Utilization
Health care utilization and expenditures by Vietnam veterans. American Public Health Association Annual Meeting, 1991.
Authors: Beauregard K and Potter D.
Description: This paper examines health care utilization and expenditures for veterans who
served during the Vietnam War era. Data are from the household survey of NMES.
Information on approximately 1,100 Vietnam War era veterans is used to present
national estimates of health care utilization and expenditures for inpatient
hospital stays, hospital outpatient and emergency room visits, mental health
care, and ambulatory care visits. Also examined are patterns of use of the
Veterans Administration's health care system. Estimates are characterized by
demographic, socioeconomic, and health status indicators comparing veterans to a
cohort of nonveterans.
Determinants of ambulatory mental health services use for school-age children and adolescents. Health Services Research Oct. 1996; 31(4), pp. 409-427.
Authors: Cunningham P and Freiman M.
Description: This study used the 1987 NMES to analyze a comprehensive multivariate model of
the use of mental-health-related ambulatory care services by children ages 6-17.
It was found that children with poor mental health in high-income families were
more than three times as likely to have a mental-health-related visit as children with poor mental health in low-income families. The number of mental-health-related visits and the likelihood of seeing a mental health specialist also increased along with family income. Mental health use by other family
members was strongly associated with use by children. The study concludes that
the socioeconomic status of children is an important factor in explaining unmet
need for mental health services.
Interactions between use of and insurance for specialty ambulatory mental health services. Presented at the Seventh Biennial Research Conference on the Economics of Mental Health; Sept. 1994; Bethesda, MD. Discussion paper, June 1996
Author: Freiman M.
Description: Data from the 1987 NMES were used to analyze some aspects of the interaction
between the coinsurance rate for ambulatory mental health care and the
probability of use of such care. Some evidence for selection effects was found,
in that when an instrument is estimated for the coinsurance rate for ambulatory
mental health services, this instrument is found to perform better than the
actual insurance rate in a demand equation for these services. The results for
the instrumental equation also suggest that the selection bias often discussed
with regard to mental health insurance and service use may involve both supply
and demand side effects in the labor market. The implications of these results
for estimating the effects of broad changes in coverage are discussed.
Use of health care for the treatment of mental problems among racial/ethnic subpopulations. Medical Care Research and Review Mar. 1997; 54(1), pp. 80-100.
Authors: Freiman M and Cunningham P.
Description: This paper uses the 1987 NMES to analyze the degree to which interactions among
race, ethnicity, and other characteristics of a person and his or her local area
are important in determining the probability of any mental health care use.
Separate equations are estimated for "blacks and Hispanics" and "whites and
other groups." Simulations are then performed where the probabilities of use
are estimated for individuals in one racial/ethnic group using coefficients
estimated for another racial/ethnic group. These simulations show that the
probability of use for blacks and Hispanics would be similar to whites if they
were subject to the same behavioral patterns (regression coefficients) as
whites, and vice versa. The results indicate the limitations of simply using
dummy variables to represent race/ethnicity and the value of learning more about
how the health care system interacts with persons of different racial/ethnic
backgrounds. Policies that directly affect the location, characteristics, and
behavior of health care providers, as well as the behavior of consumers, may be
as relevant to achieving equality of use or access as incremental changes in
health coverage.
The demand for health care for the treatment of mental problems among the
elderly. In: Advances in Health Economics and Health Services Research. Volume
14. Greenwich, CT: JAI Press; 1993.
Authors: Freiman M, Cunningham P, and Cornelius L.
Description: Much of the research on the demand for mental health care has focused on
ambulatory care visits. This focus would not appear to be entirely appropriate
for the elderly, as ambulatory visits are neither the most prevalent form of
treatment nor the most expensive. In general, the mental health use the
researchers found among the elderly was characterized by its low intensity for
those with any such use. The most common type of mental health treatment among
the noninstitutionalized elderly in the 1987 NMES was prescription drugs. This
use of medicines is substantially more prevalent among the elderly than other
age groups. It was found that being newly widowed was a strong predictor of
mental health treatment during the year. For such a situation, a limited-term
prescription for a mild tranquilizer and/or hypnotic may be sufficient and
appropriate. However, widowhood occurred for only 2.4 percent of the sample, so
its potential to explain prescription drug treatment is limited. The frequency with which prescription medicines were found to be the sole form of treatment
for a mental problem raises the question of whether at least some portion of
these problems might better be treated with more intensive ambulatory care or
other treatments.
Psychotropic medication use among the elderly. Presented at the NAMH Research Conference on Mental Health Services Research; Sept. 1995; Bethesda, MD. Discussion paper, August 1996.
Authors: Freiman M and Norquist G.
Description: Using the 1987 NMES, it was found that over four million elderly persons
residing in the community used psychotropic medicines for a mental condition in
1987. Such use is substantially greater among the elderly than other age
groups. These elderly psychotropic drug users utilize the health care system
for a wider range of conditions and illnesses, use a larger number of
nonpsychotropic medicines, and are more likely to have difficulties in basic
locomotion and movement than elderly persons who are not taking psychotropic
drugs. A notable feature of this drug use is the almost total absence of
involvement with the specialty mental health sector. These results provide a
useful baseline that raises some potential concerns, and against which results
from later periods can be evaluated. The results also suggest that the high
level of use of psychotropic drugs for mental conditions among the elderly, who
often have other substantial health problems and limitations of functioning, and
who make almost no use of the specialty mental health treatment sector, remains
a cause for concern.
Determinants of ambulatory treatment mode for mental illness. Health Economics July 2000; 9(5), pp. 423-434.
Authors: Freiman M and Zuvekas S.
Description: A reduced-form bivariate probit model was used to jointly analyze the choice for
ambulatory treatment from the specialty mental health sector and/or the use of
psychotropic drugs. Significant differences in treatment choices by education,
gender, and race/ethnicity were found. Women were more likely than men to use
specialty mental health services and more likely to use psychotropic
medications. Biases and misperceptions on the part of the patients must be
considered when interpreting these differences, as well as traditional patient
preferences. The results are further discussed in this article as they relate
to other findings and policies.
Health insurance, health reform, and outpatient mental health treatment: Who benefits? Inquiry Summer 1999; 36, pp. 127-146.
Author: Zuvekas S.
Description: This research examined the impact of proposed health policy changes on the use
of outpatient mental health treatment among adults with different mental health
needs using data from the 1987 NMES and the National Institute of Mental
Health's Epidemiologic Catchment Area Study. It was found that health insurance
substantially increases the use of treatment by those with severe mental
disorders, but that increased health insurance coverage alone cannot meet the
treatment needs of this group. It was also found that those in better mental
health account for a significant proportion of additional expenditures when
insurance coverage is expanded. The investigator concludes that policies
intended to increase access to mental health treatment must carefully consider
the potential costs of substantial increased use by those not targeted by these
policies.
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Other
The influence of parental separation on smoking initiation in adolescents. Journal of Health and Social Behaviors Mar 2002; 43(1), pp. 56-71.
Author: Kirby J.
Description: In this study, it is suggested that parental separation is one possible risk
factor for smoking initiation. To examine this, a nationally representative
sample of American adolescents was interviewed at two points in time. Two questions were addressed: Is there a relationship between parental separation
and the likelihood that an adolescent will initiate smoking? If there is a
relationship, through what factors does parental separation operate to influence
the initiation of smoking in adolescents? The findings suggest that parental
separation increases the likelihood that adolescents will start smoking. It
does so in part by raising depressive symptoms and rebelliousness in
adolescents. Despite the significance of these indirect effects, however, the
bulk of the effect of parental separation on smoking initiation is direct.
Carve outs and related models of contracting for specialty care: Framework and highlights of a workshop. American Journal of Managed Care, Jun 1998; 4 Suppl, pp. SP11-21.
Authors: Friedman B, Devers K, Hellinger F, et al.
Description: This article provides an overview of papers presented at a workshop sponsored by
AHCPR in January 1998. The papers, published in this special issue of the
American Journal of Managed Care, focus on one set of strategies: the use of
carve-outs and related models of contracting for specialty care. The defining
common feature of these contracts is that they engage providers and management
entities different from those otherwise available to care for the same patients
within a health plan. The other common feature of these arrangements is that
they receive significant attention in the marketplace and almost no attention
from research. The purpose of the workshop and this special issue of the
American Journal of Managed Care was to identify what is known and not known
about these arrangements and develop an agenda for future research.
Developing integrated mental health service delivery systems. Living in the community with disability: A cross-group perspective. 1998. V. Mor and S. Allen, editors. New York: Springer Publications.
Authors: Robinson G and Brach C.
Description: This book chapter discusses three methods for integrating mental health services
for persons with severe mental illness living in the community: case management,
capitation, and central authorities.
Maternal psychological distress: the role of children's health. Women and Health 1996; 24(1), pp. 59-75.
Authors: Hahn B and Schone B.
Description: This article examines the factors associated with psychological distress in
women, combining clinical-based studies, which have focused on children's health
and mother's distress, with sociological studies of the impact of social and
economic factors on women's distress. Using data from NMES, this research
examines the association between children's health and mother's distress, as
well as whether that relationship is mediated by socioeconomic, demographic, and
social network factors. Results of the study demonstrate that acute and chronic
conditions have different effects on maternal distress and that marital stress
affects the relationship between children's health and maternal distress by
increasing the impact of some variables and decreasing the effect of others.
These findings suggest that children's health has an important effect on
symptoms of maternal distress; the results also suggest that the role of
children's health must be considered in the context of other economic and social
factors.
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Evidence-Based Practice Reports
Under the Evidence-based Practice Program at AHRQ, 12 5-year contracts have been
awarded to institutions in the United States and Canada to serve as Evidence-based
Practice Centers (EPCs). The EPCs review all relevant scientific
literature on assigned clinical care topics and produce evidence reports and
technology assessments, conduct research on methodologies and the effectiveness
of their implementation, and participate in technical assistance activities.
Public and private-sector organizations may use the reports and assessments as
the basis for their own clinical guidelines and other quality improvement activities. All evidence reports produced by AHRQ are available online.
Following is a list of completed evidence reports related to mental health.
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Attention-Deficit/Hyperactivity
Jadad AR, Boyle M, Cunningham C, et al. Treatment of Attention-Deficit/Hyperactivity Disorder. Evidence Report/Technology Assessment Number 11. (Prepared by McMaster University, Hamilton, Ontario, Canada under Contract No. 290-97-0017.) AHRQ Pub. No. 00-E005. Rockville, MD: Agency for Healthcare Research and Quality. Nov. 1999.
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Depression
Mulrow CD, Williams JW, Trivedi M, et al. Treatment of Depression: Newer
Pharmacotherapies. Evidence Report/Technology Assessment Number 7. (Prepared by
the San Antonio Evidence-based Practice Center based at the University of Texas
Health Science Center at San Antonio under Contract No. 290-97-0012.) AHCPR Pub.
No. 99-E014. Rockville, MD: Agency for Health Care Policy and Research. Feb.
1999.
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Alcohol Dependence
West SL, Garbutt JC, Carey TS, et al. Pharmacotherapy for Alcohol Dependence.
Evidence Report/Technology Assessment Number 3. (Prepared by the Research
Triangle Institute, Research Triangle Park, NC under Contract No. 290-97-0011)
AHCPR Pub. No. 99-E004. Agency for Health Care Policy and Research. Jan. 1999.
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Clinical Guidelines
AHRQ-supported clinical practice guidelines are in the public domain within the
United States and may be used and reproduced without special permission. HSTAT
(Health Services/Technology Assessment Text), a free electronic service,
provides computer access to the full text of clinical practice guideline
products and can be accessed at http://text.nlm.nih.gov. The HSTAT site
includes AHRQ-supported guidelines, quick reference guides, and consumer guides
in both English and Spanish on common clinical conditions. Following are
descriptions of mental-health-related guidelines developed by AHRQ.
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Treating Tobacco Use and Dependence
Chair of the Guideline Panel: Michael C. Fiore, M.D., M.P.H., University of Wisconsin
Center for Tobacco Research and Intervention
This Public Health Service clinical practice guideline, developed by a private-sector
panel of experts convened by a consortium of Federal and nonfederal
partners, was issued in June 2000. AHRQ was among the partners. The guideline
was developed to assist all health care providers, especially those with direct
patient contact, to help tobacco users quit.
These materials are available at www.surgeongeneral.gov/tobacco/default.htm and through the AHRQ Web site (www.ahrq.gov). Tobacco guideline materials
are available through the AHRQ Publications Clearinghouse.
This Public Health Service tobacco guideline supersedes an earlier AHRQ-sponsored guideline on smoking cessation.
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Depression in Primary Care
Chair of the Guideline Panel: A. John Rush, M.D., University of Texas Southwestern Medical Center.
These clinical practice guidelines were developed to assist primary care
providers, including physicians, nurse practitioners, mental health nurse
specialists, physician assistants, social workers, and others in the diagnosis
of depressive conditions and the treatment of major depressive disorders. The
guidelines were published in 1993 and were based primarily on research done in
psychiatric settings. They included a clinical practice guideline, a quick
reference guide for clinicians, and a patient guide. These guideline products
are no longer current and are provided for archival purposes only at www.ahrq.gov/clinic/cpgarchv.htm. Several individuals who participated in the development of the original guidelines have reviewed studies published between 1992 and 1998 on treatment of depression in primary care settings.
For more information, see "Treating Major Depression in Primary Care Practice: An Update
of the Agency for Health Care Policy and Research Practice Guidelines," by
Herbert C. Schulberg, Wayne Katon, Gregory E. Simon, and A. John Rush in the
December 1998 Archives of General Psychiatry 55, pp. 1121-1127. CD-ROM disks
featuring the depression guidelines, including the quick reference guide and
patient booklets, are available at all 600 Federal Depository Libraries located
throughout the country and at many medical libraries in hospitals, universities,
and managed care organizations.
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Early Identification of Alzheimer's and Related Dementias
Co-Chairs of the Guideline Panel: Paul T. Costa, Jr., Ph.D., National Institute on
Aging, and T. Franklin Williams, M.D., FACP, University of Rochester Medical
Center.
These guidelines were developed to aid clinicians, patients, and family members
in the recognition, diagnosis, and treatment of Alzheimer's disease and related
dementias. They included a clinical practice guideline, a quick reference guide
for clinicians, and a patient and family guide. These guideline products are no
longer current and are provided for archival purposes only at: www.ahrq.gov/clinic/cpgarchv.htm.
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National Guideline Clearinghouse™
The National Guideline Clearinghouse™ (NGC) is a comprehensive database of
evidence-based clinical practice guidelines and related documents. This
database is produced by AHRQ, in partnership with the American Medical
Association and the American Association of Health Plans. The NGC mission is to
provide physicians, nurses, and other health professionals, health care
providers, health plans, integrated delivery systems, purchasers, and others an
accessible mechanism for obtaining objective, detailed information on clinical
practice guidelines and to further their dissemination, implementation, and use.
Key components of the NGC include:
- Structured abstracts (summaries) about the guideline and its development.
- A utility for comparing attributes of two or more guidelines in a side-by-side comparison.
- Syntheses of guidelines covering similar topics, highlighting areas of similarity and difference.
- Links to full-text guidelines, where available, and/or ordering information for print copies.
- An electronic forum, NGC-L, for exchanging information on clinical practice guidelines, their development, implementation, and use.
- Annotated bibliographies on guideline development methodology, implementation, and use.
Currently, 100 mental-health-related guidelines are housed in the NGC. They are
broken down into the following related subconcepts:
- Adjustment disorders—3 guidelines.
- Anxiety disorders—9 guidelines.
- Delirium, dementia, amnestic, cognitive disorders—23 guidelines.
- Dissociative disorders—1 guideline.
- Eating disorders—4 guidelines.
- Factitious disorders—1 guideline.
- Impulse control disorders—1 guideline.
- Mental disorders diagnosed in childhood—24 guidelines.
- Mood disorders—19 guidelines.
- Neurotic disorders—1 guideline.
- Personality disorders—2 guidelines.
- Schizophrenia and disorders with psychotic features—6 guidelines.
- Sexual and gender disorders—4 guidelines.
- Sleep disorders—12 guidelines.
- Somatoform disorders—1 guideline.
- Substance-related disorders—26 guidelines.
The Web address for the NGC is: www.guideline.gov.
It can also be accessed through the AHRQ Web site.
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User Liaison Program
The User Liaison Program (ULP), established in 1978, contributes to AHRQ's
mission by timely synthesis and dissemination of research findings to State
policymakers and researchers. ULP's flagship products are small policy-thematic
workshops and skill-building workshops, as well as workshops designed for
specific States on request. The program also produces teleconferences and
written products such as issue summaries, Web-based materials, and distance
learning programs. In addition to providing information and tools to make
informed health policy decisions, ULP serves as a bridge between State and local
health policymakers and the health services research community, by bringing back
to AHRQ the research questions being asked by key policymakers. Following are
brief descriptions of workshops related to mental health.
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Depression: Implications for State and Local Health Care Programs
This workshop was designed for State and local health officials from the executive and legislative branches responsible for designing, implementing, and managing programs and policies that influence the delivery of health services, particularly services related to depression. The workshop was held in Washington, DC, July 10-12, 2000.
At the completion of this workshop, participants were expected to be better able to:
- Understand the impact of depression and how it is addressed within the current health care system.
- Put into operation an evidence-based framework to consider health care system strategies to improve the diagnosis and treatment of the condition.
- Assess the latest health services research findings to identify promising approaches to meeting the needs of patients with depression.
- Analyze promising strategies and initiatives implemented by public and private organizations to better serve people suffering from depression.
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Improving the Outcomes of State Health and Human Service Initiatives: Integrating Mental Health and Substance Abuse Strategies
This seminar offered State executive and legislative officials and senior-level State policymakers information to develop a better understanding of the individual insurance market and the impact that implemented reforms have had to date. It was held in Albuquerque, New Mexico, July 19-21, 1999.
The workshop objectives were developed to provide participants with:
- Important research about the nature of the mental health/substance abuse (MH/SA) problems that exist within program populations.
- Information on key trends and developments in the finance and delivery of MH/SA services.
- The opportunity to examine the cutting-edge efforts of States that are promoting better outcomes from program initiatives by incorporating MH/SA strategies.
- An examination of issues and opportunities regarding evaluation and impact of MH/SA-related strategies and interventions.
- A forum for discussing challenging issues within their own States and for sharing insights and lessons learned among participants.
The set of audiotapes from this workshop (AHRQ No. 00-AV04) is available for free from the AHRQ Clearinghouse. Call the AHRQ Publications Clearinghouse, 1-800-358-9295; or E-mail them at AHRQPubs@ahrq.hhs.gov.
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Reducing Violence: Issues, Options, and Opportunities for State Governments
This workshop was designed for State and local officials and others responsible for initiating and supporting violence prevention policies and programs. The workshop was held in Albuquerque, NM, on February 7-9, 2000.
At the completion of this workshop, participants were expected to be better able to:
- Assess research findings on violence reduction strategies.
- Put into operation a research-based framework to help guide the design of effective violence prevention strategies.
- Identify and use a range of strategies and policies regarding school and youth violence, intimate partner violence, suicide, and child/elder abuse.
- Determine methods that States and localities can use to collect and analyze data for design, monitoring, and evaluation of violence prevention initiatives.
- Recognize and take advantage of opportunities to play a leadership role in developing effective violence prevention initiatives in their communities.
The set of audiotapes from this workshop (AHRQ No. 00-AV09) is available for $25
from the AHRQ Clearinghouse. Call the AHRQ Publications Clearinghouse, 1-800-358-9295; or E-mail them at AHRQPubs@ahrq.hhs.gov.
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Other Activities
U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force (USPSTF), an independent panel of
private-sector experts in primary care and prevention, was convened by the U.S. Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and chemoprophylaxis. The Task Force's pioneering efforts culminated in the 1989 Guide to Clinical Preventive Services. A second edition of the guide, published in 1996, included assessments of more than 200 services offered in primary care settings for adults, pregnant women, and children. Now a third USPSTF is updating assessments and recommendations and addressing new topics.
The mission of the Task Force is to:
- Evaluate the benefits of individual services.
- Create age-, gender-, and risk-based recommendations about services that should routinely be incorporated into primary medical care.
- Identify a research agenda for clinical preventive care.
Additional mental-health-related topics are in progress. They include:
- Screening: Dementia, family violence.
- Counseling: Avoiding problem drinking, prevention of suicide risk, prevention of youth violence.
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Foundation for Accountability Abstracts
AHRQ funded a series of scientific papers to support the performance measurement efforts of the Foundation for Accountability (FACCT). The authors of these papers reviewed the science base and provided recommendations on measures. FACCT had identified the topics covered in this series—population-level measurement areas such as satisfaction and a number of clinical conditions—as first priorities. The following mental-health related report is available.
Measuring Health Care Quality: Major Depressive Disorder—This discussion paper analyzes assessment tools for major depressive disorder (MDD) along the following dimensions:
- Diagnostic status, remission, and relapse.
- Severity of illness.
- Patient functioning and quality of life.
- Disease management.
- Family social support and family burden.
- Patient satisfaction.
- Disease progression.
The authors make recommendations concerning effective measures to use, measurement strategy, and risk adjustment. They then describe a number of quality measurement (accountability) systems. The authors conclude that measurement tools for MDD are readily available and can be used in conducting accountability systems.
This discussion paper was written by G. Richard Smith, Cindy L. Mosley, and Brenda M. Booth, of the Center for Outcomes Research and Effectiveness, University of Arkansas for Medical Sciences. A print copy is available for free from the AHRQ Publications Clearinghouse, AHCPR Publication No. 96-N023.
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HIV Cost and Services Utilization Study
The HIV Cost and Services Utilization Study (HCSUS) was the first major research effort to collect information on a nationally representative sample of people in care for HIV infection. HCSUS examines costs of care, utilization of a wide array of services, access to care, quality of care, quality of life, unmet needs for medical and nonmedical services, social support, satisfaction with medical care, and knowledge of HIV therapies. HCSUS is funded through a cooperative agreement between AHRQ, several other Federal agencies, and RAND. HCSUS is addressing a broad array of issues relevant to public policy formulation and health services research including:
- Cost, use, and quality of care.
- Access to care.
- Unmet needs for care.
- Quality of life.
- Social support.
- Knowledge of HIV.
- Clinical outcomes.
- Mental health.
- The relationship of these variables to provider type and patient characteristics.
Findings: A national sample of 2,864 HIV-infected adults receiving medical care
were enrolled in HCSUS. The study showed that revealing their HIV-positive
status triggered physical assaults on about 45 percent of the HIV-infected
people who were attacked by someone close to them. Overall, 21 percent of
women, 12 percent of men who reported having sex with men, and 8 percent of
heterosexual men reported physical harm after their HIV diagnosis.
Women who identified themselves as gay, lesbian, or bisexual reported partner or other
relationship violence nearly as often as women who self-identified as
heterosexual (24 vs. 20 percent). Yet women living with a male vs. female
sexual partner were almost three times more likely to report violence after
their HIV diagnosis (25 vs. 9 percent). Also, women whose CD4 cell counts were
at least 500 reported nearly 75 percent more violence than women with lower cell
counts, suggesting that revealing HIV status may have triggered the violence.
National surveys of U.S. women aged 19-29 years in poor families indicate that 6
percent have been assaulted, which is less than one-third the rate reported by
the HIV-infected women surveyed by HCSUS.
Men at higher risk of being assaulted were those who reported having sex with men, were 40 years of age or younger, were Hispanic, self-identified as gay or bisexual, had no financial assets, had a female partner, were homeless, or reported a history of drug dependence. Men with a high school education or less had nearly three times the odds of being harmed as more educated men.
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AHRQ Domestic Violence Scholar-in-Residence
Jeffrey Coben, M.D., Associate Professor of Emergency Medicine, Surgery, and Public Health at the Hahnemann School of Medicine, Medical College of Pennsylvania, and Director, Center for Violence and Injury Control at Allegheny General Hospital, West Penn Allegheny Health System, was the AHRQ Domestic Violence Scholar-in-Residence from September 2000 to July 2001. This program was co-supported by the Family Violence Prevention Fund.
Dr. Coben worked with AHRQ's Center for Outcomes and Effectiveness Research on several projects that will provide scientific information on the cost, quality, outcomes, and effectiveness of domestic violence screening and interventions available to domestic violence victims in health care settings. The Donabedian model to measure quality of health care looks at the structure, process, and outcomes of the program. AHRQ attempts to achieve its mission through health services research, a field that investigates the structures, processes, and effect of health care services. The Scholar in Residence examined health care services as they relate to domestic violence, particularly the structure and process aspects. The goal is to better define these issues.
Findings: A toolkit designed to permit a formal assessment of a hospital's performance in implementing a program to deal with intimate partner violence (IPV) is near completion. The instrument contained in this toolkit was developed based on input from a panel of 19 experts, including IPV researchers, advocates, and program planners. The Delphi process of consensus development was used, and the panelists were instructed to concentrate on structural and process measures of program performance.
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AHRQ Publication No. 03-0001
Current as of January 2003
Internet Citation:
Compendium of Research Related to Mental Health. Program Note 6. AHRQ Publication No. 03-0001, January 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/mentalcomp/