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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.

Dartmouth Symposium on Pediatric Sedation. Joseph P. Cravero, M.D., Dartmouth College, Hanover, NH. AHRQ grant HS10110, project period 8/22/00-8/21/01.

The sedation of pediatric patients for procedures and tests represents an area of medical practice devoid of standardization. In fact, different specialists use widely different medications, techniques, and monitoring equipment even though they are trying to achieve the same end point, a quiet, nonstressed, motionless child. The Dartmouth Summit on Pediatric Sedation consisted of four morning lectures which outlined the past problems and future challenges facing providers of pediatric sedation. The afternoon session involved a roundtable discussion of several "hot button" issues in this field, using videotaped case vignettes as a starting point. A complete transcript of the conference was used as a "data set" to examine major themes that were brought up during the meeting. These themes address issues involving the delivery of safe, efficient, and effective care in a setting of limited resources. The result is an outline for improvement in practice for the field of pediatric sedation and medical care delivery in a wider sense.

Select NTIS to order copies of the abstract and executive summary, NTIS accession no. PB2002-102263; 16 pp, $23.00 paper, $12.00 microfiche.

Impact of Guidelines on Quality of Care: Unstable Angina. Catarina I. Kiefe, M.D., M.S., Ph.D., University of Alabama, Birmingham. AHRQ grant HS08843, project period 9/30/97-9/29/01.

This quasiexperimental study involved an intervention to improve adherence to a clinical guideline for management of unstable angina. The study design included the longitudinal analysis of data over a 7-year period beginning just prior to release of the guideline in 1994 and concluding in 1999. Twenty-two volunteer hospitals in one State were recruited and randomly assigned to one of three groups: hospital-specific data feedback of performance on quality indicators combined with a physician opinion leader-driven quality improvement (QI) project intervention, hospital-specific data-driven feedback with a usual model QI project intervention, and no intervention. The QI projects were locally guided and based on the model used by the Centers for Medicare & Medicaid Services' Health Care Quality Improvement Program. More than 4,800 medical records were abstracted and linked to Medicare claims data for this study.

Select NTIS to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-101690; 48 pp, $25.50 paper, $12.00 microfiche.

Managed Care and Community Health Centers. Shi Leiyu, Dr.P.H., M.B.A., M.P.H., Ph.D., Johns Hopkins University, Baltimore, MD. AHRQ grant HS09831, project period 9/30/98-9/29/01.

This project had two objectives: to examine the relationship between community health centers' (CHCs) involvement in managed care and various center characteristics and to identify factors significantly associated with CHCs' involvement in managed care. Data for this study come from the Uniform Data System maintained by the Bureau of Primary Health Care. The researchers found that CHCs involved in managed care have more diversified sources of revenue and depend less on grant funding. Longitudinal analyses indicated that centers involved in managed care serve a significantly smaller proportion of uninsured patients but a higher proportion of Medicaid users than those not involved in managed care. They also found that CHCs' involvement in managed care is largely in response to external market pressures—i.e., Medicaid managed care and the prospect of reduced Federal grant funding. Other significant factors include center size, urban location, and proportion of users who are covered by Medicaid.

Select NTIS to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-102315; 62 pp, $27.00 paper, $12.00 microfiche.

Methods to Improve Data on PPO Performance. Liza Greenberg, M.P.H., R.N., American Accreditation Healthcare Commission, Washington, DC. AHRQ grant HS10105, project period 7/1/00-6/30/01.

This project provided partial support for a national conference, "PPO Performance Measurement: Agenda for the Future." The goal was to discuss approaches to assessing quality in PPOs and develop a research agenda for improving information on PPO performance. Five papers were commissioned for the conference from academic health services researchers, each of which examined an aspect of performance measurement in PPOs. Findings include: PPOs are increasingly important delivery systems, with over 100 million individuals enrolled; no common definition exists for PPOs; PPOs often do not have enrollment and claims data comparable to PPOs; PPOs have the capability to conduct performance assessment related to users and to process and structural measures.

Select NTIS to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-102929; 14 pp, $23.00 paper, $12.00 microfiche.

Paradoxical Trends in Influenza Immunization Rates and Rates of Hospitalization for Pneumonia and Influenza in the Elderly. Paul Hebert, Ph.D., University of Minnesota, Minneapolis. AHRQ grant HS10154, project period 7/1/99-12/31/00.

Over the past two decades, the percentage of elderly individuals who receive annual influenza immunization has increased from 20 percent in the late 1970s, to over 65 percent in 1996. In spite of this increase, the rate of hospitalization for pneumonia and influenza (P&I) among Medicare beneficiaries has not decreased; it increased from 15.0/1,000 beneficiaries in 1986 to 20.3/1,000 in 1996. The goal of this study was to find out why. The flu shot dividend failed to materialize for three basic reasons. First, influenza is responsible for only a small percentage of total P&I hospitalizations in the elderly. Although 65 percent of all P&I hospitalizations occur during influenza season, only 10-15 percent of those hospitalizations have influenza as an underlying cause. Consequently, even if 100 percent vaccination coverage were achieved, P&I hospitalization rates could only decrease by between 10 and 15 percent. Second, this study found that influenza immunization was not associated with a reduction in the likelihood of any influenza-related medical encounter. Third, there is some evidence that an aging fee-for-service Medicare population, expansion of Medicaid "buy-in" programs for Medicare beneficiaries, and biased selection of beneficiaries into Medicare HMOs has contributed to an increase in rates of P&I hospitalizations among fee-for-service Medicare beneficiaries.

Select NTIS to order copies of the abstract, executive summary, and dissertation, NTIS accession no. PB2002-102485; 36 pp, $25.50 paper, $12.00 microfiche.

Staff Work in an Urban Medical Rehabilitation Hospital. Diane R. Pawlowski, M.A., Ph.D., Wayne State University, Detroit, MI. AHRQ grant HS09603, project period 9/1/97-8/31/99.

This ethnographic study examined the staff social universe in an urban medical rehabilitation institute. Field work occurred from 1993 to 1995; 6 months of followup interviews were conducted at the 155-bed, 50-year-old hospital. Participant observation included staff meetings, social events, and routine work on traumatic brain and spinal cord injury units. Content analysis was applied to 54 staff interview transcripts. Cultural factors in the staff social universe affect patient care and later life. Key findings include how cultural value conflicts present in the facility's social organization and life may undermine efforts to maximize patient independence; staff metaphor use to describe the social universe; source of value dilemmas and structural challenges; and source of social validation and personal fulfillment. A significant finding is the dilemma faced by staff with disabilities who must educate patients, as well as coworkers and colleagues, who may have little or no contact with or knowledge of life with disabilities prior to arrival at the hospital.

Select NTIS to order copies of the abstract and executive summary of dissertation, NTIS accession no. PB2002-100380; 13 pp, $23.00 paper, $12.00 microfiche.

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