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AHCPR Awards 12 New Research Projects Aimed at Improving Quality of Care for Vulnerable Populations

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Press Release Date: November 18, 1999

The Agency for Health Care Policy and Research (AHCPR) today announced funding for 12 new research projects which are aimed at developing measures of quality of care for vulnerable populations. These grants are funded under AHCPR's Request for Applications (RFA) entitled "Measures of Quality of Care for Vulnerable Populations," which was released on December 22, 1998. The goal of the RFA, part of a series of three new calls for research on quality of health care, was to develop and test new quality measures which can be used in the purchase or improvement of health care services for these populations.

The funding for these new projects is anticipated to total $8.84 million over a 3-year period. The newly funded projects are:

  • Measuring Patient Satisfaction: Low Literacy Populations. Principal investigator: Judy Shea, Ph.D. University of Pennsylvania, Philadelphia, PA. $1,531,035; 09/30/99-09/29/02. (Grant No.: HS10299)

    This study will adapt AHCPR's Consumer Assessment of Health Plans (CAHPS®) survey to make it even more accessible to low-literacy populations by developing and testing two alternative formats—illustrated and interactive voice-response. CAHPS® is a series of surveys and reporting formats that helps consumers and other purchasers make decisions about health plans by providing them with information on what members of health plans think about the care and services they receive.

  • Measuring the Quality of Care for High Risk Infants. Principal investigator: Jeannette A. Rogowski, Ph.D. RAND, Santa Monica, CA. $1,120,241; 09/30/99-09/29/02. (Grant No.: HS10328)

    In this project, investigators will seek to achieve the following objectives: 1) develop new methods to measure the quality of care for very low birth weight infants that overcome the problems of small sample size, bias from patient mix, and the multidimensional nature of quality; 2) apply these methods for the estimation of past quality of care and the prediction of future quality of care; and 3) identify and apply a minimum set of quality measures that summarize quality differences and economic performance across time and place (i.e., hospitals).

  • A Patient-Centered Quality Measure for Asian-Americans. Principal investigator: Russell S. Phillips, M.D. Beth Israel Deaconess Medical Center, Boston, MA. $1,073,524; 09/30/99-09/29/02. (Grant No.: HS10316)

    In this project, investigators will develop and validate a questionnaire to examine the quality of care from the patient's perspective for Asian Americans of Chinese and Vietnamese descent.

  • Measuring Quality of Care for Vulnerable Children. Principal investigator: Michael Seid, Ph.D. Children's Hospital and Health Center, San Diego, CA. $928,081; 09/30/99-09/29/01. (Grant No.: HS10317)

    The goal of this project is to validate an existing pediatric health-related quality-of-life instrument, the Pediatric Quality of Life Inventory (PedsQL), as an outcome measure of quality of care for vulnerable children. In cooperation with the San Diego Unified School District, investigators also will examine the relationships among structures and processes of care, health-related quality of life, and school outcomes in the context of HealthLink, a district-wide school health initiative. The research will include English, Spanish, Tagalog and Vietnamese-speaking children and families.

  • Quality Measurement in Residential Care. Principal investigator: M. Catherine Hawes, Ph.D. Menorah Park Center for the Aging, Beachwood, OH. $720,911; 09/30/99-09/29/02. (Grant No.: HS10315)

    This study will develop quality measures for residential care facilities that could be used in external quality assurance systems, consumer report cards, and in performance feedback systems for providers. In addition, investigators will develop quality improvement protocols and a resident classification model that could be used to adjust for case mix intensity for such facilities.

  • Prescription Benefits As a Quality Measure. Principal investigator: Barry G. Saver, M.D. University of Washington, Seattle, WA. $617,145; 09/30/99-09/29/01. (Grant No.: HS10318)

    This project will evaluate whether the comprehensiveness of prescription drug coverage can serve as a measure of quality of care among elderly Medicare beneficiaries with chronic health conditions. Investigators also will assess whether the magnitude of the relationship between comprehensive prescription drug coverage and quality of care is greater among indigent people.

  • Computerized Tool Assessment in Low Literacy Patients. Principal investigator: Elizabeth A. Hahn, M.A. Center on Outcomes Research and Education, Evanston, IL. $594,939; 09/30/99-09/29/01. (Grant No.: HS10333)

    This project will develop and evaluate an audiovisual computer-based system to assess health status and quality-of-life outcomes for English-speaking cancer patients with low levels of literacy. These assessments will be compared with patients with high levels of literacy for equivalence.

  • Measuring the Quality of Care for Diabetes. Principal investigator: Jack Needleman, Ph.D. Harvard University, Cambridge, MA. $566,751; 09/30/99-09/29/01. (Grant No.: HS10332)

    This study will use Medicaid data from six states to develop claims-based quality measures for ambulatory diabetes care. The specific aims of the study are to: 1) identify specific components of care for managing diabetes that are appropriate indicators, and can be tracked through administrative databases; 2) analyze variation in receipt of specified indicator care components including testing the ability of claims data to support analysis, determining variation in practice patterns, and assessing the level of variation; 3) determine the relationship between inpatient admission rates for diabetes and the level and type of ambulatory care received; and 4) arrange the indicator ambulatory care components in priority order for appropriateness in use in a quality-monitoring system.

  • Facility Effects on Racial Differences in New Hampshire Quality. Principal investigator: Mary L. Fennell, Ph.D. Brown University, Providence, RI. $541,447; 09/30/99-09/29/01. (Grant No.: HS10322)

    This project will explore an understanding of how nursing home structure and local community contexts interact to affect the quality of care experienced by white and minority nursing home residents. Specific aims are to: 1) quantify the extent to which access to nursing home care is segregated by race and ethnicity; 2) develop a measure of racial/ethnic disparities in the quality of care that compares the odds of receiving poor quality of care for whites and nonwhites; 3) examine variation in and relationships between the two separate concepts of nursing home quality of care and racial/ethnic disparities; 4) test for the effects of demographic "mismatch" between community and nursing home staff on racial/ethnic disparity; and 5) develop and test a multilevel model explaining variation in nursing home quality of care as well as racial/ethnic disparities as a function of patient level, facility level and community level factors.

  • Quality Measures for Severe/Persistent Mental Illness. Principal investigator: Richard C. Hermann, M.D. Harvard University, Boston, MA. $496,842; 09/30/99-09/29/01. (Grant No.: HS10303)

    This project will: 1) identify, inventory, and describe existing measures of the quality of mental health care for individuals with severe and persistent mental illness; 2) develop selected measures and test their meaningfulness and feasibility; and 3) implement selected measures as part of ongoing efforts to improve the quality of treatment provided to Medicaid recipients and other patients with severe and persistent mental illness in Massachusetts.

  • Cultural Relevance of a Community of Care Measure. Principal investigator: Norma C. Ware, Ph.D. Harvard Medical School, Boston, MA. $424,467; 09/30/99-09/29/01. (Grant No.: HS10335)

    This study will examine the cultural relevance of a new measure of continuity of care in mental health services for African-Americans, Puerto Ricans, and whites. This project will build upon an effort, supported by the National Institute of Mental Health (NIMH), in which anthropological methods were used to develop a research measure of continuity of care. The NIMH project involved interviewing 400 individuals with serious mental illness in a six-phase study composed of: an ethnographic study to produce operational definitions; interview construction; preliminary testing via cognitive interviews; review by a panel of experts and two pilot tests; a field test; and psychometric evaluation.

  • Using Census Data to Monitor Care to Vulnerable Groups. Principal investigator: Kevin Fiscella, M.D. Highland Hospital, Rochester, NY. $225,005; 09/30/99 -09/29/01. (Grant No.: HS10295)

    This study will have three specific aims: 1) to develop a series of practical, clinically relevant indicators that are sensitive to differences in quality of care provided to socioeconomically vulnerable populations; 2) to evaluate the performance of census-based data as proxies for socioeconomic conditions of individuals; and 3) to determine the extent to which socioeconomic measures account for disparities in the quality of care provided to African-American and Hispanic patients.

AHCPR is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. AHCPR sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services. Select for more information about AHCPR, its research findings, and publications.

For additional information, contact the AHCPR Press Office, (301) 427-1364: Salina Prasad, (301) 427-1864 (

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