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The abstracts included in this appendix briefly describe the evaluation reports completed by the Department of Health and Human Services (HHS) during fiscal 1995. They are listed in alphabetical order by agency. The sponsoring agency, report title, abstract, and Federal contact person(s) are listed for each report. For more information on any of the reports, please call the contact listed at the end of each abstract. Copies may be obtained by contacting either the Policy Information Center or the National Technical Information Service. Their addresses are given below.
Final reports for most of the evaluations listed in this appendix have been submitted to the HHS Policy Information Center (PIC), a centralized source of information on in-process, completed, and ongoing HHS evaluations; short-term evaluative research; and policy-oriented projects. The PIC maintains a resource database containing information on more than 6,000 completed and ongoing studies sponsored by HHS, other Federal agencies, and private sector entities. The PIC provides executive summaries (if available) at no cost.
The PIC identification number appears after the Federal contact's phone number. For information about using PIC resources, please contact the following:
Policy Information Center
Office of the Assistant Secretary of
Planning and Evaluation
Department of Health and Human Services
Room
438F, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201
(202) 690-6445
The National Technical Information Service (NTIS) is an information clearinghouse run by the Department of Commerce. It provides reports in both paper and microform formats for a fee. If a final report has been registered with this service, the NTIS accession number follows the PIC ID entry. For more information about ordering copies of reports from NTIS, please contact the following:
National Technical Information Service
Department of
Commerce
5285 Port Royal Road
Springfield, VA 22161
(703)
487-4650
Child Access Demonstration Projects: Final Wave I Report
Child Maltreatment 1993: Reports From the States to the National Center on Child Abuse
Children on Hold: Improving the Response to Children Whose Parents Are Arrested and Incarcerated
Demonstration Partnership Program Projects: Project Design and Evaluation Guidebook (Third Revised Edition)
Demonstration Partnership Program Projects: Self-Sufficiency Project Implementation Manual
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From 1990--Homeless and Youth at Risk
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Case Management/Family Development
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Micro-Business and Self-Employment
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings from FY 1991--Minority Males
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Youth at Risk
Evaluation of the Key States Initiative
Foster Youth Mentors
Increasing Participation in Work and Work-Related Activities: Lessons From Five State Welfare Reform Demonstration Projects (Two Volumes)
Low-Income Energy Assistance Program: Report to Congress for Fiscal Year 1993
Matching Opportunities to Obligations: Lessons for Child Support Reform From the Parents' Fair Share Pilot Phase
Outcomes of Permanency Planning for 1,165 Foster Children
Selected Annotated Bibliography on Youth and Gang Violence Prevention, Community Team Organizing and Training, and Cultural Awareness Curriculums
Something Old, Something New: A Case Study of the Post-Employment Services Demonstration in Oregon
Strengthening Families and Neighborhoods: A Community-Centered Approach--Final Report on the Iowa Patch Project
Study of the Impact on Service Delivery of Family Substance Abuse
Update From the Multistate Foster Care Data Archive: Foster Care Dynamics 1983-93
Youth With Runaway, Throwaway, and Homeless Experiences: Prevalence,
Drug Use, and Other At-Risk Behaviors (Three Volumes)
TITLE: Child Access Demonstration Projects: Final Wave I Report
ABSTRACT NUMBER: 001
ABSTRACT: Since the passage of the 1984 Child Support Enforcement amendments and the 1988 Family Support Act, courts and child support agencies have vastly increased their efforts to establish a child's paternity and establish and enforce child support orders. However, many noncustodial parents' groups have complained that there has not been a parallel increase in enforcement of their rights to parental access. This report presents information from child access demonstration projects in Florida, Idaho, and Indiana that began in October 1990 (wave I). These projects were designed to determine whether mediation services for child access problems would reduce parent conflict; reduce interference with visitation rights; and encourage full, voluntary compliance with child support obligations. The report finds that (1) problems with parental access to children arise frequently (12 to 24 percent in Florida and Idaho), primarily in divorce cases; (2) access problems are more complex than visitation denial; (3) disagreements about visitation seem to increase over time; (4) mediation produced an agreement between parents in about two-thirds of cases, but this conclusion is complicated by the fact that a high proportion of cases assigned to mediation were never attended; and (5) there is no way to tell how long mediated agreements between parents might last. The project was extended through June 1996. (Final report 239 pages, plus appendixes.)
AGENCY SPONSOR: Office of Child Support Enforcement
FEDERAL CONTACT: David Arnaudo
PHONE NUMBER: 202/401-5364
PIC ID: 5972
PERFORMER ORGANIZATION: Policy Studies, Inc., Denver, CO; Center
for Policy Research, Denver, CO
TITLE: Child Maltreatment 1993: Reports From the States to the National Center on Child Abuse
ABSTRACT NUMBER: 002
ABSTRACT: The National Child Abuse and Neglect Data System (NCANDS) collects data on child maltreatment reported from States, territories, and other jurisdictions. This study presents data collected from reports of child maltreatment investigated by States in 1993. NCANDS compiles aggregate data from States in its Summary Data Component (SDC) and also contains case-level data that allow more detailed analyses in its Detailed Case Data Component (DCDC). Pilot testing of the DCDC data collection instrument has been completed, and the DCDC is being phased in nationally. An analysis of the data from the first 10 participating States was to be available in late 1995. The study finds that (1) almost 2 million reports of child abuse and neglect were received by child protective service agencies and referred for investigation in 1993; (2) 1993 is the first year since 1976 in which the rate of reported child abuse and neglect cases has not increased; (3) 53 percent of all reports come from professionals, including educators, law enforcement and justice officials, medical professionals, social service professionals, and child care providers; (4) 18 percent of all reports come from family members; (5) 38 percent of the 1.6 million investigations of alleged abuse or neglect resulted in a disposition of substantiated or indicated child abuse; 53 percent were not substantiated or indicated child abuse; and (6) neglect is the most common type of maltreatment, followed by physical, sexual, medical, and emotional abuse.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Gail Collins
PHONE NUMBER: 202/205-8087
PIC ID: 5387.1
PERFORMER ORGANIZATION: Bowers and Associates, Reston, VA;
American Humane Association, Englewood, CO
TITLE: Children on Hold: Improving the Response to Children Whose Parents Are Arrested and Incarcerated
ABSTRACT NUMBER: 003
ABSTRACT: An estimated 1.5 million children in the United States have an incarcerated parent. As a result of "get tough on crime" policies, the number of incarcerated women has tripled. It is estimated that, on any given day, 167,000 children have mothers in prisons and jails. This report explores what communities are doing nationwide to meet the needs of children whose caretakers are arrested or incarcerated. The report finds that the typical incarcerated woman is likely to be young, single, unemployed, and African-American or Hispanic, with limited education, job skills, and income; a history of drug abuse; and two to three young children. The report uses national telephone surveys of 500 law enforcement, child welfare, and corrections officials in 100 counties. It examines survey responses from patrol officers, narcotics officers, child protective services, foster care parents, and corrections staff. It reports on site visits to communities with exemplary responses to children whose parents are arrested: Galveston, Texas; Mobile, Alabama; San Antonio, Texas; and St. Louis, Missouri. Site visits to exemplary programs for children whose parents are incarcerated are reported on for Albany, New York; Bethel Bible Village, Tennessee; San Antonio, Texas; and San Francisco, California. (Final report 288 pages, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 5853
PERFORMER ORGANIZATION: American Bar Association, Center on
Children and the Law, Chicago, IL
TITLE: Demonstration Partnership Program Projects: Project Design and Evaluation Guidebook (Third Revised Edition)
ABSTRACT NUMBER: 004
ABSTRACT: The Demonstration Partnership program (DPP) represents the first formal research and development component within the Community Service Block Grant. Federal guidelines require that the projects funded under DPP include a strong third-party evaluation component to determine whether they are worthy of replication. The objectives of the program are to (1) stimulate community action agencies to develop new approaches that provide for greater self-sufficiency among the poor; (2) test and evaluate new approaches; (3) disseminate project results and evaluation findings; and (4) strengthen the ability of eligible entities to integrate, coordinate, and redirect activities that promote maximum self-sufficiency among the poor. DPP grants are made to innovative projects that can be coordinated with a grantee's ongoing program. The projects can also combine resources, including partnerships with other community agencies. This guidebook is intended to help grant applicants and grantees understand the role of evaluation in the grants process, in selecting and working with a third-party evaluator, and in preparing the required evaluation reports. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 4336.4
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Self-Sufficiency Project Implementation Manual
ABSTRACT NUMBER: 005
ABSTRACT: "The Self-Sufficiency Project Implementation Manual" is a synopsis of lessons drawn from 8 years of DPP projects. DPP projects were designed to demonstrate the effectiveness of innovative services that promote self-sufficiency among low-income individuals and families who rely on or are at risk of relying on public assistance. DPP has concentrated on five issues in its projects: (1) case management; (2) micro-enterprise development; (3) minority male employment; (4) homelessness; and (5) youth at risk. The implementation manual presents generic models for establishing effective community-based programs in these areas and offers ideas on evaluating such programs. All models are presented in the form of logic models for consistency. Each section of the manual is organized into general lessons and specific lessons learned regarding each of the five project types. The manual is designed for use by community action agencies, community-based organizations, and local community program planners who are interested in developing a self-sufficiency project.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 4336.3
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From 1990: Homeless and Youth at Risk
ABSTRACT NUMBER: 006
ABSTRACT: This report presents the findings from three grants that focused on homeless adults and youth at risk. Two of the projects addressed the needs of homeless adults, while one concentrated on homeless youths. The projects focused on adults were directed toward very different populations. The Tacoma, Washington program worked with adult males who, while homeless, were generally free from most problems that prevent reintegration into the workplace. The project had considerable success in collecting data and in moving clients to the workforce. At follow-up, 80 percent of the case-managed group had jobs. About one-third of these jobs included benefits, and 50 percent were permanent. Half of the clients who were homeless at the beginning of the project were not at follow-up. Unlike the Tacoma project, the Duluth, Minnesota project, which targeted residents of low-income housing, did not exclude residents with special problems, such as a history of mental illness, drug abuse, or criminal involvement. This project was less successful in collecting data and in integrating clients into the workforce. However, participants achieved significantly higher incomes than the control group, although their wages were still low. The project targeted to youth was located in Portland, Oregon. It focused on helping homeless youth at risk find a more stable environment. Many of the youths were using illicit drugs, had criminal histories or mental problems, and came from violent homes. Stabilizing the youths and meeting their emergency needs were the first priorities of the project. The project had problems tracking clients, since many of the youths did not follow up with counselors. Many did not return to the program out of fear that their parents might be contacted. As a consequence, the outcome analysis was difficult to develop. Despite these difficulties, some conclusions were reached, such as: (1) 75 percent of the youths who completed the program have a stable residence unconnected to street life; and (2) 83 percent of those who completed the program are employed, are participating in an educational or vocational training program, or are serving in the Armed Forces. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6056.1
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Case Management/Family Development
ABSTRACT NUMBER: 007
ABSTRACT: This report describes two efforts designed to increase the self-sufficiency of public assistance recipients through case management. The two DPPs were located in DuPage, Illinois, and Stevens Point, Wisconsin. In each project several agencies cooperated to provide coordinated, integrated, and appropriate services to individuals or families receiving public assistance. A case manager coordinated the care received by clients. The target population in DuPage was single-parent families; and in Stevens Point the target population was families whose total income was below 125 percent of the poverty level. Both projects were intended to increase the economic self-sufficiency of clients. The DuPage project included 83 participants in its experimental group. Despite numerous attempts to engage them, about 45 percent of the treatment group never presented themselves for service, never followed up, or were unable to participate because of mental health problems. The Stevens Point program focused on helping working poor families pursue home ownership. Three groups were compared: a control group, a comparison group of participants in a low-income buyers group, and a target group who were enrolled in the home-buyers group and receiving integrated case-management services. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6054.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Micro-Business and Self-Employment
ABSTRACT NUMBER: 008
ABSTRACT: This report presents the results of three programs designed to help low-income individuals start their own business or pursue self-employment to achieve economic self-sufficiency. Two of the programs, one located in Ukiah, California, and one on Wetumpka, Alabama, were relatively close to major urban centers. The third program in Bozeman, Montana, by contrast, was located in one of the more sparsely populated areas of the United States. The populations served by the three programs were quite dissimilar: Ukiah targeted only women; Bozeman targeted only Aid to Families with Dependent Children (AFDC) and food stamp recipients; and Wetumpka targeted a blue-collar and semirural population of mixed gender and race. The Ukiah program was a great success, forcing some participants to wait several weeks before receiving services. Unfortunately, some participants that could not be served immediately did not return to the program when space became available. The Bozeman project assisted low-income individuals in obtaining small business loans. By the end of the project, 39 loans had been awarded to 37 recipients. Additionally, the program awarded loans to 12 Native Americans, or 86 percent of the goal. All programs were relatively successful and had positive impacts on their communities. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6055.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Minority Males
ABSTRACT NUMBER: 009
ABSTRACT: This report presents the results of three DPPs focused on minority males. Two of the projects, located in Milwaukee, Wisconsin, and Boston, Massachusetts, organized their approaches around a combination of a job club and case management. The third project, located in Lexington, Kentucky, used a combination of mentoring and case-management support. The important differences between the programs lay in their target audiences. The Milwaukee and Lexington projects focused almost exclusively on African-Americans, while the Boston project expanded this focus to include Hispanics. Participants' ages ranged from 14 to 34 years; the Lexington project focused on the younger end of the spectrum, the Boston project on the middle, and the Milwaukee program on the older group. The Milwaukee program concentrated on issues of racial bias in education and employment as a means to reduce minority male unemployment. Individual training and education was also used to lessen the negative effects of family and community dysfunction. In Lexington, problems included a lack of suitable mentors. Only 10 percent of 300 possible mentors completed the application, and this number was further reduced after a check of police records. However, the program demonstrated that mentors and participants must be matched one-to-one. The Boston program achieved a 58 percent completion rate. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6058
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Youth at Risk
ABSTRACT NUMBER: 010
ABSTRACT: This report presents the findings from four types of youth-at-risk projects funded under DPP: school-based, teen parents, employment training, and homeless youth. Regardless of the approach taken, all products had some core service components in common, including case management, social support services, educational services, and employment training. Four projects were school based. The Yakima, Washington, program targeted low-income high school youth to increase their educational success and wage rates and to reduce their reliance on public assistance. The Morristown, Tennessee, program provided school-based interventions to 148 preteen girls to reduce adolescent pregnancy rates. The Greenfield, Massachusetts, program provided case-management services, as well as nontraditional interventions (cooperative games, outdoor challenge activities). The Everett, Washington, program helped teenage mothers increase their education and job readiness. Two projects focused on employment training (Tacoma, Washington, and Austin, Texas). The Tacoma program served JTPA youths aged 17 to 21 at risk of gang or drug involvement or dropping out of school and eligible for Job Training Partnership Act services. The second project was intended to increase the potential for self-sufficiency and to strengthen service linkages. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6057.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver Spring,
MD
TITLE: Evaluation of the Key States Initiative
ABSTRACT NUMBER: 011
ABSTRACT: After passage of the Refugee Act of 1980, it became apparent that a large percentage of refugee families were remaining in welfare programs for extended periods of time. In response, the Office of Refugee Resettlement implemented the Key States Initiative (KSI) in fiscal 1987. The initiative was intended to increase employment among the refugee community and reduce dependence on welfare. Eight States emerged with high welfare dependency characteristics, and of these States, five chose to participate in this new program: Minnesota, New York, Pennsylvania, Washington, and Wisconsin. For each State, the report provides information on program design features, program participant characteristics, program outcomes, and lessons learned. The report also discusses the conclusions that can be drawn from a composite view of KSI program principles. The report finds that (1) programs that emphasize self-sufficiency goals, such as welfare termination, are more successful than those focusing only on job placement; (2) employment-related services provided to all potential wage earners in the family increased the odds that the family would leave the welfare rolls; (3) results-oriented vocational training programs worked better when they obtained employer commitments to training, program design, teaching resources, and job placement; and (4) clients are more cooperative with staff who have cultural backgrounds similar to their own.
AGENCY SPONSOR: Office of Refugee Resettlement
FEDERAL CONTACT: Loren Bussert
PHONE NUMBER: 202/401-5364
PIC ID: 5959
PERFORMER ORGANIZATION: Office of Refugee Resettlement,
Washington, DC
TITLE: Foster Youth Mentors
ABSTRACT NUMBER: 012
ABSTRACT: The University of Illinois Urbana-Champaign School of Social Work examined the factors characteristic of successful relationships between foster youths and older citizen mentors. The program compared 250 successful mentor/foster youth matches with 250 unsuccessful matches. Data focused on the characteristics of the mentors, the foster youths, and the mentoring program. The study also includes evaluations of each match from both participants. Study samples were taken from programs that offer mentoring as part of their service delivery. Programs include The Peoria Children's Home Association (Illinois); Covenant House Rites of Passage (New York); Judge Baker Children's Center; Fairfax County Mentor Program (Virginia); and various mentoring programs from Montana, New Hampshire, Alabama, and Kentucky. Project findings were disseminated to independent living programs throughout the United States in order to facilitate the use of mentors in efforts to transition older youths from foster care.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 4388
PERFORMER ORGANIZATION: University of Illinois, School of Social
Work, Urbana, IL
TITLE: Increasing Participation in Work and Work-Related Activities: Lessons From Five State Welfare Reform Demonstration Projects (Two Volumes)
ABSTRACT NUMBER: 013
ABSTRACT: This study uses data from State and local officials, case record reviews, and management reports to examine key implementation and operational issues in five States currently conducting welfare reform demonstration projects: Colorado, Iowa, Michigan, Utah, and Vermont. Reforms in these five States emphasize strategies designed to increase participation in work and work-related activities. Specifically, the report looks at (1) the strategies States use to increase participation in the Job Opportunities and Basic Skills (JOBS) training program (or similar programs); (2) the role of child care in increasing program participation; (3) the extent to which the culture of welfare offices has changed from one of check issuance to one of finding employment for recipients; and (4) the early lessons to be drawn from the experiences of these States. The report finds that States use many strategies to increase participation, including (1) reducing exemptions and serving more participants; (2) redefining participation to include unsubsidized employment and activities, such as substance abuse and mental health counseling and parenting classes; and (3) increasing penalties for nonparticipation. All five States budgeted for additional expenditures for staff and child care. All States reported that it is extremely difficult to change the culture of welfare offices. Volume 2 presents a site visit summary for each State. (Final report: volume 1, 96 pages; volume 2, 174 pages.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Peter G. Germanis
PHONE NUMBER: 202/401-9316
PIC ID: 5815
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Low-Income Home Energy Assistance Program: Report to Congress for Fiscal Year 1993
ABSTRACT NUMBER: 014
ABSTRACT: This report examines how States used funding they received under the Low-Income Home Energy Assistance Program (LIHEAP), describes trends in home energy consumption, reviews demographic data on LIHEAP beneficiaries, and assesses State compliance with the LIHEAP legislation for fiscal 1993. During that year, States spent $1.525 billion from LIHEAP, 86 percent of which came from Federal net allotments. States used the funds to provide heating and cooling assistance, energy crisis intervention or assistance, low-cost home weatherization, or other energy-related home repairs. The report finds that (1) 32 percent of home energy is used for space heating or cooling; (2) low-income households are more likely to heat with fuel oil, kerosene, or liquified petroleum gas and are less likely to heat with electricity; (3) low-income households consume less energy than other households (about 10 percent less for heating, 32 percent less for cooling, 17 percent less for appliances, and 5 percent less for water heating); (4) although these households consume less energy, a greater percentage of their annual income is spent on energy needs; (5) about 20 percent of those households eligible for LIHEAP received assistance in 1993 (they were among the poorest of all eligible households); and (6) States generally comply with requirements for setting benefit levels and legibility. See also PIC ID 4638. (Final report 37 pages, plus appendixes.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Donald Sykes
PHONE NUMBER: 202/401-9333
PIC ID: 4638.1
PERFORMER ORGANIZATION: Office of Community Services, Division
of Energy Assistance, Washington, DC
TITLE: Matching Opportunities to Obligations: Lessons for Child Support Reform From the Parents' Fair Share Pilot Phase
ABSTRACT NUMBER: 015
ABSTRACT: The Parents' Fair Share (PFS) demonstration program requires that the noncustodial parents of children on welfare participate in employment related and other services when they are unemployed and unable to meet child support obligations. This study evaluates the operational feasibility of the PFS approach, ascertains whether a full-scale evaluation is warranted, and studies the target population. This effort studied 4,000 noncustodial parents in nine States who were not able to meet their child support obligations. Baseline data from enrollment forms, management information data, child support payment records, child support orders, site visits, peer support feedback forms, and participant and staff interviews were used to evaluate the pilot phase. The report finds that (1) the PFS program appears to be operationally feasible and shows enough promise to warrant a full-scale evaluation of its impacts and cost-effectiveness; (2) the program shows most ability to effect changes in individuals in poor support groups with a set curriculum; (3) cases received attention that were neglected prior to PFS; (4) employment and training systems were more difficult to change because of institutional barriers and limitations in program design choices, but the number of options in this area increased over time; and (5) many PFS parents appeared to be living in poverty, but most saw their children regularly and wished to support them. See also PIC ID 5952.1.
AGENCY SPONSOR: Office of Child Support Enforcement
FEDERAL CONTACT: Mark Fucello
PHONE NUMBER: 202/401-4538
PIC ID: 5952
PERFORMER ORGANIZATION: Manpower Demonstration Research
Corporation, New York, NY
TITLE: Outcomes of Permanency Planning for 1,165 Foster Children
ABSTRACT NUMBER: 016
ABSTRACT: This report presents the findings of a study of 1,165 children in foster care. It examines the distribution of the children in four permanency planning (PP) exit categories after up to 18 months in care, and any changes in the child's PP status within 12 months of leaving the foster family. The report gives information on the demographic characteristics of the children, the reasons for their removal from the family, and characteristics of their stays in foster care. The report finds that many significant differences among children in the two study sites (San Diego County, California, and Pierce County, Washington) are explained in part by differences in child and family characteristics, but also by differences in the service systems in the sites. Pierce County's system has greater judicial system involvement, greater use of voluntary placements, and administrative rather than court reviews. The report also finds that the over-representation of minority children calls for an ethnicity-sensitive practice in child welfare systems. Furthermore, the large number of children with mental health, physical health, and behavioral problems in the study population reveals the need for appropriate services for this population. The report also finds that (1) two-thirds of children in both sites were reunited with their families; (2) adoptions were more frequent in Pierce County than in San Diego County, while long-term foster care was more frequent in the latter site; and (3) guardianship was used sparingly in both sites.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 5874
PERFORMER ORGANIZATION: San Diego State University, Child and
Family Research Group, San Diego, CA; Manpower Demonstration Research
Corporation, New York, NY
TITLE: Selected Annotated Bibliography on Youth and Gang Violence Prevention, Community Team Organizing and Training, and Cultural Awareness Curriculums
ABSTRACT NUMBER: 017
ABSTRACT: This report is intended as a resource for youth-serving organizations, as well as individuals, researchers, and policymakers concerned with youth issues. This annotated bibliography provides brief summaries of materials ranging from reports and monographs to curriculums, training manuals, articles, and other literature and products. The entries in the bibliography were selected in a search of local and national print and electronic libraries and databases. Items were selected, annotated, and organized in the following general sections: (1) youth violence/gang violence; (2) youth violence prevention programs; (3) youth violence, gang, and drug prevention curriculums; (4) interpersonal skills training; (5) peer mediation; (6) multicultural awareness curriculums and cultural sensitivity training; (7) immigrants; (8) team organizing; (9) community collaboration; (10) interagency cooperation and partnerships; (11) community empowerment; and (12) training methodologies and strategies. Author, subject, geographic area, organization, project, and center indexes are provided. See also PIC ID 5875 and 5875.1. (Final report, 172 pages.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Terry Lewis
PHONE NUMBER: 202/205-8102
PIC ID: 5875.2
PERFORMER ORGANIZATION: Development Services Group, Inc.,
Bethesda, MD
TITLE: Something Old, Something New: A Case Study of the Post-Employment Services Demonstration in Oregon
ABSTRACT NUMBER: 018
ABSTRACT: The Federal Post-Employment Services Demonstration (PESD) was initiated in response to indications that many people who leave welfare for work lose their jobs fairly quickly and return to the welfare rolls. The demonstration is intended to help those who become employed keep their jobs, to help those who lose their jobs return to work quickly, and to reduce the amount of time families receive Aid to Family with Dependent Children (AFDC). PESD operates in Riverside, California; Chicago, Illinois; Portland, Oregon; and San Antonio, Texas. This report provides an indepth look at the program's operations in Oregon, gives the background for PESD and contrasts it with programs such as JOBS, which focuses on preemployment services. It describes the AFDC/JOBS program in Oregon and the State's postemployment initiative, the JOBS Employment Retention Initiative (JERI). The report then describes early patterns of job loss and reemployment in JERI, finding that job turnover is significant for participants (61 percent lost their first jobs during the first year of the demonstration). However, participants who lose their jobs return to work fairly quickly. The report describes the structure of the JERI program and makes general recommendations about how States might move from a preemployment services model to a post-employment services model. (Final report 48 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Research, and Evaluation
FEDERAL CONTACT: Nancye Campbell
PHONE NUMBER: 202/401-5760
PIC ID: 6002
PERFORMER ORGANIZATION: Project Match, Erikson Institute,
Chicago, IL
TITLE: Strengthening Families and Neighborhoods: A Community-Centered Approach--Final Report on the Iowa Patch Project
ABSTRACT NUMBER: 019
ABSTRACT: The Iowa Patch project, modeled on the British patch system of community-centered service delivery, was an innovative method of testing services improvement in a distressed urban neighborhood in Linn County, Iowa. The project attempted to overcome categorical barriers that prevent the pooling and use of informal and formal resources needed for flexible social services. The project ran in tandem with, and was supported by the Linn County Decategorization project, an Iowa initiative merging child welfare funding streams and involving the community in comprehensive services planning. The project showed that, overall, services were integrated and improved using the patch model. The project overcame normal turfism to successfully collocate an interagency team of human services workers; it successfully devolved responsibility for service delivery to the team and to line workers on the team; and it shifted the workers' practice from a deficit and crisis orientation to one that is proactive, preventive, and holistic. Services were more accessible and workers were more approachable and were able to develop informal relationships with consumers and local helping networks. Workers also did more in-home work with consumers. The Patch project has developed well beyond the level of a demonstration program and has been integrated with other agencies in Linn County's Family Research Center program. (Final report 148 pages, plus appendix.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Dolson
PHONE NUMBER: 202/401-0133
PIC ID: 5977
PERFORMER ORGANIZATION: University of Iowa, Iowa City, IA
TITLE: Study of the Impact on Service Delivery of Family Substance Abuse
ABSTRACT NUMBER: 020
ABSTRACT: This report was originally intended to provide the Administration on Children, Youth and Families (ACYF) with information on the incidence of family drug abuse, and the effects of this abuse on ACYF programs. The comprehensive survey and study first planned was not approved by the Office of Management and Budget. Therefore, the scope of the study was reduced to include a literature review of relevant research from 1986 through 1994 and intensive case studies of the effects of family alcohol and other drug (AOD) abuse on ACYF-funded programs. The literature review and site visits show that (1) Child Protective Services (CPS) are the ACYF programs most seriously negatively affected by family AOD abuse, followed by foster care, Head Start and other early childhood education programs, runaway and homeless youth (RHY) programs, and adoption services; (2) front-line staff in most ACYF-funded programs are ill-equipped and poorly trained for dealing with substance-abusing families; (3) ACYF-funded programs that effectively intervene in cases of family AOD abuse are significantly hampered by the lack of appropriate AOD treatment outlets; and (4) family AOD abuse has resulted in new challenges to all ACYF-funded programs in meeting their mandated functions, including accelerated termination of parental rights policies, postadoption and foster placement support programs, and modification of the Head Start program to address the needs of nonparental caretakers. (Final report 33 pages, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Dolson
PHONE NUMBER: 202/260-6165
PIC ID: 4399
PERFORMER ORGANIZATION: Cygnus Corporation, Inc., Washington, DC
TITLE: Update From the Multistate Foster Care Data Archive: Foster Care Dynamics 1983-93
ABSTRACT NUMBER: 021
ABSTRACT: The Multistate Foster Care Data Archive contains foster care career histories for all children who have been in State-supervised substitute-care living arrangements. The data for the archive are extracted directly from the administrative data systems operated by each State's child welfare agency. The information is comprehensive and longitudinal at the individual level. Five States participated in the original archive: California, Illinois, Michigan, New York, and Texas. These States provide services to almost one-half of the total child substitute-care population in the United States. This report covers 1983-93, updating a 1994 report examining foster care dynamics between 1983 and 1992. The report is descriptive and is not a policy analysis. The report finds that (1) the five States described here have different levels of child care placement activity; (2) the trend in each of the States has been one of significant growth in the numbers of children receiving State-supported care; (3) admissions have been far greater than discharges, and most episodes of rapid caseload change follow a shift in admission levels; (4) most child care placement activity was concentrated in major urban centers; (5) much of the recent growth in foster care has involved the placement of children with relatives, while the number of children placed in institutional and group care settings has remained stable; and (6) infants and young children are the fastest growing age groups in the foster care population.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Penelope L. Maza
PHONE NUMBER: 202/205-8172
PIC ID: 5885.1
PERFORMER ORGANIZATION: Chapin Hall Center for Children,
University of Chicago, Chicago IL
TITLE: Youth With Runaway, Throwaway, and Homeless Experiences: Prevalence, Drug Use, and Other At-Risk Behaviors (Three Volumes)
ABSTRACT NUMBER: 022
ABSTRACT: This report is the first national study of substance use, suicide attempts, and other at-risk behaviors among youth with runaway, throwaway, or homeless experience. Information comes from four sources: youths in shelters, youths on the street, youths in households, and directors of youth shelters. The survey of youths and youth shelter directors shows that (1) these youths are exposed to high-risk environments before as well as after they leave home; (2) about half of the youths classified as runaways could also be considered throwaways by their families; (3) these youths are much more likely than youths in general to engage in problem behaviors, including substance abuse, suicide attempts, unsafe sexual behavior, and criminal activity; (4) the youths from families who use drugs are particularly likely to engage in high-risk behaviors; (5) a high proportion of these youths spend time in institutions such as foster homes, psychiatric hospitals, and juvenile justice facilities; and (6) these youths are more likely to engage in many problem behaviors after leaving home than before, perhaps because doing so is a means of survival. The report recommends improvements in services for youths with these experiences. It notes that services must address all needs, from primary prevention to intervention and treatment. Furthermore, services must be community based, accessible, and comprehensive. (Final report three volumes variously paginated, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Griffin, Ph.D.
PHONE NUMBER: 202/205-8138
PIC ID: 3871
PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC
Quality of Long-Term Care in Home and Community-Based Settings: Defining the Issues
Real People, Real Problems: An Evaluation of the Long-Term Care
Ombudsman Programs of the Older Americans Act
TITLE: Quality of Long-Term Care in Home and Community-Based Settings: Defining the Issues
ABSTRACT NUMBER: 023
ABSTRACT: This study is the first step in implementing the 1992 amendments to the Older Americans Act, which authorize the Department of Health and Human Services to conduct two studies. The first study is on the quality of care provided by board and care (B & C) facilities, while the second study is on home care services for older and disabled individuals. The study listed here developed the conceptual framework and provisional design for the two mandated studies.
AGENCY SPONSOR: Office of Program Operations and Development
FEDERAL CONTACT: James Steen
Room 4262, Cohen Building
PHONE NUMBER: 202/619-0075
PIC ID: 5962
PERFORMER ORGANIZATION: National Academy of Sciences, Institute
of Medicine, Washington, DC
TITLE: Real People, Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act
ABSTRACT NUMBER: 024
ABSTRACT: The long-term care ombudsmen program, administered by AoA, provides ombudsmen who advocate to protect the health, safety, welfare, and rights of the institutionalized elderly in nursing facilities and board and care homes. This report examines (1) State compliance with program mandates; (2) conflicts of interest; (3) effectiveness of the program; and (4) adequacy of resources for the program. The report finds that (1) the ombudsman program as a whole has not been fully implemented with regard to the provisions of the Older Americans Act; (2) not all residents of long-term care facilities have meaningful access to ombudsmen, and many are not aware of the program's existence; (3) ombudsmen provide timely responses to complaints; (4) implementation of the ombudsman program for residents of nursing facilities is uneven, and for residents of B&C homes it has not been implemented in any meaningful way; (5) because the ombudsman program is part of State government and its hierarchy, conflicts of interest and loyalty exist within the program, yet regulations do not reflect this reality; and (6) the ombudsman programs function well in many States, serving many thousands of institutionalized elderly, despite the obstacles of inadequate funding, staff shortages, low salary levels, and conflicts of interest. The report recommends improvements in each of the main areas it discusses. (Final report 248 pages, plus appendixes.)
AGENCY SPONSOR: Office of Program Operations and Development
FEDERAL CONTACT: Nancy Wartow
PHONE NUMBER: 202/619-1058
PIC ID: 5819
PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC
Develop, Apply, and Evaluate Medical Review Criteria and Educational Outreach Based Upon Clinical Practice Guidelines: Acute Postoperative Pain and Urinary Incontinence
Developing Quality and Utilization Review Criteria for Management of Cataracts in Adults: Phase II Final Report
Developing Quality and Utilization Review Criteria for Pressure Ulcers in Adults: Phase II Final Report
Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology
Design of a Survey to Monitor Consumers' Access to Care, Use of Health Services, Health Outcomes, and Patient Satisfaction: Final Report
Overcoming Barriers to Implementation and Integration of Clinical Information Management Systems: Feasibility Study
Practice Patterns and Expenditures in Managed Care and Indemnity Plans: A Condition-Specific Analysis
Directory of Minority Health and Human Services Data Resources
Development of Designs for Evaluation of the Process of Clinical Guideline Development
Users' Perceptions of Four Clinical Practice Guidelines and Their Development Process
Setting Priorities for Clinical Practice Guidelines
AHCPR Clinical Practice Guideline Program: Report to Congress
TITLE: Develop, Apply, and Evaluate Medical Review Criteria and Educational Outreach Based Upon Clinical Practice Guidelines: Acute Postoperative Pain and Urinary Incontinence
ABSTRACT NUMBER: 025
ABSTRACT: This project, a contract with the Center for Clinical Quality Evaluation in Washington, DC, was designed to translate three AHCPR-supported clinical practice guidelines into tools that could be used to evaluate quality of care. Using the methodology developed in "Using Clinical Practice Guidelines to Evaluate Quality of Care: Issues and Methods" (AHCPR Publication Numbers 95-0045 and 95-0046), the project developed quality/utilization review criteria and clinical performance measures based on three guidelines: urinary incontinence; acute postoperative pain; and benign prostatic hyperplasia, or BPH. The project used five Medicare Peer Review Organizations to develop and test the criteria and performance measures. These criteria and measures were used to assess the care provided to a sample of randomly selected cases of Medicare patients. The peer review organizations also played an integral role in developing, implementing, and evaluating alternative educational outreach strategies based on the BPH guideline.
The project found that it is possible to develop valid and reliable guideline-based performance measures from AHCPR-supported guidelines. The structure of guideline recommendations can strongly influence the development of clinical performance measures. The project also found that targeted educational efforts based on the BPH-supported guidelines resulted in improved performance on specified measures. (Final report 107 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5973
PERFORMER ORGANIZATION: Center for Clinical Quality Evaluation,
Washington, DC
TITLE: Developing Quality and Utilization Review Criteria for Management of Cataracts in Adults: Phase II Final Report
ABSTRACT NUMBER: 026
ABSTRACT: This project developed and tested quality and utilization review criteria and review systems based on AHCPR-supported clinical practice guidelines on cataracts in adults. The project included two phases. In phase I, project teams developed and tested initial drafts of review criteria and review systems. These drafts were then refined and key components tested again in phase II. Conclusions from phase I are (1) guideline-based review criteria and systems can be developed and used in reviewing quality and utilization in a range of health care delivery settings; (2) review criteria derived from a guideline can be organized into many types of review systems with different goals and purposes; (3) guidelines must contain several critical elements to be useful for clinical decisionmaking and for development of review criteria and review systems; (4) operationalization and measurement are key challenges in review system development. Phase II conclusions are (1) the medical record-based review system designed to assess adherence to AHCPR-supported cataract guidelines is feasible and useful; (2) guidelines must be more specific and have more comprehensive information to optimize their development; and (3) use of a review system may improve documentation practices and adherence to recommendations.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5633
PERFORMER ORGANIZATION: Rand Corporation, Santa Monica, CA
TITLE: Developing Quality and Utilization Review Criteria for Pressure Ulcers in Adults: Phase II Final Report
ABSTRACT NUMBER: 027
ABSTRACT: This project developed guideline-based quality and utilization review criteria that can be used to assess clinical care to prevent pressure ulcers. These criteria can be used to assess conformance with recommendations in clinical practice guidelines and to target areas for clinical quality improvement. The project developed and tested measures that can be used to assess aspects of care that may be related to the development of pressure ulcers. The measures included the development of care plans and nutritional assessments, as well as care behavior related to positioning patients, alleviating pressure, and cleansing and moving patients. The focus of the review system is on patients with limited mobility, specifically patients with stroke or hip fracture. However, the review system can be adapted for use with other patient groups. The review system based on the pressure ulcer guideline was designed in collaboration with the Department of Veterans Affairs (VA) and focused on testing the review criteria for use in both VA and non-VA hospitals. The criteria will be used as part of future collaborative research between AHCPR and the VA. AHCPR and the VA are involved in a VA-wide effort to disseminate the guideline to 45 hospitals.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5634
PERFORMER ORGANIZATION: Rand Corporation, Santa Monica, CA
TITLE: Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology
ABSTRACT NUMBER: 028
ABSTRACT: Clinical performance measures are instruments that estimate the extent to which a health care provider (1) delivers appropriate clinical services in a safe, competent, and timely manner; and (2) achieves desired outcomes in terms of patient health and satisfaction. This project formulates a typology for analyzing the properties and uses of clinical performance measures that have been developed by government and nongovernment organizations, including AHCPR. The report stresses that the typology developed does not classify measures in terms of good and bad, but rather according to the setting for which they were developed, the purpose for which they were developed, and the properties that relate to the measures' potential suitability for its original or other purpose. The report also discusses using performance measures for quality improvement and consumer education. It discusses the use of performance measure sets, ranging in size from less than 10 measures to hundreds. Furthermore, the report examines the desired properties of measures, including (1) detailed specifications to ensure uniformity of application; (2) testing for reliability and validity as measures of performance; (3) allowance for patient differences in making comparisons; and (4) well-planned graphical displays of comparisons. Finally, the report discusses making the measures affordable and offers possible uses for them. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5630
NTIS ACCESSION NUMBER: PB 96-144639
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Design of a Survey to Monitor Consumers' Access to Care, Use of Health Services, Health Outcomes, and Patient Satisfaction: Final Report
ABSTRACT NUMBER: 029
ABSTRACT: This project developed survey instruments to be used by health plans, employers, health alliances, States, accrediting agencies, the Federal Government, and others. The surveys measure consumers' assessments of their health insurance plans, in order to provide meaningful and useful information to other consumers choosing a health insurance plan. The report presents a set of prototype instruments containing an initial set of questions and procedures to assess a range of consumer issues. The report also contains an overview of the conceptual development process and the rationale for the current survey design. The methods and results of cognitive testing are described, as is the logic and evolution of the items contained in the prototype survey. The report concludes with a discussion of the prototype survey's strengths and limitations and a brief overview of recommendations for additional development and testing. (Final report 85 pages, plus appendixes.)
AGENCY SPONSOR: Center for Quality Measurement and Improvement
FEDERAL CONTACT: Sandra Robinson
PHONE NUMBER: 301/594-1352
PIC ID: 6011
PERFORMER ORGANIZATION: Research Triangle Institute, Research
Triangle Park, NC
TITLE: Overcoming Barriers to Implementation and Integration of Clinical Information Management Systems: Feasibility Study
ABSTRACT NUMBER: 030
ABSTRACT: Clinical information systems capture and retrieve information at the point of health care delivery, display clinically meaningful results from multiple services, display chronological histories of patients' medical interventions, compare data on patients with similar characteristics, and share information between sites of care. Although such systems are commercially available, hospitals have been slow to implement them. This report examines the sociological, organizational, technological, and financial barriers to the implementation and optimal use of integrated clinical information systems. The report provides details on the feasibility of a study of 8 to 16 sites representing 4 to 8 major vendor products. It also provides details on site selection, research design, and a data collection plan. The report finds that the study should use focused case studies to carry out four main objectives: (1) identify target systems and provider site characteristics; (2) identify and recruit provider sites; (3) identify and solicit vendor participation; and (4) design an evaluation plan for the study, including a process and structure evaluation and an outcomes study. The report also gives a schedule for the implementation of the study. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5039
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
TITLE: Practice Patterns and Expenditures in Managed Care and Indemnity Plans: A Condition-Specific Analysis
ABSTRACT NUMBER: 031
ABSTRACT: This project studied overall costs and utilization in managed care settings and how differences in practice patterns affect these variables. The project focused, in particular, on differences in practice patterns in managed care settings. The project assessed the use of selected tests and procedures for patients with heart attacks, congestive heart failure, delivery, back pain, or asthma. One of the conclusions of the project was that although the volume of claims studied was enormous, the coding used on the claim forms appeared to allow the selection of specific target procedures and tests. Also, the prevalence of such interventions was enough to detect important differences in practice patterns. In general, the use of claims to assess differences in practice patterns seems promising. However, during the project, problems continued in the receipt of usable data, causing one of the three participating carriers to withdraw from the project. This withdrawal terminated the project because confidentiality could no longer be guaranteed. General lessons from these experiences relate to project design and data management. For example, projects of this sort should be segmented, with initial data acquisition and cleaning coming first. Thus, carriers will be participating in a funded project, but large amounts of resources will not be expended until all the data are acquired.
AGENCY SPONSOR: Center for Primary Care Research
FEDERAL CONTACT: Linda A. Siegenthaler
PHONE NUMBER: 301/594-1357
PIC ID: 5664
PERFORMER ORGANIZATION: University of California, San Francisco,
San Francisco CA
TITLE: Directory of Minority Health and Human Services Data Resources
ABSTRACT NUMBER: 032
ABSTRACT: This directory is intended for use by policymakers, researchers, and the public as a reference to resources within the Department of Health and Human Services that contain race and ethnicity data. Databases with broad utility, from ongoing departmental data projects to program administrative or evaluation activities, are included in the directory. The directory includes information from the Office of the Secretary, the Administration for Children and Families, the Health Care Financing Administration, the nonindependent Social Security Administration, and the Public Health Service. Each entry includes the following information: (1) the title of the data source; (2) the sponsoring office; (3) an abstract summarizing key characteristics of the database; (4) the race and ethnicities categorized in the database; (5) data limitations; (6) other data; (7) the program supported by the data project or system; (8) the general purpose of the database; (9) the status of the database; (10) the start date, start date period, or start/end dates; (11) the availability of the database; (12) constraints on use of the database; (13) the data media; (14) the distributor of public use files; (15) the agency contact person; and (16) the available data products. (Final report 278 pages.)
AGENCY SPONSOR: Center for Information Technology
FEDERAL CONTACT: Harvey Schwartz
PHONE NUMBER: 301/594-1483
PIC ID: 5911
PERFORMER ORGANIZATION: Moshman Associates, Inc., Bethesda, MD
TITLE: Development of Designs for Evaluation of the Process of Clinical Guideline Development
ABSTRACT NUMBER: 033
ABSTRACT: This project was a response to AHCPR Reauthorization Act of 1992. The project focused on the development and testing of designs to evaluate AHCPR's process for guideline development. The project identified key dimensions of the process of clinical practice guideline development and compared these dimensions among AHCPR and non-AHCPR-funded guidelines. The key dimensions selected were chosen because they varied across guideline development efforts; and they were viewed by experts as likely to affect the quality of guidelines and their acceptance by clinicians and other targeted audiences. The report recommends that AHCPR (1) consider pursuing its legislative mandate to review and assess guidelines developed by other organizations using appropriate methodologies; (2) examine mechanisms to streamline the organizational arrangements of expert panels (one of two types of panels used by AHCPR); (3) consider the development of standing panels, each addressing a broad class of conditions or technologies; (4) consider obtaining some front-end external review during the guideline development process to obtain information that could enhance the usefulness of the guideline to clinicians; (5) consider identifying and training a small pool of consumer representatives who could serve on multiple panels; and (6) undertake research to determine how the development process relates to the use of guidelines by key end users.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5629
PERFORMER ORGANIZATION: George Washington University Medical
Center, Washington, DC
TITLE: Users' Perceptions of Four Clinical Practice Guidelines and Their Development Process
ABSTRACT NUMBER: 034
ABSTRACT: Clinical practice guidelines assist practitioners, health care providers, and consumers in making decisions about health care interventions for specific clinical circumstances. This report determines if aspects of various guideline development processes are associated with typical users' perceptions about the guideline's validity, reliability, cost, and utility. The report finds that (1) clinical applicability and ease of use are two major criteria by which participants assess the potential value of clinical guidelines and upon which they base their decisions to adopt and use them; (2) most participants want guidelines that help them solve problems in a clinical setting by updating their knowledge, outlining the latest developments, or providing guidance in areas where the participants' experience is limited; (3) panel selection, topic selection, and literature review are critical to a guideline's validity; (4) participants believe that recommendations made in the clinical guidelines must be verified by their own judgment and experience; and (5) some participants also feel that inappropriate implementation of clinical guidelines can have a negative impact on practice. The report recommends that (1) AHCPR continues to develop--under rigorous conditions--guidelines that reflect changes in the field of medicine. (Final report 110 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5956
PERFORMER ORGANIZATION: American Institutes for Research,
Washington, DC
TITLE: Setting Priorities for Clinical Practice Guidelines
ABSTRACT NUMBER: 035
ABSTRACT: This project described and evaluated possible methods for setting priorities for guideline topics. The report concludes that the current priority-setting approach used by AHCPR is relatively open, fairly explicit, and generally defensible. The report recommends that six general criteria be applied in considering topics for guidelines and technology assessment: prevalence of the problem; burden of illness imposed by the problem; cost; variability in practice; potential of a guideline or assessment to improve health outcomes; and the potential of a guideline or assessment to reduce costs. The report recognizes that the data used to score particular topics on these six criteria will often be incomplete. The report recommends possible ways to improve the procedures used in setting priorities for clinical practice guidelines. These recommendations focus on (1) methods for obtaining expert judgment and developing consensus positions; and (2) the desirability of a basic procedure manual. The report also recommends that AHCPR more precisely and narrowly define the topics selected for guideline development. The report concludes that AHCPR could play a useful role as a clearinghouse that collects and disseminates guidelines developed by other organizations. It also concludes that AHCPR needs an explicit, open, and defensible process for assessing the soundness of guidelines developed by other organizations.
AGENCY SPONSOR: Center for Primary Care Research
FEDERAL CONTACT: David Lanier, M.D.
PHONE NUMBER: 301/594-1357
PIC ID: 5631
PERFORMER ORGANIZATION: Institute of Medicine, Washington, DC
TITLE: AHCPR Clinical Practice Guideline Program: Report to Congress
ABSTRACT NUMBER: 036
ABSTRACT: The AHCPR Reauthorization Act of 1992 (Public Law 102-410) required that AHCPR report to Congress on three aspects of its clinical practice guideline program: methods for selecting guideline topics, methods for developing guidelines, and methods for assessing guideline quality. This report summarizes AHCPR's clinical practice guideline program to date in areas including guideline development, research and evaluation activities, and analyses of the guideline program conducted by organizations such as the Physician Payment Review Commission and the Office of Technology Assessment. It also examines potential directions for the future. (Final report 39 pages, plus appendixes.)
AGENCY SPONSOR: Office of the Forum for Quality and Effectiveness in Health Care
FEDERAL CONTACT: Kathryn Rickard
PHONE NUMBER: 301/594-1455
PIC ID: 5949
PERFORMER ORGANIZATION: Agency for Health Care Policy and Research, Rockville, MD
Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Final Report
Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report
Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention (CLPP)
Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)
Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)
Evaluation of the Content and Conduct of Health Examination Surveys
Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado
Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component
Evaluation of the Feasibility of an Injury Risk Factor
Evaluation of the Impact of a Diabetes Guide for Patients
Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers
Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools
Final Report: Assessment of CDC's Press Relations Functions
Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities
Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)
Rapid Assessment of Influenza Vaccination in the United States
Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data
Working With Community-Based Organizations To Advance the Childhood
Lead Poisoning Prevention Agenda
TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Final Report.
ABSTRACT NUMBER: 037
ABSTRACT: This project develops a comprehensive evaluation strategy to be incorporated into planning, budgeting, and legislative decisionmaking processes of the National Center for Chronic Disease Prevention and Health Promotion. The final report discusses the major findings of a 1993 review of the planning and evaluation environment at NCCDPHP. It finds that (1) getting programs into the field is a higher priority at CDC than is assessing the efficacy and effectiveness of these programs; (2) funding decisions are unrelated to evaluation; (3) there is little connection between planning and evaluation at NCCDPHP or CDC; and (4) a stronger commitment to evaluation is needed. A pilot test of the evaluation strategy developed by the project shows that (1) data transfers between Federal, State, and local levels are costly and imperfect, and they require an approach linked to public health objectives; (2) States are concerned that program performance indicators fail to capture the complexity of the States' problems and accomplishments; (3) a too-detailed and overly specific evaluation methodology poorly assesses State and local implementations of chronic disease prevention programs; and (4) the Government Performance and Review Act and block grant funding will have a substantial impact on NCCDPHP programs. The report recommends a flexible approach to evaluation for NCCDPHP. See also PIC ID 4746. (Final report 95 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Lisa Daily
PHONE NUMBER: 770/488-5706
PIC ID: 4746.1
PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA
TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report
ABSTRACT NUMBER: 038
ABSTRACT: This project develops a comprehensive evaluation strategy that can be incorporated into planning, budgeting, and legislative decisionmaking processes at NCCDPHP. This strategy will provide direction on whether Center programs can be evaluated. It will guide decisions about which program components should be evaluated, will provide direction regarding the scope of the evaluation, will clarify the types of data that should be routinely collected to support planning and evaluation activities, and will indicate when and how evaluation results should be fed back into the decisionmaking process. A six-step iterative process was used to develop the Evaluation for Decisionmaking Strategy. The strategy incorporates the views of public health stakeholders and was developed with the advice of NCCDPHP managers, policymakers, and evaluators. The final concept for the strategy attempts to balance the scientific rigor needed for proper evaluations and the flexibility required when dealing with real programs. The strategy links evaluation to the decisionmaking process by defining five program decision points that are associated with stages of program development. These decision points are (1) identification of needs; (2) examination of the policy context; (3) program design; (4) program implementation; and (5) program maintenance. A user's guide is provided to help NCCDPHP planners and evaluators implement the strategy. (Interim report 73 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Lisa Daily
PHONE NUMBER: 770/488-5403
PIC ID: 4746
PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA
TITLE: Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention
ABSTRACT NUMBER: 039
ABSTRACT: This report examines how the move toward managed care by State Medicaid programs affects the provision of the major service components of CDC Childhood Lead Poisoning Prevention (CLPP) programs. It also examines how CLPP programs have responded to the challenges of managed care. Site visits to Florida, Indiana, Minnesota, Rhode Island, and Tennessee were conducted. The report finds that (1) managed care will affect all components of CLPP programs because it leads to decentralization and privatization of functions that are currently centralized; (2) State and local health departments will spend less time on assurance and more on assessment and policy development under managed care, and they will also have a diminished role in direct service delivery; and (3) many of the changes in the managed care environment may make it difficult to obtain the sort of data needed to perform new functions such as assessment and quality assurance. The report discusses several strategies that CDC can use to adapt to the managed care environment. In general, these strategies are in the areas of (1) maintaining public sector service delivery; (2) building a legal infrastructure, whether this involves a screening law, a reporting law, or an enforcement of protocols and data collection to support enforcement; and (3) funding core public health functions. See also PIC ID 4373 and 4373.2. (Final report 29 pages.)
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Nancy Tips
PHONE NUMBER: 770/488-7277
PIC ID: 4743.1
NTIS ACCESSION NUMBER: PB 96-144670
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)
ABSTRACT NUMBER: 040
ABSTRACT: This report evaluates the current system used to classify external causes of injury in order to facilitate the correct use of the International Classification of Diseases "Supplemental Classification of External Causes of Injury and Poisoning" (E-Codes). The study evaluates the E-Code tabular list and alphabetical index and recommends improvements; (2) evaluates existing E-Code coding guidelines and recommends improvements; (3) evaluates E-Code training materials and recommends improvements; and (4) develops and evaluates prototype training materials, including a model training syllabus for E-Code use. E-Code stakeholders were asked to participate in the evaluation by serving on a technical advisory panel. The panel evaluated and recommended changes to the E-Code tabular list and alphabetical index. These changes were field tested by training 138 subjects: medical record department coding staff from eight hospitals (four trauma hospitals and four community hospitals); and health information management students. Test sites in four States were used. The field test demonstrated that experienced coders liked the revisions and could use the new codes with minimal training. Participants praised expanded guidelines, the addition of clarifying examples, the new alphabetic index, and the new tabular list. (Final report three volumes, variously paginated, plus appendixes.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Perrianne Lurie
PHONE NUMBER: 301/436-4216
PIC ID: 4742
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)
ABSTRACT NUMBER: 041
ABSTRACT: Of all deaths in the United States, about 20 percent are investigated by medical examiner or coroner (ME/C) offices. In all, more than 2,200 jurisdictions are responsible for death investigation and certification. Records from these jurisdictions are timely and detailed, and constitute the ultimate source of information on sudden and unexpected deaths. CDC established MECISP in 1987 to coordinate these data for researchers and public health officials. MECISP's main product is a database containing data collected from ME/C sites. MECISP also produces a biannual directory listing ME/C jurisdictions and summarizing death investigation laws.
This report reviews the activities at MECISP in order to evaluate and suggest improvements to the process of sharing information on death investigation in the United States. The report finds that (1) MECISP's main role is to be a broker between death investigators and people who can best use data from these investigations to improve public health; (2) death investigation data, particularly MECISP data, are underused, because of problems with access, visibility, relevance, coverage, and quality; and (3) correcting these problems requires resources that MECISP does not have, such as staff with technical expertise in the area. The report makes several recommendations, chiefly one that calls for greater resources.
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Gib Parrish, M.D.
PHONE NUMBER: 404/488-3310
PIC ID: 5350
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Evaluation of the Content and Conduct of Health Examination Surveys
ABSTRACT NUMBER: 042
ABSTRACT: The Third National Health and Nutrition Examination Survey (NHANES III) is the seventh in a series of surveys with health examination components conducted by the National Center for Health Statistics (NCHS) since 1960. The survey asked 30,000 persons about their demographic, socioeconomic, dietary, and health history. An examination component for each participant includes phlebotomy, as well as examinations by a physician, a dentist, specialized interviewers, and health technicians. About 5,000 sample persons are examined each year in two 3-year cycles of data collection. NCHS is considering a design for NHANES-97 that includes recurring 2-year data collection cycles, which will examine a sample of about 7,500 each year (a 50 percent increase). This report (1) explores methods for increasing the sample size by 50 percent; (2) examines the core content of the examination; (3) evaluates other health examination studies; and (4) discusses the feasibility of collecting specified nutrition assessment measures in a setting other than a mobile examination center. For each of these tasks, the report presents objectives, methodology, and major findings and recommendations. This report is available from NTIS only. (Final report two volumes, variously paginated.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Natalie Fuller-Dupree
PHONE NUMBER: 301/436-7080
PIC ID: 5512
NTIS ACCESSION NUMBER: PB 95-221974
PERFORMER ORGANIZATION: Westat, Inc., Rockville, MD
TITLE: Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado
ABSTRACT NUMBER: 043
ABSTRACT: This project evaluated a pilot edition of a Spanish-language diabetes patient guide targeted to Hispanic populations. This guide, "Encarguese de Su Diabetes: Una Guia Para Su Cuidado," was developed by staff of the Division of Diabetes Translation at CDC. The rationale for this evaluation was to ensure that the final guide would be culturally relevant and readable for individuals with at least a sixth-grade level of education. Specifically, the project used focus group discussions to determine the understandability, relevance, usefulness, and adaptability of the guide among diverse Hispanic populations in the United States. The focus group discussions were held throughout the United States. Phase I of the project resulted in a revised Spanish-language version of the guide, and phase II was directed at refining issues related to finalization, production, and distribution of the guide.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Patricia Mitchell
PHONE NUMBER: 770/488-5015
PIC ID: 5352
PERFORMER ORGANIZATION: Casals and Associates, Arlington, VA
TITLE: Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component
ABSTRACT NUMBER: 044
ABSTRACT: FACE identifies and investigates fatal occupational injuries, with the goal of preventing them. It identifies work situations at high risk for fatal injury and formulates and disseminates prevention strategies to those who can intervene in the workplace. This report assesses the effectiveness of information dissemination for FACE programs in three States. The report (1) describes communication channels and information users; (2) identifies prevention efforts resulting from information provided by FACE; (3) assesses indicators of changed work behaviors that might be attributed to the program; and (4) assesses the potential effectiveness of specific dissemination strategies within each of the three States. The report finds that (1) employers generally assess the program favorably; (2) some employers are concerned that the inclusion of specific points might cast an unfavorable light on their companies, and that some recommendations are economically or technically unfeasible; (3) most employers who have made workplace changes did so immediately following a fatality, and many reported these changes to other managers in the company; (4) FACE materials are widely used for professional education, public information, advocacy, regulation, surveillance, and vocational training; and (5) organizational and economic influences govern the dissemination of FACE materials. The report concludes that the program is effective and of high quality in each State reviewed.
AGENCY SPONSOR: National Institute of Occupational Safety and Health
FEDERAL CONTACT: Theodore Pettit
PHONE NUMBER: 304/284-5796
PIC ID: 5506
PERFORMER ORGANIZATION: Research Triangle Institute, Research
Triangle Park, NC
TITLE: Evaluation of the Feasibility of an Injury Risk Factor
ABSTRACT NUMBER: 045
ABSTRACT: This report evaluates the feasibility of a national telephone survey as (1) a surveillance system for injury risk factors; (2) a means through which to monitor progress toward injury objectives for the year 2000; and (3) a tool for evaluating injury control programs. A national telephone survey of 5,238 adults was conducted. The response rate for the survey was 54 percent of households determined to be eligible for the study. While telephone response rates have been declining over the past decade, the 29 percent refusal rate for this survey was higher than anticipated. Analyses suggest that neither the sampling methodology nor the survey length were related to problems with response rates; but instead that these problems were related to (1) the perceived (rather than actual) length of the survey; (2) sensitivity of topics; and (3) informed consent procedures.
AGENCY SPONSOR: National Center for Injury Prevention and Control
FEDERAL CONTACT: Jeffrey Sacks, M.D.
PHONE NUMBER: 770/488-4652
PIC ID: 4522
PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA
TITLE: Evaluation of the Impact of a Diabetes Guide for Patients
ABSTRACT NUMBER: 046
ABSTRACT: This project provided information to CDC's Division of Diabetes Translation about how different dissemination approaches affected the behavior of providers, and how health care practice was impacted when the guides were presented to primary care practitioners as part of a specialized training seminar at community health centers. The study recommended that (1) programs have a champion at each local intervention site; (2) an adequate market for the intervention be present prior to program implementation; (3) sources of capital be targeted and linked to the unit of analysis; (4) agreements with each intervention site be obtained to ensure necessary levels of human and structural support; and (5) sufficient time be allowed for system change.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Dawn Satterfield
PHONE NUMBER: 770/488-5020
PIC ID: 5934
PERFORMER ORGANIZATION: Research Triangle Institute, Research
Triangle Park, NC
TITLE: Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers
ABSTRACT NUMBER: 047
ABSTRACT: In 1991, CDC's Division of Diabetes Translation published two guides for diabetes care. One, "The Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers," was aimed at health care providers. The second, "Take Charge of Your Diabetes: A Guide for Care," was aimed at patients. This project provides information to the Division of Diabetes Translation on the dissemination approaches for the provider guide. Three urban community health centers served as intervention sites. Two of them received the provider guide and a 4-hour education and activation program; one of these two also received the patient guide. The third center received the provider guide without explanation. The project determined how different dissemination approaches affect the behavior of providers, and how health care practice is impacted when the guides are presented to primary care practitioners as part of a specialized training seminar. The report finds no conclusive evidence that the intervention had a strong effect on practitioner behavior. Although there were some improvements, these could not be traced to the intervention. Furthermore, the intervention may not have been strong enough to affect provider behavior, especially given the high staff turnover rates at these centers. (Final report 56 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Dawn Satterfield
PHONE NUMBER: 404/488-5020
PIC ID: 4108
PERFORMER ORGANIZATION: Research Triangle Institute, Research
Triangle Park, NC
TITLE: Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools
ABSTRACT NUMBER: 048
ABSTRACT: This project evaluated the progress and activities conducted by the 71 HIV education programs funded by CDC's Division of Adolescent and School Health (DASH). These programs are funded through cooperative agreements with State and local education agencies. Data elements were obtained from reading the program file documents and were abstracted for each funded year of the 5-year period, 1987-92, for each program. A database was composed from these elements that will allow CDC to answer specific evaluation questions regarding the development of programs and the extent to which CDC policies and guidelines were followed during the funding period.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Peter Hunt
PHONE NUMBER: 404/488-5343
PIC ID: 6070
PERFORMER ORGANIZATION: MACRO International, Inc., Atlanta, GA
TITLE: Final Report: Assessment of CDC's Press Relations Functions
ABSTRACT NUMBER: 049
ABSTRACT: CDC's News Division within the Office of Public Affairs (OPA) was established in 1987 to handle inquiries from the press. The volume of calls to this office has more than doubled between 1991 (8,000 inquiries) and 1994 (more than 20,000 inquiries), but the number of press officers available to respond to calls has remained constant. This report examines OPA's News Division and its relationship with CDC centers, institutes, and offices (CIOs) and with the press. The key finding is that the News Division is understaffed for the volume of calls. The report also finds that some CIOs recognize that OPA is overwhelmed, yet they are pleased with the services it provides; others are generally dissatisfied and desire more proactive media relations services. Reporters say that they have difficulty reaching the News Division and that their inquiries are not answered in a timely way. Furthermore, a review of external press offices finds that OPA staff handle more than twice the number of inquiries than do staff of comparable organizations. The report recommends that (1) communications technology such as voice mail, batch faxing, electronic mail, and automated tracking of press inquiries be instituted; (2) staffing levels be increased to 9 or 10 press officers; (3) internal policies and procedures guiding current and future activities be developed; and (4) individual CIO needs be determined and met.
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: Helen T. Kuykendall
PHONE NUMBER: 404/639-3286
PIC ID: 5915
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities
ABSTRACT NUMBER: 050
ABSTRACT: CDC established the Office of Women's Health (OWH) in 1994. This report identifies the role, functions, strategies, activities, and benchmarks for OWH. The report maintains that OWH has five key functions: (1) leadership; (2) advocacy; (3) internal coordination; (4) external relationship building at the national, State, and local levels; and (5) research and program development. The report also discusses the guiding principles of OWH and suggests how it should position itself in light of these principles. For example, the report stresses that OWH must have the goodwill of other offices within CDC, and suggests that the Associate Director for Women's Health be made a member of CDC's senior management team in order to highlight the vital role OWH will play. The report suggests that OWH (1) create a vision at CDC for women's health; (2) increase the visibility of women's health programs within CDC and to external audiences; (3) develop formal, systematic communication mechanisms for internal exchange of information about CDC's women's health activities; (4) facilitate coordination and collaboration between CDC and other Public Health Service offices that deal with women's health; and (5) dedicate allocated funding to support projects that address priorities and gaps in women's health efforts. The report also discusses such issues as building relationships, staffing, and priorities for the coming year. (Final report 24 pages, plus appendixes.)
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: Wanda Jones
PHONE NUMBER: 404/639-7230
PIC ID: 5913
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)
ABSTRACT NUMBER: 051
ABSTRACT: Three events have placed significant demands upon CDC's National Immunization Program: (1) the measles outbreak in the late 1980's and early 1990's, which brought the importance of childhood immunization to the forefront of public attention; (2) the President's Childhood Immunization Initiative (CII) of 1994, which made the immunization of preschool children a key health priority; and (3) mandates to eliminate indigenous cases of specific vaccine-preventable diseases and to increase vaccine coverage to at least 90 percent among 2-year-old children. An increase in the NIP operation budget of 160 percent and a staff increase of approximately 50 percent occurred between fiscal 1993 and 1995. This report examines NIP's management structure and style, its communication and decisionmaking processes and strategies, its patterns of authority, and its delegation of work and responsibility. The report offers recommendations in the following areas: (1) strategic planning, (2) day-to-day management, and (3) staff issues. (Final report 43 pages, plus appendixes.)
AGENCY SPONSOR: National Immunization Program
FEDERAL CONTACT: Victoria Westberg
PHONE NUMBER: 404/639-8204
PIC ID: 5916
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Rapid Assessment of Influenza Vaccination in the United States
ABSTRACT NUMBER: 052
ABSTRACT: This project determines the 1992-93 and 1993-94 influenza vaccine coverage in sites where CDC plans to conduct active surveillance for Guillain-Barre syndrome (GBS). This determination should permit CDC to (1) assess whether receipt of influenza vaccine in these years was associated with an increased risk for GBS; (2) determine whether a change in recommendations for influenza vaccination is warranted; and (3) provide insight into usage patterns of influenza vaccination.
AGENCY SPONSOR: National Immunization Program
FEDERAL CONTACT: Robert Chen
PHONE NUMBER: 301/402-3497
PIC ID: 5894
PERFORMER ORGANIZATION: MACRO International, Inc., Atlanta, GA
TITLE: Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data
ABSTRACT NUMBER: 053
ABSTRACT: This project was intended to improve the analysis of NCHS data. The project evaluated NCHS's present analytical methods and developed a prototype automated data analysis system, the Automated System for Survey Information and Statistical Tools (ASSIST). During the project, ASSIST was used as a communications tool between NCHS analysts and the contractor staff to explore and assess data access. NCHS also considered the accessibility of the data to users whose computing expertise ranged from novice to expert. The prototype was also used in (1) evaluating and assessing problems associated with multiple data set storage; (2) determining the requirements for the use of data across data systems; and (3) determining whether both user and provisional data should be employed. (Final report five pages.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Marcus Sanchez
PHONE NUMBER: 301/436-7904
PIC ID: 3575
PERFORMER ORGANIZATION: American Management Systems, Inc.,
Arlington, VA
TITLE: Working With Community-Based Organizations To Advance the Childhood Lead Poisoning Prevention Agenda
ABSTRACT NUMBER: 054
ABSTRACT: As public health services evolve, CDC must recognize that at least three important changes in emphasis must occur within its CLPP programs. These three changes are (1) a shift from direct service delivery to assessment, policy development, and quality assurance; (2) a shift from secondary prevention to primary prevention; and (3) a new goal of coordinating the care and followup of lead-poisoned children and their families.
Joining into partnership with community-based organizations (CBOs) may help ease the impact of these changes. This report is intended to help CLPP grantees and local health departments build better relationships with CBOs and to provide suggestions as to how they can broaden their mission to include a community-based prevention agenda. The report gives examples of successful collaborations and concludes that (1) grantees may have difficulty finding appropriate CBOs to work with, since not all CBOs will be interested in preventing lead poisoning; (2) CBOs have a different accountability and organizational structure than public sector organizations and may have different working styles; (3) grantees should choose long-established CBOs with good records in the community; (4) CBOs, like the public sector, must compete for limited resources; and (5) CBOs may have high staff turnover and little institutional memory. See also PIC ID 4743 and 4743.1. (Final report 22 pages.)
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Nancy Tips
PHONE NUMBER: 404/488-7277
PIC ID: 4743.2
NTIS ACCESSION NUMBER: PB 96-144688
PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD
Assessment of the Mammography Quality Standards Act of 1992 (MQSA)
Nationwide Evaluation of X-Ray Trends (NEXT)
Third Annual Performance Report on the Prescription Drug User Fee Act
of 1992: Fiscal Year 1995 Report to Congress
TITLE: Assessment of the Mammography Quality Standards Act of 1992 (MQSA)
ABSTRACT NUMBER: 055
ABSTRACT: FDA is charged with ensuring that accessibility to quality mammography services is maintained for all facilities performing mammographies, in accordance with MQSA. Under this statute, FDA is required to certify and annually inspect over 10,000 mammography facilities. Prior to the passage of MQSA, FDA's oversight responsibility was limited to approving new mammographic processors, X rays, and tubing. However, MQSA requires that facilities within its jurisdiction meet quality standards developed by FDA if these facilities are to obtain certification by the Agency. FDA is concerned that recent trends by third-party payers to captivate payments for mammography services have severely limited the ability of facilities to absorb any cost increases caused by the quality standards. These cost increases, as well as excess capacity, may cause low-volume facilities to leave the industry. This project addresses these problems in two ways. First, it measures the effect of standards on patient access to mammography, especially in rural areas. It also develops a cost model that will be used to predict the impact of proposed standards on the costs of providing mammography. This project addresses these issues by collecting and analyzing data from facilities that provide mammography services.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Steve Tucker
PHONE NUMBER: 301/443-1839
PIC ID: 6080
PERFORMER ORGANIZATION: Eastern Research Group, Inc., Rosslyn,
VA
TITLE: Nationwide Evaluation of X-Ray Trends (NEXT)
ABSTRACT NUMBER: 056
ABSTRACT: NEXT is a collaborative program conducted jointly between FDA and State radiation control agencies. The study estimates the radiation dosage from diagnostic X-ray examinations, using data collected from previous NEXT surveys of different types of X-ray examinations. The study generates data on image quality, photographic processing quality, and types of practice. The data are used by public health and professional organizations to set policy. The studies are conducted in cooperation with the Conference of Radiation Control Directors. Products generated in the study include (1) "National Survey of Mammographic Facilities," in 1985, 1988, and 1992; (2) "Mammography (and Radiology?) Is Still Plagued With Poor Quality in Photographic Processing and Darkroom Fog"; (3) "Assessment of Skin Entrance Kerma in the United States: The Nationwide Evaluation of X Ray Trends (NEXT)"; (4) "How Good (or Bad) Is Film Processing?"; and (5) "Automatic Film Processing: Analysis of 9 Years of Observations."
AGENCY SPONSOR: Center for Devices and Radiological Health
FEDERAL CONTACT: Orhan Suleiman
PHONE NUMBER: 301/594-3332
PIC ID: 4984
PERFORMER ORGANIZATION: Conference of Radiation Control
Directors, Washington, DC
TITLE: Third Annual Performance Report on the Prescription Drug User Fee Act of 1992: Fiscal Year 1995 Report to Congress
ABSTRACT NUMBER: 057
ABSTRACT: Fiscal 1995 marked the third year of the 5-year implementation of the Prescription Drug User Fee Act (PDUFA) of 1992. This Act authorized the collection of fees from the pharmaceutical industry in order to facilitate FDA's timely review of human drug applications. The Act mandates that FDA prepare yearly reports for each fiscal year in which fees are collected. This third annual report, for fiscal 1995, was prepared in response to that mandate. It presents findings as to how well FDA has accomplished its performance goals for fiscal 1995. These performance-related goals were jointly established by FDA and the pharmaceutical industry and fall into three main categories: eliminating overdue backlogs, building excellence into the review process, and achieving high performance. The report finds that (1) New Drug Applications (NDAs) approval was 23 percent higher after PDUFA's enactment than in the 2 years prior; (2) a high percentage of first reviews were accomplished within the 12-month timeframe specified in the PDUFA; and (3) other reasons for quicker approval times include high rates of affirmative first actions, quick action on approvables, and effective "refuse-to-file" screening. (Final report 24 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Paul Coppinger and Kate McEvoy
PHONE NUMBER: 301/443-4230
PIC ID: 6079
PERFORMER ORGANIZATION: Office of Planning and Evaluation, Food and Drug Administration, Rockville, MD
Comparative Study of the Use of Early and Periodic Screening, Detection, and Treatment and Other Preventive and Curative Health Care Services by Children Enrolled in Medicaid
Evaluation of the Maryland Access to Care Demonstration: Managed Care for Medicaid Recipients
Evaluation of the Medicaid Extension Demonstrations
Evaluation of United Mine Workers of America Demonstration
Expanded Cross-Cutting Evaluation on Medicare Prevention Demonstrations Under Consolidated Omnibus Budget Reconciliation Act
Final Evaluation Report of the 1989 Grant Program for Rural Health Transition: Send Us More Doctors, Please
Interim Report of the Evaluation of the Essential Access Community Hospital/Rural Primary Care Hospital Programs
Medicare Participating Heart Bypass Center Demonstration: Appropriateness Study
Medicare Participating Heart Bypass Center Demonstration: Data Collection Design
Medicare Participating Heart Bypass Center Demonstration: Evaluation Design
Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume One, The First Three Years
Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume Two, Marketing Activities of Participating Hospitals
Medicare Risk Program for HMOs: Final Summary Report on Findings From the Evaluation
Monitoring the Impact of Medicare Physician Payment Reform on
Utilization and Access
TITLE: Comparative Study of the Use of Early and Periodic Screening, Detection, and Treatment and Other Preventive and Curative Health Care Services by Children Enrolled in Medicaid
ABSTRACT NUMBER: 058
ABSTRACT: This project was comprised of a series of individual research projects that studied the effect of the changes in the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program introduced by the Omnibus Budget Reconciliation Act of 1989 on the process of providing health services to children and on the appropriateness of expenditures for the services provided in Tennessee, Georgia, Michigan, and California. These projects compared Medicaid-enrolled children in four EPSDT programs with other Medicaid-enrolled children in the four States who are not receiving EPSDT services, regarding enrollment patterns, service utilization, and expenditures, with a particular emphasis on preventive health services. They also compared Medicaid-enrolled children with non-Medicaid-enrolled children, insured and uninsured, on the use of and expenditures for preventive services and other health care services, using national survey data.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Feather Ann Davis, Ph.D.
PHONE NUMBER: 410/786-6590
PIC ID: 6236
PERFORMER ORGANIZATION: SysteMetrics Division of MedStat, Inc.,
Ann Arbor, MI
TITLE: Evaluation of the Maryland Access to Care Demonstration: Managed Care for Medicaid Recipients
ABSTRACT NUMBER: 059
ABSTRACT: The Maryland Access to Care (MAC) demonstration became operational in December 1991 and eventually covered about two-thirds of Medicaid recipients in the State. The targeted population was Aid to Families with Dependent Children (AFDC) recipients, Supplemental Security Income (SSI) participants, and Sixth Omnibus Budget Reconciliation Act-eligible children. The MAC program was mandatory for recipients in the MAC-eligible categories. The program matched MAC recipients with a primary medical provider (PMP) that acted as the recipient's gatekeeper to the health care system. These PMPs also continued under the standard Medicaid fee-for-service reimbursement systems, but, to encourage their participation, Medicaid fees for primary care services were increased by an average of 50 percent under the MAC program. Specialists were reimbursed for nonemergency specialty care provided to MAC patients only if these services were referred by the patients' PMPs. The evaluation employed a pre-/post-test comparison and a post-test description of program operations. The data came primarily from Medicaid enrollment and claims files and from provider surveys. The project was extended to allow the performance of additional analyses to compare the performance of office-based and hospital outpatient providers under the MAC program.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Paul J. Boben, Ph.D.
PHONE NUMBER: 410/786-6629
PIC ID: 6235
PERFORMER ORGANIZATION: People-to-People Health Foundation,
Inc., Bethesda, MD
TITLE: Evaluation of the Medicaid Extension Demonstrations
ABSTRACT NUMBER: 060
ABSTRACT: This project was an evaluation of three demonstrations mandated under section 6407 of the Omnibus Budget Reconciliation Act of 1989. They evaluated alternative models for extending health insurance coverage to children under 20 years of age who lacked insurance. The demonstrations occurred in the States of Florida, Maine, and Michigan. Each State used a different strategy for providing the new coverage. Florida tested the effectiveness of marketing a school-based affordable insurance package that delivers services through a managed care network. Maine conducted a statewide program that subsidized comparable private employer-based group coverage, where such insurance was believed to be cost effective. Michigan tested the effectiveness of a public/private partnership between the State and Michigan Blue Cross and Blue Shield, using donated funds to subsidize a mainstream outpatient insurance package. The evaluation examined the effect of these demonstrations on various outcome and process measures of access to care, private insurance coverage, and cost of care. The methodology took into account the distinctiveness of the three demonstrations while incorporating a strategy that allowed for comparisons between programs in terms of penetrating the eligible population. Case studies were coupled with analysis of program data to describe the structure and processes of the demonstrations. In addition, primary data were collected through surveys of both program participants and controls. Separate analyses of program costs and program effectiveness were included.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Paul J. Boben, Ph.D.
PHONE NUMBER: 410/786-6629
PIC ID: 6234
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
TITLE: Evaluation of United Mine Workers of America Demonstration
ABSTRACT NUMBER: 061
ABSTRACT: This is an evaluation of the United Mine Workers of America (UMWA) Health and Retirement Funds (the UMW Funds) Medicare Part B capitation demonstration. This demonstration replaced the Funds' Health Care Prepayment Plan arrangement with the Health Care Financing Administration (HCFA), in which it had been reimbursed for Medicare Part B services on a cost basis. In its place, the Funds assumed risk for Medicare Part B services under a capitated payment mechanism. The evaluation addressed the cost-effectiveness of capitation based on an analysis of changes in utilization and cost resulting from the demonstration. It also undertook a detailed case study describing the cost management programs and changes occurring in the organization as a result of the demonstration. Based on this approach, the evaluation was unable to discern a causal relationship between the demonstration and the events that occurred subsequent to its implementation. Events that happened during the demonstration may have been independent or could have been related in complicated ways. Thus, in an interim report the evaluation concluded that the demonstration had no measurable operational effect on the Funds beyond the obvious effect of ending the reimbursement dispute between HCFA and UMW Funds. The final report indicated that there was no evidence to clearly support a conclusion about the cost-effectiveness of capitation for UMW Funds' beneficiaries.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Ronald W. Lambert
PHONE NUMBER: 410/786-6624
PIC ID: 6233
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
TITLE: Expanded Cross-Cutting Evaluation of Medicare Prevention Demonstrations Under Consolidated Omnibus Budget Reconciliation Act
ABSTRACT NUMBER: 062
ABSTRACT: This project was a cross-cutting evaluation of the five Medicare prevention demonstrations mandated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. These demonstrations tested the effectiveness of providing disease prevention and health promotion services to Medicare beneficiaries. Congress stipulated that the preventive health service package was to include health screenings, health risk appraisals, immunizations, and counseling and instruction in diet and nutrition, stress reduction, exercise programs, sleep regulation, injury prevention, substance abuse and mental disorders prevention, self-care (including medication use), and smoking cessation. In May 1988, cooperative agreements were awarded to five schools of public health to implement the demonstrations. Waivered services were provided between May 1989 and April 1991. A preliminary Report to Congress was submitted in July 1989. While the original legislation mandated 4-year demonstrations, the Omnibus Budget Reconciliation Act (OBRA) of 1990 extended them to 5 years. This extension allowed for an additional year of followup for purposes of evaluation, added an interim Report to Congress (which was submitted in September 1993), and required that the final Report include a comprehensive evaluation of the long-term effects of the demonstration.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Deborah C. Van Hoven
PHONE NUMBER: 410/786-6625
PIC ID: 6237
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
TITLE: Final Evaluation Report of the 1989 Grant Program for Rural Health Transition: Send Us More Doctors, Please
ABSTRACT NUMBER: 063
ABSTRACT: This report evaluates the impact of the Rural Health Care Transition (RHCT) grant program on the cohort of 181 rural hospitals that received grants in September 1989. The report uses three methods to evaluate the program: (1) a trend analysis of all grantees to determine whether the program improved their utilization rates and finances; (2) a pregrant/postgrant comparison to examine managerial improvements; and (3) a case study, descriptive analysis of projects implemented. The report finds that (1) the grant program does not seem to affect hospital finances or managerial capacity in a measurable way, but it does help some hospitals and areas where the majority of patients served would have had to travel or go without services in the absence of the grant program projects; (2) adult day care programs are least likely to be implemented and, if implemented, to be retained; (3) patient services such as community education programs are fairly easy to implement, but are likely to be abandoned because of high cost; and (4) outpatient, home health, emergency rooms, and emergency transportation programs are most frequently implemented and retained. The report concludes that the grant program does not address fundamental problems facing rural hospitals. The program cannot change the hospitals' financial weakness, their high numbers of uninsured patients, the low demand for their services, the high cost of providing low-volume emergency services, or the shortage of rural physicians. (Final report 168 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Siddhartha Mazumdar
PHONE NUMBER: 410/786-6673
PIC ID: 5283
NTIS ACCESSION NUMBER: PB 94-142312
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Interim Report of the Evaluation of the Essential Access Community Hospital/Rural Primary Care Hospital Programs
ABSTRACT NUMBER: 064
ABSTRACT: This report documents the initial development of the Essential Access Community Hospital (EACH) and the Rural Primary Care Hospital (RPCH) programs, which are Federal-State initiatives to maintain access to health care services in rural areas by developing rural health networks and by integrating health care. Through qualitative and quantitative analysis of background information provided by program grantees, secondary data from HCFA's Medicare Cost Reports (1987-89) and Market Area File (1988-89), and site visits to State agencies and hospitals in California, Colorado, Kansas, New York, North Carolina, South Dakota, and West Virginia, the report examines program development at the State and local levels. It finds that (1) States have made uneven progress in program development; (2) p