Appendix A

PERFORMER ORGANIZATION: Harvard University School of Public Health, Boston, MA

PIC NUMBER: 5651

P.I.: R. Heather Palmer, M.D.

TITLE: Evaluation of Cost Analyses Conducted on Clinical Practice Guidelines: Final Report

ABSTRACT NUMBER: 002

ABSTRACT: This study examined the methodologies and data sources used in cost studies for eight clinical practice guidelines (urinary incontinence, pressure ulcers, cataract, depression, low back pain, otitis media, benign prostatic hyperplasia, and sickle cell anemia). It was found that the primary distinction among the studies was whether they estimated treatment costs under the guidelines. Analysts in the studies that did not estimate treatment costs felt it would require too many assumptions to do so. They were concerned about the assumptions that must be made to estimate treatment costs and made the following recommendations: reduce the number of assumptions necessary to estimate treatment costs and restrict the empirical analysis to the direct medical costs of treatment; compare treatment patterns and costs before and after guideline implementation; use a variety of data sources--such as administrative claims, clinical trials, and medical record abstractions; use episodes of care as the unit of analysis, to provide a link between the clinical and economic dimensions of the guidelines; use a substantive expert as analyst, so that he or she is able to start on the description of current practice immediately without waiting for guidance from the panel; and emphasize the importance of the cost studies to the panels since the panels are typically made up of medical professionals who may place greater emphasis on clinical practice and outcomes and less emphasis on cost.

FEDERAL CONTACT OFFICE: Office of Program Development

NTIS ACCESSION NUMBER: PB 95-193694

PIC NUMBER: 5652

PERFORMER ORGANIZATION: SysteMetrics, Cambridge, MA

P.I.: William Crown, Ph.D.

TITLE: Identification of Data Sources Appropriate for Use in Conducting Cost Analysis Required for the Development of Clinical Practice Guidelines: Final Report

ABSTRACT NUMBER: 003

ABSTRACT: Databases that provide cost information relating to clinical guidelines have not been established. However, several databases have been identified as worthy of investigation because of their potential utility in estimating costs of guideline components. The purpose of this study was to investigate the content of these databases, evaluate their usefulness, develop a cost-measurement methodology using these existing databases, and describe how the methodology could be used for selected guidelines. It was determined that no one database can be used to estimate the costs of clinical guidelines. Since often there are no data on certain services in claims databases or there are significant questions about the accuracy of available data, data must be assembled from several sources. Per-patient costs for current and guideline patterns need to be multiplied by data on the prevalence of the condition to arrive at aggregate cost for the United States. In this calculation, differences in per-patient costs are projected to understand overall impact.

FEDERAL CONTACT OFFICE: Office of Program Development

NTIS ACCESSION NUMBER: PB 95-193652

PIC NUMBER: 5653

PERFORMER ORGANIZATION: Center for Health Policy Studies, Columbia, MD

P.I.: Benjamin Dugger, Sc.D.

TITLE: Overcoming Barriers to Integration and Implementation of Clinical Information Management Systems

ABSTRACT NUMBER: 004

ABSTRACT: The purpose of the feasibility study was twofold: (1) to determine the practicality of studying the barriers to implementation and integration of advanced clinical information systems and (2) to specify the type of research design for an implementation study to investigate these issues. Despite the promise of clinical information systems, there have been few concerted research efforts to understand the barriers that impede dissemination or the benefits that accrue from implementation. The report presents the design for a major, and feasible, research study of integrated health care information systems. With written letters of cooperation from 24 institutions, the project would study 8 to 16 sites (depending on funding level) representing 4 to 8 major vendor products and would focus on both outcomes of implementation and barriers to adoption of system features. The report provides details on study feasibility, site selection, research design, and a data collection plan.

FEDERAL CONTACT OFFICE: Office of Program Development

NTIS ACCESSION NUMBER: PB 95-193371

PIC NUMBER: 5039

PERFORMER ORGANIZATION: ABT Associates, Cambridge, MA

P.I.: Catherine Joseph

TITLE: Report on Inappropriate Extension of Hospitalization

ABSTRACT NUMBER: 005

ABSTRACT: The purpose of this contract was to perform a literature review and interview experts about inappropriate hospital-stay extension and the role of discharge planning, and to produce a summary document identifying research needs and potential existing data sources. The project was undertaken to address a Senate Appropriations Committee request for information on the extent to which inappropriate hospital duration occurs, the reasons for such inappropriate extension of hospitalization, and the extent to which hospital discharge planning can reduce inappropriate continuation of hospital stays. The project also describes best practices in hospital discharge planning. Key findings of the project are these: 5 percent or more of total hospital days are likely to be accounted for by extended stays that are not medically necessary, the cost of which is conservatively estimated at $420 million in 1987 dollars; the reasons for extended hospital stays include lack of sufficient nursing home beds and other alternative placement settings, paperwork delays in qualifying patients for posthospital benefits, and delays in appointing conservators for incompetent patients. Discharge planning appears to have only a small impact on extended hospital stays, but it may be having greater impact on appropriateness of placement and the likelihood of readmission. The problem is pervasive, despite incentives for early discharge. A solution is more likely to be a systemic change coming from outside the hospital; or there may be some level beyond which reduction of such stays is infeasible.

FEDERAL CONTACT OFFICE: Office of Program Development

NTIS ACCESSION NUMBER: PB 95-193710

PIC NUMBER: 5655

PERFORMER ORGANIZATION: Research Triangle Institute, Washington, DC

P.I.: James S. Lubalin, Ph.D.

TITLE: Research on the Cost Effectiveness of Managed Care Health Plans: A Literature Review

ABSTRACT NUMBER: 006

ABSTRACT: The purpose of this project was to identify, compile, categorize, and critically analyze published and unpublished literature on the cost-effectiveness of managed health care plans, to draw conclusions about the cost-effectiveness of various approaches to these plans and indicate important remaining policy-relevant gaps in knowledge. Managed care plans were compared with indemnity (fee-for-service) plans with regard to utilization and cost performance. It was found that managed care plans had lower hospital utilization, greater use of less costly alternatives to expensive procedures and tests, greater use of preventive measures, comparable quality of care, and somewhat lower enrollee satisfaction generally but much greater satisfaction with cost. The study also concluded that policymakers need much more evidence on managed care plan performance. It recommends funding larger, more comprehensive research projects to determine what works in managed care, rather than just whether managed care works.

FEDERAL CONTACT OFFICE: Office of Program Development

PERFORMER ORGANIZATION: Center for Health Policy Research, George Washington University, Washington, DC

PIC NUMBER: 5654

P.I.: Michele Solloway, Ph.D.

Centers for Disease Control and Prevention

Agency for Toxic Substances and Disease Registry

Listing of Abstract Titles

Assessing Prevention Effectiveness: A Collaborative Effort With Selected Health Maintenance Organizations (Phase I)

Assessment of Information Dissemination Activities--Office on Smoking and Health

Congenital Syphilis: Estimated Direct Medical Care Cost for the United States--1990

Development of an Evaluation Plan for DCPC's State-Based Comprehensive Breast and Cervical Cancer Early Detection and Control Program

Estimating Expenditures for Chronic Hepatitis B

Evaluation of CDC and ATSDR Training Activities

Evaluation of National Health Interview Survey Diagnostic Reporting

Evaluation of Sexually Transmitted Disease Clinic Flow and Utilization

Evaluation of the Morbidity and Mortality Weekly Report Series

Lessons From Implementing State-Based Diabetes Control Programs: An Evaluation

Report of the Working Group To Revise the Model State Vital Statistics Act and Regulations

Vital Records Evaluation Using 1988 National Maternal and Infant Health Survey Data

TITLE: Assessing Prevention Effectiveness: A Collaborative Effort With Selected Health Maintenance Organizations (Phase I)

ABSTRACT NUMBER: 007

ABSTRACT: This project, the first of a two-phase study, reviewed existing health maintenance organizations (HMOs) to develop a framework and the process to assess prevention effectiveness; the characteristics, organization, and types of preventive services offered; and the potential for working in collaboration with CDC. Based on essential criteria developed to guide the process of site selection, a series of site visits was conducted. A data collection instrument and semistructured interview was conducted during each of the site visits. Strengths and weaknesses of HMO data collection systems were identified and recommendations were provided to CDC on which five HMOs would most appropriately meet the needs of CDC for phase two of the study.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Arlington, VA

PIC NUMBER: 4111

P.I.: Bryan R. Luce, Ph.D.

TITLE: Assessment of Information Dissemination Activities--Office on Smoking and Health

ABSTRACT NUMBER: 008

ABSTRACT: The purpose of this study was to develop recommendations for key management and operational aspects of the information dissemination function in the Office of Smoking and Health (OSH), with particular emphasis on the response system. Although the study focuses on information dissemination, its broader context is OSH's evolving leadership role within the tobacco control community. The project consisted of internal and external interviews. The external interviews were conducted with individuals representing Federal Agencies that might be using information approaches relevant to OSH. In addition to information dissemination models, reports of site visits, and telephone interviews, the final report contains recommendations to OSH on organizational considerations and strategic planning.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Macro International, Atlanta, GA

PIC NUMBER: 4684

P.I.: Katie Baer, M.P.H.

TITLE: Congenital Syphilis: Estimated Direct Medical Care Cost for the United States--1990

ABSTRACT NUMBER: 009

ABSTRACT: The purpose of this study was to estimate the 1990 direct medical costs of congenital syphilis in the United States. Three types of costs were included in the study: medical care incurred during the first year of life; special education for infants who experience impairment due to congenital syphilis; and lifetime custodial care for infants who experience profound effects of congenital syphilis. After classifying cases by severity, researchers created a computer model that integrated incidence data with varying assumptions (such as case severity distribution, price level, etc.). Based on the analysis, it is estimated that the present value of costs for medical care, special education, and lifetime custodial care for the 1990 incident congenital syphilis cohort was in the range of $100-$200 million.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Washington, DC

PIC NUMBER: 5301

P.I.: Bryan R. Luce, Ph.D.

TITLE: Development of an Evaluation Plan for DCPC's State-Based Comprehensive Breast and Cervical Cancer Early Detection and Control Program

ABSTRACT NUMBER: 010

ABSTRACT: The primary purpose of this evaluation was to collect data pertinent to program-related decisions. The evaluation focused on State health agency breast and cervical cancer program components (public education, provider education, quality assurance, surveillance, screening, and followup) as well as the combined effect of program components. Short-term, intermediate, and long-term program and health outcomes were assessed. Assessment of program development and implementation was considered along with traditional evaluations of program efficiency and effectiveness.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

PIC NUMBER: 4744

P.I.: Thomas J. Cook, Ph.D.

TITLE: Estimating Expenditures for Chronic Hepatitis B

ABSTRACT NUMBER: 011

ABSTRACT: The purpose of this effort was to provide CDC with estimates of the direct medical cost of hepatitis B, particularly the acute care costs of services rendered to individuals identified as having or having had an episode of hepatitis B. These estimates were developed using recent paid claims histories from reimbursement files for persons recorded as having been treated for one or more specific diagnoses associated with hepatitis B. Data collection proceeded on a dual track: both a private market source and Medicaid data were obtained. The Medicaid data were procured from the repository from the Tape-to-Tape data development effort conducted for Health Care Financing Administration (HCFA). States that participated in this project supplied their machine-readable files to an HCFA contractor, and those files were translated into a single common format. The States from which Medicaid data were obtained for this study are California, Georgia, and Michigan. Private market data were obtained from United Health Care (UHC), an organization that directs and/or maintains data for managed care plans in a number of States. The review of these data and methods was successful in that generally consistent estimates were computed from each of the four jurisdictions. Further, there were no bizarre variations with respect to age, race, or sex. Unanticipated results and glitches in some areas might be resolved with further examination.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Arlington, VA

PIC NUMBER: 5802

P.I.: Ruth E. Brown, M.S.

TITLE: Evaluation of CDC and ATSDR Training Activities

ABSTRACT NUMBER: 012

ABSTRACT: As local health departments face fiscal upheavals, this study assessed their current and emerging training needs through focus groups and site visits. Training needs were compared with a newly developed inventory of training activities offered by CDC. Local health programs were found to need training in advocacy, evaluation, and public information. They were found to be deficient at training needs assessment, a formal way of identifying and monitoring the skills employees need to do their jobs better or to attain their career goals. CDC, which itself has limited training resources, is found to have no periodic mechanisms for staying in touch with State and local training needs. Recommendations, including those for new training technology (i.e., interactive software and satellite communications), are galvanizing CDC and ATSDR to develop training activities that dovetail with local needs.

FEDERAL CONTACT OFFICE: Public Health Practice Program Office

PERSON: Dennis McDowell

PHONE NUMBER: 404/639-3707

PIC NUMBER: 4745

PERFORMER ORGANIZATION: Macro Systems International, Atlanta, GA

P.I.: Thomas Chapel

TITLE: Evaluation of National Health Interview Survey Diagnostic Reporting

ABSTRACT NUMBER: 013

ABSTRACT: The purpose of this project was to evaluate diagnostic reporting in the National Health Interview Survey, which addressed major current health issues through the collection and analysis of national data on the civilian noninstitutionalized population of the United States. The survey provides national data on the incidence of acute conditions and injuries, the prevalence of chronic conditions and impairments, the extent of disability, and the use of health care services. The basic design of the evaluation study involved a comparison of information obtained from respondents to the basic health questionnaire, minimally modified, with reports obtained from the respondents' sources of health care. The primary objectives were to determine whether medical record documentation confirmed respondents' reports about selected conditions and impairments, to determine whether conditions mentioned in the record were mentioned by respondents, to assess the reporting and timing of doctor visits and hospitalizations, and to evaluate the validity of proxy reports to items in the questionnaire. The condition-related objectives are addressed in this final report; utilization data are addressed in an auxiliary report.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: National Center for Health Statistics, Hyattsville, MD

PIC NUMBER: 3199

P.I.: Deborah M. Winn

TITLE: Evaluation of Sexually Transmitted Disease Clinic Flow and Utilization

ABSTRACT NUMBER: 014

ABSTRACT: This study sought to study overburdening among sexually transmitted disease (STD) clinics in metropolitan areas with high STD morbidity. It assessed the impact of challenges to STD service delivery that developed in the late 1980s and early 1990s, including increasing incidence rates for STDs, addition of HIV services, retrenchment of funding, and more elaborate patient testing. These factors led to an inability in many clinics to see all clients who present for STD testing and/or treatment on a given day. The study sought to examine the effectiveness of STD clinics in providing services to those who seek care in the clinic and to clarify the factors that lead to overburdening.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Arlington, VA

PIC NUMBER: 4164

P.I.: Martha L. Hare, Ph.D.

TITLE: Evaluation of the Morbidity and Mortality Weekly Report Series

ABSTRACT NUMBER: 015

ABSTRACT: The Morbidity and Mortality Weekly Report (MMWR) is a principal means by which CDC communicates key information on a timely basis to the public health community. In recent years, the scope of the MMWR has broadened, reflecting the larger mission of CDC. This study sought to learn how well the MMWR is communicating information to this broader public health audience while continuing to convey timely information about outbreaks and infectious diseases. A mail/-telephone readership survey was given to 375 individuals on the MMWR mailing list, 375 subscribers to the MMWR through the Massachusetts Medical Society, and 250 primary care physicians who subscribe to the Journal of the American Medical Association (in which articles from the MMWR are reprinted). The study characterized selected audiences for the MMWR series, examined the public health impact of information published in the MMWR, and identified opportunities for improving the dissemination of public health information contained in the MMWR series. The study found that the MMWR was valued for its accuracy, relevance, and concise reporting format. Readers were from diverse professional backgrounds. The number of readers is likely double the 450,000 on mailing lists. Recommendations may result in some refinements to content and format.

FEDERAL CONTACT OFFICE: Epidemiology Program Office

PERSON: Richard A. Goodman, M.D., M.P.H.

PHONE NUMBER: 404/639-3636

PIC NUMBER: 5357

PERFORMER ORGANIZATION: Battelle, Arlington, VA

P.I.: James O. Hersey, Ph.D.

TITLE: Lessons From Implementing State-Based Diabetes Control Programs: An Evaluation

ABSTRACT NUMBER: 016

ABSTRACT: The purpose of this project was to assess the effectiveness and identify exemplary practices of State-based diabetes control programs (DCPs) in providing services with the potential of reducing diabetes-related mortality and morbidity. Intensive site visits to 9 of the 27 DCPs were conducted. The study analyzed archival data and interviews with DCP and non-DCP personnel in State and local programs. The study looked for exemplary practices associated with four outcomes: program reach--the number of persons screened, counseled, referred, and treated as the result of DCP activities; system change in terms of improved coverage for diabetes services and increased numbers of clinics and providers offering diabetes services; integration of diabetes services into ongoing medical service delivery; and leveraging resources for and institutionalization of diabetes programs. Findings indicated that DCPs have had measurable impact on diabetes services. Specific program accomplishments are cited, as are recommendations for program expansion and refinement.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Arlington, VA

PIC NUMBER: 5299

P.I.: James O. Hersey, Ph.D.

TITLE: Report of the Working Group To Revise the Model State Vital Statistics Act and Regulations

ABSTRACT NUMBER: 017

ABSTRACT: The purpose of this project was to determine what revisions were needed in the Model State Vital Statistics Act and Regulations to accommodate changes in social customs and technology relative to the registration of vital events and the analysis of vital statistics data. A group of consultants representing State vital registration and statistics executives advised the contractor as to what changes were necessary.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: Pace Enterprises, Inc., Atlanta, GA

PIC NUMBER: 4065

TITLE: Vital Records Evaluation Using 1988 National Maternal and Infant Health Survey Data

ABSTRACT NUMBER: 018

ABSTRACT: The purpose of this study was to compare selected data elements reported in the 1988 National Maternal and Infant Health Survey (NMIHS) with information contained in the original vital records, maintained by the States, covering the same set of birth events and/or fetal deaths. More than 3,200 live birth certificates and more than 4,500 fetal death reports were compared with data from the 1988 NMIHS. The quality and completeness of the information reported in the vital record was assessed, discrepancies with respect to the NMIHS identified, and the nature and frequency of the discrepancies examined. The four components of the study were (1) the check box items in the new birth and fetal death certificate; (2) underlying cause of fetal death; (3) industry and occupation; and (4) multiple causes of death. Of the check box items, medical risk factors, obstetric procedures, complications of labor and delivery, method of delivery, and newborn abnormalities were studied. Among the data sources, maternal alcohol and tobacco use and prenatal weight gain were compared.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERFORMER ORGANIZATION: JWK Inter-national Corporation, Annandale, VA

PIC NUMBER: 4067

Food and Drug Administration

Listing of Abstract Titles

Evaluation of Influenza Virus Vaccine in High Risk Infection Categories

Increasing the Safety of the Blood Supply by Screening Donors More Effectively

TITLE: Evaluation of Influenza Virus Vaccine in High Risk Infection Categories

ABSTRACT NUMBER: 019

ABSTRACT: The objective of this study was to ensure the continued protection of the public from the influenza virus through ongoing investigation into the reactogenicity, immunogenicity, and protective efficiency of split product and whole virus influenza vaccines and other vaccines that are commercially available or being considered for licensure. Information from the study is helping scientific reviewers assess current vaccines, while providing guidance to developing vaccines for licensure in the Center for Biologics Evaluation and Research. The sera obtained during this study are being used to provide standard sets of sera so that results from different national and international reference laboratories can verify comparability of results. The studies in infants are reproduced by no other source and serve as an important reference resource.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERSON: Tim Hagerty

PHONE NUMBER: 301/443-4076

PIC NUMBER: 4355

PERFORMER ORGANIZATION: Hackensack Medical Center, Hackensack, NJ

P.I.: Peter Gross

TITLE: Increasing the Safety of the Blood Supply by Screening Donors More Effectively

ABSTRACT NUMBER: 020

ABSTRACT: The goal of the study was to improve the blood donation process by integrating and simplifying all information (particularly HIV/AIDS-related information) presented to donors. The study evaluated mechanisms for blood donor education that address the needs of first-time donors and blood center staff. The study findings are helping the Center for Biologics Evaluation and Research staff screen out unsuitable donors and motivate healthy ones to donate more frequently. As a result of this study, a new donor screening process and a training program for health screeners were developed.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation

PERSON: Tim Hagerty

PHONE NUMBER: 301/443-4076

PIC NUMBER: 5685

PERFORMER ORGANIZATION: American Institutes for Research, Washington, DC

Health Resources and Services Administration

Listing of Abstract Titles

Evaluation Design: Evaluation of the Effectiveness of Community Health Centers

Linkage Programs: Survey of Mental Health Services

Perinatal Pilot-Test Summary and Implementation Report

HIV Service Networks in Four Rural Areas

Implementation of Title I of the Ryan White CARE Act of 1990

The Participation of People With HIV in Title I HIV Health Services Planning Councils

Evaluation of Methods for Estimating Unit Costs of HIV Health and Support Services

Rural Health Travels the Telecommunica-tions Highway--Reaching Rural

The Demographic and Treatment Characteristics of the Hill-Burton Population

Survey of Beneficiaries of Nursing Education Projects

The Training and Practice of Preventive Medicine Specialists: An Underutilized Resource

Evaluation of Bureau of Health Professions Strategic Directions--Phase I

TITLE: Evaluation Design: Evaluation of the Effectiveness of Community Health Centers

ABSTRACT NUMBER: 021

ABSTRACT: The purpose of this joint HRSA/OASH project was to develop a study design that would examine the efficiency and effectiveness of community and migrant health centers (C/MHCs); the centers' impact on the health status of their users; and ways in which the centers can improve their performance. Comparison of costs, utilization, and health outcomes for similar populations not using C/MHCs are part of the design. Issues of how and when various outcomes are reported, how data concerning them can be gathered, and whether the specified outcome measures are appropriate for evaluation were studied. The report calls for analysis of approximately 50 community health centers (CHCs) in 10 States. The report recommends that effectiveness and impact of the CHC model(s) be assessed by describing the characteristics of the CHC delivery model(s); measuring the impact of the model(s) on use of health services, health care expenditures, and indicators of health status; and identifying factors that contribute to the observed impact. The design formed the basis for an evaluation of the centers that began in September 1994.

FEDERAL CONTACT OFFICE: Division of Community and Migrant Health, Bureau of Primary Health Care

PERSON: Judy Rodgers

PHONE NUMBER: 301/594-4340

PIC NUMBER: 4918

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Ann Zuvekas

TITLE: Linkage Programs: Survey of Mental Health Services

ABSTRACT NUMBER: 022

ABSTRACT: In 1989, HRSA's Bureau of Primary Health Care and the National Institute on Drug Abuse cosponsored the Integrated Primary Care and Substance Abuse Treatment Program, referred to as the "Linkage Program," a multiyear demonstration program supporting 21 community-based approaches for linking substance abuse and primary care services. This demonstration led to recognition of the need for mental health services in these linkage projects. A survey was designed to examine various delivery system features pertaining to availability, scope, and delivery of mental health services, and barriers to providing these services. The 15 projects that received fourth-year continuation grants (which included seven community health centers) were the focus of this study. The major finding was that most linkage projects evolved a supportive environment for assessment of mental health problems and a system of referral to and delivery of mental health services. However, projected need for mental health services outstripped delivery system capacity. Findings from this study will help other providers of primary care services establish the necessary alliances and treatment networks to reduce delivery system fragmentation and develop a continuum of inpatient and ambulatory mental health services.

FEDERAL CONTACT OFFICE: Division of Programs for Special Populations, Bureau of Primary Health Care

PERSON: Thomas M. Coughlin

PHONE NUMBER: 301/594-4450

PIC NUMBER: 3557.2

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

P.I.: Marilyn Falik, Ph.D.

TITLE: Perinatal Pilot-Test Summary and Implementation Report

ABSTRACT NUMBER: 023

ABSTRACT: The purpose of this study was to develop and pilot test a patient-specific data collection tool for perinatal patients and infants receiving services in Community and Migrant Health Centers (C/MHCs) funded by HRSA's Bureau of Primary Health Care (BPHC) and to prepare a plan for implementing this tool. This study is part of an effort to develop and implement a BPHC-wide data and evaluation strategy to improve the availability of information about patients served by grantees. Two patient-specific forms were designed to capture information regarding specific process and outcomes measures. The first would collect data about pregnant women using prenatal and/or postpartum services in C/MHCs, and the second would collect data on infants age 12 months or younger whether or not their mothers used prenatal or postpartum services in a C/MHC. A pilot test was conducted in eight centers over 5 months, and feedback was collected from 22 additional centers via telephone interviews. The pilot test provided information about the data collection instruments with regard to availability of the requested data and completeness and reliability of the data collected, and identified the need to revise the data items, definitions, instructions, and formats. The study found that universal adoption of the forms would be burdensome and expensive. It recommends instead that the form be used in a study of 4,000 mother-child pairs at about 20 C/MHC sites over a 4-year period.

FEDERAL CONTACT OFFICE: Division of Programs for Special Populations, Bureau of Primary Health Care

PERSON: Thomas M. Coughlin

PHONE NUMBER: 301/594-4450

PIC NUMBER: 4208.1

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Ann Zuvekas

TITLE: HIV Service Networks in Four Rural Areas

ABSTRACT NUMBER: 024

ABSTRACT: The purpose of this study was to identify and describe systems of HIV care in four rural areas. The study was designed to build understanding of how HIV services are being organized and delivered in different rural environments and to identify service gaps and barriers to care. The case studies identified two distinct approaches to providing medical care to rural residents with HIV: (1) an HIV clinic, located in a rural health department or community health center, that develops cooperative working agreements with physicians in private practice and (2) care provided by primary care physicians who are linked with a medical school or rural-based regional care facility for training and backup consultation. The case studies also documented the need to place more emphasis on HIV training and education in rural areas to create more positive environments for the development of medical and support services. The study's findings and recommendations are being used to design a national study of HIV care in rural areas that will be funded by HRSA. This rural study will be integrated with a large national study of HIV costs and service utilization that is being sponsored by the Agency for Health Care Policy and Research. Case study findings also are being used to formulate HRSA polices on rural HIV care and to provide technical assistance to States with large rural populations.

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Katherine Marconi, Ph.D.

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5642

PERFORMER ORGANIZATION: David Berry Company, Las Vegas, NV

P.I.: David Berry

TITLE: Implementation of Title I of the Ryan White CARE Act of 1990

ABSTRACT NUMBER: 025

ABSTRACT: This project measured the extent to which five policy objectives of Title I of the Ryan White CARE Act were achieved in Baltimore, MD, and Oakland, CA: (1) local control and definition of priority setting for the allocation of funds to community AIDS service organizations; (2) rapid disbursement of funds; (3) increased access to services by expanding existing services and adding new agencies; (4) improved coordination of HIV-related services; and (5) increased access to HIV services for underserved populations. To measure progress toward these objectives, surveys were conducted of all identified AIDS services providers and nonrandom samples of people with HIV in 1991 and 1993 in Baltimore and Oakland. Additionally, case studies of the Title I Planning Council processes in each city were completed. All policy objectives, with the exception of improved coordination among services, were met, and a series of recommendations was made for the future administration of this Act. The Henry J. Kaiser Family Foundation funded the 1993 surveys. (The report also presents planning council studies conducted in four eligible metropolitan areas that were not part of the HRSA baseline study.)

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Moses B. Pounds

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5639

PERFORMER ORGANIZATION: Johns Hopkins University, Baltimore, MD

P.I.: David D. Celentano, Sc.D.

TITLE: The Participation of People With HIV in Title I HIV Health Services Planning Councils

ABSTRACT NUMBER: 026

ABSTRACT: Ryan White CARE Act Title I Health Services Planning Councils are required by statute to include membership from "affected communities, including individuals with HIV disease." Experience has indicated, however, that eliciting and sustaining participation by these individuals is one of the major challenges facing councils. This study was conducted to identify factors supporting the initial and sustained involvement of HIV-positive individuals in the councils, and identify alternative methods employed by the councils to gain input from and provide feedback to HIV-positive populations in the absence of direct participation. In-depth discussions and focus groups were held in Atlanta, Philadelphia, San Diego, and Seattle, with a total of 113 participants, 90 of whom were HIV-positive. The study found that the councils have undergone an evolution with regard to how they recruit HIV-positive members and whom they recruit: all councils now express commitment to recruiting HIV-positive members of greater ethnic and gender diversity. All councils reported using numerous mechanisms for obtaining input from HIV-positive nonmembers, including public forums, client needs surveys, and participation in advocacy groups. Based on the study report, the Division of HIV Services has issued a policy statement on council membership.

FEDERAL CONTACT OFFICE: Division of HIV Services, Bureau of Health Resources Development

PERSON: Steven R. Young

PHONE NUMBER: 301/443-9091

PIC NUMBER: 5643

PERFORMER ORGANIZATION: Academy for Educational Development, Washington, DC

TITLE: Evaluation of Methods for Estimating Unit Costs of HIV Health and Support Services

ABSTRACT NUMBER: 027

ABSTRACT: The purpose of this study was to evaluate the procedures used to estimate costs of providing health and social services to people with HIV infection. This study compared two methods of costing Ryan White CARE Act services. The first method used an average unit cost approach: total program budgets are divided by total number of service units to yield an average unit cost. The results indicate a wide variation in costs, as a result of actual variations in the content, quality, and volume of services provided, as well as some reporting and methodological errors. The second methodology used a direct cost profile approach to construct the cost of one standard unit of service. This method was tested among a selected group of five Texas CARE Act providers using a questionnaire. This method proved difficult to administer and less accurate than the average unit cost method, although some cost estimates are provided. The study concluded that the average unit cost method is more intuitive and straightforward for CARE Act providers, primarily because most providers use program budgets. A manual for estimating the unit costs of HIV care is now available to Ryan White CARE Act grantees.

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Christine Hager

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5640

PERFORMER ORGANIZATION: Texas Department of Health, Austin, TX

P.I.: Susan Griffin

TITLE: Rural Health Travels the Telecommunications Highway--Reaching Rural

ABSTRACT NUMBER: 028

ABSTRACT: The Health Resources and Services Administration sponsored a workshop in November 1993, in Washington, DC, to consider the use of telecommunications technology for providing medical care to rural patients and for reducing the isolation of rural health professionals. The workshop was intended to address the application of telecommunications to clinical care (telemedicine) and to the education of health professionals (distance learning). The purpose of the workshop was to discuss policy issues that affect the development and appropriate use of telemedicine systems. The workshop included descriptions of operating telemedicine systems and the problems they have had to overcome. Workshop participants also provided advice for future telemedicine evaluations. A number of commissioned papers identified and assessed barriers and opportunities for applying this technology in rural areas. The workshop provided an opportunity to develop consensus in order to advance the effective use of this technology in rural areas. In addition, the workshop contributed to the development of the Rural Telemedicine Grant Program and of an exploratory evaluation of the program that began in September 1994. The workshop also strengthened collaborative relationships with staff of other Federal Agencies, such as HCFA and the Departments of Agriculture and Commerce, that are funding telemedicine projects.

FEDERAL CONTACT OFFICE: Office of Rural Health Policy

PERSON: Carole L. Minzter

PHONE NUMBER: 301/443-0835

PIC NUMBER: 5644

PERFORMER ORGANIZATION: Ryan-McGinn, Arlington, VA

P.I.: Teri Randall

TITLE: The Demographic and Treatment Characteristics of the Hill-Burton Population

ABSTRACT NUMBER: 029

ABSTRACT: The purpose of this study was to determine the demographic characteristics of the population receiving medical services under the Hill-Burton Uncompensated Services Program and the conditions for which treatment was required. These characteristics and conditions were compared with those of the general population. Data were obtained from both Hill-Burton records and patient medical records at each of the 50 facilities selected for participation in the study. Records for 4,835 patients were examined. Specific Diagnostic Related Groups and International Classification of Disease Codes were obtained for each record. The findings indicated that, compared with the total U.S. population, the study population was more likely to be female, young adult, and unmarried, with very low household income. The study population required services classified as injury, obstetrical, and ill-defined conditions more often than the general population. Patient records showed that 69.4 percent had no health insurance and 80.1 percent had no coverage for the services received.

FEDERAL CONTACT OFFICE: Office of Facilities Compliance, Bureau of Health Resources Development

PERSON: Jacob E. Tenenbaum

PHONE NUMBER: 301/443-4303

PIC NUMBER: 5641

PERFORMER ORGANIZATION: Arthur Testoff Company, New Carrollton, MD

P.I.: Arthur Testoff

TITLE: Survey of Beneficiaries of Nursing Education Projects

ABSTRACT NUMBER: 030

ABSTRACT: The purpose of this study was to evaluate the programs carried out under Title VIII of the Public Health Service Act and to prepare the biennial report to Congress mandated by Section 859(b) of the Act. The six programs evaluated were Nursing Special Projects Grants and Contracts, Nursing Education Opportunities for Individuals From Disadvantaged Backgrounds Program Grants, Grants for Advanced Nurse Education, Nurse Practitioner and Nurse-Midwifery Program Grants, Professional Nurse Traineeships, and Nurse Anesthetist Traineeships. Separate surveys of grantees and graduates were conducted. The overriding conclusion of this study is that the Title VIII programs are meeting the purposes they were designed to accomplish. Federal support has stimulated the development of projects that address significant nursing education and practice issues. Moreover, the funds provided for the development of educational programs for advanced practice nurses and for the support of students are creating a stable resource of advanced practice nurses.

FEDERAL CONTACT OFFICE: Division of Nursing, Bureau of Health Professions

PERSON: Evelyn B. Moses

PHONE NUMBER: 301/443-6315

PIC NUMBER: 4433

PERFORMER ORGANIZATION: Washington Consulting Group, Washington, DC

P.I.: Cyrus Baghelai

TITLE: The Training and Practice of Preventive Medicine Specialists: An Underutilized Resource

ABSTRACT NUMBER: 031

ABSTRACT: This project was designed to provide detailed information through case studies on the practice profile of residents in selected preventive medicine residency (PMR) programs funded by HRSA. The study examined the recruitment of residents during their training, the various mechanisms used to finance the training of residents, and the career options available to graduates of PMR programs. The study involved the appointment of an expert working committee whose members conducted site visits to 10 preventive medicine residency programs. The culmination of the project was a 3-day workshop held in Washington, DC, in August 1993, which brought together PMR program directors with the major constituencies for preventive medicine. Workshop recommendations included "marketing" preventive medicine to medical students, developing a national strategy for incorporating preventive medicine into the standard medical school curriculum, and reassessing the fourth year of the preventive residency program.

FEDERAL CONTACT OFFICE: Division of Associated, Dental, and Public Health Professions, Bureau of Health Professions

PERSON: Ronald B. Merrill

PHONE NUMBER: 301/443-6896

PIC NUMBER: 4911

PERFORMER ORGANIZATION: American College of Preventive Medicine, Washington, DC

P.I.: Hazel K. Keimowitz

TITLE: Evaluation of Bureau of Health Professions Strategic Directions--Phase I

ABSTRACT NUMBER: 032

ABSTRACT: This study is Phase I of an effort to develop a fully integrated, computerized data system to facilitate program effectiveness evaluation and data analysis of Titles VII and VIII programs administered by the Bureau of Health Professions (BHPr). The purpose of Phase I was to develop a set of outcome indicators to evaluate the effectiveness of programs in the context of BHPr's strategic directions and to identify potential data sources and gaps related to these indicators. Phase II will solicit external customer input on the proposed set of indicators developed in Phase I and identify strategies to address data gaps. A third phase may be needed to develop a consolidated data system for assessing progress toward achieving strategic program objectives bureauwide.

FEDERAL CONTACT OFFICE: Office of Research and Planning, Bureau of Health Professions

PERSON: Betty B. Hambleton

PHONE NUMBER: 301/443-1590

PIC NUMBER: 5497

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Susanna Ginsburg

Indian Health Service

Listing of Abstract Titles

An Assessment of Emergency Medical Services

Evaluation of Home Care Services in the Aberdeen Area

Evaluation of Maternal and Child Health Data

Health Promotion and Aging: Improving the Understanding of Geriatric Patients Related to Medications and Their Proper Use

IHS Indirect Cost Study

Intervention Study To Influence Healthier Lifestyles Among Young Adolescent Navajo Indians

Long Term Health Projections for Alcohol Abuse-Related Hospitalizations

Report to Congress on the Indian Health Service With Regard to Health Status and Health Care Needs of American Indians in California in Response to Public Law 100-713

Use of an Alternate Model of Nursing Documentation To Increase Efficiency and Effectiveness of Patient Care Charting

TITLE: An Assessment of Emergency Medical Services

ABSTRACT NUMBER: 033

ABSTRACT: This project evaluated the Emergency Medical Service (EMS) program activities of the Indian Health Service (IHS) at national, area, and service unit levels. The project assessed how well the IHS EMS services are meeting national and applicable State standards. It identified strengths of the existing program as well as areas needing improvement. Because the same methodology has been and is being consistently applied in communities and States throughout the United States, the IHS assessment provided a useful comparison of the IHS program with those of the States. The project provided information on how EMS provided to reservation populations compared with EMS available to non-Indian rural communities. The end product is a report representing the consensus of review team members and contains detailed assessments in each of 10 specific areas. The report provides a basis on which to recommend improvements to the EMSs to meet the needs of the American Indian and Alaska Native communities.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Division of Medical Systems Research & Development, Tucson, AZ

PIC NUMBER: 5549

P.I.: Peter G. Decker

TITLE: Evaluation of Home Care Services in the Aberdeen Area

ABSTRACT NUMBER: 034

ABSTRACT: This project explored issues related to home health care services in the Aberdeen [SD] Area as an alternative to hospital care and an adjunct to all other existing clinical services. The project evaluated needs as well as home care services provided by the IHS and others within the IHS system in the Aberdeen Area. The project relates to the range, quality, and appropriateness of curative and preventive services as well as broader financial and reimbursement issues. The purpose of the study was to explore the dimension of needs and the scope of existing community-based services to a specific population in the Aberdeen Area, specifically American Indians who currently receive or who would benefit from home care services. This included indivi-duals of all ages and with all types of health problems. With growing concern for cost containment and implementation of a prospective payment system, the health care industry has changed dramatically in the last 4 years. The health care literature is replete with analyses of the expansion in home care services and problems resulting from patients being discharged "quicker and sicker." These changes, coupled with technological advances, have increased the needs and demands for home care services and the types, complexity, and volume of services delivered nationally.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: American Indian Health Care Association, St. Paul, MN

PIC NUMBER: 5000

P.I.: Carol M. Baines

TITLE: Evaluation of Maternal and Child Health Data

ABSTRACT NUMBER: 035

ABSTRACT: The purpose of this evaluation, conducted in two parts, was to assess the availability, utilization, and quality of the Navajo Area Indian Health Service's data sets in maternal and child health (MCH). Part 1 was an assessment of the process of data collection and the perceived data needs. Interviews were conducted with service unit staff, affiliated tribal programs, IHS personnel specializing in data collection, Headquarters West, and IHS Headquarters in Rockville, among others. Findings included the following: the current MCH database does not meet the needs of clinical staff; researchers compiled a list of specific data requirements for a broad range of health parameters; there is a downward trend in multidisciplinary MCH teamwork; area offices emphasize management and finance rather than population-based health; there is no community--oriented health approach among the majority of health professions and service unit administrators; and infant and child health have become fragmented into specific pediatric initiatives. Part 2 was an assessment of the quality of an MCH data set through a comparison between computerized entries into delivery room logs and actual patient records. The congruity was high, with the exception of data on "planned pregnancies" and "anemia," supporting the validity and importance of continued integration of 15 or so most important variables into the Resource and Patient Management System. Findings are expected to increase the availability of the data to physicians and midwives nationally.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Maternal and Child Health Program, Billings, MT

PIC NUMBER: 5544

P.I.: Diane Jeanotte, R.N.

TITLE: Health Promotion and Aging: Improving the Understanding of Geriatric Patients Related to Medications and Their Proper Use

ABSTRACT NUMBER: 036

ABSTRACT: This project surveyed Navajo patients' use of medications at the Chinle Service Unit and assessed the general level of patient understanding of medications. It also evaluated the effectiveness of using interactive video technology for non-English-speaking patients and those with limited English ability. Study recommendations will be helpful in assessing and improving Navajo geriatric health care. It was determined that the program for diabetic information was limited. The hardware video was bulky, ran too long, and was not practical for the major population with limited English abilities. There were no recommendations for use at other clinics in the IHS.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Headquarters East IHS, Rockville, MD

PIC NUMBER: 5006

P.I.: Viola Dwight

TITLE: IHS Indirect Cost Study

ABSTRACT NUMBER: 037

ABSTRACT: This study determined the dollar amount of all IHS overhead costs, where and how money was spent, and how it was linked to the provision of direct health care. These goals were accomplished through interviews, research, and analysis of financial data. Interviews were conducted throughout the IHS organization. Interview information was compared with financial data to distinguish between overhead and direct health care. Functional analyses and cost center analyses were performed. Overhead costs for FY 1992 were calculated at 19.1 percent. Because some cost centers commingled direct and overhead costs, data obtained from individual cost centers were difficult to segregate and quantify. Cost accounting procedures were found not to be uniformly applied within IHS. Such inconsistency made it difficult to compare overhead costs among Area offices. The study proposed a refined cost center design that carefully distinguishes between overhead and direct care costs. It also offered recommendations, including timely reviews of cost center expenditures.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Native American Consultants, Inc., Washington, DC

PIC NUMBER: 5552

P.I.: Joseph Tinneman

TITLE: Intervention Study To Influence Healthier Lifestyles Among Young Adolescent Navajo Indians

ABSTRACT NUMBER: 038

ABSTRACT: Approximately 1,200 seventh and eighth grade students from three junior high schools were studied for 2 school years, 1991 to 1993. Heights, weights, and a brief behavioral survey were recorded during the fall and spring of each year. At the intervention school, certificates for specific nutrition or fitness activities were completed by students and parents and collected by homeroom teachers. Homerooms competed for monetary prizes to be used for educational activities. The results for students at the intervention school were compared with those for students at the control school. A number of problems arose, some of which could be avoided in the future and some of which are intrinsic to this type of research. Teachers, administrators, parents, and students often had other commitments with higher priority, such as academic classes, exams, and athletics. Although students may have been willing to participate, some were reluctant to do something different from their peers, especially if their peers did not think it was "cool" to participate in the fitness-nutrition program. The number of students willing to participate was initially small and often inconsistent in followup responses. Distances between participating schools was great and made it difficult to achieve an impact on the students. Self-reported data, which are known from many studies to be fraught with problems, were not reliable enough to be generalizable.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Navajo Area IHS, Chinle, AZ

PIC NUMBER: 5026

P.I.: Park W. Gloyd

TITLE: Long Term Health Projections for Alcohol Abuse-Related Hospitalizations

ABSTRACT NUMBER: 039

ABSTRACT: This study made long-term pro-jections for a specific disease and/or health category to determine (1) if current health and mortality patterns will continue without further scientific, treatment, or behavioral improvements and (2) the number of American Indians and Alaska Natives who will become ill or die from a specifically identified condition over the next 25 years. The study included an estimate of contributions expected from advances and innovations in current treatment and technology and changes in societal behavioral patterns, and evaluated how these contributions affected existing mortality rates and savings from eliminating medical costs and lost productivity. The study did reveal a decline in alcohol abuse; however, it was not as significant as it should have been. In fact, alcohol abuse may be worsening for women ages 55-64. Findings of the study include recommending long-term projection models that will give a truer picture of which intervention methodo-logies are most effective.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: Support Services, Inc., Silver Spring, MD

PIC NUMBER: 5034

P.I.: Walter Hillabrant, Ph.D.

TITLE: Report to Congress on the Indian Health Service With Regard to Health Status and Health Care Needs of American Indians in California in Response to Public Law 100-713

ABSTRACT NUMBER: 040

ABSTRACT: This study documented the health status and access to health care services of American Indians in California, especially in tribes that are not federally recognized. Through analysis of vital statistics and other databases, comparisons were made between California Indians who are members of federally recognized tribes and those who are not. On the basis of these and other comparisons, American Indians in non-federally recognized tribes in California generally had poorer health status than those in federally recognized tribes. The health status of both groups was inferior to that of other populations. For example, 6.4 percent of California Indian babies were low birthweight, whereas 5.2 percent of statewide births were low birthweight. These and related findings underscored the importance of maintaining and expanding coverage to the entire American Indian population of California. This study was coordinated with the California Area Office of the Bureau of Indian Affairs, the California Health Department, California State Indian organizations, and clinics.

FEDERAL CONTACT OFFICE: Division of Planning, Evaluation, and Legislation

PERSON: Leo Nolan

PHONE NUMBER: 301/443-4700

PIC NUMBER: 4955

PERFORMER ORGANIZATION: University of California, Los Angeles, CA

P.I.: Leila Beckwith

TITLE: Use of an Alternate Model of Nursing Documentation To Increase Efficiency and Effectiveness of Patient Care Charting

ABSTRACT NUMBER: 041

ABSTRACT: The purpose of the project was to evaluate current inpatient nursing documentation at three Billings [MT] Area hospitals and, at the option of the hospital, to evaluate a new documentation format. Two of the three hospitals chose to implement FOCUS charting, a new method that streamlines the process by requiring written notes only for abnormal patient characteristics. This method was developed by Creative Nursing Management of Minneapolis, Minnesota. The existing system relied on documentation of both normal and abnormal characteristics. The specific goals of FOCUS charting were to (1) improve the quality and content of nursing documentation; (2) facilitate inclusion of information required by certifying agencies; (3) decrease charting time; and (4) increase nursing satisfaction. The third site, Ft. Belknap, opted to keep the existing system because it is a small facility scheduled for conversion to an outpatient facility in the near future. The impact of current and new procedures was assessed via two surveys--a nursing satisfaction survey and a documentation time survey. Chart reviews were also performed at each site before and after implementation of the new documentation format. There was overall improvement with FOCUS charting, although patient education and discharge planning remained problematic. Regardless of the method, all service units successfully met documentation standards in an August 1994 survey by the Joint Commission on Accreditation of Health Care Organizations. The FOCUS chart method was permanently adopted by one of the hospitals.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERFORMER ORGANIZATION: IHS Billings Area Office, Billings, MT

PIC NUMBER: 5003

P.I.: Jaloo Zelonis

National Institutes of Health

Listing of Abstract Titles

Adverse Events Associated With Childhood Vaccines--Evidence Bearing on Causality

Meeting the Nation's Needs for Biomedical and Behavioral Scientists

Evaluating the Effects of School-Based Intervention Programs To Prevent Teenager Drug Use and Abuse

Evaluation of NIH-Funded Condom Research Phase I: Evaluability Assessment

Indoor Allergens--Assessing and Controlling Adverse Health Effects

Outreach/Risk Reduction Strategies for Changing HIV-Related Risk Behaviors Among Injection Drug Users

Study To Assess the Current and Future Demand for Bone Marrow and the Impact on Size of the National Marrow Donor Registry

Survey of the Knowledge, Attitudes, and Practices of Physicians Related to Blood Use, Transfusion, and Donation

TITLE: Adverse Events Associated With Childhood Vaccines--Evidence Bearing on Causality

ABSTRACT NUMBER: 042

ABSTRACT: This study entailed a broad review of all relevant medical and scientific literature on the potentially serious risks associated with currently licensed childhood vaccines. This study was mandated by Congress under Section 313 of Public Law 99-660 to yield essential information that would help the Public Health Service draft recommendations on the use of certain mandated childhood vaccines and appropriate compensation for adverse reactions. The project was funded by the National Institutes of Health, the National Vaccine Program, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration. The final report is a book, Adverse Events Associated with Childhood Vaccines--Evidence Bearing on Causality, published by the National Academy Press in 1993. It summarizes the relevant input from interested organizations and individuals and describes the nature and extent of the relationship, if any, between the specified adverse events and the vaccines or vaccine components. In addition, the book describes the available data on the circumstances under which administration of these vaccines increases risks of serious or chronic adverse events and on the definition of any known risk groups for these adverse events.

FEDERAL CONTACT OFFICE: Division of Microbiology and Infectious Disease, NIAID

PERSON: Regina Rabinovich, M.D.

PHONE NUMBER: 301/496-5893

PIC NUMBER: 4198.1

PERFORMER ORGANIZATION: Institute of Medicine, National Academy of Sciences, Washington, DC

P.I.: Sylvia Cunningham

TITLE: Meeting the Nation's Needs for Biomedical and Behavioral Scientists

ABSTRACT NUMBER: 043

ABSTRACT: This report examines the Nation's future need for biomedical and behavioral research scientists and the role the National Research Service Awards (NRSA) program can play in meeting them. The report is based on three activities: (1) a panel on estimation procedures was established to provide numerical analysis of educational and employment prospects and of national needs for biomedical and behavioral research personnel; (2) a public hearing was held to solicit the views of a broad constituency associated with NRSA programs; and (3) committee meetings were held to discuss and debate information and recommendations. The committee finds that the NRSA program, although small, is influential and prestigious. It is powerful in its ability to change research emphases and to attract the highest quality individuals to research careers. Furthermore, initiatives introduced through NRSA can have a powerful impact on new research emphases or constituencies. The report makes several recommendations, including the following: (1) raise the real value of stipends to a more competitive level; (2) maintain the annual number of predoctoral and postdoctoral awards in the basic biomedical sciences at 1993 levels; (3) increase the number of awards in the behavioral sciences; and (4) increase the awards in clinical sciences, oral health research, nursing research, and health services research.

FEDERAL CONTACT OFFICE: Office of the Director, NIH

PERSON: Walter Schaffer, Ph.D.

PHONE NUMBER: 301/435-2770

PIC NUMBER: 5567

PERFORMER ORGANIZATION: National Academy of Sciences, Washington, DC

P.I.: National Academy of Sciences

TITLE: Evaluating the Effects of School-Based Intervention Programs To Prevent Teenager Drug Use and Abuse

ABSTRACT NUMBER: 044

ABSTRACT: The purpose of this followup study was to assess the long-term effectiveness of a junior high school-based prevention program for reducing student drug use and abuse. The intervention was based on Life Skills Training, an approach that teaches social resistance and other personal and coping skills. In 1986, schools were randomly assigned to one of two approaches to teaching Life Skills Training or to a control group (no training). This followup study was conducted 6 years later to determine the long-term efficacy of the intervention. The probability of smoking, drinking immoderately, or using marijuana was significantly lower, by as much as 40 percent, for students who received the intervention programs than for those in the control group. The study provides the first evidence that school-based intervention programs conducted by regular classroom teachers can produce durable reductions in tobacco, alcohol, and illicit drug use. The results provided empirical support for the efficacy of a school-based prevention strategy based on a broad-spectrum, cognitive-behavioral approach in prevention of drug use and abuse. Long-term prevention of effects were found, providing impetus for the widespread adoption of similarly designed programs.

FEDERAL CONTACT OFFICE: Division of Epidemiology and Prevention Research, NIDA

PERSON: Larry A. Seitz, Ph.D.

PHONE NUMBER: 301/443-1514

PIC NUMBER: Unassigned

PERFORMER ORGANIZATION: Cornell University Medical College, New York, NY

P.I.: Gilbert J. Botvin, Ph.D.

TITLE: Evaluation of NIH-Funded Condom Research Phase I: Evaluability Assessment

ABSTRACT NUMBER: 045

ABSTRACT: The objectives of this evaluation were to (1) assess the findings of condom use research efforts; (2) guide the development of future program areas; and (3) suggest methodological guidelines to facilitate the evaluation of future condom use research programs. This initial phase was an evaluability assessment to identify and inventory the universe of condom research studies as well as to determine whether or not a formal evaluation of past NIH-funded behavioral research on condom use would be feasible and useful. The results of this evaluability assessment are to be used by the Technical Advisory Group to decide whether to proceed to subsequent phases of more intensive evaluation. The conclusions of this activity indicate that an expanded evaluation is feasible and could provide useful information to guide the development of future program areas and to facilitate the evaluation of future condom research programs. A critical feasibility issue for any research synthesis is the identification of the universe of relevant studies. The Phase I activity developed a reproducible methodology to create a sampling frame, established a sampling frame of more than 500 studies, and developed and applied definitions that permitted sorting studies by key research characteristics and abstracting relevant information about funded projects. The final report will be disseminated to NIH Institutes and committees as well as other organizations or individuals involved in condom use research.

FEDERAL CONTACT OFFICE: Office of Policy Analysis and Technology Transfer, NIAID

PERSON: Wendy Liffers

PHONE NUMBER: 301/496-6752

PIC NUMBER: 5494

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

P.I.: John W. Tintoul

TITLE: Indoor Allergens--Assessing and Controlling Adverse Health Effects

ABSTRACT NUMBER: 046

ABSTRACT: The purpose of this study was to characterize what is known among a broad range of experts whose efforts are directed toward achieving cleaner indoor environments. The focuses of this study were to evaluate the indoor environment and to appraise the knowledge base commonly available to physicians with respect to human exposure to indoor allergens. A committee of experts was appointed to (1) examine and characterize what is known about the adverse effects on human health caused by reactions, including asthma, to indoor allergens; (2) characterize the magnitude of these problems nationally; (3) define the populations commonly affected; and (4) identify the specific causative agents. The study reviewed published epidemiological reports, estimated the economic impact of these diseases, and determined the risk factors. It examined methods used in patient diagnosis and measurement of indoor allergen exposures and evaluated methods of abatement and control of sources of allergens. The study resulted in a book titled Indoor Allergens: Assessing and Controlling Health Effects. The book pointed out that indoor allergen exposure is a major risk factor for asthma and that exposure to indoor allergens may be increasing, in part because of house construction methods that have made homes "tight" and in part because individuals are spending more time indoors. The study should raise public perception of the importance of indoor allergens in the pathogenesis of asthma and allergic diseases, and provide a framework for a research agenda to relieve the problem created by indoor allergens. The dissemination of the report should result in research proposals to pursue the suggestions in the report. In addition, NIAID intends to use the National Asthma Education Program to further disseminate the information in the report.

FEDERAL CONTACT OFFICE: Division of Immunology, Allergy, and Transplantation, NIAID

PERSON: Marshall Plaut, M.D.

PHONE NUMBER: 301/496-8973

PIC NUMBER: 4465

PERFORMER ORGANIZATION: Institute of Medicine, National Academy of Sciences, Washington, DC

P.I.: Andrew Pope, Ph.D.

TITLE: Outreach/Risk Reduction Strategies for Changing HIV-Related Risk Behaviors Among Injection Drug Users

ABSTRACT NUMBER: 047

ABSTRACT: This study evaluates the effectiveness of outreach programs for reducing HIV-related risk behaviors of injection drug users (IDUs) and their sexual partners. Under the sponsorship of the National AIDS Demonstration Research Project, the outreach programs offer information about HIV infection, strategies for reducing the risk, counseling, support groups, and training in cognitive and social skills. The programs operated at 28 sites, at which data were collected on 13,475 IDUs and 1,637 sexual partners of IDUs. Investigators used a before/after design, comparing data at 6-month followup with those at baseline by using the AIDS Initial Assessment (AIA) and AIDS Followup Assessment (AFA). Comparison of AIA and AFA data for IDUs and analysis of interview data revealed that the interventions yielded significant decreases in HIV-related risk behaviors, especially related to needle use. Significant increases were found in the use of new rather than reused needles, bleach for cleaning injection equipment, and condoms--all behaviors that reduce risk. This study provided evidence that IDUs and their sexual partners can be reached, can listen to educational strategies to reduce risk, and can change their HIV-related risk behaviors. Reduction in drug injection frequency and use of noninjected drugs was especially noteworthy. Study findings led to the creation of a permanent program.

FEDERAL CONTACT OFFICE: Division of Epidemiology and Prevention Research, NIDA

PERSON: Richard Needle, Ph.D., M.P.H.

PHONE NUMBER: 301/443-6720

PIC NUMBER: 4655.1

PERFORMER ORGANIZATION: NOVA Research Company, Bethesda, MD

TITLE: Study To Assess the Current and Future Demand for Bone Marrow and the Impact on Size of the National Marrow Donor Registry

ABSTRACT NUMBER: 048

ABSTRACT: The objective of the study was to estimate the current and future size of the National Marrow Donor Program (NMDP) Registry. The purpose of the NMDP was to develop and maintain a registry of volunteer unrelated bone marrow donors; to facilitate bone marrow transplants by serving as a coordinating and communications center for a network of donor, collection, and transplant centers in the United States and internationally; and to facilitate research into the efficacy of unrelated donor marrow transplants. Bone marrow transplantation is used to treat patients with chronic myelocytic leukemia, Franconi's anemia, and severe combined immune deficiency, as well as patients with acute leukemia and lymphoma who have relapsed following initial therapy. The scope of the program was enlarged in 1992 to increase the number of minority donors in the registry. Strategic options with financial, cost, and service level implications were developed that will be used in program management.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation, NHLBI

PERSON: Barbara Packard

PHONE NUMBER: 301/496-6331

PIC NUMBER: 5687

PERFORMER ORGANIZATION: Institute of Medicine, National Academy of Sciences, Washington, DC

P.I.: Michael A. Soto, Ph.D.

TITLE: Survey of the Knowledge, Attitudes, and Practices of Physicians Related to Blood Use, Transfusion, and Donation

ABSTRACT NUMBER: 049

ABSTRACT: NHLBI conducted a nationwide survey that will provide quantitative measures of the reported knowledge, attitudes, and practices related to autologous and homologous blood transfusion and donation that are held by two groups of practicing physicians--physicians in specialty groups who are heavy users of blood and blood products and physicians in specialty groups who are involved in primary patient care. These two groups of physicians represent nine physician specialties--six specialties that are heavy users of blood products (anesthesiology, general surgery, cardiovascular surgery, orthopedic surgery, obstetrics and gynecology, and neonatology) and three specialties of physicians involved in primary patient care (family practice, internal medicine, and general practice). Specifically, the survey measures how numerous advances in the use of blood and blood components and alternatives to homologous blood transfusion have affected the medical community. Survey results are being used to maximize the professional education component of the National Blood Resource Education Program and thereby to further ensure that blood and blood components are transfused only when therapeutically appropriate to ensure an adequate supply of safe blood and blood components to meet the Nation's needs.

FEDERAL CONTACT OFFICE: Office of Program Planning and Evaluation, NHLBI

PERSON: Barbara Packard

PHONE NUMBER: 301/496-6331

PIC NUMBER: 4008

PERFORMER ORGANIZATION: Maya Tech Corporation, Silver Spring, MD

Substance Abuse and Mental Health Services Administration

Listing of Abstract Titles

Evaluation Design for the Comprehensive Community Services Program for Children With Serious Emotional Disturbance

Evaluation of Demonstration Treatment Programs in Job Corps

Evaluation of OSAP Demonstration Projects for Community Partnerships

Evaluation of OSAP Demonstration Projects on Pregnant and Postpartum Women and Their Infants (PPWI)

Making a Difference: Interim Status Report of the McKinney Research Demonstration Programs for Homeless Mentally Ill Adults

Second Report to Congress on Alcohol and Drug Abuse Prevention, 1993

TITLE: Evaluation Design for the Comprehensive Community Services Program for Children With Serious Emotional Disturbance

ABSTRACT NUMBER: 050

ABSTRACT: This project developed an overall design and instrumentation package for the Community Mental Health Services Program for Children with Serious Emotional Disturbance. The design was formulated to ensure that information needed to support Federal, State, and local policymakers is readily available and that data collected are useful in improving systems of care for children. The product of this contract is an evaluation design, which will be implemented under another contract.

FEDERAL CONTACT OFFICE: Office of Demonstration Programs, Center for Mental Health Services

PERSON: Roger Straw, Ph.D.

PHONE NUMBER: 301/443-3606

PIC NUMBER: 5029

PERFORMER ORGANIZATION: Macro International, Calverton, MD

P.I.: Susan Zaro

TITLE: Evaluation of Demonstration Treatment Programs in Job Corps

ABSTRACT NUMBER: 051

ABSTRACT: This evaluation examines the cost-effectiveness of the Drug Treatment Enrichment Program in curbing drug use among students receiving training at Job Corps Centers. Job Corps Centers are residential employment and training programs for high-risk youth. The evaluation, which began in July 1992 and continues for 4 years, compares the course of the Drug Treatment Enrichment Program, which provides enhanced services to curtail drug use, with the standard drug prevention and treatment program used at Job Corps Centers. Student drug use is assessed at intake, during, and 12 months after training at four centers with the enrichment program and at four control centers with the standard program. The most recent update from this demonstration program, covering almost 3,000 students entering the centers over a 6-month period in 1993, is contained in the Second Annual Report (November 1993). The enrichment program was found to be more successful and also more costly than the standard program. While 63 percent of students entering the enrichment program used drugs in the month before the program, their drug use declined to 31 percent during the program. In contrast, while 69 percent of students entering the standard program reported drug use, their use declined to 45 percent. The total cost of the enrichment program at each center was 2.5 times that at the control center. The evaluation is still in progress, with more updates expected.

FEDERAL CONTACT OFFICE: Office of Scientific Analysis and Evaluation, Center for Substance Abuse Treatment

PERSON: Charlene Lewis

PHONE NUMBER: 301/443-7730

PIC NUMBER: 4523

PERFORMER ORGANIZATION: Caliber Associates, Fairfax, VA

P.I.: Patricia Devine

TITLE: Evaluation of OSAP Demonstration Projects for Community Partnerships

ABSTRACT NUMBER: 052

ABSTRACT: The National Evaluation of the Community Partnership Demonstration Program (CPDP) is mandated by Congress to document and describe CPDP's implementation and identify successful strategies and common inhibitors to forming effective partnerships and implementing intervention strategies. This is a two-tiered evaluation that includes a broad assessment of all 251 partnerships, using routine collection and analysis of uniform information and an intensive assessment of 36 selected partnerships. The process and outcome evaluation is in its third and final year of data collection, documentation, and evaluation of partnership form and function. Interim reports were prepared in 1992 and 1993.

FEDERAL CONTACT OFFICE: Office of Scientific Analysis and Review, Center for Substance Abuse Prevention

PERSON: Shakeh Kaftarian

PHONE NUMBER: 301/443-4783

PIC NUMBER: 4515

PERFORMER ORGANIZATION: ISA Associates, Alexandria, VA

P.I.: Janice Roehl

TITLE: Evaluation of OSAP Demonstration Projects on Pregnant and Postpartum Women and Their Infants (PPWI)

ABSTRACT NUMBER: 053

ABSTRACT: This evaluation assessed the implementation and effectiveness of the Pregnant and Postpartum Women and Their Infants (PPWI) Demonstration Program funded between 1989 and March 1991. The evaluation examined the process of implementing 90 PPWI grants: the coordination of program services within a large community environment and successes in overcoming obstacles to implementation. The outcome evaluation included 26 PPWI projects and addressed program effectiveness and the impact of the program on mother and child outcomes. Key findings of the evaluation included the following: The PPWI grantees were successful in improving the coordination, availability, and accessibility of health and alcohol and other drug-related services. At least one-third of the women served by these programs reduced their substance use. Babies born to PPWI clients were generally healthy, especially if their mothers took full advantage of prenatal services. Grantees made working agreements with an average of 13 other organizations for delivery of comprehensive services.

FEDERAL CONTACT OFFICE: Office of Scientific Analysis and Review, Center for Substance Abuse Prevention

PERSON: Soledad Sambrano

PHONE NUMBER: 301/443-9136

PIC NUMBER: 4517

PERFORMER ORGANIZATION: Macro International, Calverton, MD

P.I.: James Ross

TITLE: Making a Difference: Interim Status Report of the McKinney Research Demonstration Programs for Homeless Mentally Ill Adults

ABSTRACT NUMBER: 054

ABSTRACT: This evaluation is a multisite research demonstration project offering case management and housing to the homeless mentally ill. A total of 896 homeless adults with severe mental illness were randomly assigned to an intervention that combined housing and social services or to traditional services. The interventions varied across sites but were oriented to training participants in daily living, linking them to needed social and medical services, and assisting them in the receipt of entitlements and housing. Interim findings indicate that each of the five sites has been successful in reducing homelessness and improving the mental health of study participants: homeless adults with severe mental illness are willing to use accessible services targeted to their needs. The factors contributing to the success of the project include mental health treatment, receipt of entitlement income, and reliance on an interdisciplinary team of staff, including some formerly homeless people with mental illness. Participants' substance abuse was more significant than their mental illness in preventing them from finding or keeping housing. These interim findings are from followup at 6 to 12 months. Final results, from followup at 18 to 24 months, are expected to offer strategies for the design and management of programs for the homeless mentally ill.

FEDERAL CONTACT OFFICE: Center for Mental Health Services, SAMHSA

PERSON: Roger Straw, Ph.D.

PHONE NUMBER: 301/443-3606

PIC NUMBER: Unassigned

PERFORMER ORGANIZATION: Homeless Research Project

P.I.: Anthony Lehman, M.D., The Baltimore Project, Baltimore, MD

Stephen Goldfinger, M.D., The Boston Project, Boston, MA

David Stern, Ph.D., The New York City Street Outreach Project, New York, NY

Elie Valencia, J.D., The New York City Critical Time Project, New York, NY

Richard Hough, Ph.D., The San Diego Project, San Diego, CA

TITLE: Second Report to Congress on Alcohol and Drug Abuse Prevention, 1993

ABSTRACT NUMBER: 055

ABSTRACT: The National Structured Evaluation is the first systematic assessment of alcohol and other drug abuse prevention approaches that have been implemented across the country. The overall objective is to improve understanding of the elements of effective alcohol and other drug abuse prevention. It will address three evaluation questions. Which current prevention projects are effective and which factors contribute to their success? Can successful prevention efforts be replicated to other target populations? Which efforts are most effective with the general population, and which ones are most effective with special populations? The first report to Congress identifies drug abuse education and prevention efforts (including practices of Federal, State, and local governments) that focus on reducing alcohol and other drug abuse. The report lists programs that have evaluation components and reviews the reported findings and conclusions. The results show that many programs have not been evaluated; there are mixed results regarding strategies, outcomes, and impact on different target populations; and comprehensive community-based programs show the most promise. The report recommends evaluation technical assistance for program managers; increased program development research; support for comprehensive, community-based programs; and development of an evaluation information center.

FEDERAL CONTACT OFFICE: Office of Intergovernmental and External Affairs, Center for Substance Abuse Prevention

PERSON: Mel Segal

PHONE NUMBER: 301/443-5266

PIC NUMBER: 4313

PERFORMER ORGANIZATION: Conwal, Inc., Falls Church, VA

P.I.: Gay Hill, Ph.D.

Office of the Assistant Secretary fOR Health

Listing of Abstract Titles

Advanced Practice Nursing Education: Strategies for the Allocation of the Proposed Graduate Nursing Education Account

Assessment of AIDS Non-Acute Care AIDS Treatment Facilities

Developing Effective Health Communication Strategies for High-Risk Youth Outside of School

Evaluating Educational Outcomes of School Health Programs

Evaluation of NDMS 1992 Open Arms Exercise and Response to Florida Hurricane Andrew

Evaluation of the 1990 U.S.-Mexico Border Sister Cities Health Initiative: Final Report

An Evaluation of WomenÕs Reproductive Health Services Provided in Community/Migrant Health Centers in Region VIII

For a Healthy Nation: Returns on Investment in Public Health

Improving the Supply, Training, and Distribution of Primary Care Providers Under Federal Health Care Reform

Integration of Support Services Into Comprehensive Primary Care

Nutritional Status Indicators of Low-Income Populations

Patterns of Care for HIV/AIDS Patients

Region IX Hepatitis B Project Final Report

Report of the American Institute of Nutrition (AIN) Steering Committee on Healthy Weight

Study Design for an Evaluation Study of the Vaccine Adverse Event Reporting System (VAERS)

A Study of the Economic Underpinnings of Vaccine Supply

Supporting Statement for a Study To Evaluate the Effects of the Use of "Put Prevention Into Practice" Materials in Primary Health Care

TITLE: Advanced Practice Nursing Education: Strategies for the Allocation of the Proposed Graduate Nursing Education Account

ABSTRACT NUMBER: 056

ABSTRACT: This project examines issues related to the Administration's proposals to establish an all-payer pool to support graduate nurse training as part of health care reform. It provides background on the advanced practice nursing workforce and outlines possible approaches to allocation of the proposed graduate nurse education (GNE) fund. Trends in nursing supply and demand are addressed, including the number of nurses in practice by type of training, geographic location, and practice setting as well as statistics on the educational programs preparing them for practice. The discussion begins with the registered nurse workforce, as these practitioners form the pool eligible for advanced practice study, and moves to a consideration of each of the four areas of advanced practice nursing specialization (nurse practitioners, nurse-midwives, nurse anesthetists, and clinical nurse specialists). Next, trends in the costs of nursing education and sources of funding available to nursing programs and their students are examined. Finally, the author puts forth strategies pertaining to the allocation of GNE funds and gives details on cost simulations under various options.

FEDERAL CONTACT OFFICE: Office of the Assistant Secretary of Health, DHHS

PERSON: Marcy Gross

PHONE NUMBER: 202/690-5824

PIC NUMBER: 5668

PERFORMER ORGANIZATION: University of Pennsylvania School of Nursing, Philadelphia, PA

P.I.: Linda H. Aiken, Ph.D., R.N., F.A.N.

TITLE: Assessment of AIDS Non-Acute Care AIDS Treatment Facilities

ABSTRACT NUMBER: 057

ABSTRACT: The purpose of the project was to evaluate how the designs of three types of AIDS treatment facilities affected the services provided in the facilities. The question addressed was whether certain facility design features either contribute to or detract from the conduct of the treatment program(s) for which the facility is used. During the 4 fiscal years beginning with 1988, the Public Health Service made grants to assist in the construction or renovation of non-acute, intermediate, and long-term care facilities for patients with AIDS or other HIV-related conditions. Projects eligible for assistance were those for (1) renovation of existing traditional health care facilities such as hospitals and nursing homes, and other than traditional health care facilities, such as residential housing, and (2) construction of new health care facilities to provide comprehensive intermediate and/or long-term care for some or all of the various stages of illness an HIV-infected person may experience. Using a case study approach, a team (consisting of an AIDS treatment professional with experience in planning and implementing non-acute AIDS treatment programs and an architect with experience in the design of health care facilities) evaluated each of six facilities built in Region IX with grant assistance. The team gathered data from grant application files, direct observation of the facilities, and interviews with project sponsors. The final report describes significant aspects of the design, construction, and program use of each facility. Strengths and weaknesses of each facility are highlighted, with recommendations for facility designers. Intended users of project findings are designers of AIDS treatment facilities and treatment staff with responsibility for facility planning.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PHONE NUMBER: 202/401-0734

PIC NUMBER: 5682

NTIS ACCESSION NUMBER: PB 95-194726

PERFORMER ORGANIZATION: ESS Architects, San Francisco, CA

P.I.: Abelardo Ruiz

TITLE: Developing Effective Health Communication Strategies for High-Risk Youth Outside of School

ABSTRACT NUMBER: 058

ABSTRACT: This focus group study generated information about the knowledge, attitudes, behaviors, beliefs, and environments of at-risk youth. Youth are considered to be at risk if they are ages 10 through 18 and regularly engage in tobacco use, substance use, unprotected sex, and/or violence. Target population data were collected through a literature review and focus groups. High-risk youth were found to be fairly knowledgeable about healthy practices, but they do not incorporate this awareness into practice. They were found to be willing to listen to trusted, credible adults in alternative settings. Project findings suggest strategies to (1) help service providers, intermediaries, families, and other adult role models to become effective health communicators; (2) focus on linked behaviors rather than categorical issues; and (3) integrate communications with programs and services. This project is the first interdepartmental communications research effort of the Public Health Service and the Departments of Justice, Education, and Transportation.

FEDERAL CONTACT OFFICE: Office of Disease Prevention and Health Promotion

PERSON: Mary Jo Deering, Ph.D.

PHONE NUMBER: 202/205-5968

PIC NUMBER: 4490

PERFORMER ORGANIZATION: S.W. Morris Company and Global Exchange

P.I.: Ruth Karimi

TITLE: Evaluating Educational Outcomes of School Health Programs

ABSTRACT NUMBER: 059

ABSTRACT: This evaluation design report presents a general framework for assessing the effects of school health intervention on students' school performance. As recognized by the Nation's health promotion and disease prevention and education agendas--Healthy People 2000 and Goals 2000--health and education are inextricably linked: good health is necessary for effective learning, and education is necessary for maintaining good health. However, robust empirical evidence of this link from well-designed evaluations does not exist. This study was undertaken to guide efforts to gather such empirical evidence. This report begins with an overview of the eight general categories of school health intervention: (1) health education, (2) health services, (3) healthy school environments, (4) school nutrition services, (5) physical education and fitness, (6) integrated school and community health promotion, (7) school counseling, and (8) health promotion for faculty and staff. It reviews the types of school performance measures and primary data sources for obtaining those measures. Measures include educational achievement (e.g., grade promotion patterns), student behaviors (e.g., attendance), and student attitudes toward school and themselves. The primary data sources are school records and student surveys. The report reviews the procedures needed to collect data from each source and the issues regarding the use of intermediate versus long-term educational outcomes. Two major design evaluation options are presented. The first option is to use data collected by national surveys by the National Center for Education Statistics. The second is to conduct multischool demonstrations, either as add-ons to existing evaluation of the health outcomes of school health programs or as new efforts to test alternative health interventions. With these options, schools gain the tools to justify not only the health importance but also the academic importance of their health programs.

FEDERAL CONTACT OFFICE: Office of Disease Prevention and Health Promotion

PERSON: James Harrell

PHONE NUMBER: 202/205-8611

PIC NUMBER: Unassigned

PERFORMER ORGANIZATION: Mathematica Policy Research, Princeton, NJ

P.I.: Craig Thornton, Ph.D.

TITLE: Evaluation of NDMS 1992 Open Arms Exercise and Response to Florida Hurricane Andrew

ABSTRACT NUMBER: 060

ABSTRACT: The National Disaster Medical System (NDMS) is a cooperative effort of public and private organizations and individuals to provide emergency medical treatment, casualty evacuation, and definitive medical care to victims of natural and manmade catastrophic disasters. This system is a cooperative effort among four Federal Departments and Agencies: the Department of Health and Human Services, the Department of Defense, the Department of Veterans Affairs, and the Federal Emergency Management Agency. The inadequate Federal response to Hurricane Andrew stimulated a number of evaluations of Federal catastrophic disaster programs and policies. These programs are usually activated by a request from the State when State resources are overwhelmed. The Office of Emergency Preparedness initiated an evaluation of NDMS emergency response, beginning with a conference to assess its performance in the Florida hurricane response. The results led to a full evaluation of the program. The results of the evaluation confirmed that NDMS is a valuable program, but it needs to be strengthened. Seven issue areas were identified, and other participants in the NDMS program were appointed to develop options and recommendations for these issue areas.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: Maximus, McLean, VA

PIC NUMBER: 5691

TITLE: Evaluation of the 1990 U.S.-Mexico Border Sister Cities Health Initiative: Final Report

ABSTRACT NUMBER: 061

ABSTRACT: This report contains an evaluation of the activities initiated by the Office of International Health during 1990-91 to enhance the presence of the Public Health Service (PHS) in the U.S.-Mexico border region, with the objective of improving public health status. The activities included the U.S.-Mexico Border Health Group, Project Consenso, and the Sister Cities Health Initiative. The evaluation provided insights into these activities to guide future PHS efforts in bilateral health activities in the U.S.-Mexico border region. There are mutual concerns over the problems of air pollution, toxic waste dumping, sewage and water contamination, traffic congestion, and lack of services. The evaluators felt that Project Consenso was a success in that it set the stage for the continuation of a management process for the conduct of bilateral activities in health. It also pointed up the unique nature of the border communities and the need for U.S. and Mexican national presence in discussions regarding what are normally local public health issues. The strongest aspect of the development of the Sister Cities Health Initiative projects was the spirit of binational cooperation exhibited by all the participants. Ongoing dialog among the participants focusing on the role of local health authorities and technical assistance were key to project development and strongly suggest the model for future progress in the border region. The intent of the Sister Cities Health projects is to reinforce and strengthen local infrastructure, and it appears that they are doing just that. There was strong sentiment for more clearly defining the PAHO Field Office role in border activities. It was felt that the office could adopt a more consultative role with public and private health institutions on the border. The report contains recommendations made by participants interviewed to facilitate the continuing process of managing binational health issues in the border region.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: M.S. Mexico Border Health Association, El Paso, TX

PIC NUMBER: 5628

P.I.: Ignacio G. Gosset, Ph.D.

TITLE: An Evaluation of Women's Reproductive Health Services Provided in Community/Migrant Health Centers in Region VIII

ABSTRACT NUMBER: 062

ABSTRACT: In 1993, a multidisciplinary interagency task force was formed to assess reproductive health services in various public health agency programs. The task force identified a gap in reproductive health care information in the community/migrant health care setting and embarked on an evaluation project to examine the regional public health information infrastructure. The evaluation study focused on a representative sample of women 20 to 44 years of age who received reproductive health care services from one of 36 study sites. A 220-item data collection instrument was designed to collect and analyze the frequency and extent of services provided. Findings were also compared across urban, rural, and frontier study populations. The demographic and utilization patterns revealed that the typical client was a married, Hispanic, employed female with a high school education, between 25 and 29 years of age. Preventive health screenings were the most highly documented health services delivered (blood pressure, weight, and pap smears). Prenatal records were consistently the most complete. Documentation for reproductive and other types of health promotion education and counseling appeared low when compared with other services. Services related to reporting of abuse and violence were the most poorly documented, followed by reporting of mental health problems. The evaluation study will provide regional programs with an information base to assess services for continuous improvement of quality of care.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

NTIS ACCESSION NUMBER: PB 95-193686

PIC NUMBER: 5670

PERFORMER ORGANIZATION: University of Colorado Health Sciences Center, Denver, CO

P.I.: Gene W. Marsh, Ph.D.

TITLE: For a Healthy Nation: Returns on Investment in Public Health

ABSTRACT NUMBER: 063

ABSTRACT: This study describes public health programs and the role they play at the national, State, and local levels in avoiding preventable injury and illness and decreasing demand for personal care services. It also suggests the need to increase the research base on the effectiveness of public health strategies. The population-based approaches described have provided the foundation for significant improvements in health and life expectancy, including declines in heart disease and stroke, infectious disease, and motor vehicle and workplace injuries. Other successes include the virtual elimination of polio since the mid-sixties, declines of nearly 50 percent in dental decay in children since 1974, and a 70 percent reduction in childhood blood lead levels since 1976. At the same time, persistent public health problems remain (e.g., outbreaks of new infectious diseases such as AIDS and familiar diseases such as tuberculosis). Tuberculosis provides an instructive example of a strong public health program that was effective in controlling a disease that resurged when the program was dismantled, resulting in 39,000 preventable cases and $421 million in avoidable direct medical costs between 1985 and 1992. This evaluation finds that appropriate investment in public health may lead to future savings on the medical care side. For example, conservative estimates of the impact of population-based strategies aimed at heart disease, stroke, occupational injuries, motor vehicle-related injuries, low birthweight, and gunshot wounds suggest that $69 billion in medical care spending for these conditions could be averted by 2000. This reduction will be achieved through reductions in cases of heart disease and stroke, estimated to reach 8.4 million and 3.3 million cases avoided, respectively, by 2015 as a result of public health prevention strategies.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: Battelle, Arlington, VA

PIC NUMBER: 5680

P.I.: Bryan A Luce, Ph.D.

TITLE: Improving the Supply, Training, and Distribution of Primary Care Providers Under Federal Health Care Reform

ABSTRACT NUMBER: 064

ABSTRACT: This project provided an analysis of issues related to proposals for improving the supply, training, and distribution of primary care providers as part of health care reform. Many of the health care reform proposals considered by Congress included provisions that would have changed the mechanism for making decisions with respect to the number and types of new physicians. Information provided in this report includes a chart book on the supply, training, and distribution of physicians; technical papers providing background on the need for increased numbers of generalist physicians and the rationale for proposals to control the supply of new physicians; proposals for an all-payer pool for graduate medical education; estimates of the number of physicians in research training tracks at NIH and elsewhere; and preliminary estimates of the number of advanced practice nurses and physician assistants that would be needed to substitute for physicians if the number of physician residents were reduced.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: Center for Health Policy Research, George Washington University, Washington, DC

PIC NUMBER: 5666

P.I.: Michele Solloway, Ph.D.

TITLE: Integration of Support Services Into Comprehensive Primary Care

ABSTRACT NUMBER: 065

ABSTRACT: Federally funded community and migrant health centers (C/MHCs) and other community resources, such as the Supplemental Food Program for Women, Infants, and Children (WIC) and mental health centers, are the principal resources for the prevention, detection, and treatment of a variety of health problems. The need to evaluate the integration of nutrition, mental health, social work, and dental services provided through the C/MHCs or their linkages with other community resources is evidenced by the compromised health status of underserved clients in this country. This project evaluated the integration of nutrition, mental health, social work, and dental services provided at C/MHCs with emphasis on special categorical populations, such as the HIV-infected, the homeless, substance abusers, women, and children. The final report includes analysis of the survey responses, reports of the site visits, and recommendations for techniques and strategies that can improve integration of services.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

NTIS ACCESSION NUMBER: PB 95-193728

PIC NUMBER: 5657

PERFORMER ORGANIZATION: Wilson Yoak Associates, Jefferson City, MI

P.I.: Lorna M. Wilson, R.N., M.P.H.

TITLE: Nutritional Status Indicators of Low-Income Populations

ABSTRACT NUMBER: 066

ABSTRACT: In 1988, the Public Health Service joined with the American Institute of Nutrition (AIN) in a cooperative agreement to examine state-of-the-art techniques for measuring nutritional status and to make recommendations for a core set of nutritional status indicators for low-income populations. A workshop, several symposia, and an AIN multidisciplinary task force on core indicators of nutritional status were planned and carried out. The collected reports resulting from these activities have been compiled in a final report. The task force drew on the symposia and workshop papers in its assessment, which provides an introduction to the concept of nutritional state and the components that must be considered in identifying core indicators for its assessment in difficult-to-sample populations. These components include food security, nutritional concerns, survey coverage, and sampling concerns. Core indicators of nutrition state are suggested in the context of the purposes for which the data are used.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

NTIS ACCESSION NUMBER: PB 95-193736

PIC NUMBER: 5658

PERFORMER ORGANIZATION: American Institute of Nutrition, Bethesda, MD

P.I.: Richard G. Allison, Ph.D.

TITLE: Patterns of Care for HIV/AIDS Patients

ABSTRACT NUMBER: 067

ABSTRACT: This study examined patterns of care for HIV/AIDS patients who received services in federally funded community health centers in New York and New Jersey. Site visits were made to a sample of six urban centers that represented different types by organizational setting (hospital-based, hospital-affiliated, and freestanding) and by health services delivery orientation (designated AIDS clinic or integrated care plan). The focus of the study was to describe the health services delivery models used by the centers or their approach to administration, organization, and operation of HIV-related health service programs and activities. The study found that despite differences in the organization of the centers, the administration and provision of services is basically the same. The report also presents findings on the types of services delivered, the role of case management, and increased demand for services by high-risk groups.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: Market Care, New York, NY

PIC NUMBER: 4498

P.I.: George Z. Cestero

TITLE: Region IX Hepatitis B Project Final Report

ABSTRACT NUMBER: 068

ABSTRACT: The purpose of the project was to evaluate the effectiveness of hepatitis B health education/outreach program activities at six federally funded primary care centers in Region IX that target Asian and Pacific Islander patients. The carrier rate of this disease ranges from 10 to 15 percent in the Asian Pacific population in contrast to 0.3 percent in the U.S. population. The study objectives were to examine the role Southeast Asian refugee and Asian immigrant leaders play in the design and delivery of health education programs; develop criteria for measuring effective health education programs; identify effective hepatitis B health education programs; and identify the elements of effective programs. Three major barriers to the development of effective hepatitis B programs for Asian and Pacific Islander populations were identified: (1) lack of understanding of the importance of hepatitis B screening and vaccination by the patient population; (2) lack of reimbursement by third parties for hepatitis B screening and vaccines for adolescents and adults (currently, reimbursement is provided only for prenatal patients); and (3) limited availability of bilingual/bicultural interpreters trained in health education materials. The final report recommends that the following elements should be included in effective hepatitis B outreach and education programs: (1) staff who are sensitive to cultural beliefs and attitudes affecting hepatitis B; (2) reimbursement for hepatitis B screening and vaccines for all age groups; (3) translated health education materials; (4) integrated hepatitis B activities with standard patient care protocols; (5) use of ethnic media (TV, radio, newspapers, magazines); and (6) linkages with school-based health programs and other community-based outreach programs serving the high-risk Asian/Pacific Islander population.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

NTIS ACCESSION NUMBER: PB 95-193389

PIC NUMBER: 5681

PERFORMER ORGANIZATION: Association for Asian Pacific Community Health Organization, Oakland, CA

TITLE: Report of the American Institute of Nutrition (AIN) Steering Committee on Healthy Weight

ABSTRACT NUMBER: 069

ABSTRACT: As part of a cooperative effort between the Department of Health and Human Services' Public Health Service and the American Institute of Nutrition (AIN), AIN convened a 2-day workshop to review new data and perspectives pertinent to defining "healthy weight." AIN provided transcripts of the workshop and copies of submitted materials to PHS/OASH/ODPHP. A report from the AIN Steering Committee on Healthy Weight was published in the Journal of Nutrition (124:2240-2243, 1994). The report summarizes the Steering Committee's conclusions from the workshop, including areas of agreement, and identifies issues for which further data and discussions are needed. The report has been provided to the 1994-95 Dietary Guidelines Advisory Committee for use in its deliberations on the definition of healthy weight.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: American Institute of Nutrition, Bethesda, MD

PIC NUMBER: 5014

P.I.: Richard G. Allison, Ph.D.

TITLE: Study Design for an Evaluation Study of the Vaccine Adverse Event Reporting System (VAERS)

ABSTRACT NUMBER: 070

ABSTRACT: This project provided an evaluation design to assess the functional capabilities (including reliability and data quality) of the Vaccine Adverse Event Reporting System (VAERS). It examined methods for improving reporting, followup, and analysis of VAERS data, and assessed the level of awareness about VAERS among health care providers and consumers. There are four major evaluation points: (1) the degree to which this system meets the program's needs and legislative requirements; (2) the reliability and accuracy of information submitted to it, including how well instructions are followed when completing forms; (3) management of secondary and/or followup information; and (4) the perception of VAERS among health care providers, manufacturers, and consumers.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation

PERFORMER ORGANIZATION: Research Triangle Institute, Washington, DC

PIC NUMBER: 5013

P.I.: James S. Lubalin, Ph.D.

TITLE: A Study of the Economic Underpinnings of Vaccine Supply

ABSTRACT NUMBER: 071

ABSTRACT: This project studied the economic and commercial underpinnings of ensuring an adequate supply and distribution of vaccines. The project conducted a meta-analysis of related vaccine supply studies to identify alternative models for the purchase and distribution of vaccines; the effect of scientific advances on research, development, and purchase of vaccines; the application of economic theory to the vaccine market; comparisons of vaccine distribution systems administered by vaccine manufacturers and State agencies; and the implications of purchasing vaccines from foreign firms. The final report presented findings on price increases in vaccines since 1977; factors affecting production of supply; the economics of public versus private sector supply of vaccines; and the limited importance of foreign suppliers in meeting U.S. needs. The study found, for example, that States that supply vaccines at low prices to physician offices and encourage parents to have their children vaccinated have somewhat higher rates of immunization. These and many other findings have enhanced CDC's ability to negotiate lower prices from manufacturers and have broad utility for policy and legislation.

FEDERAL CONTACT OFFICE: PHS-CDC Immunization/Vaccine Stockpile, National Vaccine Program Office

PERSON: Chester Robinson, D.P.A.

PHONE NUMBER: 301/594-6350

PIC NUMBER: 5015

PERFORMER ORGANIZATION: Mathematica Policy Research, Princeton, NJ

P.I.: Craig Thornton, Ph.D.

TITLE: Supporting Statement for a Study To Evaluate the Effects of the Use of "Put Prevention Into Practice" Materials in Primary Health Care

ABSTRACT NUMBER: 072

ABSTRACT: This project developed an evaluation instrument to measure the impact of Put Prevention Into Practice (PPIP) materials on the delivery of preventive care services by primary care providers. Data generated will help PHS develop and refine the PPIP materials and provide direction to other Federal Agencies interested in using PPIP materials in their programs. This information will help primary care providers, national primary care provider organizations, and the academic community determine the appropriate use of these materials in clinical practice and education. These data will also provide policymakers involved with the reform of the health care delivery system with information on the utility of PPIP materials in increasing the delivery of clinical preventive services by primary care providers.

FEDERAL CONTACT OFFICE: Disease Prevention and Health Promotion, and Health Planning and Evaluation