Announcements

AHCPR announces CAHPS® advisory group

The Agency for Health Care Policy and Research recently announced the members of the advisory group for the Consumer Assessments of Health Plans Study (CAHPS®). CAHPS® is a 5-year project to help consumers select high-quality health care plans and services appropriate for their needs.

The goals of CAHPS® are to:

• Develop and test survey instruments that can be used to obtain assessments of health plans and services from consumers.
• Develop easily understandable reports to convey survey information back to consumers.
• Evaluate the usefulness of these reports to consumers in selecting health care plans and services.

The advisory group was appointed by the three consortia, led by Research Triangle Institute, RAND Corporation, and Harvard University, which are implementing the CAHPS® project under cooperative agreements with AHCPR. The advisory group will advise the consortia members on implementing the CAHPS® surveys.

The group also is charged with helping to find appropriate demonstration or testing sites, assisting with dissemination of information about CAHPS® products, and encouraging use of the products. The advisory group is scheduled to meet twice per year until 1998 and once per year thereafter. The members of the advisory group are:

• Rina Alcalay, Associate Professor, Department of Rhetoric and Communications, University of California, Davis.
• Christina Bethell, Director of Accountability Measurement, Foundation for Accountability.
• Carol Cronin, Senior Vice President, Health Pages.
• Helen Darling, Manager, Health Care Strategy and Programs, Corporate Benefits, Xerox Corporation.
• Joyce Dubow, Senior Policy Advisor, Public Policy Institute American Association of Retired Persons.
• Vicki Gates, Administrator, Oregon Health Plan.
• George Isham, M.D., Medical Director, Health Partners.
• William F. Jessee, M.D., Vice President, Quality and Managed Care, American Medical Association.
• Mary Kennedy, Performance Measurement and Quality Improvement Division, Department of Health and Human Services, Minnesota Medicaid.
• Jeffrey Koplan, President, Prudential Center for Health Care Research.
• Robert Krughoff, President, Center for the Study of Services.
• Catherine Kunkle, Vice President, National Business Coalition on Health.
• Jim Mortimer, President, Midwest Business Group on Health.
• Mark Smith, M.D., Vice President, Kaiser Family Foundation.
• Dan Wolfson, President and CEO, HMO Group.

AHCPR funds new projects

The Agency for Health Care Policy and Research has awarded new research and conference grants, as described below. Please note that investigators generally do not publish findings until a study has ended or is nearing completion.

Research Grants

Development of a child health status measure.
Prin. investigator: Barbara Starfield, M.D.
Organization: Johns Hopkins University, Baltimore, MD
Project no: AHCPR grant HS08829
Period: 8/1/96 to 7/31/00
First year funding: $439,828

Required request: Determinants of family consent
Prin. investigator: Laura A. Siminoff, Ph.D.
Organization: University Hospitals of Cleveland, Cleveland, OH
Project no: AHCPR grant HS08209
Period: 8/1/96 to 7/31/98
First year funding: $687,819

Sestamibi for emergency department triage for suspected cardiac ischemia
Prin. investigator: Harry P. Selker, M.D.
Organization: New England Medical Center, Boston, MA
Project no: AHCPR grant HS09110
Period: 8/1/96 to 7/31/99
First year funding: $781,722

Small Grants

Benefit of CEA in patients with contralateral occlusion
Prin. investigator: Ronda R. Pindzola, Ph.D.
Organization: University of Pittsburgh Medical Center, Pittsburgh, PA
Project no: AHCPR grant HS09021
Period: 9/1/96 to 8/31/98
First year funding: $30,072

Comparative analysis of Medicaid capitation rate methods
Prin. investigator: Ginny Hsieh, M.P.H.
Organization: Johns Hopkins University, Baltimore, MD
Project no: AHCPR grant HS09338
Period: 9/1/96 to 8/31/97
Funding: $32,115

Determinants of first nursing home entry
Prin. investigator: Kathleen Cagney, M.A.
Organization: Johns Hopkins University, Baltimore, MD
Project no: AHCPR grant HS09334
Period: 9/30/96 to 9/29/97
Funding: $27,059

Economic implications of health insurance
Prin. investigator: Kanika Kapur, B.A.
Organization: Northwestern University, Evanston, IL
Project no: AHCPR grant HS09333
Period: 9/1/96 to 8/31/97
Funding: $22,892

Effect of sleep promotion in the critical care unit
Prin. investigator: Carrie Jane Wallace, Ph.D.
Organization: LDS Hospital, Salt Lake City, UT
Project no: AHCPR grant HS09335
Period: 9/1/96 to 8/31/97
Funding: $32,400

Exploratory data analysis to detect preterm risk factors
Prin. investigator: Jonathan C. Prather, B.S.
Organization: Duke University Medical Center, Durham, NC
Project no: AHCPR grant HS09331
Period: 9/1/96 to 8/31/97
Funding: $31,698

Government funding of AIDS education through Latino CBOs
Prin. investigator: M. Elena Letona-Milles, M.S.
Organization: University of Massachusetts, Boston, MA
Project no: AHCPR grant HS09337
Period: 9/30/96 to 9/29/97
Funding: $32,346

Impact of ethics consultation in the ICU
Prin. investigator: Lawrence J. Schneiderman, M.D.
Organization: University of California, San Diego, La Jolla, CA
Project no: AHCPR grant HS09349
Period: 9/30/96 to 9/29/98
First year funding: $43,063

Impact of HMOs on hospital quality and costs
Prin. investigator: Kevin Gerhard Volpp, A.B.
Organization: University of Pennsylvania, Philadelphia, PA
Project no: AHCPR grant HS09325
Period: 9/1/96 to 8/31/97
Funding: $29,569

Impact of prenatal Medicaid program on newborns' health
Prin. investigator: Christopher Allen Trenholm, B.A.
Organization: University of North Carolina, Chapel Hill, NC
Project no: AHCPR grant HS09332
Period: 9/1/96 to 8/31/97
Funding: $29,079

Measuring primary care quality in managed care systems
Prin. investigator: Donald A. Barr, M.D.
Organization: Stanford University, Stanford, CA
Project no: AHCPR grant HS09350
Period: 9/30/96 to 9/29/97
Funding: $79,205

Medicaid managed care for asthma: Does plan type matter?
Prin. investigator: Alexandra Shields, M.A.
Organization: Brandeis University, Waltham, MA
Project no: AHCPR grant HS09327
Period: 9/1/96 to 5/31/97
Funding: $32,279

Optimal policies for clinical lab quality control
Prin. investigator: James Christian Benneyan, M.S.
Organization: University of Massachusetts, Amherst, MA
Project no: AHCPR grant HS09329
Period: 9/30/96 to 9/29/97
Funding: $31,644

Postpartum mandate: Estimated costs and benefits
Prin. investigator: Jesse D. Malkin, B.A.
Organization: RAND Corporation, Santa Monica, CA
Project no: AHCPR grant HS09342
Period: 9/1/96 to 8/31/97
Funding: $29,996

Primary care performance for low-income children in HMOs
Prin. investigator: Margarita Patricia Hurtado, Dr.P.H.
Organization: Johns Hopkins University, Baltimore, MD
Project no: AHCPR grant HS09339
Period: 9/1/96 to 8/31/97
Funding: $31,870

Spatial model of trauma care facilities
Prin. investigator: Charles Christos Branas, M.S.
Organization: Johns Hopkins University, Baltimore, MD
Project no: AHCPR grant HS09326
Period: 9/30/96 to 9/29/97
Funding: $30,212

Surgical noncompliance in Hmong immigrants
Prin. investigator: Jun Hu, M.D.
Organization: Emory University, Atlanta, GA
Project no: AHCPR grant HS09336
Period: 9/1/96 to 8/31/97
Funding: $32,015

Conference Grants

Developing a minority health services research agenda
Prin. investigator: Herbert W. Nickens, M.D.
Organization: Association of American Medical Colleges, Washington, DC
Project no: AHCPR grant HS09344
Period: 9/1/96 to 8/31/97
Funding: $49,806

Delivering education to rural health care providers
Prin. investigator: Michael G. Kienzle, M.D.
Organization: University of Iowa, Iowa City, IA
Project no: AHCPR grant HS09322
Period: 9/1/96 to 8/31/97
Funding: $29,145

Errors in health care conference
Prin. investigator: Mark S. Frankel, Ph.D.
Organization: American Association for the Advancement of Science, Washington, DC
Project no: AHCPR grant HS09324
Period: 8/1/96 to 7/31/97
Funding: $49,940

Primary care research network for nursing
Prin. investigator: Margaret Grey, Dr.P.H.
Organization: Yale School of Nursing, New Haven, CT
Project no: AHCPR grant HS09321
Period: 9/1/96 to 8/31/97
Funding: $29,893

Research agenda conference on pediatric quality of care
Prin. investigator: Alice S. Hersh, MMHS, M.S.
Organization: Association for Health Services Research, Washington, DC
Project no: AHCPR grant HS09323
Period: 8/1/96 to 7/31/97
Funding: $99,950

Sixth Regenstrief Conference
Prin. investigator: Charles M. Clark, M.D.
Organization: Regenstrief Institute, Indianapolis, IN
Project no: AHCPR grant HS09345
Period: 9/1/96 to 8/31/97
Funding: $33,850

National Research Service Awards

Health care utilization in obstructive sleep apnea
Fellow: Vishesh Kapur, M.D.
Organization: University of Washington, Seattle, WA
Project no: NRSA fellowship F32 HS00109; Bruce M. Psaty, sponsor
Period: 1-year fellowship
Funding: $35,300

Necessity and efficacy of empiric antimicrobial therapy
Fellow: Stephanie Green, M.D.
Organization: University of Pennsylvania, Philadelphia, PA
Project no: NRSA fellowship F32 HS00117; Neil O. Fishman,
sponsor
Period: 1-year fellowship
Funding: $33,800

New publications available from NTIS

The following publications and final reports are now available from the National Technical Information Service.

Advance Directives and Communication in Medical Care. AHCPR grant HS06912, 3/1/91 to 2/29/96. Lawrence J. Schneiderman, M.D., University of California, La Jolla, CA.

This project studied the effects of an advance directive on health status, costs, and patient-physician communication as facilitated by a quality-of-life instruction supplement and a procedure oriented instruction supplement. Two-hundred-twenty patients whose expected 5-year mortality rate was 50 percent or greater participated in this randomized prospective clinical trial; 50 physicians were exposed to one of two different instruction supplements (quality-of-life instruction or procedure-oriented instruction). Preliminary results indicate that patients have more difficulty responding to quality-of-life questions than procedure-oriented questions. Most respondents did not indicate a desire for aggressive treatment when quality of life would be poor. There was moderate correlation between responses to the two supplements with respect to treatment preferences. There were no differences between treatments and costs of patients whose physicians were exposed to either one or the other instruction supplement. Physicians' own preferences influenced their predictions of patients' preferences for treatments.

To purchase abstract, executive summary, and final report contact the National Technical Information Service. NTIS accession no. PB96-191440, 18 pp; $19.50 paper, $10.00 microfiche.

Cavhd vs. Hemodialysis Treatment in Acute Renal Failure. AHCPR grant HS06466, 9/30/90 to 3/31/96. Ravindra L. Mehta, D.M., M.B.B.S., M.D., University of California, La Jolla, CA.

This randomized, controlled, multicenter trial compared two protocols of renal replacement therapy—intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT)—for the treatment of acute renal failure in the intensive care unit. Despite an appropriate randomization method, significant patient differences were seen at baseline in the two groups. Unadjusted results show that mortality was lower for IHD than CRRT, but renal recovery and length of stay were similar. After adjustment for underlying severity of illness, there were no differences in mortality between the two groups. CRRT resulted in lower steady-state levels of solutes and better volume control than IHD. Overall, outcomes were similar for the two protocols.

To order abstract, executive summary, final report, and appendix A contact the National Technical Information Service. NTIS accession no. PB96-194055, 29 pp; $19.50 paper, $10.00 microfiche.

Effectiveness of Quick Medical Reference (QMR) in Medical Decision Support. AHCPR grant HS06368, 7/1/90 to 6/30/94. Richard A. Bankowitz, M.D., University of Pittsburgh, Pittsburgh, PA.

The primary goal of this project was to determine the effectiveness of Quick Medical Reference (QMR), a computer-based diagnostic system, when used by health care personnel familiar with its use. The evaluation included patients admitted to the general medicine wards of a university hospital and examined the effects of the QMR consult service on length of stay, number of consultations requested, diagnostic services used, and total charges incurred. A secondary goal was to determine the extent of diagnostic uncertainty with regard to admissions to the general medical hospital ward and to determine how, if at all, cost of diagnosis is related to diagnostic uncertainty at the time of admission. In addition to this group of 312 patients who formed the basis of the randomized controlled study, data on the primary outcome measures and estimates of residents' initial certainty of diagnosis were available on 1,778 admissions for the procedures performed and number of consultations requested. The QMR was effective at reducing the number of consultations requested but not the use of other health care services, according to the researchers.

To order executive summary and final report contact the National Technical Information Service. NTIS accession no. PB96-191457, 50 pp; $21.50 paper, $10.00 microfiche.

Heavy Use of Emergency Services: A Multidimensional Study. AHCPR grant HS08412, 8/1/94 to 6/30/96. Ruth E. Malone, Ph.D., University of California, San Francisco, CA.

This study of two inner-city trauma center emergency departments (EDs) sought to increase understanding of why certain individuals and/or groups are heavy users (HUs) of hospital emergency services. Although this utilization is regarded as problematic in an era of managed care, the economic and health status of HUs is usually marginal at best and desperate at worst. Three major findings of this study were that: (1) many HUs visit the ED primarily to meet nonmedical needs, although they also have multiple and frequently chronic medical problems; (2) market-driven changes in the practice setting are contributing to disillusionment among clinicians as they are caught between system and patient demands; and (3) the ED fulfills multiple social roles beyond that of providing emergency medical care or even primary medical care. These findings suggest that the ED should be viewed within the context of these larger roles, and that the press for "efficiency" and cost-containment may actually cause resistance in the form of increased medicalization of social problems and/or paradoxically contribute to increased visits and medical care costs as basic nonmedical needs go unrecognized and unmet.

To order abstract and executive summary of dissertation contact National Technical Information Service. NTIS accession no. PB96-194063, 13 pp; $19.50 paper, $10.00 microfiche.

HIV Treatment Decisionmaking. AHCPR grant HS07656, 8/1/93 to 7/31/96. Karolynn Siegel, Ph.D., Sloan Kettering Institute, New York, NY.

The goal of this study was to increase knowledge about the treatment-related behavior and experiences of HIV-seropositive women from diverse racial/ethnic groups. Using a combination of structured and unstructured data gathering techniques, 84 HIV infected participants were interviewed about events and circumstances leading them to be tested for HIV, their decisionmaking and behavior regarding use of antiviral therapies, and their sources of information concerning available medical care and supportive services. The women reported that delay in testing resulted primarily from psychological barriers (especially denial associated with fear and anxiety) rather than problems of access (e.g., financial or availability of confidential testing). Similarly, most women who delayed initiation of medical care for their HIV infection did so in response to their fear or denial of the seriousness of their condition. Although a majority of women initiated antiviral treatment, most ultimately terminated it, usually citing side effects or other perceptions that the drugs were either ineffectual or did more harm than good. Most women relied on their physician for information regarding HIV and its treatment, but others depended on informal sources, especially other HIV-infected women.

To order abstract and executive summary contact National Technical Information Service. NTIS accession no. PB96-189881, 13 pp; $19.50 paper, $10.00 microfiche.

Improved Targeting of Long-Term Care Discharges During Hospitalization. AHCPR grant HS07953, 8/1/93 to 7/31/95. Barbara J. Roberge, B.S.N., M.S.N., Ph.D., University of Massachusetts, Boston, MA.

The number of elderly patients admitted to the hospital is increasing, and many of these patients are at risk for admission to a long-term care (LTC) facility. Because clinicians often are unable to identify the patients who are at high risk of LTC discharge, delays in discharge planning may result in increased time spent in the hospital. Since hospitals are not fully reimbursed for these days, they accrue financial losses when hospital discharge is delayed for long-term-care-bound patients. Thus, correctly identifying patients at risk of LTC discharge has the potential to reduce hospital costs. The purpose of this study was to assess how the risk of three hospital discharge outcomes differs across subgroups of elders, using two administrative data files from a large tertiary care teaching hospital in the Northeast. The study design included two empirical models. Three survival analysis models were used to measure the risk of the three discharge destinations: death, discharge to LTC, and discharge home with services. The principal findings were that indicators of nursing need are strong predictors of all three destination outcomes under study and more strongly predict the outcomes than either demographic or diagnostic covariates.

To order abstract and executive summary of dissertation contact National Technical Information Service. NTIS accession no. PB96-194089, 4 pp; $6.50 paper, $10.00 microfiche.

Posthospital Care for African-American Elderly. AHCPR grant HS06406, 4/1/90 to 9/30/95. Enola K. Proctor, Ph.D., Washington University, St. Louis, MO.

This study tested explanations for established racial differences in the use of formal services among elderly persons discharged home from the hospital. Data sources included medical records, home health agency records, discharge planning records, patient interviews, and nurse-conducted in-home assessments. African-American patients and families were more likely to rule out institutional care (intermediate nursing home care) for reasons of preference, engage in less pursuit of nursing home placements, and more aggressively seek formal services in the home. No differences along racial lines were found in thoroughness of discharge planning, number of formal home care services arranged by discharge planners, duration of Medicare home health services, or implementation problems. Race was found to indirectly affect the level of formal service utilization through functional dependency and living alone. African-American elders were found to enter posthospital home care with higher levels of physical and cognitive impairment and to have caregivers with more limitations. Some support was found for racial differences in the use of religion as a coping mechanism. Findings clarify the increased risk among African-American elders entering home care, both in terms of greater impairment and less adequate home care plans.

To order abstract, executive summary, and final report contact National Technical Information Service. NTIS accession no. PB96-194071, 17 pp; $19.50 paper, $10.00 microfiche.

Second International Conference on Medical Aspects of Telemedicine and the Second Mayo Telemedicine Symposium. AHCPR grant HS08615, 3/1/95 to 2/29/96. Richard McGee, Ph.D., Mayo Foundation, Rochester MN.

The objective of the Second Mayo Telemedicine Symposium was to bring together the broadest possible array of health care practitioners and administrators, technology developers and providers, and national leaders in telemedicine to learn about the current successes and difficulties in telemedicine. The intent was to evaluate and stimulate interest in the use of telemedicine for improving medical care delivery. AHCPR support allowed the participation of physicians and health care administrators from underserved areas who otherwise would not have been able to attend due to financial constraints. Many of the barriers to full utilization of telemedicine technologies internationally, which were identified at the First Mayo Telemedicine Symposium, are still in place. In the United States the following primary barriers remain, not necessarily in order: (1) legal issues around licensure when practicing telemedicine, especially across State lines; (2) quality of care when telecommunications technologies are used and the need for high quality outcomes research; (3) reimbursement for services provided across telemedicine linkages; (4) cost of telemedicine technology, especially when it is utilized only on an as-needed basis for intermittent consultation; and (5) diminished national interest in extending medical care to underserved groups with the attendant increase in health care expenditures that would be required.

To order conference and symposium reports contact National Technical Information Services. NTIS accession no. PB96-194030, 19 pp, $19.50 paper, $10.00 microfiche.

Two journals seek articles on women's health and maternal and child health

The Journal of Women's Health and the Maternal and Child Health Journal are encouraging submission of articles, as follows. The Maternal and Child Health Journal is a new quarterly, peer-reviewed publication that expects to publish its first issue in January 1997. It will address the following areas of maternal and child health practice, policy, and research: epidemiology, demography, and health status assessment; innovative service initiatives; program implementation; policy analysis and advocacy; and professional development. Milton Kotelchuck, Ph.D., M.P.H., is the journal's editor.

For submission information, contact Milton Kotelchuck, Ph.D., Editor, Maternal and Child Health Journal, University of North Carolina, School of Public Health, Chapel Hill, NC 27599-7400; phone (919) 966-5981; fax (919) 966-0458; E-mail mkotelchuck@sophia.sph.unc.edu.

For subscription information, contact Journals Customer Service, Plenum Publishing Corporation, 233 Spring Street, New York, NY 10013; phone (212) 620-8470 or (800) 221-9369; fax (212) 463-0742.

The Journal of Women's Health is a bimonthly, peer-reviewed journal published by the Society for the Advancement of Women's Health Research. Bernadine P. Healy, M.D., Dean of the Ohio State University's College of Medicine, is editor-in-chief. The journal focuses on diseases and medical conditions that hold greater risk for and are more prevalent among women. It features clinically oriented articles, but also will consider review articles and case reports. The emphasis is on clinical research, especially in clinical trials, and on issues of clinical care relating to women.

The Journal of Women's Health is now included in MEDLINE®, making it a more attractive choice for authors. AHCPR's researchers and grantees are encouraged to submit relevant articles. Manuscripts should be submitted to Christine Kasuba, Editorial Coordinator, The Page Center W16, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

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