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, his or her affiliation, grant number and project period, and provides a description of the project.

Assessing Pediatric Quality of Life in a Clinical Trial. Robert D. Annett, Ph.D., University of New Mexico, Albuquerque. AHRQ grant HS09123, project period 6/1/96-11/30/98.

This study examined the relationship between health status measures and quality of life outcomes within a population of 339 children with mild to moderate asthma and their parents participating in the Childhood Asthma Management Program. Moderate asthma occurred in 63 percent of the children, with the remainder demonstrating mild asthma. Predictors of child-reported quality of life were the child's anxiety, sociodemographic variables, extent of symptom exaggeration, and asthma severity ratings. Measures of asthma severity played no role in predicting quality-of-life outcomes reported by the children's parents. Children experienced few asthma symptoms and had a generally positive quality of life, suggesting that mild to moderate asthma does not impair quality of life. (Abstract, executive summary, and final report of conference are available from NTIS, accession no. PB2000-100275; 18 pp, $23.00 paper, $12.00 microfiche).

Cochrane Collaboration's Sixth Annual International Colloquium. Patricia P. Dickersin, Ph.D., University of Maryland, Baltimore. AHRQ grant HS09818, project period 5/1/98-2/28/99.

This report presents the proceedings of the Cochrane Collaboration's sixth annual international meeting, which was held October 22-26, 1998, in Baltimore, MD. The Cochrane Collaboration is an international, nonprofit organization that prepares, maintains, and promotes the accessibility of evidence-based health care information. (Abstract, executive summary, and final report of conference are available from NTIS, accession no. PB2000-101193; 28 pp, $23.00 paper, $12.00 microfiche)

Cost and Quality in the Treatment of Hypertension. Randall S. Stafford, M.D., Ph.D., Massachusetts General Hospital, Boston. AHRQ grant HS09538, project period 9/1/97-2/28/99.

The researchers examined factors associated with managing hypertension, including how the use of calcium channel blockers has changed over time, differences in cardiovascular disease prevention practices among various medical specialties, factors that can predict patterns of hypertension treatment, and medical journal advertising for hypertension treatment. They also examined a framework for measuring the quality of medication prescribing for hypertension. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-102841; 18 pp, $23.00 paper, $12.00 microfiche)

Demonstrating Computer Support Impact on AIDS Patients. David H. Gustafson, Ph.D., University of Wisconsin, Madison, WI. AHRQ grant HS08096, project period 12/01/93-06/30/97.

Men and women (n = 279) with advanced HIV infection who were treated at HIV clinics in Madison and Milwaukee, WI, were randomly assigned to receive in-home access to a computer-based information and support system (CHESS) for 1 year or no intervention beyond standard care. Data collected included use of CHESS, pre- and posttest surveys and interviews, health care billing information, and medical records. As in previous studies involving CHESS, the system was heavily used, an average of 248 times per subject. Beneficial effects of CHESS were smaller and less consistently apparent than in previous studies, however. More frequent CHESS users appeared to have better quality of life outcomes than lighter users. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-101741; 176 pp, $44.00 paper, $17.00 microfiche)

Developing Culturally and Linguistically Appropriate Prenatal Health Education Materials for Spanish-Speaking Women. Virginia Gonzales, Ed.D., University of Washington, Seattle, WA. AHRQ grant HS09836, project period 9/30/98-9/29/99.

This project tested a protocol for adapting existing English-language health education materials to serve non-English-speakers. In this case, prenatal health information was adapted for use by Spanish-speaking women. The materials were evaluated in terms of comprehension and usefulness. Users were able to decipher meaning despite low-literacy skills. Translated test materials proved easy to read, acceptable, and persuasive for Medicaid-funded mothers who had 9 years of education, on average. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-101194; 26 pp, $23.00 paper, $12.00 microfiche)

Economics of Spend-Down to Medicaid. Edward C. Norton, Ph.D., University of North Carolina, Chapel Hill. AHRQ grant HS09515, project period 9/30/96-9/29/99.

Assets must be depleted before Medicaid will cover nursing home care, a process termed "spend-down to Medicaid." The researchers studied four specific economic issues related to spend-down: (1) Why has the market for private long-term care insurance been slow to evolve, making spend-down to Medicaid the default insurance for many Americans? (2) Are trusts used to hasten spend-down to Medicaid? (3) Has the Medicare Catastrophic Coverage Act (MCCA) achieved its intended goals of reducing spousal impoverishment for those also covered by Medicaid? and (4) How do expectations about entering a nursing home depend on expectations about continuing to live and leaving a bequest? The study showed that Medicaid crowds out private insurance, trusts are usually established for reasons other than spend-down, the MCCA did not achieve its desired effects, and Medicaid does not raise expectations about nursing home entry. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-102842; 76 pp, $29.50 paper, $12.00 microfiche)

Effectiveness of Treatment Strategies for Low Back Pain. Richard A. Deyo, M.D., M.P.H., University of Washington, Seattle. AHRQ grant HS08194, project period 8/1/94-7/31/99.

The goals of this project were to characterize treatment outcomes of patients with sciatica and spinal stenosis; assess the impact of interventions on back surgery patterns; and survey alternative providers about back pain. Patients treated surgically for herniated discs of spinal stenosis had better outcomes over 5 years than patients treated nonsurgically. However, return-to-work rates were equivalent, and other outcomes converged somewhat by 5 years. Areas with the highest surgery rates also had the worst surgical outcomes. Guidelines for spinal fusion surgery coupled with reimbursement incentives reduced rates of spine fusion in Washington State, and a community-based intervention resulted in a significant decrease among communities with unusually high back surgery rates. Massage therapists and acupuncturists had more back pain visits than naturopaths. Although each profession had a distinctive approach, cross licensure was common, and massage was used by all three professions. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-101829; 46 pp, $25.50 paper, $12.00 microfiche)

Efficiency of Prenatal Care for Women and Children's Health. Marie E. McCormick, M.D., Harvard School of Public Health, Boston, MA. AHRQ grant HS09528, project period 1/1/97-12/31/98.

This conference summary discusses the effectiveness of prenatal interventions in women's and children's health, gaps in the literature, and recommendations for future research. According to conference speakers, few adverse fetal outcomes (preterm delivery, intrauterine growth restriction, or congenital malfunctions) can be prevented with current technology. However, appropriate prenatal management could substantially reduce infant morbidity. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-102853; 14 pp, $23.00 paper, $12.00 microfiche)

Exits, Recidivism, and Caseload Growth: The Effects of Private Health Insurance Markets and the Demand for Medicaid. Krista M. Peireira, B.A., University of California, Berkeley. AHRQ grant HS09894, project period 8/1/98-7/31/99.

Using administrative data from the California Longitudinal Database of Cases, the researchers examined the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from Medicaid, reentry into Medicaid, and the program's overall caseload growth in California between 1987 and 1995. (Abstract and executive summary of dissertation are available from NTIS, accession no. PB2000-100612; 12 pp, $23.00 paper, $12.00 microfiche)

Hospital Response to Medicare Reimbursement Incentives: Hospital-Based Skilled Nursing Facilities and Their Impact on Discharge Behavior. Stuart A. Hagen, M.B.A., University of Chicago, Chicago, IL. AHRQ grant HS09676, project period 9/30/97-9/29/98.

This study examined two hypotheses: one, that incentives created by Medicare's Prospective Payment System (PPS) induced hospitals to open hospital-based skilled nursing facilities, and two, that the impact of opening such a facility was a reduction in average length of hospital stay and a predisposition to use skilled nursing care as a discharge destination alternative. Using California hospital-level and patient-level data for 1982 to 1992, the researchers found that changes in Medicare policy were largely responsible for the decision of hospitals to open hospital-based skilled nursing facilities. Hospitals with skilled nursing facilities have shorter lengths of stay than they would otherwise be able to achieve. They also are more likely to use skilled nursing care and less likely to use home health care as a discharge destination than hospitals without skilled nursing facilities. (Abstract, executive summary, and dissertation are available from NTIS, accession number PB2000-101809; 338 pp, $51.00 paper, $23.00 microfiche)

Manual Therapy in Primary Care of Low Back Pain. Timothy S. Carey, M.D., M.P.H., University of North Carolina, Chapel Hill. AHRQ grant HS08293, project period 2/1/95-7/31/99.

The researchers recruited and trained 33 primary care allopathic physicians in the basics of spinal manipulation for acute low back pain. They enrolled 295 patients in a randomized trial of therapies for low back pain in 31 physician's offices, comparing manual therapy with enhanced care (a similar number of visits, a specific explanation of the spinal problem, and a series of instructional pamphlets). Patient followup at 2, 4, and 8 weeks found that clinical outcomes were similar between the two patient groups. Ninety percent of patients had returned to their previous level of functioning by 8 weeks, and satisfaction was high in both groups. The researchers conclude that training primary care physicians in manual therapy is feasible, but that the similarity of outcomes seen in this trial makes it unlikely that this will become a major therapeutic tool for allopathic physicians. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-101832; 42 pp, $25.50 paper, $12.00 microfiche)

Model of the RN Labor Supply in Western New York. Carol S. Brewer, Ph.D., State University of New York at Buffalo, Buffalo, NY. AHRQ grant HS09353, project period 9/30/96-9/29/99.

The socioeconomic characteristics and work attitudes of 802 registered nurses (RNs) were compared during a period of transition to greater managed care penetration and deregulation in Western New York. Hospital-based nurses had the highest hourly wages and income and more benefits than other RNs. Spousal incomes were lower for full-time nurses. Hospital-based RNs experienced more job redefinition and RN replacement and indicated significantly less satisfaction over the previous year than nonhospital nurses. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-100276;40 pp, $25.50 paper, $12.00 microfiche)

Outcomes of Pharmaceutical Therapy of HIV Disease. Richard D. Moore, M.D., M.H.Sc., Johns Hopkins University, Baltimore, MD. AHRQ grant HS07809, project period 2/1/93-1/31/99.

The researchers developed a comprehensive, longitudinal database of individuals infected with HIV in an urban primary care setting. They used the data to examine the effectiveness of a wide range of antiretroviral and antimicrobial therapies in preventing progression of HIV disease and opportunistic infections, determine the association of surrogate laboratory markers with clinical outcomes, delineate the frequency and consistency of prescription drug use, and identify the sociodemographic and clinical characteristics associated with the use of and response to drug therapy for HIV infection. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-100684; 52 pp, $27.00 paper, $12.00 microfiche)

Patterns of Care and Costs Among TMD Patients in an HMO. B. Alex White, D.D.S., M.P.H., Kaiser Foundation Research Institute, Oakland, CA. AHRQ grant HS09347, project period 9/30/96-9/29/98.

This project compared the use and cost of medical and dental care services for 8,801 patients with temporomandibular disorders (TMDs) who were members of the Kaiser Permanente Northwest Division and had at least one TMD clinic visit or TMD-related procedure from January 1990 through December 1995. The researchers identified an equal number of comparison subjects without TMD visits or procedures from the same HMO. The mean age for patients in both groups was about 40.5 years, and about 80 percent of the subjects were female. Excluding out-of-plan services, TMD patients used significantly more services than comparison subjects, and they had 1.6 times higher mean costs for all services. These differences in use and costs were consistent over a wide range of service categories and could not be explained by TMD treatment alone. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-100682; 58 pp, $27.00 paper, $12.00 microfiche)

Pharmaceutical Care and Pediatric Asthma Outcomes. Andreas S. Stergachis, M.S., Ph.D., University of Washington, Seattle. AHRQ grant HS07834, project period 3/1/93-2/28/98.

The PEAK (Pharmaceutical Care Evaluation of Asthma in Kids) study was a community-based randomized controlled trial designed to assess the changes in disease control, functional status, and cost associated with the introduction and delivery of a structured program of pharmaceutical care for pediatric patients with asthma. The study involved 330 children aged 6 to 17 years from 14 pharmacies providing intervention (IN) and 18 pharmacies providing usual care (UC) in Western Washington State. After specialized training, pharmacists in the IN group provided individualized asthma care assessment and patient education for up to 1 year following each child's entry into the study. Of the 153 subjects recruited into the IN Group, 105 (69 percent) received at least one intervention from a pharmacist, mostly during face-to-face visits with the parent and/or the child. Compared with the UC group, there was no evidence that IN patients experienced improvements in pulmonary function, functional status, quality of life, asthma management, or satisfaction with care. (Abstract, executive summary, and final report are available from NTIS, accession no. PB2000-101828; 70 pp, $27.00 paper, $12.00 microfiche)

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 of care in infants with fever, determine the accuracy of current clinical parameters, and 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, while 52 percent received antibiotics. The average cost of treatment for a non-hospitalized 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, findings from this study warrant changing current practice behaviors. (Abstract, executive summary, final report, and appendixes are available from NTIS, accession no. PB2000-100683; 176 pp, $44.00 paper, $17.00 microfiche)

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