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Methods and Measures

Assessing Pediatric Quality of Life in a Clinical Trial
Grant/Contract Number: HS09123
Project Period: 06/96-05/98
Principal Investigator: Robert D. Annett, Ph.D.
University of New Mexico
Albuquerque, NM 87131-5311
Purpose: To examine the relationship between a general multidimensional approach to quality of life measurement and a disease-specific approach to measuring quality of life in asthmatic children. Two different methods of assessing quality of life are being examined by administering the Pediatric Quality of Life Questionnaire (PQLQ) to asthmatic children and parents at the 12-month followup visit at five of the Childhood Asthma Management Program (CAMP) centers. The PQLQ administration is occurring in conjunction with the administration of the current CAMP quality of life questionnaire battery and other clinical information obtained at each visit, allowing the investigators to examine disease-specific quality of life in the context of the multidimensional measures currently employed in CAMP. This study employs discriminant function analyses in the data analysis.

Improving Efficiency and Quality with Information Systems
Grant/Contract Number: HS08297
Project Period: 07/94-06/96
Principal Investigator: David W. Bates, M.D., M.Sc.
Institution: Brigham and Women's Hospital
Boston, MA 02115
Purpose: To evaluate the effectiveness of an information system for improving the use of ancillary tests, measure the impact of actively promoting patient specific information and probabilities designed to improve the quality of therapy, and investigate ways in which information systems may help organizations monitor quality through a series of randomized controlled trials. This study should lead to improved quality and efficiency in giving providers information and feedback at the time orders are written.

Randomized Trial Comparing Masked/Unmasked Meta-Analysis
Grant/Contract Number: HS07728
Project Period: 07/93-12/95
Principal Investigator: Jesse A. Berlin, Sc.D.
Institution: University of Pennsylvania
Philadelphia, PA 19104-6021
Purpose: To answer an important methodological question about the effect of "blinding" in meta-analysis. The investigators compared results of two meta-analyses of the same set of randomized controlled trials. In the first meta-analysis, information that would reveal the identity of the included studies was provided to reviewers; in the second, reviewers were blinded to all identifying information. This randomized trial tested the hypothesis that blinding of reviewers, often difficult and expensive to do, leads to systematic differences in the results of meta-analysis.

Health Outcome Measurement in Nursing Homes
Grant/Contract Number: HS07585
Project Period: 09/93-03/96
Principal Investigator: Francis G. Caro, Ph.D.
Institution: University of Massachusetts
Boston, MA 02125-3393
Purpose: To develop a quality assurance methodology that is focused on patient outcomes for nursing homes in Massachusetts. The project developed facility level health outcome measures for nursing homes adjusted for patient characteristics. It was a first step in creating an analytic research file and analytic framework that can be used on a continuing basis to improve the quality of nursing home care in Massachusetts as well as in other States.

Multi-Institutional Test Bed for Clinical Vocabulary
Grant/Contract Number: HS08751
Project Period: 09/94-09/97
Principal Investigator: Christopher G. Chute, M.D.
Institution: Mayo Foundation
Rochester, MN 55905
Purpose: To strengthen electronic medical records systems by maintaining terminology models between and within the Mayo Foundation and Kaiser Permanente using relational tools and evaluating more sophisticated tools. The study measures the relative merits of terminology additions and changes as they affect guideline development and patient data retrieval. It also evaluates the impact of terminology variants on physician practice and satisfaction.

A Model of Patients' Preferences in Serious Illness
Grant/Contract Number: HS06754
Project Period: 08/91-01/94
Principal Investigator: Neal V. Dawson, M.D.
Institution: Case Western Reserve University
Cleveland, OH 44109-1998
Purpose: To (1) determine how seriously ill patients value commonly occurring symptoms and health outcomes, (2) estimate the effect of patient experiences with symptoms and health outcomes upon the values or preferences they associated with these variables, and (3) develop a common metric of patient utility. The results of this study will inform judgments made for patients who are unable to make judgments for themselves and inform policy decisions that may influence the care of seriously ill patients. Patients rated 21 sets of attributes (scenarios), and additional demographic and experiential data were collected. A composite patient preference model (CPPM) was derived by using conjoint analysis.

Validating Risk Prediction Models in Cardiology
Grant/Contract Number: HS08805
Project Period: 09/95 09/97
Principal Investigator: Elizabeth R. DeLong, Ph.D.
Institution: Duke University Medical Center
Durham, NC 27710 7510
Purpose: To test and develop methods to validate risk prediction models in cardiology. Using data from Duke, Minnesota, New York, Northern New England, HCFA, and Oklahoma, this investigation will develop validation strategies and apply them concurrently to existing models and datasets. While the methodology will primarily be implemented in the area of cardiology, the results should be applicable to other health care areas.

Using Outcomes to Assess Quality: Do Readmissions Matter?
Grant/Contract Number: HS06331
Project Period: 04/92-05/96
Principal Investigator: Arnold M. Epstein, M.D., M.A.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To determine whether readmission outcomes can be used to assess the quality of hospital care received by patients. Related Adverse Readmissions (RARs), defined as readmissions potentially related to less than optimal care during the initial hospitalization, were specified for patients recently treated for pneumonia and congestive heart failure. The project tested whether RARs can be used reliably to identify patients who may have received lower quality care. Quality of care on the index admission is being assessed to validate the relationship between quality of care and RARs. The study also solicited expert opinions.

Ongoing Development and Evaluation of HEDIS Measures
Grant/Contract Number: HS09473
Project Period: 09/96-09/99
Principal Investigator: Arnold M. Epstein, M.D.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To suggest a refinement of specific measures and identify important problems with individual indicators in the Health Plan Employer Data and Information Set (HEDIS) based on a rigorous and broad evaluation of HEDIS 3.0. Specifically, investigators will evaluate the new "reporting set" measures in HEDIS 3.0 and a subset of the original "reporting set" measures with respect to their relevance for users, the soundness of the science that underlies them, and the feasibility of implementing them. The study will develop and evaluate complete operational specifications for a subset of "testing set" measures that are particularly strong candidates for the next version of HEDIS.

Linking Health Databases: A Blueprint for Action
Grant/Contract Number: HS06639
Project Period: 05/91-04/92
Principal Investigator: Mark Epstein, Sc.D., M.S.P.H.
Institution: National Association of Health Data Organizations
Falls Church, VA 22046-4517
Purpose: To address the feasibility of linking public and private research related health databases. The study identified major research related databases maintained in the public and private sectors and provided health services researchers with useful information on the statistical characteristics of existing databases and the type of data available. The project also revised its Resource Manual on State health data organizations for use by health researchers.

Longitudinal Comparison of Measures for Health Outcomes
Grant/Contract Number: HS06491
Project Period: 09/90-02/96
Principal Investigator: Dennis G. Fryback, Ph.D.
Institution: University of Wisconsin
Madison, WI 53706
Purpose: To conduct a population-based longitudinal study of older adults to determine the relationship between two measures of health status: the Short Form General Health Survey used in the Medical Outcomes Study and the Quality of Well-Being scale. The resulting data gave population-based estimates of the relationships between two major measures of health status and estimate age- and sex-specific interval changes in these measures. They also provided population-based views on quality of life and changes in individual viewpoints.

Equation-Based Severity Measures for Revascularizations
Grant/Contract Number: HS06285
Project Period: 04/93-03/96
Principal Investigator: Arthur A. Hartz, M.D., Ph.D.
Institution: Medical College of Wisconsin
Milwaukee, WI 53226
Purpose: To evaluate equation-based severity of illness measures for patients having coronary artery bypass surgery or angioplasty to determine whether they can be improved, whether they are stable over time and over geographic region, and whether they are associated with risk adjusted patient outcomes after hospital discharge. The association of risk-adjusted outcomes with possible determinants of quality of care are being tested in a pilot study. Five types of data are being analyzed for this study.

Screening Quality of Care Using Administrative Data
Grant/Contract Number: HS09099
Project Period: 05/95-04/98
Principal Investigator: Lisa I. Iezzoni, M.D.
Institution: Beth Israel Hospital
Boston, MA 02215
Purpose: To examine three questions addressing different dimensions of validity of the Complications Screening Program (CSP) developed by the investigators (see HS06512): (1)HS06512 Do hospitals code diagnoses and procedures completely and accurately in their discharge abstracts? (2) Are the CSP assumptions from discharge abstract data, used in judgments about potential quality problems, correct? (3) Are individual cases flagged by the CSP as potentially problematic more likely to have quality problems than other cases?

Screening Inpatient Quality Using Postdischarge Events
Grant/Contract Number: HS08248
Project Period: 09/94-03/97
Principal Investigator: Lisa I. Iezzoni, M.D.
Institution: Beth Israel Deaconess Medical Center
Boston, MA 02215
Purpose: To develop computerized algorithms to screen hospitals for potentially substandard care using readily available administrative data pertaining to the inpatient stay and outpatient and other nonacute care in the period immediately following discharge. This study seeks to create the CSP-O, which is the outpatient version of the Complications Screening Program, and to examine the results of applying the CSP-O to a Medicare Part A and B administrative data file including all elderly Medicare admissions to a stratified random sample of 500 acute care hospitals.

Evaluating Severity Adjustors for Patient Outcome Studies
Grant/Contract Number:HS06742
Project Period: 09/91-09/94
Principal Investigator: Lisa I. Iezzoni, M.D.
Institution: Beth Israel Hospital
Boston, MA 02215
Purpose: To compare nine different severity indexes for predicting resource use, mortality in the hospital and post- discharge, and in hospital complications; and to look at the impact of different risk-adjustment strategies on perceptions about the outcomes of care. Results of this study detailed important considerations for choosing among severity measurement systems for different research objectives, particularly patient outcome studies.

Screening Quality of Care Using Administrative Data
Grant/Contract Number: HS06512
Project Period: 09/90-09/92
Principal Investigator: Lisa I. Iezzoni, M.D.
Institution: Beth Israel Hospital
Boston, MA 02215
Purpose: To develop and evaluate computerized algorithms to screen for substandard care and poor outcomes in hospital patients by using readily available administrative data. This project delineated screens and evaluated their results by using Uniform Hospital Discharge Data Set data from hospitals in Massachusetts and California. This study provided a tool for examining hospital quality and patient outcomes by using large administrative databases and assisted in targeting more efficient chart-based reviews of quality and patient outcome.

Refining the Measurement of Quality of Care
Grant/Contract Number: HS06546
Project Period: 04/91-03/94
Principal Investigator: Katherine L. Kahn, M.D.
Institution: RAND
Santa Monica, CA 90407-2138
Purpose: To develop reliable and valid measures of the quality of care for Medicare patients ages 65 and older. The project answered a series of questions about clinical epidemiology, quality of care methods, and health policies using an existing nationally representative database of the target population. This project resulted in a series of manuscripts documenting the analyses and their implications for future measurement of quality of care.

Methodologic Studies on APACHE III
Grant/Contract Number: HS05787
Project Period: 01/88-03/92
Principal Investigator: William A. Knaus, M.D.
Institution: George Washington University
Washington, DC 20037
Purpose: To further understand and refine a severity of illness index, the Acute Physiology and Chronic Health Evaluation (APACHE) III. This study aimed at providing physicians, hospitals, and patients with nationally representative information that would improve the use and quality of adult medical surgical intensive care services. The study was based on information collected from 16,000 intensive care unit (ICU) admissions from 40 acute care hospitals and on data on the structure, management, and process of ICU care at the hospitals.

Databases for Ambulatory Care Effectiveness Studies
Grant/Contract Number: 290-91-0015
Project Period: 05/91-11/92
Principal Investigator: Selma C. Kunitz, Ph.D.
Institution: Kunitz and Associates, Inc.
Rockville, MD 20852
Purpose: To stimulate and promote research on the effectiveness of medical treatments on diseases generally managed on an outpatient basis. This AHCPR project identified and improved access to extant databases of ambulatory care medical records. It determined the availability and accessibility of ambulatory care medical records systems and databases that contain patient descriptors, treatment, and outcome information. It also assessed the feasibility of combining existing databases to create a central database resource to support research on the effectiveness of medical care. As a result of this study, AHCPR published an extensive literature review on ambulatory care records systems entitled "Automated Data Sources for Ambulatory Care Effectiveness Research."

Meta-Analytic Techniques for Assessing Valve Surgery
Grant/Contract Number: HS07566
Project Period: 09/93- 03/95
Principal Investigator: Benjamin Littenberg, M.D.
Institution: Washington University School of Medicine
St. Louis, MO 63110-1093
Purpose: To improve the outcome of patients with valvular heart disease and to expand the use of meta-analysis beyond the realm of randomized controlled trials. A meta-analysis of patient outcomes after valve surgery provided valuable information for patients and physicians considering choice of prosthesis. A new statistical method was then developed and applied to analyze the data.

Codes and TCP/Toolkits for Exchanging Clinical Data
Grant/Contract Number: HS08750
Project Period: 09/94-09/97
Principal Investigator: Clement J. McDonald, M.D.
Institution: Indiana University
Indianapolis, IN 46202-2859
Purpose: To eliminate barriers in transferring patient observations to computer based medical records systems. The project will develop toolkits for implementing message standards and universal codes for identifying distinct test results, clinical measurements, and sections of dictated reports transmitted via these standards; develop a portable set of C++ programs/subroutines for sending and receiving patient observations between independent systems using standard medical informatics and Internet protocols; and develop naming conventions and assign a fully specified name and code for each unique laboratory result, most clinical measurements, and components of narrative clinical reports.

Adult Global Quality Assessment Tool
Grant/Contract Number: HS09463
Project Period: 09/96-09/99
Principal Investigator: Elizabeth A. McGlynn, Ph.D.
Institution: RAND Corporation
Santa Monica, CA 90407-2138
Purpose: To develop a more comprehensive approach to quality assessment than has been previously designed. Specifically, researchers will (1) synthesize evidence about the effectiveness of interventions for 15 20 important conditions; (2) develop draft, evidence-based quality of care criteria in each clinical area; (3) conduct formal expert panels to select indicators; (4) design and pilot test a computerized data collection method that uses enrollment and administrative data to select an enriched random sample of enrollees; (5) field test the data collection methods on enrollees from four managed care plans; (6) evaluate the utility of the method for distinguishing among health plans; and (7) produce and disseminate a tool—applicable to the entire population—for implementation by health plans, accrediting bodies, and other researchers.

History of the Randomized Clinical Trial
Grant/Contract Number: HS06792
Project Period: 09/90-08/91
Principal Investigator: Marcia L. Meldrum, M.B.A., M.A.
Institution: State University of New York
Stony Brook, NY 11794-4348
Purpose: To investigate the process that led to the acceptance of randomized clinical trials (RCTs) as the "gold standard" for the evaluation of effectiveness of medical products and procedures, and to review specific trials of the 1950s and 1960s and the negotiation process that framed their planning and implementation. The study tested the hypothesis that the RCT is not a static dogma, but a dynamic tool that was crafted and modified to meet changing medical and social needs within its history.

Effects of Stressful Life Events on Health Outcomes
Grant/Contract Number: HS06622
Project Period: 07/90-08/91
Principal Investigator: Lisa S. Meredith, Ph.D., M.A.
Institution: RAND
Santa Monica, CA 90407-2138
Purpose: To investigate how stressful life events affect health outcomes of chronically ill elderly men and women over time and to develop a model for scoring life events across age groups. This research used data from the Medical Outcomes Study. The results of the study had implications for health care planning, particularly in the area of resource allocation for the increasing needs of the elderly.

Hierarchical Statistical Modeling in Health Policy Research
Grant/Contract Number: HS07118
Project Period: 08/92-07/96
Principal Investigator: Carl Morris, Ph.D.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To accomplish the transfer of a new statistical development, hierarchical (multilevel) statistical modeling, to health services, outcomes, and policy research. Hierarchical models will provide better inferences for individual units by borrowing strength of information from the ensemble. They make it possible to account properly for different levels and sources of variation in complex datasets. The findings will be disseminated to the general community of researchers via a series of prototype analyses for specific problems.

Meta-Analysis for Medicine: Application and Methods
Grant/Contract Number: HS05936
Project Period: 07/88-06/94
Principal Investigator: Frederick Mosteller, Ph.D.
Institution: Harvard University
Boston, MA 02115
Purpose: To carry out new meta-analyses and update previous meta-analyses for certain diagnostic and therapeutic procedures. The project assessed the quality of clinical trials in health and medicine by using empirical studies that show how features of research designs, including randomization, placebos, blinding, stopping rules, and multifactorial designs, influence the reliability of study results. The study contributed to the knowledge of specific diagnostic procedures and methods for their evaluation.

Cost Effectiveness of Utility Assessment in Hypertension
Grant/Contract Number: HS07606
Project Period: 01/93-12/97
Principal Investigator: Robert F. Nease, Jr., Ph.D., M.S.
Institution: Washington University Medical School
St. Louis, MO 63110
Purpose: To apply a formal approach for determining whether patient preferences should be incorporated into practice guidelines in the context of mild hypertension. The study will use a utility assessment tool to estimate the cost effectiveness of individualizing treatment recommendations to account for patient preferences. The utilities of mildly hypertensive patients will be incorporated into an existing decision model to determine the impact of the variation in patient preferences on the health benefit offered by medical treatment relative to monitoring.

Measuring Effectiveness of Clinical Management Systems
Grant/Contract Number: HS06469
Project Period: 9/90-09/94
Principal Investigator: R. Heather Palmer, M.B., S.M., B.Ch.
Institution: Harvard University
Boston, MA 02115
Purpose: To develop indicators of the technical quality of care related to clinical management systems in primary health care. Questionnaires were made and mailed to ambulatory care patients. Indicators were combined into regular reports of system performance in the areas of provision of care, completion of workups, implementation of treatment decisions, implementation of preventive care, and communication with patients.

Critical Pathways and Feedback to Improve Quality
Grant/Contract Number: HS08311
Project Period: 07/94-06/97
Principal Investigator: Steven D. Pearson, M.D., M.Sc.
Institution: Brigham and Women's Hospital
Boston, MA 02115
Purpose: To (1) assess the impact of Critical Pathways on hospital length of stay, overall resource utilization, patient satisfaction with care, and clinical outcomes; and (2) evaluate the importance of the feedback of variance data as part of a continuous quality improvement program by describing the types and sequences of process changes that occur during the CQI development cycle.

Risk and Risk Factor Modeling Project
Grant/Contract Number: HS07002
Project Period: 02/92-01/95
Principal Investigator: Louise Russell, Ph.D.
Institution: Rutgers University
New Brunswick, NJ 08903
Purpose: To develop a comprehensive multivariate model of the risk of death and other adverse health outcomes as functions of a common set of important risk factors, using data from the 1987 National Health and Nutrition Examination Survey Epidemiological Follow up Study. The model provided a picture of the impact of different risk factors on health. It permitted the effects of a wide variety of interventions against those risk factors to be estimated in a common framework so that valid comparisons could be made across interventions.

Sharing Paperless Records Among Provider Networks
Grant/Contract Number: HS08749
Project Period: 12/94-11/97
Principal Investigator: Charles Safran, M.D.
Institution: Beth Israel Hospital
Boston, MA 02215
Purpose: To test the hypothesis that the medical record for inpatients and outpatients can be rendered entirely paperless, using a computer based online medical record system (OMR) that was developed for an office based general medical practice at Beth Israel Hospital. The study focuses on the interaction of the provider with the computer based medical record as well as sharing of patient records across disciplines, across traditional inpatient/outpatient boundaries, and across a geographically dispersed community. The OMR will be transformed into a community based medical record that serves medical and surgical specialty interests as well as office and hospital based needs. It will serve as a test bed for the development of a structural and functional model of a medical record that will provide access to problem and medication lists, navigation of a clinical narrative, trigger points for clinical guideline usage, and patient summaries.

Combining Different Data Sources to Assess Treatments
Grant/Contract Number: HS08532
Project Period: 02/95-01/97
Principal Investigator: Christopher H. Schmid, Ph.D.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To enhance and evaluate three major approaches to combining results from clinical studies, namely, meta-analysis, super analysis, and meta-regression. These approaches are being applied to clinical areas such as the impact of the use of thrombolytic therapy and the treatment of hypertension and congestive heart failure. The constructed models are being assessed with respect to their form of presentation, variable selection, estimated treatment effect, model goodness of fit, predictive performance, clinical applicability, and applicability to health care policy.

A Time-Insensitive Predictive Instrument Impact Trial
Grant/Contract Number: HS07360
Project Period: 02/93-05/95
Principal Investigator: Harry P. Selker, M.D., M.S.P.H.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To test, in a multicenter 17,500-patient controlled clinical trial, the impact of the acute cardiac ischemia (ACI) Time-Insensitive Predictive Instrument (TIPI) electrocardiograph on (1) reducing unnecessary non-ACI critical care unit admissions; (2) reducing mistaken emergency department (ED) discharges to home of patients with ACI, especially those with acute myocardial infarction (AMI); (3) reducing the number of AMI-related complications by improved triage performance; (4) reducing time from ED presentation to triage; and (5) reducing time to the ED use of thrombolytic therapy for AMI. In this large prospective test in a wide range of hospitals, the ACI-TIPI predictions automatically generated by an electrocardiograph accurately predicted the likelihood of ACI, of AMI, and of ACI-related complications.

Assessing Appropriateness of Expert Panels: How Reliable?
Grant/Contract Number: HS07185
Project Period: 09/93-08/96
Principal Investigator: Paul G. Shekelle, M.D., M.P.H.
Institution: RAND
Santa Monica, CA 90407-2138
Purpose: To test the reliability of expert panels in assessing the appropriateness and necessity of medical procedures. These assessments have become increasingly important to third party payers, health policy analysts, and practicing clinicians through their use in the development of practice guidelines, utilization review guidelines, and quality assurance guidelines. Three panel sessions and a mail survey are being conducted in each of two conditions.

Failure Rate: A New Outcome Measure of Quality of Care
Grant/Contract Number:HS06560
Project Period: 02/92-01/95
Principal Investigator: Jeffrey H. Silber, M.D., Ph.D.
Institution: University of Pennsylvania
Philadelphia, PA 19104
Purpose: To further develop and validate the failure rate, a new outcome measure. The death rate was dissected into its component parts, the adverse occurrence rate and the failure rate, in order to develop improved measures of hospital quality of care. This study sought to confirm a previous finding that factors that predict failure are distinct from those that predict mortality or adverse occurrence.

Development of a Child Health Status Measure
Grant/Contract Number: HS08829
Project Period: 03/89- 03/00
Principal Investigator: Barbara Starfield, M.D., M.P.H.
Institution: The Johns Hopkins University
Baltimore, MD 21205
Purpose: To produce child health status instruments that comprehensively measure the health and illness profile of children aged 5 to 11. During phases I and II, this study will develop a set of acceptable, reliable, and valid instruments to assess the health status of children based on 220 parent-child pairs in urban Balitmore. Phase III will be devoted to producing the final versions of the instruments, which will be systematically tested in geographically distinct populations with different racial and ethnic backgrounds. The resulting instruments will permit children's health status and development to be monitored over time and in response to health services interventions.

Resource Use in Seriously Ill Medicare Patients
Grant/Contract Number: HS09129
Project Period: 07/95-06/97
Principal Investigator: Joan M. Teno, M.D., M.S.
Institution: Center to Improve Care of the Dying
Washington, DC 20037
Purpose: To link the Medicare claims files of beneficiaries with two databases that have examined both the process of decision making and the outcomes of illnesses in seriously ill hospitalized patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) and in hospitalized patients more than 80 years old (Hospitalized Elderly Longitudinal Project). The results of the study will enable the researchers to perform analyses aimed at informing public policy discussion, such as examining the correlates of resource utilization and examining the impact on resource use of the SUPPORT intervention and the Patient Self Determination Act.

Statistical Methods for Quality-of-Life Outcomes Research
Grant/Contract Number: HS07767
Project Period: 03/93-02/97
Principal Investigator: Marcia Anne Testa, Ph.D.
Institution: Harvard School of Public Health
Boston, MA 02115
Purpose: To (1) evaluate and analyze current and potential measurement and statistical techniques used in quality-of-life-related patient outcomes through a review of the literature; (2) refine existing analytical and statistical methodology so that it is appropriate for evaluation of pharmacologic therapies; and (3) develop data analysis demonstration projects within major analytical areas by applying selected methods to existing quality-of-life clinical trials databases of hypertension, diabetes, and human immunodeficiency virus.

Community-Based Pharmaceutical Care: A Controlled Trial
Grant/Contract Number: HS09083
Project Period: 06/96-05/00
Principal Investigator: Morris Weinberger, Ph.D.
VA Medical Center
Indianapolis, IN 46202
Purpose: To develop algorithms to facilitate pharmaceutical care for the treatment of asthma. A randomized controlled trial, with 460 patients in a pharmacy intervention group and two control groups, will be undertaken. The pharmacy intervention group will be provided with patient-specific clinical information displayed on their computer workstations when filling prescriptions. This study will take advantage of Indiana University's long-standing project to develop an electronic medical record. Patient records will be available to the pharmacist from 6 hospitals and 24 free-standing clinics. Pharmacy records will also be made available to these linked providers.

Evaluating Outcomes of Hospital Care Using Claims Data
Grant/Contract Number: HS05745
Project Period: 07/87-02/93
Principal Investigator: John E. Wennberg, M.D., M.P.H.
Institution: Dartmouth Medical School
Hanover, NH 03755-3863
Purpose: To (1) generate descriptive statistics of mortality and morbidity for the most frequent index medical admissions and surgical procedures, and to examine the relationship between outcomes and hospital characteristics; (2) test the specific hypotheses concerning the associations between alternate therapeutic approaches and patient outcomes for a selected subset of the frequent medical and surgical hospitalizations; and (3) validate outcomes for prostatectomy through a review of patient records. Medicare and Manitoba Health Commission claims data were evaluated for their utility in relation to the first two aims.

Outcome Assessment: Validation of Cognitive Function Scale
Grant/Contract Number: HS06530
Project Period: 02/92-12/95
Principal Investigator: Pamela G. Williams Russo, M.D., M.P.H.
Institution: Cornell Medical Center
New York, NY 10021
Purpose: To develop a multi-item scale of cognitive functional status that can be used in practice and research to evaluate change in cognitive function in the elderly, and that can be integrated with other patient centered measurements of functional status and well being. This study tested the reproducibility, validity, and responsiveness of the scale and integrated the results with those obtained using the Medical Outcomes Study instrument (SF-36) and with formal neuropsychologic testing.

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Current as of March 1997
AHCPR Pub. No. 97-R047

Internet Citation:

Medical Treatment Effectiveness Program (MEDTEP) Research Projects, 1989-1996. AHCPR Pub. No. 97-R047, March 1997. Agency for Health Care Policy and Research, Rockville, MD.


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