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AHRQ funds new projects in four areas of emphasis

The Agency for Healthcare Research and Quality (formerly AHCPR, the Agency for Health Care Policy and Research) recently funded new research projects in four areas of emphasis: Improving quality of care for vulnerable children, translating evidence-based research into improved clinical practice, assessing quality improvement strategies, and improving the quality of care through nursing research. Readers are reminded that findings usually are not available until a project is concluded or nearing completion.

Quality of care for vulnerable populations. AHRQ has funded 12 new research projects aimed at developing measures of quality of care for vulnerable populations. Funding for these new projects is anticipated to total $8.84 million over a 3-year period.

  • Measuring patient satisfaction: Low literacy populations. Principal investigator: Judy Shea, Ph.D., University of Pennsylvania, Philadelphia. Grant HS10299; $1,531,035; 09/30/99-09/29/02.
    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 various plans think about the care and services they receive.
  • Measuring quality of care for high-risk infants. Principal investigator: Jeannette A. Rogowski, Ph.D., RAND, Santa Monica, CA. Grant HS10328; $1,120,241; 09/30/99-09/29/02.
    Specific objectives of this project are to: (1) develop new methods for measuring quality of care for very low birthweight infants that can overcome the problems of small sample size, bias from patient mix, and the multidimensional nature of quality; (2) apply the methods to estimate past and predict 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. Grant HS10316; $1,073,524; 09/30/99-09/29/02.
    These investigators will develop and validate a questionnaire to examine 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. Grant HS10317; $928,081; 09/30/99-09/29/01.
    The goal 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 outcomes in the context of HealthLink, a district-wide school health initiative. The project will include children and families that speak English, Spanish, Tagalog, and Vietnamese.
  • Quality measurement in residential care. Principal investigator: M. Catherine Hawes, Ph.D., Menorah Park Center for the Aging, Beachwood, OH. Grant HS10315; $720,911; 09/30/99-09/29/02.
    The researchers will develop quality measures for residential care facilities that can be used in external quality assurance systems, consumer report cards, and performance feedback systems for providers. Investigators will develop quality improvement protocols and a resident classification model that can 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. Grant HS10318; $617,145; 09/30/99-09/29/01.
    The researchers 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. They 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. Grant HS10333; $594,939; 09/30/99-09/29/01.
    The researchers 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.
  • Measuring quality of care for diabetes. Principal investigator: Jack Needleman, Ph.D., Harvard University, Cambridge, MA. Grant HS10332; $566,751; 09/30/99-09/29/01.
    Researchers will use Medicaid data from six States to develop claims-based quality measures for ambulatory diabetes care.
  • Facility effects on racial differences in New Hampshire quality. Principal investigator: Mary L. Fennell, Ph.D. Brown University, Providence, RI. Grant HS10322; $541,447; 09/30/99-09/29/01.
    The researchers will examine how nursing home structure and local community contexts interact to affect the quality of care for white and minority nursing home residents.
  • Quality measures for severe/persistent mental illness. Principal investigator: Richard C. Hermann, M.D., Harvard University, Boston, MA. Grant HS10303; $496,842; 09/30/99-09/29/01.
    The researchers will identify, inventory, and describe existing measures of the quality of mental health care for individuals with severe and persistent mental illness; develop selected measures and test their meaningfulness and feasibility; and implement selected measures as part of ongoing efforts to improve the quality of treatment provided to patients with severe and persistent mental illness.
  • Cultural relevance of a continuity of care measure. Principal investigator: Norma C. Ware, Ph.D., Harvard Medical School, Boston, MA. Grant HS10335; $424,467; 09/30/99-09/29/01.
    The researchers will examine the cultural relevance of a new measure of continuity of care in mental health services for blacks, whites, and Puerto Ricans.
  • Using census data to monitor care to vulnerable groups. Principal investigator: Kevin Fiscella, M.D., Highland Hospital, Rochester, NY. Grant HS10295; $225,005; 09/30/99-09/29/01.
    The goals of this study are to develop a series of practical, clinically relevant indicators that are sensitive to differences in quality of care provided to socioeconomically vulnerable populations; evaluate the performance of census-based data as proxies for socioeconomic conditions of individuals; and determine the extent to which socioeconomic measures account for racial disparities in quality of care.

Translating evidence-based research into improved clinical practice. AHRQ has funded four new research projects aimed at implementing research findings, evidence-based tools, and scientific information in everyday practice. Funding for these new projects is anticipated to total $4.60 million over a 3-year period.

  • Do urine tests increase chlamydia screening in teens? Principal investigator: Mary-Ann Shafer, M.D., University of California, San Francisco. Grant HS10537; $1,531,064; 09/30/99-09/29/02.
    The goal of this study is to improve screening for sexually transmitted diseases (STDs) among asymptomatic, sexually active teenagers attending Kaiser Permanente outpatient clinics. Investigators will design a small-group educational program for clinic personnel augmented with weekly supervision and followup to reinforce the educational content.
  • Improving diabetes care collaboratively in the community. Principal investigator: Marshall H. Chin, M.D., University of Chicago. Grant HS10479; $1,353,930; 09/30/99-09/29/02.
    The objective of this study is to improve the quality of care and health outcomes of indigent, vulnerable patients with diabetes who receive care at rural and urban community health centers.
  • Evidence-based surfactant therapy for preterm infants. Principal investigator: Jeffrey D. Horbar, M.D., University of Vermont, Burlington. Grant HS 10528; $1,239,742; 09/30/99-09/29/02.
    The objective is to standardize practices in surfactant administration for the prevention and treatment of neonatal respiratory distress syndrome to reduce both mortality and morbidity of preterm infants.
  • Practice profiling to increase tobacco cessation. Principal investigator: Susan H. Swartz, M.D., Maine Medical Assessment Foundation, Manchester. Grant HS10510; $473,543; 09/30/99-09/29/02.
    The objective is to evaluate the effects of tobacco cessation profiling on provider and practice behavior—including screening for tobacco use and provision of tobacco cessation treatment—and evaluate the effects of the practice interventions on the quitting behavior of smokers.

Assessment of quality improvement strategies. AHRQ has funded five new research projects aimed at assessing quality improvement strategies, including education, the use of information systems, continuous quality improvement, behavioral interventions, academic detailing, and use of regulations. Funding for these new projects is anticipated to total $8.42 million over a 3-year period.

  • Organizational determinants of HIV care improvement. Principal investigator: Paul D. Cleary, M.D., Ph.D., Harvard University, Boston, MA. Grant HS10408; $2,381,217; 09/30/99-09/29/02.
    The researchers will assess the use of a rapid-cycle quality improvement strategy to improve the care of patients with HIV/AIDS who are being treated in clinics receiving Title-III Ryan White funds. They will assess the quality of HIV care provided by participating clinics, track changes in such care subsequent to quality improvement efforts, and analyze which organizational characteristics and policies were related to such changes.
  • Improving heart failure care in minority communities. Principal investigator: Jane E. Sisk, M.A., Ph.D., Mount Sinai School of Medicine, New York, NY. Grant HS10402; $2,307,609; 09/30/99-09/29/02.
    The objectives of this study are to evaluate the effects of nurse management of congestive heart failure (CHF) on hospitalization rates and functional status of patients and determine how these factors are related to measures of patients' knowledge, attitudes, and behaviors regarding CHF; evaluate patient satisfaction, costs, and cost-effectiveness of nurse management of CHF; and disseminate study results across New York State via selected organizations.
  • Strategies for continuous quality improvement efforts: A national randomized trial. Principal investigator: T.B. Ferguson, M.D., Society of Thoracic Surgeons, Chicago, IL. Grant HS10403; $1,416,376; 09/30/99-09/29/02.
    The researchers will assess the impact of a national cardiac surgery database maintained by the Society of Thoracic Surgery in providing the infrastructure to conduct a national program of quality improvement for patients undergoing coronary artery bypass grafting procedures.
  • Hospital performance and beta-blocker use after AMI. Principal investigator: Harlan M. Krumholz, M.D., Yale University, New Haven, CT. Grant HS10407; $1,163,543; 09/30/99-09/29/02.
    This project will focus on efforts to increase the use of beta-blockers after heart attack. The researchers will study hospital characteristics associated with improved performance and identify hospital-based quality improvement interventions that are most effective in increasing the use of beta-blockers for these patients.
  • Evaluating quality improvement strategies. Principal investigator: Charles J. Homer, M.D., Children's Hospital, Boston, MA. Grant HS10411; $1,150,949; 09/30/99-09/29/02.
    The researchers will assess the impact of an office-based quality improvement strategy compared with "usual care" in the management of pediatric asthma in different practices in the same integrated health care delivery system.

Nursing Research to improve health care quality. Three new research projects have been funded in the area of nursing research and health care quality. The funding for these new projects is anticipated to total $2.94 million over a 3-year period.

  • Evidence-based practice: From book to bedside. Principal investigator: Marita Titler, Ph.D., R.N., School of Nursing, University of Iowa, Iowa City. Grant HS10482; $1,463,673; 09/30/99-09/29/02.
    The objective is to promote the translation of research on acute pain management into clinical practice using a multidimensional approach targeted to hospitalized elderly. The study will consist of a 3-year randomized evaluation in 12 hospitals across Iowa, Missouri, and Illinois.
  • Evidence-based "reminders" in home health care. Principal investigator: Penny H. Feldman, Ph.D., Visiting Nurse Service of New York. Grant HS10542; $1,001,798; 09/30/99-03/30/02.
    The goal of this project is to improve provider performance and promote adherence to evidence-based practice strategies among home health care nurses. Researchers will provide information on provider's use of evidence-based guidelines in the treatment of two highly prevalent chronic diseases: congestive heart failure and cancer and the impact of using the guidelines on the quality and cost of care.
  • Quality of hypertension care for Asian refugees. Principal investigator: Candice C. Wong, M.D., Ph.D., University of California, San Francisco. Grant HS10276; $472,985; 09/30/99-09/29/01.
    The researchers will develop a measure of the quality of care for hypertension in a population of Hmong refugees in Fresno, CA. The goals are to define quality of care for hypertension from the Hmong perspective, develop a hypertension quality-of-care instrument for use with Hmong patients, and pilot-test the instrument.

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