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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.

Biofeedback and Urinary Incontinence in Older Women. Elizabeth Dugan, Ph.D., Wake Forest University School of Medicine, Winston-Salem, NC. AHRQ grant HS10663, project period 7/1/00-12/31/01.

The prevalence, cost, and treatment outcomes associated with urinary incontinence (UI) provide compelling reasons to study novel treatments. The primary aims of this 1-year pilot study were to assess the ability to recruit participants to take part in a randomized clinical trial of the efficacy of biofeedback in treating UI; develop experience with intervention materials, data collection procedures, and participant management related to the proposed clinical trial; and develop confidence in the hypothesis that the proposed biofeedback regimen is associated with clinically meaningful treatment effects. The multidisciplinary investigative team randomized postmenopausal women for biofeedback treatment to either three visits or six visits. The study identified some necessary modifications to the enrollment scheduling procedures. Results on two key indicators (change in frequency of UI and quality of life) suggest that three sessions of biofeedback therapy should be used in the followup study.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-105097; 13 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Cause and Effect of Hospital Distress and Closure. Richard C. Lindrooth, Ph.D., Northwestern University, Evanston, IL. AHRQ grant HS10730, project period 9/30/99-9/29/01.

Most metropolitan areas and many rural communities have been affected by hospital closure, raising concerns that closure will affect access to care in their communities. These researchers found that in urban markets, hospital closure occurs in markets with an excess supply of beds. The hospitals that do close tend to be inefficient hospitals; and the efficiency of the market improves after closure. However, hospitals that close also treat a relatively large proportion of Medicaid patients, and this may be correlated with uncompensated care. In rural markets, hospitals that survive tend be more diversified. Surviving hospitals tend to have a larger proportion of outpatient surgeries, outpatient visits, and more high-tech equipment that is used in an outpatient setting. Hospital mergers that result in the closure of one of the facilities lead to significant cost savings. Other types of mergers do not result in any consistent cost savings over time. This result is also due to the desirability of closing excess beds in the face of low occupancy rates. None of these results suggest that hospitals should be encouraged to close; rather, in markets where access is not a problem, hospitals should not be prevented from closing. Further research is needed to determine the optimal occupancy rate in light of uncertain future demand for beds.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104719; 40 pp, $25.50 paper, $12.00 microfiche) are available from NTIS.

Comparison of Quality of Life Measures in Heart Failure. Susan J. Bennett, D.S.N., Indiana University, Indianapolis. AHRQ grant HS09822, project period 7/1/98-6/30/01.

Health-related quality of life (HRQOL) instruments have been used to measure HRQOL in heart failure patients, but how different instruments compare in the same groups of patients is not known. The purpose of this study was to compare the reliability and validity of three HRQOL measures in 211 heart failure patients recruited from clinics affiliated with an urban hospital. Two disease-specific instruments, the Chronic Heart Failure Questionnaire (CHQ) and the Living with Heart Failure Questionnaire (LHFQ), and one generic instrument, the Short-Form 12 (SF-12), were administered. Patients reported moderate to low HRQOL scores. Floor or ceiling effects were noted in the disease- specific instruments. Internal consistency and reliability of the CHQ and LHFQ were satisfactory. Construct, convergent, and discriminant validity were supported for each instrument. All three instruments were satisfactory for measuring HRQOL, but the disease-specific instruments were preferable to the generic instrument.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104720; 34 pp, $25.50 paper, $12.00 microfiche are available from NTIS.

Effectiveness of NHLBI Guide on Childhood Asthma Outcomes. Philip V. Scribano, D.O., Connecticut Childrens Medical Center, Hartford. AHRQ grant HS09825, project period 9/30/98-9/29/01.

In 1997, the National Asthma Education Program consensus panel, organized by the National Heart, Lung and Blood Institute (NHLBI), revised the guidelines for the care and management of children and adults with asthma. The impact of these guidelines on asthma care in the United States is unclear, since hospitalization rates and mortality continue to rise. The researchers examined the impact of using clinical practice guidelines on the quality of asthma care as defined by a reduction in the 7-day relapse rate and improvement in functional outcome using the Child Health Questionnaire. They evaluated the efficacy of a program designed to adhere to the NHLBI guidelines on asthma management in an emergency department observation unit setting. The study involved a prospective cohort design of all children aged 1 to 18 seen in the Connecticut Children's Medical Center emergency department for an asthma exacerbation. The researchers examined whether or not care in the alternative observation unit can provide similar outcomes to traditional inpatient hospitalization.

Print copies of the abstract and executive summary, NTIS accession no. PB2002-104710; 17 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Efficacy of Telemedicine Colposcopy. Daron G. Ferris, M.D., Medical College of Georgia, Augusta. AHRQ grant HS08814, project period 9/30/97-9/29/01.

The purpose of this study was to estimate the efficacy of telecolposcopy for rural health care sites. Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics, and the images were transmitted to a tertiary care center for interpretation by a distant expert colposcopist. Another colposcopist (site exert) in attendance at the rural site also examined the same subjects. Colposcopists independently determined the exam adequacy, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed. Teleconsultation was required for 36.2 percent of examinations. A significantly lower percentage of satisfactory colposcopic exams were noted by the distant colposcopists (60 percent) compared with the other colposcopists. Colposcopic impression agreement with histology varied minimally, 59.7 percent for local colposcopists, 52.7 percent for site experts, and 55.7 percent for distant experts. The researchers conclude that telecolposcopy may help reduce barriers to medical access for women in rural areas.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104713; 62 pp, $27.00 paper, $12.00 microfiche are available from NTIS.

Ensuring Quality Cancer Care: Symposium. Charles L. Bennett, M.D., Ph.D., Northwestern University, Evanston, IL. AHRQ grant HS10933, project period 9/30/00-9/29/01.

The Robert H. Lurie Comprehensive Cancer Center of Northwestern University convened a cancer care symposium in November 2000. The objectives of the 1-day meeting were to discuss and define quality cancer care, identify methodologies for defining quality, describe those factors (particularly those related to culture and ethnicity) that impede access to quality cancer care, and instruct participants in the use of evidence-based oncology to improve cancer care outcomes.

Print copies of the abstract, executive summary, and final report of symposium, NTIS accession no. PB2002-104711; 10 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Health Care Privacy: Measuring Performance. Matthew K. Wynia, M.D., M.P.H., American Medical Association, Chicago, IL. AHRQ grant HS10928, project period 8/15/00-8/14/01.

The Ethical Force Program is a broad-based collaborative effort to develop and validate performance measures for ethics that will be useful throughout the health care system and serve as overall markers of health care quality. A primary domain for performance measure development in ethics is the protection of privacy and confidentiality in health care. This project involved an expert working conference on the development of measures to assess organizational privacy and confidentiality protections. The meeting was held November 14-15, 2001 in Washington, DC. Attendees worked on refining and/or developing workable performance measures and the creation of organization-specific toolkits for assessing ethics quality in four discrete types of organizations (hospitals, physician groups, health plans, and employer/purchasers). Plans were devised for field-testing the measures.

Print copies of the abstract and executive summary, NTIS accession no. PB2002-104712; 12 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Improving Emergency Medical Services for Children Through Outcomes Research: An Interdisciplinary Approach. Ellen F. Crain, M.D., Ph.D., Ambulatory Pediatric

Association, McLean, VA. AHRQ grant HS10942, project period 1/1/01-12/31/01. This project provided support for a conference focused on strategies to overcome barriers to research in pediatric emergency medicine. The goals were to review existing outcome measures, including their strengths and weaknesses and their applicability to pediatric emergency medicine; identify areas where new measures are needed; promote dialogue between health services researchers, representatives of Federal agencies, and pediatric emergency medicine investigators; and foster a new generation of pediatric emergency medicine researchers with improved understanding of health services research methodology.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-106800; 34 pp, $25.50 paper, $12.00 microfiche are available from NTIS.

Primary Care Fellowship Evaluation. Diane Brannon, Ph.D., Pennsylvania State University, University Park, PA. AHRQ grant HS10714, project period 9/30/99-9/29/01.

The U.S. Public Health Service's (PHS) Health Resources Services Administration has conducted the Primary Care Policy Fellowship program annually since 1991. The goal of the fellowship is to enhance the capabilities of mid-career primary care academicians, researchers, administrators, and practitioners concerning primary care policy development, the legislative process, resource identification, and leadership skills. As of 1999, some 260 fellows had completed the program. These researchers evaluated the long term impact of the fellowship on participants' career activities and on the capabilities of the nominating organizations. Content analysis of annual evaluation reports, a survey of past fellows, and interviews with organizational stakeholders were conducted. Of the 48 percent of surveyed fellows responding, the large majority (83 percent) did cite specific ways in which the fellowship had influenced their careers. Organizational stakeholders also identified specific projects completed by fellows. Recommendations for improvement focused on broadening the impact at the nominating organization level.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104721; 42 pp, $25.50 paper, $12.00 microfiche are available from NTIS.

Second National Conference on Health Care Journalism. Melinda S. Voss, M.P.H., Association of Health Care Journalists, Minneapolis, MN. AHRQ grant HS10927, project period 1/15/01-1/14/02.

This project provided support for a national conference on health care journalism held March 22-24, 2002 in Atlanta, GA. More than 150 journalists attended and took part in sessions on health care quality, access to care, prescription drugs, health care fraud, gun violence, genetics, obesity, health care reform, and other topics.

Print copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-10927; 18 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Spouse Involvement in Cardiac Patients' Exercise Behavior Change. Tantina B. Hong, Ph.D., Wayne State University, Detroit, MI. AHRQ grant HS11263, project period 9/30/00-9/29/01.

Health promoting behaviors such as exercise are known to be beneficial in lessening the disabling effects of heart disease. This study examined the social processes underlying exercise behavior change in 80 married couples.

Print copies of the abstract, executive summary, and dissertation, NTIS accession no. PB2002104715; 132 pp, $36.00 paper $17.00 microfiche are available from NTIS.

Use of Quality Report Cards by Patients, Physicians, and MCOs. Dana B. Mukamel, Ph.D., University of Rochester School of Medicine, Rochester, NY. AHRQ grant HS089803, project period 9/30/96-9/29/01.

Quality report cards, which provide the public with information about the performance of hospitals, physicians, and managed care organizations (MCOs), have become a permanent fixture of health care markets. This study was designed to evaluate their effectiveness in influencing the contracting practices of MCOs and referrals among fee-for-service (FFS) patients using the New York State Cardiac Surgery Reports. These reports provide information about surgeons' and hospitals' risk adjusted mortality rates (RAMR) and are considered to be highly valid and reliable. Survey data, data about contracting between MCOs and cardiac surgeons, and Medicare claims data were analyzed using statistical regression techniques. Results indicate that the information in these reports is associated with both MCO contracting practices and referrals in the FFS sector. MCOs are more likely to include in their provider panels cardiac surgeons with lower RAMR and those who have been designated as high quality outliers. Further, FFS patients are more likely to seek surgeons with lower RAMR. The importance of RAMR increased in the year following the first publication of the reports, while the importance of other signals for quality (such as price and experience of the surgeon) diminished.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104716; 16 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Using Census Data to Monitor Care to Vulnerable Groups. Kevin Fiscella, M.D., M.P.H., Highland Hospital, Rochester, NY. AHRQ grant HS10295, project period 9/30/99-9/29/01.

Convenient practical measures of socioeconomic status are needed by health care organizations to monitor progress towards the Healthy People 2010 goal of eliminating disparities. This project had three goals: one, develop clinically relevant indicators that are sensitive to socioeconomic disparities in the quality of primary health care; two, examine the relative performance of census-based indicators for monitoring socioeconomic disparities in quality of care; and three, determine which primary care indicators are sensitive to racial/ethnic differences in quality of care after adjustment for socioeconomic status. Using data from the Medical Expenditure Panel Survey Household Component (MEPS-HC), quality measures for preventive health, costs, and satisfaction were developed. Significant socioeconomic disparities were observed across most preventive and utilization measures. There were few socioeconomic, racial, or ethnic disparities in satisfaction, and there was no consistent variation by race or ethnicity in health care use. Adjustment for socioeconomic factors had little effect on these variations.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104718; 56 pp, $27.00 paper, $12.00 microfiche are available from NTIS.

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