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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.

Adult Medicaid Patients' Dental Visits in Hospital Emergency Departments. Leonard A. Cohen, D.D.S., M.P.H., University of Maryland, Baltimore. AHRQ grant HS10129, project period 7/1/99-9/30/01.

This study examined the use of emergency departments (EDs) during the 4-year period February 16, 1991 to February 15, 1995 for the treatment of mouth pain and infections associated with the teeth and periodontal tissues. The study involved a natural experiment, the change in Maryland Medicaid policy that eliminated dentist reimbursement and participation in the program, to establish two study periods. Data tapes describing 3,639 Medicaid patients' use of EDs were obtained from the Maryland Medicaid Management Information System. Controlling for age, race, and sex, the rate of ED claims was 12 percent higher in the post-change period. ED visits were higher among the 21-44 age group, whites, and males. Comparisons between periods show significant increases in the rates during the post-change period for males, whites, blacks, and the 21-44 and 45-64 age groups. Although there were more claims in the post-change period, total costs were lower in the pre-change period.

Abstract, executive summary, and final report (accession no. PB2002-101215); 52 pp, $27.00 paper, $12.00 microfiche, are available from NTIS.

Agenda for Research in Ambulatory Safety. Glenn T. Hammons, M.D., Medical Group Management Association, Englewood, CO. AHRQ grant HS10106, project period 8/1/00-7/31/01.

This report provides a synthesis of a multidisciplinary conference held November 30-December 1, 2000, to develop an agenda for research in ambulatory patient safety. It reviews what is known about patient safety in ambulatory care and synthesizes information from presentations and discussions at the conference, including 11 consensus recommendations for research and demonstrations.

Abstract, executive summary, and conference synthesis (accession no. PB2002-102308); 24 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Beneficiaries' Use of Quality Reports for Choosing Medicare Plans. Jennifer D. Uhrig, Ph.D., Pennsylvania State University, University Park. AHRQ grant HS10797, project period 6/14/00-8/31/01.

Cognitive interviews and a randomized laboratory experiment were conducted to determine how Medicare beneficiaries use comparative quality information when choosing a health plan and whether providing such information affects beneficiaries' choice of plan. The effects of providing quality information on plan choice differed by plan type. Providing information about plan quality did not significantly influence the choice between original Medicare and an HMO, but it did affect the choice of HMO. Providing comparative information about plan quality did not make the task of choosing a plan easier for Medicare beneficiaries, and it did not increase the confidence they had in their plan choice.

Abstract and executive summary of dissertation (accession no. PB2002-101463); 18 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from the Health Plan Choice Experiment. Katherine M. Harris, M.A., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS10367, project period 9/30/99-9/39/01.

The objective was to investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. A survey was administered to respondents between the ages of 25 and 65 in the West Los Angeles area who had private health insurance. The presence of quality information reduced the importance of provider network features in plan choices. However, differences by type of quality measure were not statistically significant. Overall, the results provide empirical evidence that consumers are willing to trade unrestricted provider access for better quality, and that quality measures based on the assessments of medical experts are valued at least as much as those based on consumer judgment.

Abstract, executive summary, and final report (accession no. PB2002-102314); 56 pp, $27.00 paper, $12.00 microfiche, are available from NTIS.

Community-Based Health Services Research Curriculum. Charles J. Homer, M.D., M.P.H., Children's Hospital, Boston, MA. AHRQ grant HS09792, project period 7/1/98-6/30/01.

The goal was to develop research capacity at the interface between traditional child health care and community systems. First, the researchers developed, implemented, and evaluated a curriculum in community-based child health services research, including a monthly seminar using the case method. Second, they developed and implemented six community-based child health services research cases including one interactive, hypermedia, Web-based case. Third, they conducted two annual conferences on community-based child health services research. They reported positive changes following the seminars in awareness of issues, confidence, and readiness to carry out community-based research studies.

Abstract, executive summary, and final report (accession no. PB2002-101688); 22 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Crisis of Academic Medical Centers. Henry J. Aaron, Ph.D., Brookings Institution, Washington, DC. AHRQ grant HS10108, project period 8/15/00-8/14/01.

This report summarizes a conference focused on issues surrounding the financial distress now affecting many academic medical centers (AMCs). AMCs link three critical functions: training physicians and other health professionals; delivering state-of the-art medical care; and carrying out laboratory and clinical research. Some attribute the financial distress facing many AMCs to a dramatically worsened financial environment. Others claim that the AMCs are responsible for their own problems, which have arisen from poor administration.

Abstract and executive summary (accession no. PB202-101695); 18 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Developing a Latino Health Agenda for 2010. Hector G. Balcazar, Ph.D., University of North Texas Health Science Center, Fort Worth, TX. AHRQ grant HS10079, project period 5/16/00-9/29/01.

This 3-day national conference focused on Latino health issues—including disparities and barriers to overcoming them—and development of a Latino health agenda for 2010. The conference outcome was establishment of the National Latino Health Collaborative to focus on eliminating Latino health disparities and promoting collaboration among partners in Latino research monitoring advocacy and policy implementation.

Abstract and executive summary (accession no. PB2002-101697); 8 pp, $12.00 paper, $12.00 microfiche, are available from NTIS.

Development of a Child Health Status Measure. Anne W. Riley, M.D., M.P.H., Johns Hopkins University, Baltimore, MD. AHRQ grant HS08829, project period 8/1/96-7/31/01.

The Child Health and Illness Profile-Child Edition (CHIP-CE™), a generic child health status questionnaire, was developed and validated. The CHIP-CE™ comprehensively describes the health of children 6-11 years of age in the domains of satisfaction, comfort, resilience, risk avoidance, achievement and, for parents only, disorders. The Child Report Form (CHIP-CE/CRF) is fully illustrated with cartoon-type characters that anchor the 5 responses for the 45 health items. It is complemented by a standard, 45-item, parent report form (PRF) and a comprehensive PRF with 76 items. The field research was conducted in four geographically and culturally distinct areas, with six samples involving approximately 2,000 children and 1,300 parents. The CRF and Standard PRF require 15 minutes to complete, and the comprehensive six-domain (with disorders) parent version requires 20 minutes. They are practical in medical settings, homes, and classrooms.

Abstract, executive summary, and final report (accession no. PB2002-101694); 20 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Effects of a Nursing-Based Intervention in Two Emergency Departments. Robert M. Palmer, M.D., M.P.H., Cleveland Clinic Foundation, Cleveland, OH. AHRQ grant HS09725, project period 6/1/99-5/31/01.

This randomized clinical trial was carried out in two emergency departments (ED) to test the Systematic Intervention for a Geriatric Network of Evaluation and Treatment (SIGNET), which included a six-item triage risk screening tool (TRST), a geriatric assessment by a trained advance practice nurse in the ED, and referral to community agencies of patients discharged from the ED but thought to be at risk for adverse health outcomes. The trial involved 650 participants: 326 were randomized to the intervention and 324 to usual care. Subsequently, 45 percent of the participants were stratified by the TRST as "high risk," 146 in the intervention group and 145 in the usual care group; 541 participants completed the 4-month study. At 30 and 120 days after the index ED visit, the outcomes of repeat ED visit, hospitalization, and nursing home admission were similar for participants in both groups. Health care costs did not differ between the two groups, but there were fewer nursing home admissions among high-risk intervention participants compared with usual care participants.

Abstract, executive summary, and final report (accession no. PB2002-101691); 40 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Efficiency Improvements via Monitoring in Medical Group Practice. Noelle Molinari, A.B., A.B.D., Wayne State University, Detroit, MI. AHRQ grant HS11275, project period 9/30/00-9/29/01.

The researcher tested the hypothesis that medical partnerships can effectively respond to moral hazard by monitoring their members using methods employed by firms. A partnership model was developed to describe the decisionmaking process in medical groups. To evaluate the impact of group structure on choice of compensation scheme, surveillance system, and technical efficiency, empirical analysis was performed using data collected by the Medical Group Management Association.

Abstract and executive summary of dissertation (accession no. PB2002-102309); 16 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Employee Response to Health Plan Performance Ratings. Michael E. Chernew, Ph.D., University of Michigan, Ann Arbor. AHRQ grant HS10050, project period 3/1/99-2/28/01.

This project examined how the release of health plan performance information influences employee health plan choices. It was based on the observed enrollment patterns of employees of a large auto manufacturer in 1996 and 1997, who for the first time, were given health plan performance ratings for all available HMOs as part of open enrollment materials. The results show that employees avoid plans with many below average ratings, and that individuals are willing to pay between $5 and $45 to avoid a plan with one additional below average rating.

Abstract, executive summary, and final report (accession no. PB2002-102264); 24 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Examination of Flexible Spending Accounts. Mark H. Showalter, Ph.D., Brigham Young University, Provo, UT. AHRQ grant HS10829, project period 9/1/00-11/30/01.

The researchers developed a framework for analyzing flexible spending account (FSA) participation and usage. They explored patterns of usage of FSA accounts using data from a medium-sized benefits firm for 1996. FSA participation was found to be lower than what might reasonably be expected from an economic framework. The evidence suggests that much of an FSA election amount is based on foreknowledge of expenditures.

Abstract, executive summary, and final report (accession no. PB2002-102313); 50 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Expanding Partnership in Primary Care Research Training. Robert C. Like, M.D., M.S., Robert Wood Johnson Medical School, Piscataway, NJ. AHRQ grant HS09788, project period 8/1/98-7/31/01.

This project involved the development, piloting, and integration of an applied primary care/health services research curriculum into a postdoctoral primary care research fellowship program. The curriculum was well received by fellows and faculty and contributed to their scholarly productivity.

Abstract, executive summary, and final report (accession no. PB2002-102312); 36 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Exploring Provider Supply, Practice Volume, and Practice Site in an Analysis of Cataract Management. Stephanie L. Maxwell, B.A., Johns Hopkins University, Baltimore, MD. AHRQ grant HS08470, project period 8/1/94-7/31/96.

Cataract extraction is the most commonly performed Medicare surgical procedure, with about 1.5 million extractions annually. Previous studies found that extensive variation exists before, during, and after surgery in cataract management. This study used 1991-1992 Medicare claims data to examine three provider factors (ophthalmologist supply, cataract surgery volume, and type of facility) and their association with the use of six pre-operative diagnostic tests and YAG laser capsulotomy. Area population and physician data also were incorporated, and a model was developed to estimate the odds of undergoing each of seven ophthalmic services. Significant variation in service use existed by practice volume and site. In particular, high-volume practices, ambulatory surgical centers, and office-based surgical sites were associated with increased use of services. High rates of provider supply were associated with relatively little variation in use. The study also confirmed the importance of controlling for health status. Patients with glaucoma, diabetic retinopathy, or corneal disease were significantly more likely to undergo the services studied than patients without those conditions.

Abstract, executive summary, and dissertation (accession no. PB2002-101477); 260 pp, $54.00 paper, $23.00 microfiche, are available from NTIS.

False-Positive Mammograms and Detection-Controlled Estimation. Andrew N. Kleit, Ph.D., Pennsylvania State University, University Park. AHRQ grant HS10068, project period 7/1/99-6/30/01.

In addition to the usual costs associated with mammography, other costs are incurred when there is a false-positive reading that leads to further tests. Although estimates vary, it appears that up to 10 percent of all mammograms fall into the false-positive category. This project examined the incidence of false-positive mammograms using detection controlled estimation (DCE), together with an extensive database from a large hospital-based mammography program in a medium-sized Southern city. Study results imply that access to a previous mammogram greatly reduces the incidence of false-positive readings by as much as 50 to 80 percent.

Abstract, executive summary, and final report (accession no. PB2002-101464); 32 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Family Influences on Children's Health and Health Care. Whitney P. Witt, M.P.H., Johns Hopkins University, Baltimore, MD. AHRQ grant HS11254, project period 9/1/00-6/30/01.

This study examined the correlates of psychosocial adjustment and mental health care use in 1994-1995 among 4,000 disabled children ages 6-17 years. Mothers reported on children's health, psychosocial problems, mental health services use, and who, if anyone, coordinated the child's medical care. Results show that family stressors are strongly associated with poor psychosocial adjustment and mental health care use among children with disabilities. Among children with poor psychosocial adjustment, only 40 percent received mental health services, suggesting that there are substantial barriers to these services. These children were more likely to receive outpatient mental health services and avoid hospitalization if their medical care was jointly coordinated by a family member and their physician.

Abstract and executive summary of dissertation (accession no. PB2002-100381); 20 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Health Education in an HMO: Effectiveness and Efficiency. Ronald W. Toseland, Ph.D., Research Foundation of the State University of New York, Albany. AHRQ grant HS09788, project period 9/30/96-9/29/01.

This project evaluated the short and long-term effectiveness of a health education program (HEP) for spouses of frail older people in a staff model HMO. HEP includes emotional and problem-focused coping strategies, education, and support in eight weekly 2-hour group sessions and 10 monthly 2-hour followup sessions. For caregivers, HEP was more effective than usual care in the short-term for reducing depression, maintaining social integration, increasing problem-solving effectiveness, increasing knowledge of community services and how to access them, enhancing feelings of competence, and improving the way caregivers responded to the care recipient. Most of these changes persisted at 1 and 2 years after intervention.

Abstract, executive summary, and final report (accession no. PB2002-102311); 38 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Health Expense Risk Assessment Using Administrative Data. Richard T. Meenan, Ph.D., Kaiser Foundation Research Institute, Oakland, CA. AHRQ grant HS10688, project period 7/1/00-6/30/01.

This project used a large multi-HMO administrative data set for 1995-1996 to compare various risk-adjustment models as population-based screens for enrollees at relatively higher risk of generating large future medical expenditures. Early identification of these enrollees can promote effective secondary and tertiary prevention through care or disease management. The Global Risk-Adjustment Model (GRAM-96) was somewhat more accurate in identifying "high-cost" cases, but all models demonstrated fair to good accuracy.

Abstract, executive summary, and final report (accession no. PB2002-101465); 77 pp, $29.50 paper, $12.00 microfiche, are available from NTIS.

Health-Related Quality of Life Issues for Dialysis Patients. Michael G. Trisolini, M.B.A., Brandeis University, Waltham, MA. AHRQ grant HS10580, project period 7/1/99-9/30/01.

Until now, evaluations of care for dialysis patients have focused on biomedical quality, use of services, and cost indicators. The patient's self-assessed, health-related quality of life (HRQOL) has received much less attention. This study evaluated factors affecting HRQOL and the impact on patient outcomes. The results showed that a wide range of psychosocial factors affect HRQOL, which implies that Medicare should consider modifying its reimbursement policy for dialysis centers to promote expanded use of allied health and home health services, enhanced family and social support networks, and improved rehabilitation through increased staff encouragement.

Abstract and executive summary of dissertation (accession no. PB2002-101214); 18 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Historically Black Colleges and Universities and Health Care Administration Health Services Research Conference: Investigating Determinants of Health Disparities. Betty W. Fomby, Southern University, Baton Rouge, LA. AHRQ grant HS10932, project period 9/15/00-9/14/01.

This report describes a conference held in New Orleans, LA, in September 2000. There were four main objectives:

  1. Enhance the capabilities of HBCUs to partner with Federal agencies and with each other.
  2. Learn about the research and educational opportunities available at AHRQ, the Centers for Medicare and Medicaid Services, and the Office of Rural and Minority Health.
  3. Develop strategies to address the differences in health status and disparities experienced by blacks.
  4. Learn from examples of current research conducted at HBCUs that investigated the determinants of health disparities in blacks.

Abstract and executive summary of conference (accession no. PB2002-101462); 18 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Improving Clinical and Economic Outcomes of NSAID Therapy. Wayne A. Ray, Ph.D., Vanderbilt University, Nashville, TN. AHRQ grant HS07768, project period 7/1/93-7/31/99.

These researchers conducted outcomes studies that identified nonsteroidal antiinflammatory drugs (NSAIDs) as associated with substantial excess adverse clinical outcomes and costs, demonstrated that these costs could be reduced by increased use of generic medications, and suggested that a safer approach was increased use of acetaminophen and topical medications to control musculoskeletal symptoms. They also conducted two randomized controlled trials of an educational program designed to reduce use of NSAIDs among the elderly living in the community and in nursing homes.

Abstract, executive summary, and final report (accession no. PB2002-102310); 26 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Medical Innovation and Changes in Practice Patterns. Michael Chernew, Ph.D., University of Michigan, Ann Arbor. AHRQ grant HS09838, project period 8/1/98-7/31/01.

The goal of this project was to identify the managed care mechanisms that influence the extent to which medical innovations change medical practice. The researchers focused on practice patterns for patients with coronary artery disease (CAD) in four diverse delivery systems. A total of 27 individuals were interviewed, including physicians and administrators from health plans and physician groups. Preliminary results suggest that managed care plans are hesitant to micro-manage physician practices in clinical areas in which they do not have clear evidence. Most of the effect of managed care comes through more general pressure placed on physician groups. In the absence of evidence, authority lies with the physicians. Physicians are very aware of evidence, but they are willing to adopt technology prior to strong evidence if there is reason to believe the technology might resolve known clinical concerns and if anecdotal evidence suggests it may help.

Abstract and executive summary (accession no. PB2002-101698); 11 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Organization Typology of Emerging Health Organizations. Stephen M. Shortell, M.B.A., Ph.D., Northwestern University, Evanston, IL. AHRQ grant HS09524, project period 6/1/97-5/31/98.

The goal of this project was to use existing theory and data to empirically develop a taxonomy of health networks and systems that share common strategic and structural features. The taxonomy is based on three key dimensions:

  1. Differentiation referring to the number of different products/ services provided along a continuum of care.
  2. Integration referring to the mechanisms used to achieve unity of effort across organizational components.
  3. Centralization referring to the extent activities take place at centralized versus dispersed locations.

Abstract and executive summary (accession no. PB2002-101692); 32 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Process and Outcomes of Long-term Care Decisionmaking Among Korean-American Elders. Jong Won Min, Ph.D., University of California, Los Angeles. AHRQ grant HS10785, project period 7/1/00-6/30/01.

Decisionmaking about long-term care is largely determined by cultural context. The purpose of this study was to examine processes and outcomes of long-term care decisions among older Korean immigrants when they lose functional independence. Findings are from a cross-sectional survey involving face-to-face interviews with a sample of 153 Korean-American elders in Los Angeles. The study revealed that as the impairment worsened, requiring longer and more intensive care, the respondents' willingness to rely on an "informal source" of care decreased. Acculturation and the level of adherence to traditional values exerted significant effects on long-term care decisions in this population.

Abstract, executive summary, and dissertation (accession no. PB2002-101687); 275 pp, $54.00 paper, $23.00 microfiche, are available from NTIS.

Psychosocial Interventions for Metastatic Breast Cancer. Ruvanee M. Pietersz, Ph.D., University of Chicago. AHRQ grant HS10565, project period 9/30/99-6/30/01.

Research goals were to explore the changes that occur in the lives of women with metastatic breast cancer and examine the impact of two interventions (expressive-supportive group psychotherapy and an online support group) for increasing psychosocial well-being. Women with metastatic breast cancer were randomly assigned to either an intervention group or a control group. The findings indicate that women with metastatic disease tend to decline in social connection, activity, and coping because of the difficulties they encounter in their daily lives. Both interventions prevented psychosocial declines, although the two interventions differed in the use of specific therapeutic methods, the presence of a skilled professional, and the physical proximity of group members. This research also suggests that the ideal online support group for this population is characterized by frequent interaction, discussions that are not restricted to breast-cancer related topics, and early establishment of health norms of disclosure.

Abstract, executive summary, and dissertation (accession no. PB2002-10140); 291 pp, $56.00 paper, $23.00 microfiche, are available from NTIS.

Second Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Phoebe L. Barton, Ph.D., University of Colorado Health Sciences Center, Denver. AHRQ grant HS10102, project period 7/1/00-6/30/01.

This workshop was designed to introduce and teach the concepts of evidence-based medicine to clinicians and other decisionmakers. Using a problem-based, small group format, participants developed questions, identified and synthesized relevant evidence, critically appraised the evidence, and learned to apply these skills in a clinical setting. Participants included a diverse group of clinicians and policymakers.

Abstract, executive summary, and final report (accession no. PB2002-101689); 22 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Secondary Pharmacologic Prevention of Ischemic Stroke in an Elderly Nursing Home Population. Brian Quilliam, R.Ph., Brown University, Providence, RI. AHRQ grant HS11256, project period 9/30/00-9/29/01.

The researchers used cross-sectional, cohort, and case-control study designs to describe treatment patterns, estimate the relative beneficial effects (subsequent stroke and mortality) and the relative bleeding effects of secondary stroke prevention agents among a population of elderly stroke survivors living in a nursing home. They found that nearly two-thirds of residents were not being treated with secondary stroke prevention agents. Age, comorbidity, race/ethnicity, and cognitive and physical functioning were all predictive of treatment. Both antiplatelets and anticoagulants decreased rates of all-cause mortality relative to non-use. There was an increased risk of hospitalization for bleeding among people taking aspirin or warfarin, yet the absolute risk was small.

Abstract and executive summary of dissertation (accession no. PB2002-101213); 18 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Stability of Psychiatric Symptoms in Primary Care. David A. Katerndahl, M.D., University of Texas, San Antonio. AHRQ grant HS10676, project period 4/1/00-3/31/01.

The goal of this project was to design and evaluate methods to test the Dynamic Model of Mental Health Problems. The researchers recruited 80 primary care patients, employed three different methods for six monthly interviews, and conducted qualitative interviews of 16 patients. No difference between interview methods was found. Recruitment was difficult, and about half of the subjects crossed a distress-nondistressed threshold at least once; 25 percent developed at least one DSM diagnosis. This preliminary research provided essential information for use in designing a study to evaluate the Dynamic Model of Mental Health Problems.

Abstract, executive summary, and final report (accession no. PB2002-108254); 54 pp, $27.00 paper, $12.00 microfiche, are available from NTIS.

Temporal Variations in U.S. Infant Death from Perinatal Causes by Race, Birthweight, and Time Period of Birth. Amanda J. Liddle, B.S.N., M.P.H., University of Alabama, Birmingham. AHRQ grant HS11259, project period 9/30/00-9/29/01.

This population-based study examined the effects on time to death of various technologies that evolved in the late 1980s and early 1990s to improve infant survival. The researchers used national and State vital records data for the period 1985-1995 to examine time to infant death from perinatal causes at varying birthweights and for two races (black and white). The researchers found that mortality and total number of days to death decreased, death was postponed for some infants, and there was a continuing but changing racial disparity. This may have policy and fiscal implications for maternal and child health policymakers, health care delivery organizations, use of resources, outcomes research, and clinical care.

Abstract, executive summary, and dissertation (accession no. PB2002-101459); 214 pp, $47.00 paper, $23.00 microfiche, are available from NTIS.

Timing of Prophylactic Surgery for Diverticulitis. Robert J. Richards, M.S., University of Kansas Medical Center, Kansas City. AHRQ grant HS10827, project period 8/1/00-7/31/01.

Although surgery is recommended after two or more bouts of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. These researchers compared the costs (estimated from Medicare reimbursement rates) and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year old hypothetical cohorts. They found that surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies.

Abstract, executive summary, and final report (accession no. PB2002-101693); 28 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

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