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AHCPR invites contract proposals for
evidence-based centers and nominations of topics for reports and
As part of its program to strengthen the scientific evidence base
used by health care organizations to improve clinical practice,
the Agency for Health Care Policy and Research is accepting
proposals to fund Evidence-based Practice Centers (EPCs). The
EPCs will produce evidence reports and technology assessments for
use by systems of care, professional societies, purchasers, and
others. These groups will be able to use the reports and
assessments as the scientific foundation for developing and
implementing their own clinical practice guidelines, performance
measures, and other clinical quality improvement tools, and for
making decisions related to the effectiveness or appropriateness
of specific health care technologies.
In addition, AHCPR is seeking nominations of topics for the
evidence reports and technology assessments to be produced by the
EPCs. These reports and assessments will involve the prevention,
diagnosis, treatment, and management of common diseases and
clinical conditions, and where appropriate, the use of
alternative/complementary therapies, as well as specific medical
procedures or health care technologies. The reports and
assessments will be based on comprehensive reviews and rigorous
analyses of the relevant scientific evidence—emphasizing
and detailed documentation of methods, rationale, and
assumptions—and peer reviews.
Until the new centers are established, AHCPR will convert the
work of the last two panels under its former guideline program
into the first evidence reports to be issued under the new
program. These reports will address screening for colorectal
cancer and the diagnosis and management of chronic headache pain.
AHCPR also expects to produce two additional evidence reports
during this transition phase in cooperation with public- and
private-sector partners. The topics for these reports will be
announced in the near future.
The solicitation for Evidence-based Practice Centers was
published in the November 22, 1996, Commerce Business Daily. The
Request for Proposals (RFP) will be released no sooner than
December 6, 1996, and the closing date for proposals will be 90
days after release of the RFP.
For copies of the Evidence-based Practice Centers RFP (RFP no.
AHCPR-97-0001), send a written request to the Agency for Health
Care Policy and Research, Contracts Management Staff, Attention:
Al Deal, Executive Office Center, Suite 601, 2101 East Jefferson
Street, Rockville, MD 20852; telefax (301) 443-7523. Include the
requestor's name, affiliation, address, and telephone and fax
An announcement regarding the nomination of topics for the EPCs
will be published shortly in the Federal Register. To be considered for the first group of evidence
reports, topic nominations should be submitted within 60 days of
the date of publication of the notice to: Douglas B. Kamerow,
M.D., M.P.H., Director, Office of the Forum for Quality and
Effectiveness in Health Care, Agency for Health Care Policy and
Research, 6000 Executive Boulevard, Willco Building, Suite 310,
Rockville, MD 20852.
AHCPR funds studies on hysterectomy and
treatments for uterine conditions
The Agency for Health Care Policy and Research recently funded
three research projects to determine the outcomes of surgery
versus other treatments for dysfunctional uterine bleeding (DUB),
as well as patient treatment preferences for women with
endometriosis, chronic pelvic pain, fibroids, uterine prolapse
and DUB. Each year in the United States, 590,000 women have
hysterectomies for various conditions. The majority of
hysterectomies are performed before menopause, often for abnormal
U.S. hysterectomy rates are much higher than in other Western
nations, and rates vary by geographic region, race/ethnicity, and
socioeconomic status. Although alternative treatments are
available, there are few data comparing these treatments to
hysterectomy or one form of hysterectomy to another. This lack of
information makes it more difficult for women to choose the
treatment option that is best for them.
The following studies resulted from a "Request For Application"
issued March 1, 1996, by AHCPR. The awards total $17.4 million
over 5 years for the following studies:
- Surgical Treatment Outcomes Project for Dysfunctional
Uterine Bleeding. Principal investigator Kay Dickersin,
University of Maryland at Baltimore, AHCPR grant HS09506,
project period 1996 to 2001. The purpose of this study is to
determine the equivalence of two therapies for
DUB—hysterectomy and endometrial ablation—using two
randomized controlled trials. The researchers will examine
the natural history of DUB, the effectiveness of treatment,
- MEDTEP Study on Hysterectomy and Dysfunctional Uterine
Bleeding. Principal investigator Sarah E. Fowler,
Case-Western/Henry Ford Health Sciences Center, Detroit, MI,
AHCPR grant HS09502, project period 1996 to 2001. Using
collaborative, multisite, randomized controlled trials, this
study will compare the effectiveness, relative costs, and
patient outcomes of hysterectomy, endometrial ablation, and
hormone therapy for women with dysfunctional uterine
- Medicine Or Surgery? Principal investigator Stephen
Hulley, University of California at San Francisco, AHCPR
grant HS09478, project period 1996 to 2001. The researchers
will conduct two randomized controlled trials: one to
compare the effects (including quality of life) and costs of
medical therapy versus hysterectomy; the other to compare
the effects of supracervical versus total hysterectomy on
function and well-being in women who undergo abdominal
hysterectomy. The study also will determine rates and
patient preferences for management options for women with
diagnoses of fibroids, dysfunctional uterine bleeding,
chronic pelvic pain, endometriosis, or uterine prolapse.
AHCPR announces opportunity for senior nurse
The Agency for Health Care Policy and Research, in conjunction
with the American Academy of Nursing, is seeking applicants for
the position of Senior Scholar in Residence for 1997-1998. This
program was developed in collaboration with the American Nurses
Association and the National Institute of Nursing Research to
encourage a senior nurse scientist to develop areas of
investigation that integrate clinical nursing care questions with
critical issues of health care quality, costs, and access. The
Federal agencies will pay up to half of the candidate's salary
during the course of the assignment, but fringe benefits (e.g.,
insurance, retirement) will be maintained and paid by the
candidate's home institution. Nominations will be accepted from
individuals or institutions. Individual nominations require an
endorsement of the application by the candidate's home
Candidates should be experienced nurse investigators with an
advanced degree in health services research or a related area,
preferably with clinical experience in the delivery of primary
care or experience in performing policy analyses related to
primary care. Competitive candidates will have experience in
writing, publication, and teaching and, on completion of the
Senior Scholar in Residence program, will be prepared to return
to an enhanced research career and facilitate the development of
research capabilities in others.
The successful candidate will serve as an integral member of the
agencies' extramural research programs, with a primary focus
within AHCPR. As part of the program, the scholar will undertake
a research project that assists AHCPR in fulfilling its mission
and produce a paper for publication on the project. The
assignment will begin on or after July 1, 1997.
Applications are due by January 15, 1997, and should include a
curriculum vitae and a letter of intent describing the research
project the applicant would like to undertake, as well as a cover
letter describing career objectives, experience, and future
potential relating to the senior scholar experience. The most
highly qualified candidates may be interviewed.
should be submitted to Janet Heinrich, Dr.P.H., R.N., Director,
American Academy of Nursing, 600 Maryland Avenue, S.W.,
Washington, DC 20024; phone (202) 651-7238; fax (202) 554-2641;
Conference on minorities and cancer planned
Washington, DC, will be the site of the 6th Biennial Symposium on
Minorities, the Medically Underserved, and Cancer. The conference
will be held April 23-27 at the Hyatt Regency, Capitol Hill, and
will feature scientific and educational general sessions,
technical assistance and demonstration workshops, student
mentoring programs, educational exhibits, a library and resources
center, an awards program, and networking opportunities. The
Agency for Health Care Policy and Research is a cosponsor of the
conference, which will be particularly relevant for cancer
survivors, specialists, primary care clinicians, scientists,
educators, community leaders, students, and others interested in
community-based cancer prevention and control programs for
minorities and the medically underserved.
Participants will exchange the latest scientific and treatment
information and share strategies for reducing the
disproportionate incidence of cancer morbidity and mortality
among minorities and the medically underserved in the United
States. Conference sessions will enhance the knowledge of
participants in the areas of primary and secondary cancer
prevention, early detection, and treatment. An overall goal is to
promote culturally competent cancer care and services and
ethnically balanced research, especially clinical trials.
For more information or to register, contact Ruth Sanchez, 6th
Biennial Symposium, 1720 Dryden, Suite C, Houston, TX 77030;
telephone (713) 798-5383; fax (713) 798-3990; or visit the
conference Web site at http://icc.bcm.tmc.edu/symposium/.
Return to Contents
Maas, W.R. (1996, June). "Demands and
development of self-reported assessments of oral health outcomes."
Journal of Dental Education 60(6), pp. 508-513.
This paper describes the larger social, political, and economic
environment in which individual dental research efforts and
collective research agendas are advanced. The author, a senior
dental consultant in the Agency for Health Care Policy and
Research, points out that, despite concerns about constrained
support for dental research, there is reason to be optimistic
that environmental forces may encourage development of
self-assessed oral health outcome measures. For example, dental
care may soon represent a significant health plan benefit for
which performance measures are lacking. Also, there is anecdotal
information that some people who have a choice of health plans,
such as Federal civilian employees, choose their medical plan on
the basis of the dental coverage it affords. Dental plans serving
younger members will be under pressure to adopt comprehensive
preventive health standards and measure performance against them.
Dental plans serving older members also may need to consider
patient perceptions of oral health outcomes.
Publication No. 96-R130) are available from the AHCPR Publications Clearinghouse.
Mayfield, J.A. (1996, July). "A foot risk
to predict diabetic amputation in Pima Indians." (AHCPR grant
HS07238). Diabetes Care 19(7), pp. 704-709.
Several risk classification systems to predict amputation risk in
diabetic patients have recently been developed and widely
disseminated. These classification systems usually include
measures of neuropathy, bone deformities, and a history of prior
foot ulceration, with one including vascular status. However, all
of these systems were developed from expert opinion. This study
quantifies the contribution of various factors to the risk of
amputation in diabetic patients to develop a foot-risk scoring
system based on clinical data. The population-based, case-control
study included adult diabetics, half of whom were Pima or Tohono
O'odham Indians. Case patients had undergone a lower extremity
amputation between 1983 and 1992; control subjects had not
undergone amputation by 1992. The researchers reviewed medical
records to determine patient risk and health status before the
pivotal event that led to the amputation and found that male sex,
end-organ complications of eye, heart, and kidney, and poor
glucose control were associated with a higher amputation rate.
Peripheral neuropathy, peripheral vascular disease, deformity,
and a prior ulcer also were associated with an increased risk of
lower extremity amputation.
O'Connor, P.W., Tansey, C.M., Detsky, A.S.,
and others (1996,
July). "The effect of spectrum bias on the utility of magnetic
resonance imaging and evoked potentials in the diagnosis of
suspected multiple sclerosis." (AHCPR grant HS05427).
Neurology 47, pp. 140-144.
Magnetic resonance imaging (MRI) has revolutionized the practice
of neurology and is particularly useful for detecting the subtle
white matter lesion used to diagnose multiple sclerosis (MS).
However, these abnormalities are frequently found at a stage of
disease when the clinical findings are inconclusive. All patients
with MS do not have an abnormal brain MRI, and all patients with
multiple small cranial lesions on MRI do not have MS. "Spectrum"
is a term coined to describe the range of features (clinical,
pathologic, and comorbid) that are found in patients and control
subjects. Spectrum bias is the tendency for the effectiveness of
a test (or treatment) to vary as a function of these variables,
including disease severity. In this study, neurologists evaluated
303 patients with suspected MS and also scanned them with MRI;
204 patients also received evoked potential (EP) testing. Both EP
and MRI results demonstrated an association between disease
frequency, disease severity, and test sensitivity, with greater
disease frequency and intensity suggesting more impressive
diagnostic test performance. The distorting effect of clinical
severity on MRI and EP sensitivity in suspected MS underscores
the fact that diagnostic tests perform differently in different
groups of patients.
O'Dell, M.W., Hubert, H.B., Lubeck, D.P., and
(1996). "Physical disability in a cohort of persons with AIDS:
Data from the AIDS time-oriented health outcome study." (AHCPR
grant HS06211). AIDS 10, pp. 667-673.
Severe disability is unusual among persons with AIDS (PWAs)
living in the community, but mild to moderate disability is
common. From 10 to 50 percent of these persons have some
difficulty in daily activities, ranging from dressing themselves
and rising from a chair to grocery shopping and doing household
chores. The ability of a PWA to function is most influenced by
the number of AIDS-related symptoms, level of fatigue, and
general health status, especially the number of AIDS-related
infections. A person's level of disability is not correlated with
CD4 cell count, a marker of the disease's progression, or time
elapsed since AIDS diagnosis, according to this study. The
researchers analyzed a sample of 546 persons (528 men and 18
women). Study participants were predominantly white,
well-educated, homosexual men (mean age of 37 years) who were
evaluated 475 days following AIDS diagnosis. Between 50 and 90
percent of men and 33 to 88 percent of women had no difficulty
functioning. Severe disability (inability to perform a task)
ranged from 7 to 17 percent depending on sex and functional task.
About half of the PWAs studied might have benefited from
rehabilitation, yet less than 4 percent had recent contact with a
physical therapist. Among the men, 17 percent had some difficulty
gripping objects, 29 percent reaching, and 52 percent had
problems carrying out other activities such as errands and
household chores; 28 percent had some difficulty rising from a
chair, and 38 percent had trouble walking; 11 percent had
problems eating and 21 percent dressing/grooming. Of several
factors studied, including treatment with antiretroviral drugs in
the previous 3 months and educational level, symptoms contributed
most to variations in disability (26.9 percent), followed by
fatigue (3.7 percent) and number of AIDS-related infections (1.8
percent). The authors conclude that physical functioning varies
among persons with AIDS living in the community, and a
substantial number of these individuals experience mild to
moderate deficits related to instrumental activities of daily
living. They call for additional studies to address the need for
and efficacy of appropriate rehabilitation interventions in
persons with AIDS experiencing physical disability.
Palmer, R.H. (1996). "Measuring clinical
performance to provide
information for quality improvement." (AHCPR contract
282-92-0038). Quality Management in Health Care 4(2), pp.
Clinical performance measures summarize the quality of care given
to groups of patients by a practice, provider network, or health
plan. Clinical managers can use these measures to drive and track
internal quality improvements. Purchasers and accrediting
organizations can provide benchmarks based on comparisons of
performance in order to stimulate internal improvements. Whether
a measure is suitable for a particular use depends in large part
on the purpose of the user. For instance, a high degree of
validity in measurement is desirable if an external agent intends
to use the measure to sanction or deny payment to a provider.
This article explains desired properties of such clinical
performance measures and the AHCPR Typology of Clinical
Performance Measures Project, whose goal is to promote the
design, collection, retrieval, and evaluation of quality measure
sets. The author points out that clinical performance measures
should provide detailed specifications to ensure uniformity of
application; testing for reliability and validity as measures of
performance; consideration of patient differences in making
comparisons; and well-planned graphic displays of comparisons.
Schmidt, J.R., and Deichert, J.A. (1996).
uninsured rates: Accuracy and stability." (AHCPR grant HS07397).
Journal of Health Care for the Poor and Underserved 7(2),
Estimating the number of persons lacking health insurance and
analyzing their characteristics has been an important research
area during the past decade. Calculating uninsured rates is
critical for this research. This study shows that uninsured rates
of all counties in an area can be predicted by combining survey
data from a subset of area counties and secondary data on
economic indicators that are available for all counties. The
authors present a set of indicators related to the uninsured rate
and develop prediction models from surveys taken 2 years apart in
the same counties. They assessed the accuracy and stability of
the prediction models and found that accuracy levels are highest
when contemporaneous rates are predicted. Accuracy deteriorates,
however, when rates in a later time period are predicted using
models from a prior period, according to the authors.
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