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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.

AMIA 2000 Annual Symposium. J.M. Overhage, M.D., Ph.D., American Medical Informatics Association, Bethesda, MD. AHRQ grant HS10115, project period 9/1/00-2/28/01.

The American Medical Informatics Association's 2000 annual fall symposium drew nearly 2,000 attendees from around the world. The program included in-depth tutorials, workshops, paper presentations, panels, theater style demonstrations, and meet-the-expert sessions. Attendees developed a research agenda for medical informatics by identifying applied and operational research topics best explored by developmental support, demonstrations, and evaluations, as well as more theoretic or basic research areas that will require laboratory investigation and basic developmental work.

Abstract and executive summary, NTIS accession no. PB2001-106535; 26 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Community-Based Pharmaceutical Care. Morris Weinberger, Ph.D., Indiana University, Indianapolis. AHRQ grant HS09083, project period 6/1/96-5/31/01.

Using a randomized, controlled trial, these researchers evaluated a pharmaceutical care program for 1,113 patients with asthma or chronic lung disease who filled prescriptions in 36 community pharmacies. Pharmacies were randomized to pharmaceutical care or one of two control groups (peak flow monitoring, usual care). Patients in the pharmaceutical care group received recent patient-specific clinical data (peak flow rates, emergency department visits, hospitalizations, medications), customized patient educational materials, training, and resources to support pharmaceutical care. Patients in pharmaceutical care had significantly higher peak flow rates compared with the usual care patients but not with the patients in the peak flow monitoring group. Moreover, patients in the pharmaceutical care group were significantly more satisfied with both their pharmacists and health care. While significant improvement in both medication compliance and health-related quality of life were observed among the pharmaceutical care patients, similar improvements were observed in both control groups. Asthma patients receiving pharmaceutical care had more visits for acute exacerbations than those in usual care.

Abstract, executive summary, and final report, NTIS accession no. PB2001-108114; 44 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Cost-Effectiveness of Improving Care for Depression in Managed, Primary Care Practices. Kenneth B. Wells, M.D., M.P.H., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS08349, project period 4/1/95-3/31/01.

This project involved development and evaluation of a quality improvement program for depression for use in nonacademic, community-based primary care practices. Six large primary care organizations were recruited, including 46 primary care clinics with 181 of their 183 primary care clinicians. Practices were randomized to care as usual care (UC—i.e., written guidelines only) or one of two quality improvement (QI) toolkits (one for psychotherapy and one for medication) that provided training resources for clinicians and patients to initiate and adhere to guideline-concordant care for depression. The researchers enrolled 1,356 depressed patients in the 2-year study. The interventions improved the rate of appropriate depression care by 10 percentage points relative to UC over the first year and improved clinical and quality-of-life outcomes, employment status, and household wealth. Increased health care costs over 2 years were modest ($400 to $500 for each intervention relative to UC). Minority patients benefited the most clinically, whites improved in employment, and all groups improved in wealth under QI.

Abstract, executive summary, and final report, NTIS accession no. PB2001-108534; 110 pp, $33.00 paper, $17.00 microfiche, are available from NTIS.

Couples' Preferences for Prostate Cancer Screening. Robert J. Volk, Ph.D., University of Texas Medical Branch, Galveston. AHRQ grant HS08992, project period 9/30/96-9/29/00.

The researchers examined the preferences of 168 male primary care patients and their spouses for the outcomes of prostate cancer screening, treatment, and life with metastatic disease. Utilities were collected for six treatment outcome states and two health states involving metastatic prostate cancer. In general, wives' utilities for each health state were higher than husbands' utilities, indicating that the wives were less willing to trade quantity for quality of life. Concordance between the perspectives was low. A subset of patients was unwilling to trade time for any health state considered. The findings show that husbands' and wives' preferences for prostate cancer screening and treatment are highly variable. Including the spouse in decisionmaking about prostate cancer screening seems warranted.

Abstract, executive summary, and final report, NTIS accession no. PB2001-106536; 32 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Credentialing Physician Specialists: A World Perspective. Philip G. Bashook, Ed.D., American Board of Medical Specialties, Evanston, IL. AHRQ grant HS10095, project period 5/1/00-4/30/01.

The American Board of Medical Specialties Research and Education Foundation (ABMS) and the Royal College of Physicians and Surgeons of Canada (RCPSC) jointly sponsored an international conference, "Credentialing Physician Specialists: A World Perspective," in Chicago, June 8-10, 2000. The conference provided a forum to compare credentialing systems, compare assessment methods and standards for awarding credentials, and discuss how to link specialty credentialing with maintenance of competence.

Abstract, executive summary, and proceedings of conference, NTIS accession no. PB2001-108559; 254 pp, $54.00 paper, $23.00 microfiche, are available from NTIS.

Developing and Testing Asthma Quality of Care Measures. Yvonne M. Coyle, M.D., University of Texas, Southwestern Medical Center, Dallas. AHRQ grant HS09461, project period 9/30/96-9/29/00.

The purpose of this project was to develop a system to evaluate the quality of acute asthma care. Study subjects were adults treated for acute asthma in a public hospital emergency department. Lung function change from the time of acute asthma care up to 2 to 3 weeks later provided a short-term measure of asthma morbidity. Patients' personal and environmental risk factors were used in the statistical analysis to assist in determining which acute asthma care treatments were effective in improving lung function. The most important patient and environmental risk factors for lung function following treatment for acute asthma were less knowledge about asthma and exposure to indoor allergens. Scheduling asthma care followup and providing patient education on asthma medication use at discharge were found to be most effective for improving lung function following acute asthma care and were translated into quality of care measures.

Abstract, executive summary, and final report, NTIS accession no. PB2001-106537; 44 pp, $25.50 paper, $12.00 microfiche, are available from NTIS.

Disclosing Financial Incentives: Will Consumers Understand and Value the Information. Tracy E. Miller, J.D., Mount Sinai School of Medicine, New York, NY. AHRQ grant HS09810, project period 2/1/98-1/31/00.

This was a pilot study to inform efforts by policymakers and employers to educate enrollees about financial incentives and gatekeeping practices in managed care. Many States have mandated the disclosure to enrollees of practices to control use of services, yet little is known about enrollee knowledge, attitudes, and preferences in relation to this information. Information about practices to limit use can empower consumers as they choose a plan. Individuals also need this information to understand and exercise their rights once they are enrolled. At the same time, the information may diminish patients' trust in their physicians.

Abstract, executive summary, and final report, NTIS accession no. PB2001-108113; 28 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Effects of Withholding Payments from Managed Care Plans on the Costs of Care in Medical Group Practices. John K. Kralewski, Ph.D., University of Minnesota, Minneapolis. AHRQ grant HS10055, project period 6/1/96-5/31/01.

The goal was to assess the effects of a managed health care plan's decision to withhold a portion of a clinic's payment on the subsequent use of resources to care for patients in that clinic. The influence of clinic organizational and cultural factors on costs and on the effects of withholds was also included in this analysis. Two associated studies related to clinic payment method were conducted: the effects of clinic structure and payment on prescription drug use and disease prevention practices. Data were obtained on 86 clinics providing services for a Blue Cross managed care program during 1997. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. The effects of clinic and physician payment methods on per member per year adjusted patient costs were evaluated. Patient costs were adjusted for differences in payment schedules and patient age and sex.

Abstract, executive summary, and final report, NTIS accession no. PB2001-108484; 102 pp, $33.00 paper, $17.00 microfiche, are available from NTIS.

National Quality Forum for Ambulatory Health Care. Naomi J. Kuznets, M.S., Ph.D., AAAHC Institute for Quality, Wilmette, IL. AHRQ grant HS10934, project period 9/30/00-9/29/01.

In June, 2001, the AAAHC Institute for Quality Improvement convened a National Quality Forum for Ambulatory Health Care in New Orleans, LA. The purpose was to provide a forum to disseminate clinical quality improvement knowledge in ambulatory health care. The issues discussed included methodological topics (study topic selection; survey development and piloting; sampling; data cleaning and analysis; and report drafting); study results; problem-solving techniques; and approaches used by several leading organizations and how these approaches could be applied to the ambulatory setting.

Abstract and executive summary of conference, NTIS accession no. PB2001-108533; 16 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

National Study of Home Care: Providers, Users, and Outcomes. Karen E. Peters, M.P.H., University of Illinois, Chicago. AHRQ grant HS08992, project period 8/1/95-7/31/97.

Relationships between agency- and client-level variables were examined to explore the relative influences of each on length of stay (LOS) as a measure of resource use in home health care. A multilevel theoretical perspective and analytical method were used. Cross-sectional data were analyzed on 905 agencies and 4,870 clients from the 1992 National Home Health and Hospice Care Survey (NHHCS) which collects data through a series of surveys on agency characteristics and patient populations. Models were developed to explain the variation in average LOS among U.S. home health care agencies, controlling for patient level characteristics. Findings indicate that 29 percent of the variance was accounted for, and there was a marginally significant variation in average LOS among chain-affiliated agencies. Organizational theory suggests that structural characteristics serve as indicators of organizational behavior, and changes in structure may affect the way in which care is provided and use of services is negotiated by different home health care stakeholders. These stakeholders may have conflicting agendas that impact on decisions concerning cost, quality, access to care, and outcomes.

Abstract and executive summary of dissertation, NTIS accession no. PB2001-108524; 16 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Nursing Home Quality Indicators Dissemination Conference. Carol R. Hegeman, M.S., Foundation for Long Term Care, Albany, NY. AHRQ grant HS10085, project period 1/1/00-12/31/00.

The Foundation for Long Term Care held the 1-1/2 day dissemination conference "Nursing Home Quality Indicators from Theory to Practice," in a train-the-trainer format for nurse managers in New York State to advance understanding of the practical applications of health outcomes research in the nursing home setting. The conference provided a systematic process for using quality improvement (QI) data in real-world cases of problem identification, evaluation, resolution, and ongoing QI activities. Nurses who attended the training learned to interpret the QI numbers, how to read and interpret reports, ways to use the information to target problem areas, how to make nursing homes responsive to resolution of QI problems, and how to disseminate this information to other nurse managers.

Abstract, executive summary, and attachment B, NTIS accession no. PB2001-104544; 16 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Patient Outcomes Associated with Antidepressant Drugs. Judith M. Garrard, Ph.D., University of Minnesota, Minneapolis. AHRQ grant HS07772, project period 3/1/93-2/28/99.

This 5-year project involved a prospective cohort study of approximately 500 elderly (65 years and older) enrollees in a managed care organization that provided a pharmacy benefit to community-dwelling (noninstitutionalized) elderly people. Results included empirical findings of potential underdetection of depression among the elderly who reported depressive symptoms, the role of minor depression in self-assessment of comorbidities among these subjects, and the association between minor depression and a more negative perception of quality of life compared with elderly people who did not have symptoms of depression.

Abstract, executive summary, and final report, NTIS accession no. PB2001-106533; 22 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Promoting a Research Agenda: The Impact of Managed Care on Public Health. Barbara J. Hatcher, Ph.D., American Public Health Association, Washington, DC. AHRQ grant HS10092, project period 3/1/00-2/28/01.

The American Public Health Association (APHA) Task Force on Public Health and Managed Care held a 2-day conference in September 2000 on the impact of managed care on public health. Conference attendees examined recent studies on the impact of managed care on public health and identified gaps in existing research, the needs of users of research, and the priorities of organizations that fund research. Attendees used this information to develop a broad research agenda that addresses public health priorities. Particular attention was given to vulnerable populations, comprehensiveness of services, and the public health infrastructure.

Abstract, executive summary, final report, and appendixes A-C, NTIS accession no. PB2001-104547; 26 pp, $23.00 paper, $12.00 microfiche, are available from NTIS.

Understanding Clinical and Administrative Outcomes. Jeremy Holtzman, M.D., University of Minnesota, Minneapolis. AHRQ grant HS09735, project period 7/1/98-1/31/01.

Although assessing outcomes of health care is an important endeavor, the difficulty in collecting and interpreting outcomes data limits their usefulness. In this study, the researchers investigated the relationship of administrative data, specifically Medicare claims for services, with outcomes information to assess the possibility of using administrative data as a surrogate for directly collected outcomes data. They used data on patient reports of outcomes following cholecystectomy and total hip arthroplasty, which had been collected as part of the Post-Hospitalization Outcomes Study. They merged these data with medical records data and Medicare claims. For cholecystectomy, there was little relation between symptomatic outcomes and subsequent use of health care services. For total hip arthroplasty, there was a significant relationship between pain and functional status in the year following hip replacement and Medicare claims for services. However, the use of services was across so many diagnoses it was unclear whether it was related to the results of surgery or overall illness burden.

Abstract, executive summary, and final report, NTIS accession no. PB2001-106538; 62 pp, $27.00 paper, $12.00 microfiche, are available from NTIS.

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