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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.

Records of all 750,000 documents archived at the National Technical Information Service—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. Also, all items in the database from 1997 to the present now can be downloaded from the NTIS Web site. Documents from 1-20 pages are free; documents 21 pages and over are $8.95 per download. Select NTIS for more information.

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 (1995-present) of Research Activities, select Search Research Activities. To search for information, enter either the grant/contract number or principal investigator's name in the query line.

A reference librarian can help you find related journal articles through the National Library of Medicine's Pub Med®.

Closing the Gap: Applying Injury Prevention Science to Patient Safety. Stephen W. Hargarten, M.D., M.P.H., Medical College of Wisconsin, Milwaukee. AHRQ grant HS10111, project period 8/15/00-8/14/01.

Thirty-two injury prevention scientists and patient safety experts met from around the country to discuss the applicability of injury prevention principles to patient safety and to develop a research agenda using injury control and public health approaches to enhance current efforts to increase patient safety. Participants discussed the utility of the phase factor matrix for both analysis of causal relationships and identification of intervention strategies. Recommendations for better, more informative data were made, and several specific research projects highlighting the utility of the injury prevention approach were presented. Participants made several specific recommendations for increased data, conceptualization of definitions, and specific research areas that should be pursued. This report summarizes the conference.

The abstract and executive summary, NTIS accession no. PB2003-101394; 34 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Determinants of Nursing Home Residents' Hospital Use. Orna Intrator, Ph.D., Brown University, Providence, RI. AHRQ grant HS09723, project period 7/1/98-6/30/01.

Previous research has shown that many hospitalizations from nursing homes are avoidable. This study of facility characteristics that influence hospitalizations of long-stay nursing home residents found that, on average, 14 percent of long stayers in urban facilities were hospitalized in a 6-month period, and 3 percent of these residents were hospitalized with dehydration. Hospitalization rates varied among facilities from 0 to 45 percent. Facilities that operated with more physicians and physician extenders and those that conducted on-site training and evaluations of nurse aides were less likely to hospitalize their residents. States with higher Medicaid payment rates and case-mix reimbursement methods had reduced hospitalization rates. These findings need to be re-examined in more States and post-Prospective Payment System (PPS). Findings from this study could be used to guide facilities and policymakers in organizing and regulating medical and nursing care for patients.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101393; 100 pp, $29.50 paper, $17.00 microfiche are available from the National Technical Information Service.

Does Primary Care Access Decrease Respiratory Emergency Department Visits? Robert A. Lowe, M.D., M.P.H., University of Pennsylvania, Philadelphia. AHRQ grant HS09261, project period 6/1/98-5/31/02.

The objective of this project was to determine the association between primary care practice (PCP) site characteristics and emergency department (ED) use among members of a Medicaid managed care organization, after adjusting for patient characteristics. Study personnel visited PCPs affiliated with a Medicaid HMO to ascertain characteristics of the practices. Administrative data from the HMO were used to determine rates of ED use for the patients assigned to the practices and to determine patient demographics and chronic medical conditions. Overall ED use rates were studied, along with several subsets of ED visits, to determine the independent association between PCP site characteristics and ED use. The researchers studied 57,850 HMO enrollees at 353 primary care practice sites. The overall ED use rate was 0.80 ED visits per member-year. Several practice site characteristics, including evening hours, proportion of patients covered by Medicaid in the practice, active patients per clinician-hour, and availability of peak flow meters and nebulizers, were significantly associated with use of EDs by Medicaid patients assigned to those practices.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101415; 48 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Expert System Diagnosis of Depression and Dementia. Roderick K. Mahurin, Ph.D., Battelle Memorial Institute, Seattle, WA. AHRQ grant HS09828, project period 9/30/98-9/29/99.

This project involved development of a computer-based expert system to assist mental health practitioners in differentiating depression and dementia. These two disorders are present with high frequency in primary care settings, yet they often are difficult to differentiate. The decision rules used by the system were derived from published lists of clinical features that distinguish depression from dementia, as well as specific suggestions from experienced medical and mental health practitioners. A clinician interacts with the system through a straightforward question and answer format or alternatively by submitting prepared tables of clinical data. One of the following four outcome classifications is presented for consideration by the clinician, along with reasoning behind the decision: depression, dementia, dementia with depression, or other disorder. Clinical and test data from 1,858 cases seen by a neuropsychology service at a major medical center were entered into the system. The system correctly classified 92 percent of these cases. With increased acceptance, such expert systems have the potential to provide diagnostic and treatment recommendations in medical settings without ready access to clinical specialists, such as in rural health care settings and underserved urban areas.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101521; 24 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Nephrologist Care and Outcomes in Renal Insufficiency. Jerome L. Avorn, M.D., Brigham & Women's Hospital, Boston, MA. AHRQ grant HS09398, project period 9/30/98-9/29/99.

The researchers found that patients with chronic kidney disease who see a nephrologist excessively late during the course of their disease are at risk of experiencing several detrimental outcomes: inadequate preparation of vascular access for hemodialysis, higher mortality once on renal replacement therapy, and lower access to renal transplantation. Patients who are most likely to experience delayed referral to a nephrologist are of low socioeconomic status and minority race. All of these outcomes are costly to society by way of loss of life, higher health care costs, and also by means of creating inequalities or enhancing those that already exist.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101420; 14 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Organizational Infrastructure for Patient Safety. Robert L. Wears, M.D., M.S., University of Florida, Gainesville. AHRQ grant HS10952, project period 3/1/01-2/28/02.

Safety efforts in health care have focused primarily on the "lower level" factors such as workers, their tools, the work team, and the environment. Factors considered basic to safety in other industries, e.g., institutional culture and the social-regulatory-economic environment, have not yet received much attention. This 2-day conference brought together 34 experts from organizational behavior, health care management, and health systems research to begin focusing on these higher level factors.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101412; 50 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Pediatric Emergency Care: Severity and Quality. Murray M. Pollack, M.D., Children's Research Institute, Washington, DC. AHRQ grant HS10238, project period 9/30/99-9/39/02.

The goals of this project were to investigate emergency department (ED) factors associated with quality of pediatric care using a nationally applicable model to control for severity of illness in the ED. Institutional care factors chosen for investigation included patient volume (high/low), presence or absence of pediatric emergency medicine specialists, and presence or absence of residents. EDs were randomly selected from all U.S. hospitals with pediatric ICU capabilities, using a stratified design to provide equal representation of hospitals with and without the three care factors. Logistic regression and generalized estimating equations (GEE), to account for patient clustering effects, were used to model the outcome of mandatory admission. Admission errors and discharge errors were calculated by comparing observed to expected based on the GEE model. Hospitals submitted records for 729 patients each, for a total sample of 11,664 patients. A severity model was developed which performed well. Total errors (admission plus discharge) were strongly associated with residents; there was no association with other care factors. After controlling for severity of illness and patient clustering among institutions, the presence of residents was associated with admission decisionmaking errors in the ED.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101524; 36 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Uniting Practice and Research in Long-term Care. Larry W. Lawhorne, M.D., AMDA Foundation, Columbia, MD. AHRQ grant HS10967, project period 9/30/01-9/29/02.

The AMDA Foundation Research Network held its first annual meeting in Dallas, TX, November 3-4, 2001. The chief goal was to develop ideas for research that will provide a systematic base of evidence for providing health care in a long-term care (LTC) setting. A major goal is the development of an LTC practice-based research network. Timely questions currently facing the field include the effectiveness of clinical practice guidelines in improving care: how disease management programs work in LTC, and how physicians can help create evidence-based practices for LTC. Over the course of this day-and-a-half meeting, participants generated topics for possible research projects, crafted a research agenda for the future, and developed five network research projects.

The abstract, executive summary, and final report, NTIS accession no. PB2003-101414; 18 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

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