Health Care Utilization and Recurrence of
Abdominal Pain
Grant/Contract Number: HS05705
Project Period: 05/90-04/94
Principal Investigator: Alan M. Adelman, M.D.
Institution: Hershey Medical Center
Hershey, PA 17033-0850
Purpose: To provide information on the natural history of
abdominal pain; assess the risk factors
associated with its recurrence and resolution, as well as factors
associated with seeking medical attention for this problem; and
describe the health utilization patterns of individuals with
abdominal pain. The study led to more efficient and cost
effective ways of dealing with this common problem.
Evaluation of Clinical Outcomes in Small Areas
of Michigan
Grant/Contract Number: HS06486
Project Period: 08/90-07/93
Principal Investigator: Laurence F. McMahon, Jr., M.D.,
M.P.H.
Institution: University of Michigan
Ann Arbor, MI 48109-0376
Purpose: To examine small area variations in Michigan
communities for cholecystectomies and
procedures used in the diagnosis, treatment, and screening of
colon cancer. The study involved a disease specific meta
analysis and, with the help of a clinician panel, derived a set
of accepted approaches to the patient. The appropriateness of
technology usage was assessed, and patient outcomes were
conducted. A community based educational intervention was
designed, conducted, and assessed to improve care and patient
outcomes.
Pediatric Gastroenteritis Patient Outcomes Research
Grant/Contract Number: 290-90-0043
Project Period: 09/90-12/96
Principal Investigator: Nancy Merrick, M.D.
Institution: MEDSTAT Group
Santa Barbara, CA 93111-2348
Purpose: To (1) evaluate alternative therapies for pediatric gastroenteritis and describe which are
most effective within different clinical populations; (2) identify the factors that inhibit use of the
most effective and appropriate therapies, including physician practice patterns and patient access
problems; (3) investigate physician-patient interaction and measure the effect and extent of patient
compliance; and (4) recommend improvements in interventions for pediatric gastroenteritis. The
study will evaluate findings in the literature and analyze primary and secondary data sources.
Outcome Assessment of Patients with Biliary Tract Disease
(PORT)
Grant/Contract Number: HS06481
Project Period: 08/90-09/95
Principal Investigator: J. Sanford Schwartz, M.D.
Institution: University of Pennsylvania
Philadelphia, PA 19104-6218
Purpose: To improve the evaluation, management, and health
outcomes of patients with biliary tract disease. The study (1)
determined the rates of use, variation in rates of use, and
health outcomes associated with alternative diagnostic tests and
therapeutic modalities; (2) identified appropriate indications
for alternative tests and treatments and optimal management
strategies; (3) used this information to help physicians improve
their practice and the health outcomes of their patients; (4)
assessed the impact of the interventions on physician practice
and health outcomes; and (5) demonstrated the feasibility of
strategies involving physicians in developing and implementing
effective intervention programs. Researchers analyzed claims
data and primary data on patient outcomes and patient and
physician preferences.
Urban Health Institute at Harlem Hospital Center
Grant/Contract Number: HS07399
Project Period: 09/92-09/97
Principal Investigator: Charles K. Francis, M.D.
Institution: Harlem Hospital Center
New York, NY 10037
Purpose: To establish the Harlem Hospital Center Urban Health
Institute to help optimize the effectiveness of medical resources
and services in urban African American populations by examining
variability in current medical practice and the relation between
clinical outcomes and practice variation. Areas of research
include HIV, hypertension and heart disease, and prevention of
violence and injury to children and adolescents.
Midwest Latino MEDTEP Research Center
Grant/Contract Number: HS07376
Project Period: 04/93-05/96
Principal Investigator: Aida L. Giachello, Ph.D.
Institution: University of Illinois
Chicago, IL 60608-6906
Purpose: At the University of Illinois, a Midwest Latino MEDTEP Research Center was funded
to assess the effectiveness and appropriateness of health and medical services at the primary care
level to the Puerto Rican communities in Illinois and other midwestern states. Areas of research
included type 2 diabetes, asthma, prenatal care, and hypertension.
UCLA/MEDTEP Center for Asians and Pacific Islanders
Grant/Contract Number: HS07370
Project Period: 09/92-08/97
Principal Investigator: Takashi Makinodan, Ph.D.
Institution: UCLA/VA/RAND/MEDTEP
Los Angeles, CA 90073
Purpose: To coordinate the research, training and education, information dissemination, and
technical assistance activities related to the Asian- and Pacific Islander-American population.
Areas of research include (1) cultural adaptation of self-report instruments; (2) comparison of
these self-report activity measures; (3) end-of-life decision making; (4) birth outcomes; and
(5) tuberculosis.
Morehouse Medical Treatment Effectiveness Center (MMEDTEC)
Grant/Contract Number: HS07400
Project Period: 09/92-08/97
Principal Investigator: Robert M. Mayberry, Ph.D., M.P.H.
Institution: Multidisciplinary Research Center
Atlanta, GA 30310-1495
Purpose: To develop the Morehouse School of Medicine's Medical Treatment Effectiveness
Center (MMEDTEC), which will conduct research on the effectiveness and appropriateness of
medical care services and procedures related to health outcomes of African Americans,
particularly in the South. The support hospitals and other provider affiliates of MMEDTEC will
provide a coordinated program of research, technical assistance, dissemination, and training of
minority researchers. Staff and researchers will address problem areas such as hypertension and
selected sequelae, women and infant health, and cancer. Each study conducted will address the
effectiveness of interventions on the well-being of African Americans. Staff training and
curriculum development for training researchers will also be developed.
Meharry Minority MEDTEP Research Center
Grant/Contract Number: HS07387
Project Period: 03/93-08/96
Principal Investigator: Bettie Nelson Knuckles, Dr.P.H.
Institution: Meharry Medical College
Nashville, TN 37208
Purpose: To establish a developmental minority MEDTEP health
services research center at Meharry Medical College in order to
search for more effective ways of providing quality medical care
for the growing number of poor and medically underserved African
Americans. Areas of research include hypertension and sickle
cell disease.
AAMC HSR Institute for Minority Faculty
Grant/Contract Number: HS09262
Project Period: 09/96-09/00
Principal Investigator: Herbert W. Nickens, M.D.
Institution: Association of American Medical Colleges
Washington, DC 20037-1127
Purpose: To develop the health services research skills of 50 junior underrepresented faculty
(Black, American Indian/Alaska Native, Mexican-American, and mainland Puerto Ricans) through
a series of seminars and workshops as well as independent study. The principal component of this
program is the development of a concept paper into a full-fledged proposal suitable for
submission for funding to the Agency for Health Care Policy and Research. The program will be
evaluated using both process and outcome measures.
Mexican American Effectiveness Research Center
Grant/Contract Number: HS07397
Project Period: 09/92-08/97
Principal Investigator: Jacqueline A. Pugh, M.D.
Institution: University of Texas
San Antonio, TX 78284
Purpose: To establish a Mexican American Effectiveness Research
Center (MERECE) to study treatment effectiveness for chronic
disabling conditions in Mexican Americans. Areas of research
include type 2 diabetes, mental health issues, and functional
status measures. The center also provides training to
investigators for outcomes research within the Mexican
American population, provides technical assistance to MERECE
related projects, and disseminates research information.
Ethnic/Racial Minority Health Policy Research Institute
Grant/Contract Number: HS08671
Project Period: 10/94-03/97
Principal Investigator: Carla J. Serlin, Ph.D., M.S.N., B.S.N.
Institution: American Nurses Association
Washington, DC 20024-2571
Purpose: To develop an Ethnic/Racial Minority Health Policy Institute that will support 10
Fellows who are early in their research careers. Institute goals are to increase the health
policy-relevant research skills and generation of research grant applications of doctorally prepared
minority nurses. Institute Fellows' research applications focus on the delivery of health care
services to vulnerable, disadvantaged, or racial/ethnic minority populations in order to reduce the
health disparities among Americans.
University of Maryland Center for Minority Health
Research
Grant/Contract Number: HS07392
Project Period: 01/93-01/98
Principal Investigator: Bonita Stanton, M.D.
Institution: University of Maryland
Baltimore, MD 21201
Purpose: To establish a Center for Minority Health Care Research
at the University of Maryland, Baltimore Campus. The primary
goals of this Center are to identify interventions that
improve the health outcomes of inner city African Americans and
conduct research on areas such as reproductive health, adolescent
health, violence, effective health communications, and asthma.
MEDTEP Research Center on Minority Populations
Grant/Contract Number: HS07386
Project Period: 02/93-01/98
Principal Investigator: Barbara Tilley, Ph.D.
Institution: Henry Ford Health System
Detroit, MI 48202-3450
Purpose: To focus and improve the health status and clinical
outcomes of African Americans served in a large HMO health care
setting. The center will focus its research efforts on clinical
outcomes in the areas of child and adult asthma and type 2
diabetes.
New Mexico MEDTEP Research Center for Ethnic
Populations
Grant/Contract Number: HS07389
Project Period: 09/92-11/95
Principal Investigator: Christopher E. Urbina, M.D., M.P.H.
Institution: University of New Mexico
Albuquerque, NM 87131-5141
Purpose: To develop and manage a Medical Treatment Effectiveness
Program Research Center on Minority Populations in order to
prioritize health research issues pertinent to American
Indians and Hispanics in New Mexico. Research areas included
cervical and breast cancer, childhood asthma, and alcoholism.
Medical Effectiveness Research Center for Diverse
Populations
Grant/Contract Number: HS07373
Project Period: 01/93-01/98
Principal Investigator: A. Eugene Washington, M.D.
Institution: San Francisco General Hospital
San Francisco, CA 94110
Purpose: To establish a MEDTEP Research Center on Minority
Populations at the San Francisco branch of the University of
California, targeting African Americans and Hispanics/Latinos.
Areas of research include cancer, cardiovascular disease, type 2
diabetes, reproductive health, glaucoma, prenatal care, and
depression.
Hawaii Asian Pacific Island MEDTEP Research Center
Grant/Contract Number: HS07381
Project Period: 09/92-08/95
Principal Investigator: Robert M. Worth, M.D., Ph.D.
Institution: Pacific Health Research Institute
Honolulu, HI 96813
Purpose: To develop an Asian and Pacific Islander MEDTEP
Research Center in Hawaii in order to improve the practice of
medicine and patient care through outcomes research for Asians
and Pacific Islanders. Areas of research included primary care,
maternal and child health, medical decision making, functional
status measures, thyroid disease, cancer, and type 2
diabetes.
Manual Therapy in Primary Care of Acute Low Back
Pain
Grant/Contract Number: HS08293
Project Period: 02/95-07/98
Principal Investigator: Timothy S. Carey, M.D., M.P.H.
Institution: University of North Carolina
Chapel Hill, NC 27599-7590
Purpose: To determine (1) whether allopathic physicians can
effectively integrate manual therapy, including simple spinal
manipulation, into primary care practice; and (2) whether the
use of simple spinal manipulation therapy (SMT) can improve the
clinical outcomes of patients with acute back pain. The study is
training physicians in SMT and conducting a randomized
trial. Outcome measures include patient function as measured by
the Roland Morris functional status scale for low back pain,
patient satisfaction, and the time it takes the patient to
improve and return to work.
Low Back Pain: Outcomes and Efficiency of Care
Grant/Contract Number: HS06664
Project Period: 08/91-07/95
Principal Investigator: Timothy S. Carey, M.D., M.P.H.
Institution: University of North Carolina
Chapel Hill, NC 27599-7590
Purpose: To track low back pain problems from the onset of
symptoms and patient's decision to seek care, through clinical
decisions about diagnosis and treatment of patients in office
practices. The research program focused on the outcomes of care
and costs. It involved two studies: (1) a telephone survey of
North Carolina households that described the incidence of low
back pain, the rate at which individuals sought care from
practitioners, and the type of practitioner they sought care
from; and (2) a cohort study of patients presenting to
practitioners' office. The results determined which factors
contribute most to recovery from acute back pain.
Chiropractic Versus Physical Therapy: A Randomized Trial
Grant/Contract Number: HS07915
Project Period: 08/93-01/97
Principal Investigator: Daniel C. Cherkin, Ph.D.
Institution: Group Health Cooperative of Puget Sound
Seattle, WA 98101-1448
Purpose: To compare the effectiveness of three types of nonsurgical treatments for low back
pain: spinal manipulation as performed by chiropractors, the McKenzie method of physical
therapy, and standard medical care supplemented by an inexpensive educational booklet. The
study will recruit subjects from two primary care clinics in a large health maintenance organization
and randomize them to receive one of the three treatments. Outcomes, utilization, and costs will
be estimated to provide information on the relative benefits and costs of these treatments for low
back pain.
Effectiveness of Treatment Strategies for Low Back
Pain
Grant/Contract Number: HS08194
Project Period: 08/94-07/98
Principal Investigator: Richard A. Deyo, M.D., M.P.H.
Institution: University of Washington
Seattle, WA 98195
Purpose: To build on and extend the work of the low back pain
PORT (HS06344, see below) by providing more definitive
information for refining and implementing clinical guidelines
about lumbar spine surgery and its alternatives, and to evaluate
a novel program for enhancing the effectiveness for primary care
guidelines. Specific aims are (1) to compare long term
functional and work related outcomes of alternative surgical and
nonsurgical treatments for patients with sciatica or spinal
stenosis; and (2) to assess the impact of back pain guidelines
and health care reform efforts on regional and national trends in
back surgery rates, reoperation rates, fusion rates, and
nonsurgical hospitalization rates.
Videodisc for Back Surgery Decisions: A Randomized
Trial
Grant/Contract Number: HS08079
Project Period: 09/94-08/97
Principal Investigator: Richard A. Deyo, M.D., M.P.H.
Institution: University of Washington
Seattle, WA 98195
Purpose: To conduct a randomized trial to evaluate the impact of
an already developed interactive media educational program on
patient functional status, satisfaction with medical care,
knowledge of low back problems relevant to making informed
choices, likelihood of selecting surgical therapy, and health
care utilization. This trial compares the low back interactive
videodisc program with written educational materials as adjuncts
to usual care for low back pain in a closed panel health
maintenance organization and a fee for service academic
surgical practice.
Back Pain Outcome Assessment Team (PORT)
Grant/Contract Number: HS06344
Project Period: 09/89-02/95
Principal Investigator: Richard A. Deyo, M.D., M.P.H.
Institution: University of Washington
Seattle, WA 98195
Purpose: To assess alternative types of lumbar spine surgery, a
variety of nonsurgical interventions, and diagnostic tests
commonly used for patients with back pain. Findings were
disseminated via targeted feedback to physicians and hospitals in
areas with high surgical rates and by means of special materials
for educating patients whose decision making role is especially
important in these usually elective procedures.
Assessing and Improving Outcomes: Total Knee Replacement
(PORT)
Grant/Contract Number: HS06432
Project Period: 04/90-09/95
Principal Investigator: Deborah A. Freund, Ph.D., M.P.H.
Institution: Indiana University
Indianapolis, IN 46202-5102
Purpose: To advance the state of knowledge about total knee
replacement (TKR) by (1) determining and explaining variation in
TKR rates and outcomes in the United States (Indiana and Western
Pennsylvania) and the province of Ontario; and (2) constructing
and analyzing a comprehensive decision model to aid physicians
and patients in deciding whether to undertake TKR. These results
were then disseminated to physicians and patients in order to
improve patient care.
Analysis of Practices: Hip Fracture Repair and Osteoarthritis
(PORT)
Grant/Contract Number: HS06658
Project Period: 09/90-03/96
Principal Investigator: James I. Hudson, M.D.
Institution: University of Maryland
Baltimore, MD 21201
Purpose: To assess the effectiveness of alternative management
pathways for hip fracture and total hip replacement for
osteoarthritis. This project will help optimize utilization of
health care resources for patients undergoing these procedures.
A retrospective analysis of Medicare billing data and a
prospective analysis of two patient cohorts, process of care, and
physician questionnaires are being conducted.
Chiropractic Versus Medical Care for Low Back Pain
Grant/Contract Number: HS07755
Project Period: 04/95-03/00
Principal Investigator: Hal Morgenstern, Ph.D.
Institution: UCLA School of Public Health
Los Angeles, CA 90095-1772
Purpose: To assess the effectiveness and cost effectiveness of
four popular management strategies used in the treatment of low
back pain. The randomized study is being conducted in a
multispecialty group practice over a 5 year period. The results
of this project will have important implications to national
health care policy and clarify the roles of medical doctors,
chiropractors, and physical therapists in the treatment of low
back pain.
Selective Cervical Spine Radiography in Blunt Trauma
Grant/Contract Number: HS08239
Project Period: 08/96-07/98
Principal Investigator: William R. Mower, M.D., M.E.
UCLA Emergency Medicine Center
Los Angeles, CA 90024
Purpose: To reduce radiographic cervical spine imaging by demonstrating that clinical criteria can
reliably exclude cervical spine injury in "no risk" blunt trauma victims without misidentifying any
injured patient. This multicenter prospective study will test two hypotheses: (1) Blunt trauma
victims have no risk of cervical spine fracture or dislocation if they are awake and alert, are not
intoxicated, have no tenderness on palpation of the bony cervical spine, and have no other painful
distracting injuries; and (2) Implementation of these criteria will reduce the number of
radiographic spine evaluations without missing any significant cervical spine injuries. Reductions
in the number of radiographic evaluations will be determined by counting the number of
radiographic evaluations performed on "no risk" patients. Charge reductions will be estimated by
summing radiographic charges for all "no risk" patients. Reductions in radiation exposure will be
determined by summing the life-time decrease in radiation morbidity and mortality for all "no risk"
individuals.
Functional Outcomes in Patients With Hip Fractures
Grant/Contract Number: HS09459
Project Period: 09/96-09/01
Principal Investigator: Albert L. Siu, M.D.
Institution: Mount Sinai Medical Center
New York, NY 10029-6574
Purpose: To determine the feasibility and validity of functional status as a measure of quality for
patients with hip fracture by following a network of 26 hospitals and 12 nursing homes in the
New York metropolitan area. Analyses will (1) describe the functional outcomes; (2) adjust the
functional outcomes for baseline function, other health, and sociodemographic variables; (3)
evaluate the reliability and validity of different approaches by which functional outcomes could
have been obtained; (4) evaluate the extent to which the process of care influenced the
risk-adjusted functional outcomes; and (5) evaluate the extent to which an intervention to improve
medical care resulted in improved function.
Outcomes Associated with Therapy for Otitis Media
Grant/Contract Number: HS07816
Project Period: 07/93-06/97
Principal Investigator: Stephen Berman, M.D.
Institution: University of Colorado
Denver, CO 80262
Purpose: To describe current practice patterns and expenditures for the management of otitis
media in pediatric Medicaid recipients using the Colorado Medicaid Medical Events Database
(M-Med) as a source of data. Dependent variables in the M-Med analysis include visits for otitis
media and surgical procedures; independent variables include age, sex, pharmacological therapies,
other interventions, source of care, and location of care.
Natural History of Blood Lead and Effect of
Intervention
Grant/Contract Number: HS08764
Project Period: 05/95-04/96
Principal Investigator: Helen J. Binns, M.D.
Institution: Children's Memorial Hospital
Chicago, IL 60614
Purpose: To determine the natural history of blood lead (BPb)
levels over 1 year among inner city children, focusing on
children receiving testing before the 1991 Centers for Disease
Control (CDC) statement lowered the BPb level of concern. Data
are being collected via a retrospective medical record review of
children having blood drawn for Bpb level determination at three
Chicago inner city pediatric offices during defined enrollment
periods before and after the CDC lowered the BPb level of
concern. The study also evaluates the efficacy of intervention
programs in place at these practices in 1992 to determine if lead
intervention programs alter the natural history of BPb levels
over 1 year.
Physician Opinions on the Diagnosis and Referral of Children
with Cerebral Palsy to
Physical Therapy
Grant/Contract Number: HS06429
Project Period: 04/90- 06/91
Principal Investigator: Suzanne K. Campbell, Ph.D., P.T.
Institution: University of Illinois
Chicago, IL 60612
Purpose: To explore the nature of physicians' beliefs in the
efficacy of physical therapy in the management of children with
cerebral palsy and to identify differences in referral decisions
based on physician and child characteristics. By using a
questionnaire with case descriptions and videotapes of children
with motor dysfunction, the study asked physicians whether they
would refer each child to physical therapy and what outcomes they
expected. This study sought to (1) compare decisions across
medical specialties; (2) compare decisions with previously
reported training in developmental disabilities, beliefs in the
efficacy of physical therapy, and propensities to refer; and (3)
capture decisions in a period of increased uncertainty regarding
both cerebral palsy diagnosis and physical therapy efficacy.
Poor Outcome Following Acute Otitis Medi
Grant/Contract Number: HS07035
Project Period: 09/93-08/97
Principal Investigator: Jack Froom, M.D.
Institution: State University of New York
Stony Brook, NY 11794-8461
Purpose: To examine the separate and combined effects of antibiotic therapy, patient variables,
day care, and signs and symptoms present at the initial physician visit for acute otitis media
(AOM) on either the resolution of an attack or evidence of poor outcome at a followup
examination in three primary care populations in the United States, the United Kingdom, and the
Netherlands. A decision tree is being developed to identify the relative benefits in terms of health
care utilization and costs, days of illness, and parental time lost from work associated with the
three treatment strategies for patients with different risk characteristics
Pediatric Preventive Care Incentives in a Medicaid
HMO
Grant/Contract Number: HS07634
Project Period: 04/93-09/96
Principal Investigator: Alan L. Hillman, M.D., M.B.A.
Institution: University of Pennsylvania
Philadelphia, PA 19104-6218
Purpose: To assess the impact of a system of periodic feedback
and financial incentives on compliance with pediatric preventive
care clinical guidelines in a mandatory Medicaid health
maintenance organization (HMO) and to investigate whether the
provision of detailed feedback reports to sites every 6 months,
linked with a financial bonus program specifically tied to
preventive care, improves on the HMO's currently observed
pediatrics standards compliance rate of 60 percent.
Approximately 51 pediatric primary care sites are participating
in the prospective, randomized controlled trial. Computerized
scoring algorithms will be used to determine compliance.
Improving Children's Health Outcomes: Negotiated
Care
Grant/Contract Number: HS06897
Project Period: 09/91-12/95
Principal Investigator: Sherrie H. Kaplan, Ph.D., M.P.H.
Institution: New England Medical Center Hospitals
Boston, MA 02111
Purpose: To establish whether an intervention program that
involves children, parents, and physicians in treatment decisions
for children with chronic disease improves the active involvement
of children and leads to more accurate assessments of their
health status, both clinically and through self reports.
Inflammatory bowel disease and juvenile diabetes were used
as models for the development of this program. This program
included the use of tools that piqued the interest of children,
including video games, board games, and a videotape.
Office Systems To Improve Preventive Care for Children
Grant/Contract Number: HS08509
Project Period: 09/96-09/00
Principal Investigator: Peter A. Margolis, M.D., Ph.D.
Institution: University of North Carolina
Chapel Hill, NC 27599-7225
Purpose: To implement and evaluate an intervention to increase rates of preventive services in
private pediatric practices in North Carolina. In this randomized clinical trial, physicians will be
encouraged to develop practice-specific "office systems" that involve members of office staff as a
team to provide preventive care and patient education. The impact of the intervention will be
measured on rates of preventive services, changes in physicians' and staff knowledge and attitudes
about organizing the practice to provide preventive care, and changes in patients' knowledge
about preventive care and attitudes toward its importance.
Homemade Cereal Based Oral Rehydration Therapy (PORT
II)
Grant/Contract Number: HS08335
Project Period: 08/94-09/96
Principal Investigator: Alan Meyers, M.D., M.P.H.
Institution: Boston City Hospital
Boston, MA 02118
Purpose: To evaluate the safety and effectiveness of homemade
cereal based oral rehydration solutions (CORS) in a controlled
experimental fashion. If the experimental C ORS is found to
be safe and effective, child health providers may choose it as a
low cost alternative to commercial ORS. With proper supervision,
it may then be recommended to families who may otherwise find the
cost of oral rehydration therapy to be prohibitive.
Nursing Effectiveness in Preventive Child Health
Program
Grant/Contract Number: HS06510
Project Period: 02/91-01/94
Principal Investigator: Dorothy S. Oda, D.N.Sc., R.N.
Institution: University of California
San Francisco, CA 94143-0608
Purpose: To test the effectiveness of two public health nursing
interventions on the rate of health assessments received by low
income children eligible for the Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) program. Thisstudy evaluated the
impact of services such as telephone contacts and home visits on
the rate of health assessments. The results provided information
regarding the effect of interventions on efforts to increase
EPSDT program participation.
Strategies for Care of the Very Low Birthweight Infant
Grant/Contract Number: HS08385
Project Period: 08/96-07/99
Principal Investigator: Nigel S. Paneth, M.D., M.P.H.
Michigan State University
East Lansing, MI 48824-1316
Purpose: To develop ethical, cost-effective, and appropriate strategies for the clinical
management of the very low birthweight (VLBW) infants as well as for resource allocation. The
study will assess school-age outcomes in VLBW survivors in three population-based data sets
from the Netherlands, Canada, and the United States. It will also estimate costs of care used in
the three cohorts at current U.S. prices. A randomized trial will be undertaken, involving infants
for whom administration of intensive care is uncertain, to determine whether exposure of parents
to a multimedia interactive video educational intervention will improve decision making in the
nursery. The study will develop recommendations to guide both clinical care and public
policy.
Assessment of Febrile Infants Less Than 2 Months of
Age
Grant/Contract Number: HS06485
Project Period: 05/93 04/97
Principal Investigator: Robert H. Pantell, M.D.
Institution: University of California
San Francisco, CA 94143
Purpose: To assess which factors in the management of febrile
infants are associated with variations in clinical outcomes. The
questions being addressed include the following: (1) What
is the nature of diagnostic and treatment variability of febrile
(>38 C) infants (<2 months) by office based pediatricians?
(2) How effective are current clinical strategies in predicting
which febrile infants have serious illness? (3) What are the
benefits, harms, and costs in febrile infants associated with
these varying diagnostic and treatment strategies? (4) Can
physicians identify febrile infants for whom the risk of disease
is sufficiently low that a "treat all" policy is unwarranted
because the harms (morbidity) and costs of this policy exceed the
benefits and costs of a more selective strategy? Participating
physicians will gather clinical, laboratory, diagnostic, and
management information during the 2-year study period. Followup
diagnostic assessments also will be made.
Child Development in Relation to Early Otitis
Media
Grant/Contract Number: 92-112 F
Project Period: 06/91-05/96
Principal Investigator: Jack L. Paradise, M.D.
Institution: Children's Hospital of Pittsburgh
Pittsburgh, PA 15213-3417
Purpose: To determine whether persistent otitis media with
effusion during the first 3 years of life results in lasting
impairments of speech, language, cognitive, or psychosocial
development, and if so, whether prompt tympanotomy tube placement
(TTP) is efficacious in preventing or lessening the impairments.
The study will also determine whether and to what extent the
number of TTP operations can be reduced by increasing the
duration of otitis media with effusion required before TTP is
undertaken. It will delineate the occurrence and natural history
of otitis media and associated hearing loss in infants and young
children. Middle ear status will be monitored frequently,
hearing levels will be monitored monthly, standardized
questionnaires will be used to assess developmental functioning
in a random sample, and otological and audiological status will
be monitored systematically.
Regional Variation in Pediatric Hospitalization
Grant/Contract Number: HS06060
Project Period: 09/90-08/94
Principal Investigator: James M. Perrin, M.D.
Institution: Massachusetts General Hospital
Boston, MA 02114
Purpose: To identify and explain documented variations in rates
of pediatric hospitalization for five common childhood illnesses
in three Northeast cities. The study used Poisson regression
models, contingency tables, and linear and logistic regression
models to analyze hospitalization rates. The results provided
insight into pediatric admission decisions and helped to
determine appropriate criteria for childhood hospital
utilization.
Illness Severity and Practice Variation Among Newborn ICUs
Grant/Contract Number: HS07015
Project Period: 04/94-03/97
Principal Investigator: Douglas K. Richardson, M.D., M.B.A.
Institution: Beth Israel Deaconess Medical Center
Boston, MA 02215
Purpose: To (1) measure the degree of variability in outcomes of neonatal intensive care unit
(NICU) patients, holding constant severity of illness, gestational age, weight, and other variables;
and (2) measure the degree of variability in resource use at the study sites, including length of stay
and a proxy for costs. The purpose is to ascertain variability
in outcome (mortality, complications, resource use) from the NICU not attributable to patient
severity, and identify variations in practice that may increase cost without improving outcome.
Pharmaceutical Care and Pediatric Asthma Outcomes
Grant/Contract Number: HS07834
Project Period: 03/93-02/97
Principal Investigator: Andreas S. Stergachis, Ph.D.
Institution: University of Washington
Seattle, WA 98195
Purpose: To conduct a study that will analyze the results of
pharmacists' services on health outcomes and costs for young
asthma patients, who often represent the most chronic asthma
cases. This includes the recruitment of 400 chronic asthma
patients from youth to late teens who receive baseline medical
tests. They will be serviced by selected and randomized
pharmacies that will deliver usual care or pharmacy based
intervention and will be tracked by the pharmacists up to 1 year
after their program entry. The study will ultimately measure the
patient's pulmonary function, functional status, school
attendance, and asthma related health care costs to determine the
cost effectiveness of pharmaceutical care for pediatric asthma
patients.
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