Performance Improvement 1995. Agency for Health Care Policy and Research

02/01/1995

Listing of Abstract Titles

Analysis of Peer and Pilot Review Data Clinical Practice Guidelines

Evaluation of Cost Analyses Conducted on Clinical Practice Guidelines: Final Report

Identification of Data Sources Appropriate for Use in Conducting Cost Analysis Required for the Development of Clinical Practice Guidelines: Final Report

Overcoming Barriers to Integration and Implementation of Clinical Information Management Systems

Report on Inappropriate Extension of Hospitalization

Research on the Cost Effectiveness of Managed Care Health Plans: A Literature Review

TITLE: Analysis of Peer and Pilot Review Data Clinical Practice Guidelines

ABSTRACT NUMBER: 001

ABSTRACT: The Agency for Health Care Policy and Research (AHCPR), through its Office of the Forum for Quality and Effectiveness in Health Care (Office of the Forum), is mandated by Congress to develop clinical practice guidelines. This development process includes a review of draft guidelines by independent health practitioners and other relevant professionals to provide information about their quality and potential usefulness (peer review). Additional information can be obtained about a guideline's value if its recommendations are assessed in patient care situations by practicing clinicians (pilot review). The purpose of this project was to review and analyze the results of peer and pilot testing for six AHCPR-sponsored guidelines and to develop recommendations for future peer review and pilot testing methodologies. This contract culminated in a report that offered several recommendations for improving peer and pilot review procedures, including limiting the number of peer and pilot reviewers to 50; increasing the number of primary care, consumer advocate, and nonphysician reviewers; improving the yield of completed reviews by contacting potential reviewers in person; providing improved instructions to reviewers; providing longer timeframes for organizational reviews; and drafting a rationale for changes recommended for a guideline when review comments are evaluated and saving this draft as documentation of the panel's deliberations.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5651

PERFORMER ORGANIZATION: Harvard University School of Public Health, Boston, MA

P.I.: R. Heather Palmer, M.D.

TITLE: Evaluation of Cost Analyses Conducted on Clinical Practice Guidelines: Final Report

ABSTRACT NUMBER: 002

ABSTRACT: This study examined the methodologies and data sources used in cost studies for eight clinical practice guidelines (urinary incontinence, pressure ulcers, cataract, depression, low back pain, otitis media, benign prostatic hyperplasia, and sickle cell anemia). It was found that the primary distinction among the studies was whether they estimated treatment costs under the guidelines. Analysts in the studies that did not estimate treatment costs felt it would require too many assumptions to do so. They were concerned about the assumptions that must be made to estimate treatment costs and made the following recommendations: reduce the number of assumptions necessary to estimate treatment costs and restrict the empirical analysis to the direct medical costs of treatment; compare treatment patterns and costs before and after guideline implementation; use a variety of data sources--such as administrative claims, clinical trials, and medical record abstractions; use episodes of care as the unit of analysis, to provide a link between the clinical and economic dimensions of the guidelines; use a substantive expert as analyst, so that he or she is able to start on the description of current practice immediately without waiting for guidance from the panel; and emphasize the importance of the cost studies to the panels since the panels are typically made up of medical professionals who may place greater emphasis on clinical practice and outcomes and less emphasis on cost.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5652

NTIS ACCESSION NUMBER: PB 95-193694

PERFORMER ORGANIZATION: SysteMetrics, Cambridge, MA

P.I.: William Crown, Ph.D.

TITLE: Identification of Data Sources Appropriate for Use in Conducting Cost Analysis Required for the Development of Clinical Practice Guidelines: Final Report

ABSTRACT NUMBER: 003

ABSTRACT: Databases that provide cost information relating to clinical guidelines have not been established. However, several databases have been identified as worthy of investigation because of their potential utility in estimating costs of guideline components. The purpose of this study was to investigate the content of these databases, evaluate their usefulness, develop a cost-measurement methodology using these existing databases, and describe how the methodology could be used for selected guidelines. It was determined that no one database can be used to estimate the costs of clinical guidelines. Since often there are no data on certain services in claims databases or there are significant questions about the accuracy of available data, data must be assembled from several sources. Per-patient costs for current and guideline patterns need to be multiplied by data on the prevalence of the condition to arrive at aggregate cost for the United States. In this calculation, differences in per-patient costs are projected to understand overall impact.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5653

NTIS ACCESSION NUMBER: PB 95-193652

PERFORMER ORGANIZATION: Center for Health Policy Studies, Columbia, MD

P.I.: Benjamin Dugger, Sc.D.

TITLE: Overcoming Barriers to Integration and Implementation of Clinical Information Management Systems

ABSTRACT NUMBER: 004

ABSTRACT: The purpose of the feasibility study was twofold: (1) to determine the practicality of studying the barriers to implementation and integration of advanced clinical information systems and (2) to specify the type of research design for an implementation study to investigate these issues. Despite the promise of clinical information systems, there have been few concerted research efforts to understand the barriers that impede dissemination or the benefits that accrue from implementation. The report presents the design for a major, and feasible, research study of integrated health care information systems. With written letters of cooperation from 24 institutions, the project would study 8 to 16 sites (depending on funding level) representing 4 to 8 major vendor products and would focus on both outcomes of implementation and barriers to adoption of system features. The report provides details on study feasibility, site selection, research design, and a data collection plan.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5039

NTIS ACCESSION NUMBER: PB 95-193371

PERFORMER ORGANIZATION: ABT Associates, Cambridge, MA

P.I.: Catherine Joseph

TITLE: Report on Inappropriate Extension of Hospitalization

ABSTRACT NUMBER: 005

ABSTRACT: The purpose of this contract was to perform a literature review and interview experts about inappropriate hospital-stay extension and the role of discharge planning, and to produce a summary document identifying research needs and potential existing data sources. The project was undertaken to address a Senate Appropriations Committee request for information on the extent to which inappropriate hospital duration occurs, the reasons for such inappropriate extension of hospitalization, and the extent to which hospital discharge planning can reduce inappropriate continuation of hospital stays. The project also describes best practices in hospital discharge planning. Key findings of the project are these: 5 percent or more of total hospital days are likely to be accounted for by extended stays that are not medically necessary, the cost of which is conservatively estimated at $420 million in 1987 dollars; the reasons for extended hospital stays include lack of sufficient nursing home beds and other alternative placement settings, paperwork delays in qualifying patients for posthospital benefits, and delays in appointing conservators for incompetent patients. Discharge planning appears to have only a small impact on extended hospital stays, but it may be having greater impact on appropriateness of placement and the likelihood of readmission. The problem is pervasive, despite incentives for early discharge. A solution is more likely to be a systemic change coming from outside the hospital; or there may be some level beyond which reduction of such stays is infeasible.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5655

NTIS ACCESSION NUMBER: PB 95-193710

PERFORMER ORGANIZATION: Research Triangle Institute, Washington, DC

P.I.: James S. Lubalin, Ph.D.

TITLE: Research on the Cost Effectiveness of Managed Care Health Plans: A Literature Review

ABSTRACT NUMBER: 006

ABSTRACT: The purpose of this project was to identify, compile, categorize, and critically analyze published and unpublished literature on the cost-effectiveness of managed health care plans, to draw conclusions about the cost-effectiveness of various approaches to these plans and indicate important remaining policy-relevant gaps in knowledge. Managed care plans were compared with indemnity (fee-for-service) plans with regard to utilization and cost performance. It was found that managed care plans had lower hospital utilization, greater use of less costly alternatives to expensive procedures and tests, greater use of preventive measures, comparable quality of care, and somewhat lower enrollee satisfaction generally but much greater satisfaction with cost. The study also concluded that policymakers need much more evidence on managed care plan performance. It recommends funding larger, more comprehensive research projects to determine what works in managed care, rather than just whether managed care works.

FEDERAL CONTACT OFFICE: Office of Program Development

PERSON: Irma Arispe

PHONE NUMBER: 301/594-1455

PIC NUMBER: 5654

PERFORMER ORGANIZATION: Center for Health Policy Research, George Washington University, Washington, DC

P.I.: Michele Solloway, Ph.D.

View full report

Preview
Download

"PerformanceImprovement1995.pdf" (pdf, 941.92Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®