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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 all 750,000 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 www.ntis.gov 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®.

Development of the New England Clinicians Forum. Jennifer E. Granger, M.P.H., Connecticut Primary Care Association, Hartford. AHRQ grant HS13568, project period 9/30/02-9/29/03.

This project provided support for the New England Clinicians Forum to expand its capacity to conduct and link research to community care sites. As a result, this practice-based research network is now a sustainable entity with the potential for significant contributions to the literature on primary care in culturally diverse and medically underserved populations.

The abstract and final report (NTIS Accession No. PB2004-105594; 22 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Development and Testing of an Instrument to Assess Pain. Kandyce Richards, Ph.D., R.N., University of Miami School of Nursing, Miami, FL. AHRQ grant HS10788, project period 9/30/00-11/30/01.

This project provided support for the refinement and testing of a tool for assessing pain in hospitalized patients. The project involved four South Florida hospitals that served as recruitment sites for data collection. Both focus groups and individual interviews were used during data collection. Content analysis led to a preliminary 40-item instrument, which was scored by 200 subjects during piloting and testing. A 30-item questionnaire was finalized.

The abstract and final report (NTIS Accession No. PB2004-106401; 18 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Disease Management for Asthmatics in Medicaid HMOs. Alan Hillman, M.D., University of Pennsylvania, Philadelphia. AHRQ grant HS10044, project period 4/1/99-6/15/00.

The goals of this project were to implement and test a 2-year quality improvement intervention for asthma care in 43 pediatric practices in Boston and Detroit. Twenty-two practices received the intervention in the first year and the remainder in the second year. The proportion of children who received appropriate medication therapy did not differ based on intervention status.

The abstract and final report (NTIS Accession No. PB2004-106782; 22 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

For-Profit Hospital Ownership and Medicare Spending. Elaine M. Silverman, M.D., Dartmouth-Hitchcock Medical Center, Hanover, NH. AHRQ grant HS11012, project period 9/1/00-8/31/03.

The goal of this project was to confirm previous findings that showed an association between for-profit hospital ownership and increased Medicare spending between 1989 and 1995. The researchers examined whether this association continued through 1999. They used data from the continuous Medicare History Sample to calculate adjusted spending rates in each area. They found that annual per capita spending was higher in areas served by for-profit hospitals than in areas served by not-for-profit hospitals through 1999. For-profit hospitals were associated with higher proportions of discharges coded for complex (and thus more highly reimbursed) diagnoses among admissions for respiratory illness. The researchers conclude that areas served by for-profit hospitals continued to be associated with higher per capita Medicare spending through 1999. Spending on hospital services accounted for a large part of these differences and may be related to coding practices.

The abstract, executive summary, and final report (NTIS Accession No. PB2004-106402; 32 pp, $29.50 paper, $14.00 microfiche) are available from NTIS.

Geographic Accessibility of Health Care in Rural America. Wilbert M. Gesler, Ph.D., University of North Carolina at Chapel Hill. AHRQ grant HS09624, project period 9/30/98-2/29/04.

This study was conducted in 12 rural counties in the western region of North Carolina to measure the effects of geographic factors on the use of health care services and to assess the extent to which sociodemographic, cultural, and health status characteristics reduce these effects. The researchers used a dataset based on 1,059 personal survey interviews. They found that geographic and spatial behavior variables had limited association with use of health care in this rural region, after demographic, social, cultural, and health status factors were controlled. More geographic and other variables were associated with discretionary use (check-ups, chronic care) than with nondiscretionary care (illness and other acute care visits).

The abstract and final report (NTIS Accession No. PB2004-106425; 20 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Optimal Antithrombotic Therapy in Atrial Fibrillation. Brian F. Gage, M.D., Barnes-Jewish Hospital, St. Louis, MO. AHRQ grant HS10133, project period 7/1/99-6/30/03.

The goals of this project were to determine the real-world outcomes of antithrombotic therapy in Medicare beneficiaries who have atrial fibrillation (AF) and to increase the appropriate use of antithrombotic therapy in this population. The researchers used data from medical chart reviews representing seven States with 3 years of Medicare Part A claims data to form a National Registry of AF. They used the dataset to quantify the risks of stroke and hemorrhage and to form clinical prediction rules for these adverse events. They carried out two randomized controlled trials to evaluate the optimal method of managing warfarin therapy and two decision analyses to evaluate the cost-effectiveness of antithrombotic therapy. By combining stroke risk factors and risk factors for hemorrhage, they were able to accurately predict future stroke or major hemorrhage in AF patients. Using the two schemes, the researchers were able to determine the cost-effectiveness of aspirin and warfarin for AF patients.

The abstract and final report (NTIS Accession No. PB2004-105593; 16 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

Policy Implications of Primary Care Practice Patterns. David Blumenthal, M.D., Massachusetts General Hospital, Boston. AHRQ grant HS07892, project period 5/1/95-10/31/97.

This project consisted of a series of substudies that examined what primary care practitioners do, how what they do is changing, influences on such changes, and the implications for policy. Examples of findings include: primary care physicians should be exposed during training to health problems of underserved populations; internists may face the greatest pressure to reduce intensity of their practice styles; and combining primary care physicians from multiple specialties in the same practice may result in an optimal balance of skill and experience. Other findings include: physicians who want to shorten visits will be tempted to avoid complex older patients and to provide fewer preventive, diagnostic, and therapeutic services; increasing ethnic diversity and provision of preventive services are associated with longer primary care visits; and these trends may conflict with managed care emphasis on physician productivity.

The abstract and final report (NTIS Accession No. PB2004-106427; 16 pp, $26.50 paper, $14.00 microfiche) are available from NTIS.

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