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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.

Assessing Match in Child-Clinician Communication. Charles W. Kalish, Ph.D., University of Wisconsin, Madison, WI. AHRQ grant HS09556, project period 9/30/97 to 9/29/99.

There is increasing sentiment that children, like other patients, should be active participants in their own health care. Yet to what degree are young children capable of managing health information? Thirty 4- and 5-year-old children were interviewed following a simulated clinical health assessment. Results demonstrated that children and clinicians shared interpretations of many aspects of the examination. However, children had a narrower definition of health relatedness. Moreover, the importance children attached to elements of a health encounter was proportionate to their perceptions of the elements as related to health. Results also suggest that the role of the parent as intermediary between the child and clinician may be problematic. In particular, children seemed not to attend to communication directed at or made by the parent during a clinical examination.

The abstract, executive summary, and final report, NTIS accession no. PB2000-106430; 22 pp, $23.00 paper, $12.00 microfiche can be purchased from NTIS.

Clinical Performance Measures for Dental Care Plans. James D. Bader, D.D.S., M.D., M.P.H., Ph.D., University of North Carolina, Chapel Hill, NC. AHRQ grant HS09453, project period 9/30/96 to 9/29/99.

The objective was to develop standardized measures to assess clinical aspects of the performance of managed dental care plans. Stakeholders representing dental plans, purchasers, and providers refined initial sets of measures. Refined administrative data-based measures were piloted tested in two dental HMOs. Chart audit-based measures were tested in seven dental programs. Seven effectiveness-of-care measures assessing disease activity classification, preventive treatment, and outcomes for caries, periodontal disease, and tooth loss were developed. Six use-of-services measures focusing on prophylaxis, third-molar surgery, and preventive, restorative, prosthetic, surgical, and endodontic care were specified. Five access-to-services measures for visit and examination rates, appointment waiting time, and provider availability and turnover also were specified. Pilot testing of the administrative data-based version of the effectiveness of care and use of services measures indicated reasonable reliability and sensitivity but also demonstrated the need for supervision or auditing of the process. The chart-audit-based procedures also yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic, namely caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most but not all measures in the one program where the comparison could be made.

The abstract, executive summary, and final report, NTIS accession no. PB2000-106630; 66 pp, $27.00 paper, $12.00 microfiche can be purchased from NTIS.

Impact of Managed Care on African-Americans. Mahmud Hassan, Ph.D., University of Alabama at Birmingham, Birmingham, AL. AHRQ grant HS09569, project period 9/30/97 to 1/31/00.

This study examined the impact of managed care on African-Americans with respect to their access to and use of health-care services. Using data from the National Health Interview survey of 1994, the researchers estimated the managed care penetration rates among blacks in 33 Standard Metropolitan Statistical Areas. They used the number of physicians' visits and the days of hospital inpatient stays in 1 year as two alternative measures of use of health care services. The regression analysis clearly showed that an increase in managed care penetration in the market and/or among whites has a proportional positive increase in managed care penetration rates among blacks. The multinomial logit regressions showed that the number of annual visits to physicians is very similar for blacks enrolled in either managed care or non-managed care plans. However, blacks enrolled in managed care plans were less likely to have a high level of inpatient days compared with blacks enrolled in non-managed care plans. The researchers speculate that enhanced preventive care and early treatment of illness avoid the need for hospital care for many managed care enrollees.

The abstract and executive summary, NTIS accession no. PB2000-105771; 46 pp, $25.50 paper, $12.00 microfiche can be purchased from NTIS.

Market Forces and Rural Health: System and Consumer Impact. Keith J. Mueller, Ph.D., University of Nebraska Medical Center, Omaha, NE. AHRQ grant HS09196, project period 9/30/95 to 9/29/98.

The goals of this project were to assess how rapidly changes in health care delivery are occurring in rural areas, determine the involvement of rural providers and community leaders in the changes, and disseminate information gained through this project to policymakers and educators. Data were collected through telephone interviews of 63 key informants and field studies of activities in six communities. This project found that there has been very little change in health care financing in rural areas. Where change has occurred, through the use of different strategies for purchasing health care services, there has been little behavioral change on the part of rural health care providers. Three factors are important in differentiating across different responses by rural communities to changes in health care financing: feelings of local leadership about change, resources available locally to support change, and community capacity, in health care infrastructure and payment from residents, to support new systems.

The abstract, executive summary, and final report, NTIS accession no. PB2000-106628; 22 pp, $23.00 paper, $12.00 microfiche can be purchased from NTIS.

Meeting the Challenge of Managing Health Care Information: Strategies and Investments. Kathleen H. Gersowitz, Research Foundation of SUNY, Albany, NY. AHRQ grant HS10078, project period 9/15/99 to 2/15/00.

Local health care information management professionals were invited to attend a day-long conference focused on managing health care information. Speakers and panelists presented views and perspectives and audience members participated in the dialog on strategies, investments, and best practices for managing health care information and technology. Discussions focused on current levels of information technology, management strategies being used today, and future directions. The attendees agreed to the value and future benefits to be gained and called for more focus on a cost/benefit analysis of various strategies, practical guidelines for managing health care information, models from other industries, and specific strategies that can be implemented to deal with the ever-changing field of information technology.

The abstract, executive summary, and final report, NTIS accession no. PB2000-106629; 34 pp, $25.50 paper, $12.00 microfiche can be purchased from NTIS.

Risk-Bearing Arrangements and Capital Financing for Integrated Health Systems. Douglas A. Conrad, Ph.D., University of Washington, Seattle, WA. AHRQ grant HS09536, project period 7/1/97 to 6/30/99.

These researchers conducted case studies in emerging integrated health systems. The goals were to develop a preliminary assessment of the cost and quality implications of risk-bearing arrangements crafted between health plans and provider organizations and gain insights concerning alternative capital financing strategies used by systems. The study revealed that capitating appropriately sized and managed medical groups for either professional services only (primary care and specialty care) or a more inclusive range of services (approaching "global" risk) appears to result in reduced health care costs per member per month. In the cases considered, plans and provider organizations were able to sustain such arrangements, and selected consumer satisfaction and clinical measures did not suggest a reduction in quality. In capital financing, health care organizations follow a "pecking order," from bank loans and internal equity financing at early stages in their growth, then publicly issued debt, and finally public equity. Systems' "make-buy" decisions reflect that even in markets with excess capacity, the effective price for "renting" (rather than owning or creating one's own) services includes not just the "spot price" (short run marginal cost) of those services, but also the renter's expected incremental capacity costs.

The abstract, executive summary, and final report, NTIS accession no. PB2000-105772; 136 pp, $36.00 paper, $17.00 microfiche can be purchased from NTIS.

Taxonomy of Patient Requests and Physician Responses. Richard L. Kravitz, M.D., M.S.P.H., University of California, Davis, CA. AHRQ grant HS09812, project period 3/1/98 to 2/29/00.

The goal of this project was to develop a reliable and valid system for identifying and classifying patients' requests for services in office practice. In phase one of the study, the researchers tested a preliminary taxonomy of patient requests and physician responses (TORP-I), which they found to be valid and reliable in general internal medicine. They could not confirm its applicability in other clinical settings. In phase two, TORP was refined and expanded and assessed for its reliability, validity, and utility in both internal medicine and cardiology. The researchers found TORP to be a potentially useful tool for studying an important aspect of the physician-patient interaction.

The abstract, executive summary, and appendix 3, NTIS accession no. PB2000-107461; 48 pp, $25.50 paper, $12.00 microfiche can be purchased from NTIS.

Value of Future Health and Preventive Health Behavior. Gretchen B. Chapman, Ph.D., Rutgers State University of New Jersey, New Brunswick, NJ. AHRQ grant HS09519, project period 9/30/96 to 9/29/98.

Two studies examined the relationship between preventive health behavior and an aspect of patient preferences known as time preferences—the subjective value of future outcomes relative to immediate ones. Two preventive health behaviors were examined: acceptance of a free influenza vaccine by workplace employees and medical management of hypertension among community-dwelling elderly adults. The researchers predicted that people with more future-oriented time preferences would be more likely to accept a flu shot and adhere to medication prescriptions. The study of influenza vaccination found only a small association between time preference and shot acceptance, and the study of hypertension medication found no such relationship. It appears from this study that time preferences play little role in decisions about preventive health behaviors.

The abstract, executive summary, and final report, NTIS accession no. PB2000-106627; 14 pp, $23.00 paper, $12.00 microfiche can be purchased from NTIS.

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