Fiscal Year 1998
New initiatives from the Agency for Healthcare Research and Quality (AHRQ) in child and adolescent health care are summarized, focusing on improving the quality,
safety, efficiency, and effectiveness of health care. Goals are described for each study.
Outcomes
Childhood Injuries Evaluated in the Office Setting. This study is examining instruments for
assessing pediatric office management of injuries in children and recognition, reporting and
management of suspected child abuse by pediatricians in the office setting. This effort is
focusing on three goals: (1) determining the incidence of suspected child abuse injuries seen in
an office setting, (2) determining management and scope of childhood injuries seen in an office
setting, and (3) testing the feasibility of the research design and instruments for a nationwide
study. Principal Investigator: Emalee Flaherty, Children's Memorial Hospital, Chicago, IL.
(Grant No. R03 HS09811) (03/01/98-02/28/99)
Study of Functional Outcome After Trauma in Adolescents. This project is determining the
degree of disability, quality of life, and psychological well-being after trauma in adolescents aged
12-17 years. This study is also examining risk factors for functional limitation after major
trauma in adolescents. The Quality of Well-being Scale (Child Questionnaire), and the
Functional Disability Score will be used in this study. Principal Investigator: Troy Holbrook,
University of California-San Diego, La Jolla, CA. (Grant No. R01 HS09707)
(09/30/98-09/29/03)
Effectiveness of the National Health, Lung and Blood Institute (NHLBI) Guidelines on
Childhood Asthma Outcomes. This research is: (1) determining the ability of a busy, pediatric
emergency room complying with NHLBI Guidelines for management of acute childhood asthma
and factors associated with emergency rooms non-compliance, (2) determining the effect of
complying with NHLBI Guidelines on the rate of asthma relapse, treatment, and the functional
status of children admitted to the treatment sites, and (3) evaluating the role of an observation
unit in management of acute childhood asthma. Principal Investigator: Philip Scribano,
Connecticut Children's Medical Center, Hartford, CT. (Grant No. R03 HS09825)
(09/30/98-09/29/00)
Youth Partners in Care: Quality Improvement in Depression. This study is a randomized control
trial of an intervention for treatment of adolescent and young adult depression within managed
primary care settings. Intervention effects will be assessed, compared to usual care, quality of
care, satisfaction with care, clinical symptoms and daily functioning, service use and cost, and
parental psychological distress. Depression in youth interferes with functioning during a critical
developmental period and is associated with adverse outcomes, such as suicide, risk for drug and
alcohol problems, and adult depression. Principal Investigator: Joan Asarnow, University of
California-L.A., Los Angeles, CA. (Grant No. R01 HS09908) (08/01/98-07/31/03)
Quality
Quality of Care for Children with Special Needs in Managed Care. This research is assessing the
effect of selected organizational features of nine different managed care organizations (MCOs)
on the processes and outcomes of care for children with special health care needs (CSHCN).
MCO organizational features included in the research are: (1) characteristics of the provider
network, (2) use of prior authorization procedures for specialty referrals, (3) presence and type of
disease management programs, and (4) ownership status of the managed care organization.
Quality of care will be assessed for children with asthma, diabetes, and for CSHCN with varying
conditions aggregated by their functional status. Principal Investigator: Elizabeth Shenkman,
University of Florida, Gainesville, FL. (Grant No. U01 HS09949) (07/01/98-06/30/01)
Asthma Care Quality in Varying Managed Medicaid Plans. This study is identifying features of
managed care organizations (MCO) that are associated with the quality of care for children with
asthma insured by Medicaid. The MCO features to be studied include payment mechanisms,
provider profiles and incentives, and disease management programs, as well as features of care
measured at the individual patient level such as accessibility, continuity, and self-care practices.
Quality measures will include change over time in asthma-related quality of life, hospitalization
and emergency department visits, and anti-inflammatory medication use. Principal Investigator:
Tracy Lieu, Kaiser Foundation Research Institute, Oakland, CA. (Grant No. U01 HS09935)
(07/01/98-06/30/99); Harvard Pilgrim Health Care, Brookline, MA (07/01/99-03/31/01)
Improving Quality of Care for Newborns with Jaundice. Studies of hospital readmissions and
emergency department use in the first several weeks of life have established that jaundice is the
most common single diagnosis and the most common "preventable" cause of high cost health
services use. This five-year project is testing the impact of a collaborative quality improvement
intervention on adherence to the American Academy of Pediatrics Guidelines for Jaundice
Management. Researchers are using the Consumer Assessment of Health Plans Survey to
examine the effects of the quality survey management improvement initiative on parents' views
of health care. Principal Investigator: R. Heather Palmer, Harvard School of Public Health,
Boston, MA. (Grant No. R01 HS09782) (05/01/98-04/30/03)
Impact of Managed Care Organization (MCO) Policy on Quality of Pediatric Asthma Care. This study is: (1) determining the impact that transition from fee-for-service to managed care has on
quality of treatment, quality of life, and health outcomes for indigent children with asthma; and
(2) determining the impact that exposure to specific managed care organization policies have on
processes and outcome indicators of care for pediatric asthma patients. The findings are
expected to shed new light on how restrictive MCO policies affect quality and outcomes for
children with asthma. Principal Investigator: Bruce Stuart, University of Maryland at Baltimore,
Baltimore, MD. (Grant No. U01 HS09950) (09/30/98-09/29/01)
State Children's Health Insurance Program (SCHIP) Evaluation Strategy Workshop. Through a
contract, AHCPR co-sponsored the May 1998 American Academy of Pediatrics Workshop, in
collaboration with the Maternal and Child Health Bureau of the Health Resources and Services
Administration, the National Institute of Child Health and Human Development, Pfizer Pediatric
Health and the Friends of Children Corporate Fund. A SCHIP Evaluation Tool was developed
with indicators to measure the impact of SCHIP on assessing three domains on quality of health
care access, process, and outcomes. The tool will: (1) provide concrete indicators to assist
legislators, members of Congress and other policy makers in understanding the goal of SCHIP;
(2) be useful to the States in improving the quality of their SCHIP on a continuous basis; and (3)
provide these data and information to legislators on the impact of SCHIP on the health status of
previously uninsured children.
Cost, Use and Access
Does Primary Care Access Decrease Respiratory Emergency Department Visits? This study is
examining the relationship between emergency department utilization for respiratory problems
by parents enrolled in a Medicaid managed care organization and characteristics of their primary
care providers, including children with asthma, otitis media, and other respiratory disorders.
Principal Investigator: Robert A. Lowe, University of Pennsylvania, Philadelphia, PA.(Grant No.
R01 HS09261) (06/01/98-05/31/00)
Low Birth Weight in New York City: The Role of Context and Segregation. This research is
examining the impact of residential segregation on concentrated poverty, access to prenatal care,
and individual perinatal risk factors among women who gave birth in New York City. The
purpose is to understand the role residential segregation plays in the black/white low birth weight
gap. A multi-level analysis will be used to determine individual, neighborhood, and borough
effects on low birth weight under different levels of residential segregation in New York.
Principal Investigator: Kim Jaffee, Syracuse University, Syracuse, NY. (Grant No. R03
HS10061) (09/01/98-08/31/99)
Health, Health Insurance and Welfare Dynamics. This study is investigating the relationship
between transitions from welfare dependence and health insurance coverage. This effort will also
help policy-makers simulate how changes in the private health insurance market will affect
Medicaid caseloads. The results are intended to: (1) help improve projections of Medicaid
expenditures and caseloads, and (2) help project work participation by those on public assistance.
Principal Investigator: Krista M. Perreira, University of California-Berkeley, Berkeley, CA.
(Grant No. R03 HS09884) (08/01/98-07/31/99)
Factors that Influence Children's Health Care Utilization. This study is testing an innovative
model of nurse-managed primary care settings for low-income minority children. This effort will
be the first of a series of studies examining the impact of nurse-managed clinics on health care
utilization. The study's research questions include: (1) Are sociodemographic and financial
factors (e.g., age, sex, race/ethnicity, family income, family structure) associated with children's
health status? (2) Are specific family factors such as a parent's behavior, family environment,
and/or a parent's depressive symptoms associated with children's (aged 1-5) health status? and
(3) What is the effect of child health status on child health utilization? Principal Investigator:
Sabrina T. Wong, University of California-S.F., San Francisco, CA. (Grant No. R03 HS10004)
(09/30/98-09/29/99)
Building the Field of Child Health Services Research
Ambulatory Pediatric Association Child Health Services Research Conference. The project
convened a one-day Child Health Services Research Conference to precede the Annual Meeting
of the Pediatric Academic Societies in New Orleans ( May 1998). A key issue identified during
this conference was a need to improve junior faculty development in health services research.
The conference addressed general topics such as the overview of child health services research,
quality, measures, data sources, research settings, and effectiveness and cost-effectiveness
research regarding children. Principal Investigator: James Perrin, Ambulatory Pediatric
Association, Mclean, VA. (Grant No. R13 HS09815) (04/01/98-09/30/98)
Child Health Services Research Training Program. This project is supporting and expanding an
ongoing training program for pediatric health services research within the Children's Hospital in
Boston. This program offers a diverse range of applied health services research opportunities
across the continuum of care, including tertiary care centers, community hospitals, pediatric
practices, neighborhood clinics, and HMOs. Areas of research have included: (1) quality
improvement, (2) quality measurement, (3) community systems, and (4) evaluation of changes in
the health care system. Principal Investigator: Donald Goldmann, Children's Hospital, Boston,
MA. (Grant No. T32 HS00063) (09/30/94-06/30/03)
Community-based Health Services Research Curriculum. This Institutional Training Innovation
Incentive Award Program is developing a curriculum on performing effectiveness research in
community settings for the National Research Service Award (NRSA) Health Services Research
Fellows at Children's Hospital, Boston. NRSA fellows will work in partnership with community
health centers, payers, public health, schools, and other community settings. The organization's
first step is to establish a process to include a needs assessment to identify key curricular
elements. The goal is to develop a series of cases, as well as an Annual Community-Based
Health Services Research Conference for faculty, fellows, and community partners. Principal
Investigator: Charles J. Homer, Children's Hospital, Boston, MA. (Grant No. R25 HS09792)
(07/01/98-06/30/01)
Faculty Development Awards
Faculty Development for General Pediatrics Faculty Teaching in Community-Based Settings. An
Interagency Agreement between AHRQ and the Health Resources and Services
Administration's Bureau of Health Professions supported the Ambulatory Pediatric
Association's (APA) Primary Care Pediatrics Research Awards. The APA 1998 award
recipients and funded projects were: (1) Andrew Aligne, M.D., Rochester General Hospital,
"Passive Smoking and Children: An Analysis of NHANES III to Determine Outcomes
Associated with Childhood Exposure to Environmental Tobacco Smoke," and (2) Shale Wong,
M.D., Children's Hospital Denver, "Prescribing Patterns and Factors Influencing Choice of
Antibiotic for Otitis Media."
Additional Information
For more information, contact:
Denise Dougherty, Ph.D.
Senior Advisor, Child Health
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: (301) 427-1868
Fax: (301) 427-1561
E-mail: Denise.Dougherty@ahrq.hhs.gov
AHRQ Publication No. 00-P008
Replaces AHCPR Publication No. 99-P012
Current as of May 2000
Internet Citation:
Research on Child and Adolescent Health: New Starts. Fiscal Year 1998. Fact Sheet. Agency for Health Care Policy
and Research, Rockville, MD. http://www.ahrq.gov/research/childr98.htm