon CT scanning, obtained on a helical or spiral CT scanner, without a period of either inpatient or outpatient observation.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107821; 62 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Pharmacists as Adult Immunizers: Effects on Sites and Rates of Vaccine Delivery. John D. Grabenstein, R.Ph., Ph.D., University of North Carolina, Chapel Hill. AHRQ grant HS10021, project period 9/30/98-9/29/00.
This study involved a cross-sectional survey of 1,730 adults vaccinated by pharmacists at 21 pharmacies in 10 States. More than 96 percent of the respondents were fully satisfied. Many of those vaccinated considered pharmacists advantageous for access, proximity, trust, convenience, and cost. Another component of the study contrasted influenza vaccination patterns among adult prescription recipients in urban Washington State, where pharmacists administer vaccines, and urban Oregon, where they do not. Influenza vaccination rates were 7 percent higher in Washington State than in Oregon in 1998, adjusting for baseline (1997) differences.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107479; 16 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Prevention and Competing Demands in Primary Care. Benjamin J. Crabtree, Ph.D., University of Nebraska Medical Center, Omaha. AHRQ grant HS08776, project period 9/30/96-9/29/99.
The goal of this study was to determine why otherwise effective approaches to quality improvement often fail to bring about change when implemented in primary care practices. Eighteen in-depth case studies were conducted in a diverse sample of Midwestern family practices to examine organizational contexts that enhance or inhibit delivery of preventives services and efforts to change. These practices had a common set of activities, such as charting, billing, and patient care, but approaches to accomplish these activities had emerged individually over time and were shaped by distinct external and internal stimuli. Assessment and intervention processes developed during this study can be used to tailor interventions to bring about change in diverse practice settings.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107457; 60 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Primary Care Physician Participation in Managed Care. Andrew B. Bindman, M.D., University of California, San Francisco. AHRQ grant HS09557, project period 9/30/97-9/29/98.
A longitudinal survey was mailed in 1996 and again in 1998 to 713 general internists, family physicians, pediatricians, and obstetricians-gynecologists in 13 urban California counties to determine whether the expansion of Medicaid managed care was associated with a change in the number and characteristics of primary care physicians treating Medicaid and uninsured patients. The survey revealed no statistically significant change in the percentage of the physicians seeing Medicaid patients in their practices. There was, however, a slight decrease in the percentage of physicians accepting new Medicaid patients and a larger decrease in the percentage of these physicians who had uninsured patients in their practices. The findings suggest that expansion of Medicaid did not improve access to primary care physicians for California's Medicaid beneficiaries or the uninsured.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107458; 32 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.
Risk and Risk Factor Modeling Project. Louise B. Russell, Ph.D., Rutgers University, New Brunswick, NJ. AHRQ grant HS07002, project period 2/1/92-1/31/95.
This project produced a comprehensive model of the risks of death, hospitalization, and nursing home admission as a function of a common set of biomedical and behavioral risk factors. The relationships on which the model is based were estimated with data from a nationally representative sample of noninstitutionalized U.S. adults, the Epidemic Follow-up Study (NHEFS) of the National Health and Nutrition Examination Study (NHANES I). The model can be used to project the health effects of risk-factor modification over a 20-year period in a common framework which assures that comparisons across interventions are valid. It is particularly appropriate for studies of the effectiveness and cost-effectiveness of preventive interventions.
Abstract, executive summary, and final report, NTIS accession no. PB2000-108004; 284 pp, $56.00 paper, $23.00 microfiche are available from the National Technical Information Service.
Symposium on Evidence-Based Practice of Oncology. Benjamin M. Djulbegovic, M.D., University of South Florida, Tampa. AHRQ grant HS10075, project period 8/1/99-7/31/00.
This symposium was organized to teach skills for the practice of evidence-based oncology and to present the strengths and weaknesses of the available body of evidence for the most common disorders in oncology.
Final report, NTIS accession no. PB2000-107861; 11 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.
Utah Usage of EMS Services by Children. Anthony J. Suruda, M.P.H., University of Utah, Salt Lake City. AHRQ grant HS09057, project period 9/1/95-11/30/99.
This study examined how Utah children used emergency medical services (EMS) and related hospital care in 1991-92. The EMS and hospital records were linked using special software. Ambulance and hospital charges for children were estimated to be $35 million, not counting physician charges, prescriptions, and rehabilitation care. The principal findings of the study concerned the care of children younger than 5 years of age. These children received fewer procedures prior to being transported to a hospital and required more time at the scene for assessment. Some interventions, such as splinting of fractured arms prior to transport to a hospital, were related to reduced hospital charges. A training program for ambulance personnel in intravenous (IV) line placement resulted in a reduction in the amount of time EMS personnel spent at the scene.
Abstract, executive summary, and final report, NTIS accession no. PB2000-107454; 16 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.
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