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Grant final reports now available from NTIS

The following grant final reports are now available from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator, 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 NTIS—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. For information about findings from the projects described here, please access the relevant final reports at the NTIS Web site. Also, all items in the database from 1997 to the present can be downloaded from NTIS.

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 of Research Activities, select "Search Research Activities." To search for information, enter either the grant or contract number or the principal investigator's last name in the query line. A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.

AcademyHealth Annual Research Meeting. Wendy G. Valentine, M.H.A., AcademyHealth, Washington, DC. AHRQ grant HS08201, project period 3/20/03-2/29/04.

This project provided support for AcademyHealth's annual meeting held June 23-25, 2003 in Nashville, TN. This report describes the meeting, which featured 124 regular sessions and 2 poster sessions, as well as a wide range of affiliate meetings and an exhibit program. The abstract, executive summary, and final report (NTIS Accession No. PB2004-104610; 34 pp, $8.95, $18.95 customized CD) are available from NTIS.

Advancing Risk Adjustment for Schizophrenia. Bradley C. Martin, Ph.D., University of Georgia Research Foundation, Inc., Athens. AHRQ grant HS10815, project period 7/1/00-12/31/02.

The goal of this study was to develop and validate a series of schizophrenia-specific risk adjustment cost models. The researchers linked Georgia Medicaid claims data with institutional inpatient data for 21,602 continuously eligible people with schizophrenia. They used the data to build a prospective diagnosis-, demographic-, and drug-based combined risk adjustment cost model. The found that risk adjustment models based on drug or ICD-9-CM information performed equally well, and the combined models outperformed other models. The models can be used to stratify prospective 1-year total costs or payments and, with caution, to stratify mental health costs and payments. The abstract, executive summary, and final report (NTIS Accession No. PB2004-104991; 94 pp, $34.00 paper, $13.00 microfiche) are available from NTIS.

Application of Conjoint Analysis to Preferences of Low Back Pain Patients. Richard T. Meenan, Ph.D., Kaiser Foundation Research Institute, Oakland, CA. AHRQ grant HS11726, project period 9/30/01-3/31/03.

Conjoint analysis (CA) establishes the relative importance of different attributes of a good or service, as well as marginal rates of substitution between attributes. The two main goals of this project were (1) to examine the feasibility of CA for eliciting preferences over hypothetical chiropractic and primary care visits that vary by process and outcome attributes among Kaiser Permanente Northwest enrollees with acute low back pain and (2) produce preliminary utility and willingness-to-pay estimates related to low back pain treatment that incorporate process and outcome attributes. The abstract, executive summary, and final report (NTIS Accession No. PB2004-103332; 60 pp, $31.50 paper, $14.00 microfiche) are available from NTIS.

Assessment of Physician-Patient Communication. Sheldon D. Horowitz, M.D., American Board of Medical Specialties, Evanston, IL. AHRQ grant HS12083, project period 3/20/02-3/19/03.

The project provided support for a conference held March 21-22, 2002 to (1) provide a forum for discussion of qualitative and quantitative approaches to assess physician-patient communication, and (2) begin to develop tools to assess such communication by residents during training and by physician specialists for maintenance of certification. The abstract, executive summary, and final report (NTIS Accession No. PB2004-103326; 16 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Conference on Communication and Patient Safety. Jay Callahan, Ph.D., National Patient Safety Foundation, Chicago, IL. AHRQ grant HS11012, project period 4/15/01-12/15/01.

This project provided support for a conference held in Rancho Mirage, CA, in 2001. Attendees focused on the crucial role of communication research on communication for the purpose of reducing medical errors and improving patient safety. Highlights included intra-staff communication, effective communication as a core element in a culture of safety, human factors, health literacy, disclosing medical errors, and the threat of litigation as a deterrent to disclosure and communication. The abstract and executive summary (NTIS Accession No. PB2004-106426; 16 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Cultural Relevance of a Continuity of Care Measure. Norma C. Ware, Ph.D., Harvard Medical School, Boston, MA. AHRQ grant HS10335, project period 9/30/99-9/29/03.

The goal of this project was to evaluate the cultural relevance of CONNECT, a structured interview designed to assess continuity of care in mental health services. Focus groups were held with black and Puerto Rican mental health service providers, and open-ended interviews were conducted with 62 individuals with serious mental illness (black, Puerto Rican, white). The goal was to identify new, culturally relevant domains and items for CONNECT. Based on the study findings, neither the qualitative nor the quantitative data suggest a need to make changes to CONNECT to increase cultural relevance for the target groups. The abstract, executive summary, and final report (NTIS Accession No. PB2004-105630; 30 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Developing a Model for the Allocation of Resources for the Prevention of CVD in South Carolina. David M. Ward, Ph.D., Medical University of South Carolina, Charleston. AHRQ grant HS09809, project period. 2/1/98-1/31/99.

The objective was to develop a resource allocation model to assess the impact on efficiency of different resource apportionment decisions for the prevention of cardiovascular disease (CVD). The model was developed to allow for the distribution of resources across the 46 counties of South Carolina, five age strata, both sexes, two racial strata, five CVD risk factors (smoking, hypertension, hyperlipidemia, sedentary lifestyle, and menopause), and two interventions (drug therapy and counseling) for each CVD risk factor. The findings suggest that short-term allocations for prevention of CVD should be targeted to hypertension drug therapies for the elderly. The abstract, executive summary, and final report (NTIS Accession No. PB2004-105578; 28 pp, $26.50, paper, $14.00 microfiche) are available from NTIS.

Effects of WIC on Child Medicaid Dental Use and Costs. Jessica Y. Lee, D.D.S., University of North Carolina, Chapel Hill. AHRQ grant HS11607, project period 9/30/01-9/29/02.

The project objective was to evaluate the relationship of WIC to the use of oral health services and expenditures among Medicaid preschool aged children and assess WIC's potential to improve access to dental care. A total of 49,783 children with over 200,000 visits were enrolled in the study. WIC children used more preventive and diagnostic services, had fewer dental-related emergency room and hospital visits, used more restorative services, and had lower dental-related expenditures than non-WIC children covered by Medicaid. The abstract, executive summary, and final report (NTIS Accession No. PB2004-105631; 28 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Improving Quality with Outpatient Decision Support. David W. Bates, M.D., Brigham and Women's Hospital, Boston, MA. AHRQ grant HS11046, project period 9/30/01-12/31/03.

The researchers examined the gaps between evidence and practice and assessed the ability of computer-based decision support to overcome the barriers to evidence-based practice. They focused on the ambulatory setting and patient visit to examine the usefulness of computer-generated alerts, reminders, and guidelines for health maintenance, disease and medication management, and ordering of ancillary tests. The abstract, executive summary, and final report (NTIS Accession No. PB2004-105258; 18 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Inpatient Practices of Hospitalists vs. Traditional PCPs. Melissa K. Rowe, Ph.D., RAND, Santa Monica, CA. AHRQ grant HS10696, project period 4/1/00-3/31/02.

Hospitalists are inpatient physicians who provide care for patients from admission to discharge, allowing primary care physicians (PCPs) to use their time more effectively by focusing on outpatient practice. The goal of this study was to develop and pilot-test a structured, Web-based survey to measure PCP and hospitalist clinical and professional practices and their attitudes toward different aspects of the hospitalist model. The comparative analyses of PCP and hospitalist responses indicated several areas that warrant further study with a larger sample. The survey was shown to have sound psychometric properties, allow detection of differences in the populations sampled, and provide a foundation for further development and testing in a large, nationally representative sample of physicians. The abstract, executive summary, final report, and appendixes (NTIS Accession No. PB2004-104612; 80 pp, $34.00 paper, $14.00 microfiche) are available from NTIS.

International Crossing Borders Conference. Mary L. Bond, Ph.D., University of Texas, Arlington. AHRQ grant HS13803, project period 9/6/02-9/5/03.

The international conference, "Emerging Knowledge in Culture and Health: Caring for Hispanic Populations," a component of the "Crossing Borders" series, was held October 11-12, 2002, at the University of Texas in Arlington. The goal was to disseminate state-of-science information to health providers, administrators, and educators on two Healthy People 2010 indicators: responsible sexual behavior and injury and violence as they influence the health and welfare of Hispanic populations. The abstract and final report (NTIS Accession No. PB2004-104607; 14 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Managed Care Impact on Critical Care Service Utilization. Diane M. Dewar, Ph.D., Research Foundation of SUNY, Albany, NY. AHRQ grant HS10713, project period 6/1/00-5/31/02.

These researchers investigated the impact of managed care on economic and clinical outcomes for hospitalized patients with prolonged mechanical ventilation who were discharged with specific diagnoses during the period 1995-1998. This period encompasses the time before and after enactment of the competitive hospital reimbursement system, the Health Care Reform Act of 1996, in New York State. They found that managed care and enactment of the competitive reimbursement system were associated with decreased use of hospital resources. Competition also was associated with poorer long term health outcomes and greater numbers of discharges to skilled nursing facilities. On the other hand, the increase in social worker and case management interventions under the competitive regime resulted in a greater likelihood of hospital survival. Managed care had no unique impact on health outcomes. The abstract, executive summary, and final report (NTIS Accession No. PB2004-104608; 20 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Measuring Quality of Care for High-Risk Infants. Jeannette A. Rogowski, Ph.D., RAND, Santa Monica, CA. AHRQ grant HS10328, project period 9/30/99-9/29/03.

There is wide variation in mortality rates across neonatal intensive care units, even after controlling for severity of illness, that is not well understood. These researchers used data from the Vermont Oxford Network for the period 1994-2000 to identify ways to improve measurement of the quality of neonatal intensive care for infants with very low birthweight (VLBW, under 1500 grams) and to study the hospital characteristics associated with high quality care. Mortality rates were found to be higher for hospitals with less than 50 VLBW admissions per year and for hospitals that treat a high percent of black VLBW infants (more than 35 percent). However, volume explained only 9 percent of the variations across hospitals in mortality rates and therefore may not be useful as a proxy indicator for hospital quality. The abstract, executive summary, and final report (NTIS Accession No. PB2004-105629. 26 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Measuring Quality of Care for Vulnerable Children. Michael Seid, Ph.D., Children's Hospital Research Center, San Diego, CA. AHRQ grant HS10317, project period 9/30/99-9/29/02.

The goal of this research was to develop and test measures of quality of care for vulnerable children, including young children of Latino farm workers. Two measures were tested in four languages—English, Spanish, Vietnamese, and Tagalog—to examine how vulnerable children access and navigate the health care system and the resulting outcomes of care. The researchers also examined the links between race/ethnicity, language, and access to care on parents' perceptions of the quality of primary care provided to their children. The abstract, executive summary, and final report (NTIS Accession No. PB2003-104238; 24 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Policy Appraisal of the U.S. Human Genome Project. Lauren A. McCain, M.A., University of Colorado, Boulder. AHRQ grant HS11401, project period 4/5/01-5/31/03.

For this thesis, the researcher performed a policy appraisal of the U.S. Human Genome Project (HGP), which involves a $3.3 billion public investment. Project promoters justified the project with assurances that sequencing the human genome would lead to health benefits for all. This analysis shows that although some people have benefited from HGP, problems exist at every level of the research, technology development, and clinical application processes. One problem lies in the fragmented nature of the larger network of institutions and policies responsible for overseeing development and dissemination of genetic and genomic products and services. Another problem arises from the narrow and technical definition of the project, which isolates HGP from its larger social context and excludes patients and consumers from decisionmaking. The abstract, executive summary, and thesis (NTIS Accession No. PB2004-104993; 396 pp, $75.50 paper, $29.50 microfiche) are available from NTIS.

Quality of Hypertension Care for Asian Refugees. Candice C. Wong, Ph.D., University of California, San Francisco. AHRQ grant HS10276, project period 9/30/99-9/29/03.

The purpose of this project was to develop and test a survey on quality of hypertension care for use among Hmong Americans, who have the highest poverty rate (64 percent) and the highest proportion of linguistic isolation (61 percent) of all Asian Americans. Hmong community members were involved in developing the survey, and the instrument was tested among 323 hypertensive patients recruited through clinics, community organizations, and medical outreach in Fresno and Sacramento, CA. The mean age of participants was 58, 91 percent had no formal education, and 86 percent spoke English poorly. Although more than 90 percent of subjects had health insurance, 47 percent could not name their health plan, and 55 percent had difficulty choosing a doctor. Knowledge about hypertension was inconsistent and influenced by cultural beliefs. Although 55 percent rated their health as excellent or good, 90 percent suffered from psychological distress that interfered with hypertension management, which in turn contributed to a high rate of uncontrolled hypertension (72.9 percent). The abstract, executive summary, and final report (NTIS Accession No. PB2004-105628; 16 pp, $26.50, microfiche $14.00) are available from NTIS.

Status Epilepticus Outcomes in the United States. N. Edwin Trevathan, M.D., Washington University, St. Louis, MO. AHRQ grant HS11453, project period 7/1/01-6/30/02.

The researchers examined data from the National Inpatient Sample, a component of AHRQ's Healthcare Cost and Utilization Project (HCUP), to determine whether status epilepticus (SE) increases the risk of death. They also determined the risk factors for having SE among inpatients. Overall, convulsive SE more than doubled the risk for death among U.S. inpatients, even after controlling for multiple coexisting conditions. SE also increased the risk of death among young children (1 month to 4 years). SE increased the risk of death among subpopulations of U.S. inpatients with certain conditions, such as bacterial meningitis, carotid stroke, and several others. The researchers conclude that SE is a major risk factor for inpatient death. The abstract, executive summary, and final report (NTIS Accession No. PB2004-104990; 50 pp, $29.50 paper, $14.00 microfiche) are available from NTIS.

Using Cancer Registries to Assess Quality of Cancer Care. John Ayanian, M.D., Harvard Medical School, Boston, MA. AHRQ grant HS09869, project period 9/30/98-9/29/03.

These researchers evaluated the accuracy of treatment data in population-based cancer registries and assessed the quality of care for colorectal cancer using registry data and a survey of physicians and patients. They studied cohorts of patients diagnosed with colorectal cancer during the period 1994-2000 in California. To augment the registry data, they surveyed physicians of 1,956 patients diagnosed during 1996 and 1997 and obtained responses for 1,449 patients (74.1 percent). They found that surgical outcomes and use of adjuvant therapy differed significantly by age, race, socioeconomic factors, and hospital volume. When surveyed, minority patients and non-English speaking white patients reported significantly more problems than English-speaking white patients with coordination of care, access to cancer care, and receipt of desired information from physicians. The abstract and final report (NTIS Accession No. PB2004-106429; 24 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

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