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Grant final reports now available from NTIS

The following grant final reports are now available from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator, his or her affiliation, grant number, and project period and provides a brief description of the project.

Records of documents archived at NTIS—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. For information about findings from the projects described here, please access the relevant final reports at the NTIS Web site. Also, all items in the database from 1997 to the present can be downloaded from the NTIS Web site. Go to 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 of Research Activities, select "Search Research Activities." To search for information, enter either the grant or contract number or the principal investigator's last name in the query line. A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.

AAMC HSR Institute for Minority Faculty. Herbert W. Nickens, M.D., Association of Medical Colleges, Washington, DC. AHRQ grant HS09262, project period 9/30/96-6/30/02.

The AAMC Health Services Research Institute is a program for junior minority faculty (African American, Hispanic, and American Indian) at U.S. medical schools to develop their skills in health services research. The focus was on developing a concept paper into a research proposal suitable for submission to AHRQ or another funding source. Students also took part in formal sessions, seminars, and mock study sections. Abstract, executive summary, and final report (NTIS accession no. PB2005-102222; 164 pp., $47.50 paper, $20.00 microfiche) are available from NTIS.

Access to Medicare Hospice for Nursing Home Residents. Pedro Gozalo, Ph.D., Brown University, Providence, RI. AHRQ grant HS11457, project period 7/1/01-6/30/03.

The main goal of this study was to explore the factors influencing access to hospice care for dying nursing home residents. After adjusting for patient, provider, and market factors, the researchers found no association between certain facility characteristics—such as for-profit status—and access to hospice care. However, nursing homes with a higher ratio of minority residents have fewer residents opting for hospice care. On the other hand, homes with special care units have a higher number of residents who choose hospice. Distance from the nursing home to the nearest hospice provider in excess of 15 miles was associated with significantly reduced access to hospice care. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102214; 30 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

Assessing Organizational Features of Health Care Settings to Improve Quality. Deborah S. Main, Ph.D., University of Colorado Health Science Center, Denver. AHRQ grant HS12059, project period 9/30/01-9/30/03.

This project provided support for a small conference involving 45 participants from different medical disciplines and the organizational and social sciences. They discussed conceptual and methodological models for understanding the organizational features of primary care settings. The goal was to develop strong conceptual models and methods for primary care research, which are presented in the conference proceedings. Abstract, executive summary, and final report (NTIS accession no. PB2005-101336; 44 pp., $29.50 paper, $14.00 paper) are available from NTIS.

Characterizing Medical Error: A Primary Care Study. Steven H. Woolf, M.D., Virginia Commonwealth University, Richmond. AHRQ grant HS11117, project period 9/15/00-8/31/02.

The four goals of this project were to: (1) develop patient-focused typologies of medical errors and injuries in outpatient primary care settings; (2) gain an understanding, from the patient's perspective, as to which of these errors and injuries are the most common and the most serious; (3) compare and contrast the patient descriptions with reports of errors obtained from physicians; and (4) provide a basis for further investigation of the epidemiology, cause, and prevention of the most common and most serious errors/harms. Abstract, executive summary, and final report (NTIS accession no. PB2005-101335; 16 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

Effect of Health Plans on Hypertension and Diabetes Care. Edward Guadagnoli, Ph.D., Harvard Medical School, Boston, MA. AHRQ grant HS09936, project period 7/1/98-6/30/03.

These researchers evaluated whether features of physicians' practices—including practice arrangements, clinical management strategies, and financial arrangements—influence the quality of care provided to patients with hypertension or diabetes. They studied 1,335 patients with hypertension and the same number with diabetes and collected data from physicians, patients, and medical records. In general, they found a lack of consistency in the practice characteristics related to the quality of care for both hypertension and diabetes. Abstract, executive summary, and final report (NTIS accession no. PB2005-102218; 216 pp., $54.50 paper, $26.50 microfiche) are available from NTIS.

Evaluation of an Adaptive Patient Data Entry Interface. David F. Lobach, Ph.D., M.D., Duke University Medical Center, Durham, NC. AHRQ grant HS09706, project period 9/30/98-9/29/02.

The goal of this project was to demonstrate the effectiveness of a computer system that uses multimedia and touch screen technology to adapt the human-computer interface to the native language and reading literacy of the user. The study involved 705 adult patients and was conducted in two sites: an academic family medicine clinic and an indigent adult medicine clinic. The researchers found that the system collected significantly more information from patients, especially those with low reading literacy, than was collected with conventional (paper) means. They conclude that advances in technology now enable patients to directly enter their clinical information into a computer irrespective of reading or computer literacy. Abstract, executive summary, and final report (NTIS accession no. PB2005-101337; 66 pp., $31.50 paper, $14.00 microfiche) are available from NTIS.

Factors Associated with Hospice Utilization. Susan C. Miller, Ph.D., Brown University, Providence, RI. AHRQ grant HS11004, project period 9/30/00-9/29/02.

The goal of this study was to determine whether hospice daily visit volume varied by care setting (nursing home vs. non-nursing home). The sample included 9,460 patients cared for in a nursing home and 15,484 cared for in another setting during the period October 1998 through September 1999. Visits were provided by 21 hospices (all owned by one parent company) across seven States. Average daily hospice visits were 1.1 for nursing home patients and 1.2 for non-nursing home patients. After controlling for a number of confounding factors, site of care was not significantly associated with visit volume. However, nursing home patients were more likely than non-nursing home patients to have aide, clergy, and social worker average daily visits above the median. Thus, there were differences between the two groups in volume mix but not overall volume of hospice visits. Abstract and final report (NTIS accession no. PB2005-102219; 22 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

Family Physician Reports of Medical Error. Anton J. Kuzel, M.D., Virginia Commonwealth University, Richmond, VA. AHRQ grant HS11725, project period 9/30/01-6/30/03.

The researchers examined 75 anonymous error reports filed by 18 U.S. family physicians who were participating in an international study on the causes of medical errors. They reviewed the narratives of the reports and tabulated the consequences to patients, both those reported by physicians and those inferred by the investigators. A chain of errors was documented in 77 percent of incidents. Of the 83 percent of errors that involved treatment or diagnosis, 67 percent originated from miscommunication. When asked whether the patient was harmed, 7 physicians answered affirmatively in 43 percent of the cases in which their narratives described harms. Psychological and emotional effects accounted for 17 percent of physician-reported consequences but 69 percent of investigator-inferred consequences. The researchers conclude that physicians are an unreliable source for reporting harms; the emotional impact of errors is poorly recognized by physicians and deserves greater attention; and safety initiatives should focus more on preventing miscommunication than on improving judgment. Abstract, executive summary, and final report (NTIS accession no. PB2005-101333; 28 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

Fourth Annual Evidence-Based Practice Conference. Bernadette Melnyk, Ph.D., R.N., University of Rochester, Rochester, NY. AHRQ grant HS13817, project period 9/30/02-9/29/03.

This project provided support for a national conference attended by 218 nurses and other interdisciplinary health care providers from 18 States. The goal was to help attendees acquire the skills to search for the latest scientific evidence affecting practice, critically appraise the strength of the evidence, plan practice changes in response to the evidence, overcome barriers to evidence-based care, plan strategies to evaluate evidence-based care, and become knowledgeable about the latest evidence affecting certain populations, including high-risk children, older adults, and patients with acute/chronic illnesses. Abstract, executive summary, and final report (NTIS accession no. PB2005-101334); 14 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

Government Coverage of Traditional Indigenous Medicine. J.K. Olson-Garewal, M.D., University of Arizona, Tucson. AHRQ grant HS10930, project period 8/15/00-2/14/02.

This project provided support for two conferences focused on traditional indigenous medicine. The first conference included speakers from three countries—New Zealand, South Africa, and the United States—who discussed their respective countries' indigenous health care systems and problems and progress in incorporating these practices into government-regulated and supported health care systems. The second conference concentrated on government support of traditional Indian Medicine and included U.S. traditional healers, tribal leaders, and representatives of the leading Federal health care funding agencies. The major themes centered on the importance of traditional healing in the American Indian community, the need for support of traditional practitioners without compromising their integrity or autonomy, the role of traditional health care in economic self-sufficiency, and the Federal health care payers' willingness to follow the Tribes' lead in this area. Abstract and final report (NTIS accession no. PB2005-102221); 212 pp., $54.50 paper, $26.50 microfiche) are available from NTIS.

Hospital CEOs' Perception of Competition: A Pilot Study. Min Woong Sohn, Ph.D., University of Chicago, Chicago, IL. AHRQ grant HS10810, project period 6/1/00-5/31/02.

These researchers developed and pilot-tested a questionnaire on market competition among hospitals. They sent the questionnaire to 71 hospital administrators in the Chicago area in 2001 and achieved a 76 percent response rate. Overall, administrators were reluctant to share sensitive information with the researchers and did not respond to questions pertaining to competitor identification. Over 50 percent of respondents did not answer some questions (particularly those from for-profit hospitals), suggesting a potential selection problem in the data obtained through a survey like this. The researchers conclude that a survey of hospital administrators is not a reliable method for obtaining data on market competition among hospitals. Abstract and final report (NTIS accession no. PB2005-102220; 48 pp., $29.50 paper, $14.00 microfiche) are available from NTIS.

Innovations Incentive Initiative in a Health Services Research Training Program. Patricia Danzon, M.D., Ph.D., University of Pennsylvania, Philadelphia. AHRQ grant HS09790, project period 9/1/98-8/31/03.

This project provided support for two specific innovations. The first supported creation of a syllabus for a Ph.D., level course on outcomes research taught to health services research trainees in the National Research Service Award program at the University of Pennsylvania. The second innovation created a summer research scholars program for underrepresented minority students at the University to enhance their understanding and interest in a health services research career. Abstract and final report (NTIS accession no. PB2005-102212); 14 pp., $26.50 paper, $14.00 microfiche) are available from NTIS.

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