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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.

Copies of the reports are available from the National Technical Information Service.

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®.

Chiropractic versus Medical Care Low-Back Pain. Hal Morgenstern, Ph.D., University of California, Los Angeles. AHRQ grant HS07755, project period 5/1/95-10/13/01.

Despite the public-health importance of low-back pain, little is known about the relative effectiveness of treatment strategies in managed care. The primary objectives of this study were to compare the effectiveness of medical and chiropractic care for low-back pain in managed care and to assess the effectiveness of physical therapy and modalities among patients receiving medical or chiropractic care. Randomization of 681 low-back-pain patients presenting to a large managed-care facility produced four treatment groups: medical care with and without physical therapy and chiropractic care with and without physical modalities. Followup assessments were obtained by mail questionnaires at 2 and 6 weeks, 6, 12, and 18 months, and a telephone interview was conducted at 4 weeks. The primary outcome variables were intensity of low back pain and related disability. Among subjects not assigned to receive physical therapy/modalities, there was slightly more improvement in the chiropractic group than in the medical group. Among subjects assigned to medical care, there was more improvement and remission in the physical-therapy group. Among subjects assigned to chiropractic care, there was little or no association between physical modalities and low-back-pain outcome. Average costs were highest in the medical care with physical therapy group and lowest in the medical care only group. However, chiropractic patients were more satisfied than medical patients.

Select National Technical Information Service to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-104717; 78 pp, $29.50 paper, $12.00 microfiche).

Health Values in Patients with Chronic Hepatitis C Infection. Kenneth E. Sherman, Ph.D., University of Cincinnati, Cincinnati, OH. AHRQ grant HS10366, project period 9/30/99-3/31/01.

Patients with hepatitis C (HCV) generally report reduction in health-related quality of life (QOL), and these QOL measures have been used to estimate health utilities in economic modeling. These researchers hypothesized that patient-derived health utilities would differ from those determined by physician/expert panels or by extrapolation of QOL measures, and that these utilities could serve as the basis for QOL adjustment in future economic modeling studies. They recruited 124 patients with chronic HCV infection representing a cross-section of disease severity and administered a disease specific SF-36, Beck Depression Inventory (BDI) and Health Utilities assessment using Health Rating Scale (RS), Time Tradeoff (TTO), and Standard Gamble (SG). Correlation between measures and factor analysis was performed. Modified SF-36 scores were lower than population normative values, particularly in the Physical Composite Score (PCS) scale. The PCS was closely correlated with RS but not with TTO or SG. Both TTO and SG failed to show significant variability in relation to disease activity as determined by serum alanine aminotransferase level, histologic stage, or presence of decompensated liver disease. BDI was significantly inversely correlated with TTO and SG. Although QOL is decreased in patients with chronic HCV infection, as reflected by the disease specific SF-36 and the RS, patient-derived health utilities are not strongly associated with QOL measures. Utility measures obtained from HCV patients differ significantly from previous surrogate measures of health values. The utilities derived in this study can be used for economic cost-effectiveness analysis of treatment interventions in patients with chronic HCV.

Select National Technical Information Service to order copies of the abstract, executive summary and final report, NTIS accession no. PB2002-107325; 14 pp, $23.00 paper, $12.00 microfiche.

HMO Research Network National Conference. Dennis D. Tolsma, M.P.H., Kaiser Permanente-Georgia Region, Atlanta. AHRQ grant HS10096, project period 4/4/00-4/3/01.

The Sixth Annual HMO Research Network conference was held April 4-5, 2000, in Atlanta, GA. The conference was hosted by Kaiser Permanente-Georgia Region and the USQA Center for Research™ and cosponsored by the AHRQ and the Centers for Disease Control and Prevention. There were four plenary sessions designed to bring out key issues in managed care research, six concurrent sessions focused on research methodology and research administration, and two interactive poster sessions.

Select National Technical Information Service to order copies of the abstract and conference proceedings, NTIS accession no. PB2002-107326; 12 pp, $23.00 paper, $12.00 microfiche.

Implementing Family Programs in Psychiatric Settings. Linda E. Rose, Ph.D., Johns Hopkins University, Baltimore, MD. AHRQ grant HS10378, project period 9/30/99-9/29/01.

This research focused on interventions provided to families of psychiatric patients. Eleven focus groups were conducted with health care providers, families, patients, and mental health advocates. Participants discussed barriers to care, available treatment programs, and suggestions for future programs. All group sessions were recorded, transcribed, and analyzed using a qualitative approach. Major findings were: health professionals reported a lack of system support and practice-based constraints, including time; lack of coordination of services; need for both education and support for families; lack of collaborative relationships with families; families' lack of motivation/difficulty accepting care; and families "caught in the middle" between patient and therapist. Suggestions for effective intervention were to acknowledge family concerns, help families deal with grief and fear, individualize care to each family, and refer family members to community supports. Families wanted help in dealing with crises, handling threats of patient violence, and getting into the health care system.

Select National Technical Information Service to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-107327; 40 pp, $25.50 paper, $12.00 microfiche.

International Conference on Objective Measurement. Kendon J. Conrad, Ph.D., University of Illinois at Chicago. AHRQ grant HS10941, project period 1/15/01-1/14/02.

This project provided support for the International Conference on Objective Measurement (ICOM): Focus on Health Care, which was held October 19-20, 2001, in Chicago. It was cosponsored by the Department of Veterans Affairs Health Services Research and Development Services, the National Cancer Institute, and the Institute for Objective Measurement. There were more than 100 presentations by psychometricians and health care clinicians, principally using item response theory (IRT) with a focus on health care. ICOM brought together some of the top theoreticians in Rasch/IRT with a large group of health care researchers and clinicians from around the world. A proposed supplement to the journal Medical Care that comprises 14 manuscripts from the meeting is currently in review.

Select National Technical Information Service to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-107328; $46 pp, $25.50 paper, $12.00 microfiche.

Physician Cesarean Rate and Risk-Adjusted Birth Outcomes. Tong Li, Ph.D., University of Medicine and Dentistry of New Jersey School of Public Health, Piscataway. AHRQ grant HS10795, project period 6/15/00-6/14/01.

The cesarean-section rate in the United States has been considered high by many experts, and efforts have been made to lower the rate. However, the safety of a lower rate for the general population has not been investigated. A population-based, retrospective cohort study was conducted to examine this issue based on 171,295 singleton births in New Jersey hospitals between January 1, 1996 and December 31, 1997. Linked live birth/fetal death certificate data and hospital discharge data were used for the analysis. Physicians were divided into three groups based on their cesarean rate during the study period: low (18 percent or less), medium (18 to 27 percent), and high (more than 27 percent). Perinatal mortality, rate of birth injury, and uterine rupture were compared among the physician groups. Differences in patient risks were adjusted using multivariate models. Low- and high-rate physicians were not different from medium-rate physicians in terms of perinatal mortality. Higher rate physicians did not have better perinatal outcomes for low and very low birthweight infants. Rate of intracranial hemorrhage was higher in the low-rate group compared with the medium-rate group. Rate of uterine rupture was lower for the low-rate group compared with the medium-rate group. Medium- and high-rate groups were similar in the occurrence of birth injury and uterine rupture. These data suggest that a lower rate of cesarean section can be achieved without increasing perinatal mortality, and that the rate of uterine rupture is reduced. However, a low cesarean rate may be associated with increased risk of intracranial hemorrhage.

Select National Technical Information Service to order copies of the abstract, executive summary, and dissertation, NTIS accession no. PB2002-106701; 128 pp, $36.00 paper, $17.00 microfiche.

State of the Art: Telemedicine/Telehealth Symposium. An International Perspective. Rashid L. Bashshur, Ph.D., University of Michigan, Ann Arbor. AHRQ grant HS10936, project period 1/1/01-12/31/01.

The University of Michigan Health System and the World Health Organization, along with AHRQ and other sponsors, convened this international symposium on the state of the art in telemedicine/telehealth, which was held August 23-25, 2001, in Ann Arbor. The participants concluded that for telemedicine to achieve its full potential, it will be necessary to: have substantial and long-term investment in research to assess clinical effectiveness and cost/benefit ratios of telemedicine applications; develop, verify, and implement national and international standards and protocols; adapt telemedicine applications to geographical and cultural differences in terms of available information infrastructure and local disease and medical care processes; and promote national and international cooperation in funding, research, implementation, and evaluation.

Select National Technical Information Service to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-106700; 208 pp, $47.00 paper, $17.00 microfiche.

Specialty Care in Closed vs. Open Access HMOs. Jose Escarce, M.D., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS09414, project period 7/16/97-9/29/00.

These researchers used data from a large managed care organization that offers both a closed-panel, gatekeeper HMO and an open-panel, point of service HMO to assess the impact of these managed care models on the demand for primary and specialty care and on medical care expenditures. They found no evidence that use or expenditures for physician services or total medical care expenditures were higher in the point of service plan than in the gatekeeper plan. In fact, the few significant differences that were found in use or expenditures suggested higher use in the gatekeeper plan. They also found evidence that primary care services and specialty services are complements, rather than substitutes, in managed care plans that require enrollees to select primary care physicians. These findings suggest that eliminating the requirement that patients obtain care through a primary care gatekeeper does not necessarily result in higher use or expenditures in managed care plans with modest cost-sharing provisions.

Select National Technical Information Service to order copies of the abstract, executive summary, and final report, NTIS accession no. PB2002-107329; 113 pp, $33.00 paper, $17.00 microfiche.

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