Outcomes of Pharmaceutical Therapy
of HIV
Disease
Grant/Contract Number: HS07809
Project Period: 02/93-01/98
Principal Investigator: Richard D. Moore, M.D.
Institution: Johns Hopkins University
Baltimore, MD 21205
Purpose: To (1) develop a comprehensive longitudinal database of
human immunodeficiency virus (HIV) infected individuals cared for
in an urban setting, (2) examine the effectiveness of
antiretroviral and antimicrobial therapies in preventing
progression of HIV disease and its complications, (3) determine
the association of surrogate laboratory markers with clinical
outcomes, (4) delineate the frequency and consistency of
prescription drug use, and (5) identify the sociodemographic and
clinical patient characteristics associated with consistent use
of and response to drug therapy.
Cost Effective Management of HIV
Related Illness
Grant/Contract Number: HS06694
Project Period: 07/90-06/93
Principal Investigator: Anna N.A. Tosteson, Sc.D.
Institution: Dartmouth Medical School
Lebanon, NH 03756
Purpose: To (1) develop a model for HIV infected patients
presenting with central nervous system disorders (CNS model), (2)
integrate the CNS model with previously developed models
for respiratory disorders, and (3) explore the feasibility of
developing a natural clinical history model of HIV infection.
The CNS model assessed the life expectancy, quality adjusted life
expectancy, short term morbidity, cost, and cost effectiveness of
all clinically reasonable management strategies.
A Health Status Measure to Evaluate Drug
Therapy for PCP
Grant/Contract Number: HS07824
Project Period: 09/93-08/95
Principal Investigator: Albert W. Wu, M.D., M.P.H.
Institution: Johns Hopkins University
Baltimore, MD 21205
Purpose: To examine the reliability and validity of a brief
health status measure for acquired immunodeficiency syndrome
(AIDS) patients infected with Pneumocystis carinii pneumonia
(PCP). The study analyzed data collected in a randomized AIDS
clinical trial comparing three treatment regimens for acute PCP.
The results help in planning future AIDS trials incorporating
health status measures.
Prostate Cancer: A Retrospective Survival Analysis
Grant/Contract Number: HS06770
Project Period: 04/91-07/94
Principal Investigator: Peter C. Albertsen, M.D., M.S.
Institution:University of Connecticut
Farmington, CT 06032-9984
Purpose: To calculate the disease-specific mortality rate for conservatively treated localized
prostate cancer. Using a detailed retrospective analysis, the study compared this rate with the
general population of men alive during the same time period. The implications of the findings for
clinical practice and health policy and future research are important. The study led to a better
understanding of the natural progression of prostate cancer and provided the necessary statistical
and ethical foundation for constructing case-control studies and treatment algorithms.
Breast and Colon Screening Evaluated by Cancer Mortality
Grant/Contract Number: HS07038
Project Period: 12/91-02/97
Principal Investigator: Graham A. Colditz, M.D., Dr.P.H.
Institution: Channing Laboratory
Boston, MA 02115
Purpose: To evaluate the effectiveness of screening for breast and colon cancers. Breast
screening behaviors are being evaluated in relation to age-specific breast cancer mortality during 5
years of followup. Using data from the Health Professionals Follow-up Study and Nurses' Health
Study, a model of colon cancer incidence and mortality will be developed to estimate the number
of colon cancers prevented through screening.
Care, Costs, and Outcomes of Local Breast
Cancer (PORT
II)
Grant/Contract Number: HS08395
Project Period: 09/94-09/99
Principal Investigator: Jack Hadley, Ph.D.
Institution: Georgetown University Medical Center
Washington, DC 20007
Purpose: To identify the determinants of and calculate
cost-effectiveness ratios for three alternative treatments for
local breast cancer in the elderly: modified radical mastectomy
(MRM), breast-conserving surgery (BCS) with radiotherapy (RT),
and BCS without RT. A prospective convenience cohort of newly
diagnosed elderly (65+) breast cancer patients are being
interviewed post treatment and followed for up to 2 years; their
surgeons are being surveyed; and surveys of nationally
representative, retrospective, random samples of breast
cancer surgeons and their patients are being conducted. The
project will develop clear recommendations regarding the
appropriateness of observed patterns of treating local breast
cancer in the elderly, taking account of circumstances that may
differ with age, initial health, and access to different types of
providers.
Cancer Prevention for Minority Women in a Medicaid HMO
Grant/Contract Number: HS07720
Project Period: 09/93-09/96
Principal Investigator: Alan L. Hillman, M.D., M.B.A.
Institution: University of Pennsylvania
Philadelphia, PA 19104-6218
Purpose: To investigate the impact of feedback and financial incentives on compliance with
cancer screening guidelines in a mandatory Medicaid health maintenance organization. With a
focus on improving the quality of care delivered to a traditionally underserved minority
population, the study investigated whether the provision of feedback to primary care sites every 6
months, when linked to a financial bonus program specifically based on the extent of cancer
prevention provided, improves on primary care provider attention to prevention for women aged
50 years and older. Approximately 100 primary care sites participated in the prospective,
randomized controlled study. Computerized scoring algorithms were used to determine
compliance.
Enhanced Accuracy of MRI for Staging Prostate
Cancer
Grant/Contract Number: HS07027
Project Period: 12/91-12/95
Principal Investigator: Barbara J. McNeil, M.D., Ph.D.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To identify the perceptual features of magnetic
resonance imaging (MRI) that are diagnostically relevant and to
aid the image reader in numerically scaling those features and
combining them into an estimate of the probability of the disease
stage in question. An evaluation involving five MRI readers was
conducted to compare their average accuracy in reading the cases
in the standard manner with their average accuracy in reading as
enhanced by perceptual and decision techniques. Steps in this
project included interviews and consensus meetings with experts,
perceptual studies, and psychometric analyses.
Evaluation of Practice Variations and Costs
for Cancer
Grant/Contract Number: HS06589
Project Period: 08/91-07/94
Principal Investigator: Sheldon M. Retchin, M.D., M.S.P.H.
Institution: Medical College of Virginia
Richmond, VA 23298-0270
Purpose: To (1) evaluate the choice of initial treatment for
cancer; (2) assess the influence of initial choice of therapy,
patient characteristics, tumor characteristics, comorbidity, and
geographic location on outcomes; and (3) estimate the costs of
cancer care according to patient characteristics, tumor stage,
type of cancer, as well as comorbid illnesses. The study used
tumor registry, Medicare claims, and state personal income tax
data. The results help policymakers in their efforts to reduce
practice variations and therefore improve the effectiveness of
care for cancer patients.
Regional Variation in Cancer Treatment and Mortality
Grant/Contract Number: HS06879
Project Period: 04/91-07/93
Principal Investigator: Jonathan M. Samet, M.D., M.S.
Institution: The Johns Hopkins University
Baltimore, MD 21205-2179
Purpose: To develop a comprehensive multivariate model of the risk of death and other adverse
health outcomes as functions of a common set of important risk factors, using data from the 1987
National Health and Nutrition Examination Survey Epidemiological Follow-up Study. The model
provided a picture of the impact of different risk factors on health. It permitted the effects of a
wide variety of interventions against those risk factors to be estimated in a common framework so
that valid comparisons could be made across interventions.
Treatment Choices and Outcomes in Prostate
Cancer (II)
Grant/Contract Number: HS08208
Project Period: 04/94-03/99
Principal Investigator: James A. Talcott, M.D., S.M.
Institution: Dana Farber Cancer Institute
Boston, MA 02115
Purpose: To enhance the understanding of treatment for early
prostate cancer by extending the project's multidisciplinary,
multi-institutional pilot study to an additional 600 patients.
The purpose of the pilot study is to develop the most effective
approach to creating a large scale database to assess global and
disease specific health and symptom status before treatment, and
3 and 12 months later. The project assesses issues of
generalizability by comparing the results of the study with a
population-based cohort of early prostate cancer patients in
Hartford, Conn., and a cross sectional survey of patients in a
California health maintenance organization. It also evaluates
the economic costs of alternative treatments, including indirect
costs.
Treatment Choices and Outcomes in Prostate
Cancer (I)
Grant/Contract Number: HS06824
Project Period: 01/92-12/93
Principal Investigator: James A. Talcott, M.D., S.M.
Institution: Dana Farber Cancer Institute
Boston, MA 02115
Purpose: To characterize (1) the appropriateness of staging
studies preceding therapy for newly diagnosed early prostate
cancer patients; (2) the variability in treatment choices; and
(3) patient functional, psychosocial, and psychosexual outcomes 6
months after treatment, and the factors influencing each of these
outcomes. This multidisciplinary, multi institutional pilot
study tested the feasibility of collecting highly detailed
information from newly diagnosed cancer patients, and provided
descriptive, hypothesis generating data necessary to design
definitive studies of treatment variability, patient decision
making, and functional outcomes of treated patients with early
prostate cancer.
Breast Cancer Screening Policy and
Practice
Grant/Contract Number: HS06545
Project Period: 09/91-09/94
Principal Investigator: Thomas R. Taylor, M.D., Ph.D.
Institution: University of Washington
Seattle, WA 98195
Purpose: To (1) describe primary care physician performance
related to screening mammography in a randomly selected group of
family medicine practices, (2) identify factors associated with
differences in primary care physician decision policies and
practice, and (3) test the efficacy of an educational
intervention based on physician decision policies in improving
physician breast cancer screening practice. Reviews of medical
records were conducted to examine the characteristics of 60
randomly selected practices, and 236 practices were randomly
assigned to one of two interventions or a control group.
Right Heart Catheterization: Appropriate/Effective Use
Grant/Contract Number: HS08354
Project Period: 07/96-06/98
Principal Investigator: Alfred F. Connors, Jr., M.D.
University of Virginia
Charlottesville, VA 22908
Purpose: To determine the (1) the effectiveness of right heart catheterization (RHC) in terms of
survival, functional status, quality of life, and satisfaction with care; (2) variation in use of RHC in
seriously ill patients; and (3) association of RHC and utilization of resources in the critically ill.
The study will use the Cleveland Health Quality Choice Project, the APACHE III, and the
SUPPORT datasets. These datasets are designed to allow adjustment for severity of illness,
diagnosis, acute physiology, and other important patient characteristics; demonstrate large
interhospital differences in use of RHC; and are representative of both critically ill patients in
general and of the current use of RHC. The results of this study will be of direct relevance to
health policy makers, to purchasers of medical care, to physicians and their patients who seek
guidance in the effective use of RHC, and to investigators who wish to refine the indications for
use of this common and expensive technology.
Outcome Assessment Program in Ischemic Heart Disease
(PORT)
Grant/Contract Number: HS06503
Project Period: 07/90-12/95
Principal Investigator: Elizabeth R. DeLong, Ph.D.
Institution: Clinical Research Institute
Durham, NC 27705
Purpose: To identify sources of variation in the medical care of patients with chronic ischemic
heart disease. The study aimed to (1) develop strategies for the appropriate referral of patients
for cardiac catheterization and for
the revascularization with either coronary angioplasty or bypass surgery; and (2) examine the
variations in the use
of cardiac catheterization, angioplasty, and bypass surgery that result in adverse outcomes or
inappropriate use
of resources.
CORSAGE: A Hybrid Expert System for
Myocardial
Infarction
Grant/Contract Number: HS06065
Project Period: 07/88-06/93
Principal Investigator: George A. Diamond, M.D.
Institution: Cedars Sinai Medical Center
Los Angeles, CA 90048
Purpose: To develop and evaluate an expert system called
CORSAGE, which serves as an interface between a relevant clinical
database and the practicing physician. It also aids the
management of patients admitted to the coronary care unit with a
suspected myocardial infarction. By implementing CORSAGE, the
monetary cost of care, length of hospital stay, subsequent
coronary event rate, and quality of life will be measured. The
study quantified physician acceptance and used epidemiologic
followup and psychosocial assessment to determine the impact on
patient management.
Outcomes Following Community Interventions
for Acute
MI
Grant/Contract Number: HS06473
Project Period: 04/91-03/95
Principal Investigator: Mickey S. Eisenberg, M.D., Ph.D.
Institution: Kings County Emergency Medical Services
Seattle, WA 98164
Purpose: To measure the effectiveness of interventions
encouraging people with symptoms of an acute myocardial
infarction (AMI) to seek medical care early and to call 911 for
paramedic evaluation to reduce AMI mortality. Two types of
interventions were tested: (1) personalized mailings and (2)
mailings and a phone call from a public health nurse. Each
intervention had a control group to be compared with, and each
was preceded by an awareness campaign via television and radio.
Outcomes of this prospective, randomized trial were determined by
a community wide hospital surveillance system.
Cost/Utility of Stroke Prevention
Grant/Contract Number: HS06098
Project Period: 12/88-12/93
Principal Investigator: Theodore G. Ganiats, M.D.
Institution: University of California
La Jolla, CA 92093-0807
Purpose: To evaluate the relative benefit cost/utility of
various practice styles across the United States, using the
General Health Policy Model and Quality of Well Being
questionnaire. The project worked in conjunction with medical
schools involved in two National Institutes of Health (NIH)
studies of two significant risk factors of stroke: asymptomatic
carotid atherosclerosis and nonvalvular atrial fibrillation.
Telephone interviews focusing on quality of life issues were
conducted with all consenting participants of both NIH studies.
The results of the study helped to inform physicians in making
treatment decisions by adding quality of life information to the
NIH studies.
Effectiveness/Outcomes Linkages in CHF by
Neurocomputing
Grant/Contract Number: HS06830
Project Period: 09/93-08/97
Principal Investigator: Philip H. Goodman, M.D., M.S.
Institution: University of Nevada
Reno, NV 89520
Purpose: To (1) evaluate the usefulness of neurocomputational techniques for extracting
clinically meaningful information from massive health care databases; (2) exploit the ability of
neural networks to discern multivariate patterns (i.e., cluster meaningful local interactions among
predictor variables) in order to select important predictors and detect heretofore unanticipated
patterns of comorbidity, service utilization, and practice style; and (3) obtain practical health
services results useful for concurrently evaluating and improving the practice of coronary artery
bypass surgery. The study is using case and administrative records.
Diagnostic Uncertainty and Variation in Use of
Services
Grant/Contract Number: HS06409
Project Period: 09/90-12/92
Principal Investigator: Lee A. Green, M.D., M.P.H.
Institution: University of Michigan
Ann Arbor, MI 48109-0708
Purpose: To demonstrate that differences in hospital admission
rates for acute ischemic heart disease result directly from
different physician decision making patterns, and to show that
the differences are concentrated among those patients presenting
the greatest uncertainty in diagnosis. This study was
accomplished by comparing doctors' hospital admission decisions
under conditions of uncertainty in two demographically similar
communities with differing rates of hospital use. A
retrospective examination of decisions to admit or release
approximately 1,000 patients was conducted.
Assessing Risk Factors and Hospital Quality for CABG
Grant/Contract Number: HS07086
Project Period: 09/91-09/94
Principal Investigator: Edward L. Hannan, Ph.D., M.S.
Institution: State University of New York
Rensselaer, NY 12144-3456
Purpose: To (1) determine which preoperative risk factors are significantly related to the
probability of a coronary artery bypass graft (CABG) patient experiencing an in-hospital mortality
or perioperative complicatio; and (2) use this information to assess the relative quality of care
provided by hospitals and surgeons performing CABG. This project, an extension of a previous
study conducted by the investigators, used a new and substantially expanded database to identify
preoperative risk factors and to relate them to perioperative complications.
Cardiac Arrhythmia Management: Patient and
Economic Outcomes (PORT II)
Grant/Contract Number: HS08362
Project Period: 08/94-07/99
Principal Investigator: Mark A. Hlatky, M.D.
Institution: Stanford University
Stanford, CA 94305-5092
Purpose: To develop a comprehensive decision model to screen and
treat patients at risk for sudden cardiac death due to
ventricular arrhythmias. Information regarding mortality,
morbidity, functional status, quality of life, cost, and patient
preferences are being incorporated in the model. Six
interrelated projects are being performed to accomplish this
goal. The study involves use of administrative data and a nested
case control study to determine risk factors.
CNNC and Outcomes in Cardiovascular Surgical
Population
Grant/Contract Number: HS06611
Project Period: 08/90-08/91
Principal Investigator: Mary E. Kerr, Ph.D., R.N.
Institution: University of Pittsburgh
Pittsburgh, PA 15261
Purpose: To examine the effectiveness of a taxonomy of nursing
diagnoses—Conditions that Necessitate Nursing Care
(CNNC)—in predicting selected patient outcomes following
cardiovascular surgery. The nursing care needs were measured at
four time points: (1) at hospital admission, (2) 24 hours after
surgery, (3) when transferred from the intensive care unit,
and (4) on the day of discharge. Functional health status and
quality of life factors were also measured in 100 patients
undergoing coronary artery bypass graft surgery. This study
provided health care institutions with a method to assess the
effect of nursing care on patient outcomes.
Cardiac Procedure Use: A Prospective Cohort Study
Grant/Contract Number: HS08302
Project Period: 09/96-08/00
Principal Investigator: Thomas H. Lee, M.D., M.Sc.
Partners Community Healthcare, Inc.
Boston, MA 02199-8001
Purpose: To evaluate the reasons for the racial and gender differences in the use of cardiac tests
and procedures. This prospective cohort study will examine the use of exercise tolerance tests,
coronary angiography, coronary artery bypass surgery, and percutaneous transluminal coronary
angioplasty over a 1-year period for approximately 3,400 patients with acute chest pain, of whom
approximately 2 percent will be African American and 50 percent will be women. The study will
test the following hypotheses: (1) African Americans and women are as likely as whites and
males to undergo procedures if they meet criteria for appropriateness, but are less likely to
undergo procedures if the appropriateness of a procedure is uncertain; (2) the probability that a
patient will undergo an invasive cardiac procedure is influenced by attitudes toward the risk of
procedures; and (3) the outcomes of patients with chest pain are not influenced by race and
gender and use of procedures if adjustments are made for their clinical and nonclinical data.
Secondary and Tertiary Prevention of Stroke (PORT)
Grant/Contract Number: 290-91-0028
Project Period: 09/91-03/00
Principal Investigator: David Matchar, M.D.
Institution: Duke University
Durham, NC 27705
Purpose: To investigate clinical strategies for preventing stroke in people who are at high risk for
such events. This investigation identifies and explains variations in clinical strategies for stroke
prevention, including medical interventions such as aspirin and anticoagulants, and surgical
interventions such as carotid endarterectomy. These clinical strategies are analyzed in terms of
relative patient outcomes, resource use, and scientific uncertainties. Specific groups targeted in
this effort include patients who have had either minor strokes or transient ischemic attacks (TIAs),
as well as individuals who have never had strokes or TIAs but who do have either medically
defined markers of cerebrovascular disease or conditions associated with embolism.
Prospective Outcome Study of Intermittent Claudication
Grant/Contract Number: HS07184
Project Period: 08/93-07/97
Principal Investigator: Walter J. McCarthy, M.D.
Institution: Northwestern University Medical School
Chicago, IL 60611
Purpose: To analyze treatment selection and outcomes for approximately 600 consecutive
patients who make an initial visit to 20 Chicago-area vascular surgeons and are diagnosed with
intermittent claudication. The objectives are to (1) model selection for treatmen; (2) evaluate the
effects of smoking and exercise habits on outcomes for treated and untreated patients; and
(3) describe and evaluate the clinical and functional outcomes within and between treatment
groups. Patients are surveyed at baseline and during home visits; clinical data are abstracted from
office, laboratory, and hospital records; and surgeons are surveyed.
Health Related Quality of Life in
Intermittent
Claudication
Grant/Contract Number: HS06675
Project Period: 09/90-06/92
Principal Investigator: Martha D. McDaniel, M.D.
Institution: Veterans Administration Medical Center
White River Junction, VT 05009
Purpose: To develop an accurate instrument for the evaluation of
health related quality of life in a broad range of patients with
intermittent claudication (deficient arterial blood supply in an
exercising muscle). The pilot study used this instrument to
study the relative effects on functional health of a range of
therapies for intermittent claudication. A questionnaire was
administered and tests on resting flow, pressure measurements,
and treadmill were conducted.
The Consequences of Variation in Treatment
for Acute
Myocardial Infarction (PORT)
Grant/Contract Number: HS06341
Project Period: 09/89-02/95
Principal Investigator: Barbara J. McNeil, M.D., Ph.D.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To study the treatment of acute myocardial infarction
(AMI), specifically, the use of diagnostic and therapeutic
interventions during and shortly after hospitalization for AMI,
and their value in improving patient survival, health status,
functional capacity, and quality of life in the chronic post AMI
period. The results of these analyses were used to develop and
disseminate recommendations that will help physicians effectively
treat AMI patients.
Quality of Care Measures for Cardiovascular Patients
Grant/Contract Number: HS09487
Project Period: 09/96-09/01
Principal Investigator: Barbara J. McNeil, M.D., Ph.D.
Institution: Harvard Medical School
Boston, MA 02115
Purpose: To address the care of individuals with chronic diseases of the cardiovascular system,
particularly those affecting vulnerable populations such as the elderly, the poor, or minority
groups, with the development of a set of quality measures. The clinical performance measures
will link all sites of care for patients from the inpatient setting to the rehabilitation setting. The
study will involve work with four health plans Allina, Pacificare, United HealthCare, and
Prudential at four delivery sites, and through them will be able to evaluate patients in a variety
of financing systems. These performance measures will range from components of care (e.g.,
treatment approaches) to individual processes within components (e.g., a particular drug
type).
Angina in Primary Care
Grant/Contract Number: HS06901
Project Period: 02/92-01/97
Principal Investigator: Alvin Ira Mushlin, M.D., Sc.M.
Institution: University of Rochester
Rochester, NY 14642
Purpose: To improve the diagnosis and outcome of patients in the
primary care system with suspected angina. The accuracy of
diagnostic tests is being calculated with reference to
followup information about patients' clinical course and
functional status outcomes. Information from this project will
be linked to the stable angina PORT to develop guidelines for
more informed diagnostic decision making in primary care
settings.
Primary Care Lipid Practice and
Policy
Grant/Contract Number: HS06574
Project Period: 09/90-02/94
Principal Investigator: William E. Neighbor, M.D.
Institution: University of Washington
Seattle, WA 98195
Purpose: To validate Case Policy Analysis as a measure of lipid
screening and management practices in hypertensive patients, and
to develop and pilot an intervention based on case policy
feedback as a means of modifying physician practice. The study
determined the degree to which primary care physician clinical
decision policies accurately reflect practice in screening and
management of hypercholesterolemia in hypertensive patients. It
also identified factors associated with differences in primary
care physician decision policies and practice.
Home-Based Exercise in Patients with Heart Failure
Grant/Contract Number: HS08772
Project Period: 07/95-06/97
Principal Investigator: Roberta K. Oka, D.N.Sc., R.N.
Institution: University of California
San Francisco, CA 94143-0610
Purpose: To evaluate the efficacy of a physical activity program versus usual care in improving
physical performance and quality of life/well-being in eligible patients with New York Heart
Association class II to IV heart failure, stable for at least 3 months. The study tests the
hypothesis that individuals who receive the physical activity regimen will demonstrate significant
improvements in physical fitness, functional status, and quality of life/well-being compared with
subjects in the usual care group.
Predictions and Outcomes in Congestive Heart
Failure
Grant/Contract Number: HS06274
Project Period: 04/90-03/95
Principal Investigator: Roy M. Poses, M.D.
Institution: Memorial Hospital of Rhode Island
Pawtucket, RI 02860
Purpose: To develop predictive models of important outcomes
(short and medium term complications, mortality, and functional
limitations) for patients with congestive heart failure,
and to compare these models' performance with that of physicians'
unaided predictions to distinguish between patients with
congestive heart failure who do need intensive care and those
who do not. The study also examined whether the quality of
physicians' predictions were influenced unfavorably by cognitive
biases or inappropriate use of heuristics, and whether the
variability in physicians' decisions resulted from variability in
how they weight patient variables and institutional factors.
Race and Gender Differences in Clinical
Decision
Making
Grant/Contract Number: HS07315
Project Period: 12/94-11/97
Principal Investigator: Kevin A. Schulman, M.D., M.B.A.
Institution: Georgetown University Medical Center
Washington, DC 20007
Purpose: To examine whether physician decision making
contributes to race and gender differences in patterns of medical
care for coronary artery disease (CAD). The study hypothesizes
that physicians underestimate the risks of CAD in blacks compared
with whites and in women compared with men and that physicians
have higher thresholds for recommending diagnostic procedures in
blacks compared with whites and in women compared with men. Case
descriptions and a survey are being developed using interactive
video disc technology. The project should provide insight into
the role of physician decision making in limiting access to
cardiac procedures among blacks and women.
Thrombolytic Predictive Instrument (TPI) Clinical Trial
Grant/Contract Number: HS08212
Project Period: 06/94-06/97
Principal Investigator: Harry P. Selker, M.D., M.S.P.H.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To demonstrate the clinical impact of the use of the thrombolytic predictive instrument
(TPI) and to test the accuracy of the TPI's predictions. Based on multivariate regression models
derived from the study's large database including major thrombolytic therapy (TT), the TPI will
predict acute (30-day) mortality; 1-year mortality; and complications of TT, including
hemorrhagic stroke, major bleeding, and cardiac arrest. Completion of this clinical trial should
show the potential impact of the use of multiple clinical data sources for effectiveness research
and of a new type of predictive instrument to promote effectiveness of an important therapy in the
actual clinical setting.
Assessment of Coronary Care Unit Use in
Different
Hospitals
Grant/Contract Number: HS05549
Project Period: 05/87-04/92
Principal Investigator: Harry P. Selker, M.D., M.S.P.H.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To examine variations in the decision to admit patients
to coronary care units in different hospitals, including both
clinical factors and demographic characteristics such as
patient age, sex, race, and insurance status. The study further
developed the methodology of assessing the performance of
logistic regression models. The results are useful to those who
use logistic regression in health services, epidemiologic, and
other research.
An MI Thrombolytic Therapy Outcome Predictive
Instrument
Grant/Contract Number: HS06208
Project Period: 09/89-09/92
Principal Investigator: Harry P. Selker, M.D., M.S.P.H.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To develop a real time thrombolysis predictive
instrument for emergency room and emergency medical service use.
This instrument optimized outcomes of thrombolytic therapy by
specifically identifying those patients likely to benefit from
thrombolytic therapy and facilitating the earliest possible
thrombolytic therapy administration.
Thrombolytic Predictive Instrument (TPI)
Clinical
Trial
Grant/Contract Number: HS08212
Project Period: 06/94-06/97
Principal Investigator: Harry P. Selker, M.D., M.S.P.H.
Institution: New England Medical Center
Boston, MA 02111
Purpose: To demonstrate the clinical impact of the use of the
thrombolytic predictive instrument (TPI) and to test the accuracy
of the TPI's predictions. Based on multivariate regression
models derived from the study's large database including major
thrombolytic therapy (TT), the TPI will predict acute (30 day)
mortality; 1 year mortality; and complications of TT, including
hemorrhagic stroke, major bleeding, and cardiac arrest.
Completion of this clinical trial should show the potential
impact of the use of multiple clinical data sources for
effectiveness research and of a new type of predictive instrument
to promote effectiveness of an important therapy in the actual
clinical setting.
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