AHCPR funds studies on respiratory disease
care and improving health care quality
The Agency for Health Care Policy and Research recently funded
several new studies on asthma and pneumonia—respiratory
diseases that affect millions of Americans and significantly contribute to
health care costs and lost productivity. AHCPR also has funded
another group of studies that will provide science-based
information to facilitate the development of tools and information
for use in measuring and improving health care quality.
In the area of respiratory disease, AHCPR has funded a 5-year,
$6.08 million randomized clinical trial to improve asthma care
for children and adolescents. The prevalence of childhood asthma,
a serious and costly health problem, has more than doubled since
1970. Asthma affects nearly 5 million children under 18 years of
age, and costs approximately $1.9 billion for treatment,
according to the American Lung Association. Currently, data are
very limited on the effectiveness of asthma treatment, according
to AHCPR's Administrator, Clifton R. Gaus, Sc.D.
The disease restricts breathing, can trigger other health
problems, and sometimes leads to the death of affected
individuals. Asthma also may cause emotional and growth problems
in children, and it is responsible for a significant number of
lost school and work days.
Under the direction of the principal investigator, Kevin B.
Weiss, M.D., of Rush Presbyterian-St. Luke's Medical Center in
Chicago, the researchers will test the cost-effectiveness of
practice guidelines intended to reduce asthma morbidity among
children. The research team will determine the effectiveness of
an opinion-leader training program, using academic detailing
principles, to increase doctors' use of guideline recommendations
on anti-inflammatory medications for children on chronic
bronchodilator therapy. In addition, the researchers will test a
new organizational approach that managed care providers could use
to deliver pediatric asthma care.
The study, to be conducted in three large health maintenance
organizations in Boston, Chicago, and Seattle, is one of AHCPR's
large-scale projects that evaluate the effectiveness of different
methods of diagnosing, treating, managing, and preventing, where
applicable, widespread health problems. AHCPR is providing $1.28
million for the first year and has earmarked $4.80 million to
complete the study. The National Heart, Lung, and Blood
Institute, which developed the guideline to be used in the study,
is contributing $800,000 to the project (AHCPR/NHLBI grant
HSHL08368).
AHCPR also funded the following respiratory disease
studies:
- Outcomes of Lower Respiratory Illness in Nursing Home
Residents (AHCPR grant HS08551). Under this 3-year, $2.16
million grant, David R. Mehr, M.D., of the University of
Missouri-Columbia, will lead the first outcomes research
project to determine whether residents of nursing homes who
contract pneumonia, but are at low risk of dying from the
disease, can be treated in the facility as safely and
effectively as in a hospital. The researchers will develop
and test a method doctors could use to estimate expected
outcomes of nursing home residents who have pneumonia. If
proven effective, the formula could help physicians more
accurately identify low- and high-risk patients and reduce
the number of medically unnecessary hospital admissions.
- Dissemination of Guidelines for Pneumonia Length of Stay
(AHCPR grant HS08282). Michael J. Fine, M.D., University of
Pittsburgh, is the principal investigator of this study that
will evaluate the impact of medical care guidelines on the
length of stay of persons hospitalized for treatment of
community-acquired pneumonia. AHCPR has committed $1.53
million to fund the 3-year study; the National Institute of
Allergy and Infectious Diseases is providing $388,858.
- Developing and Testing Asthma Quality of Care Measures
(AHCPR grant HS09461). Under the direction of Yvonne C.
Coyle, M.D., of the University of Texas Southwestern Medical
Center in Dallas, researchers will develop and test
technical measures of the quality of adult asthma care.
Overall AHCPR funding for the 3-year study totals $805,710.
Health plans, providers, and consumers across the United States
are the intended beneficiaries of the second group of 10 studies
which focus on quality of care. According to Dr. Gaus, objective,
research-based, quality of care measures are essential for
improving services, balancing costs and quality, and knowing
where costs can be reduced without jeopardizing patients' health.
AHCPR has awarded approximately $13.52 million over 5 years to
fund seven new studies that are collectively known as Q-SPAN
(Expanding Quality of Care Measures). These new studies are:
- Clinical Performance Measures for Dental Care Plans
(AHCPR
grant HS09453). Led by James D. Bader, D.D.S., of the
University of North Carolina, Chapel Hill, this 2-year
project will develop a set of outcomes-based performance
measures for general dentistry, with a special focus on
cavities, which together with gum disease, account for most
dental claims. The researchers will validate, pilot test,
and implement the measures in two large dental managed care
plans. Total estimated funding: $374,014.
- Ongoing Development and Evaluation of HEDIS Measures
(AHCPR
grant HS09473). Under the direction of Arnold M. Epstein,
M.D., Harvard University, Boston, MA, the researchers will
evaluate the recently published draft version of the Health
Plan Employer Data and Information Set (HEDIS 3.0)—currently
the most widely used measure of health plan performance—and
develop operational specifications for measures that the
National Committee for Quality Assurance may include in the
next version of HEDIS. Total estimated funding for this
3-year project is $2.31 million.
- Measuring Quality by Achievable Benchmarks of Care
(AHCPR
grant HS09446). Catarina I. Kiefe, M.D., Ph.D., of the
University of Alabama, Birmingham, and colleagues will
refine and test the feasibility of using Achievable
Benchmarks of Care—derived from pooled data of the best
health care performers—because consistent data-driven
definitions of benchmark performance are not currently
available. The goals of this 5-year project are to increase
providers' ability to transition from quality measurement to
actual changes in clinical practice, and to improve
methodology for deriving quality measures from readily
available data. Total estimated funding: $1.77 million.
- Adult Global Quality Assessment Tool (AHCPR grant
HS09463).
Led by Elizabeth A. McGlynn, Ph.D., of RAND Corporation,
Santa Monica, CA, this 3-year project will develop and test
clinically based sets of measures for assessing quality of
care delivered to men under age 50 and men and women ages 50
and older who are enrolled in managed care plans. This
project complements another study by the
investigators—funded by the Health Care Financing
Administration—to develop managed care measures sets for use
in evaluating quality of care provided to premenopausal
women and to children and adolescents. Total estimated
funding: $1.43 million.
- Quality of Care Measures for Cardiovascular Patients
(AHCPR
grant HS09487). Barbara J. McNeil, M.D., Ph.D., of Harvard
University, Boston, MA, and her colleagues will develop and
test a set of clinical measures for cardiovascular care
performance using data collected from four health plans that
enroll a broad spectrum of patient types. The researchers
will focus on developing measures for a group of
interrelated cardiovascular conditions. Total estimated
funding for this 5-year project is $4.16 million.
- Quality Outcomes in Subacute and Home Care Programs
(AHCPR
grant HSO9455). Principal investigator John N. Morris,
Ph.D., Hebrew Rehabilitation Center for the Aged, Boston,
MA, and colleagues will measure quality of care in two
increasingly important but little studied transitional
settings for rehabilitative-restorative care following acute
hospital discharge: nursing home subacute care and home
care. During this 3-year project, the researchers will
create, validate, and set benchmark values of longitudinal
change for activities of daily living, mobility, cognition,
communication, and other outcomes. Total estimated funding:
$1 million.
- Functional Outcomes in Patients with Hip Fractures
(AHCPR
grant HS09459). In this 5-year project, principal
investigator Albert L. Siu, M.D., of Mount Sinai School of
Medicine, New York, NY, and his colleagues will address hip
fracture care management and outcomes by developing a
workable quality measurement system providers can use to
assess the quality of care they provide patients with hip
fracture—an increasingly prevalent and costly health
problem. Total estimated funding: $2.47 million.
Upon their availability, AHCPR may include quality of care
measures produced by the studies in AHCPR's landmark Computerized
Needs-Oriented Quality Measurement Evaluation System (CONQUEST)
and in its technical assistance program, the Quality Measurement
Network (QMNet).
In addition, AHCPR has awarded approximately $3.23 million to
fund three other studies on health care quality. These studies
are:
- Value of Future Health and Preventive Health Behavior
(AHCPR
grant HS09519). The principal investigator for this project
is Gretchen B. Chapman, Ph.D., Rutgers State University of
New Jersey, New Brunswick. The project focuses on the
effects of time preferences (how people value their health
status at different stages in life plus the value they give
to possible future personal health problems) on why people
do or do not adopt preventive health behaviors. The total
estimated funding for this 1-year project is $194,913.
- Office Systems to Improve Preventive Care for Children
(AHCPR grant HS08509). Led by Peter Margolis, M.D., Ph.D.,
of the University of North Carolina, Chapel Hill, the
researchers will determine whether pediatric practices that
use office systems for preventive services have higher rates
of immunization and screening for anemia, tuberculosis, and
lead poisoning than other pediatric practices, and if rates
vary in relation to the number of system components used.
Total estimated funding for this 4-year project is $1.49
million.
- Development of a Child Health Status Measure (AHCPR
grant
HS08829). Under the direction of Barbara Starfield, M.D., of
Johns Hopkins University, Baltimore, MD, this project will
develop an instrument that comprehensively measures the
health and illness profiles of children ages 5 to 11. The
instrument is intended for use in monitoring the influence
on children of changes in health system organization and
interventions in health services. Both parent and child
versions of the instrument will be developed and
systematically tested in geographically distinct populations
with different racial and ethnic backgrounds. Total
estimated funding for this 4-year project is $1.55 million.
Earlier in 1996, AHCPR funded the following five studies focused
on quality of care issues: Frank Ahern, Ph.D., Pennsylvania State
University, "Impact of Prospective Drug Use on Health"; A.
Connors, Jr., M.D., Case Western Reserve University, "Right Heart
Catheterization: Appropriate/Effective Use"; Jose Escarce, M.D.,
University of Pennsylvania, "Superspecialization of Medical and
Surgical Subspecialists"; Thomas Lee, M.D., Brigham and Women's
Hospital, "Cardiac Procedure Use: A Prospective Cohort Study";
and Joel Tsevat, M.D., University of Cincinnati Medical Center,
"Understanding Health Values of HIV Infected Patients."
Contract awarded for new quality measurement
network
The Agency for Health Care Policy and Research recently awarded a
contract to MEDSTAT, worth up to $5 million over 3 years, to
develop the Quality Measurement Network (QMNet). The goal of the
QMNet project is to create a quality measurement information
resource through a collaboration between the public and private
sectors. QMNet will build on the framework of AHCPR's prototype
CONQUEST (Computerized Needs-Oriented Quality Measurement
Evaluation System), a landmark computer tool designed to make it
easier for health plans, providers, and purchasers to identify,
choose, and use clinical performance measures.
According to AHCPR's Administrator, Clifton R. Gaus, Sc.D., the
goal is for QMNet to become a comprehensive, publicly accessible
quality measurement resource that helps both the public and
private sectors to improve health care quality and that,
ultimately, QMNet may aid in the creation of a free-standing
quality network.
Currently, CONQUEST is the only available automated source of
information on clinical performance measures, including whether
the measure is an outcomes or process gauge, the type of review
for which the measure was developed, the extent of validity and
reliability testing which the measure has undergone, and the
level of care or setting for which the measure was developed.
QMNet will provide far more detailed and comprehensive
information on a wider range of clinical performance measures.
Additionally, QMNet will provide extensive information on a
greater number of medical conditions, including age groups
affected, prevalence, utilization and costs, potentially
preventable adverse outcomes, comorbidities, risk factors, and
clinical services recommended or not recommended on the basis of
scientifically based guidelines. Beginning in 1997, semiannual
updates of the prototype computer tool will be released through
QMNet.
MEDSTAT and its subcontractors, the Harvard School of Public
Health and Mikalix, will evaluate the extent to which the
structure of CONQUEST meets the clinical performance measurement
needs of public- and private-sector users, identify and evaluate
additional measures and measure sets to be added to the measures
database, and identify gaps in measure sets and areas of clinical
performance measurement that need additional research and
development. As part of the QMNet project, the contractors will
provide technical assistance to users—via phone, Internet
and
mail—on the most effective ways to use the databases.
To ensure that QMNet is responsive to users' needs, AHCPR has
entered into a partnership with other leaders in the field of
quality measurement: the Foundation for Accountability (FACCT),
the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), and the National Committee for Quality Assurance (NCQA).
The partners will advise MEDSTAT on the technical development of
QMNet.
MEDSTAT also is charged with developing a feasibility study that
may help transform QMNet into a private-sector, self-supporting
entity at the end of the contract period.
Register now for spring '97 conference on
networked
consumer health information
The Agency for Health Care Policy and Research and other agencies
of the U.S. Department of Health and Human Services are
sponsoring "Partnerships '97: Partnerships for Networked Consumer
Health Information," to be held April 14-16, 1997, at Georgetown
University Conference Center, Washington, DC. Conference
presenters and participants will explore dynamic developments in
the field of consumer health informatics (CHI). "Partnerships
'97" will be held in conjunction with "HII97: The Emerging Health
Information Infrastructure," the leading conference examining key
policy issues on implementing an information infrastructure
supporting healthcare applications.
"Partnerships '97" sessions will focus on consumer health
informatics applications tailored for managed care and other
health care providers, employers, patients, and the general
public. It will bring together those who develop interactive
applications and Web sites with those who buy or use them. The
conference will feature leaders from the CHI industry, public
officials and staff from the new Administration and Congress,
executives from managed care and business, representatives of
community and nonprofit organizations, health professionals, and
individual consumers and patients.
For more information or to register, contact the Friends of the
National Library of Medicine, 1555 Connecticut Avenue, N.W.,
Suite 200, Washington, DC 20036-1108; phone (202) 462-0992; fax
(202) 462-9043.
Return to Contents
Research Briefs
Holohan, T.V. (1996). "Cost-effectiveness
modeling of
simultaneous pancreas-kidney transplantation." International
Journal of Technology Assessment in Health Care 12(3), pp.
416-424.
In this paper, the former Director of the Center for Health
Care
Technology, Agency for Health Care Policy and Research, uses a
cost-effectiveness model to compare simultaneous pancreas-kidney
transplantation (SPK) to kidney transplantation alone (KTA) with
continued insulin therapy among type-1 diabetics with end-stage
renal disease. SPK has been advocated as an effective and
appropriate treatment for type 1 diabetics with end-stage renal
disease. Proponents have argued that the benefits of SPK exceed
those of kidney transplantation alone with continued insulin
therapy. However, the procedure is quite resource intensive. The
costs of SPK, perioperative problems, the frequency and intensity
of rejection episodes, and the number of posttransplantation
readmissions secondary to complications are greater than those of
KTA. Moreover, the benefits accruing from SPK over and above
those of KTA remain unclear, with improvements in patient
survival not demonstrated. Advocates of SPK argue that
recipients' quality of life is improved and that such benefits
justify the implant. The cost-effectiveness analysis comparing
these two approaches reveals that the two procedures are equally
cost-effective only for diabetics whose annual costs for
treatment of complications of hyper- and hypoglycemia are quite
high.
Reprints (AHCPR Publication No. 97-R014) are available from
the AHCPR Publications
Clearinghouse.
Schwartz, H.A., Kunitz, S.C., and Kozloff, R.
(1996). "Building
data research resources from existing data sets: A model for
integrating patient data to form a core data set." Proceedings of
the 1995 Annual Meeting of the American Statistical
Association, pp. 151-165, Washington, DC: Department of the Treasury, Internal
Revenue Service.
Harvey A. Schwartz, Ph.D., of the Center for Information
Technology, Agency for Health Care Policy and Research, and his
colleagues suggest that building research databases from existing
data sets hinges on developing a prototype patient care record.
They address which patient data are needed, the potential sources
for these data, whether the currently collected data are
sufficient and accessible, whether the data should be linked to
form an automated patient record, where the record should reside,
and ownership of the record, as well as security/ confidentiality
issues to identify and control misuse of the patient records
within a health data infrastructure. Dr. Schwartz and his
colleagues propose a model to build an automated patient record
with four steps: identify core data set; identify existing data
codes; elicit support; and use linkage mechanisms. They also
identify important policy issues important that must be
considered. This paper was presented, along with several others
examining record linkage applications for health care policy, at
the 1995 Joint Statistical Meetings. It is included in the
Internal Revenue Service's Methodology Report, Turning
Administrative Systems Into Information Systems: 1995. To get a
copy of the report, you must write to Director, Statistics of
Income Division, P.O. Box 2608, Washington, DC 20013-2608;
request a copy of IRS publication 1299 (Rev. 6-96), catalog
number 63296M.
Reprints of this article only (AHCPR
Publication No. 96-R129) are available from the AHCPR
Publications Clearinghouse.
Return to Contents
AHCPR Publication No. 97-0007
Current as of December 1996
Internet Citation:
Research Activities newsletter. December 1996, No. 199. AHCPR Publication No. 97-0007. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/dec96/
540 Gaither Road Rockville, MD 20850