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Bush, N.E., Wooldridge, J., Foster, V., and others (1999). "Web site design and development issues: The Washington State breast and cervical health program Web site demonstration project." (AHCPR grant HS09407). Oncology Nursing Forum 26(5), pp. 857-865.

The authors describe the development of a customized Web site to assist Breast and Cervical Health Program (BCHP) outreach staff in a Seattle community screening program. They discuss the outreach staff's Internet knowledge and describe access and barriers during a 2-year period using the Web site. The site was based on continuous input from a sample of BCHP outreach workers, screening coordinators, and public health nurses from regional health districts and program-contracted clinics. The researchers evaluated the BCHP Web site in 1996 and again in 1998 using mailed and online Web questionnaires to these groups. They also monitored "hits" to the Web site monthly. They found that its use rose steadily over the 2 years to reach a stable plateau. The authors conclude that public health programs with meager resources can benefit from the relatively inexpensive use of customized and versatile Web sites.

Chapman, G.B., and Coups, E.J. (1999). "Time preferences and preventive health behavior: Acceptance of the influenza vaccine." (AHCPR grant HS09519). Medical Decision Making 19, pp. 307-314.

Why do people often fail to follow preventive health measures such as diet and exercise regimens that would reduce their risk of heart disease or choose not to have vaccinations to prevent disease? Probably because these measures typically involve immediate costs and only future benefits. Consequently, people with future-oriented time preferences should be more likely to adopt preventive measures. This study examined the relationship between time preferences and acceptance of free influenza vaccination among 412 corporate employees. The researchers measured time preferences in two domains, money and health, and asked participants about vaccine attitudes and beliefs. There was a small relationship between vaccination acceptance and monetary time preferences but not with the health time-preference measures. Other variables, such as perceived effectiveness of the vaccine, were more predictive.

Eisen, S.V., Shaul, J.A., Clarridge, B., and others (1999, June). "Development of a consumer survey of behavioral health services." (AHCPR grant HS09250). Psychiatric Services 50(6), pp. 793-798.

Consumers' evaluations are considered important indicators of the quality of behavioral health services. This paper describes development of a consumer survey designed to assess the quality of mental health and substance abuse services and to evaluate insurance plans that provide such services. The Consumer Assessment of Behavioral Health Services survey began with a review of existing consumer satisfaction surveys and input from several groups working toward development of nationally standardized satisfaction surveys. The researchers used consumer focus groups to ensure all important quality domains were included. Results of a pilot test conducted with 160 consumers—82 enrolled in Medicaid plans and 78 in commercial plans—suggested that the survey was able to distinguish between the two groups in evaluations of care and insurance plans. More testing will follow.

Hartley, D., Jackson, J., Mueller, K.J., and others (1999, Winter). "AHCPR-funded rural managed care centers: Report from the field." (AHCPR cooperative agreement HS08612). Journal of Rural Health 15(1), pp. 87-93.

In 1994, the Agency for Health Care Policy and Research awarded cooperative agreements to five university-based groups to promote the establishment of managed care institutions and development of rural health networks. This paper summarizes the experiences of these rural managed care centers during the first 3 years of this initiative. Project directors faced occasional hostility at the mention of managed care in some rural communities and, to a large extent, worked on infrastructure development activities focused on information systems. Directors cited hospital and physician leadership as key ingredients for progress toward their goals of managed care contracting or infrastructure development. Communities in which a majority of physicians were in solo practice seemed to have the most difficulty taking the developmental steps toward managed care. The authors conclude that development of information systems and efforts to foster leadership in the medical community are areas in which grant funding of this type can be most effective.

Schwartz, J.A., and Chapman, G.B. (1999, July). "Are more options always better? The attraction effect in physicians' decisions about medications." (AHCPR grant HS09519). Medical Decision Making 19, pp. 315-323.

Increased numbers of medication and treatment options have affected consumer choice and physician behaviors. The purpose of this study was to determine whether the attraction effect—a bias commonly found in consumer-choice studies—would also occur in physicians' decisionmaking. In the attraction effect, the addition of a third alternative to a choice set influences preferences for the two original options. In this study, 40 internal medicine residents reviewed three patient cases (depression, sinusitis, and vaginitis) and then chose the most appropriate medication for each patient. In some versions of the cases, two medication options were available. Other versions included a third medication (the decoy) that was inferior in every way to one of the original options (target) but not to the others (competitors). The addition of the "decoy" medication increased the likelihood of choosing the target medication. Thus, the attraction effect does occur in physicians' decisions about medications. Physicians should be aware of this bias when evaluating or suggesting several similarly attractive medications or treatment options for the same medical condition.

Treadwell, J.R., and Lenert, L.A. (1999, July). "Health values and prospect theory." (AHCPR National Research Service Award fellowship F32 HS00122). Medical Decision Making 19, pp. 344-352.

This paper describes prospect theory (PT) and how it can be applied to health values. Prospect theory is a descriptive theory of choice that was originally developed to explain monetary choices. PT has the potential to accurately characterize how people assign values to health states. In other words, people evaluate health states not according to some absolute criterion but rather according to their relative perceptions of good and poor health. A person in poor health can psychologically adapt to that state and eventually view it as "not so bad." By contrast, a person in good health may rate that poor health state quite negatively, because it is so much worse than their current health. In a review of relevant health research, the authors found mixed support for prospect theory but encourage more research into the application of PT to health values.

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AHCPR Publication No. 00-0003

AHRQ Advancing Excellence in Health Care