New Studies Focus on Improving Quality of Care

Press Release Date: December 6, 1996

Health plans, providers and consumers across the United States are the intended beneficiaries of 10 new studies announced today by the federal Agency for Health Care Policy and Research (AHCPR). The studies will help to provide science-based information needed by the public and private sectors to develop tools and information that will lead to improvements in health care quality.

According to Clifton R. Gaus, Sc.D., AHCPR administrator, objective, research-based quality-of-care measures are essential for improving services, balancing costs and quality, and knowing where costs can be reduced without jeopardizing patients' health.

"These studies will benefit consumers in two ways. First, improved quality of care translates into better outcomes; second, it will give consumers objective information on performance—not just differences in prices—on which to base their decisions when choosing a health plan or individual treatment facility," said Dr. Gaus.

AHCPR has awarded approximately $13.52 million over five years to fund seven new studies that are collectively known as Q-SPAN (Expanding Quality of Care Measures). These new studies are:

• Clinical Performance Measures for Dental Care Plans.(Grant No.: HS09453) Principal investigator: James D. Bader, D.D.S., University of North Carolina, Chapel Hill, N.C. 1996-1998. Total estimated funding: $374,014.

  Will develop a set of outcome-based performance measures for general dentistry, with a special focus on cavities, which, together with gum diseases, account for most dental claims. The researchers will validate, pilot test, and implement the measures in two large dental managed care plans.

• Ongoing Development and Evaluation of HEDIS Measures. (Grant No.: HS09473) Principal investigator: Arnold M. Epstein, M.D., Harvard University, Boston, Mass. 1996-1999. Total estimated funding: $2.31 million.

  Will evaluate the recently published draft version of the Health Plan Employer Data and Information Set (HEDIS 3.0)—currently the most widely used measures of health plan performance—and develop operational specifications for measures that the National Committee for Quality Assurance may include in the next version of HEDIS.

• Measuring Quality by Achievable Benchmarks of Care. (Grant No.: HS09446) Principal investigator: Catarina I. Kiefe, M.D., Ph.D., University of Alabama, Birmingham, Ala. 1996-2001. Total estimated funding: $1.77 million.

  Will refine and test the feasibility of using Achievable Benchmarks of Care—derived from pooled data of the best health care performers—because consistent data-driven definitions of benchmark performance are not currently available. The goals are to increase providers' ability to transition from quality measurement to actual changes in clinical practice, and to improve methodology for deriving quality measures from readily available data.

• Adult Global Quality Assessment Tool. (Grant No.: HS09463) Principal investigator: Elizabeth A. McGlynn, Ph.D., RAND Corporation, Santa Monica, Calif. 1996-1999. Total estimated funding: $1.43 million.

  Develops and tests clinically based sets of measures for assessing quality of care delivered to men under age 50, and men and women ages 50 and older, who are enrolled in managed care plans. This AHCPR project complements another study by the investigators—funded by the Health Care Financing Administration—to develop managed care measures sets for use in evaluating quality of care provided to pre-menopausal women, children and adolescents.

• Quality of Care Measures for Cardiovascular Patients. (Grant No.: HS09487) Principal investigator: Barbara J. McNeil, M.D., Ph.D., Harvard University, Boston, Mass. 1996-2001. Total estimated funding: $4.16 million.

  Develops and tests a set of clinical measures for cardiovascular care performance from data collected from four health plans that enroll a broad spectrum of patient types. The researchers will focus on developing measures for a group of interrelated cardiovascular conditions.

• Quality Outcomes in Subacute and Home Care Programs. (Grant No.: HSO9455) Principal investigator: John N. Morris, Ph.D., Hebrew Rehabilitation Center for the Aged, Boston, Mass. 1996-1999. Total estimated funding: $1 million.

  Measures quality of care in two increasingly important, but little studied transitional settings for rehabilitative-restorative care following acute hospital discharge: nursing home subacute care and home care. The researchers will create, validate and set benchmark values of longitudinal change for activities of daily living, mobility, cognition, communication and other outcomes.

• Functional Outcomes in Patients with Hip Fractures. (Grant No.: HS09459) Principal investigator: Albert L. Siu, M.D., Mount Sinai School of Medicine, New York, N.Y. 1996-2001. Total estimated funding: $2.47 million.

  Addresses hip fracture care management and outcomes by developing a workable quality measurement system providers can use to assess the quality of care they provide patients with hip fracture—an increasingly prevalent and costly health problem.

Upon their availability, AHCPR may include quality of care measures produced by the studies in AHCPR's landmark Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST) or in CONQUEST's eventual successor, the Quality Measurement Network (QMNet).

In addition, AHCPR has awarded approximately $3.23 million to fund three other studies on health care quality. These studies are:

• Value of Future Health and Preventive Health Behavior. (Grant No.: HS09519) Principal investigator: Gretchen B. Chapman, Ph.D., Rutgers State University of New Jersey, New Brunswick, N.J. 1996-1997. Total estimated funding: $194,913.

  Focuses on the effect of time preferences (how people value their health status at different stages in life plus the value they give to possible future personal health problems) on why people do or do not adopt preventive health behaviors.

• Office Systems to Improve Preventive Care for Children. (Grant No.: HS08509) Principal investigator: Peter Margolis, M.D., Ph.D., University of North Carolina, Chapel Hill, N.C. 1996-2000. Total estimated funding: $1.49 million.

  Determines whether pediatric practices that use office systems for prevention have higher rates of immunizations and screening for anemia, tuberculosis and lead, and if rates vary in relation to the number of system components used.

• Development of a Child Health Status Measure. (Grant No.: HS08829) Principal investigator: Barbara Starfield, M.D., Johns Hopkins University, Baltimore, Md. 1996-2000. Total estimated funding: $1.55 million.

  Develops an instrument that comprehensively measures the health and illness profile of children ages five to 11. The instrument is intended to be used to monitor the influence on children of changes in health system organization and interventions in health services. Both parent and child versions of the instrument will be developed and systematically tested in geographically distinct populations with different racial and ethnic backgrounds.

Earlier in 1996, AHCPR funded the five following studies focusing on quality of care issues: Frank Ahern, Ph.D., Pennsylvania State University, "Impact of Prospective Drug Use on Health"; A. Connors, Jr., M.D., Case Western Reserve, "Right Heart Catheterization: Appropriate/Effective Use"; Jose Escarce, M.D., University of Pennsylvania, "Superspecialization of Medical and Surgical Subspecialists"; Thomas Lee, M.D., Brigham and Women's Hospital, "Cardiac Procedure Use: A Prospective Cohort Study"; and Joel Tsevat, M.D., University of Cincinnati Medical Center, "Understanding Health Values of HIV Infected Patients."

The Agency for Health Care Policy and Research, a part of the Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost and enhance access to essential services. AHCPR's broad programs of research and technology assessment bring practical, science-based information to medical practitioners and to consumers and other health care purchasers.

For additional information, contact AHCPR Public Affairs: Howard Holland, (301) 427-1857, Salina Prasad, (301) 427-1864.