Announcements

Grant final reports now available from NTIS

The following grant final reports are now available for purchase from the National Technical Information Service (NTIS). Each listing identifies the project's principal investigator (PI), his or her affiliation, grant number, and project period and provides a description of the project.

Assessing Outcomes of Dental Care with Claims Data. Stephen A. Eklund, D.D.S., Dr.P.H., University of Michigan, Ann Arbor. AHRQ Grant HS09554, project period 9/30/97-9/29/99.

The specific aims of this study included evaluation of the association between use of professionally applied topical fluoride and restorations (dental fillings) in primary and permanent teeth of children. In an analysis of insurance claims for treatment provided to 15,190 children by 1,556 different dentists, no association between the frequency of use of professionally applied topical fluoride and restorative care was found. The most powerful predictor of restorative care for these children was the overall propensity of the treating dentist to place restorations in children. Further, although professional application of topical fluoride is recommended only in children with moderate and high rates of dental caries (cavities), approximately two-thirds of children in this study with a low number of caries received topical fluoride at every recall visit, nearly twice a year.

Editor's Note: Select "Application of topical fluoride during children's dental checkups has no impact on restorative care," for a summary of a journal article stemming from this grant.

Abstract, executive summary, and final report, NTIS accession no. PB2000-103847; 24 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Cancer—Reaching Medically Underserved Populations. Charles L. Bennett, M.D., Ph.D., Northwestern University School of Medicine, Chicago, IL. AHRQ Grant HS10080, project period 11/11/99-11/12/00.

This conference report summarizes the sessions at the symposium, "Cancer—Reaching Medically Underserved Populations: Low Literacy and Culturally Specific Barriers," held on November 12, 1999. Conference participants focused on barriers, including those related to literacy and culture, to effective cancer prevention and treatment for minority and other medically underserved populations. Strategies were presented for developing research programs that address the specific needs of these populations, and techniques were explored to disseminate information regarding unique, effective programs that increase access to early detection, prevention, and treatment programs for these groups.

Abstract, executive summary, and final report, NTIS accession number PB2000-103852; 22 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Childhood Injuries Evaluated in the Office Setting. Emalee G. Flaherty, M.D., Children's Memorial Hospital, Chicago, IL. AHRQ grant HS09811, project period 3/01/98-2/28/99.

Health care providers in a regional, practice-based network completed written survey forms about their experience in treating child abuse. In the preceding year, 56 percent of 85 providers in 17 practices estimated that they had treated a total of 152 children they suspected had been abused. Seven providers indicated that they had not reported a child with suspected abuse. The same providers then collected information prospectively about consecutive office encounters. They recorded detailed information about injury-related visits involving about 659 injuries treated during 12,510 office encounters. None of the injuries was classified as "definitely caused by physical abuse," but the providers considered seven (1 percent) to be "moderately suspicious" for abuse. The researchers conclude that primary care providers report most but not all cases of suspected child abuse that they identify, and that many variables influence their decisionmaking processes.

Abstract, executive summary, and final report, NTIS accession no. PB2000-103848; 34 pp, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

Impact of Ethics Consultation in the ICU. Lawrence J. Schneiderman, M.D., University of California, San Diego. AHRQ grant HS09349, project period 9/30/96-9/29/99.

Abstract, executive summary, and final report of a conference, NTIS accession no. PB2000-103851; 32 pages, $25.50 paper, $12.00 microfiche are available from the National Technical Information Service.

PROs Febrile Infant Study. Robert H. Pantell, M.D., American Academy of Pediatrics, Elk Grove, IL. AHRQ grant HS06485, project period 5/1/93-4/30/98.

The purpose of this prospective, observational cohort study was to document current clinical practices and costs in infants with fever, determine the accuracy of current clinical parameters, and attempt to develop an optimal clinical prediction model. The researchers obtained data collected by 577 pediatricians from March 1, 1995, to April 30, 1998, on 3,066 infants less than 3 months old with fever of at least 38 degrees C (100.4 degrees F). Over 1,100 of the infants required more than one office visit, and laboratory testing was performed on three-quarters of infants. Slightly more than one-third of the infants were hospitalized, and 52 percent received antibiotics. The average cost of treatment for a nonhospitalized infant was $192.29, compared with $3,412.82 for a hospitalized infant. No association between type of insurance and hospitalization rate was found. Rates of serious bacterial illness (SBI) were less than previous reports: 0.5 percent of infants had bacterial meningitis, and 1.7 percent had bacteremia. According to the researchers, these findings warrant changing current practice behaviors.

Abstract, executive summary, final report, and appendixes, NTIS accession no. PB2000-100683; 176 pp, $44.00 paper, $17.00 microfiche are available from the National Technical Information Service.

Randomized Trial Comparing Acupuncture, Therapeutic Massage, and Self-Care Education for Chronic Low Back Pain. Daniel C. Cherkin, Ph.D., Center for Health Studies, Seattle, WA. AHRQ grant HS09351, project period 9/30/96-3/31/99.

The researchers randomly assigned 262 adults with persistent back pain to receive either self-care education, acupuncture, or massage. After 10 weeks, patients receiving massage or acupuncture were more satisfied compared with those receiving self-care education. Massage was more effective than self-care in reducing symptoms and improving function and more effective than acupuncture in improving function. After 1 year, outcomes in the massage group were similar to those for self-care but significantly superior to those for acupuncture for symptoms and superior for function. The cost of outpatient care for back pain during the followup year (excluding the intervention costs) was up to 45 percent less in the massage group than in the other groups.

Abstract, executive summary, and final report, NTIS accession no. PB2000-101195; 56 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Solution for Verification Bias in Diagnostic Tests. Xiao-Hua (Andrew) Zhou, Ph.D., Indiana University, Indianapolis. AHRQ grant HS08559, project period, 9/30/94-10/31/99.

The researchers have developed four sets of new statistical methods for correcting verification bias in the evaluation of diagnostic tests. The first set consists of three methods for estimating the receiver-operator characteristics (ROC) curve of a diagnostic test and its corresponding area. The second set consists of three methods for comparing the relative accuracy of two diagnostic tests. The researchers also developed computer software for implementing these methods. These efforts will provide a comprehensive treatment of verification bias in efficacy studies of diagnostic tests and thus improve the usefulness of the studies.

Abstract, executive summary, and final report, NTIS accession number PB2000-103949; 16 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Use and Effects of Health Information. Todd H. Wagner, B.A., University of California, Berkeley. AHRQ grant HS09997, project period 9/30/98-9/29/99.

This study followed a natural experiment, the Healthwise Communities Project (HCP), that started in Boise, ID, in 1996. The results show that the intervention, which was designed to provide residents with self-care information, was associated with significant increases in the use of medical reference books, telephone advice nurses, and computers for health information. Nevertheless, health outcomes were not appreciably better or worse for the average resident. Positive gains were generally found in people with chronic conditions, such as diabetes and depression, suggesting that future self-care interventions could maximize effectiveness by targeting needy or at-risk populations with appropriately tailored information.

Abstract and executive summary of a dissertation, NTIS accession no. PB2000-101191; 14 pp, $23.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Using Outcomes Data to Evaluate Health Plans, Delivery Networks, and Individual Providers. David R. Nerenz, Ph.D., Henry Ford Health System, Detroit, MI. AHRQ grant HS09805, project period 1/1/98-12/31/98.

This report describes the conference "Using Outcomes Data to Evaluate Health Plans, Delivery Networks, and Individual Providers," held April 22-24, 1998. Conference topics ranged from the broad and theoretical (e.g., Will outcomes data tell us what we want to know?) to the highly technical and specific (e.g., How can health plan data be used to risk-adjust outcomes and payments?).

Abstract, executive summary, and final report, NTIS accession no. PB2000-102989; 56 pp, $27.00 paper, $12.00 microfiche are available from the National Technical Information Service.

Using the Complexity Model to Enhance Diabetes Management in Three Family Medicine Practices: A Qualitative, Comparative Case Study. Lynn D. Helseth, Ph.D., University of Nebraska Medical Center, Omaha. AHRQ grant HS09994, project period 9/29/98-6/30/99.

This study tested an intervention to change family practices' management of patients with diabetes, based on complexity theory, a conceptual model for understanding and directing changes in family medicine practices. Based on qualitative case study data—including observation of patient encounters, chart review, structured and unstructured observation, and informal and in-depth interviews—and guided by complexity theory, the researchers conducted tailored practice-level interventions in three community family medicine practices.

Abstract, executive summary, and dissertation, NTIS accession no. PB2000-101810; 230 pp, $51.00 paper, $23.00 microfiche are available from the National Technical Information Service.

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