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AHCPR and AAHPF issue RFA for studies on quality of care for chronic disease in managed care

The Agency for Health Care Policy and Research (AHCPR) and the American Association of Health Plans Foundation (AAHPF) have issued a joint call for studies to determine the impact of different features of health plans on the quality of care provided to patients with chronic illnesses and on outcomes. Together, AHCPR and AAHPF will provide up to $7 million over a 3-year period to support peer-reviewed, outcomes-focused studies. The foundation is the research arm of the American Association of Health Plans (AAHP), a national organization representing over 1,000 health plans that serve approximately 140 million Americans.

These studies are representative of a research focus that is moving beyond questions of differences between managed and fee-for-service care or between types of health maintenance organizations, according to John M. Eisenberg, M.D., AHCPR's Administrator. These studies will look at how changes in organizational structures and care models being developed by health plans impact patient health. The collaborative effort between AHCPR and AAHPF provides a framework for impartial, scientifically rigorous studies.

Over 80 percent of privately insured Americans now depend on some form of managed care for their health needs, as do roughly 30 percent of Medicaid recipients and nearly 14 percent of Medicare beneficiaries. The two latter groups have the highest incidence of chronic illnesses—the focus of this research.

This research, which addresses quality and outcomes of care for people with chronic diseases, will focus on special populations, including women, minorities, and the elderly, and will serve as a catalyst to encourage cooperative research with others who have a commitment to this mission. According to Karen Ignagni, M.B.A., AAHP's president, this industry-wide research supplements the ongoing research of AAHP's individual member plans and has the potential to greatly benefit millions of Americans.

Although research to date has not been sufficiently sensitive to variations in quality or outcomes that may result from specific features of health plans, studies have uncovered a number of challenges for both managed care and fee-for-service plans. These include the need for greater compliance with well-established guidelines for caring for patients with chronic illnesses and the need to assess chronically ill patients' understanding of their condition and examine their functional ability.

The new research solicitation calls for studies focusing on widespread chronic conditions or aggregations of conditions, especially if they have a disproportionate impact on children, women, minorities, or the elderly. Health plan features that researchers may want to study because they may affect performance include the availability of specialists and subspecialists, types of providers involved in primary care, and methods for influencing provider practice, including risk-sharing.

The announcement, "Quality of Care Under Varying Features of Managed Care Organizations," is available online.

Prospective applicants are asked to submit a letter of intent by November 31, 1997, that includes a descriptive title of the proposed project; the name, address, and telephone number of the principal investigator and other key personnel; and the number and title of this RFA. Letters of intent should be sent to either Bernard Friedman, Ph.D., Center for Organization and Delivery Studies, or James Cooper, M.D., Center for Primary Care Research, Agency for Health Care Policy and Research, 2101 East Jefferson Street, Rockville, MD 20852. The deadline for applications is January 6, 1998. See the application kit for submission information.

This Request for Applications (RFA HS-98-005) was published September 19, 1997, in volume 26, number 31, of the NIH Guide to Grants and Contracts.

For more information about this research, contact Bernard Friedman, Ph.D., at AHCPR's Center for Organizational and Delivery Studies, (301) 427-1404; E-mail:

New publications available from AHCPR

The following publications were published recently by the Agency for Health Care Policy and Research.

A Compendium of Selected Public Health Data Sources: A Working Document.

This document is an important resource for those interested in locating health data. Its 250-plus pages describe 76 electronic and hard-copy sources of data from Federal and non-Federal entities on a broad array of health-related topics ranging from youth risk-behavior to older Americans. For each entry, the Compendium provides a general description of the activity, a brief but detailed explanation of the data content, information on access to the data, and a contact. Appendixes list Bureau of the Census State Data/Information Centers, agency heads and contact persons for designated State Centers for Health Statistics, public health officials who are part of the Center for Disease Control and Prevention's information network, and World Wide Web addresses for State health agencies and related organizations. In addition, an overview of the Health Care Financing Administrations data files is included. Copies of A Compendium of Selected Public Health Data Sources: A Working Document (AHCPR Publication No. 97-0004) are available from the AHCPR Publications Clearinghouse.

AHCPR Program Notes.

AHCPR's Center for Organization and Delivery Studies recently published three Program Notes that summarize ongoing and completed AHCPR research on managed care, long-term care, and the Medicaid Program.

  • AHCPR Research About Managed Care. Program Note 3 (AHCPR Publication No. 97-0023). Because the health care system has changed so rapidly and extensively, little is known about the long-term effects of managed care on access to care, cost, and quality of care. This Program Note reviews a wide range of AHCPR studies on managed care, the vast majority of which were conducted on health maintenance organizations (HMOs), the prototypic managed care organization. Research is reviewed by category: changes in health care markets; organization and delivery of services; impact on clinical decisionmaking, access, and quality; interventions that improve outcomes; impact on cost; rural studies; and tools to measure quality. Copies of AHCPR Research About Managed Care (AHCPR Publication No. 97-0023) are available from the AHCPR Publications Clearinghouse.
  • AHCPR Research on Long-Term Care. Program Note 4 (AHCPR Publication No. 97-0054). Long-term care is an increasingly important and rapidly changing part of today's health care delivery system. The need for long-term care services continues to grow, placing financial pressure on both individuals and governments and fueling unprecedented changes in the health care marketplace. In turn, changes in market and delivery systems are raising questions about the appropriateness, cost, and quality of services delivered in different settings. AHCPR has undertaken and funded studies in long-term care to provide answers to fundamental questions by purchasers, providers, consumers, and policymakers. This Program Note summarizes the results of AHCPR research in six broad areas of investigation: use, cost, and financing; access and quality of care; organization and delivery of care; consumer and caregiver behavior; special populations; and data development and methodology. Copies of AHCPR Research on Long-Term Care (AHCPR Publication No. 97-0054) are available from the AHCPR Publications Clearinghouse.
  • Meeting Medicaid's Cost and Quality Challenges: The Role of AHCPR Research. Program Note 5 (AHCPR Publication No. 97-0044). Medicaid program costs increased dramatically in the late 1980s and early 1990s due to rapid expansion of eligibility, a national recession, inflation in health care spending, and State use of statutory loopholes to leverage Federal dollars. Partly to control costs, the Medicaid program has moved rapidly toward using managed care. AHCPR has been (1) providing science-based research to support Federal and State efforts, (2) disseminating research findings and guidelines that managed care plans and providers servicing the Medicaid population can use to lower costs and improve quality, and (3) providing technical assistance to State policymakers and administrators seeking to improve their Medicaid programs. AHCPR's research and technical assistance falls into six areas: care for elderly and disabled populations, maternal and child health, research and technical assistance on HIV and AIDS, drug policy, informing consumers, and system financing and management. Copies of Meeting Medicaid's Cost and Quality Challenges (AHCPR Publication No. 97-0044) are available from the AHCPR Publications Clearinghouse.

El paciente y los medicamentos de receta: Una guia para el paciente.

The popular consumer guide, Prescription Medicines and You, recently published in English by AHCPR, is now available in Spanish. It can help Spanish-speaking consumers—particularly elderly consumers—avoid potentially dangerous mistakes involving prescription medicines and learn how and to whom they can talk about their medications. The brochure was developed by AHCPR in partnership with the National Council on Patient Information and Education.

This 17-page brochure describes common mistakes patients make with their medications, such as deciding to stop taking a medicine before they are supposed to or not taking the proper dosage. It also explains how patients can work with their physicians to make decisions about treatment plans that involve prescription drug use, talks about reporting side effects and other information to the physician or nurse, and suggests questions to ask the doctor or nurse about the use of prescription medicines.

The guide, El paciente y los medicamentos de receta: Una guia para el paciente (AHCPR Publication No. 97-0002; in English 96-0056), is available free (in single or bulk copies) from the AHCPR Publications Clearinghouse.

Hospital Cost and Utilization Project (HCUP-3).

HCUP-3 is a Federal-State-industry partnership to assemble encounter-level health care data that are publicly available for use in health services research and health policy analysis. The HCUP-3 National Inpatient Sample (NIS) contains discharge records from a 20 percent nationally representative sample of U.S. community hospitals. The database contains clinical, demographic, hospital, and census data for each discharge and includes all payers. Currently, 17 partner States contribute State-wide data to the HCUP-3 NIS project. At this time, NIS data are available though 1994; 1995 data will become available in January 1998.

AHCPR recently published three HCUP-3 Pocket Guides that show summary statistics by three classification schemes—diagnosis-related groups (DRGs), principal procedures, and principal diagnoses. Summary statistics are shown for the number and percent of discharges, mean lengths of stay, and mean total charges. These 4 1/2" x 7" publications are designed to be handy guides for use by researchers, hospital planners, market analysts, policymakers, and others.

DRGs are accompanied by a crosswalk showing the major diagnostic categories (MDCs) to which their subject areas correspond. Procedures and diagnoses are classified according to the Clinical Classifications for Health Policy Research (CCHPRs). The CCHPRs were developed by AHCPR researchers as a way to classify diagnoses and procedures into mutually exclusive and clinically meaningful categories for use in aggregate statistical reporting. The CCHPRs' description and algorithm are publicly available and are being updated through September 1998.

The three Pocket Guides are available from the AHCPR Publications Clearinghouse as follows:

  • Diagnosis-Related Groups (AHCPR Publication No. 97-0056).
  • Principal Diagnoses (AHCPR Publication No. 97-0058).
  • Principal Procedures (AHCPR Publication No. 97-0057).

Medical Expenditure Panel Survey (MEPS).

MEPS is the third in a series of nationally representative surveys of medical care use and expenditures sponsored by AHCPR. MEPS is cosponsored by the National Center for Health Statistics (NCHS). The first of these surveys, the National Medical Care Expenditure Survey (NMCES), was conducted in 1977, and the second, the National Medical Expenditure Survey (NMES), in 1987.

MEPS collects detailed information on health care use and expenses, sources of payment, and insurance coverage of individuals and families in the United States at different intervals and over time. Select for a more complete description of MEPS or access materials related to MEPS on the AHCPR Web site.

The second in a series of MEPS Highlights and the first two MEPS Methodology Reports are now available from AHCPR:

  • Characteristics of Nursing Home Facilities and Residents. Nursing Home Update 1996; MEPS Highlights No. 2. This publication presents information gathered from a nationally representative sample of nursing homes during the first half of 1996. It covers nursing home size and ownership, continuum of care, functional status of residents, use of advance directives, and Medicare and Medicaid enrollment. Copies of MEPS Highlights No. 2 (AHCPR Publication No. 97-0036) are available from the AHCPR Publications Clearinghouse.
  • Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. The Household Component (HC) of MEPS collects detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment. This report describes the design and methods of the 1996 MEPS HC, including comparability with other medical expenditure surveys, relationship to the National Health Interview Survey, preliminary contact and rounds of data collection, and survey instruments. The types of statistics produced by the MEPS HC and uses of the data are described. In addition to producing annual estimates for a variety of health care measures, the data can be used for analyses to inform researchers and policymakers about how the characteristics of individuals and families, including their health insurance, affect medical care use and spending. In conjunction with data from earlier expenditure surveys, these data can be used to study trends in the nature and distribution of national health expenditures, sources of care, and amounts and types of services used by the U.S. noninstitutionalized population. Copies of MEPS Methodology Report No. 1 (AHCPR Publication No. 97-0026) are available from the AHCPR Publications Clearinghouse.
  • Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2. As part of its "reinventing government" activities, the Department of Health and Human Services developed a survey integration plan. This report describes enhancements and efficiencies incorporated into MEPS as a result of survey integration, such as cost savings, enhanced analytic capacity, increased opportunities for longitudinal analyses, reduction of major data gaps, and improvements in the timeliness of data release. The sample design of the Household Component, which uses NCHS National Health Interview Survey as its frame, is described. Sampling unit definitions, eligibility criteria, sample size targets, and precision requirements are discussed. Copies of MEPS Methodology Report No. 2 (AHCPR Publication No. 97-0027) are available from the AHCPR Publications Clearinghouse.

AHCPR funds new projects

The following new projects were funded recently by the Agency for Health Care Policy and Research. Readers are reminded that the results of studies usually are not available or published until a project is completed or nearing completion.

Conference Grants

Emergence of hospitalists in American health care

Project director: Robert M. Wachter, M.D.
Organization: University of California
San Francisco, CA
Project number: AHCPR grant HS09541
Period: 9/1/97 to 5/31/98
Funding: $46,658

Oral health 2000 national consortium: Grassroots synergy

Project director: Denise S. Lebloch, B.S.
Organization: Oral Health America
Chicago, IL
Project number: AHCPR grant HS09546
Period: 9/1/97 to 2/28/98
Funding: $10,000

Quality criteria for health information on the Internet

Project director: Helga E. Rippen
Organization: Mitretek Systems, Inc.
McLean, VA
Project number: AHCPR grant HS09549
Period: 9/30/97 to 9/28/98
Funding: $10,000

Toward a women's health outcomes research agenda

Project director: Margaret A. Anderson, M.A.
Organization: Society for the Advancement of Women's Health Research
Washington, DC
Project number: AHCPR grant HS09548
Period: 9/30/97 to 9/29/98
Funding: $45,000

Dissertation Grants

Competition and the quality of hospital care

Project director: June F. O'Leary, M.S.
Organization: University of California
Los Angeles, CA
Project number: AHCPR grant HS09681
Period: 9/30/97 to 9/29/98
Funding: $32,400

Medical practice guidelines for contrast media

Project director: John B. Hernandez, B.A.
Organization: RAND Corporation
Santa Monica, CA
Project number: AHCPR grant HS09686
Period: 9/30/97 to 5/31/98
Funding: $29,987

Provider risk-sharing in managed care

Project director: Meredith B. Rosenthal, A.B.
Organization: Harvard Medical School
Boston, MA
Project number: AHCPR grant HS09660
Period: 9/30/97 to 9/29/98
Funding: $22,233

PPS impact on hospital-based skilled nursing units

Project director: Stuart A. Hagen, M.B.A.
Organization: Harris Graduate School of Public Policy
Chicago, IL
Project number: AHCPR grant HS09676
Period: 9/30/97 to 9/29/98
Funding: $26,082

Research Grants/Cooperative Agreements

Impact of guidelines on quality of care: Unstable angina

Project director: Catarina I. Kiefe, M.D., Ph.D.
Organization: University of Alabama
Birmingham, AL
Project number: AHCPR grant HS08843
Period: 9/30/97 to 9/29/00
First year funding: $472,648

Market power and efficiency effects in hospital mergers

Project director: Gloria J. Bazzoli, Ph.D.
Organization: Hospital Research and Educational Trust
Chicago, IL
Project number: AHCPR grant HS09201
Period: 9/30/97 to 4/30/99
First year funding: $229,201

Small Project Grants

Comparing mean costs before and after a policy change

Project director: Xiao-Hua Zhou, Ph.D.
Organization: Indiana University
Indianapolis, IN
Project number: AHCPR grant HS09543
Period: 9/1/97 to 3/31/99
Funding: $25,196

Evaluation of a model of managed care for SCD patients

Project director: Thomas R. Konrad, Ph.D.
Organization: Sheps Center for Health Services Research
Chapel Hill, NC
Project number: AHCPR grant HS09553
Period: 9/30/97 to 9/29/98
Funding: $71,194

Experience of low-income women with breast cancer

Project director: Anne S. Kasper, Ph.D.
Organization: University of Illinois
Chicago, IL
Project number: AHCPR grant HS09558
Period: 9/30/97 to 9/29/98
Funding: $67,712

Factors affecting bargaining between pharmacists and insurers

Project director: John M. Brooks, Ph.D.
Organization: University of Iowa
Iowa City, IA
Project number: AHCPR grant HS09541
Period: 9/1/97 to 8/31/98
Funding: $73,500

Hospitals' strategic responses to competitive markets

Project director: Dana B. Mukamel, Ph.D.
Organization: University of Rochester
Rochester, NY
Project number: AHCPR grant HS09545
Period: 9/30/97 to 9/29/98
Funding: $79,365

Impact of managed care on African Americans

Project director: Mahmud Hassan, Ph.D.
Organization: University of Alabama
Birmingham, AL
Project number: AHCPR grant HS09569
Period: 9/30/97 to 1/31/99
Funding: $53,119

Medicaid changes: Impact on at-risk children

Project director: Laurel K. Leslie, M.D.
Organization: Childrens Hospital Research Center
San Diego, CA
Project number: AHCPR grant HS09563
Period: 9/30/97 to 9/29/98
Funding: $39,317

Ownership status, market concentration, and hospital pricing

Project director: Gary J. Young, Ph.D.
Organization: Boston University
Boston, MA
Project number: AHCPR grant HS09568
Period: 9/30/97 to 9/29/98
Funding: $61,153

Primary care physicians' participation in Medicaid managed care

Project director: Andrew B. Bindman, M.D.
Organization: University of California
San Francisco, CA
Project number: AHCPR grant HS09557
Period: 9/30/97 to 9/29/98
Funding: $73,322

Attention Researchers: The Department of Health and Human Services has launched GrantsNet, an online resource to help you locate and access information about grant programs available through HHS and selected other Federal departments. It can help you:

  • Find grant information.
  • Search for funding.
  • Learn how to apply for a grant.

The site also includes information on administering grants, a calendar of events pertaining to grants, and other topics of interest to potential applicants. Be sure to visit GrantsNet at:

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