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AHCPR funds studies on respiratory disease care and improving health care quality

The Agency for Health Care Policy and Research recently funded several new studies on asthma and pneumonia—respiratory diseases that affect millions of Americans and significantly contribute to health care costs and lost productivity. AHCPR also has funded another group of studies that will provide science-based information to facilitate the development of tools and information for use in measuring and improving health care quality.

In the area of respiratory disease, AHCPR has funded a 5-year, $6.08 million randomized clinical trial to improve asthma care for children and adolescents. The prevalence of childhood asthma, a serious and costly health problem, has more than doubled since 1970. Asthma affects nearly 5 million children under 18 years of age, and costs approximately $1.9 billion for treatment, according to the American Lung Association. Currently, data are very limited on the effectiveness of asthma treatment, according to AHCPR's Administrator, Clifton R. Gaus, Sc.D.

The disease restricts breathing, can trigger other health problems, and sometimes leads to the death of affected individuals. Asthma also may cause emotional and growth problems in children, and it is responsible for a significant number of lost school and work days.

Under the direction of the principal investigator, Kevin B. Weiss, M.D., of Rush Presbyterian-St. Luke's Medical Center in Chicago, the researchers will test the cost-effectiveness of practice guidelines intended to reduce asthma morbidity among children. The research team will determine the effectiveness of an opinion-leader training program, using academic detailing principles, to increase doctors' use of guideline recommendations on anti-inflammatory medications for children on chronic bronchodilator therapy. In addition, the researchers will test a new organizational approach that managed care providers could use to deliver pediatric asthma care.

The study, to be conducted in three large health maintenance organizations in Boston, Chicago, and Seattle, is one of AHCPR's large-scale projects that evaluate the effectiveness of different methods of diagnosing, treating, managing, and preventing, where applicable, widespread health problems. AHCPR is providing $1.28 million for the first year and has earmarked $4.80 million to complete the study. The National Heart, Lung, and Blood Institute, which developed the guideline to be used in the study, is contributing $800,000 to the project (AHCPR/NHLBI grant HSHL08368).

AHCPR also funded the following respiratory disease studies:

  • Outcomes of Lower Respiratory Illness in Nursing Home Residents (AHCPR grant HS08551). Under this 3-year, $2.16 million grant, David R. Mehr, M.D., of the University of Missouri-Columbia, will lead the first outcomes research project to determine whether residents of nursing homes who contract pneumonia, but are at low risk of dying from the disease, can be treated in the facility as safely and effectively as in a hospital. The researchers will develop and test a method doctors could use to estimate expected outcomes of nursing home residents who have pneumonia. If proven effective, the formula could help physicians more accurately identify low- and high-risk patients and reduce the number of medically unnecessary hospital admissions.
  • Dissemination of Guidelines for Pneumonia Length of Stay (AHCPR grant HS08282). Michael J. Fine, M.D., University of Pittsburgh, is the principal investigator of this study that will evaluate the impact of medical care guidelines on the length of stay of persons hospitalized for treatment of community-acquired pneumonia. AHCPR has committed $1.53 million to fund the 3-year study; the National Institute of Allergy and Infectious Diseases is providing $388,858.
  • Developing and Testing Asthma Quality of Care Measures (AHCPR grant HS09461). Under the direction of Yvonne C. Coyle, M.D., of the University of Texas Southwestern Medical Center in Dallas, researchers will develop and test technical measures of the quality of adult asthma care. Overall AHCPR funding for the 3-year study totals $805,710.

Health plans, providers, and consumers across the United States are the intended beneficiaries of the second group of 10 studies which focus on quality of care. According to Dr. Gaus, objective, research-based, quality of care measures are essential for improving services, balancing costs and quality, and knowing where costs can be reduced without jeopardizing patients' health.

AHCPR has awarded approximately $13.52 million over 5 years to fund seven new studies that are collectively known as Q-SPAN (Expanding Quality of Care Measures). These new studies are:

  • Clinical Performance Measures for Dental Care Plans (AHCPR grant HS09453). Led by James D. Bader, D.D.S., of the University of North Carolina, Chapel Hill, this 2-year project will develop a set of outcomes-based performance measures for general dentistry, with a special focus on cavities, which together with gum disease, account for most dental claims. The researchers will validate, pilot test, and implement the measures in two large dental managed care plans. Total estimated funding: $374,014.
  • Ongoing Development and Evaluation of HEDIS Measures (AHCPR grant HS09473). Under the direction of Arnold M. Epstein, M.D., Harvard University, Boston, MA, the researchers will evaluate the recently published draft version of the Health Plan Employer Data and Information Set (HEDIS 3.0)—currently the most widely used measure of health plan performance—and develop operational specifications for measures that the National Committee for Quality Assurance may include in the next version of HEDIS. Total estimated funding for this 3-year project is $2.31 million.
  • Measuring Quality by Achievable Benchmarks of Care (AHCPR grant HS09446). Catarina I. Kiefe, M.D., Ph.D., of the University of Alabama, Birmingham, and colleagues will refine and test the feasibility of using Achievable Benchmarks of Care—derived from pooled data of the best health care performers—because consistent data-driven definitions of benchmark performance are not currently available. The goals of this 5-year project are to increase providers' ability to transition from quality measurement to actual changes in clinical practice, and to improve methodology for deriving quality measures from readily available data. Total estimated funding: $1.77 million.
  • Adult Global Quality Assessment Tool (AHCPR grant HS09463). Led by Elizabeth A. McGlynn, Ph.D., of RAND Corporation, Santa Monica, CA, this 3-year project will develop and test clinically based sets of measures for assessing quality of care delivered to men under age 50 and men and women ages 50 and older who are enrolled in managed care plans. This project complements another study by the investigators—funded by the Health Care Financing Administration—to develop managed care measures sets for use in evaluating quality of care provided to premenopausal women and to children and adolescents. Total estimated funding: $1.43 million.
  • Quality of Care Measures for Cardiovascular Patients (AHCPR grant HS09487). Barbara J. McNeil, M.D., Ph.D., of Harvard University, Boston, MA, and her colleagues will develop and test a set of clinical measures for cardiovascular care performance using data collected from four health plans that enroll a broad spectrum of patient types. The researchers will focus on developing measures for a group of interrelated cardiovascular conditions. Total estimated funding for this 5-year project is $4.16 million.
  • Quality Outcomes in Subacute and Home Care Programs (AHCPR grant HSO9455). Principal investigator John N. Morris, Ph.D., Hebrew Rehabilitation Center for the Aged, Boston, MA, and colleagues will measure quality of care in two increasingly important but little studied transitional settings for rehabilitative-restorative care following acute hospital discharge: nursing home subacute care and home care. During this 3-year project, the researchers will create, validate, and set benchmark values of longitudinal change for activities of daily living, mobility, cognition, communication, and other outcomes. Total estimated funding: $1 million.
  • Functional Outcomes in Patients with Hip Fractures (AHCPR grant HS09459). In this 5-year project, principal investigator Albert L. Siu, M.D., of Mount Sinai School of Medicine, New York, NY, and his colleagues will address hip fracture care management and outcomes by developing a workable quality measurement system providers can use to assess the quality of care they provide patients with hip fracture—an increasingly prevalent and costly health problem. Total estimated funding: $2.47 million.

Upon their availability, AHCPR may include quality of care measures produced by the studies in AHCPR's landmark Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST) and in its technical assistance program, the Quality Measurement Network (QMNet).

In addition, AHCPR has awarded approximately $3.23 million to fund three other studies on health care quality. These studies are:

  • Value of Future Health and Preventive Health Behavior (AHCPR grant HS09519). The principal investigator for this project is Gretchen B. Chapman, Ph.D., Rutgers State University of New Jersey, New Brunswick. The project focuses on the effects of time preferences (how people value their health status at different stages in life plus the value they give to possible future personal health problems) on why people do or do not adopt preventive health behaviors. The total estimated funding for this 1-year project is $194,913.
  • Office Systems to Improve Preventive Care for Children (AHCPR grant HS08509). Led by Peter Margolis, M.D., Ph.D., of the University of North Carolina, Chapel Hill, the researchers will determine whether pediatric practices that use office systems for preventive services have higher rates of immunization and screening for anemia, tuberculosis, and lead poisoning than other pediatric practices, and if rates vary in relation to the number of system components used. Total estimated funding for this 4-year project is $1.49 million.
  • Development of a Child Health Status Measure (AHCPR grant HS08829). Under the direction of Barbara Starfield, M.D., of Johns Hopkins University, Baltimore, MD, this project will develop an instrument that comprehensively measures the health and illness profiles of children ages 5 to 11. The instrument is intended for use in monitoring the influence on children of changes in health system organization and interventions in health services. Both parent and child versions of the instrument will be developed and systematically tested in geographically distinct populations with different racial and ethnic backgrounds. Total estimated funding for this 4-year project is $1.55 million.

Earlier in 1996, AHCPR funded the following five studies focused on quality of care issues: Frank Ahern, Ph.D., Pennsylvania State University, "Impact of Prospective Drug Use on Health"; A. Connors, Jr., M.D., Case Western Reserve University, "Right Heart Catheterization: Appropriate/Effective Use"; Jose Escarce, M.D., University of Pennsylvania, "Superspecialization of Medical and Surgical Subspecialists"; Thomas Lee, M.D., Brigham and Women's Hospital, "Cardiac Procedure Use: A Prospective Cohort Study"; and Joel Tsevat, M.D., University of Cincinnati Medical Center, "Understanding Health Values of HIV Infected Patients."

Contract awarded for new quality measurement network

The Agency for Health Care Policy and Research recently awarded a contract to MEDSTAT, worth up to $5 million over 3 years, to develop the Quality Measurement Network (QMNet). The goal of the QMNet project is to create a quality measurement information resource through a collaboration between the public and private sectors. QMNet will build on the framework of AHCPR's prototype CONQUEST (Computerized Needs-Oriented Quality Measurement Evaluation System), a landmark computer tool designed to make it easier for health plans, providers, and purchasers to identify, choose, and use clinical performance measures.

According to AHCPR's Administrator, Clifton R. Gaus, Sc.D., the goal is for QMNet to become a comprehensive, publicly accessible quality measurement resource that helps both the public and private sectors to improve health care quality and that, ultimately, QMNet may aid in the creation of a free-standing quality network.

Currently, CONQUEST is the only available automated source of information on clinical performance measures, including whether the measure is an outcomes or process gauge, the type of review for which the measure was developed, the extent of validity and reliability testing which the measure has undergone, and the level of care or setting for which the measure was developed. QMNet will provide far more detailed and comprehensive information on a wider range of clinical performance measures.

Additionally, QMNet will provide extensive information on a greater number of medical conditions, including age groups affected, prevalence, utilization and costs, potentially preventable adverse outcomes, comorbidities, risk factors, and clinical services recommended or not recommended on the basis of scientifically based guidelines. Beginning in 1997, semiannual updates of the prototype computer tool will be released through QMNet.

MEDSTAT and its subcontractors, the Harvard School of Public Health and Mikalix, will evaluate the extent to which the structure of CONQUEST meets the clinical performance measurement needs of public- and private-sector users, identify and evaluate additional measures and measure sets to be added to the measures database, and identify gaps in measure sets and areas of clinical performance measurement that need additional research and development. As part of the QMNet project, the contractors will provide technical assistance to users—via phone, Internet and mail—on the most effective ways to use the databases.

To ensure that QMNet is responsive to users' needs, AHCPR has entered into a partnership with other leaders in the field of quality measurement: the Foundation for Accountability (FACCT), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the National Committee for Quality Assurance (NCQA). The partners will advise MEDSTAT on the technical development of QMNet.

MEDSTAT also is charged with developing a feasibility study that may help transform QMNet into a private-sector, self-supporting entity at the end of the contract period.

Register now for spring '97 conference on networked consumer health information

The Agency for Health Care Policy and Research and other agencies of the U.S. Department of Health and Human Services are sponsoring "Partnerships '97: Partnerships for Networked Consumer Health Information," to be held April 14-16, 1997, at Georgetown University Conference Center, Washington, DC. Conference presenters and participants will explore dynamic developments in the field of consumer health informatics (CHI). "Partnerships '97" will be held in conjunction with "HII97: The Emerging Health Information Infrastructure," the leading conference examining key policy issues on implementing an information infrastructure supporting healthcare applications.

"Partnerships '97" sessions will focus on consumer health informatics applications tailored for managed care and other health care providers, employers, patients, and the general public. It will bring together those who develop interactive applications and Web sites with those who buy or use them. The conference will feature leaders from the CHI industry, public officials and staff from the new Administration and Congress, executives from managed care and business, representatives of community and nonprofit organizations, health professionals, and individual consumers and patients.

For more information or to register, contact the Friends of the National Library of Medicine, 1555 Connecticut Avenue, N.W., Suite 200, Washington, DC 20036-1108; phone (202) 462-0992; fax (202) 462-9043.

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Research Briefs

Holohan, T.V. (1996). "Cost-effectiveness modeling of simultaneous pancreas-kidney transplantation." International Journal of Technology Assessment in Health Care 12(3), pp. 416-424.

In this paper, the former Director of the Center for Health Care Technology, Agency for Health Care Policy and Research, uses a cost-effectiveness model to compare simultaneous pancreas-kidney transplantation (SPK) to kidney transplantation alone (KTA) with continued insulin therapy among type-1 diabetics with end-stage renal disease. SPK has been advocated as an effective and appropriate treatment for type 1 diabetics with end-stage renal disease. Proponents have argued that the benefits of SPK exceed those of kidney transplantation alone with continued insulin therapy. However, the procedure is quite resource intensive. The costs of SPK, perioperative problems, the frequency and intensity of rejection episodes, and the number of posttransplantation readmissions secondary to complications are greater than those of KTA. Moreover, the benefits accruing from SPK over and above those of KTA remain unclear, with improvements in patient survival not demonstrated. Advocates of SPK argue that recipients' quality of life is improved and that such benefits justify the implant. The cost-effectiveness analysis comparing these two approaches reveals that the two procedures are equally cost-effective only for diabetics whose annual costs for treatment of complications of hyper- and hypoglycemia are quite high.

Reprints (AHCPR Publication No. 97-R014) are available from the AHCPR Publications Clearinghouse.

Schwartz, H.A., Kunitz, S.C., and Kozloff, R. (1996). "Building data research resources from existing data sets: A model for integrating patient data to form a core data set." Proceedings of the 1995 Annual Meeting of the American Statistical Association, pp. 151-165, Washington, DC: Department of the Treasury, Internal Revenue Service.

Harvey A. Schwartz, Ph.D., of the Center for Information Technology, Agency for Health Care Policy and Research, and his colleagues suggest that building research databases from existing data sets hinges on developing a prototype patient care record. They address which patient data are needed, the potential sources for these data, whether the currently collected data are sufficient and accessible, whether the data should be linked to form an automated patient record, where the record should reside, and ownership of the record, as well as security/ confidentiality issues to identify and control misuse of the patient records within a health data infrastructure. Dr. Schwartz and his colleagues propose a model to build an automated patient record with four steps: identify core data set; identify existing data codes; elicit support; and use linkage mechanisms. They also identify important policy issues important that must be considered. This paper was presented, along with several others examining record linkage applications for health care policy, at the 1995 Joint Statistical Meetings. It is included in the Internal Revenue Service's Methodology Report, Turning Administrative Systems Into Information Systems: 1995. To get a copy of the report, you must write to Director, Statistics of Income Division, P.O. Box 2608, Washington, DC 20013-2608; request a copy of IRS publication 1299 (Rev. 6-96), catalog number 63296M.

Reprints of this article only (AHCPR Publication No. 96-R129) are available from the AHCPR Publications Clearinghouse.

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AHCPR Publication No. 97-0007
Current as of December 1996

The information on this page is archived and provided for reference purposes only.


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