Performance Improvement 1997. Appendix A. Abstracts of HHS Evaluations Completed in Fiscal Year 1996

02/01/1997

The abstracts included in this appendix describe the evaluation reports completed by the Department of Health and Human Services (HHS) during fiscal year (FY) 1996. 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 person listed at the end of each abstract. Copies may be obtained by contacting either the Policy Information Center or the National Technical Information Service, addresses for which are given below.

Policy Information Center

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 short-term evaluative research, policy-oriented projects, and in-process, completed, and ongoing HHS evaluations. The PIC maintains a resource data base 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

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

National Technical Information Service

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

National Technical Information Service
Department of Commerce
5285 Port Royal Road
Springfield, VA 22161
(703) 487-4650

Administration for Children and Families

Contents

Evaluation of Child Support Guidelines

Evaluation of Four Child Access Demonstration Programs Funded by the Federal Office of Child Support Enforcement

Evaluation of the Child Access Demonstration Projects: Report to Congress

Evaluation of Nine Comprehensive Community-Based Child Abuse and Neglect Prevention Programs

Final Evaluation Report for the Case Management Enhancement Project at the East Orange District Office of the New Jersey Division of Youth and Family Services

Final Report: National Evaluation of Home-Based Services Programs for Runaway Youth

Gang Families in a Public Housing Project

Length of Service and Cost-Effectiveness in Three Intensive Family Service Programs: Final Report

Social and Educational Development of Tribal-Based Communities of the Sonoran and Negev Deserts

Survey of Head Start Family Self-Sufficiency Initiatives

Survey of Head Start Family Self-Sufficiency Initiatives: Case Studies in Six Communities

Transfer of International Innovations: Development of a Clinical Monitoring System To Support Foster Care in Michigan

Women and Infant Nurturing Services (WINGS)
 

TITLE: Evaluation of Child Support Guidelines

ABSTRACT NUMBER: 001

ABSTRACT: This study evaluated presumptive child support guidelines in order to (1) assess the impact of shifting from voluntary to presumptive guidelines using the Current Population Survey--Child Support and Alimony Supplement of 1992; (2) assess changes and activities of state Guideline Commissions using materials submitted by the States; (3) carry out a prospective administrative survey of 11 State guidelines applications; and (4) conduct unstructured interviews with State, local, and judicial personnel in the states participating in the survey. The report finds little impact on child support orders when States treat guidelines as presumptive rather than voluntary. A review of 48 formal State guidelines shows that States' inquiries range from questions about the guideline formula to the responsibility of new spouses to the definition of income. Furthermore, a review of State studies of deviations from guidelines shows that most States deviate in 25 percent or less of cases, but that the range of deviation is from 81 percent to 3 percent. A study of cases in 11 states and 21 sites (4,000 cases) shows that the formal deviation rate is 17 percent, but that there was a range of 50 percent to 0 percent by county. Reasons for deviations include agreement between parties, second-parent households, extended visitation and custody, and low income. Seventy-four percent of deviations decrease the award. Finally, the report finds that treatment of special factors--such as second families, income imputation, verified income, health insurance, extraordinary health, child care, postsecondary education, taxes, custody, and visitation--was low and extremely variable.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: (202) 401-5364

PIC ID: 5983

PERFORMER ORGANIZATION: CSR, Incorporated, Washington, DC
 

TITLE: Evaluation of the Child Access Demonstration Projects: Report to Congress

ABSTRACT NUMBER: 002

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 Wave I report finds that: (1) the nature of access disputes is complicated and long-standing for one or both parents--insufficient time, visitation denial, feeling cut out of the child's life, scheduling problems, fights during drop-off and pick-up, problems caused by new relationships, concerns about proper supervision and safety; (2) nonattendance at mediation was a big problem; (3) parenting/visitation agreements were arrived at in 65 to 70 percent of the cases when both parents attended mediation sessions; (4) there were fewer problems after mediation than before; (5) visitation rates increased for experimental cases compared to control cases in most sites; (6) the speed of dispute resolution was not affected; (7) the incidence of relitigation was low--5 percent--but not affected by the experiments; and (8) compliance with child support increased for all experimental groups over the control groups and ranged up to 24 percent increases. See also PIC ID Nos. 5972.1 and 5972.2. (Final report: 239 pages, plus appendices.)

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: (202) 401-5364

PIC ID: 5972

PERFORMER ORGANIZATION: Center for Policy Research, Denver, CO
 

TITLE: Evaluation of Four Child Access Demonstration Programs Funded by the Federal Office of Child Support Enforcement

ABSTRACT NUMBER: 003

ABSTRACT: Although attention has long been paid to issues of child support enforcement, problems of noncustodial parental access to their children have been less studied. However, there is substantial research demonstrating that parental contact and payment of child support are related. This report summarizes the result of the second (Wave II) set of Child Access Demonstration Projects funded by the Office of Child Support Enforcement. Four States participated in the demonstration. In Arizona, divorced couples under enforceable visitation orders received monitoring calls according to different frequencies and schedules, while parents in the control group received no calls. In Idaho, parents seeking divorce or modification of visitation orders took part in family skills education. Detailed access plans were developed by participants, or they were referred to mediation. The Iowa project provided counseling services to noncustodial parents who called the operating organization. In Massachusetts, parents seeking divorce or modification of child access participated in education programs or assessment and counseling. The report finds that (1) both custodial and noncustodial parents report problems concerning child access; (2) parents in Wave II experimental and control groups reported decreased access problems; (3) in Massachusetts, fathers in the experimental group were less likely to report that their ex-spouse made negative comments about them to their children, and custodial parents in Arizona and Massachusetts reported fewer incidences of children being upset at drop-off and pick-up times; (4) no statistically significant differences in payment of child support were evident after the Wave II projects; and (5) most parents expressed satisfaction with the demonstration projects. See also PIC ID Nos. 5972 and 5972.2. (Final report: 154 pages, plus appendices.)

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: (202) 401-5364

PIC ID: 5972.1

PERFORMER ORGANIZATION: Center for Policy Research, Denver, CO
 

TITLE: Evaluation of Nine Comprehensive Community-Based Child Abuse and Neglect Prevention Programs

ABSTRACT NUMBER: 004

ABSTRACT: This evaluation (1) designed and implemented a process and impact evaluation of nine comprehensive community-based child abuse and neglect prevention projects funded by the National Center for Child Abuse and Neglect; (2) provided technical assistance to the nine projects in meeting the requirements of the evaluation; and (3) aided the programs in their efforts to design and implement their own internal program evaluations. The evaluation was conducted in three phases over a 3-year period. The 9 projects examined 10 service components, many of which were different across the programs. Therefore, a series of individual experimental designs were developed for each service component. Process and impact data were collected across programs and through a series of studies conducted in each site. All grantees were aided in refining their evaluation and research plans. An electronic bulletin board was established for use by the grantees. Two site visits were made each month and evaluation technical assistance was provided by telephone, electronic bulletin board, and mail. Grantee evaluators were advised on statistical techniques, instruments, and data collection methods. An evaluation plan, technical assistance overview, and bibliography have been submitted to the Administration on Children, Youth, and Families for review.

AGENCY SPONSOR: Administration on Children, Youth, and Families

FEDERAL CONTACT: Emily Cooke

PHONE NUMBER: (202) 205-8709

PIC ID: 5851

PERFORMER ORGANIZATION: CSR, Incorporated, Washington, DC
 

TITLE: Final Evaluation Report for the Case Management Enhancement Project at the East Orange District Office of the New Jersey Division of Youth and Family Services

ABSTRACT NUMBER: 005

ABSTRACT: In mid-1992, New Jersey's Division of Youth and Family Services (DYFS) requested applications that might demonstrate improvements in child welfare service delivery and program cost effectiveness through the computerization of many caseworkers' record keeping tasks. The East Orange District Office is located in a municipality contiguous to Newark, the State's largest city and, in mid-1992, supervised about 1,500 children in 760 families. This report describes the extent to which computerization changed the allocation of DYFS caseworkers' time. In the half-year leading up to the project's start, the East Orange District Office was noteworthy for having added a disproportionately large number of children to its caseload and for having placed disproportionately high percentages of these children in foster care for relatively long periods of time. During the project's life span, these trends were reversed, due to a combination of a new District Office manager and the introduction of a number of operational changes including computerization of the office. The report concludes that, between 1993 and 1995, the establishment of a new management team in the office, which stressed heightened accountability, tighter controls, and closer monitoring of individual staff performance, was largely responsible for eliminating previous delays in the disposition of new referrals and in reducing caseloads. The report postulates that these new procedures and a new work ethos were more responsible for beneficial trends than computerization. Furthermore, the time workers spent on various record-keeping activities did not decline between 1993 and 1995 as a consequence of automation, but increased at first as workers learned how to use the new computers. Thus, while computerization has no clear near-term benefits, it can be instituted as one of several components in a wide-ranging office reorganization.

AGENCY SPONSOR: Administration on Children, Youth, and Families

FEDERAL CONTACT: James Dolson

PHONE NUMBER: (202) 401-0133

PIC ID: 6397

PERFORMER ORGANIZATION: A.L. Nellum and Associates, Washington, DC
 

TITLE: Final Report: National Evaluation of Home-Based Services Programs for Runaway Youth

ABSTRACT NUMBER: 006

ABSTRACT: This report presents the results of five demonstration programs that sought to develop and implement home-based service models for at-risk youth. The first set of demonstrations, funded beginning in February 1989, developed and tested model programs of treatment for dysfunctional families to enable the family to remain the primary caregiver while protecting the interests of at-risk youth. The demonstrations were based in Baltimore, Maryland, and Nashville, Tennessee. The second set of demonstrations, funded beginning in September 1991, were based in Kauai, Hawaii; San Diego, California; and Tucson, Arizona. These programs implemented models to address and prevent runaway behavior among adolescents. The report finds that all projects provided families with relatively short-term interventions with the intent of linking them to existing resources in the community for longer-term services and generally served youth between 12 and 17 years of age. The projects encountered several problems with the provision of these services, including multiproblem families, a lack of community resources, a lack of support from other community agencies, and staff turnover. Effective service practices included employing bilingual and culturally sensitive staff; round-the-clock staff availability; and using a co-therapist approach. Furthermore, the report finds that (1) only the Kauai evaluation examined an array of participant outcomes; it reported success in preventing out-of-home placements for youth, decreased incidence of runaway and truant behaviors, improved family functioning, and improvements in child behaviors and emotional well-being; (2) the Nashville evaluation, although it used a control group, only assessed the outcomes of out-of-home placements, it was successful in preventing out-of-home placements; and (3) projects need more guidance on evaluation to ensure that cross-site analysis is possible. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Administration on Children, Youth, and Families

FEDERAL CONTACT: James Griffin, Ph.D.

PHONE NUMBER: (202) 205-8138

PIC ID: 5847

PERFORMER ORGANIZATION: KRA Corporation, Columbia, MD
 

TITLE: Gang Families in a Public Housing Project

ABSTRACT NUMBER: 007

ABSTRACT: This project examined families containing multiple gang members in a low-income Mexican-American community in Los Angeles. The project considered the relationships among macrostructural and economic forces and household organization, family childrearing practices, sibling/relational influences, socialization of street children, culture and traditions, and levels of acculturation, especially in the colonization or marginalization process. The study identified family patterns and processes leading to gang membership. Additionally, the study provided a better understanding of family dynamics in families with more than one gang member, how childrearing practices and street culture are transmitted to children, and how gang habits and values are transmitted among family members. Project findings were presented in a report targeted to service providers, as well as in a summary targeted to the general public. Famlies and individuals participating in the study were informed of the findings and referred to counselors and substance abuse groups. See also PIC ID No. 50421.1.

AGENCY SPONSOR: Administration on Children, Youth, and Families

FEDERAL CONTACT: Maria Candamil

PHONE NUMBER: (202) 205-8054

PIC ID: 5042

PERFORMER ORGANIZATION: James Diego Vigil, Whittier, CA
 

TITLE: Length of Service and Cost-Effectiveness in Three Intensive Family Service Programs: Final Report

ABSTRACT NUMBER: 008

ABSTRACT: This project examines the impact of the length of service provision on outcomes in family preservation programs located in Portland, Oregon; Pendleton, Oregon; and Baltimore, Maryland. While there is widespread anecdotal and legislative support for time-limited provision of family services, there are few scientific data on how or why limiting service delivery is more effective in family preservation programs. Thus, this project develops an experimental design to test the effect of length of service on client outcomes and cost-effectiveness. Families were randomly assigned to 3- and 6-month service contracts and, in one site, to a control condition with no specified length of service. Location of services (home or office), target populations, and staffing pattern (teams or individual workers, combined or separate case management) varied among study sites. In the Baltimore site, 193families participated; in Pendleton, 79 families participated; In each site, two equal groups were assigned to 3-month and 6-month contracts. In Portland, of the 188-family total, 60families were assigned to 3-month contracts, 55 to 6-month contracts, and 73 to the "no time limit" group. The report finds that, overall, study participants experienced low out-of-home placement rates, low rates of maltreatment, and significant improvement in family, parent, and child functioning. The only significant instance of length of service affecting outcomes was seen in the Portland site, where families in the 6-month group had a much lower placement rate in the year following the study than families in the 3-month group. Low-income families and those with child behavior problems achieved better outcomes in the 6-month group, even though most families preferred indeterminate time frames for service receipt. The report concludes that 6-month periods of in-home family treatment provided to families with older children and significant histories of prior services were most effective.

AGENCY SPONSOR: Administration on Children, Youth, and Families

FEDERAL CONTACT: Cecelia Sudia

PHONE NUMBER: (202) 205-8764

PIC ID: 4386

PERFORMER ORGANIZATION: University of Iowa, School of Social Work, IowaCity,IA
 

TITLE: Social and Educational Development of Tribal-Based Communities of the Sonoran and Negev Deserts

ABSTRACT NUMBER: 009

ABSTRACT: This project transferred an innovative, cooperative community-university model for empowering economically disadvantaged minority communities to respond to the unique needs of their children at risk of leaving school early. The model focuses on dropout prevention for preteen Bedouin Arab students in a tribal community in the Negev Desert of Southern Israel. This demonstration model has been transferred to the Pascua Yaquis in a tribal community in the Sonoran Desert of Southern Arizona. The model includes components for (1) in-school linguistically and culturally appropriate instruction; (2) community-based after-school programs; and (3) family education and training. The social service model refined and disseminated by this project addresses the dire needs of at-risk youth through the use of a community-based approach. The University of Arizona and Ben-Gurion University of the Negev committed their resources for technical assistance to the two communities in order to firmly establish such a capability. In keeping with the tenets of a true community-based approach, the transfer of the model from Israel to the United States has been spearheaded by the two indigenous communities themselves, through the Rahat Council and the Pascua Yaqui Tribe, with the universities playing only a support role. The project is family centered, focusing on locally developed educational and support strategies emanating from the participants, strategies which stress their rights and responsibilities in assuming leadership roles in decision making. The final project report is expected to influence policy and program decisions affecting socially and economically disadvantaged youth at risk of early school leaving.

AGENCY SPONSOR: Office of Policy and Evaluation

FEDERAL CONTACT: James Dolson

PHONE NUMBER: (202) 401-0133

PIC ID: 5978

PERFORMER ORGANIZATION: University of Arizona, College of Education, Tucson,AZ
 

TITLE: Survey of Head Start Family Self-Sufficiency Initiatives

ABSTRACT NUMBER: 010

ABSTRACT: The Head Start Bureau within the Administration for Children, Youth, and Families (ACYF) launched the Survey of Head Start Family Self-Sufficiency Initiatives in order to explore ways in which programs could work with families to improve their employability, literacy, and substance abuse. The report presents findings on self-sufficiency activities provided directly by Head Start programs as well as those presented indirectly through collaboration with local service providers. The report finds that: (1) Head Start programs use formal surveys and assessments to identify a family's need for literacy and employability services, but assess the need for substance abuse services more informally; (2) most program directors perceive the greatest need for employability services and the least need for substance abuse services; (3) programs meet families' literacy needs by providing information and educational materials, as well as assessment and identification of problems; outside agencies provide individual tutoring and group instruction; (4) programs provide employability services consisting of volunteer opportunities, vocational training, referrals to postsecondary education, and school or job application assistance; outside agencies provide career assessments and job-readiness classes; (5) programs address substance abuse needs by conducting educational and prevention activities or by providing assessment services; outside agencies provide support groups, assessments, education, and prevention activities; and (6) programs devote resources of staff time and training, space for activities, transportation activities, and child care assistance to help families with literacy, employability, and substance abuse needs. The report provides specific recommendations for how staff can meet the needs of families in areas that promote self-sufficiency. See also PIC ID No. 4983.1 and 4973.2. (Final report variously paginated plus appendices.)

AGENCY SPONSOR: Administration for Children, Youth, and Families

FEDERAL CONTACT: John Corrigan

PHONE NUMBER: (202)205-8403

PIC ID: 4973

PERFORMER ORGANIZATION: CSR, Incorporated, Washington, DC
 

TITLE: Survey of Head Start Family Self-Sufficiency Initiatives: Case Studies in Six Communities

ABSTRACT NUMBER: 011

ABSTRACT: This report presents the findings of six case studies carried out as part of the Survey of Head Start Family Self-Sufficiency Initiatives. This survey explored ways in which programs could work with families to improve their employability, literacy, and substance abuse. The case studies have been stripped of all identifying information in order to preserve the anonymity of program directors, staff, and community agency representatives. The case studies show that program directors believe that their Head Start families are in need of literacy services, although the underlying causes of illiteracy vary across sites. For example, one site is located in a rural county where 32 percent of the population did not graduate from high school and two other programs serve significant non-English speaking populations. The six programs recognized and addressed employability in varying ways. One Migrant Head Start program director did not think that clients needed employability services because they were migrant workers who already had jobs. Other sites offered information and referral, but only when parents requested assistance. Although one program was more active in working on employability issues, but the program did little to address families concerns about temporary work or low-paying jobs. Most program directors were concerned about substance abuse and its effect upon families, but programs have difficulties in assessing and meeting families needs for services in this area. The report also discusses conclusions drawn from the case studies in the following areas: (1) staff perceptions of their roles; (2) identifying the most effective service; (3) barriers to families receiving services; and (4) collaborations with other organizations. See also PIC ID nos. 4973 and 4973.1. (Final report variously paginated.)

AGENCY SPONSOR: Administration for Children, Youth, and Families

FEDERAL CONTACT: John Corrigan

PHONE NUMBER: (202)205-8403

PIC ID: 4973.1

PERFORMER ORGANIZATION: CSR, Incorporated, Washington, DC
 

TITLE: Transfer of International Innovations: Development of a Clinical Monitoring System To Support Foster Care in Michigan

ABSTRACT NUMBER: 012

ABSTRACT: Children in foster care do not always receive adequate care. They may "drift" in the system and may remain cut off from their families for unnecessarily extended periods of time. The aim of the project is to enhance effective and accountable services through the transfer of an innovative Clinical Information System for Foster Care. This computerized system is based on a model combining structured and systematic monitoring of each individual child with the aggregation of this information across the whole agency. Developed on a national level in Israel, the system's use is now mandated in that country. It has been modified and expanded to fit the U.S. foster care system. The system has been tested and integrated into the metropolitan Detroit offices of a statewide foster care agency, Lutheran Child and Family Services. It has become part of that agency's routine practice procedures throughout the State. The system facilitates ongoing monitoring and prioritization of treatment for children in care, coordination and shared language among practitioners and services, and processing of collected data for policy formulation, evaluation, and research. The system provides an integrated response to the needs of all partners in the agency, including administrators, managers, and policymakers. However, the main focus of the Integrated Information System is the information needs of the clinical staff of the agency, caseworkers, and clinical supervisors. The Integrated Information System includes three seamlessly integrated system modules: Foster Care, Foster Families, and Adoption. The conceptual framework and methodology used in the current system for foster care can easily be adapted to suit the needs of other child and family programs and to improve integration among such service delivery systems as child protective services, family preservation, youth residential care, and adoption programs.

AGENCY SPONSOR: Office of Policy and Evaluation

FEDERAL CONTACT: James Dolson

PHONE NUMBER: (202) 401-0133

PIC ID: 5976

PERFORMER ORGANIZATION: Wayne State University, Merrill-Palmer Institute, Detroit, MI
 

TITLE: Women and Infant Nurturing Services (WINGS)

ABSTRACT NUMBER: 013

ABSTRACT: The Women and Infant Nurturing Services program was intended to address the spiral of increasing female substance abuse and subsequent incarceration. The program targets pregnant, substance-abusing inmates using incarceration as a point of treatment intervention. Staffed by a social worker, a nurse practitioner, and student interns, the project coordinates and enhances services presently in place at the Rose M. Singer Correctional Facility on Riker's Island in New York City and, by collaborating with community-based case managers, secures appropriate postrelease services. The in-jail programs consist of substance abuse treatment; prenatal health and nutritional care; HIV education; parenting classes; mental health services; and assistance with entitlement preparation. If a woman delivers her child while still incarcerated, she is able to remain with the child at Singer's Baby Nursery. If a woman has not delivered by the time of her release, staff will secure community medical linkages and provide transitional supportive services. Women are linked to needed postrelease social services, including appropriate day or residential community substance abuse treatment facilities designed to meet their special needs.

AGENCY SPONSOR: Office of Policy and Evaluation

FEDERAL CONTACT: James Dolson

PHONE NUMBER: (202) 401-0133

PIC ID: 5979

PERFORMER ORGANIZATION: New York Department of Corrections, MiddleVillage,NY

Administration on Aging

 

TITLE: Serving Elders at Risk: The Older Americans Act Nutrition Programs. National Evaluation of the Elderly Nutrition Program, 1993-1995

ABSTRACT NUMBER: 014

ABSTRACT: The Elderly Nutrition Program provides grants to State Agencies on Aging to support the provision of daily meals to the el- derly, specifically targeting elders who have the greatest economic and social need. The 1992 Amendments to the Older Americans Act directed the Administration on Aging and the Assistant Secretary for Planning and Evaluation to evaluate the nutrition programs funded under Titles III and VI of the act, the Elderly Nutrition Program (ENP). Title III provides funds to State units on aging to help them provide meals and nutrition services to elders in congregate or home-based settings; Title VI provides funds to tribal organizations to help them deliver the same services to older Native Americans. This series of reports evaluates (1) the program's effects on participants' nutritional status and socialization; (2) the use and effectiveness of the program; (3) program administration efficiency and effectiveness; and (4) program funding sources. The report finds that (1) people who receive ENP meals have higher daily intakes of key nutrients than similar nonparticipants; (2) ENP meals provide 40 percent to 50 percent of participants' daily intake of most nutrients; (3) participants have more social contacts per month than nonparticipants; (4) between 80 percent and 90 percent of participants have income levels below 200 percent of the poverty level, live alone, and are either overweight or underweight; (5) the average cost of an ENP meal, including the value of donated labor and supplies, under Title III is $5.17 for a congregate meal and $5.31 for a home-delivered meal; comparable costs under Title VI are $6.19 and $7.18, respectively; and (6) ENP is part of a growing network of home and community-based care services. The report concludes that ENP successfully fulfills the nutritional and social needs of the elderly. (Executive summary: 32 pages; Volume I: 313 pages; Volume II: 188 pages; and Volume III: 21 pages, plus appendices.)

AGENCY SPONSOR: Office of Program Operations and Development

FEDERAL CONTACT: Jean Lloyd

PHONE NUMBER: (202) 619-2005

PIC ID: 6175

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ

Agency for Health Care Policy Research

Contents

CONQUEST 1.0: Overview of Final Report and User's Guide

Develop, Apply, and Evaluate Medical Review Criteria and Educational Outreach Based Upon Practice Guidelines: Final Project Report

Oregon Consumer Scorecard (OCS) Project: Final Report

Publications of the Patient Outcomes Research Teams (PORTS), May 1996, and Medical Treatment Effectiveness Projects
 

TITLE: CONQUEST 1.0: Overview of Final Report and User's Guide

ABSTRACT NUMBER: 015

ABSTRACT: This project develops a prototype computer-based framework for identifying, evaluating, and selecting clinical performance measures. The Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST 1.0) consists of two interlocking data bases, one containing information on clinical performance measures and a second on clinical conditions. Information on attributes of clinical performance measures--such as the clinical rationale for a measure, requirements for constructing the denominator and numerator, the purpose and content of the measure, analysis considerations, and reliability and validity testing--is contained in the "measures" data base. The measures data base allows users to directly compare performance measures on one or more attributes in order to select the measures most appropriate to their needs. The condition data base synthesizes information for guidelines supported by the Agency for Health Care Policy and Research (AHCPR), as well as those developed by other organizations, and medical effectiveness research so that users can access scientific information to guide their selection of the most meaningful measures for their specific client populations. CONQUEST 1.0 was developed under the leadership of R. Heather Palmer, M.B., B.C.H., of the Center for Quality of Care Research and Education at the Harvard School of Public Health. The data base is available through AHCPR's Internet web site: http://www.ahcpr.gov. The User's Guide is available through the Policy Information Center.

AGENCY SPONSOR: Center for Quality Management and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: (301) 594-1352

PIC ID: 5961

PERFORMER ORGANIZATION: Mikalix and Company, Lexington, MA
 

TITLE: Develop, Apply, and Evaluate Medical Review Criteria and Educational Outreach Based Upon Practice Guidelines: Final Project Report

ABSTRACT NUMBER: 016

ABSTRACT: This project evaluates three Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines by assessing their usefulness for quality measurement of improvement purposes. The project derived medical review criteria and clinical performance measures for the guidelines on postoperative pain management (POP), urinary incontinence (UI), and benign prostatic hyperplasia (BPH); it also developed data specifications, and data collection and analysis procedures for the guidelines. The project also implemented and evaluated the BPH guideline-based performance measures using alternative quality improvement strategies. An earlier report (PIC ID No. 5973) presents findings related to the guidelines on POP and UI; this report examines BPH and educational outreach. The impact of the guidelines was examined in four ambulatory care settings in four states. The report finds that review criteria could be derived from the BPH guideline and that other elements of a valid, reliable performance measurement system could be developed. Furthermore, the application of this system to a sample of ambulatory records demonstrated that this highly structured, explicit review system is reliable and provides detailed information about conformance with the guidelines. The report examines the impact of the educational intervention on physicians' practice and attitudes. It finds that: (1) significant performance rate changes followed the educational intervention for some BPH criteria; (2) few differences in behavioral changes between urologists and primary care practitioners were observed; and (3) those physicians who received only the criteria and clinical practice guideline, rather than the educational intervention, did not exhibit marked changes in behavior. See also PIC ID No. 5973. (Final report 77 pages plus appendices.)

AGENCY SPONSOR: Office of Policy and Evaluation

FEDERAL CONTACT: Phyllis Zucker

PHONE NUMBER: (301) 594-1454

PIC ID: 5973.1

PERFORMER ORGANIZATION: Center for Clinical Quality Evaluation, Washington, DC
 

TITLE: Oregon Consumer Scorecard Project: Final Report

ABSTRACT NUMBER: 017

ABSTRACT: This project supported the State of Oregon in the development of a prototype scorecard that could assist consumers in selecting a health plan that best suits their needs. It also determined the extent to which such a scorecard could serve as a comparative performance measurement tool providing feedback to health plans, purchasers, and State policymakers about how well health plans are performing and meeting the expectations and needs of their consumers. The scorecard is designed to assist consumers in two ways: by providing comparative health information and by serving as an educational tool on health plan operations for consumers. The project provided a range of information about the gaps in current quality measurement efforts, the need to tailor information to a variety of consumer needs, and issues related to the interpretation of data. The project also collected information on health plan management issues, consumer survey information, and qualitative information through consumer focus groups. The report finds that (1) consumers were highly receptive to the materials presented and were eager for objective choice materials; (2) a major challenge confronting the project was how to present comparative health plan data on consumer satisfaction and performance that were meaningful, understandable, and reliable; (3) there are differences between how professionals and consumers think about quality; (4) consumers expressed a strong preference for choice information that was personally relevant and geographically sensitive; (5) uniform data specifications will help to consolidate and reduce the data burden on health plans; (6) information about the severity of condition or risk adjustment is needed if consumers are to get reliable and accurate comparative information about health plans; (7) consumers prefer multimedia presentations of the scorecard; and (8) the costs of producing a scorecard are formidable. (Final report: 51 pages, plus appendices.)

AGENCY SPONSOR: Office of Policy and Evaluation

FEDERAL CONTACT: Sandra Robinson

PHONE NUMBER: (301) 594-1349

PIC ID: 5960

PERFORMER ORGANIZATION: Oregon Health Policy Institute, Portland, OR
 

TITLE: Publications of the Patient Outcomes Research Teams (PORTS), May 1996, and Medical Treatment Effectiveness Projects

ABSTRACT NUMBER: 018

ABSTRACT: This project tracked the activities and effects of research conducted under the Medical Effectiveness Treatment Program (MEDTEP). Using secondary data sources such as newspaper and journal articles, the project collected information on the products of Agency for Health Care Policy and Research-sponsored medical effectiveness research and the diffusion of these findings into other sources. A bibliography entitled Publications of the Patient Outcomes Research Teams (PORTS): PORT and PORT II Projects provides information about publications arising from each PORT, listed by the condition that each addressed. Also included is information about the grant or contract number, project title, name and institution of the principal investigator, project start and completion dates, and a brief description of the project. A second bibliography entitled Medical Treatment Effectiveness Program Research Projects: 1989 through 1995 presents a comprehensive list of MEDTEP research projects. Projects are categorized under Clinical Studies, with two subcategories: Guideline Implementation and Evaluation; and Methods and Measures. Within each category, projects are in alphabetical order by the name of the principal investigator. PORT and PORT II projects are marked. As in the first bibliography, information includes the grant or contract number, project title, name and institution of the principal investigator, project start and completion dates, and a very brief description of the project. For those projects that have been completed, executive summaries and final reports may be available through the National Technical Information Center. (PORTS bibliography: 49 pages; MEDTEP bibliography: 73 pages.)

AGENCY SPONSOR: Center for Outcomes and Effectiveness Research

FEDERAL CONTACT: Mary Cummings

PHONE NUMBER: (301) 594-1485

PIC ID: 4311

PERFORMER ORGANIZATION: Walcoff and Associates, Inc., Fairfax, VA

Centers for Disease Control and Prevention

Contents

Assessment of Accountability Procedures for the Vaccines for Children Program: Final Report

Evaluation of the Community-Based Mosquito-Control Programs for Dengue Hemorrhagic Fever (DHF) Prevention and Control Program at the San Juan Laboratories, Puerto Rico

Evaluation of the NNIS System: Final Study Report

Georgia State Assessments of Immunization Coverage: Impact of Management and Clinic Immunization Practices (Three Volumes)

Key Monitoring Indicators of the Nation's Health and Health Care and Their Support by NCHS Data Systems

Private Sector Health Care Organizations and Public Health: Potential Effects on the Practice of Local Public Health
 

TITLE: Assessment of Accountability Procedures for the Vaccines for Children Program: Final Report

ABSTRACT NUMBER: 019

ABSTRACT: This study provided information to assist in developing an appropriate accountability system for the Vaccines for Children (VFC) program that is both rigorous and practical for use in clinical settings. As part of this study, data collection procedures for proposed systems were tested to determine their practicality and usefulness for collecting vaccine usage data. The study also provided information about the acceptability of any accountability system to health care providers, since a system that is perceived as overly burdensome could discouarge participation in the VFC program.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Wesley Hodgson

PHONE NUMBER: (404) 639-8222

PIC ID: 5935

PERFORMER ORGANIZATION: Battelle Centers for Public Health Research and Evaluation, Alexandria, VA
 

TITLE: Evaluation of the Community-Based Mosquito Control Programs for Dengue Hemorrhagic Fever (DHF) Prevention and Control Program at the San Juan Laboratories, Puerto Rico

ABSTRACT NUMBER: 020

ABSTRACT: Dengue hemorrhagic fever (DHF) is a mosquito-transmitted viral disease that has been present in the Americas for the last 200 years. There have been two major epidemics of DHF in recent years (Cuba, 1981, and Venezuela, 1989-90), and sporadic cases have been documented in 12 other locations in the hemisphere, including Puerto Rico. DHF causes severe headache, bone and joint pain, and prostration. In some cases, it may produce hemorrhagic manifestations and death. This report assesses a comprehensive cross-sectional evaluation of the impact of the community-based dengue prevention pilot programs in Puerto Rico on (1) dengue-related knowledge; (2) human behavior; and (3) indices of infestation of the mosquito (Aedes aegypti) carrying the disease. Surveys of knowledge and practices were administered to children and their parents, and surveys of the yards and homes of parents were conducted to describe the number and type of larval habitats of the Aedes aegypti mosquito. Focus groups and in-depth interviews were also conducted. Surveys for mosquito larvae were conducted in 703 premises across five different study sites from April to June 1995. The report finds that (1) overall, 18.3 percent of the premises had at least one container positive for Aedes aegypti larvae; 24.9 percent had at least one container positive for some type of mosquito larvae; (2) larval indices were higher in more rural housing; and (3) the most common containers for Aedes aegypti larvae were water-storage containers, plant-related containers, tires, small disposable containers, and animal drinking dishes. The report also finds that exposure to dengue prevention programs in Head Start, elementary schools, and the Children's Museum are associated with both higher levels of correct knowledge and lower levels of incorrect knowledge about mosquito life cycles, modes of disease transmission, larval container habitats, and control measures. Children also communicated their learning to their parents.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Jose Rigau

PHONE NUMBER: (787) 766-5181

PIC ID: 5355

PERFORMER ORGANIZATION: Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD
 

TITLE: Evaluation of the NNIS System: Final Study Report

ABSTRACT NUMBER: 021

ABSTRACT: The Centers for Disease Control and Prevention (CDC), National Center for Infectious Diseases conducts the National Nosocomial Infections Surveillance (NNIS) System to create a national data base of infections associated with hospitalization in general adult and pediatric acute care hospitals in the United States. Therefore, it is important to develop an accurate method for determining the current rate of nosocomial infection within the entire NNIS system or within a specific hospital. This study develops a methodology for assessing NNIS hospitals' accuracy in identifying and reporting nosocomial infections in NNIS hospitals; it also assesses the utility of criteria used to diagnose these infections. A pilot test examined nosocomial infections in two hospitals, while Phase II of the study uses retrospective medical record reviews in eight hospitals located in the eastern United States. Infection control practitioners (ICPs) reviewed 1,252 records from the ten hospitals; a total of 1,326 infections were identified in 691 medical records. Pneumonia was the most prevalent infection (36.6 percent), followed by other infection sites (23.2 percent), urinary tract infections (18.7 percent), blood stream infections (12.8 percent), and surgical site infections (8.7 percent). The effectiveness of infection control practitioner performance was reviewed in cases where discrepancies between observers occurred. Of the 3,052 infection sites recorded on the initial reviews, 61 percent did not require adjudication. Nineteen percent of the remainder were judged to be false negative; 14 percent were false positives; 3.9 percent were misclassified; 1.3 percent were subject to a date discrepancy; and 0.1 percent were both misclassified and subject to a date discrepancy. The report recommends that NNIS manual criteria be updated or modified in regard to (1) the determination of the site of nosocomial infections and (2) pathogen codes. (Executive summary: 9 pages.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: T. Grace Emori, R.N.

PHONE NUMBER: (404) 639-6438

PIC ID: 5349

PERFORMER ORGANIZATION: Analytical Sciences, Inc., Durham, NC
 

TITLE: Georgia State Assessments of Immunization Coverage: Impact of Management and Clinic Immunization Practices (Three Volumes)

ABSTRACT NUMBER: 022

ABSTRACT: One of the goals of the Public Health Service by the year 2000 is to have 90percent of preschool children immunized by the time they are 24 months of age. The diseases against which immunization is sought are diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, hemophilius influenza type B, and hepatitis B. In an effort to improve immunization rates, the State of Georgia conducted annual audits of clinic records from 1986 to 1994 to assess the coverage rates in public immunization clinics. This study evaluates how these audits have affected immunization coverage levels in the preschool population and the medical and management policies and practices that influence immunization rates. All 227 immunization clinics in Georgia were surveyed and audited. Thereport finds that between 1987 and 1993, the State's immunization rate improved from 31 percent to 90 percent. Analysis shows that participation in audits is associated with higher immunization rates. The report recommends that (1) comprehensive efforts to improve immunization rates should continue; (2) a system of periodic clinic audits should be instituted; (3) access to clinics should be assured; (4) early outreach and reminder procedures should be used; and (5) adequate staff and financial resources should be committed. Volume II contains appendices to the study, while Volume III contains computer documentation. (Final report: Volume I: 195 pages; Volume II: variously paginated; and Volume III: 359 pages.)

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Andrew Baughman

PHONE NUMBER: (404) 639-8239

PIC ID: 5354

PERFORMER ORGANIZATION: Battelle Centers for Public Health Research and Evaluation, Alexandria, VA
 

TITLE: Key Monitoring Indicators of the Nation's Health and Health Care and Their Support by NCHS Data Systems

ABSTRACT NUMBER: 023

ABSTRACT: This project evaluates the adequacy and appropriateness of information collected in the National Center for Health Statistics (NCHS) data systems to support key monitoring indicators for health reform. The results of the evaluation are intended as guidance in strengthening and revising NCHS data systems to meet the need for a widely accepted set of key monitoring indicators for the Nation. The report notes that over the course of the project, major shifts in Federal policy focus and political support for broad health care reform occurred. Instead of a Federal-level program, much of the responsibility for health care reform is being shifted to the State level. Ongoing changes in public priorities and in private payer and provider initiatives make the need for good information all the more critical for policymakers. The report concludes that criteria for evaluating the quality of key health indicators, including data relevance and reliability, must address fundamental questions about health and the health care system components that will withstand rapid system change. Basic questions about indicators and information needs are a critical element in identifying a robust set of system components to be monitored, regardless of the ultimate shape, scope, and level of public funding of health programs. Public debate and shifts in the marketplace make the immediate need for accurate information systems all the more pressing. Baselines for future benefits must be developed if the positive or negative effects of health system reform are to be measured. The report: also addresses specific indicator identification and NCHS data systems evaluation, primarily in the area of population health and personal health care services. (Final report: 75 pages, plus appendices.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Ronald Wilson

PHONE NUMBER: (301) 436-7032

PIC ID: 5500

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Private Sector Health Care Organizations and Public Health: Potential Effects on the Practice of Local Public Health

ABSTRACT NUMBER: 024

ABSTRACT: This study examines the emerging role of private health care providers, especially health maintenance organizations, in delivering public health services. It takes as its conceptual framework the Institute of Medicine model of 3 core public health functions, and the Public Health Service elaboration of these functions into 10 essential public health services. The study identifies and presents case studies of private health care organizations providing these services. It synthesizes findings from site visits to eight health systems and managed care organizations that were identified as being active in public health and population-based activities in their communities. The report finds that (1) service delivery and assurance are two key essential services most likely to be conducted in the private sector; (2) private-sector health care delivery organizations are active in all three core public health functions (assessment, policy development, and assurance); (3) private organizations take on public health functions for a number of reasons, including altruism and business-related reasons; and (4) almost 40 percent of the public health activities of private organizations are carried out by the organization alone. Finally, although the report praises private efforts rooted in altruism, it cautions that the separation of these public health activities from the business strategy of an organization may mean that they are eliminated in an era when private health care organizations are increasingly pressured by the bottom line. (Executive summary: 15 pages; Final report: 39 pages, plus appendices.)

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Nancy Cheal

PHONE NUMBER: (404) 639-7095

PIC ID: 6213

PERFORMER ORGANIZATION: Macro International, Inc., Atlanta, GA

Food and Drug Administration

Contents

Fourth Annual Performance Report: Prescription Drug User Fee Act of 1992--Fiscal Year 1996 Report to Congress

Impact of the NLEA on Consumers: Recent Findings From FDA's Food Label and Nutrition Tracking System

Status of Nutrition Labeling of Processed Foods--1995: Food Label and Package Survey (FLAPS)
 

TITLE: Fourth Annual Performance Report: Prescription Drug User Fee Act of 1992--Fiscal Year 1996 Report to Congress

ABSTRACT NUMBER: 025

ABSTRACT: FY 1996 marks the fourth year of the 5-year implementation of the Prescription Drug User Fee Act (PDUFA) of 1992, which authorizes the collection of fees from the pharmaceutical industry in order to facilitate the Food and Drug Administration's (FDA's) timely review of human drug applications. The Act mandates that the FDA prepare reports each fiscal year for which fees are collected. The fourth annual report, covering FY 1996, was prepared in response to that mandate, presenting findings on how well the FDA has accomplished its performance goals for FY 1996. These performance-related goals were jointly established by the FDA and the pharmaceutical industry. They fall into three main categories: (1) eliminating overdue backlogs; (2) building excellence into the review process; and (3) achieving high performance. Eighteen of the goals have already been accomplished and reported on in previous years' performance reports. Four goals were in effect in 1996, while seven will be in effect for 1997. The report finds that the fourth year of PDUFA was successful, in that FDA has exceeded every PDUFA performance goal, despite its increasing workload. A record number of new product approvals and shorter review times during FY1996 enabled new products to reach the market faster.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Paul Coppinger

PHONE NUMBER: (301) 443-4230

PIC ID: 6079.1

PERFORMER ORGANIZATION: Office of Planning and Evaluation, FDA, Rockville,MD
 

TITLE: Impact of the NLEA on Consumers: Recent Findings From FDA's Food Label and Nutrition Tracking System

ABSTRACT NUMBER: 026

ABSTRACT: The Nutrition Labeling and Education Act (NLEA) of 1990 was intended to provide consumers with better nutrition information on food labels and to enable them to make more healthful food choices. Regulations to implement NLEA were issued by the Food and Drug Administration in January 1993. This report examines the impact of the NLEA on consumers, using several measures of behavior. The report finds that NLEA caused a number of significant changes in reported label use practices and beliefs of the general public, suggesting that it is easier for consumers to use the quantitative nutrition information on the food label. For example, consumers say that they most often use the Nutrition Facts panel of the label, which contains quantitative information about nutrient amount and is the part of the label that showed the greatest increase in reported use. Consumers use the Nutrition Facts panel to see if a product is high or low in a particular nutrient, to judge its overall nutrition content, and to compare the nutrition profile of different brands. Furthermore, consumers report greater confidence in the veracity of nutrition and health claims made on labels. The report also finds that NLEA has had a significant impact on the availability and market share of food promoted on the basis of health and nutrition. In several instances, fat-modified versions of foods have been introduced to the market. For example, fat-modified cookies had a market share of 15 percent in 1995, up from nearly 0 percent in 1990; at the same time, fat-modified cheeses more than doubled their share of cheese sales. Finally, NLEA has also helped facilitate the flow of useful nutrition education messages to the public. Public awareness of, and interest in, dietary risk factors has steadily increased, indicating the continuing importance of the food label as a source of accurate nutrition information. See also PIC ID No. 4988. (Final report: 6 pages, plus appendix.)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Brenda Derby

PHONE NUMBER: (202) 205-5363

PIC ID: 4988.1

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA, Washington, DC
 

TITLE: Status of Nutrition Labeling of Processed Foods--1995: Food Label and Package Survey (FLAPS)

ABSTRACT NUMBER: 027

ABSTRACT: The Food Label and Package Survey (FLAPS) provides a data base containing label and package information recorded from the packages of a scientifically derived sampling of food products representative of the U.S. processed packaged food industry. The 10th FLAPS survey reflects the status of processed, packaged food labels subsequent to the publication of regulations promulgated in response to the Nutrition Labeling and Education Act of 1990. It focuses on the percentage of packaged foods sold annually that bear quantitative nutrition labeling, as well as on data on health claims, nutrient content claims, and ingredients. The survey found that (1) nutrition-labeled products account for about 96.1 percent of the annual sales of processed, packaged foods across 58 major product groups; (2)there was a 27.2 percent increase in the proportion of nutrition-labeled products between 1993 and 1995; (3) 100 percent of processed meat products surveyed are nutrition-labeled, an increase of 47.9 percent over 1993; (4) 44 of 58 major product groups have nutrition labels for all of the brands in the sample; (5) three product groups have less than 90 percent of the products sold with nutrition labels (tea; coffee; salt, seasoning, and spices)--all these items are exempt from the requirement to display nutrition labels because they contain insignificant amounts of all nutrients; and (6) there were increases of more than 30 actual percentage points between 1993 and 1995 for 14 nutrition-labeled product groups. See also PIC ID No. 5711. (Final report: 19 pages.)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Tom O'Brien

PHONE NUMBER: (202) 205-5432

PIC ID: 5711.1

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA, Washington, DC

Health Care Financing Administration

Contents

Assessment of the Impact of Medicaid Drug Rebate Policy on Expenditures, Utilization, and Access

Assessment of the Impact of Pharmacy Benefit Managers

Effects of Predetermined Payment Rates for Home Health Care

Evaluating the Effects of Physician Payment Reform on Access: Time Series Analyses of Hospitalizations for Ambulatory-Care Sensitive Conditions

Evaluation of Arizona's Health Care Cost-Containment System Demonstration: Final Report

Evaluation of the Home Health Prospective Payment Demonstration

Evaluation of the Medicare SELECT Amendments: Case Study Report

Evaluation of the Medicare SELECT Amendments: Final Evaluation Report

Sustainable Support System for Telemedicine Research and Evaluation

Trends in Access to Health Care Services for Selected Segments of the Medicare Population

Ventilator-Dependent Unit Demonstration: Outcome Evaluation and Assessment of Post-Acute Care
 

TITLE: Assessment of the Impact of Medicaid Drug Rebate Policy on Expenditures, Utilization, and Access

ABSTRACT NUMBER: 028

ABSTRACT: The purpose of this study was to assess the impact of the Medicaid drug rebate program on expenditures, utilization, and access to medications for Medicaid recipients. The study used a decomposition analysis to determine the change in total drug expenditures before and after implementation of the Medicaid drug rebate program. The role of covered population changes, intensity (utilization rate) changes, changes in efficiency (drug product prices), changes in dispensing fees and rebates, and administrative costs were evaluated. The impact on recipient access was assessed by constructing a person-level file of prescription drug claims both pre- and post-Omnibus Budget Reconciliation Act 1990 (legislation that mandated the drug rebate program).

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Kathleen Gondek

PHONE NUMBER: (410) 786-7765

PIC ID: 6319

PERFORMER ORGANIZATION: University of Minnesota, Minneapolis, MN
 

TITLE: Assessment of the Impact of Pharmacy Benefit Managers

ABSTRACT NUMBER: 029

ABSTRACT: Pharmacy Benefit Management (PBM) companies apply managed care principles to prescription drug programs to ensure optimal and cost-effective drug prescribing and use. The industry has furnished clients with administrative efficiencies and drug program savings through retail pharmacy contracts that provide discounts on drug prices and dispensing fees, manufacturer rebates, increased generic substitution, and drug utilization review. This report characterizes PBM's; compares costs and the quality of care in providing pharmacy benefits in Medicaid programs and PBM's for privately insured or Medicaid enrollees in managed care; and analyzes the potential impact of PBM's on Medicaid and other government programs and on the larger pharmaceutical market. The report finds that (1) PBM's provide both administrative functions and drug use control activities; and (2)PBM's are dispersed throughout the nation. Seventy-one PBM's cover fewer than 5million clients and a dozen cover more than 10 million clients; 6 PBM's have between 5 and 10 million clients. Seven PBM's participated in a case study to determine the character and impact of PBM's. The report concludes that the PBM industry is complex and dynamic and that it has been successful in several areas of drug program management, including techniques directed toward clients, pharmacists, and prescribers. PBM's offer government programs like Medicaid advantages in their extensive provider networks, success in extracting favorable market reimbursement rates from pharmacies, and sophisticated claims processing and data management systems. Disadvantages include lower rebates and the uniqueness and size of the Medicaid population. PBM's have the potential to affect pharmacies and pharmaceutical manufacturers by influencing their revenue streams, which has potential long-range effects on industry consolidation and reduced access or quality.

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Kathleen Gondek

PHONE NUMBER: (410) 786-7765

PIC ID: 6395

PERFORMER ORGANIZATION: University of California, Institute for Health Policy, SanFrancisco, CA
 

TITLE: Effects of Predetermined Payment Rates for Home Health Care

ABSTRACT NUMBER: 030

ABSTRACT: The Home Health Per-Visit Prospective Payment Demonstration pays home health care agencies a prospectively set rate for home health visits, thus providing an incentive to these agencies to control their costs of delivering Medicare home health visits. This report examines 47 home health care agencies. It shows that this incentive was largely overwhelmed by the current home health care environment, which is characterized by diversity, change, and competitive pressures. Nonetheless, the opportunity to earn a profit and the increased possibility of losses may have slightly increased the level of attention agencies gave to cutting costs. The agencies randomly assigned to prospective rate setting were more likely than the control group to hold their cost increases below inflation, enabling three-fourths of the prospective payment group to earn profits. However, the average size of the real cost reduction was small (about 4 percent). These effects were limited to agencies that served predominantly Medicare patients and were not controlled by a hospital or hospice. Prospective rate setting had no discernable effect on the number of visits provided by agencies or on patients' other Medicare costs, quality of care, access to care, or use of services not covered by Medicare. (Final report: 57 pages.)

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Elizabeth Mauser, Ph.D.

PHONE NUMBER: (410) 786-6665

PIC ID: 6396

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

TITLE: Evaluating the Effects of Physician Payment Reform on Access: Time Series Analyses of Hospitalizations for Ambulatory-Care Sensitive Conditions

ABSTRACT NUMBER: 031

ABSTRACT: This project evaluated the effects of physician payment reform (PPR) on access to care in the Medicare population by studying patterns of hospitalization for ambulatory-care sensitive conditions (ASC). If there is a decrease in access in needed ambulatory care services associated with PPR, one would expect to see an increase in hospitalizations for ASC's following the implementation of PPR. The project analyzed the trend in rates of hospitalization for selected ASC conditions to see whether there is a discontinuity in the time series associated with the implementation of PPR. Analyses are compiled for the trend in hospitalizations for one ASC, congestive heart failure, for the overall Medicare population and for selected vulnerable subgroups. The results indicated no significant discontinuity in hospitalizations for this condition with the implementation of PPR.

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Thomas W. Reilly, Ph.D.

PHONE NUMBER: (410) 786-2196

PIC ID: 6315

PERFORMER ORGANIZATION: Health Care Financing Administration, Baltimore, MD
 

TITLE: Evaluation of Arizona's Health Care Cost-Containment System Demonstration: Final Report

ABSTRACT NUMBER: 032

ABSTRACT: The first HCFA evaluation of the Arizona Health Care Cost-Containment System (AHCCCS), completed in 1987, focused on the acute care program. The second, while following some acute care issues, focused on the long-term care program, the Arizona Long-Term Care System (ALTCS). It indicates generally positive findings for the use of capitation in delivering care to long-term care beneficiaries and continued success for the acute care program. Use of services appears appropriate and costs are considerably lower. This report finds that implementation of ALTCS has been generally successful: The State conducts preadmission screening and controls entry to the program, while capitated contractors determine a beneficiary's placement and manage, arrange for, and pay for a full range of acute, behavioral, health, home- and community-based, and institutional services. Although administrative costs are substantially higher than comparable Medicaid programs, the report finds that these costs support managed care activities that reduce medical service costs and result in significantly smaller overall program costs. The report also examines the AHCCCS acute care program and finds that it is very successful: Cost savings and competition are increasing, services utilization is appropriate, and the information management system has stabilized. Arizona beneficiaries have fewer hospital days, fewer procedures, and more evaluation and management services than traditional fee-for-service Medicaid programs. Overall intensity of service use is similar, but Arizona's pattern of use shows a distribution of services deemphasizing the use of institutional services and specialty care. AHCCCS annual program costs are 7 percent lower than a traditional Medicaid program for the acute care program and 16 percent lower for ALTCS. See also PIC ID Nos.2509-2509.4 and the 2158 series. (Final report: 157 pages, plus appendices.)

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Joan Peterson

PHONE NUMBER: (410) 786-0621

PIC ID: 2509.5

PERFORMER ORGANIZATION: Laguna Research Associates, San Francisco, CA
 

TITLE: Evaluation of the Home Health Prospective Payment Demonstration

ABSTRACT NUMBER: 033

ABSTRACT: This project evaluates Phase I of a demonstration designed to test the effectiveness of using prospective payment methods to reimburse Medicare-certified home health agencies for services provided under the Medicare program. In Phase I, a per-visit payment method that set a separate payment rate for each of six types of home health visits (skilled nursing, home health aide, physical therapy, occupational therapy, speech therapy, and medical social services) was tested. The contractor evaluated the effects of this payment method on agency operations, service quality, and expenditures. They also analyzed the relationship between patient characteristics and the cost and use of home health services. By October 1994, all demonstration agencies had exited the demonstration. The contractor submitted a preliminary impact report based on the findings from the first year of the demonstration. The findings suggested that treatment agencies had not decreased their cost per visit, increased their total revenues and net revenues, or altered their behavior in ways that affect the quality of home health care. The article Do Preset Per-Visit Payment Rates Affect Home Health Agency Behavior?, which discusses results from Phase I of the demonstration, appeared in the Health Care Financing Review, 16(1):91-107, Fall 1994.

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Elizabeth Mauser, Ph.D.

PHONE NUMBER: (410) 786-6665

PIC ID: 6318

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

TITLE: Evaluation of the Medicare SELECT Amendments: Case Study Report

ABSTRACT NUMBER: 034

ABSTRACT: The Medicare SELECT program is an experimental supplemental insurance policy (Medigap) that HCFA allowed to be sold in 15 States for 3 years. SELECT insurers are exempt from regulations affecting other Medigap insurers regarding the 10 standard Medigap plans, from network prohibitions against selling Medigap policies, and from antikickback regulations for Part A hospital deductions. These exemptions allow SELECT policies to restrict services to network providers (for supplemental benefits to be paid) and to negotiate discounts with hospitals. This report provides a set of descriptive case studies of 13SELECT States and a synthesis of finding across plans. The key findings from the case studies are that (1) few insurers are participating in SELECT (only 40 of the 400 HMO's and Medigap insurers in the 13 States offer SELECT; (2) Humana, Inc., and Olympic Health Management Systems are aggressively pursuing SELECT; (3) many Medigap insurers are reluctant to sell SELECT because they believe that its developmental costs are too high and that the potential return on investment is inadequate; (4) many SELECT networks include only hospitals or hospitals and pharmacies; and (5) it appears unlikely that program savings will accrue to Medicare, but beneficiaries who participate may have less expensive premiums than if they purchased identical plans without network restrictions from the same insurers. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: (410) 786-6601

PIC ID: 5966

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC
 

TITLE: Evaluation of the Medicare SELECT Amendments: Final Evaluation Report

ABSTRACT NUMBER: 035

ABSTRACT: The Omnibus Budget Reconciliation Act of 1990 authorized an experimental type of supplemental insurance (Medigap) policy. This policy, termed Medicare SELECT, was a demonstration project limited to 15 states for 3 years, beginning in 1992. This report addresses (1) implementation of the demonstration project; (2) consumer access, satisfaction, and informed consent; (3) premium affordability; and (4) impact on Medicare costs and use. The report finds that Medicare SELECT was implemented differently in each State and often differed significantly from the model implicitly expected by the legislation (the network model). As of November 1995, there were almost half a million Medicare beneficiaries enrolled in Medicare SELECT programs in 14 of the original 15 demonstration states (Massachusetts had no enrollees). Access to services and satisfaction with policies was the same for Medicare SELECT beneficiaries as for standard Medigap policy holders. There were no significant health differences between the two groups. In terms of affordability, 65-year-old SELECT beneficiaries generally have lower premiums than their counterparts enrolled in standard Medigap plans. However, as beneficiaries age, this price advantage reverses itself, so that by age 75, SELECT beneficiaries pay more for their policies than their counterparts in standard Medigap plans. Finally, Medicare SELECT was expected to reduce aggregate health care costs in the Medicare program because providers would have an incentive to establish cost-effective provider networks. It was not expected that SELECT would have any effect on utilization or Medicare program costs. However, in the first 3 years of the demonstration, 5 States show increased Medicare program costs, 4 show decreased costs, and 2 show no change. On average, implementation of Medicare SELECT resulted in a 5.7 percent increase in program costs over the 11 States. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: (410) 786-6601

PIC ID: 5966.1

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park,NC
 

TITLE: Sustainable Support System for Telemedicine Research and Evaluation

ABSTRACT NUMBER: 036

ABSTRACT: The goal of this evaluation support project was to create an effective, ongoing mechanism by which the cost, effectiveness, and utility of telemedicine services could be systematically evaluated. This was done through the formation of a Clinical Telemedicine Cooperative Group (CTCG). The CTCG was based at the Telemedicine Research Center in Portland, Oregon, a nonprofit public service research corporation formed to foster high-quality research in telemedicine. The CTCG was modeled after a successful cooperative multicentered research organization. Functions of the CTCG included (1) providing operational and statistical support for telemedicine research and evaluation; (2) maintaining a communication system to link geographically distant telemedicine projects to share information and perform research; (3) creating easily adaptable, electronic data collection and tabulation instruments for use in telemedicine research; and (4) building a comprehensive on-line telemedicine information clearinghouse for gathering, storing, and disseminating information about the utility, effectiveness, and suitability of telemedicine for a broad range of medical and social applications. This project is complete. Data collection instruments were developed for the Mercy Foundation and the Iowa Methodist Health System in Des Moines, Iowa, as well as for East Carolina University in Greenville, North Carolina.

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: William England

PHONE NUMBER: (410) 786-0542

PIC ID: 6317

PERFORMER ORGANIZATION: Telemedicine Research Center, Portland, OR
 

TITLE: Trends in Access to Health Care Services for Selected Segments of the Medicare Population

ABSTRACT NUMBER: 037

ABSTRACT: Trend data on access to health care services were developed for the years prior to, during, and after implementation of physician payment reform (PPR). The focus of the study was on health care service access for vulnerable subgroups of the Medicare population, such as persons with low income, persons without supplemental medical insurance, and persons with acute and chronic conditions. Geographic differences were also examined. These trend data were derived from the National Health Interview Survey conducted by the National Center for Health Statistics. The years 1984, 1986, 1990, and 1991 were used to develop post-PPR baseline data. The years 1992 and 1993 were used to develop post-PPR data. Descriptive data for 1984, 1986, 1989, 1990, 1991, and 1992 have been developed by sociodemographic characteristics. Relative standard errors have been computed by using a software package that takes complex sample designs into account. A multivariate model with 1984, 1986, 1989, 1990, 1991, and 1992 data has been developed to assess the impact of specific factors on use of physician services. Pre- and post-PPR data from the NHIS showed that health insurance and health status are important determinants of the use of physician services.

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Renee Mentnech

PHONE NUMBER: (410) 786-6692

PIC ID: 6316

PERFORMER ORGANIZATION: Health Care Financing Administration, Baltimore, MD
 

TITLE: Ventilator-Dependent Unit Demonstration: Outcome Evaluation and Assessment of Post-Acute Care

ABSTRACT NUMBER: 038

ABSTRACT: Mechanical ventilation is an important life-sustaining technology for some of the most seriously ill patients in any hospital. Acute respiratory failure frequently occurs in concert with failure of other organ systems or severe chronic diseases. This report presents the findings from the outcome evaluation and post-acute care analysis of the Ventilator-Dependent Unit Payment Demonstration, which evaluated costs and clinical outcomes in four ventilator-dependent units (VDU's). For the outcome evaluation, a comparison group of patients were identified from Part A discharge claims, using HCFA's pilot Uniform Clinical Data Set System. The report finds that (1) although VDU patients were substantially more eligible than the comparison group, there were many instances of apparent violations of the VDU admissions criteria among their patients; (2) in general, VDU clinical outcomes were substantially better than those for the comparison group, having lower hospital mortality and significantly higher rates of weaning from ventilators; (3) mean Medicare costs and total expenditures for comparison cases were very high, but expenditures for VDU cases were much higher, largely due to longer lengths of stay for VDU patients; and (4) national implementation with effective controls on admission would have increased Medicare expenditures in 1994 by about $0.4 billion, but implementation with ineffective controls would have increased expenditures by about $1.25 billion. An analysis of VDU patients' postacute care shows that (1) virtually all patients who were discharged alive from the VDU or acute hospital used postacute care, most of them in multiple settings; and (2) most ventilator-dependent patients have at least one acute rehospitalization and some have multiple rehospitalizations. Work for the project was performed under grant numbers: 29-P-99397/5, 29-P-99408/5, 29-P-99404/3, and 29-P-99405/1. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Research and Demonstrations

FEDERAL CONTACT: Michael Henesch

PHONE NUMBER: (410) 786-6685

PIC ID: 4590

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

Health Resources and Services Administration

Contents

Assessing the Impact of Public Spending on the Health of Vulnerable Populations: A Framework for Evaluating HRSA Programs

Community Care Network Demonstration Program: Identification and Evaluation of Lessons for Community Collaboration

Developing a HRSA Strategy for Technical Assistance to the States

Emergency Medical Services for Children: An Evaluation of Sustainability in Seven States

Evaluation of Learning Needs Using a Computerized, Standard Educational Needs Assessment Protocol for AIDS Education and Training Centers (AETCs): Final Report

Evaluation of the Bureau of Health Professions Strategic Directions: Phase II--Cross-Cutting Performance Monitoring System: Final Report

Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers

Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers: Case Study--Hawaii

Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers: Case Study--Oregon

Expanding the Capacity of Advanced Practice Nursing Education

Graduate Medical Education in Ambulatory Settings

Hospital Development and OPO Performance

Impact of Case Management on Health Status in Community and Migrant Health Centers

Primary Care: America's Health in a New Era

Quality Assurance Procedures for the Uniform Reporting System for Titles I and II of the Ryan White CARE Act

Report to Congress on the Process by Which International Medical Graduates Are Licensed To Practice in the United States

Study of the Health Care for the Homeless Program

Technical Support for Need Designation and State Primary Care Access Plan Initiatives

Test of Local-Level Health Care Reform Strategies in Selected California Counties

Tools for Monitoring Cultural Competence in Health Care
 

TITLE: Assessing the Impact of Public Spending on the Health of Vulnerable Populations: A Framework for Evaluating HRSA Programs

ABSTRACT NUMBER: 039

ABSTRACT: This project develops a conceptual framework for describing the linkages between HRSA dollars and HRSA-funded services, HRSA infrastructure-building initiatives, and changes in the health status of the populations served. Through the ability to apply an analytical process to understand these linkages, HRSA, and other HHS agencies, could better assess the potential impacts of prospective funding changes on access to care for the Nation's vulnerable populations. The health care environment in which HRSA's programs and the Public Health infrastructure operate is changing in ways that could increase access barriers for vulnerable populations and diminish the ability of providers to deliver recommended primary care services. The implementation of Welfare Reform, Medicaid managed care waivers, and other cost management strategies at the State level create the potential for an increase in the numbers of uninsured Americans and a corresponding increase in the demands for publicly funded services. HRSA, therefore, has sought to better understand the potential effects of reduced resources on the high-risk populations served by HRSA's programs and on HRSA's ability to serve greater numbers of uninsured persons. Therefore, the project explored various analytical approaches to measuring the relationship between HRSA-funded health services and health outcomes. A conceptual framework was developed to describe how specific health outcomes of vulnerable populations might be traced back to HRSA programs. As a specific application, the analytical approaches were applied to a Maternal and Child Health program administered by HRSA. In its conclusions, the authors of the report made suggestions for improvements in data measures that would facilitate the quantification of the linkages between HRSA programs and health outcomes, and proposed interim measures for assessing cutbacks in Medicaid and reductions in funding for health centers and for maternal and child health programs. The authors stated that obtaining the necessary data consistently across the Nation should be a high priority as the HHS agencies monitor changes in the American health care system and the impacts of those changes on the Public Health infrastructure. (Final report: 34 pages, plus appendices.)

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Melissa Clarke

PHONE NUMBER: (301) 443-5277

PIC ID: 6348

PERFORMER ORGANIZATION: Urban Institute, Washington, DC
 

TITLE: Community Care Network Demonstration Program: Identification and Evaluation of Lessons for Community Collaboration

ABSTRACT NUMBER: 040

ABSTRACT: This project developed a conceptual framework for an evaluation of the Community Care Network (CCN) demonstration project. The CCN project is concerned with the development of local collaborative networks that address a comprehensive range of community health needs through innovative public-private collaborations. Evaluation of the CCN demonstration project is a major opportunity to learn how to protect access for vulnerable populations in a restructured health care system. The Health Resources and Services Administration (HRSA) provided a small amount of funding to help design the overall evaluation because several of the CCN program goals are consistent with aspects of HRSA's mission. The conceptual framework for the evaluation of the program will be reviewed and used to develop the actual evaluation design for the CCN demonstration. See also PIC ID No. 6361.

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Michael Millman

PHONE NUMBER: (301) 443-0368

PIC ID: 6361.1

PERFORMER ORGANIZATION: Hospital Research and Education Trust, Chicago, IL
 

TITLE: Developing a HRSA Strategy for Technical Assistance to the States

ABSTRACT NUMBER: 041

ABSTRACT: The purpose of this study was to gain insight into the status and roles of State health departments in health reform at the State level, the types of assistance that would strengthen their capabilities, and options for delivering that assistance as responsibility and authority shifts from the Federal to the State level. The study uses focus groups with State health personnel in five States to identify deficiencies in capacity that could be addressed by various types of technical assistance. The study also explores the different methods for delivering technical assistance, such as interactive telecommunications systems, small targeting meetings, Federal technical assistance teams, leadership development activities, and clearinghouses. The report identifies critical challenges in States' information and technical assistance needs, including (1) responding to the changing role of public health and the impact of managed care; (2) overcoming barriers created by categorical funding and grant requirements; (3) enhancing State capacity to perform assessment and accountability functions; (4) improving the public health information infrastructure; (5) strengthening State leadership in building community-based systems; and (6) increasing the role of public health in the State policy-making process. The report also makes recommendations for a Health Resources and Services Administration State technical assistance strategy, which should (1)be viewed as an investment strategy; (2) build upon current resources and efforts; (3)include a variety of approaches and methods; (4) be implemented agencywide; (5) use newer technologies and approaches; (6) assess staff capabilities to provide TA and expand capacity; (7) include effective information-sharing mechanisms for interstate assistance; and (8) include evaluations and feedback loops. (Final report: 14 pages.)

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Michael Millman

PHONE NUMBER: (301) 443-0368

PIC ID: 6203

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Emergency Medical Services for Children: An Evaluation of Sustainability in Seven States

ABSTRACT NUMBER: 042

ABSTRACT: The Emergency Medical Services for Children (EMSC) program was begun in FY 1984 to provide Federal funding to assist States in eliminating gaps in the care of critically ill and injured children. This study was designed to (1) determine the ability of States to use short-term Federal funding to develop and institutionalize emergency medical services for children; (2) identify attributes associated with successful institutionalization; (3)characterize barriers to institutionalization; and (4) make recommendations for improving EMSC programs. The study employed a case study approach in assessing EMSC projects before, during, and after Federal funding was provided. Sources included existing data and key informant interviews conducted during site visits. The study found that the HRSA grants funded activities in four areas: (1) assessment of emergency medical services capabilities and development of equipment inventories and protocols; (2) development of training and educational programs for providers; (3) development of injury prevention programs; and (4)data systems development. Overall, the grant program was successful in achieving its goals in the first two areas; it was less successful in the areas of injury prevention and development of data linkage systems. Seven indicators of successful EMSC projects were identified: (1) continuity of project staff, (2) strong leadership in project management, (3)adesignated coordinator to oversee training and education, (4) development of networks and coalitions around pediatric emergency care, (5) ability to leverage additional resources, (6)prior understanding of or experience with emergency medical system issues, and (7)project personnel with a strong advocacy orientation. Recommendations address three areas: (1) strategic planning and funding; (2) grant guidance, including setting of target issues and an increased emphasis on evaluation; and (3) program development and intergovernmental relations. Together with an assessment of the EMSC program conducted by the Institute of Medicine, this report will be used in setting future program directions and goals. (Final report: 54 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells

PHONE NUMBER: (301) 594-4284

PIC ID: 6351

PERFORMER ORGANIZATION: George Washington University, Washington, DC
 

TITLE: Evaluation of Learning Needs Using a Computerized, Standard Educational Needs Assessment Protocol for AIDS Education and Training Centers (AETCs): Final Report

ABSTRACT NUMBER: 043

ABSTRACT: The human immunodeficiency virus (HIV) and its final stage--acquired immunodeficiency syndrome (AIDS)--have posed many challenges for health care providers. They have exposed deficiencies in access to health care and have severely burdened existing resources within the public health system. To help meet the need for trained and motivated health care professionals competent in treating HIV/AIDS-infected patients, the Health Resources and Services Administration established AIDS Education and Training Centers (AETC's). A network of 15 AETC's provides training for health care professionals, especially physicians, physician assistants, advanced practice nurses, registered nurses, dentists, and dental hygienists. Many AETC's have expanded their target audience to encompass allied health care providers, such as mental health workers, case managers, and other psychosocial workers. This study developed a methodology for an ongoing system of evaluating the training needs of key providers trained through AETC's. Based on the results of this evaluation, a standard needs assessment protocol was developed, which includes computerized assessment learning instruments. Presently, a learning needs assessment must be completed by each AETC every three years for key disciplines. The protocols and instruments are being implemented nationally. Once implemented, the findings from this study will make available, for the first time, a standardized nationwide data set regarding the AIDS learning needs of the general population of key primary providers caring for persons with HIV/AIDS. Broader applications of this survey process are also being considered for other areas of learning needs of health professionals, such as violence and substance abuse. (Final report: 53 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ruth Kahn

PHONE NUMBER: (301) 443-6785

PIC ID: 5604

PERFORMER ORGANIZATION: Macro International, Inc., Calverton, MD
 

TITLE: Evaluation of the Bureau of Health Professions Strategic Directions: Development of a Cross-Cutting Performance Monitoring System: Final Report

ABSTRACT NUMBER: 044

ABSTRACT: The Bureau of Health Professions (BHPr) provides policy leadership and support for health professions workforce enhancement and educational infrastructure development. This project, part of a three-phase effort to develop an integrated data system to facilitate planning and evaluation of BHPr programs, developed a set of outcome-based performance measures and a performance monitoring system that measures progress of the Bureau in meeting its strategic goals. In particular, four cross-cutting goals are examined: (1)promoting a health care workforce with a mix of the competencies and skills needed to deliver cost-effective, quality care; (2) supporting educational programs' ability to meet the needs of vulnerable populations; (3) improving cultural diversity in the health professions; and (4) stimulating and monitoring relevant systems of health professions education in response to changing health care marketplace needs. This report examines several issues including (1) whether the outcomes and indicators chosen to monitor progress can be reliably collected and analyzed; (2) whether grantees believe that identified goals, outcomes, and indicators reflect what they consider to be the most valuable contributions of their projects; (3) what data sources and collection tools are available; and (4) the kind of system that should be developed in support of required monitoring and reporting. The report also describes the plan for a monitoring system that would provide the functions needed for ongoing program management through a cycle of measurement and monitoring, especially as required by the Government Performance and Results Act. Key functions in the plan include (1) program grantee-level measurement and monitoring; (2) analysis and assessment of program performance relative to expectations; (3) identification of successes and programs that merit further investigation; and (4) data to support the process of reviewing performance at the grantee and program level. (Final report: 25 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Jennifer Burks

PHONE NUMBER: (301) 443-1530

PIC ID: 5497.1

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers

ABSTRACT NUMBER: 045

ABSTRACT: This study described and assessed the possible impact of Social Security Act Section 1115(a) Medicaid demonstration programs on two Federally Qualified Health Centers (FQHC's) in Hawaii and two in Oregon, based on the first year of implementation. Approaches included a review of existing data and site visits to the FQHC's. The report finds that (1) a change in the method of payment from cost-based reimbursement to a combination of prepaid capitation and fee-for-service rates creates a major challenge for FQHC's; (2) FQHC's experienced changes in their delivery system; (3) changes in benefit packages varied between the two States; (4) FQHC involvement in waiver development and implementation varied depending on the State (however, in both States, the FQHC's responded to the 1115 waiver by partnering with other organizations to form an HMO network); and (5)administration and management of the FQHC's has been affected by their waiver participation, although the effects have varied depending on the size, target populations, and the FQHC's prior managed care experience. The report also finds that FQHC's see the waiver programs as increasing access for beneficiaries. In addition, the report notes that there have been both positive and negative financial consequences for FQHC's as a result of their waiver participation. In both States, FQHC's are being reimbursed at rates substantially below cost-based Medicaid. All four centers indicated that they were continuing to provide services not included in the capitation rate and that they were serving patients who were not enrolled with the center. See also PIC ID No. 5738.1. (Executive summary: 6 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Beth Ann Tutunjian

PHONE NUMBER: (301) 594-4060

PIC ID: 5738

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers: Case Study--Hawaii

ABSTRACT NUMBER: 046

ABSTRACT: This is one of two case studies conducted as part of an evaluation of the impact of the Social Security Act 1115(a) waivers on Federally Qualified Health Centers (FQHC's). This case study focuses on two FQHC's in Hawaii and the State's waiver program, Health QUEST, which was implemented beginning in August 1994. The discussion of Health QUEST's impact on FQHC's is limited to the first year of waiver implementation. The case study finds that certain design and implementation features of the QUEST program have implications for FQHC's, including (1) the change from cost-based reimbursement to a combination of prepaid capitation and fee-for-service rates creates a major challenge for FQHC's; (2) QUEST enrollment experience differed from expectations; (3) there were changes in the FQHC delivery system; and (4) there was substantial improvement in benefits for enrollees formerly covered by a state-funded program, SHIP. The report finds that, although FQHC's were not actively involved in development of the waiver, following approval they began to prepare for QUEST, in part by developing their own managed care organization, AlohaCare. As of January 1995, about 17.3 percent of all QUEST enrollees were enrolled in FQHC's or in FQHC look-alikes. The report also finds that enrollment in QUEST has differed from the expectations of the two FQHC's: in one, the estimate of enrollment was too high, while in the other, the estimate was quickly exceeded. Furthermore, staffing changes in both FQHC's occurred as a result of QUEST's implementation, as did increases in paperwork and needs for management information. The report concludes that QUEST has increased access to care through broadening eligibility, and that the program has had varied financial impacts on the FQHC's: one FQHC is receiving payments well below reasonable cost reimbursement, while the other FQHC is receiving payments at rates similar to those based on reasonable costs. See also PIC ID Nos. 5738.1 and 5738.2. (Executive summary: 14 pages; case study: 69 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Beth Ann Tutunjian

PHONE NUMBER: (301) 594-4060

PIC ID: 5738.2

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Evaluation of the Impact of the Social Security Act Section 1115(a) Waivers on Federally Qualified Health Centers: Case Study--Oregon

ABSTRACT NUMBER: 047

ABSTRACT: This case study is one of two that The Lewin Group prepared as part of a study that evaluated the impact of the Social Security Act Section 1115(a) waivers on Federally Qualified Health Centers (FQHC's). This case study focuses on two FQHC's in Oregon, which implemented its waiver program, the Oregon Health Plan (OHP), beginning in February 1994. The information contained in the case study reflects the results of the first year of OHP operations and the opinions of individuals at the State Medicaid agency, the Oregon Primary Care Association, selected managed care organizations, and staff of the two FQHC's included in the study. The case study finds that several implementation features of OHP have implications for FQHC's, including (1) a change from cost-based reimbursement to a combination of capitation and fee-for-service rates; (2) expanded Medicaid eligibility; (3)restricted beneficiary freedom of choice; and (4) changes in the former Medicaid benefits package resulting in more limited coverage (but with some new benefits) for previously eligible enrollees. These changes led to a greater reliance on primary care and risk management. Some specific changes occurring in the two FQHC's included in the case study are (1) increased requirements for 24-hour coverage; (2) greater paperwork requirements due to the referrals process; (3) increased needs for management information in order to monitor changes in patient loads, new enrollees and disenrollments, and costs and utilization of services; (4) increased numbers of new patients, requiring more time for visits and fewer appointments available for previous patients; (5) increased needs for staff to check eligibility; and (6) limitations in the management information systems available, which directly affect analyses of the financial repercussions of the waiver. The case study concludes that the impacts of capitation may vary between FQHC's and that current OHP rates do not cover the costs of services at FQHC's as presently constituted. See also PIC ID Nos. 5738, 5738.1, and 5738.2. (Executive summary: 16 pages, case study: 80 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Beth Ann Tutunjian

PHONE NUMBER: (301) 594-4060

PIC ID: 5738.1

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Expanding the Capacity of Advanced Practice Nursing Education

ABSTRACT NUMBER: 048

ABSTRACT: Advanced practice nurses are registered nurses with specialized education and training beyond basic nursing education for the provision of care in clinical settings. This study examines the feasibility of increasing the production of advanced practice nurses by investigating the expansion capacity of the educational system that prepares them. Four specialty areas are under consideration: nurse practitioners, nurse-midwives, clinical nurse specialists, and nurse anesthetists. The report finds that (1) most programs are currently at capacity in some resource aspect of their program (e.g., faculty, facilities, clinical sites, etc.); (2) the availability of sites for appropriate clinical education is the single most significant factor in determining a program's ability to expand its capacity; (3) the availability of clinical faculty, including clinical coordinators and preceptors, is an important factor affecting a program's ability to expand; (4) programs report that they have sufficient faculty to teach didactic courses; (5) there is no shortage of applicants, and the student demographic mix in programs tends to mirror the supporting community; (6) advance practice nursing programs use a wide variety of educational technologies to assist with both didactic and clinical instruction and to support distance education; and (7) the effects of distance education approaches on expansion of program capacity are inconclusive thus far but appear to have potential to expand capacity significantly. The report indicates that when programs seek to expand they have accommodated in a variety of ways by using resources more efficiently, changing program structure and design, and/or seeking increased resources. The report recommendations for Federal policy directions include increased support for individuals to enable full-time study, increasing support for programs with greatest potential for expansion, and developing selective grant criteria geared toward those programs with potential for increasing overall numbers of graduates. (Final report: 38 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Evelyn Moses

PHONE NUMBER: (301) 443-6315

PIC ID: 5746

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Graduate Medical Education in Ambulatory Settings

ABSTRACT NUMBER: 049

ABSTRACT: This report examines the affiliations between primary care residency programs and the ambulatory training sites associated with them. It studies flows of personnel, money, and non-monetary benefits between these entities in order to develop an understanding of how these residency programs operate within the current funding environment for graduate medical education (GME). Information collected in a series of interviews with a total of eight primary care residency programs (four family practice programs, two general internal medicine programs, and two general pediatrics programs) was synthesized according to several key elements, including (1) organization; (2) operations; (3) residents; (4) supervising physicians; and (5) the health care marketplace. The interviews reveal that (1) there is not a significant amount of cost sharing between the programs and their affiliated ambulatory training sites; (2) the programs operate fairly well within the current GME funding environment, despite limitations to GME funding mechanisms; (3) programs are unaware of their resource costs for resident training and are unaware of how their affiliated teaching hospitals use Medicare GME funding in the medical education process; (4) programs have varied their responses to the changing health care marketplace--those involved in health maintenance organizations are active in their response to managed care, while others are relatively passive; and (5) despite the fact that physicians employed by ambulatory training sites may not be as productive when they have to supervise residents, these physicians appear willing to participate in resident training. The report also notes that the number of graduating medical students seeking primary care residencies is growing, that funding for all residencies is decreasing, and that outpatient placement opportunities are likely to decrease, as cost pressure on ambulatory training sites may make them unwilling to absorb future training costs.

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: (301) 443-1900

PIC ID: 6350

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

TITLE: Hospital Development and OPO Performance

ABSTRACT NUMBER: 050

ABSTRACT: Information about the extent and effects of hospital development activities of organ procurement organizations (OPO's) is quite limited. This report examines this issue and analyzes the efficiency of OPO's. A mail questionnaire was sent to all 66 U.S. OPO's; data regarding 64 of these are included in the analysis. These data show that (1) the median OPO in the sample served 70 hospitals with 16.5 full-time equivalents and had operating expenses of over $3 million; (2) hospital development is an important activity for most OPO's, backed by a strong commitment from OPO executive directors and a high level of resources; (3) OPO's whose directors are more committed to hospital development, which are not hospital sponsored, which serve a larger population or a larger land area, and which have a service area with higher death rates, display higher levels of hospital development activity; and (4) there is limited evidence that hospital development activities are associated with higher levels of performance, but a more valid assessment is dependent upon better performance measures and data. Part II of the report uses Data Envelopment Analysis to assess the relative efficiency of OPO's. It finds that (1) overall, 55 percent of OPO's are efficient, compared with their peers; (2) 27 percent of the 22 larger OPO's are inefficient compared with other large OPO's, while 55 percent of the 42 smaller OPO's are inefficient by comparison; and (3) efficient OPO's recover significantly more kidneys and extrarenal organs, have higher operating expenses, and have more referrals, donors, and transplants than others. (Final report: 55 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Resources Development

FEDERAL CONTACT: Larry Wannemacher

PHONE NUMBER: (301) 443-6560

PIC ID: 6349

PERFORMER ORGANIZATION: Virginia Commonwealth University, Department of Health Administration, Richmond, VA
 

TITLE: Impact of Case Management on Health Status in Community and Migrant Health Centers

ABSTRACT NUMBER: 051

ABSTRACT: In 1988, the Health Resources and Services Administration, Bureau of Primary Health Care, initiated the Comprehensive Perinatal Care Program (CPCP). The CPCP provides monies to selected community and migrant health centers (CMHC's) to develop or enhance their delivery of case management services to perinatal populations. This study evaluated the effects of case management in the CPCP on access to services and on maternal and infant health behaviors and outcomes. Case management is a process for locating and integrating primary care with other specialized services on behalf of the recipients. The study also documented trends in perinatal health indicators and examined the role of case management in dealing with pregnancies in women who are homeless, have HIV-positive status, or are substance abusers. The study consisted of three phases: (1) a case-control site study of paired CMHC's intensively using and not intensively using case management; (2) a model site study of seven CMHC's serving high risk perinatal populations; and (3) a two-part mail survey of CMHC's. The study found that case management had a positive effect on continuity and adequacy of care, awareness of other professional services available, and the user's perception of quality of care. Case management did not seem to affect the utilization rates for the Special Supplemental Food Program for Women, Infants and Children (WIC), or Medicaid eligibility assistance services. The report recommends that CMHC's (1) take the time and effort to develop a comprehensive perinatal program; (2) develop easy tools for psychosocial risk assessment, nutrition assessment, and health education; (3) develop simple tracking and follow-up systems; (4) develop patient-specific care plans; (5) develop communication systems among caregivers; (6) provide several opportunities for disclosure; and (7) establish boundaries for case management (i.e., deciding when to refer and when to treat). (Final report: 63 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: (301) 594-4450

PIC ID: 4078

PERFORMER ORGANIZATION: John Snow, Inc., Boston, MA
 

TITLE: Primary Care: America's Health in a New Era

ABSTRACT NUMBER: 052

ABSTRACT: "Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community." This definition, developed by the Institute of Medicine, was used as a guide for an Institute committee that was appointed to carry out a 2-year study addressing the opportunities for and challenges of reorienting health care in the United States. The report discusses the structural changes in the health care system that will influence the evolution of primary care and underscores the need for coordinated services and relationships with public health, mental health, and long-term care. The report also discusses the importance of the primary care team and of primary care for vulnerable populations. Recommendations create a comprehensive set of actions that would ensure the proper place of primary care in the Nation's health care system as well as an adequate supply of appropriately trained primary care providers. On the latter topic, the committee recommendations include continuing the current level of effort to increase the supply of primary care clinicians, efforts to improve their competency, and interdisciplinary training and rotations in sites such as community health centers. Other recommendations include the development of tools for monitoring and improving the quality of care and dissemination of performance information. Recommendations concerning primary care research and data needs are also included. (Final report: 262 pages, plus appendices.)

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: (301) 443-1900

PIC ID: 5612

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC
 

TITLE: Quality Assurance Procedures for the Uniform Reporting System for Titles I and II of the Ryan White CARE Act

ABSTRACT NUMBER: 053

ABSTRACT: The Ryan White Comprehensive AIDS Recovery Emergency (CARE) Act of 1990 assists States, metropolitan areas, and providers in the development of services for people living with AIDS and HIV infection. Titles I and II of this Act provide grants to disproportionately affected metropolitan areas and to States to improve the availability and coordination of services for HIV-infected people. The Uniform Reporting System (URS) supports Bureau of Health Resources Development monitoring and evaluation of the activities taking place under these Titles. This report presents a set of quality assurance procedures that could be applied to the URS, a provider-level system that was phased into operation beginning in 1992. The data collected in the URS are used to evaluate the extent to which the programs are achieving the goals of the CARE Act and to assist planning councils, State agencies, and consortia in targeting and monitoring the provision of services to specific population groups. Site studies, conducted for six grantee programs, included (1)a review of errors observed in the data submitted as part of the URS field test; (2) getting feedback from data managers on data quality issues; and (3) getting feedback from data managers on the plan developed for monitoring and improving data quality. The products of the project included quality assurance manuals for dissemination to grantees, providers, and staff of the Health Resources and Services Administration and a software module addition to the URS program to automate the preparation of error profiles. The quality assurance manuals include material covering the data quality plan, the effective use of quality profiles and targets, guidance for obtaining quality data, strategies for identifying sources of errors, and recommendations for improving data quality. The products of the project will be used to improve the quality of data submitted by CARE Act grantees. (Final report: 15 pages.)

AGENCY SPONSOR: Bureau of Health Resource Development

FEDERAL CONTACT: Ram Jain

PHONE NUMBER: (301) 443-6315

PIC ID: 5602

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

TITLE: Report to Congress on the Process by Which International Medical Graduates Are Licensed to Practice in the United States

ABSTRACT NUMBER: 054

ABSTRACT: This project examined the policies and practices of State medical boards with regard to the licensing of International Medical Graduates (IMG's) and U.S. Medical Graduates (USMG's). It also assessed how well the National Credentials Verification System (NCVS), established by the American Medical Association (AMA) in 1991, expedited the process of licensure by endorsement. The AMA discontinued the NCVS in 1994 due to the costliness of its operation. The data collection strategy consisted of an overall examination of licensure policies and practices and a survey of the processing and approval times of nine State medical boards. The report finds that (1) the time required to verify the credentials of physicians applying for licenses remains a critical element in creating differences in the application process for IMG's and USMG's; (2) it is more difficult for IMG's to obtain and for State boards to verify the credentials documentation required for licensure; (3) as of 1994, 34 licensing jurisdictions require more years of graduate medical education for IMG's than for USMG's; (4) States differ with respect to both the primary and additional requirements for licensure imposed on IMG's; and (5) very few applications, whether submitted by IMG's or USMG's, resulted in denials. The report recommends that a national credentials verification system be established. It finds that such a system is urgently needed to assist State medical boards in verifying the credentials of both international and domestic medical graduates applying for initial licensure by endorsement. (Final report: 20 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: C. Howard Davis

PHONE NUMBER: (301) 443-6785

PIC ID: 5742

PERFORMER ORGANIZATION: Macro International, Inc., Calverton, MD
 

TITLE: Study of the Health Care for the Homeless Program

ABSTRACT NUMBER: 055

ABSTRACT: This report assesses critical programmatic and policy aspects of the Health Care for the Homeless (HCH) program. It examines models of service delivery, efforts to improve access to a variety of services, barriers to effective treatment, the effects on the health status of the population, program costs and financing, and compliance with the enabling legislation. Study methodology included a literature review, an analysis of HCH program data, a survey of all HCH programs, follow-up telephone interviews with 43 HCH programs, and site visits to nine sites. The report finds that (1) almost half of HCH's are federally funded community health centers; one-fourth are public health departments, and the remainder are hospitals, shelter coalitions, and other entities. Barriers to care include lack of transportation, language and cultural conditions, and the general social conditions of homelessness. Almost 20 percent of HCH programs identified a severe shortage of mental health and substance abuse services as their greatest problem. Only 6 percent of HCH financing comes from Medicaid. Recommendations include (1) the development of outcome measures to standardize practices; (2) development of better data and information systems; and (3) greater efforts to maximize revenue from Medicaid. Specific efforts have been made in the Bureau of Primary Health Care to address some of these recommendations. A best practices manual will outline successful strategies for serving homeless people and will cover many of the specific issues concerning outreach, case management, and continuity of care highlighted by this evaluation. A working group on health outcome measures for the homeless was convened in April 1996 and the proceedings were distributed to all HCH grantees. (Executive summary: 19 pages, plus appendices; Final report: 111 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Lynda Honberg

PHONE NUMBER: (301) 594-4450

PIC ID: 5595

PERFORMER ORGANIZATION: Solon Consulting Group, Silver Spring, MD, with the UCLA Center for Health Policy Research
 

TITLE: Technical Support for Need Designation and State Primary Care Access Plan Initiatives

ABSTRACT NUMBER: 056

ABSTRACT: The purposes of this study were (1)to bring together appropriate experts to discuss methods for improving the process of designating areas of primary health care shortage or underservice, (2) to compile and compare Primary Care Access Plan data from the States; and (3) to analyze available indicators of the need for and access to primary health care services at State and local levels. The Bureau of Primary Health Care is responsible for several related programs that provide primary care services to areas and populations with access barriers to such services. This study was intended to help determine currently available indicators of shortage, access, and underservice at county and subcounty levels that could be used in a new index of medical underservice. By compiling and analyzing a data base of State Primary Care Access Plan submissions, the study also identified (1) the most efficient ways to store the data; (2) specific indicators for developing measures of the effects of State health care reform efforts; and (3) report designs to illustrate the effects. The information from the study will be used to finalize new designation criteria and support development of new regulations. (Volume I: variously paginated; Volume II: 31 pages.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Richard Lee

PHONE NUMBER: (301) 594-4280

PIC ID: 6204

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

TITLE: Test of Local-Level Health Care Reform Strategies in Selected California Counties

ABSTRACT NUMBER: 057

ABSTRACT: A core idea behind this project is the realization that health care reform at the local level can do as much, if not more, than national reform to improve access to high-quality health care for all members of a community. This idea is given strength by the fact that a significant proportion of the health care expenditures in any community comes from public funds, whether these expenditures are spent on groups for which the Government accepts responsibility (military families, veterans, the elderly, or the very poor) or on purchasing health insurance for public employees. In some communities, public expenditures for health care may equal 75 percent of the health dollars spent. This project provides a replicable model that can assist a local community (in this case, Alameda County, California) to develop and implement a local health care reform initiative. Alameda County, the sixth most populous county in the State, covers an area of 737,500 square miles. The population is 53 percent white, 17 percent black, 14 percent Asian, and 14 percent Hispanic. About 203,000 Alameda County citizens are eligible for Medicaid; about 300,000 are indigent and lacking health insurance, and about 100,000 work at some level of government. Alameda County has a history of innovative public programs, strong and visionary leaders, and active collaboration between the public, private, and academic sectors. The report finds that the county has a highly developed provider network in place; thus, the most promising strategies included the development of a value-purchasing cooperative and a countywide health information network. This report develops an implementation plan for each of these strategies. The study concludes that such systems are feasible in the county and that they are replicable in other sites. The report also discusses how the Federal Government could encourage such local-level health reforms. (Final report: variously paginated, plus appendix.)

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Karen Thiel Raykovich

PHONE NUMBER: (301) 443-2204

PIC ID: 6205

PERFORMER ORGANIZATION: Fresno Regional Foundation/Institute for Health Futures, Fresno, CA
 

TITLE: Tools for Monitoring Cultural Competence in Health Care

ABSTRACT NUMBER: 058

ABSTRACT: This project examines the dimensions of culturally competent health care practices, defined as the level of knowledge-based skills required to provide effective clinical care to patients from a particular ethnic or racial group. "Cultural competence" is thus distinguished from "cultural sensitivity," defined as the psychological propensity to adjust one's practice styles to the needs of different racial or ethnic groups. The project had as its goal the development and testing of tools that can be used to assess the cultural competence of primary care providers practicing within managed care systems. Two expert panels were convened to assist in the development of these tools. The report provides (1) findings of the physician panels and patient panels, and an analysis of their contribution to our understanding of the culturally competent model of health care delivery in the context of the two largest minority-run health maintenance organizations in California; (2) a patient satisfaction survey (tested with a sample of enrollees of the two HMO's) that can be used to evaluate the degree to which a managed care plan is providing culturally competent health care to its limited-English-speaking minority enrollees; (3) a provider self-assessment survey for use with physicians and other health care providers working in a managed care system; and (4)behavioral ethnic identifiers that can be used in enrollment forms as a cue for the provision of culturally appropriate health care services. (Final report: 61 pages, plus appendices.)

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Michael Millman

PHONE NUMBER: (301) 443-0368

PIC ID: 6352

PERFORMER ORGANIZATION: Latino Coalition for a Healthy California, SanFrancisco, CA

Indian Health Service

Contents

Evaluating the Effectiveness of Alcohol and substance Abuse Services for Native American and Alaska Native Women: Phase II Final Report

Evaluation of the Indian Health Service (IHS) Adolescent Regional Treatment Centers (RTCs)

Methodology for Adjusting IHS Mortality Data for Inconsistent Classification of Race-Ethnicity of American Indians and Alaska Natives Between State Death Certificates and IHS Patient Registration Records
 

TITLE: Evaluating the Effectiveness of Alcohol and Substance Abuse Services for Native American and Alaska Native Women: Phase II Final Report

ABSTRACT NUMBER: 059

ABSTRACT: The major goal of Phase II of this study was to collect and analyze much-needed descriptive, demographic, social, cultural, and clinical information about women receiving treatment in alcohol and substance abuse treatment centers funded in whole or in part by the Indian Health Service. This evaluation provides both qualitative and quantitative information about a group of women who have been traditionally underrepresented in research. The themes and variations that emerged from the evaluation show that the life conditions of the women studied are extreme. For many, adverse or abusive childhood experiences and conditions have carried through into adulthood. The vast majority of women were exposed to physical, sexual, or emotional abuse during their childhood and adult lives. The availability of women-centered, family-focused approaches to alcohol and other drug treatment is severely limited in the United States. The leading obstacle to treatment for women with children is the lack of adequate care for their children while they are in treatment.

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Leo Nolan

PHONE NUMBER: (301) 443-4700

PIC ID: 5675

PERFORMER ORGANIZATION: University of California, San Francisco, Institute for Health Policy Studies, San Francisco, CA
 

TITLE: Evaluation of the Indian Health Service (IHS) Adolescent Regional Treatment Centers (RTCs)

ABSTRACT NUMBER: 060

ABSTRACT: This study evaluated the effectiveness and efficiency of, and consumer satisfaction with, the nine regional treatment centers (RTC's) that provide alcoholism and substance abuse rehabilitation treatment to American Indian and Alaska Native youth. The following conclusions are based on the findings of this study. The RTC's have developed effective adolescent alcohol and substance abuse programs, but continuity of care and after-care are the biggest problems in the programs. RTC's need additional mental health staff resources, client-charting improvements, and innovative ways to increase family involvement. Recommendations include improving the continuum of care to adolescent abusers, self-evaluation, and regional treatment center effectiveness and efficacy.

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Leo Nolan

PHONE NUMBER: (301) 443-4700

PIC ID: 5941

PERFORMER ORGANIZATION: Support Services, Inc., Silver Spring, MD
 

TITLE: Methodology for Adjusting IHS Mortality Data for Inconsistent Classification of Race-Ethnicity of American Indian and Alaska Natives Between State Death Certificates and IHS Patient Registration Records

ABSTRACT NUMBER: 061

ABSTRACT: This project developed an empirically based method for improving the consistency of Indian Health Service (IHS) mortality statistics when compared with race reported for the same decedents obtained from other sources. The study findings indicate a large variation in the number of deaths reported from 1986 to 1988 across IHS Service Area Offices, as well as extensive variation in the number of deaths reported in the matched IHS National Death Index data across states of occurrence. There is also a great variation in the percentage of consistently reported American Indian and Alaska Native race identification on State death records and IHS patient registration records by State of a resident. Recommendations include replicating the study using data on deaths occurring since 1988, using the adjustment factors developed in the study, and working with States to decrease inconsistent race reporting.

AGENCY SPONSOR: Office of Planning, Evaluation and Legislation

FEDERAL CONTACT: Leo Nolan

PHONE NUMBER: (301) 443-4700

PIC ID: 5946

PERFORMER ORGANIZATION: Support Services, Inc., Silver Spring, MD

National Institutes of Health

Contents

Bridges to the Future: Program Evaluation

Clinical Research Under Support by NIDDK: Fiscal Year 1995 Data

Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector

Evaluation of NIH Shared Instrumentation Grant Program: Reports From Users

National Heart, Lung, and Blood Institute Article Citation and Patent Reference Study: An Analysis of Article Citations and Patent References to Journal Articles Supported by the National Heart, Lung, and Blood Institute

Navajo Alcohol Rehabilitation Demonstration Program

Statistics on U.S. Immigration: An Assessment of Data Needs for Future Research
 

TITLE: Bridges to the Future: Program Evaluation

ABSTRACT NUMBER: 062

ABSTRACT: In February 1992, the National Institute of General Medical Sciences (NIGMS) and the National Institutes of Health Office of Research on Minority Health announced the implementation of the Baccalaureate and Doctoral Bridge programs. The objective of the Baccalaureate Bridge program is to facilitate the transition of minority students at 2-year colleges into colleges with baccalaureate degree programs in the sciences. The Doctoral Bridge program seeks to facilitate the transition of students into Ph.D. programs when they complete the M.S. degree. Two program outcomes that are particularly relevant to the goals of the Bridges program were examined in this study: (1) the transition of students from 2-year to 4-year institutions, or from M.S. to Ph.D. programs; and (2) the retention of students in the educational pathway, both before and after making the transition from one institution to another. Although the quantity and quality of the comparison data are not high, rates of transfer among Bridges students appear to be higher than rates among other students. Success in completing the baccalaureate degree among those students who have transferred is high and is comparable to the rate found among other minority students in an evaluation of the NIGMS Minority Access to Research Careers program. At the baccalaureate level, approximately 70 percent of the students are majoring in such fields as biology, chemistry and biochemistry, molecular biology, and microbiology. From the current data, it is difficult to develop good estimates of the eventual outcomes of participants in the Doctoral Bridges program. The early cohorts of students were small. Of the 21 students in the first two cohorts, about half have transferred to a doctoral program. While the rate of Bridges student attrition from graduate programs is below the national average, it is still too soon to predict their rate of completing their doctoral programs.

AGENCY SPONSOR: National Institute of General Medical Sciences

FEDERAL CONTACT: James Onken

PHONE NUMBER: (301) 594-2764

PIC ID: 6093

PERFORMER ORGANIZATION: Turner Consulting Group and TYC Associates, Rockville, MD
 

TITLE: Clinical Research Under Support by NIDDK: Fiscal Year 1995 Data

ABSTRACT NUMBER: 063

ABSTRACT: This study was conducted in response to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) Advisory Council for a determination of the level of NIDDK support for clinical research during FY 1995. Two definitions of clinical research are currently under examination within the National Institutes of Health (NIH) and in the scientific community at large. The first, a narrow definition, requires only that patient and physician are alive in the same room; this is the one requested by the Advisory Council for estimating NIDDK support of clinical research. The broader, NIH-wide definition was adopted by the Advisory Committee to the NIH Director on Clinical Research. It includes areas of epidemiology, behavioral studies of patients, outcomes research, and health services research, as well as technology development intended for clinical use and contract studies supporting clinical research. Although the Advisory Council asked that the present study examine only clinical studies fitting the narrow definition, the concurrent need to support the efforts of NIH as a whole prompted the inclusion of NIDDK-supported clinical research fitting both definitions. The report finds that, in FY 1995, NIDDK supported (1) 678 extramural research projects fitting the narrower definition, at a cost of $178,144,000 (31percent of the NIDDK budget) and 68 applicable intramural projects, at a cost of $24,445,000 (29 percent of the budget); (2) 919 extramural projects fitting the broader definition, at a cost of $222,261,000 (37 percent of the budget) and 81 intramural projects ata cost of $27,635,000 (33 percent of the budget); (3) clinical research under the narrower definition took the largest percentage of a division budget (37 percent) in the Division of Kidney, Urologic, and Hematologic Diseases; and (4) at the program level, urology led in the percent of its budget spent on clinical research under the narrower definition.

AGENCY SPONSOR: National Institute of Diabetes and Digestive and Kidney Diseases

FEDERAL CONTACT: Carol Feld

PHONE NUMBER: (301) 496-6623

PIC ID: 6286

PERFORMER ORGANIZATION: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
 

TITLE: Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector

ABSTRACT NUMBER: 064

ABSTRACT: The Medications Development Division (MDD) at the National Institute on Drug Abuse was established to coordinate and encourage academic, private, and Federal regulatory involvement in developing and bringing to market new medications for treating drug abuse. This report examines MDD's progress and explores the factors that hinder the development of antiaddiction medications. The report finds that pharmacotherapy for the treatment of drug addiction has received little attention. In fact, despite the success of methadone for the treatment of opiate addiction, only two additional drugs have been approved, both of which were developed in the late 1960's and early 1970's. Furthermore, there is still no approved medication for treating cocaine addiction. The report also finds that the major disincentives to pharmaceutical research and development for antiaddiction medications include (1) an inadequate scientific base on the mechanisms of addiction and on the prevention of relapse, particularly for cocaine addiction; (2) a lack of financing for treatment and of trained treatment specialists; (3) narrow Federal and State regulations; (4) the relatively small market for such drugs; (5) pricing issues and the societal stigma against drug abusers; (6) liability issues and difficulties in conducting clinical research; and (7) a lack of sustained Federal leadership. The report provides recommendations to help remove these barriers. (Final report: 199 pages, plus appendices.

AGENCY SPONSOR: National Institute on Drug Abuse

FEDERAL CONTACT: Susan Azeka

PHONE NUMBER: (301) 443-6036

PIC ID: 5831

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC
 

TITLE: Evaluation of NIH Shared Instrumentation Grant Program: Reports From Users

ABSTRACT NUMBER: 065

ABSTRACT: The Shared Instrumentation Grant (SIG) Program of the National Institutes of Health (NIH) National Center for Research Resources has provided costly, state-of-the-art instruments for NIH-supported investigators since FY 1982. Between FY 1982 and FY 1995, 1,487 instruments were awarded through the SIG program, for a total program expenditure of $295.6 million. These awards were made to graduate schools, medical and other health professional schools, hospitals, and research organizations. SIG principal investigators and major users defined as NIH-supported investigators who accounted for a significant share of SIG instrument use time were surveyed through two related written questionnaires that addressed user characteristics, instrument usage and sharing arrangements, and the importance of SIG instruments to NIH research. A key finding of the survey was that in 1993, fully 70 percent of the 11-year-old instruments were still in service supporting NIH research. Furthermore, 78 percent of the major users of the oldest SIG instruments evaluated the instruments as adequate for their specific area of research. These findings indicated a greater-than-expected longevity for SIG instruments. See also PIC ID No. 2753. (Finalreport: 41 pages, plus appendices.)

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Carol Brown

PHONE NUMBER: (301) 435-0866

PIC ID: 5083

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
 

TITLE: National Heart, Lung, and Blood Institute Article Citation and Patent Reference Study: An Analysis of Article Citations and Patent References to Journal Articles Supported by the National Heart, Lung, and Blood Institute

ABSTRACT NUMBER: 066

ABSTRACT: The primary objective of all National Institutes of Health (NIH) activities is to improve the health of the American public. However, it is generally impossible to demonstrate the impact of basic research in terms of reductions in disease mortality or morbidity. Therefore, alternative measures must be relied upon. The objectives of this project are to (1) introduce the concept of examining patents as an additional measure for assessing the impact of NIH-supported research; (2) develop a methodology to use patents in evaluation research; and (3) apply this methodology to a National Heart, Lung, and Blood Institute (NHLBI) project in order to compare the outcomes for individual research project grants (R01's) funded under a Request for Applications with the outcomes of individual research project grants funded from unsolicited applications. The methods, data bases, software, and results of this project are applicable well beyond the NHLBI. Other Institutes, Centers, and Divisions will be able to use the methodology developed in this study to evaluate their own funding mechanisms.

AGENCY SPONSOR: National Heart, Lung, and Blood Institute

FEDERAL CONTACT: Carl A. Roth

PHONE NUMBER: (301) 496-3620

PIC ID: 5577

PERFORMER ORGANIZATION: National Heart, Lung, and Blood Institute, Bethesda,MD
 

TITLE: Navajo Alcohol Rehabilitation Demonstration Program

ABSTRACT NUMBER: 067

ABSTRACT: The Navajo Alcohol Rehabilitation Demonstration Program (NARDP) is a federally funded program to provide culturally sensitive treatment for Navajo Native Americans who suffer from alcoholism and the effects of alcohol abuse. NARDP is the only inpatient alcohol treatment program in the Gallup, New Mexico, area and is the only treatment program to use Navajo-speaking counselors. The program was designed exclusively for Navajo Native Americans by Behavioral Health Services (BHS), which has 6.5 beds available to NARDP. NARDP is fully integrated into BHS; the program consists of 28 days of inpatient treatment and rehabilitation based on a modified 12-step philosophy. This report presents findings from a congressionally mandated evaluation of NARDP: (1) Between March 1988 and January 1991, NARDP had a total of 425 client episodes and provided nearly 10,400 total days of treatment; (2) occupancy levels are high; (3) client interviews indicate a higher level of participation in culturally sensitive therapies after completion of an inpatient treatment program; (4) use of aftercare services is low; and (5) data obtained during the evaluation are inadequate to accurately measure client outcomes or program effectiveness, but indirect measures of effectiveness indicate a high program completion rate and a low readmission rate. (Final report: 136 pages, plus appendices.)

AGENCY SPONSOR: National Institute on Alcohol Abuse and Alcoholism

FEDERAL CONTACT: Laura Abbott

PHONE NUMBER: (301) 443-2369

PIC ID: 6018

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA
 

TITLE: Statistics on U.S. Immigration: An Assessment of Data Needs for Future Research

ABSTRACT NUMBER: 068

ABSTRACT: In September 1992, the Committee on National Statistics and the Committee on Population of the National Research Council held a workshop to explore data collection and preparation in the area of U.S. immigration. This workshop was held to help the Immigration and Naturalization Service (INS) develop a statistical information system, as required by the Immigration Act of 1990. Furthermore, the workshop provided suggestions for how data collection and analysis efforts of Federal statistical agencies and the social science research community might be improved in this regard. This report presents the conclusions and recommendations of the committees. The conclusions include (1) new large-scale data sets, including longitudinal data, are needed on immigrants by nationality group; (2) many surveys and the decennial census have limited information for distinguishing immigrant origins, making research on immigrants using existing data difficult; (3)information on legal status and visa status for legal immigrants is missing from most data; (4) data sets should focus on studies of the immigrant family; and (5) INS data could be used to study immigrants' use of various social programs, including welfare, Social Security, Medicare, and Medicaid. The report recommends that (1) the INS work with other Federal agencies and the Bureau of the Census to include key immigration questions on future censuses, including questions on nativity and parental nativity; (2) the Bureau of the Census consider ways to add local-area contextual data to the Public Use Microdata Sample files; (3)the Bureau of the Census retain key questions on immigration in the Current Population Survey; (4) Federal statistical agencies meet with counterpart agencies in Mexico to discuss the potential for establishing joint surveys on immigration; and (5) INS establish the design and usefulness of a survey of green card applicants.

AGENCY SPONSOR: National Institute of Child Health and Human Development

FEDERAL CONTACT: Mona Rowe

PHONE NUMBER: (301) 496-1877

PIC ID: 5622

PERFORMER ORGANIZATION: National Academy of Sciences, National Research Council, Washington, DC

Office of the Assistant Secretary for Planning and Evaluation

Contents

Alcohol and Other Drugs Treatment for Parents and Welfare Recipients: Outcomes, Costs, and Benefits

Americans With Disabilities

Assumptions Underlying Insurance Participation Modeling: A Background Report

Changing Numbers, Changing Needs: American Indian Demography and Public Health

Coordinated Community Responses to Domestic Violence in Six Communities: Beyond the Justice System

Cost of Domestic Violence to the Health Care System

Developing Integrated Managed Care Systems for Children With Disabilities: The State of the Art

Family and Community Violence Prevention Program: Technical Assistance in Program Evaluation and Capacity Building Assessment

Health Care in Transition: Technology Assessment in the Private Sector

Information to Guide Physician Practice

Interdisciplinary Education and Training of Professionals Caring for Persons With Disabilities: Current Approaches and Implications for a Changing Health Care System

Report on the Effects of Population on Quality of Care: Analysis of the Effect of Regulation on the Quality of Care in Board and Care Homes

Subacute Care: Policy Synthesis and Market Area Analysis
 

TITLE: Alcohol and Other Drugs Treatment for Parents and Welfare Recipients: Outcomes, Costs, and Benefits

ABSTRACT NUMBER: 069

ABSTRACT: In August 1994, the State of California released a report entitled Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA). This study found considerable savings to taxpayers associated with alcohol and drug treatment (an average of $7 saved for each dollar spent), primarily in reduced crime and reduced health care costs. While some data were reported on female clients and several statistics were reported regarding welfare receipt, the report included little detail specific to welfare clients and none regarding child welfare issues. This study analyzes the outcomes, benefits, and costs of substance abuse treatment for two partially overlapping groups: (1) parents of children under 18 years of age; and (2) recipients of public income support such as Aid to Families with Dependent Children. The report finds that many persons in substance abuse treatment, especially women, were parents, welfare recipients, or both. For example, (1) 36 percent of the California treatment population had children living with them prior to treatment--about half of these were men; (2) although women in treatment were outnumbered by men, they were much more likely to have children or to express parenting concerns; and (3) about 41 percent of all the women in treatment and 64 percent of women with children in their households received welfare income in the year before treatment. The report also finds that, compared with the year before treatment, the number of drug users after treatment among women with children who received welfare dropped about 39 percent for crack cocaine, 42 percent for cocaine powder, 48 percent for amphetamines, 14 percent for heroin, and 26 percent for alcohol. Finally, the report concludes that measurable treatment benefits exceeded treatment costs for all groups studied. (Final report: 43 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: (202) 690-5938

PIC ID: 4511

PERFORMER ORGANIZATION: National Opinion Research Center, Chicago, IL
 

TITLE: Americans With Disabilities

ABSTRACT NUMBER: 070

ABSTRACT: This project provided funds to the Census Bureau to analyze the 1990 Census questions on disability. Data were collected for the population aged 16 and over on several types of disability, such as limitations in work, ability to work, mobility limitations, and self-care limitations. The tabulations will be the only source of disability data for States, counties, and large metropolitan areas and the only source that includes persons with disabilities residing both in the community and in all types of institutions. The information will serve as a national baseline. As such, the data are useful for virtually every aspect of disability policy and for portions of health care reform and welfare reform that pertain to people with disabilities. Results from this joint Office of the Assistant Secretary for Planning and Evaluation and Census Bureau project are available on the Internet. Results are presented in tables, graphs, and maps. Tables for States, counties, and metropolitan statistical areas contain information by disability status and type of disability on a variety of characteristics, including employment and labor force status, education, income, poverty, marital status, race, and ethnicity. Separate tables are available for the elderly and nonelderly. In addition, national disability estimates from two other Census surveys, the Survey of Income and Program Participation and the Current Population Survey, are presented. The Internet address for the results is http://www.census.gov/hhes/www/disable/census.html.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Michele Adler

PHONE NUMBER: (202) 690-6613

PIC ID: 6174

PERFORMER ORGANIZATION: Bureau of the Census, Washington, DC
 

TITLE: Assumptions Underlying Insurance Participation Modeling: A Background Report

ABSTRACT NUMBER: 071

ABSTRACT: This report provides background material to help analyze policies designed to expand health insurance coverage, especially models that seek to estimate the impact of incremental health care reforms on the size and composition of the uninsured population. The report provides information regarding the "baseline uninsured" and the behavioral response to insurance strategies. The study finds that (1) the number of uninsured persons increased from 30.5 million in 1979 to 39.6 million in 1994--about one-third of this increase was due to increases in the population; (2) disagreement over estimates of the numbers of uninsured persons can be traced to several factors, including differing survey methods and disparity between "point-in-time" and "longitudinal" estimates; (3) 75 percent of the uninsured are in spells that will last longer than 1 year, while only 3.5 percent are in spells that will last less than 5 months; (4) estimates of employee insurance decisions indicate that in 1988 and 1993, about two-thirds of employees were offered insurance and enrolled in the employer's health insurance plan--only 10 percent of employees who were offered insurance did not enroll in their employer's plan; and (5) insurance coverage rates fell slightly between 1988 and 1993, from 68 to 65 percent--the percentage of employees offered insurance during this period also fell from 77.6 to 75.6 percent. The report concludes that the major contributor to the problem of uninsured workers lies in the area of insurance market supply, although it concedes that lack of demand on the part of some workers also contributes to the problem. (Final report: 65 pages, plus appendices.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Eleanor Dehoney

PHONE NUMBER: (202) 690-6250

PIC ID: 6455

PERFORMER ORGANIZATION: University of Missouri-St. Louis, St. Louis, MO
 

TITLE: Changing Numbers, Changing Needs: American Indian Demography and Public Health

ABSTRACT NUMBER: 072

ABSTRACT: This report summarizes the state of knowledge about the demography of the American Indian and Alaska Native populations, about the major health problems they face, and about their utilization of health care services. The report notes the difficulties in tracing demographic and public health trends in this population. These difficulties are attributable to several factors including (1) the relatively small proportion of the U.S. population that is American Indian; (2) American Indian residences tend to be either highly clustered in a small number of geographic areas or spread lightly over a large number of geographic areas; (3) American Indians have experienced a high rate of marital exogamy; and (4) there have been shifts over time in whether self-identifying or being identified as an American Indian is perceived as an advantage or a disadvantage. The report finds that (1) the rapid growth of the American Indian population since the turn of the century is due to changes in self-identification and relatively high fertility rates; (2) Indian infant mortality rates have improved over the past 15 years, but the death rates for American Indian youths and young adults remain high; (3) over one-half of American Indians live in urban areas; (4) American Indians have experienced a decline in infectious diseases, an increase in chronic diseases, and high levels of mortality due to violence, accidents, and alcohol and drug abuse; (5) during the 1980's, the economic situation of American Indians worsened; (6) the Indian Health Service (IHS) service population numbered about 1.21 million in 1990 (about 62 percent of the total American Indian population); and (7) IHS facilities are well suited to serve rural populations at no cost to patients, but access due to geographic isolation and budgetary issues may be difficult. (Final report: 314 pages.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Susanne A. Stoiber

PHONE NUMBER: (202) 690-7150

PIC ID: 6216

PERFORMER ORGANIZATION: National Research Council, Washington, DC
 

TITLE: Coordinated Community Responses to Domestic Violence in Six Communities: Beyond the Justice System

ABSTRACT NUMBER: 073

ABSTRACT: Dramatic changes in community response to domestic violence have occurred over the past two decades. Justice systems have implemented changes to laws and practices that hold batterers more accountable and support battered women. Awareness of domestic violence has extended past the justice and domestic violence service systems to health care providers, child welfare agencies, substance abuse services, churches, and businesses. This study examines coordinated responses to domestic violence in six communities: Baltimore, Maryland; Kansas City, Missouri; Carlton and northern St. Louis Counties, Minnesota; and San Diego and San Francisco, California. The report finds that (1) a strong community response to domestic violence requires that each part of the criminal justice system has appropriate policies that are actually followed in practice--many justice agencies in the study communities had developed their policies through discussions with other justice agencies and domestic violence service providers; (2) some study communities have adopted policies that include attention to the victim as a standard part of their response; (3) in the sites with specialized staff, many respondents feel that the specialization had improved the criminal justice response; (4) domestic violence service providers need to build relationships with providers of other services or representatives of other community sectors and to develop ways to translate their extensive experience into policies and procedures that other providers can understand and follow; (5) health care providers and other agencies must develop screening protocols to identify women who are battered, as well as a system for referring victims to the most appropriate agency; and (6) communitywide education and prevention activities are essential in formulating a coordinated response to domestic violence. (Executive summary: 21 pages; Final report: 165 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Jerry Silverman

PHONE NUMBER: (202) 690-5654

PIC ID: 6154

PERFORMER ORGANIZATION: Urban Institute, Washington, DC
 

TITLE: Cost of Domestic Violence to the Health Care System

ABSTRACT NUMBER: 074

ABSTRACT: This study (1) reviews the literature on the prevalence, incidence, and cost of domestic violence; (2) examines the literature on the mental health consequences of domestic violence; (3) determines whether it is feasible to estimate the costs associated with this impact; and (4) develops an economic model of the cost of domestic violence to the health care system. The report finds that (1) domestic violence has extensive economic consequences, affecting the health care system, the mental health system, the social service system, and the criminal justice system; (2) the available data are flawed and necessitate a large number of assumptions in order to develop estimates; (3) the data sets that focus on health care (including mental health services) do not permit identification of services received as a result of domestic violence; and (3) data derived from the criminal justice system do permit estimates of the number of episodes of domestic violence, but do not contain data on service usage or costs. The report also provides an exploratory paper on the mental health consequences of domestic violence, including depression, suicidal thoughts, substance abuse, and posttraumatic stress disorder. The model developed in the estimates direct costs, related costs, and indirect costs (including morbidity and mortality). (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sandra Howard

PHONE NUMBER: (202) 690-7778

PIC ID: 4528

PERFORMER ORGANIZATION: University of California at San Francisco, SanFrancisco, CA
 

TITLE: Developing Integrated Managed Care Systems for Children With Disabilities: The State of the Art

ABSTRACT NUMBER: 075

ABSTRACT: This project represents an initial inquiry into managed care as it affects children with disabilities. Despite the fact that many health care services are moving toward managed or coordinated care, many of those with disabilities express concern with how they will fare under such a system. The project involved a literature review and open-ended telephone interviews to gain an understanding of the state of the art in managed care for children with disabilities. Private providers and insurers, managed care experts, and State and Federal officials involved in Medicaid managed care demonstrations were interviewed. The interviews identified States or sites where managed care is being delivered or contemplated for children with disabilities. It also reviewed the various definitions of managed care used in these programs, services covered, and programs that provide traditional managed care (primarily acute care) or some combination of acute and long-term care. The project described how the programs operate and identified real and perceived barriers to care for these children under managed care systems. The project involved four site visits to States and programs already delivering managed care to these children. Using the material gathered from the interviews and site visits, the contractor developed a list of key policy concerns and barriers to developing and implementing managed care for children with disabilities.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: (202) 690-6613

PIC ID: 5760

PERFORMER ORGANIZATION: SysteMetrics/McGraw-Hill, Lexington, MA
 

TITLE: Family and Community Violence Prevention Program: Technical Assistance in Program Evaluation and Capacity Building Assessment

ABSTRACT NUMBER: 076

ABSTRACT: Since 1994, the Office of the Assistant Secretary for Planning and Evaluation has provided support for the evaluation of the Family and Community Violence Prevention Program, sponsored by the Office of Minority Health. The program was developed, implemented, and managed by the Minority Male Consortium, a group of 19 historically black colleges and universities (HBCU's), to reduce and prevent violence in both campus and community settings. This report discusses the development of an evaluation design for the program. A needs assessment was conducted to determine technical assistance (TA) requirements of Consortium members and to plan an evaluation TA conference and site visits to deliver individualized TA. The report identifies three broad areas of concern that were addressed at the TA conference. Common evaluation planning issues discussed in the report include (1) agreement among the program director, evaluator, and staff regarding evaluation design and implementation; (2) the challenges involved with data collection and analysis; and (3) the application of models and theories of violence prevention. Some consortium members encountered individual difficulties with evaluation planning. As described in the report, these difficulties included differing perspectives between the program director and evaluator; varying capabilities to implement effective programs; and recruitment and retention of appropriate subjects for the treatment groups. The report concludes that four activities are key in an overall evaluation of the program, and that, with technical assistance, individual HBCU's can make meaningful contributions to each activity. The activities are (1) audience research; (2) environmental profiling; (3) community resources inventories; and (4) assaultive behavior audits. Possible next steps for the evaluation process are recommended, along with suggestions for data collection on various topics.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Patricia S. Hazard

PHONE NUMBER: (202) 690-8291

PIC ID: 5789.1

PERFORMER ORGANIZATION: Macro International, Inc., Calverton, MD
 

TITLE: Health Care in Transition: Technology Assessment in the Private Sector

ABSTRACT NUMBER: 077

ABSTRACT: Historically, the policy discussion on technology assessment (TA) in medicine has focused most of its attention on the role of the Federal Government. This report focuses on TA in the private health care system. Although some attention is given to TA in the hospital and physician sectors, the report is concerned with TA in the managed care sector. The health system environment affecting TA has changed profoundly in the past 5 years (1990-95) compared with the period immediately preceding it (beginning in the mid-1970's). In this context, the evaluation of clinical practice for its clinical and cost-effectiveness has assumed greater market value. The use of TA in the managed care sector is primarily to support coverage decision making. However, a number of innovative developments go beyond this narrow range of issues. Finally, an examination of private-sector TA activity leads back to questions about the appropriate role of the Federal Government in TA and the appropriate division of labor between the public and private sectors.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: (202) 690-6102

PIC ID: 6180

PERFORMER ORGANIZATION: Rand Corporation, Santa Monica, CA
 

TITLE: Information to Guide Physician Practice

ABSTRACT NUMBER: 078

ABSTRACT: In recent years, many information resources have become available to physicians, including profiling, guidelines, and on-line information systems. These changes in the information environment have occurred at the same time that the health care delivery system has experienced radical changes. Thus, while physicians have a wealth of information at their disposal, the environment is chaotic. This report examines the information environment available to physicians through (1) a literature synthesis and data base retrieval system; (2) a focused study of On-Line Medical Networked Information for physicians; and (3) three physician focus groups (attending physicians in an academic medical center, a small rural practice, and a small group of resident physicians). The report finds that (1) the wealth of information available to physicians causes them to aggressively screen information sources--this screening process depends significantly on the characteristics of the physician, on the financial and legal practice environment, and on the source and type of information being provided; (2) technology advances are making it more feasible for rural physicians to communicate with colleagues, but financial constraints prevent them from taking full advantage of resources; (3) potential barriers to on-line resources include the fact that the information resources are not of enough value to justify the time needed to access them, lack of easy access, fear of computers, and concerns about information quality and security. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: (202) 690-6102

PIC ID: 4499

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Interdisciplinary Education & Training of Professionals Caring for Persons With Disabilities: Current Approaches & Implications for a Changing Health Care System

ABSTRACT NUMBER: 079

ABSTRACT: Because people with disabilities generally use more health care services than those without disabilities and more often require the use of a continuum of care, which includes long-term care and supportive community services, effective health care for this population requires the services of both health care and human services professionals. At a time when increasing numbers of disabled persons may be served by managed care organizations, the ability of professionals to work in an interdisciplinary manner is important. This project identifies and describes particular programs where professionals and students in the health care and human services professions receive interdisciplinary instruction and practical experience in the provision of care to people with disabilities. The project includes a literature review, site visit reports, and a final report on interdisciplinary training in relation to care for people with disabilities. The report concludes that there is a growing consensus that, in many cases, meeting the clients' needs cannot be accomplished effectively and efficiently by one discipline alone. While not every client with a disability may require assessment and service delivery by a team, it is evident that professionals from a variety of disciplines will be increasingly called upon to work interactively. The report also concludes that interdisciplinary training programs are addressing managed care only peripherally, and managed care organizations have little appreciation for the specific knowledge, attitudes, and skills needed by providers to appropriately serve people with disabilities. Recommendations include (1) promoting opportunities for dialog between all parties concerned with training for and delivery of services to the disabled; (2) providing incentives to encourage preservice and in-service interdisciplinary training; and (3) disseminating information regarding innovative interdisciplinary curricula and approaches.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Kathleen Bond

PHONE NUMBER: (202) 690-6443

PIC ID: 6052

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

TITLE: Report on the Effects of Population on Quality of Care: Analysis of the Effect of Regulation on the Quality of Care in Board and Care Homes

ABSTRACT NUMBER: 080

ABSTRACT: There are about 34,000 licensed board and care homes in the United States, containing more than 613,000 beds. Residents in unlicensed homes may number more than 400,000. This study examines the effects of regulation on the quality of care in board and care, or domiciliary care, facilities. Data for the study were gathered in 386 licensed board and care homes and 126 unlicensed homes in 10 States. Five of these States have an extensive regulatory system; five have very limited regulation. The 512 board and care homes had 1,138 facility staff and 3,257 residents. The report finds that (1)States with extensive regulatory systems had a significantly smaller proportion of unlicensed homes; (2)extensive regulation is associated with better quality of care, as measured by several factors, including the better ability to meet the needs of frail and disabled residents, lower use of psychotropic drugs, lower use of inappropriate prescriptions for the elderly, and increased use of assistive devices and supportive services; (3) extensive regulation and licensure also lead to better quality of life and increased safety for residents and do not contribute to an "institutional" atmosphere in board and care homes; (4)regulation also prevents homes from being in the lowest range of performance, primarily through licensure alone; (5) neither extensive regulation nor licensure has a positive effect on some aspects of quality, including a requirement for preservice staff training and staff knowledge of care, monitoring, and medication management--it also has no significant effect on the cleanliness of homes or on the likelihood that homes would have any licensed nurses on staff; and (6) there is little variation among licensed and unlicensed homes on such issues as unmet health need, residents' rights, and indicators of resident satisfaction. See also PIC ID Nos. 4720.1-4720.3. (Final report: 67 pages.)

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Floyd Brown

PHONE NUMBER: (202) 690-6613

PIC ID: 4720

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC
 

TITLE: Subacute Care: Policy Synthesis and Market Area Analysis

ABSTRACT NUMBER: 081

ABSTRACT: Medicare expenditures for postacute and acute care are expected to rise substantially as both the number and proportion of persons over age 65 grows. As an effort to reduce costs, "subacute care" is being promoted by many providers as a cost-effective alternative to inpatient hospital care, with potential savings of 40 to 60 percent. While there is no specific definition of subacute care, there is general agreement that it encompasses a wide range of medically complex or technologically advanced services at the lower end of acute care, but at a higher level of care than that traditionally provided in nonacute care settings. Services previously provided in acute care hospitals are now more frequently delivered in nonacute care hospital settings. This project was designed to provide an understanding of subacute care in select market areas. In addition to examining a wide variety of subacute care providers, patients, and payers, the project identifies incentives and barriers to the provision of subacute care and reports on the impact of subacute care as perceived by key stakeholders in targeted markets. It also develops methodologies that can be used to assess the costs, savings, and quality of subacute care. Site visits were conducted in four targeted market areas to 19 state-of-the-art, self-declared institutional subacute care providers. Telephone interviews were conducted with several home care agencies, and discussions were held with key stakeholders in the targeted markets. Findings indicate that subacute care has emerged as a result of Medicare payment policies and the pursuit of low-cost, appropriate alternatives to hospital care by managed care providers. Much of what is labeled as subacute care refers to patients previously identified as "high-end Medicare patients." Finally, most providers were implementing some, but not all, of the ideal characteristics of a subacute care program.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: (202) 690-6613

PIC ID: 6140

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

Office of Public Health and Science

Contents

Cost-Effectiveness in Health and Medicine

Evaluation of Health Needs of Newly Arriving Refugees

Measuring Expenditures for Essential Public Health Services

Survey of Accused but Exonerated Individuals in Research Misconduct Cases
 

TITLE: Cost-Effectiveness in Health and Medicine

ABSTRACT NUMBER: 082

ABSTRACT: Cost-effectiveness analysis (CEA) is a methodological tool increasingly considered by health care policymakers to evaluate which strategies will best serve theirprogrammatic or financial objectives. In 1993, the Public Health Service appointed 13scientists and scholars with expertise in CEA to the Panel on Cost-Effectiveness in Health and Medicine. The panel (1) assessed the current state of the science of CEA' methodology; (2) made recommendations for the conduct of CEAs that improve their quality, comparability, and utility; and (3) identified unresolved methodological issues. The report finds that there are several problems that limit the policy relevance of existing CEA's. For example, an individual CEA (1) may not define the perspective of its analysis; (2) may present inadequate data on effectiveness or cost, or data that are difficult to evaluate or to generalize; (3) may use a comparison intervention that distorts the cost-effectiveness ratio; (4) may inadequately represent the effect of time on the future value of health and dollars; or (5) may inadequately represent uncertainty with respect to key variables. Furthermore, CEA's may have problems that limit their comparability, such as the use of different perspectives, measures of outcome, costs, or discount rates. The report concludes that many of these problems could be mitigated if CEA practitioners would include in their studies a "reference case" that conforms to a set of standardized methodological practices. Including such a reference case would indicate that researchers had used a common methodological "toolkit" and that the study could reasonably be compared with reference case analyses of other interventions. The report presents recommendations regarding the structure and content of such a reference case. A November 1996 international workshop sponsored by an intradepartmental discussion group on cost-effectiveness allowed for broad discussion of the panel's work. (Executive summary: 24 pages.)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Kristine McCoy

PHONE NUMBER: (202) 205-8180

PIC ID: 5619

PERFORMER ORGANIZATION: Office of Disease Prevention and Health Promotion, Washington, DC
 

TITLE: Evaluation of Health Needs of Newly Arriving Refugees

ABSTRACT NUMBER: 083

ABSTRACT: This report describes and examines the health assessment and follow-up care currently available to refugees, Cuban and Haitian entrants, and Amerasian immigrants from Vietnam during the first eight months following their arrival in the United States. During this period, they are eligible for federally supported health care which fulfills dual objectives: to prevent the spread of health conditions that could affect the public health and to identify health conditions that could impede effective refugee resettlement. The purpose of the study is to collect information on current state and local refugee health care structures and services. The information gathered may help Federal officials modify and refine the support they provide to State and local jurisdictions. The study, conducted during the first quarter of fiscal year (FY) 1995, examines the seven states most impacted by refugees: Florida, California, Illinois, New York, Pennsylvania, Texas, and Washington. States rely on funding provided through the Refugee Medical Assistance (RMA) program but also utilize other funding sources, such as Preventive Health Refugee grants administered by the Centers for Disease Control and Prevention (CDC), Medicaid and state and local resources. The report finds that (1)funding flexibility enables states to fill in gaps in their refugee health programs; (2)states contracting with local providers to deliver health-screens appear to have developed a state-wide refugee health infrastructure; (3)refugee health coordinators are concerned that health screens conducted outside of refugee specific clinics do not provide accurate or complete data on testing and that some tests may be omitted; and (4)states differ in the extent to which they report back to CDC the outcomes of refugee health screens and in the extent to which follow-up care is accessible to refugees.

AGENCY SPONSOR: Office of International and Refugee Health

FEDERAL CONTACT: David B. Smith

PHONE NUMBER: (301) 443-1774

PIC ID: 6199

PERFORMER ORGANIZATION: Macro International, Inc., Calverton, MD
 

TITLE: Measuring Expenditures for Essential Public Health Services

ABSTRACT NUMBER: 084

ABSTRACT: This project will develop a tool for collecting Federal, State, and local public health expenditures, using the essential services of public health terminology. The goal of this effort is to document the relative investment in public health throughout the United States and to lay the groundwork for a system to track these expenditures over time and across agencies and levels of government. The project has provided the financial data that could be related to public health outcomes and public health infrastructure. Nine States participated in this effort: Arizona, Illinois, Iowa, Louisiana, New York, Oregon, Texas, Rhode Island, and Washington. In June 1995, State, local, and Federal officials met to discuss and plan the collection of information on public health expenditures. Participants from public health, mental health, substance abuse, and environmental agencies met in separate work groups to discuss the tools for estimating expenditures for the essential services of public health. Data collection instruments were distributed to State health officials in September 1995. These officials coordinated the data collection for State and local public health, substance abuse, and environmental agencies. A final report was released in November 1996.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Deborah R. Maiese

PHONE NUMBER: (202) 401-5809

PIC ID: 6194

PERFORMER ORGANIZATION: Public Health Foundation, Washington, DC
 

TITLE: Survey of Accused but Exonerated Individuals in Research Misconduct Cases

ABSTRACT NUMBER: 085

ABSTRACT: Approximately 70 percent of all cases of alleged scientific misconduct that come to the attention of the Office of Research Integrity (ORI) result in exoneration. However, little is known about the extent to which such cases result in adverse consequences for the accused or the extent to which institutions comply with a Public Health Service (PHS) regulation requiring them to protect the confidentiality of the accused or to restore their reputations if the accusations are not confirmed. This study presents the results of a surveysubmitted by 54 individuals who had been accused of scientific misconduct in PHS-supported research prior to 1995, and who were subsequently exonerated. The report finds that (1) 60percent of respondents report experiencing one or more negative consequences of being accused of scientific misconduct--17 percent report severe consequences, such as loss of position, promotion, or salary increase; (2) 90 percent of those who report negative consequences indicate that the negative actions began during the inquiry or investigation, and 65 percent report that these actions continued after they had been exonerated; (3) institutional officials and accusers are the major source of severe negative actions, while complainants are the most frequent source of negative actions; (4) 57 percent of respondents view the impact of the accusation on their careers as neutral, while 39 percent view the impact as negative and 4 percent view it as positive; (5) 94 percent of respondents are still conducting research--71 percent are working in the institution where they were accused of misconduct; (6) 39 percent of respondents believe that there is a continuing stigma attached to having been accused of misconduct, while 54 percent think it unlikely, and 11 percent do not know; and (7) 39 percent of respondents are dissatisfied with the efforts made by their institutions to restore their reputations. (Final report: 95 pages, plus appendix.)

AGENCY SPONSOR: Office of Research Integrity

FEDERAL CONTACT: Lawrence J. Rhoades

PHONE NUMBER: (301) 443-5300

PIC ID: 5621

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

Substance Abuse and Mental Health Services Administration

Contents

Employment Outcomes of Indigent Clients Receiving Alcohol and Drug Treatment in Washington State

Overview of Addiction Treatment Effectiveness
 

TITLE: Employment Outcomes of Indigent Clients Receiving Alcohol and Drug Treatment in Washington State

ABSTRACT NUMBER: 086

ABSTRACT: Effective treatment approaches for alcohol and other drug abuse are critically needed, especially in an era of constrained resources. Although significant progress has been made in advancing knowledge about treatment outcomes, one area where relatively little is known remains: treatment outcomes for indigent clients, especially in the area of employment. This report builds upon a Washington State Department of Social and Health Services project to evaluate treatment outcomes for indigent clients in a number of areas (medical care use, employment, use of public assistance, and treatment reentry); the report focuses on employment outcomes. The population studied includes indigent clients who were assessed for treatment during a 4-month period beginning in August 1989. The treatment group (489 clients) received care in the following modalities: intensive inpatient treatment, long-term residential treatment, recovery house treatment, and outpatient treatment. The comparison group of 168 clients included those who were assessed but who did not initiate treatment. The report finds that (1) inpatient care appears to have a greater impact on employment and earnings than outpatient care for indigent clients with serious alcohol and other drug problems; (2) the duration of treatment has an important effect on employment outcomes--clients who stay in treatment longer experience better outcomes, as do clients who complete treatment; and (3) the benefits of treatment in terms of enhanced earnings compare favorably with the costs of treatment. The report concludes that although reducing coverage for chemical dependency treatment for public clients will reduce short-term treatment costs, it may also compromise benefits of treatment, such as enhanced employment.

AGENCY SPONSOR: Office of Applied Studies

FEDERAL CONTACT: Coleen Sanderson

PHONE NUMBER: (301) 443-9372

PIC ID: 6394

PERFORMER ORGANIZATION: State of Washington, Department of Social and Health, Olympia, WA
 

TITLE: Overview of Addiction Treatment Effectiveness

ABSTRACT NUMBER: 087

ABSTRACT: A substantial body of research substantiates the effectiveness of substance abuse treatment. This report presents an overview of much of that research, describing specific treatment approaches, treatment settings, and treatment components and services, and analyzing the effectiveness of each. The report notes that addiction is a progressive, chronic, primary, relapsing disorder that generally involves the compulsion, loss of control, and continued use of alcohol and other drugs despite adverse consequences. The primary goal of addiction treatment is to meet the biological, psychological, and social treatment needs of patients. The report discusses four treatment approaches that differ from one another in terms of their philosophies of treatment: (1) methadone maintenance treatment; (2) therapeutic community treatment; (3) traditional chemical dependency treatment; and (4) outpatient "drug free" nonmethadone treatment. It also discusses treatment settings, describing not only the physical environment in which the treatment takes place but also the level of treatment intensity (the number of treatment components provided, the extent of staff attention received, and the amount of time spent receiving treatment). These treatment settings include (1) inpatient hospitalization; (2) residential treatment; (3) intensive outpatient treatment; and (4) outpatient treatment. Treatment components--or specific clinical interventions, strategies, and procedures--are also addressed, as are other factors influencing treatment outcomes, including program factors, therapist factors, and patient factors. Addiction treatment and its relation with the criminal justice system and special populations are also examined.

AGENCY SPONSOR: Office of Applied Studies

FEDERAL CONTACT: Coleen Sanderson

PHONE NUMBER: (301) 443-9372

PIC ID: 6393

PERFORMER ORGANIZATION: Office of Applied Studies, SAMHSA, Rockville, MD