Announcements

AHCPR announces new funding opportunities

The Agency for Health Care Policy and Research has announced three new funding opportunities, which are described below. The first announcement is for development of computerized decision support systems for health providers followed by expansion of quality measures and research on referrals from primary to specialty care.

Applications may be submitted by domestic and foreign nonprofit organizations, public and private, including universities, clinics, units of State and local governments, nonprofit firms and foundations, or a consortium of organizations. Women, racial/ethnic minority individuals, and persons with disabilities are encouraged to apply as principal investigators.

Grant application kits, which include the PHS 398 application and instructions are available from the NIH Grants site: http://grants.nih.gov/grants/funding/phs398/phs398.html.

Applications should be sent to the Division of Research Grants, National Institutes of Health, 6701 Rockledge Drive, Room 1040 - MSC 7710, Bethesda, MD 20892-7710 (20817 for express mail). See the individual announcement of interest for the application due date.

AHCPR welcomes the opportunity to clarify any issues or questions from potential applicants. For programmatic questions, contact the individual listed in the announcement of interest. Direct inquiries regarding fiscal matters to Mable L. Lam, Chief of Grants Management Staff; telephone (301) 427-1448; E-mail MLam@ahrq.gov.

Decision Support Systems

AHCPR invites applications to conduct research on computerized decision support systems (CDSS) as a component of electronic medical record systems. The goals of this research are to assist providers' decisionmaking and improve the cost-effectiveness of health services. Applicants should address one or more of the following elements for incorporating CDSS in electronic medical records: (1) use of clinical practice guidelines in decision support systems while security and confidentiality of patient care data are maintained in different patient care settings, (2) the impact of CDSS on the effectiveness of the patient care process, patient outcomes of care, and/or the cost of care, and (3) identification and testing of factors that influence practitioner use of CDSS.

The administrative and funding instrument will be the research grant (R01) mechanism. The total requested project period may not exceed 3 years, and the earliest anticipated award date is September 1, 1996.

Depending on the availability of funds, AHCPR expects to award up to approximately $1.5 million in FY 1996 to support the first year of approximately 6 to 10 projects under this RFA. This is a one-time solicitation, and funding beyond the initial budget period will depend on annual progress reviews by AHCPR and the availability of funds.

Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by June 12, 1996. Written and telephone inquiries concerning this RFA are encouraged. Direct inquiries regarding programmatic issues to: J. Michael Fitzmaurice, Ph.D., Center for Information Technology; telephone: (301) 427-1227; E-mail: MFitzmau@ahrq.gov

This announcement (RFA HS-96-007; AHCPR Publication No. 96-R061) appeared in the NIH Guide to Grants and Contracts on March 29, 1996.

Expansion of Quality Measures (Q-SPAN)

AHCPR announces the availability of cooperative agreements to develop and test quality of care measures. These projects are expected to expand the conceptual and methodological basis for developing quality measures and produce relevant, feasible, reliable, valid, and rigorously tested sets of new quality measures for comparison across different sites. The long-term goal of this effort is to strengthen the science base underlying the evolution of performance measures while expanding the range of available, ready-to-use measures that address the continuum of care.

The administrative and funding instrument will be the cooperative agreement (U18), in which substantial AHCPR scientific and programmatic involvement with the awardee(s) is anticipated during the performance of the project. The total project period for each project may not exceed 5 years. The earliest anticipated award date is September 1, 1996.

Depending on the availability of funds, AHCPR expects to award up to $3 million in fiscal year 1996 for several short-term and long-term projects. Funded projects will reflect a balance between short-term projects (1 to 3 years), which can rapidly produce performance measures using existing knowledge and instruments, and projects that require a longer developmental period (3 to 5 years). This is a one-time solicitation.

Applications in response to this RFA must be received in the Division of Research Grants, NIH, by June 12, 1996. Written and telephone inquiries concerning this RFA are encouraged. Direct programmatic inquiries to: Elinor Walker, Center for Quality Measurement and Improvement, Q-SPAN Project Officer; telephone: (301) 427-1311.

This announcement (RFA HS-96-004; AHCPR Publication No. 96-0036) appeared in the NIH Guide to Grants and Contracts on March 15, 1996.

Referrals From Primary to Specialty Care

AHCPR invites applications to conduct research related to patient referrals from primary care to specialty care. AHCPR is particularly interested in studies that (1) describe how changes in health care organization affect referral practices, and/or (2) measure quality of care, examine economic implications, and study other outcomes resulting from decisions by primary care providers who refer or do not refer patients to specialty providers.

The goal of this solicitation is to inform the policies related to referral within health plans and strengthen the science base underlying the evolution and use of referral protocols in ambulatory health care settings. Applicants are encouraged to form partnerships or consortia involving health plans that can provide the data and technical capabilities to study referral patterns and facilitate access to delivery settings in which the outcomes of referrals can be evaluated.

The administrative and funding instrument will be the cooperative agreement (R01) in which substantial AHCPR scientific and programmatic involvement with awardees is anticipated during the performance of the project. The total project period may not exceed 2 years, and the earliest anticipated award date is September 1, 1996.

Depending on the availability of funds, AHCPR expects to award up to $1.5 million for the first year of projects under this RFA. This is a one-time solicitation.

In September 1995, AHPCR's Center for Primary Care Research convened a conference, "Research at the Interface of Primary and Specialty Care." The purposes of the conference were to: (1) assess the current state of research related to consultation and referral; and (2) obtain suggestions regarding the most important referral-related questions to be addressed by future research. Potential applicants are encouraged to request a copy of the conference summary (AHCPR Publication No. 96-0034) from AHCPR. A brief review of the conference appears in the Journal of the American Medical Association (274, p. 1419, November 8, 1995).

Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by June 12, 1996. Direct programmatic inquiries to: David Lanier, M.D., Center for Primary Care Research; telephone: (301) 427-1567; E-mail: DLanier@ahrq.gov

This announcement (RFA HS-96-006; AHCPR Publication No. 96-R056) appeared in the NIH Guide to Grants and Contracts on March 15, 1996.

AHCPR and Kaiser to cosponsor conference on communicating with consumers about health care quality

Mark your calendars now for the fall 1996 conference, Value and Choice: Providing Consumers with Information on the Quality of Health Care. The Henry J. Kaiser Family Foundation and the Agency for Health Care Policy and Research will cosponsor the conference, which will bring together consumer advocates, public and private purchasers and coalitions, managed care plan executives, health care providers, researchers, and others interested in communicating with consumers about health care. The conference will be held October 29-30, 1996, at the Doubletree Pentagon City Hotel, which is adjacent to Washington, DC's National Airport in Arlington, VA. Examples of questions to be addressed in presentations, workshops, and exhibits include:

• What kinds of information on health care quality do consumers want and use in making health care choices?
• What do we know about the most effective formats for providing quality information to consumers?
• What can other disciplines—such as marketing, education, and communications—tell us about how people use complex information to make choices?
• Do certain population groups have special information needs?
• What about differences in language, income and education levels, or disability?
• To whom do consumers turn for information and help in understanding health care choices?
• How do emerging technologies such as the Internet affect the kinds of quality information consumers use?

A call for papers and exhibits is now in development and will be available by June 3 from AHCPR's Home Page (http://www.ahcpr.gov) and the Kaiser Family Foundation's Home Page (http://www.kff.org). Persons without Internet access may request a copy of the announcement by mail or fax from Health Systems Research, Inc., 2021 L Street N.W., Suite 400, Washington, DC 20036; fax (202) 728-9469.

AHCPR releases second installment of the hospital inpatient database and the first three HCUP-3 Pocket Guides

Hospital inpatient database. The Agency for Health Care Policy and Research recently released the Nationwide Inpatient Sample, Release 2, which presents 1993 discharge data from a 20 percent sample of U.S. hospitals in 17 States.

The Nationwide Inpatient Sample (NIS), Release 2, is part of the Healthcare Cost and Utilization Project (HCUP-3), sponsored by the Agency for Health Care Policy and Research. It is based on a stratified probability sample of hospitals, with sampling probabilities proportional to the number of U.S. community hospitals in each stratum.

NIS, Release 2 is drawn from 17 geographically dispersed States and contains information on all inpatient stays from over 900 hospitals, totaling about 6.5 million records in 1993. The States in NIS, Release 2, are Arizona, California, Colorado, Connecticut, Florida, Illinois, Iowa, Kansas, Maryland, Massachusetts, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Washington, and Wisconsin.

Inpatient stay records include clinical and resource use information typically available from discharge abstracts. Hospital and discharge weights are provided for producing national estimates. The NIS can be linked to hospital-level data from the American Hospital Association's Annual Survey of Hospitals and county-level data from the Bureau of Health Professions' Area Resource File (except for hospitals in Kansas and South Carolina).

Access to the NIS is open to all researchers who sign data use agreements. Uses are limited to research and aggregate statistical reporting.

The NIS, Release 2, is available from the National Technical Information Service (NTIS accession no. PB96-501325, $160.00 for a set of six CDs.

The NIS, Release 1, which spans the years 1988 to 1992, also is available from NTIS. The cost for the complete, 5-year, 26-CD set is $300, which includes full documentation and tools for SAS and SPSS users (PB 95-503710).

Pocket guides. The first three HCUP-3 Pocket Guides are now available from AHCPR. They present summary statistics from the NIS in an easy-to-use form. The 4-1/2" x 7" guides contain summary national statistics on the number and percent of discharges, mean length of stay, and mean total charges for hospital stays in 1992, organized by principal diagnosis, principal procedure, and diagnosis-related group. The booklets are designed for use by researchers, hospital planners, market analysts, policymakers, and others who need a ready reference to information about inpatient hospital care in the United States.

Copies of these and future Pocket Guides in the series are available from AHCPR. Request the Pocket Guide for Diagnosis-Related Groups (AHCPR Publication No. 96-0028), Pocket Guide for Principal Diagnoses (AHCPR Publication No. 96-0029), and/or Pocket Guide for Principal Procedures (AHCPR Publication No. 96-0030).

The 1993 NIS data include 6.5 million inpatient stays in 900 hospitals in 17 States, clinical and resource use variables usually found on discharge abstracts, weights to produce national estimates, and hospital identifiers to link with the American Hospital Association's Survey of Hospitals. All in a 6-CD set for $160. To order, contact the National Technical Information Service.

For more information on the NIS or HCUP-3, phone 866-290-HCUP (4287), toll-free, or E-mail hcup@ahrq.gov.

New publications available from NTIS

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

Assessment of Strategies for Prostate Cancer Screening. AHCPR grant HS07230, 6/1/92 to 7/31/94. Gerald W. Chodak, M.D., University of Chicago, Chicago, IL.

Although routine screening for prostate cancer has become widespread in recent years, no studies have demonstrated that such screening is effective in improving early detection or lowering mortality. Not only does routine screening increase health care costs, it also may result in unnecessary treatment and complications. A randomized screening study is underway, but results are not expected for 10 to 15 years. In the interim, these researchers developed a comprehensive decision model and tracked a cohort of 50-year-old men who were subjected to alternative prostate cancer screening policies. This is the first such model to include the impact of tumor grade and stage on outcome. Preliminary results show that over a range of assumptions, screening will reduce cancer mortality by approximately 20 percent, but that costs will be large in terms of health care dollars, morbidity, and unnecessary treatment. (Abstract, computer program appendix, executive summary, and final report; NTIS accession no. PB96-153887, 45 pp; $21.50 paper, $10.00 microfiche)

Bittersweet: The Transformation of Diabetes into a Chronic Illness in 20th Century America. AHCPR grant HS07476, 9/1/92 to 11/30/93. John C. Feudtner, Ph.D., University of Pennsylvania, Philadelphia, PA.

The lives of many juvenile diabetes patients in America have been shaped by the development of new medical interventions that have transformed diabetes from an acute and lethal disease into a chronic and often debilitating condition. In this dissertation, the author draws on a vast array of medical records and letters exchanged between diabetic patients and/or their family members and the staff of the Joslin Clinic in Boston, MA, to trace the experiences of these patients and their caregivers during a time of rapid development in diabetes therapies. (Abstract and executive summary of dissertation; NTIS accession no. PB96-153879, 6 pp; $10.00 paper, $10.00 microfiche)

Breast Cancer Screening Policy and Practice. AHCPR grant HS06545, 9/1/91 to 9/29/95. Thomas R. Taylor, Ph.D., University of Washington, Seattle, WA.

This project involved the following four objectives and conclusions: (1) Test the efficacy of an educational intervention to improve physicians' decisions about mammography screening in women ages 40 to 49 and 50 to 80 years; two interventions were tested and found ineffective in changing the screening behavior of physicians. (2) Predict mammography screening behavior of family physicians using survey data; for all women, the physician's sex and recommended interval between mammograms were significantly associated with screening rates, as was practice configuration for women 40 to 49 years of age and, for older women, the proportion of patients having Medicare; survey data were not reliable in predicting actual behavior. (3) Assess the relationship between physicians' risk preference, sex, and screening; no association was found between female sex, screening rates, and risk preferences. (4) Assess the effects of continuing medical education and cognitive feedback on physicians' internal policies for mammography screening; there was no evidence that CME or cognitive feedback training had an effect on internal policies. (Abstract, executive summary, and final report; NTIS accession no. PB96-156948, 67 pp; $25.00 paper, $10.00 microfiche)

Cognitive Errors Concerning Personal Health. AHCPR grant HS06660, 2/1/91 to 1/31/95. Robert T. Croyle, Ph.D., M.D., University of Utah, Salt Lake City, UT.

Six experiments were conducted to examine the accuracy of personal health judgment and the recall of health events in adults in the community. After the participants' cholesterol levels were measured and communicated to them, the researchers contacted them by telephone at various intervals and asked them to recall their cholesterol readings. Results indicate that participants were overconfident in recalling their cholesterol levels. They minimized the seriousness of having a cholesterol level above desirable range. On average, participants recalled their cholesterol levels as being lower than they actually were. In addition, distress was most likely among individuals in the high-risk group who had expected to receive a lower cholesterol score. (Abstract and executive summary; NTIS accession no. PB96-138748, 20 pp; $17.50 paper, $9.00 microfiche)

Computer Support for Protocol-Directed Therapy. AHCPR grant HS06330, 3/1/90 to 8/31/95. Mark A. Musen, M.D., Ph.D., Stanford University, Stanford, CA.

This project addressed the automation of protocol-based care for clinical trials. The researchers developed a computer-based patient record system known as T-HELPER I that allows health care workers to (1) enter and review clinical data required for the care of people who have AIDS and HIV infection and (2) browse through textual protocol documents online. A more advanced system, T-HELPER II, adds to the functionality available in T-HELPER I situation-specific clinical advice regarding patients' potential eligibility for clinical trials and the therapy patients should receive when they are already participating in clinical trials. Much of this work involved developing the computational methods required by T-HELPER II to automate aspects of protocol-based care (for example, the development of novel approaches to reasoning about protocol-directed therapy and about determining eligibility for new protocols). These systems are currently being evaluated in a controlled trial at a county-operated AIDS clinic to measure whether the additional functionality of the T-HELPER II system leads to enhanced accrual of patients to clinical trials and to changes in the attitudes of health care workers regarding computer-based decision support systems. (Abstract, executive summary, and final report; NTIS accession no. PB96-138730, 33 pp; $17.40 paper, $9.00 microfiche)

Continuity of Care for African and Hispanic Americans. AHCPR grant HS08104, 9/1/94 to 2/29/96. Llewellyn J. Cornelius, Ph.D., University of Maryland School of Social Work, Baltimore, MD.

This study used data from the 1987 National Medical Expenditure Survey (NMES) to examine African and Hispanic Americans' reliance on a regular provider for their medical care. Results showed that Hispanic Americans had greater continuity of care with a regular physician than white or African Americans. Furthermore, persons with low continuity of care had one-third higher health care expenditures per year, on average, than those with high continuity of care. Finally, the availability of evening and weekend care enhanced the degree of continuity for white patients; continuity was enhanced among Hispanic patients when evening care was available. When other characteristics of care were accounted for, the degree of continuity of care varied by both the race/ethnicity of patients and the race/ethnicity and sex of regular physicians. (Abstract, executive summary, and final report; NTIS accession no. PB96-145453, 41 pp; $17.50 paper, $9.00 microfiche)

Determining Usual Blood Pressure of Older Adults in Primary Care. AHCPR grant HS07662, 2/1/93 to 7/31/96. Kevin A. Pearce, M.D., M.P.H., Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.

The objective of this observational, cross-sectional study was to examine the accuracy of routine office blood pressure (OBP) readings by nurses and standardized OBP readings, with the aim of improving the estimation of usual blood pressure (BP) in primary care settings. For this study, 75 randomly selected primary care patients made six office visits for OBP measurements and had 24-hr arterial BP (ABP) monitoring done twice. Routine OBP readings by nurses and standardized readings by a research assistant had nearly equal accuracy with respect to mean ABP. The correlation between mean OBP and mean 24-hour ABP rose with the average number of visits, with most of the gain obtained within three visits. Defining usual BP as mean awake ABP did not change the results, and clinical and demographic variables had no effect on the relationships between OBP and ABP. The researchers concluded that readings from at least three office visits should be averaged to estimate usual BP. However, significant error in this estimation persists after six visits. ABP monitoring probably provides unique information about usual BP that cannot be captured by repeated OBP readings. Routine OBP readings can be substituted for standardized OBP readings in observational research. (Abstract, executive summary, and final report; NTIS accession no. PB96-138755, 64 pp; $19.50 paper, $9.00 microfiche)

Directory of Minority Health and Human Services Data Resources.

This directory was produced for policymakers, researchers, and the public as a reference document on data resources within the U.S. Department of Health and Human Services (HHS) that contain race and ethnicity information. It includes data resources with widespread applications. Databases from continuing departmental projects or program administrative and evaluation activities that have broad utility are included. These projects and systems include repeated surveys and disease registries either maintained or sponsored by HHS. Databases from one-time studies or data collections are also included when they contain data with broad or multiple applications. This directory contains information on databases compiled and/or maintained by each of the HHS agencies, including the Social Security Administration, which at the time this report was compiled was a component of HHS. (NTIS accession no. PB96-100185, 288 pp; $49.00 paper, $19.50 microfiche)

Predictors of Back Problems and Back-Related Disability and the Effects of Comorbidity and Other Factors on Back-Related Health Care Utilization in the United States. AHCPR grant HS07968, 9/1/93 to 5/31/95. Eric L. Hurwitz, Ph.D., University of California, Los Angeles, CA.

The objective of the study was to use a probability sample to identify predictors of back problems and back disability and to assess the effects of comorbidity and other factors on the use of back-related health care in the adult population of the United States. Cross-sectional analyses were performed using data from respondents of the 1989 National Health Interview Survey (NHIS). Adult respondents who were between the ages of 25 and 64, males, non-high school graduates, unemployed, living in the West, with disabling non-back morbidities, and with body mass index and weight in the upper 50th percentile were more likely to have a disabling back problem than to have no back problem. Those with back disabilities who reported non-disabling comorbidities were much more likely to have sought back care compared with those who did not have any comorbidities. Among all adults with back problems, those with disabling comorbidities were less likely to have sought back care. Among the back-care users, those with disabling comorbidities and back-related restricted-activity days were less likely to have sought chiropractic care compared with primary medical care. Those who were male, high-school educated, single, and employed, and who made more than nine doctor visits in the past year were more likely to use chiropractic care than primary medical care. (Abstract and executive summary of dissertation; NTIS accession no. PB96-145438, 13 pp; $17.50 paper, $9.00 microfiche)

Reducing Error in Mortality Models for ICU Patients. AHCPR grant HS06026, 9/1/88 to 9/29/93. Stanley Lemeshow, Ph.D., University of Massachusetts, Amherst, MA.

Four new mortality probability models were developed for characteristics at time of admission to the ICU and at 24, 48, and 72 hours postadmission. The models performed well in the developmental and validation samples of a study cohort alone and combined with an international multisite cohort of 19,124 patients. Model performance deteriorated with time from admission. In computer simulations varying the frequency of patient-mix variables, the more commonly occurring variables affected performance negatively more rapidly than less frequently occurring variables. (Abstract, executive summary, and final report; NTIS accession no. PB96-157151, 99 pp; $25.00 paper, $14.00 microfiche)

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