Announcements

New projects funded

The Agency for Health Care Policy and Research has awarded new research grants, research project cooperative agreements, and/or National Research Service Awards, as listed below. Please note that investigators generally do not publish findings until a study has ended or is nearing completion.

Research Grants and Cooperative Agreements

Adoption and use of telecommunications for rural health
Prin. investigator: William A. McIntosh, Ph.D.
Organization: Texas A&M University
College Station, TX
Project no: AHCPR grant HS08247
Period: 9/30/95 to 9/29/97
First year funding: $370,563

Assessing the implementation and impact of CQI efforts
Prin. investigator: Stephen M. Shortell, Ph.D.
Organization: Northwestern University
Evanston, IL
Project no: AHCPR grant HS08523
Period: 9/30/95 to 9/29/97
First year funding: $202,368

Consumer assessments of health plans study
Prin. investigator: Paul D. Cleary, Ph.D.
Organization: Harvard Medical School
Boston, MA
Project no: Cooperative agreement HS09205
Period: 9/30/95 to 9/29/00
First year funding: $599,996

Consumer assessments of health plans study
Prin. investigator: Ronald D. Hays, Ph.D.
Organization: RAND Corporation
Santa Monica, CA
Project no: Cooperative agreement HS09204
Period: 9/30/95 to 9/29/00
First year funding: $600,000

Consumer assessments of health plans study
Prin. investigator: James S. Lubalin, Ph.D.
Organization: Research Triangle Institute
Research Triangle Park, NC
Project no: Cooperative agreement HS09218
Period: 9/30/95 to 9/29/00
First year funding: $800,000

Determinants of HMO efficiency from 1985 to 1994
Prin. investigator: Douglas R. Wholey, Ph.D.
Organization: Carnegie Mellon University
Pittsburgh, PA
Project no: AHCPR grant HS09200
Period: 9/30/95 to 12/31/96
First year funding: $87,714

Effectiveness of outpatient treatment for PID
Prin. investigator: Roberta B. Ness, M.D.
Organization: University of Pittsburgh
Pittsburgh, PA
Project no: AHCPR grant HS08358
Period: 9/30/95 to 9/29/00
First year funding: $1,077,730

Effects of horizontal hospital mergers
Prin. investigator: Robert A. Connor, Ph.D.
Organization: University of Minnesota
Minneapolis, MN
Project no: AHCPR grant HS09185
Period: 9/30/95 to 12/31/96
First year funding: $128,296

Effects of managed care on physicians' practices
Prin. investigator: Jack Hadley, Ph.D.
Organization: Georgetown University
Washington, DC
Project no: AHCPR grant HS09196
Period: 9/30/95 to 9/29/97
First year funding: $183,487

Efficiency in hospitals: Do HMOs and PPOs "buy right?"
Prin. investigator: Jose Escarce, M.D.
Organization: University of Pennsylvania
Philadelphia, PA
Project no: AHCPR grant HS09194
Period: 9/30/95 to 9/29/97
First year funding: $184,940

Emergency medical services for children
Prin. investigator: Anthony J. Suruda, M.D.
Organization: University of Utah
Salt Lake City, UT
Project no: AHCPR grant HS09057
Period: 9/1/95 to 8/31/98
First year funding: $224,958

Experiment to encourage planning for critical care
Prin. investigator: Susan H. Evans, Ph.D.
Organization: University of Southern California
Los Angeles, CA
Project no: AHCPR grant HS09232
Period: 9/30/95 to 9/29/97
First year funding: $327,722

Health care delivery systems and primary care performance
Prin. investigator: Dana G. Safran, Sc.D.
Organization: New England Medical Center
Boston, MA
Project no: AHCPR grant HS08841
Period: 9/30/95 to 9/29/97
First year funding: $356,750

Health care markets, managed care, and hospital performance
Prin. investigator: Glenn A. Melnick, Ph.D.
Organization: RAND Corporation
Santa Monica, CA
Project no: AHCPR grant HS09211
Period: 9/30/95 to 9/29/98
First year funding: $194,793

HMO impact on integrated networks and services
Prin. investigator: Lawton R. Burns, Ph.D.
Organization: University of Pennsylvania
Philadelphia, PA
Project no: AHCPR grant HS09237
Period: 9/30/95 to 3/31/97
First year funding: $138,540

Impact of managed care on physician markets
Prin. investigator: William D. White, Ph.D.
Organization: University of Illinois
Champaign, IL
Project no: AHCPR grant HS09210
Period: 9/30/95 to 9/29/96
Funding: $150,483

Managed care and hospital physician integration
Prin. investigator: Michael A. Morrisey, Ph.D.
Organization: University of Alabama
Birmingham, AL
Project no: AHCPR grant HS09183
Period: 9/30/95 to 3/31/97
First year funding: $160,207

Market forces and rural health: System and consumer impact
Prin. investigator: Keith J. Mueller, Ph.D.
Organization: University of Nebraska Medical Center
Omaha, NE
Project no: AHCPR grant HS09195
Period: 9/30/95 to 9/29/97
First year funding: $108,475

Medical malpractice and liability reforms
Prin. investigator: W. Kip Viscusi, Ph.D.
Organization: Duke University
Durham, NC
Project no: AHCPR grant HS08686
Period: 9/30/95 to 9/29/96
Funding: $52,500

Outcomes of hospital dedicated AIDS units
Prin. investigator: Linda H. Aiken, Ph.D.
Organization: University of Pennsylvania
Philadelphia, PA
Project no: AHCPR grant HS08603
Period: 9/30/95 to 9/29/97
First year funding: $180,649

Patient-centered outcomes method for neurologic disease
Prin. investigator: Carolyn E. Schwartz, Sc.D.
Organization: Frontier Science and Technology Research
Foundation, Brookline, MA
Project no: AHCPR grant HS08582
Period: 9/30/95 to 9/29/98
First year funding: $203,389

Performance of strategic hospital collectives
Prin. investigator: Roice D. Luke, Ph.D.
Organization: Virginia Commonwealth University
Richmond, VA
Project no: AHCPR grant HS09217
Period: 9/30/95 to 9/29/96
Funding: $140,322

Validating risk prediction models in cardiology
Prin. investigator: Elizabeth R. DeLong, M.D.,Ph.D.
Organization: Duke University Medical Center
Durham, NC
Project no: AHCPR grant HS08805
Period: 9/30/95 to 9/29/97
First year funding: $167,925

Small Grant

Primary care physician job satisfaction and turnover
Prin. investigator: Modena E. Wilson, M.D.
Organization: Johns Hopkins University
Baltimore, MD
Project no: AHCPR grant HS08984
Period: 9/30/95 to 9/29/96
Funding: $72,151

Conference Grants

Assessing psychosocial oral health outcomes
Prin. investigator: Gary D. Slade, Ph.D.
Organization: University of North Carolina
Chapel Hill, NC
Project no: AHCPR grant HS09254
Period: 9/30/95 to 9/29/96
Funding: $49,915

Outcome measurers and care delivery systems
Prin. investigator: Janet Heinrich, Dr.P.H.
Organization: American Academy of Nursing
Washington, DC
Project no: AHCPR grant HS09242
Period: 9/30/95 to 9/29/96
Funding: $37,500

Primary care research methods and statistics conference
Prin. investigator: David A. Katerndahl, M.D.
Organization: University of Texas
San Antonio, TX
Project no: AHCPR grant HS08775
Period: 9/30/95 to 9/29/99
First year funding: $31,313

Urban women's health: Models for the future
Prin. investigator: Carole Warshaw, M.D.
Organization: Health and Medical Policy Research Group
Chicago, IL
Project no: AHCPR grant HS08885
Period: 9/30/95 to 9/29/96
Funding: $37,337

National Research Service Award Fellowships

Cost-effectiveness of MRI breast screening
Fellow: Sylvia K. Plevritis, Ph.D.
Organization: Stanford University
Stanford, CA
Project no: NRSA fellowship F32 HS00100;
Alan M. Garber, sponsor
Period: 2-year fellowship
Funding: $29,900

Psychosocial effects on gender differences in elderly function
Fellow: Susan S. Merrill, Ph.D.
Organization: University of Michigan
Ann Arbor, MI
Project no: NRSA fellowship F32 HS00114;
Lois M. Verbrugge, sponsor
Period: 1-year fellowship
Funding: $28,600

New publications available from AHCPR and NTIS

AHCPR's Program of Patient Outcomes Research and Related Activities. Report to Congress.

This report describes the patient outcomes research and other activities carried out under AHCPR's Medical Treatment Effectiveness Program (MEDTEP), which is a multifaceted and multidisciplinary approach to addressing the complex issues of health care delivery. The report, which was submitted to Congress in April 1995, describes the progress of activities under each of MEDTEP's four components: (1) outcomes research, which examines alternative clinical strategies for preventing, diagnosing, treating, and managing specific clinical conditions to assess their effectiveness, appropriateness, and cost-effectiveness in terms of patient outcomes; (2) data development, with the goal of improving patient outcomes by improving the quality of data used in patient care decisionmaking and the quality and quantity of data available for research; (3) clinical practice guideline development; and (4) dissemination and evaluation of research findings and clinical practice guidelines.

Clinical Decision Aid for Genital Chlamydia in Women. AHCPR grant HS06396, 5/1/91 to 12/31/94. Frank A. Sonnenberg, M.D., University of Medicine of New Jersey, New Brunswick, NJ.

Genital infection with Chlamydia trachomatis is the most common sexually transmitted disease in the United States. Genital chlamydia has many complications that can be prevented if treated, but the majority of infected women are asymptomatic and would not be identified for treatment without screening. The cost-effectiveness of screening has not previously been evaluated. The investigators examined risk factors for chlamydia in 2,400 women in primary care practice and determined four risk factors that were independently associated with chlamydia infection: age (sexually active women up to 30 years of age), race (black), cervical friability, and multiple sexual partners. A predictive model based on these factors has excellent discrimination between high- and low-risk patients. Using a cost-utility analysis, the researchers found that screening all patients with Chlamydiazyme or with chlamydia culture is highly cost-effective in patients up to age 50. However, selective screening of high-risk patients with culture is more cost-effective than universal screening and actually can save money compared with no testing or testing only symptomatic patients.

Consumer Survey Information in a Reforming Health Care System.

This publication summarizes a conference, jointly sponsored by AHCPR and the Robert Wood Johnson Foundation, on issues related to consumer survey information in an evolving health care system. Participants examined the need for improved information both from and for consumers, including the kinds of information needed by consumers, clinicians, health plans, and other potential users of consumer survey information; the most efficient methods for surveying consumers; the kinds of standards needed to produce reliable and useful survey data; the appropriate roles for the public and private sectors in collecting, analyzing, and disseminating consumer information; and other related issues. The report includes the conclusions of eight workshops and presents four commissioned papers that synthesize the current literature, critique existing surveys, discuss the challenges of surveying special populations, and describe the uses of information from consumer surveys.

Functional Change in Older Adults. AHCPR grant HS06795, 2/1/91 to 1/31/93. Vincent Mor, Ph.D., Brown University, Providence, RI.

Preventing functional decline and improving functional status are essential steps in achieving improved quality of life for older adults. Using the Longitudinal Study on Aging (LSOA) supplement to the 1984 National Health Interview in which the elderly cohort was contacted every 2 years until 1990, the researchers developed several measures of functional status. After controlling for health status, they found that lifestyle factors, such as exercise and social activity, were related to mortality. When functional status was defined on the basis of an activities of daily living (ADL)/ independent activities of daily living (IADL) hierarchy, 80 to 90 percent of women and men ages 80 and older who had several ADL dependencies in 1984 had died by 1990, compared with 31 percent of women and 53 percent of same-age men who had no ADL or IADL dependencies in 1984. They also found a 10 to 15 percent rate of functional improvement even among elders with moderate IADL dependence, particularly those ages 70 to 79. And finally, they examined the relationship between functional status and changes in living arrangements and found that less than 8 percent of the total elderly population moved during a 2-year period (excluding entry into a nursing home), and that most of these changes in residence occurred among elders who lived alone. Initial disability level had a strong effect on nursing home entry but little effect on other types of residential changes.

Minority Elderly Access to Long-Term Care. AHCPR grant HS07672, 2/1/93 to 12/31/94. Steven P. Wallace, Ph.D., University of California, Los Angeles.

Using data from the 1987 National Medical Expenditure Survey, the researcher examined factors that predict nursing home use, use of formal in-home personal care (such as help with bathing or dressing) in lieu of nursing home care, unpaid in-home care, or no personal care. He found that even though Medicaid improves access to formal (paid) long-term care services, older African-Americans and Latinos continue to be less likely to receive such services than whites who have similar characteristics and needs. Minority elderly also are less likely to receive nursing home care, and paid formal community-based care does not fully compensate for that lower use. Care may be shifted onto family caregivers, and some minority elders receive no care.

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