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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.

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 (1995-2002) of Research Activities, select Search Research Activities. To search for information, enter either the grant/contract number or principal investigator's name in the query line. A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.

Adoption of Cancer Pain Guidelines in Managed Care. Mildred Z. Solomon, Ed.D., Education Development Center, Inc., Newton, MA. AHRQ grant HS08691, project period 6/1/96-11/30/01.

The grantee evaluated a voluntary, two-tiered dissemination strategy designed to reduce pain among cancer patients by improving primary care nurses' and physicians' use of the AHRQ cancer pain guideline. Four treatment clinics received an intervention that encouraged caregivers to adopt routine procedures for pain screening, assessment, followup, and documentation and provided nurses and physicians with education to improve opioid knowledge and confidence in prescribing opioids. Evaluation data were drawn from 1,733 interviews with 791 patients, clinician surveys, and prescription records. Treatment clinic clinicians prescribed more opioids than those in control clinics and demonstrated increased knowledge about prescribing opioids. However, patients in the treatment clinics did not report better pain outcomes than patients in control clinics.

Although the 6-hour, skills-based educational program achieved improvements in clinician knowledge and prescribing behavior, the recommended routine assessment and documentation procedures were not adopted by clinicians. This probably accounts for the lack of impact on patient outcomes and suggests that voluntary adoption of new procedures is insufficient to improve patient outcomes. Institutional mandates may be needed to achieve substantial improvement in pain-related outcomes.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108747; 102 pp, $33.00 paper, $17.00 microfiche are available from NTIS.

Adult Global Quality Assessment Tool. Elizabeth McGlynn, M.P.P., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS09463, project period 9/30/96-9/29/01.

Recognizing the limits of existing methods for evaluating quality, these researchers developed a more comprehensive, clinically detailed system of quality assessment for adults known as the Quality Assessment Tools system, or QA Tools. They selected 25 chronic and acute conditions common to adults, reviewed the literature, developed draft indicators, selected three expert panels (nine members each) to refine and finalize the indicators using a modified Delphi method, developed medical record abstraction software to facilitate data collection, applied the method in two health plans, and analyzed the data. Data analysis continues, and only preliminary findings appear in this final report.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108736; 90 pp, $29.50 paper, $12.00 microfiche are available from NTIS.

Application of the AHCPR Urinary Incontinence Guideline in Nursing Homes. Nancy M. Watson, M.S., Ph.D., University of Rochester, Rochester, NY. AHRQ grant HS08491, project period 6/1/96-5/31/01.

These researchers assessed the extent to which the 1996 AHCPR clinical practice guideline on urinary incontinence (UI) was familiar, understood, and used in nursing homes and factors related to that process. The project involved 52 nursing homes (7,458 beds) in upstate New York. The evaluation/treatment of new cases of UI including new admissions with UI (n=201) was assessed using record review and interviews of nursing assistants. Need for UI evaluation/treatment occurred at a rate of 4.3 cases per 100 beds per 12 weeks. Overall, 31 percent of the most important guideline standards were met (0 to 65 percent) considering only those standards appropriate for each individual case. Areas of concern were medical providers' awareness of new UI, attention to reversible causes, rectal/prostate examinations, and post-void residual testing. Barriers to guideline use included lack of knowledge and resources. Awareness of and familiarity with the guideline were low. Current research is underway to see if cost savings and improved UI outcomes are possible using a focused approach by nurse practitioners to implement the guideline in nursing homes.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2001-109052; 102 pp, $33.00 paper, $12.00 microfiche are available from NTIS.

Building Bridges VII. Assessing Policy Decisions and Their Impact on Health Care Delivery. Barbara Lardy, M.P.H., American Association of Health Plans, Washington, DC. AHRQ grant HS10946, project period 3/1/01-2/28/02.

This conference was held in Seattle, WA, April 26-27, 2001, and was sponsored by the American Association of Health Plans, AHRQ, the Centers for Disease Control and Prevention (CDC), and the Blue Cross and Blue Shield Association. The conference focused on current research activities, results, and application of findings by health plans, purchasers, and the research community; how health care policymakers use research to generate quality improvements; translation of research findings into polices that improve health care delivery; and the impact of policy decisions on clinical practice and medical management.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2003-100058; 84 pp, $29.50 paper, $12.00 microfiche are available from NTIS.

Defining Risks for Chronic Disease in Spinal Cord Injury. Sin Wang, Ph.D., University of Illinois, Chicago. AHRQ grant HS11277, project period 9/30/00-9/29/01.

Previous studies have shown increased risks for various chronic diseases in spinal cord injured individuals (SCIs). The purpose of this investigation was to assess the prevalence in SCIs of type 2 diabetes, hypertension, obesity, and dyslipidemia and their associated risk factors using sampling techniques that would allow findings to be generalizable to other similar populations. This survey was conducted in a university outpatient center and involved 115 adult men with paraplegia who were recruited from active medical records at a large urban SCI hospital using systematic sampling techniques based on time since injury. The main outcome measures were body mass index (BMI), waist circumference (WC), blood pressure, serum glucose, total and LDL cholesterol, and triglyceride (TG) concentrations. Prevalence rates for diabetes, hypertension, lower HDL-cholesterol, elevated TG concentrations, underweight, and large WC were higher, while obesity and elevated TC concentrations were lower in this population than for similar able-bodied U.S. males. Large WC significantly increased risk for diabetes. This population has increased prevalence rates for the cluster of risk factors that characterize the metabolic syndrome that may explain the exaggerated prevalence of type 2 diabetes, hypertension, and cardiac disease.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108743; 106 pp, $33.00 paper, $17.00 microfiche are available from NTIS.

Does Cost-Effectiveness Make a Difference? Lessons from Pap Smears. Michael Hagen, M.D., University of Kentucky, Lexington. AHRQ grant HS10931, project period 9/15/00-9/14/01.

Participants at the 2000 meeting of the Society for Medical Decision Making explored the public policy implications of cost-effectiveness analyses and the challenges encountered when moving research results into the policy arena. Presentations focused on cost-effectiveness analysis and practice policy, cost-effectiveness in the real world of cancer screening, the role of evidence in cost-effectiveness analysis, and the role of cost-effectiveness in a managed care organization.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108739; 18 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Emergency Department Data Conference Phase 1. Agenda-Setting Meeting. Denise Love, National Association of Health Data Organizations, Salt Lake City, UT. AHRQ grant HS10944, project period 2/1/01-1/31/02.

This meeting was convened in March 2001 to address how States can overcome the technical and political barriers associated with emergency department database development and use. During the agenda-setting meeting, an advisory committee was established, background materials were assembled, topics were prioritized, and speakers were identified for the upcoming conference.

Copies of the abstract, executive summary, and conference agenda, NTIS accession no. PB2002-108740; 56 pp, $27.00 paper, $12.00 microfiche are available from NTIS.

High-Risk Periods for Child Injury Among Siblings. David Grossman, M.D., M.P.H., University of Washington, Seattle. AHRQ grant HS10724, project period 3/1/00-2/28/02.

The goal of this project was to examine patterns of injury risk within sibling groups in order to determine whether a clinical encounter for injury care could be used as a marker to identify siblings at high risk for subsequent injury. The project involved 16,335 children, aged 0-15 who were enrolled in an HMO between 1995 and 1997; this population contributed 38,215 child-years of data. The researchers tracked medically treated injuries that had been diagnosed and classified as unintentional. Incidence rates and hazard ratios were calculated for children whose siblings had been injured in the previous 180 days, compared with children without such exposure, adjusted for age, sex, sibling group size, and non-injury health care use. A total of nearly 9,000 injuries were sustained by 5,851 children. Injury incidence was 319 per 1,000 child-years among children with recent sibling injury and 235 per 1,000 child years among children without this exposure. When minor injuries were excluded, the adjusted RR was 1.95. This study showed that injury risk is shared within sibling groups and varies according to recent sibling injury experience. Clinical encounters for injury care might be used to identify sibling groups at increased risk of injury.

Copies of the abstract, executive summary, and final report; NTIS accession no. PB2002-108737; 36 pp, $25.50 paper, $12.00 microfiche are available from NTIS.

HIV Cost and Services Utilization Study (HCSUS). Martin Shapiro, M.D., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS08578, project period 9/1/94-10/31/00.

HCSUS was the first national probability sample study of people with a single chronic disease. HCSUS demonstrated that most people with HIV disease are not in regular care, and that racial/ethnic and socioeconomic disparities exist in access to care including access to HIV treatment. Case management improves care, but there is considerable unmet need for social services. Patients' physical and mental health status are impaired with HIV disease, and psychiatric disorders are very common among patients with HIV. Overall costs declined with the introduction of protease inhibitor medicines.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108744; 100 pp, $29.50 paper, $17.00 microfiche are available from NTIS.

Impact of Clinical Pathways for Rehabilitation Care. Deborah Dobrez, Ph.D., Northwestern University, Evanston, IL. AHRQ grant HS10375, project period 9/30/99-9/20/01.

Implementation of the prospective payment system (PPS) for post-acute rehabilitative care is likely to disrupt the medical rehabilitation industry, prompting institutional responses to improve efficiencies and control costs. Clinical pathway protocols could play a key role in increasing care efficiency. This study models the impact of therapy on cost and discharge function for stroke patients at a large academic acute rehabilitation hospital. The researchers estimated hypothetical PPS reimbursements and simulated the effects of institutional strategies to improve efficiency on costs and discharge function. Estimated PPS reimbursements were $10,825 less per patient on average than estimated costs (41 percent lower). The concern with cost pressure affecting treatment decisions is that patient outcomes will suffer as a result. These simulations suggest that under some scenarios there may be small changes in discharge functional status. Under other scenarios, however, cost-saving measures need not harm patient outcomes. For example, substitution from individual to group therapy was predicted to improve motor and cognitive function while reducing cost by nearly one-third on average.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108016; 20 pp, $23.00 paper, $12.00 microfiche are available from NTIS.

Northwest Health Policy Research Conference. Aaron Katz, M.D., University of Washington, Seattle. AHRQ grant HS09817, project period 4/1/98-12/31/98.

The goal of the biennial Northwest Health Policy Research Conference is to promote communication and more effective collaboration between the health policy and research communities in the Pacific Northwest; provide an opportunity for researchers to hear directly about research issues of importance to policymakers; and bring the findings of relevant health and health care research directly to policymakers. The 1998 conference offered two plenary sessions; seven concurrent morning and afternoon breakout sessions presenting original research; three workshops; and a poster session. Speakers represented public- and private-sector health and health policy researchers, analysts, and funding organizations.

Copies of the abstract and conference proceedings, NTIS accession no. PB2002-108000; 32 pp, $25.50 paper, $12.00 microfiche are available from NTIS.

Outcomes of Hospital Outcome Studies. Patrick Romano, M.D., M.P.H., University of California, Davis. AHRQ grant HS08574, project period 9/30/94-10/31/99.

The goal of this study was to evaluate the impact of hospital report cards in New York and California. The researchers conducted mail and telephone surveys of hospital administrators, quality improvement leaders, and managed care executives, and they analyzed hospital discharge data to ascertain effects on consumer choice. Hospital administrators and quality improvement leaders attend to report cards but remain skeptical about their quality and value. New York's report, based on detailed clinical data, received better ratings than California's report, which was based on administrative data. Administrators at low-mortality hospitals rated the report better and found it to be more useful than those elsewhere. A few quality improvement leaders described projects resulting from public disclosure; most expressed frustration at the untimely publication schedule and the lack of actionable information about care. There is substantial interest in hospital quality among managed care executives, but objective data receive little attention in contracting. Health plans rely more on quality measures with poor discrimination (i.e., accreditation) or subjective concepts (i.e., reputation, commitment to quality improvement, member satisfaction). Report cards had modest, inconsistent, and transient effects on consumer choice of hospitals. Volume shifts were greater among white and HMO-enrolled patients (in California) than among others.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108741; 90 pp, $29.50 paper, $12.00 microfiche are available from NTIS.

Pediatric Internet Medical Advice and Triage. Larry J. Baraff, M.D., University of California, Los Angeles. AHRQ grant HS10604, project period 9/30/99 to 9/29/01.

With the widespread dissemination of Internet technology, consumers have increased access to medical information via the Internet and to medical providers via E-mail. The objective of this project, which involved a self-administered survey, was to determine sources and quality of medical advice and information used by parents and whether parents would like to communicate with health care providers by E-mail. The study took place among consecutive parents visiting a general pediatrics faculty practice at a university medical center. The main outcome measure was reported quality of medical advice from physicians, nurse practitioners, the Internet, family and friends, and books, and the actual and desired use of E-mail to communicate with health care providers. The majority of 1,108 subjects had both Internet access (91.5 percent) and an E-mail address (87.6 percent). Approximately half used the Internet for medical information, and 30 percent used it to obtain information about a specific acute or chronic medical illness. Only 15 percent had communicated with a physician by E-mail in the previous year; however, an additional 49 percent said they would like to do so. Though at least 76 percent rated physician advice as very good or excellent by phone or at the time of the visit, only 47 percent considered medical information they had obtained via the Internet to be very good or excellent.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-108738; 88 pp, $29.50 paper, $12.00 microfiche are available from NTIS.

Spouse Involvement in Cardiac Patients' Exercise Behavior Change. Tantina Hong, Ph.D., Wayne State University, Detroit, MI. AHRQ grant HS11263, project period 9/30/00-9/29/01.

In light of the known benefits of health promoting behavior such as exercise in forestalling the disability associated with heart disease, the current study focused on examining the social processes underlying exercise behavior change in married couples. Participants were 80 patients and spouses enrolled in cardiac care. There was evidence that couples sharing the experiences in the same stage of behavior change are more in agreement in their perceptions of support and control exchanges than patients and spouses who are in different stages of change.

Copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104715; 136 pp, $36.00 paper, $17.00 microfiche are available from NTIS.

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