Performance Improvement 1995. Health Resources and Services Administration

02/01/1995

Listing of Abstract Titles

Evaluation Design: Evaluation of the Effectiveness of Community Health Centers

Linkage Programs: Survey of Mental Health Services

Perinatal Pilot-Test Summary and Implementation Report

HIV Service Networks in Four Rural Areas

Implementation of Title I of the Ryan White CARE Act of 1990

The Participation of People With HIV in Title I HIV Health Services Planning Councils

Evaluation of Methods for Estimating Unit Costs of HIV Health and Support Services

Rural Health Travels the Telecommunica-tions Highway--Reaching Rural

The Demographic and Treatment Characteristics of the Hill-Burton Population

Survey of Beneficiaries of Nursing Education Projects

The Training and Practice of Preventive Medicine Specialists: An Underutilized Resource

Evaluation of Bureau of Health Professions Strategic Directions--Phase I

TITLE: Evaluation Design: Evaluation of the Effectiveness of Community Health Centers

ABSTRACT NUMBER: 021

ABSTRACT: The purpose of this joint HRSA/OASH project was to develop a study design that would examine the efficiency and effectiveness of community and migrant health centers (C/MHCs); the centers' impact on the health status of their users; and ways in which the centers can improve their performance. Comparison of costs, utilization, and health outcomes for similar populations not using C/MHCs are part of the design. Issues of how and when various outcomes are reported, how data concerning them can be gathered, and whether the specified outcome measures are appropriate for evaluation were studied. The report calls for analysis of approximately 50 community health centers (CHCs) in 10 States. The report recommends that effectiveness and impact of the CHC model(s) be assessed by describing the characteristics of the CHC delivery model(s); measuring the impact of the model(s) on use of health services, health care expenditures, and indicators of health status; and identifying factors that contribute to the observed impact. The design formed the basis for an evaluation of the centers that began in September 1994.

FEDERAL CONTACT OFFICE: Division of Community and Migrant Health, Bureau of Primary Health Care

PERSON: Judy Rodgers

PHONE NUMBER: 301/594-4340

PIC NUMBER: 4918

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Ann Zuvekas

TITLE: Linkage Programs: Survey of Mental Health Services

ABSTRACT NUMBER: 022

ABSTRACT: In 1989, HRSA's Bureau of Primary Health Care and the National Institute on Drug Abuse cosponsored the Integrated Primary Care and Substance Abuse Treatment Program, referred to as the "Linkage Program," a multiyear demonstration program supporting 21 community-based approaches for linking substance abuse and primary care services. This demonstration led to recognition of the need for mental health services in these linkage projects. A survey was designed to examine various delivery system features pertaining to availability, scope, and delivery of mental health services, and barriers to providing these services. The 15 projects that received fourth-year continuation grants (which included seven community health centers) were the focus of this study. The major finding was that most linkage projects evolved a supportive environment for assessment of mental health problems and a system of referral to and delivery of mental health services. However, projected need for mental health services outstripped delivery system capacity. Findings from this study will help other providers of primary care services establish the necessary alliances and treatment networks to reduce delivery system fragmentation and develop a continuum of inpatient and ambulatory mental health services.

FEDERAL CONTACT OFFICE: Division of Programs for Special Populations, Bureau of Primary Health Care

PERSON: Thomas M. Coughlin

PHONE NUMBER: 301/594-4450

PIC NUMBER: 3557.2

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD

P.I.: Marilyn Falik, Ph.D.

TITLE: Perinatal Pilot-Test Summary and Implementation Report

ABSTRACT NUMBER: 023

ABSTRACT: The purpose of this study was to develop and pilot test a patient-specific data collection tool for perinatal patients and infants receiving services in Community and Migrant Health Centers (C/MHCs) funded by HRSA's Bureau of Primary Health Care (BPHC) and to prepare a plan for implementing this tool. This study is part of an effort to develop and implement a BPHC-wide data and evaluation strategy to improve the availability of information about patients served by grantees. Two patient-specific forms were designed to capture information regarding specific process and outcomes measures. The first would collect data about pregnant women using prenatal and/or postpartum services in C/MHCs, and the second would collect data on infants age 12 months or younger whether or not their mothers used prenatal or postpartum services in a C/MHC. A pilot test was conducted in eight centers over 5 months, and feedback was collected from 22 additional centers via telephone interviews. The pilot test provided information about the data collection instruments with regard to availability of the requested data and completeness and reliability of the data collected, and identified the need to revise the data items, definitions, instructions, and formats. The study found that universal adoption of the forms would be burdensome and expensive. It recommends instead that the form be used in a study of 4,000 mother-child pairs at about 20 C/MHC sites over a 4-year period.

FEDERAL CONTACT OFFICE: Division of Programs for Special Populations, Bureau of Primary Health Care

PERSON: Thomas M. Coughlin

PHONE NUMBER: 301/594-4450

PIC NUMBER: 4208.1

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Ann Zuvekas

TITLE: HIV Service Networks in Four Rural Areas

ABSTRACT NUMBER: 024

ABSTRACT: The purpose of this study was to identify and describe systems of HIV care in four rural areas. The study was designed to build understanding of how HIV services are being organized and delivered in different rural environments and to identify service gaps and barriers to care. The case studies identified two distinct approaches to providing medical care to rural residents with HIV: (1) an HIV clinic, located in a rural health department or community health center, that develops cooperative working agreements with physicians in private practice and (2) care provided by primary care physicians who are linked with a medical school or rural-based regional care facility for training and backup consultation. The case studies also documented the need to place more emphasis on HIV training and education in rural areas to create more positive environments for the development of medical and support services. The study's findings and recommendations are being used to design a national study of HIV care in rural areas that will be funded by HRSA. This rural study will be integrated with a large national study of HIV costs and service utilization that is being sponsored by the Agency for Health Care Policy and Research. Case study findings also are being used to formulate HRSA polices on rural HIV care and to provide technical assistance to States with large rural populations.

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Katherine Marconi, Ph.D.

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5642

PERFORMER ORGANIZATION: David Berry Company, Las Vegas, NV

P.I.: David Berry

TITLE: Implementation of Title I of the Ryan White CARE Act of 1990

ABSTRACT NUMBER: 025

ABSTRACT: This project measured the extent to which five policy objectives of Title I of the Ryan White CARE Act were achieved in Baltimore, MD, and Oakland, CA: (1) local control and definition of priority setting for the allocation of funds to community AIDS service organizations; (2) rapid disbursement of funds; (3) increased access to services by expanding existing services and adding new agencies; (4) improved coordination of HIV-related services; and (5) increased access to HIV services for underserved populations. To measure progress toward these objectives, surveys were conducted of all identified AIDS services providers and nonrandom samples of people with HIV in 1991 and 1993 in Baltimore and Oakland. Additionally, case studies of the Title I Planning Council processes in each city were completed. All policy objectives, with the exception of improved coordination among services, were met, and a series of recommendations was made for the future administration of this Act. The Henry J. Kaiser Family Foundation funded the 1993 surveys. (The report also presents planning council studies conducted in four eligible metropolitan areas that were not part of the HRSA baseline study.)

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Moses B. Pounds

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5639

PERFORMER ORGANIZATION: Johns Hopkins University, Baltimore, MD

P.I.: David D. Celentano, Sc.D.

TITLE: The Participation of People With HIV in Title I HIV Health Services Planning Councils

ABSTRACT NUMBER: 026

ABSTRACT: Ryan White CARE Act Title I Health Services Planning Councils are required by statute to include membership from "affected communities, including individuals with HIV disease." Experience has indicated, however, that eliciting and sustaining participation by these individuals is one of the major challenges facing councils. This study was conducted to identify factors supporting the initial and sustained involvement of HIV-positive individuals in the councils, and identify alternative methods employed by the councils to gain input from and provide feedback to HIV-positive populations in the absence of direct participation. In-depth discussions and focus groups were held in Atlanta, Philadelphia, San Diego, and Seattle, with a total of 113 participants, 90 of whom were HIV-positive. The study found that the councils have undergone an evolution with regard to how they recruit HIV-positive members and whom they recruit: all councils now express commitment to recruiting HIV-positive members of greater ethnic and gender diversity. All councils reported using numerous mechanisms for obtaining input from HIV-positive nonmembers, including public forums, client needs surveys, and participation in advocacy groups. Based on the study report, the Division of HIV Services has issued a policy statement on council membership.

FEDERAL CONTACT OFFICE: Division of HIV Services, Bureau of Health Resources Development

PERSON: Steven R. Young

PHONE NUMBER: 301/443-9091

PIC NUMBER: 5643

PERFORMER ORGANIZATION: Academy for Educational Development, Washington, DC

TITLE: Evaluation of Methods for Estimating Unit Costs of HIV Health and Support Services

ABSTRACT NUMBER: 027

ABSTRACT: The purpose of this study was to evaluate the procedures used to estimate costs of providing health and social services to people with HIV infection. This study compared two methods of costing Ryan White CARE Act services. The first method used an average unit cost approach: total program budgets are divided by total number of service units to yield an average unit cost. The results indicate a wide variation in costs, as a result of actual variations in the content, quality, and volume of services provided, as well as some reporting and methodological errors. The second methodology used a direct cost profile approach to construct the cost of one standard unit of service. This method was tested among a selected group of five Texas CARE Act providers using a questionnaire. This method proved difficult to administer and less accurate than the average unit cost method, although some cost estimates are provided. The study concluded that the average unit cost method is more intuitive and straightforward for CARE Act providers, primarily because most providers use program budgets. A manual for estimating the unit costs of HIV care is now available to Ryan White CARE Act grantees.

FEDERAL CONTACT OFFICE: Office of Science and Epidemiology, Bureau of Health Resources Development

PERSON: Christine Hager

PHONE NUMBER: 301/443-6560

PIC NUMBER: 5640

PERFORMER ORGANIZATION: Texas Department of Health, Austin, TX

P.I.: Susan Griffin

TITLE: Rural Health Travels the Telecommunications Highway--Reaching Rural

ABSTRACT NUMBER: 028

ABSTRACT: The Health Resources and Services Administration sponsored a workshop in November 1993, in Washington, DC, to consider the use of telecommunications technology for providing medical care to rural patients and for reducing the isolation of rural health professionals. The workshop was intended to address the application of telecommunications to clinical care (telemedicine) and to the education of health professionals (distance learning). The purpose of the workshop was to discuss policy issues that affect the development and appropriate use of telemedicine systems. The workshop included descriptions of operating telemedicine systems and the problems they have had to overcome. Workshop participants also provided advice for future telemedicine evaluations. A number of commissioned papers identified and assessed barriers and opportunities for applying this technology in rural areas. The workshop provided an opportunity to develop consensus in order to advance the effective use of this technology in rural areas. In addition, the workshop contributed to the development of the Rural Telemedicine Grant Program and of an exploratory evaluation of the program that began in September 1994. The workshop also strengthened collaborative relationships with staff of other Federal Agencies, such as HCFA and the Departments of Agriculture and Commerce, that are funding telemedicine projects.

FEDERAL CONTACT OFFICE: Office of Rural Health Policy

PERSON: Carole L. Minzter

PHONE NUMBER: 301/443-0835

PIC NUMBER: 5644

PERFORMER ORGANIZATION: Ryan-McGinn, Arlington, VA

P.I.: Teri Randall

TITLE: The Demographic and Treatment Characteristics of the Hill-Burton Population

ABSTRACT NUMBER: 029

ABSTRACT: The purpose of this study was to determine the demographic characteristics of the population receiving medical services under the Hill-Burton Uncompensated Services Program and the conditions for which treatment was required. These characteristics and conditions were compared with those of the general population. Data were obtained from both Hill-Burton records and patient medical records at each of the 50 facilities selected for participation in the study. Records for 4,835 patients were examined. Specific Diagnostic Related Groups and International Classification of Disease Codes were obtained for each record. The findings indicated that, compared with the total U.S. population, the study population was more likely to be female, young adult, and unmarried, with very low household income. The study population required services classified as injury, obstetrical, and ill-defined conditions more often than the general population. Patient records showed that 69.4 percent had no health insurance and 80.1 percent had no coverage for the services received.

FEDERAL CONTACT OFFICE: Office of Facilities Compliance, Bureau of Health Resources Development

PERSON: Jacob E. Tenenbaum

PHONE NUMBER: 301/443-4303

PIC NUMBER: 5641

PERFORMER ORGANIZATION: Arthur Testoff Company, New Carrollton, MD

P.I.: Arthur Testoff

TITLE: Survey of Beneficiaries of Nursing Education Projects

ABSTRACT NUMBER: 030

ABSTRACT: The purpose of this study was to evaluate the programs carried out under Title VIII of the Public Health Service Act and to prepare the biennial report to Congress mandated by Section 859(b) of the Act. The six programs evaluated were Nursing Special Projects Grants and Contracts, Nursing Education Opportunities for Individuals From Disadvantaged Backgrounds Program Grants, Grants for Advanced Nurse Education, Nurse Practitioner and Nurse-Midwifery Program Grants, Professional Nurse Traineeships, and Nurse Anesthetist Traineeships. Separate surveys of grantees and graduates were conducted. The overriding conclusion of this study is that the Title VIII programs are meeting the purposes they were designed to accomplish. Federal support has stimulated the development of projects that address significant nursing education and practice issues. Moreover, the funds provided for the development of educational programs for advanced practice nurses and for the support of students are creating a stable resource of advanced practice nurses.

FEDERAL CONTACT OFFICE: Division of Nursing, Bureau of Health Professions

PERSON: Evelyn B. Moses

PHONE NUMBER: 301/443-6315

PIC NUMBER: 4433

PERFORMER ORGANIZATION: Washington Consulting Group, Washington, DC

P.I.: Cyrus Baghelai

TITLE: The Training and Practice of Preventive Medicine Specialists: An Underutilized Resource

ABSTRACT NUMBER: 031

ABSTRACT: This project was designed to provide detailed information through case studies on the practice profile of residents in selected preventive medicine residency (PMR) programs funded by HRSA. The study examined the recruitment of residents during their training, the various mechanisms used to finance the training of residents, and the career options available to graduates of PMR programs. The study involved the appointment of an expert working committee whose members conducted site visits to 10 preventive medicine residency programs. The culmination of the project was a 3-day workshop held in Washington, DC, in August 1993, which brought together PMR program directors with the major constituencies for preventive medicine. Workshop recommendations included "marketing" preventive medicine to medical students, developing a national strategy for incorporating preventive medicine into the standard medical school curriculum, and reassessing the fourth year of the preventive residency program.

FEDERAL CONTACT OFFICE: Division of Associated, Dental, and Public Health Professions, Bureau of Health Professions

PERSON: Ronald B. Merrill

PHONE NUMBER: 301/443-6896

PIC NUMBER: 4911

PERFORMER ORGANIZATION: American College of Preventive Medicine, Washington, DC

P.I.: Hazel K. Keimowitz

TITLE: Evaluation of Bureau of Health Professions Strategic Directions--Phase I

ABSTRACT NUMBER: 032

ABSTRACT: This study is Phase I of an effort to develop a fully integrated, computerized data system to facilitate program effectiveness evaluation and data analysis of Titles VII and VIII programs administered by the Bureau of Health Professions (BHPr). The purpose of Phase I was to develop a set of outcome indicators to evaluate the effectiveness of programs in the context of BHPr's strategic directions and to identify potential data sources and gaps related to these indicators. Phase II will solicit external customer input on the proposed set of indicators developed in Phase I and identify strategies to address data gaps. A third phase may be needed to develop a consolidated data system for assessing progress toward achieving strategic program objectives bureauwide.

FEDERAL CONTACT OFFICE: Office of Research and Planning, Bureau of Health Professions

PERSON: Betty B. Hambleton

PHONE NUMBER: 301/443-1590

PIC NUMBER: 5497

PERFORMER ORGANIZATION: Lewin/VHI, Inc., Fairfax, VA

P.I.: Susanna Ginsburg

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