The following grant final reports are now available from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator, his or her affiliation, grant number, and project period and provides a brief description of the project.
The following grant final reports are now available from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator, his or her affiliation, grant number, and project period and provides a brief description of the project.
Records of documents archived at NTIS—including many AHRQ documents and final reports from all completed AHRQ-supported grants—can now be searched on the new NTIS Web site. For information about findings from the projects described here, please access the relevant final reports at the NTIS Web site. Also, all items in the database from 1997 to the present can be downloaded from the NTIS Web site. Go to www.ntis.gov for more information.
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 of Research Activities, select "Search Research Activities." To search for information, enter either the grant or contract number or the principal investigator's last name in the query line. A reference librarian can help you find related journal articles through the National Library of Medicine's PubMed®.
Comparative Analysis of State Capitation Rate Setting Methods. Ginny Hsieh, M.P.H., Johns Hopkins University, Baltimore, MD. AHRQ grant HS09338, project period 9/1/96-8/31/98.
The goal of this research was to determine how much would be gained from using more refined risk adjustment methods in setting Medicaid capitation rates. The researcher evaluated current Medicaid capitation rate setting algorithms from various States, including California, Maryland, and Michigan to assess whether these methods, which include only demographic factors, are accurately predicting costs. Another goal was to determine the feasibility of alternative risk adjustment models that include clinical and disability factors. The findings indicate that clinical risk adjustment models do have higher predictive accuracy than the actuarial-based capitation methods for certain patient populations. However, differences in predictive performance also depend in large part on modeling options. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102865; 226 pp., $59.00 paper, $20.00 microfiche are available from NTIS.)
Determinants of Cesarean Section: Explaining Recent Changes. A. Dale Tussing, Ph.D., Syracuse University, Syracuse, NY. AHRQ grant HS10065, project period 6/1/99-5/31/01.
The researchers developed a data set using vital statistics data and hospital discharge data for New York State for 1996-1998. They compared changes in obstetric methods over that time
period and found that there was a dramatic fall in the rate of repeat c-sections and a large increase in the proportion of births paid for by HMOs. Neither of the factors played a role in shifting the overall c-section rate, but dystocia (abnormal or difficult labor) did have a substantial effect. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102834; 86 pp., $34.00 paper, $14.00 microfiche are available from NTIS.)
Emergency Department Data Conference, 2002. Luis M. Paita, Ph.D., National Association of Health Data Organizations. AHRQ grant HS12065, project period 2/15/02-10/14/02.
This project provided support for a conference designed to increase the capacity of State health data agencies to collect emergency department (ED) data. Goals were to highlight best practices and priorities in key domains of data systems development, build partnerships, discuss how to manage and disseminate data, and describe ways to identify late-breaking national issues and resources that have implications for ED data systems. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102836; 116 pp., $38.00 paper, $20.00 microfiche are available from NTIS.)
Making Care Decisions for Cognitively Impaired Parents. Katharine C. Cook, M.S., University of Virginia, Charlottesville. AHRQ grant HS10762, project period 7/1/00-8/31/02.
This study involved 22 adults aged 35-64 (14 daughters, 6 sons, and 2 daughters-in-law) who were primary decisionmakers for cognitively impaired parents aged 73-91. The researchers identified a decisionmaking process that included five themes: finding a voice, professing fidelity, speaking for the speechless, correcting the course, and expressing gratitude. They identified various points along the way when caregivers could benefit from support services and resources such as the Internet and accessible, reliable, and affordable day and respite care. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102837; 128 pp., $41.50 paper, $20.00 microfiche are available from NTIS.)
Optimizing Outcome Research for Nursing Practice. Karen Sousa, Ph.D., Arizona State University, Tempe. AHRQ grant HS12061, project period 9/30/01-9/29/02.
This project provided support for a conference held in 2002 at Arizona State University to discuss findings from research on the effects of nurse staffing and skill mix on quality of care. The goal was to disseminate these new findings to those in leadership positions who have the potential to incorporate findings into practice. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102827; 20 pp, $26.50 paper, $14.00 microfiche are available from NTIS.)
Otitis Media and Language Learning Sequelae: Controversies and Current Research. Joanne E. Roberts, Ph.D., University of North Carolina, Chapel Hill. AHRQ grant HS12072, project period 1/15/02-1/14/03.
This project provided support for a conference held in May 2002, to review current research on the effects of otitis media with effusion (OME) on children's hearing and development, identify gaps and future directions for research, and discuss implications for clinical practice. Current evidence indicates hat the linkage of a history of OME in early childhood to later development—after accounting for important confounding variables—is negligible to mild in degree. However, the findings should be interpreted cautiously, given that almost all of the studies used OME rather than hearing loss as the independent variable, and many of the studies did not control for important variables that could have affected the findings. Continued study of the OME language linkage should consider measurement, study design, analysis, and population sampling issues. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102826; 18 pp, $26.50 paper, $14.00 microfiche are available from NTIS.)
Outcomes of a Managed Care Cost-Containment Strategy. Mary E. Murray, Ph.D., University of Wisconsin, Madison. AHRQ grant HS10667, project period 9/15/00-8/31/02.
The objective of this project was to determine the impact of a managed care cost-containment strategy—concurrent utilization review (UR)—on the plan of care of hospitalized patients and hospital fiscal outcomes. The UR process requires that hospital staff communicate clinical information about hospitalized patients to payers who determine whether the planned care is appropriate, medically necessary, and allowable under the terms of the contract with the provider. The researchers used a production process model and cost analysis to study the impact of denials of UR by managed care payers. They conducted a time study to identify the costs of the process, analyzed routinely collected management data, and performed a qualitative analysis of recorded interviews with hospital staff who conducted the UR process. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102213; 32 pp., $29.50 paper, $14.00 microfiche are available from NTIS.)
Outcomes of Increasing Diabetes Self-Monitoring in an HMO. Stephen B. Soumerai, Sc.D., Brigham and Women's Hospital, Boston, MA. AHRQ grant HS10063, project period 9/30/98-9/29/02.
The researchers evaluated whether a policy change to cover the cost of blood glucose monitors increased self-monitoring of blood glucose among diabetes patients in a managed care setting. They collected 48 months of data from a computerized medical record system for 3,219 continuously enrolled adult diabetes patients. They found that coverage of the cost of monitors significantly increased blood glucose monitoring among managed care patients. The improved monitoring was associated with increased adherence to medications and a reduction in blood glucose levels. (Abstract, executive summary, and final report, NTIS accession no. PB2005-101292; 42 pp., $29.50 paper, $14.00 microfiche are available from NTIS.)
Patient-Centeredness in the Frontline Emergency Department. Charles R. Denham, M.D., Texas Medical Institute of Technology, Austin. AHRQ grant HS12092, project period 7/8/02-7/7/03.
Patient-centered care reflects patient values and preferences, and patients are engaged as active participants in medical decisionmaking. Health care policymakers and patient safety experts are becoming familiar with patient-centered care, but the extent of understanding by frontline caregivers and health care consumers is less clear. This project provided support for a conference to identify strategies, methodological issues, and measures that were then used as the basis of a research agenda for enhancing patient-centered care as applied in community emergency departments. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102330; 38 pp., $29.50 paper, $14.00 microfiche are available from NTIS.)
Patient-Defined Culturally Sensitive Health Care, Part II. Carolyn M. Tucker, Ph.D., University of Florida, Gainesville. AHRQ grant HS10726, project period 9/30/00-9/29/02.
Health care inventories were developed to evaluate levels of patient-defined cultural sensitivity in health care received at community-based primary care clinics by black, Hispanic, and white Americans. In addition, an inventory was developed for use by primary care clinicians to self-evaluate their own levels of patent defined cultural sensitivity in the care they deliver. Pilot versions of these inventories were tested, and research is underway to determine the reliability and validity of the inventories. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102828; 18 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
Penetrating the Black Box: Mechanisms for Enhancing Health Efficiency and Clinical Effectiveness. Douglas A. Conrad, M.D., Ph.D., University of Washington, Seattle. AHRQ grant HS12076, project period 5/1/02-2/29/04.
This project provided support for a meeting of senior health care executives, health services researchers, and representatives of relevant research funding organizations to review current theory, methods, and research evidence on the use of financial incentives to improve the quality and efficiency of health services and to develop a research agenda and dissemination plan. The conference highlighted several questions for management and policy concerning the application of financial incentives to clinical providers. (Abstract and final report, NTIS accession no. PB2005-102215; 22 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
Preventive Medicine, 2003. Jordan Richland, M.P.H., American College of Preventive Medicine, Washington, DC. AHRQ grant HS13885, project period 9/30/01-9/29/03.
The goals of this conference were to convey information on the latest advances and current recommendations in prevention practices, policies, and programs; identify research gaps in clinical preventive medicine research; describe the evidence base underlying current recommendations on the effectiveness and delivery of clinical preventive services; and cover other important and timely topics affecting the delivery of clinical preventive services. (Abstract and executive summary, NTIS accession no. PB2005-102329; 16 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
Public's Health: A Matter of Trust. A Symposium. David A. Shore, Ph.D., Harvard School of Public Health, Boston, MA. AHRQ grant HS13810, project period 9/18/02-9/17/03.
The purpose of this conference was to present current research on declining public trust in health care and propose solutions to restore trust. Specific problems relating to medical errors, vaccines, food safety, genetics, and health care research were addressed in a large context—e.g., the role of the media and the Internet—and on a more personal level—e.g., problems with the physician-patient relationship. Solutions to improve trust were proposed, including improvements in medical education and public communications. (Abstract and final report, NTIS accession no. PB2005-102830); 16 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
Seattle Lumbar Imaging Project. Jeffrey Jarvik, M.D., M.P.H., University of Washington, Seattle. AHRQ grant HS09499, project period 9/30/98-12/31/02.
The Seattle Lumbar Imaging Project (SLIP) was a multicenter randomized trial that evaluated the consequences of substituting a rapid MRI for radiographs as the initial imaging strategy for primary care patients with low back pain. After controlling for back-related disability at baseline and study site, there was no significant difference in 12-month outcomes between the radiography and MRI groups. Patients randomized to radiography had more conventional MRIs, physical therapy, acupuncture, massage, and osteopathic and chiropractic manipulation over the study period. Patients randomized to rapid MRI had more subsequent radiographs of the lumbar spine and more specialist consultations. The mean cost of care was higher in MRI patients ($2,121) compared with radiography patients ($1,651), but the difference was not significant. Six percent of MRI patients had lumbar spine surgery within 12 months, compared with 2 percent of radiography patients. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102832; 34 pp, $29.50 paper, $14.00 microfiche are available from NTIS.)
Seventh Regenstrief Conference. Kurt K. Kroenke, M.D., Regenstrief Institute, Indianapolis, IN. AHRQ grant HS10082, project period 11/9/99-11/8/01.
This project provided support for the conference, "Investigating Symptoms: Frontiers in Primary Care Research," which was held in November 1999, in Marshall, IN. During the conference, a research agenda was developed on characterizing symptoms, measurement issues, and the physician-patient relationship as it relates to primary care practice. (Abstract and executive summary, NTIS accession no. PB2005-102829; 20 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
Superspecialization of Medical and Surgical Subspecialists. Jose Escarce, M.D., Ph.D., RAND, Santa Monica, CA. AHRQ grant HS08573, project period 7/15/97-5/31/99.
The goal of this project was to enhance understanding of the factors that influence physicians' scope of practice—that is, the services they actually provide chosen from among all the services they are trained to perform. The researchers focused on six medical and surgical subspecialties: cardiology, gastroenterology, pulmonology, orthopedic surgery, ophthalmology, and urology. They used Medicare administrative data and other secondary data files containing information on market characteristics. They found no consistent pattern; neither physician attributes nor market characteristics had consistent effects on the breadth or narrowness of physicians' scope of practice. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102217; 56 pp., $31.50 paper, $14.00 microfiche are available from NTIS.)
Testing the Effectiveness of Advance Medical Directives. Peter Ditto, Ph.D., Kent State University Foundation, Kent, OH. AHRQ grant HS08180, project period 3/1/95-2/28/02.
This three-phase longitudinal study was conducted to examine three key psychological assumptions underlying the effective use of advance medical directives in end-of-life decisionmaking. Participants were 401 elderly adults and their surrogate decisionmakers. Phase one assessed the effectiveness of four advance directive interventions in improving the accuracy of surrogate substituted judgment. Phase two examined the stability of life-sustaining treatment preferences over time. Phase three compared life-sustaining treatment preferences stated soon after a hospitalization with those stated months before and after the hospital stay. The study found that advance directive interventions are ineffective in improving the accuracy of surrogate substituted judgment, life-sustaining treatment preferences are only moderately stable over time, and individuals are less interested in life-sustaining treatment immediately after a hospitalization than they are in the months before and after a hospital stay. (Abstract, final report, and appendixes, NTIS accession no. PB2005-102864; 52 pp., $31.50 paper, $14.00 microfiche are available from NTIS.)
Training Evidence-Based Practitioners Program. Joseph Lau, M.D., New England Medical Center, Boston, MA. AHRQ grant HS09796, project period 7/1/98-6/30/01.
The goal of this project was to augment evidence-based practice capacity by training clinical specialists and primary care
providers to become evidence-based practitioners in their respective areas and organizations. The specific aims were to: teach clinicians how to translate evidence into practice in the managed care setting; teach clinicians how to become effective partners in evidence-based projects; and assist clinicians in becoming independent evidence-based medicine researchers. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102216; 38 pp., $29.50 paper, $14.00 microfiche are available from NTIS.)
Treatment Choices and Outcomes in Early Prostate Cancer. James A. Talcott, M.D., Massachusetts General Hospital, Boston. AHRQ grant HS08208, project period 4/1/94-3/31/00.
This cohort study of treatment outcomes involved 600 patients who underwent aggressive local therapy for prostate cancer: external beam radiation therapy, radical prostatectomy, or brachytherapy. The researchers followed patients for 24 months posttreatment and assessed self-reported urinary incontinence, urinary obstruction/irritation, bowel problems, and sexual dysfunction. They developed and validated scales that characterize symptom states and outcomes qualitatively as good, intermediate, or poor, and they examined factors that affect physicians' treatment recommendations and patients' treatment choices. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102833; 56 pp., $31.50 paper, $14.00 microfiche are available from NTIS.)
University of Washington Research Training Program, 1989-1999. Diane P. Martin, Ph.D., University of Washington, Seattle. AHRQ grant HS00034, project period 9/30/89-6/30/99.
For this health services research training program, the investigators recruited talented doctoral level scientists, physicians, and predoctoral students as trainees. The goal was to foster in the trainees a broad understanding of the health services system (public and private) and an awareness of issues amenable to empirical study. Other goals were to assist trainees in acquiring the capacity to design and conduct sound research, provide trainees with a meaningful health services research experience, and place graduates in academic, government, and private enterprises in which their special skills and knowledge will be used and valued. (Abstract, executive summary, and final report, NTIS accession no. PB2005-101291; 44 pp., $29.50 paper, $14.00 microfiche are available from NTIS.)
Using an Endoscope Database to Study Outcomes of Reflux. M. Brian Fennerty, M.D., Oregon Health Sciences University, Portland. AHRQ grant HS10650, project period 7/1/00-6/30/02.
The goal of this project was to determine differences in clinical outcomes between patients undergoing endoscopy who have complicated forms of gastroesophageal reflux disease (GERD) and those with normal endoscopy findings. Another goal was to determine whether a computer format and database could be used to enroll and follow patients at sites peripheral to the central study site. Although some aspects of the study were successfully completed, most of the outcomes could not be determined due to technical problems and personnel issues. (Abstract, executive summary, and final report, NTIS accession no. PB2005-102863; 12 pp., $26.50 paper, $14.00 microfiche are available from NTIS.)
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