Performance Improvement 1998. Agency for Health Care Policy and Research

02/01/1998

Contents

Publications of the Patient Outcomes Research Teams (PORTS), May 1996 and Medical Treatment Effectiveness Projects 1989 through 1995

Final Report on Changes Needed in CONQUEST's Software Based Programs

Final Report on Changes Needed in CONQUEST 1.0's Structure and Classification Scheme

Assessment of the Feasibility of Creating a Managed Care Encounter-Level Data base

Customer Satisfaction Survey of AHCPR Publications Recipients

Effects of Informatics Tools and Decision Aids to Help Patient Decision-making about Medical Screening and Treatment

Diagnostic Accuracy in Primary Care: Review of the Literature on Five Chronic Conditions-- Final Report

Evaluation of AHCPR Minority Health Services Research Training Activities

Outcomes and Effectiveness Research in the Private Sector

Partners in Research: Identifying Common Interests

Performance Measurement Inventory Phases II & III Workplan

Final Report: Small Conference Grant Program Evaluation

TITLE: Publications of the Patient Outcomes Research Teams (PORTS), May 1996 and Medical Treatment Effectiveness Projects 1989 through 1995

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 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, there is information about 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. (Bibliography: 49 pages; 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 & Associates Incorporated, Fairfax, VA

TITLE: Final Report on Changes Needed in CONQUEST's Software Based Programs

ABSTRACT: This report provides the results of an evaluation of the CONQUEST data base in order to determine the best short-term, intermediate, and long-range strategies for its continued development. Three important findings emerged from this study. First, Microsoft Access was judged to be the best platform (out of 13 alternatives) for CONQUEST in the short and immediate terms. Furthermore, many opportunities exist to improve CONQUEST over the short and immediate terms. Problems identified by users can be corrected by minor enhancements, error corrections, and superficial changes. More substantial changes are also needed, including restructuring of the data base and rewriting of the queries and Access Basic code that perform the underlying CONQUEST search and retrieval operations. Finally, the report determines that the best long-range strategy for disseminating CONQUEST information to the broadest possible audience over the widest variety of platforms is via World Wide Web. This finding also lists the advantages of using the Internet, describes the labor and equipment needed, and estimates that the project would be a multi-year effort costing more than one million dollars. The report concludes that moving CONQUEST in its current form to another stand-alone data base is not desirable. Investments in software should be limited to necessary, cost-effective changes. Further development of the data base should be designed based on the findings of this report, which should also be used in the selection of a new implementation platform. See also PIC ID Nos. 5961 and 5961.2. (Final report: 21 pages, plus appendices.)

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: (301) 594-1352

PIC ID: 5961.1

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: Final Report on Changes Needed in CONQUEST 1.0's Structure and Classification Scheme

ABSTRACT: This report presents the findings of an evaluation of the structure and classification scheme of CONQUEST 1.0. The evaluation identified changes needed to enhance the use and effectiveness of the data base's structure and classification scheme for codifying clinical performance measures and conditions. The evaluation addressed three broad questions: (1) how does the current application of CONQUEST 1.0 compare with its intended use; (2) what are the impediments to potential users; and (3) which structural and classification scheme improvements are needed in the Condition and Measures data bases? The report finds that the data base is used as intended. Users access it to learn which processes and outcomes to measure for particular conditions, to compare and select clinical performance measures, and to find measures related to practice guidelines. The report also finds that the data base must be kept current and comprehensive in order for it to be of use. Advanced and mid-level users would like additional types of measures, particularly measures on satisfaction with care and access. They would also like more functional status measures and clinical measures for non-acute settings. In regard to the structure of the data base and the classification scheme, (1) many performance measures lack enough similarities to be grouped into batches, (2) the quality of the match between conditions and measures designed for them should be improved, (3) most searches for clinical performance measures for specific conditions returned at least one measure that was not well-matched, (4) codes for clinical events may be too broad, (5) the condition list presented to users should be broadened, and (6) users would like additional information about the performance measures. The report also includes several recommendations to improve the quality of the data base. See also PIC ID Nos. 5961 and 5961.1. (Final report: 16 pages, plus appendices.)

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: (301) 594-1352

PIC ID: 5961.2

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: Assessment of the Feasibility of Creating a Managed Care Encounter-Level Data base

ABSTRACT: The rapid growth of managed care in recent years is transforming the Nation's health care system. In the process, it is also changing the ability of health services researchers and policy analysts to answer fundamental questions about access, utilization, cost, and quality of care. Data produced as a "byproduct" of the fee-for-service system (including plan-, provider-, person-, and encounter-level data) are either no longer available or vary in comprehensiveness and accuracy. As a result, there is widespread public and private interest in managed care organizations' (MCOs') ability to collect encounter-level data and in the development of an encounter-level data base that could be used for the purposes of research. This report (1) identified models that the Agency for Health Care Policy and Research (AHCPR) could employ to work with plans to facilitate the availability of data for research, (2) examines the availability and comprehensiveness of encounter-level data in MCO data bases, and (3) identifies the problems and challenges that might be encountered when trying to use or combine data from MCOs. Among key findings are that: (1) MCO data bases vary substantially in the availability and comprehensiveness of encounter-level data and the ability to link these data with administrative and financial data; (2) MCOs increasingly view their information systems and the data they store, as proprietary, and there are a number of disincentives for MCOs to share their data; (3) computer systems, which were originally touted as an inexpensive way to capture data, are technically complex and costly--problems exacerbated by the lack of industry-wide definitions and reporting standards; and (4) despite these barriers, MCOs are interested in exploring ways to work with AHCPR and other Federal agencies to facilitate the availability of data for the purposes of research. (Final report: 52 pages, plus appendices.)

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Kelly Devers

PHONE NUMBER: (301) 594-1410

PIC ID: 6374

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

TITLE: Customer Satisfaction Survey of AHCPR Publications Recipients

ABSTRACT: The Agency for Health Care Policy and Research (AHCPR) provides most information services to consumers through its Publication Clearinghouse. This report assesses consumer satisfaction with the content, format, and procedures for AHCPR publication distribution. The study statistically analyzes the results of a mail survey protocol for individuals who requested one of four patient/consumer guides: Prescription Medicines and You, Understanding Incontinence, Early Alzheimer's Disease, and You Can Quit Smoking. The report finds that respondents (1) find the guides of greater interest to elderly persons; (2) make 75 percent of their requests by telephone; (3) are pleased with the services of the Clearinghouse in distributing patient/consumer guides; (4) with access to the Internet (17 percent) still prefer to order the guides by telephone; (5) order the guides for themselves (70 percent) and that two-thirds keep it for reference; (6) respond positively to different editorial and typographical features of the guides; (7) express little interest in making any of the nine suggested changes to the guides; and (8) are satisfied overall with the guides, and that the 22 percent who are not satisfied cite insufficient information. Although the diversity of the four guides makes generalizations difficult, the report concludes that (1) due to the large number of phone requests, AHCPR should give Clearinghouse staff information about the contents of the patient/consumer guides in order to provide better customer service; (2) AHCPR should make no changes to the organization of the guides or how information is presented; and (3) AHCPR could pursue methods to identify and answer the questions and concerns of individuals who feel that the guides provide insufficient information. (Final report: 15 pages, plus tables and appendices.)

AGENCY SPONSOR: Center for Health Information Dissemination

FEDERAL CONTACT: Donna Rae Castillo

PHONE NUMBER: (301) 594-1362

PIC ID: 6375

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Effects of Informatics Tools and Decision Aids to Help Patient Decision-making about Medical Screening and Treatment

ABSTRACT: This report identifies, evaluates, and synthesizes published and unpublished research on the effects of informatics tools and decision aids used to help patients make decisions about their screening and treatment. These tools provide treatment- and disease-specific information to patients in computerized or noncomputerized form. The report finds that few controlled studies have been conducted on the effects of these tools and aids. Most only consider effects on patient knowledge and satisfaction, and examine only a few treatment choices. Few studies have investigated the effects of tools on patient-clinician communications and health behavior and health outcomes. There are no comparative studies of the cost and effectiveness of different types of tools, and the studies that have been done are of varying methodological quality. Despite these limitations, certain conclusions can be drawn. For example, (1) studies suggest that the use of informatics tools can increase patients' knowledge of treatment alternatives, and patients report that they like these tools; (2) limited evidence suggests that tools influence treatment selection; (3) greater attention to rigorous controls, adequate sample size, and standardized measurement is crucial; (4) use of tools by patients can be limited, especially if there are operational barriers to their use (such as a requirement for a second visit); (5) patients who use informatics tools generally increase their knowledge of treatment alternatives, but the comparative effectiveness of different types of tools in increasing knowledge has not been well assessed; (6) some trials find that patients who use tools are significantly more satisfied with the decisionmaking process than others and that these patients ask their physicians more questions; and (7) scattered evidence suggests that these tools can improve health outcomes by increasing patients' adherence to treatment regimens. (Final report: 43 pages, plus appendices.)

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Denise Dougherty

PHONE NUMBER: (301) 594-1321

PIC ID: 6376

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

TITLE: Diagnostic Accuracy in Primary Care: Review of the Literature on Five Chronic Conditions--Final Report

ABSTRACT: This report presents the findings of an iterative literature search and analysis on diagnostic errors and inefficiencies in primary care for five clinical conditions: cutaneous melanoma, breast cancer, heart failure, depression in children, and pediatric asthma. The report points out several gaps in the health services and the clinical knowledge base. It also suggests that these gaps can be addressed by a comprehensive research agenda on primary care, which can be used by the Agency for Health Care Policy and Research for future research agendas on each of the specific conditions. Specific research issues include the extent of inaccurate (missed, erroneous, or delayed) diagnoses, and the causes of such deficiencies; the health and monetary consequences of diagnostic errors and inefficiencies; and the effectiveness of interventions aimed at preventing or overcoming the problems. (Final report variously paginated, plus appendices.)

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: James Cooper

PHONE NUMBER: (301) 594-1357

PIC ID: 6381

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

TITLE: Evaluation of AHCPR Minority Health Services Research Training Activities

ABSTRACT: This report reviews Agency for Health Care Policy and Research (AHCPR) initiatives in health services research training to determine the degree to which they have increased minority participation in health services research. It examines two types of initiatives: (1) pre- and post-doctoral training provided through National Research Service Award grants; and (2) supplementary funding made available to individual AHCPR grantees for the purpose of providing training to individual minority candidates or investigating an area related to minority issues in health services. The report finds that AHCPR has been somewhat successful in increasing minority participation in health services research training. It identified five criteria that are necessary for program success: recruitment, leadership, networking, mentoring, and building a community of scholars. The best practices of successful non-Federal programs were identified as (1) developing sufficient infrastructure to support training, (2) providing sufficient financial support to attract the brightest trainees, and (3) providing necessary support for faculty mentors involved in the program. (Final report variously paginated.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Morgan Jackson

PHONE NUMBER: (301) 594-1455

PIC ID: 6384

PERFORMER ORGANIZATION: Barents Group, KPMG Peat Marwick LLP, Washington, DC

TITLE: Outcomes and Effectiveness Research in the Private Sector

ABSTRACT: This project analyzed and evaluated private sector activities in performing outcomes and effectiveness research (OER). It was intended to help clarify the Agency for Health Care Policy and Research's (AHCPR's) future priorities in outcomes and effectiveness research, and to provide insights regarding future opportunities for public-private partnerships in this area. The project reviewed the published literature and other documentation, conducted telephone interviews, conducted case studies, and hosted an expert panel with private sector OER leaders. The study finds that (1) organizations reporting OER activities include large insurers, managed care organizations, health product companies, employer groups, associations, and foundations; (2) private sector organizations conduct OER primarily to improve their strategic and financial positions; (3) private sector OER does not overlap considerably with government-sponsored OER; (4) health product companies usually focus their OER efforts on their new drugs and devices, while less attention is given to other health care interventions, particularly those that are not new or those used primarily for traditionally underserved or vulnerable populations; (5) although provider organizations increasingly conduct a variety of activities involving outcomes measurement, including some OER as defined in the report, much of the outcomes measurement is for monitoring health care performance against certain standards (for instance, in the case of accreditation and quality assurance); and (5) AHCPR has supported the development and validation of many of the research tools used in private sector OER. The study concludes that government-sponsored OER can continue to address certain major topics that are not covered by the private sector, and can continue to advance research tools, training, and other aspects of OER that will benefit private sector efforts.

AGENCY SPONSOR: Center for Outcomes and Effectiveness Research

FEDERAL CONTACT: Yen-pin Chiang

PHONE NUMBER: (301) 594-1485

PIC ID: 6385

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Partners in Research: Identifying Common Interests

ABSTRACT: The Agency for Health Care Policy and Research (AHCPR) undertook this project to develop a methodology for systematically matching research interests of private sector organizations with its own in order to identify potential research partners. The methodology was developed in several stages: (1) a segmentation was developed to classify private sector entities by research focus; (2) a matrix identified promising overlap between private sector research and AHCPR research interests; and (3) sample profiles were developed for nine organizations in four health industry segments (pharmaceutical/biotechnology; manufacturing/suppliers; health information systems; and philanthropy). The profiles were created for Amgen, Bristol Myers Squibb, Eli Lilly, American Home Products, Medtronic, HCIA, HBO and Company, and the California Endowment. These profiles demonstrate how available sources of information on organizations can be tapped to provide a detailed background for screening these organizations to assess opportunities for research partnering. The methodology focused on publicly traded companies and private foundations, although it is recognized that attractive partnering opportunities exist with privately held companies and a variety of nonprofit organizations other than those with philanthropic missions. The report recommends that AHCPR more fully develop, and then maintain, a matrix of private sector organizations with research interests overlapping its own research portfolio. A deliberate strategy for undertaking one or more collaborative research activities in each cluster should be undertaken in order to provide further experience in the development and management of successful research partnering. Considerations should be given to soliciting input from a cross-section of companies in the various health care market sectors when planning new research initiatives. (Final report variously paginated, plus appendices.)

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Eric Katz

PHONE NUMBER: (301) 594-1321

PIC ID: 6386

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

TITLE: Performance Measurement Inventory Phases II & III Workplan

ABSTRACT: The Performance Measurement Workgroup of the U.S. Department of Health and Human Services (HHS) Managed Care Forum requested an inventory of performance measures (i.e., clinical, population, and system) currently being used, under consideration for use, or being developed for use by HHS agencies for regulating, monitoring, comparing, and/or evaluating health care services and systems of care. The inventory, which will be created in a CONQUEST-compatible format, will be used to identify opportunities for better coordination and improved efficiency, and to prepare recommendations concerning the direction and coordination of departmental activities in regard to performance measurement. Ideally the project will include one or more non-HHS agencies, such as the Department of Veterans Affairs (VA) or the U.S. Department of Defense. The project includes three phases: Phase I is workplan development, Phase II is pilot testing of the data collection instruments and instructions, and Phase III is data collection and final report writing. As of October 1997, Phase I has been completed; a draft report for Phase II, which includes participation by the VA is in progress; and a task order for Phase III has been awarded and work is scheduled to begin in the near future. See also PIC ID Nos. 6691.1 and 6691.2. (Final report: 13 pages.)

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: (301) 594-1352

PIC ID: 6691

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

TITLE: Final Report: Small Conference Grant Program Evaluation

ABSTRACT: In 1991, the Agency for Health Care Policy and Research (AHCPR) established the current Small Conference Grant Program. The program supports conferences, doctoral dissertations, and small research projects. Under the program, grants of $50,000 or less are awarded to nonprofit organizations to support conferences on issues relevant to health services research and to AHCPR's mission. In January 1996, AHCPR made revisions to streamline the program, which included the implementation of concept letter procedures. The concept letter saves time for both reviewers and applicants because only those conferences that are of interest to AHCPR move to the full review process. The report finds that (1) small grant conference procedures are efficient and result in conferences that meet AHCPR's goals, (2) the objectives of the conferences are being met, and (3) outcomes of the conferences are in accord with their stated purpose. The study recommends that (1) future grant announcements should set a realistic, experience-based time frame for both the review of concept letters and grant applications; (2) AHCPR consider instituting a time limit on application submission once the applicant has been notified of concept letter acceptance to help the agency develop a more realistic list of expected or pending applications; (3) AHCPR be more proactive in planning the dissemination strategy of a conference to increase the impact of a conference; and (4) in the future, AHCPR might consider lending its name, rather than its money, to conferences, as a way for the Agency to extend its reach without increasing funds to the program. (Final report variously paginated, plus appendices.)

AGENCY SPONSOR: Office of Health Care Information

FEDERAL CONTACT: Donna Rae Castillo

PHONE NUMBER: (301) 594-1362

PIC ID: 6692

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

TOP OF DOCUMENT

AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY

Contents

Did We Make A Difference? ATSDR's Framework for Community-Focused Evaluation

Site-Specific Outcome Measurement Guidelines for ATSDR Cooperative Agreement States

REPORT TITLE: Did We Make A Difference? ATSDR's Framework for Community-Focused Evaluation

ABSTRACT: In 1994, the Environmental Health Policy Committee, part of the Public Health Service, recommended that all Federal agencies develop guidelines to establish outcome and impact data for use in the evaluation of their activities and products. This report outlines a framework for implementing community-focused evaluation, a program of activities undertaken to assess the outcomes and impacts of the Agency for Toxic Substances and Disease Registry (ATSDR) site-specific activities. The seven steps of the framework include (1) gathering community information, (2) defining the public health problem, (3) determining and implementing the public health action, (4) establishing evaluation goals and objectives, (5) developing outcome measures as indicators of success, (6) collecting and analyzing data, and (7) using feedback to improve public health actions. The report concludes that (1) ATSDR's community-focused evaluation framework provides a comprehensive, flexible, and timely approach to assess the short- and long-term effects of ATSDR's site-specific activities; (2) community-focused evaluation must be viewed as effective and taken seriously as a central part of responsible public health practice, and not merely as an activity to conduct if sufficient funds are left when the program is completed; (3) the collaborative and educational functions of evaluation create promising prospects for facilitating change because of their inherent emphasis on the interactive relationship between ATSDR and the community; and (4) ATSDR's community-focused evaluation program provides the Agency with the opportunity to communicate the value of its products and services to key stakeholders, while allowing for critical feedback to management and staff. See also PIC ID No. 6853.1. (Final report: 16 pages.)

AGENCY SPONSOR: Division of Health Education

FEDERAL CONTACT: Maureen Lichtveld

PHONE NUMBER: (404) 639-6204

PIC ID: 6853

PERFORMER ORGANIZATION: Agency for Toxic Substances and Disease Registry, Atlanta, GA

REPORT TITLE: Site-Specific Outcome Measurement Guidelines for ATSDR Cooperative Agreement States

ABSTRACT: The Agency for Toxic Substances and Disease Registry (ATSDR) developed this report to help State cooperative agreement personnel evaluate their efforts in the protection of public health. A number of States collaborated with ATSDR to develop guidelines for assessing the impacts and outcomes of site-specific health education activities. This report was prepared by a group of Federal and State ATSDR Cooperative Agreement staff and was intended for an audience of State and territorial personnel working under ATSDR Cooperative Agreement 607 auspices. The document deals with measurement of community members' response to the Agency's Superfund activities and includes a short section that evaluates the Agency's effect/influence on other agencies with each State. The community member section is divided into five possible areas of evaluation, which include measurements of knowledge, opinion, behavior, exposure, and health. The agency section has only one area of measurement, which is the opinion area. This area was selected in an attempt to measure the influence of ATSDR on environmental decision making and the subsequent protection of public health. This report is part of a set of tools that will allow cooperative agreement participants to assess the overall improvement in public health as a result of site-specific health education activities and to demonstrate the cooperative agreement program's effectiveness.

AGENCY SPONSOR: Division of Health Education

FEDERAL CONTACT: Maureen Lichtveld

PHONE NUMBER: (404) 639-6204

PIC ID: 6853.1

PERFORMER ORGANIZATION: Agency for Toxic Substances and Disease Registry, Atlanta, GA

TOP OF DOCUMENT

CENTERS FOR DISEASE CONTROL AND PREVENTION

Contents

Sexually Transmitted Disease (STD) Prevention in the United States: Integrated Evaluation of Public and Private Sector Disease Reporting and Service Delivery

Evaluation of ICD-10 for Morbidity Reporting in the United States

Suicide Intervention and Prevention: Evaluation of Community-Based Programs in Three American Indian Communities

Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Phase II Final Report

Assessment of the National Laboratory Training Network

Race Reporting on Birth Records by Multiracial Women: An Evaluation of Question Format Alternatives

Management and Operational Impacts of HIV Prevention Community Planning: Lessons Learned at Mid-Course and Implications for Future Activities

CDC's Early Implementation of GPRA: A Case Study-- July 1995 to November 1996

Collaborating with Managed Care Organizations for Mammography Screening and Rescreening: Guidance for NBCCEDP Grantees

Reaching Women for Mammography Screening: Successful Strategies of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Grantees

Evaluation Design for the Business Responds to AIDS (BRTA) Program

Case Studies of the Prevention Marketing Initiatives (PMI) Local Demonstration Site Projects: Experiences During Planning and Transition Phases

Evaluability Assessment of CDC-Funded Traumatic Brain Injury and Spinal Cord Injury Programs

Community Context Study: Minors' Access to Tobacco

Directions for Research on the National Immunization Survey: Final Report

In Her Own Words: A Focus Group Study of Risk and Protective Factors in Intimate Partner Violence

Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

Syphilis in the South: A Case Study Assessment in Eight Southern Communities

Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (Baltimore, MD)

Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (San Antonio, TX)

Assessment of the Programmatic Impact of One-Percent Evaluation Studies

Directory of Evaluations Administered by the CDC Office of Program Planning and Evaluation 1990-1995

TITLE: Sexually Transmitted Disease (STD) Prevention in the United States: Integrated Evaluation of Public and Private Sector Disease Reporting and Service Delivery

ABSTRACT: The Centers for Disease Control and Prevention (CDC) Division of Sexually Transmitted Disease (STD) Prevention provides financial and technical assistance to State and local agencies to support a range of prevention, research, policy development, and surveillance activities. Two parallel STD surveillance systems are currently operated by CDC, both of which rely upon regular, voluntary reporting of STD incidence by State and local agencies. Both systems are thought to suffer from less-than-complete reporting of STDs by diagnosing practitioners. Estimates of this underreporting range from 25 to 90 percent. The focus of this project, therefore, was to design and pilot test a methodology for validating the STD data routinely collected, analyzed, and published by the Division. The study's main objective was to test the feasibility of using a provider-based survey (1) to quantitatively validate CDC's data on STD diagnoses, and (2) to assess the extent to which clinicians follow CDC's treatment guidelines for STDs. The study was designed to generate estimates of STD incidence through a survey of a random sample of STD data providers in four States, and to compare these estimates with State-reported STD incidence for the same time period. The report finds that (1) the four pilot States differ in terms of their STD data-gathering policies and practices, including which diseases are reported, how cases are defined for reporting purposes, how laboratory reporting is utilized, and which date information is recorded for each case; (2) syphilis, gonorrhea, and chlamydia are reportable diseases in all four States, and in two States many additional diseases are reportable; (3) in two States, physicians must report diseases for them to be recorded, while in two others laboratory reports are sufficient; (4) STDs are considerably underreported by providers; and (5) most STD cases are seen by individual private practitioners. (Final report: 82 pages, plus appendices.)

AGENCY SPONSOR: National Center for HIV, STD and TB Prevention

FEDERAL CONTACT: John Moran

PHONE NUMBER: (404) 639-8272

PIC ID: 5348

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Boston, MA

TITLE: Evaluation of ICD-10 for Morbidity Reporting in the United States

ABSTRACT: This report evaluates (1) whether the International Classification of Disease (ICD)-10 is a significant improvement over the ICD-9; (2) whether these improvements warrant its implementation in the United States; (3) the modifications needed to improve its use for morbidity applications; and (4) whether there are any codes or concepts in ICD-9, but not in ICD-10, that should be considered for inclusion. The Technical Advisory Panel and project staff conclude that there are many strengths in ICD-10 in comparison with ICD-9. Many of the chapters contain a wealth of useful expansion in detail for which diagnostic information is typically available and which represent important clinical distinctions. These expansions will facilitate future specificity in statistical tabulations of diseases and conditions, provide some additional means for severity coding, and provide for enhanced applicability of the classification to primary care reporting. The logic and detail of ICD-10 will also contribute to progress toward the computerization of medical records. Although a number of limitations in ICD-10 are identified, the recommended modifications will overcome most of them. Therefore, it is strongly recommended that the National Center for Health Statistics implement a revised version as soon as possible.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Amy Blum

PHONE NUMBER: (301) 436-7050

PIC ID: 5503

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

TITLE: Suicide Intervention and Prevention: Evaluation of Community-Based Programs in Three American Indian Communities

ABSTRACT: Suicide is the second leading cause of death for Native Americans aged 15 to 24. American Indian/Alaska Native young people are more likely to attempt suicide; to choose a highly lethal method, such as firearms or hanging; and to be successful at committing suicide. This report evaluates the local community-based suicide intervention and prevention programs of three geographically diverse American Indian tribes (the Jicarilla Apache Tribe, the Western Athabaskan Tribe, and the Northern Woodlands Tribe). In two tribes, suicide intervention efforts had been in place since 1989 and 1990, respectively; in the third, a suicide crisis in late 1992 precipitated community response. The report finds that (1) the local nature of the evaluation process opened itself to problems of diffuse authority and lack of focus on the evaluation process; (2) suicide prevention issues, tribal identity issues, and staffing issues took precedent over the actual evaluation activities; (3) a major recommendation arising from this study was to have process evaluation activities conducted by an external (non-community member) evaluator not supervised by local staff; (4) the Jicarilla Apache program represents a suicide prevention program in a very small, cohesive, and well-coordinated community response, which depends upon a staff model; (5) at the Western Athabaskan reservation, the prevention program used several special initiatives loosely coordinated with an existing Behavioral Health Services program using a staff model; (6) using a volunteer network, the Northern Woodlands tribe produced an excellent manual describing a grassroots community approach to suicide prevention; and (7) in all three tribes, attempted and successful suicide rates were reduced. The report concludes that the staff models used in the two small and centralized reservation communities were more successful than the diffuse, volunteer effort. (Final report: 120 pages.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lloyd Potter

PHONE NUMBER: (770) 488-1557

PIC ID: 5504

PERFORMER ORGANIZATION: Indian Health Service, Rockville, MD

TITLE: Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Phase II Final Report

ABSTRACT: The Fatality Assessment and Control Evaluation (FACE) program of the National Institute for Occupational Safety and Health seeks to prevent workplace fatalities by identifying and investigating fatal occupational injuries and disseminating prevention strategies to those who can intervene in similar situations. Publications based on information from fatality investigations identify occupational hazards and prevention measures, and are disseminated to persons who can influence work conditions and information availability in related occupations and work settings.

This report (1) describes the dissemination of five recent FACE documents (4 tear-sheet Alerts and one monograph), (2) compiles users' assessments of their usefulness, and (3) identifies examples of prevention efforts and other impacts attributable to the documents. The report finds that (1) publications are generally considered technically accurate and focused on significant occupational hazards by users; (2) workers participating in focus groups see job-related chronic illnesses and nonfatal injuries as more significant than the risk of fatality, and are less convinced of tear sheets' relevance to them; (3) workers consider the tear sheets' recommendations accurate and appropriate, but are concerned by the inclusion of "common sense" recommendations; (4) the tear sheets' terminology and generally high literacy level may limit their usefulness to their target audiences; (5) the publications are generally disseminated by distributing them directly or by modifying them for inclusion in other informational materials; and (6) information from the publications is used to improve worker training, identify existing hazards, and improve safety standards. The report concludes that the FACE publications are a useful source of authoritative occupational safety information. The report includes several recommendations. See also PIC ID No. 5506. (Final report: 30 pages, plus appendices.)

AGENCY SPONSOR: National Institute for Occupational Safety and Health

FEDERAL CONTACT: Theodore Pettit

PHONE NUMBER: (304) 285-5972

PIC ID: 5506.1

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

TITLE: Assessment of the National Laboratory Training Network

ABSTRACT: The National Laboratory Training Network (NLTN) was established in 1989 to provide training in new methodologies and theoretical concepts for laboratory workers. This report assesses whether the NLTN has had a beneficial impact on public health by improving laboratory practice. Data were gathered through a series of surveys of local health department and physician office laboratory employees who participated in training, as well as comparison groups of those who did not. Other surveys of State training coordinators (STCs), laboratory inspectors, microbiology directors, microbiology program participants, and NLTN co-sponsors were also conducted. The report categorizes its findings in three groups, based upon the responses of (1) STCs, laboratory inspectors, and co-sponsors; (2) microbiologists; and (3) course participants and their comparison groups. The report finds that: (1) STCs felt supported in their jobs and used NLTN resources (88 percent were somewhat or very satisfied with NLTN services, and 90 percent were satisfied with programs); (2) laboratory inspectors often recommended training as a means to correct deficiencies, but only a small percentage used the NLTN as a training source; (3) co-sponsors rate relevance, quality, and currency of course content very highly; (4) microbiology directors rated NLTN fees, convenience, relevance, quality, currency of content, and pertinence of issues addressed favorably; (5) one-third of microbiology course participants instituted a change in practice as a result of training (80 percent rated quality and currency of content highly); and (6) course participants in the third group rated their training highly and most instituted changes or saw positive results subsequent to training. The report includes recommendations for further improving the NLTN. (Final report: 147 pages, appendices bound separately in Volume II.)

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Eunice Rosner

PHONE NUMBER: (770) 488-4129

PIC ID: 5507

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Race Reporting on Birth Records by Multiracial Women: An Evaluation of Question Format Alternatives

ABSTRACT: This report examines the implications of changing the format of the race item on the birth record filled out for every birth in the United States at the location where the birth occurred. Procedures for filling out birth certificates vary from State to State and in some States, from hospital to hospital. To provide uniform information to the vital registration system, the Federal government, in cooperation with the States, developed the U.S. Standard Certificate of Live Birth that collects relevant information about the race and Hispanic origin of the parents, but not of the baby. This study (1) evaluates how women of multiracial and Hispanic backgrounds interpret the race question on the birth certificate; (2) evaluates experimental race questions, such as the use of a multiracial cue and the use of a "mark all that apply" format; and (3) learns more about the response processes that women use when answering questions about race. Nine States and the District of Columbia recruited 763 women to participate in this study. The study tests the effects of different questions on race, both in a mail and a followup telephone survey. The mother's self-reported race is compared with what she reported on the actual birth record. Further, for those residents with two children, the study compared consistency of race reporting between the last two birth records. The report concludes that (1) the number of women reporting more than one race increases when the race questions include a multiracial cue or "mark all that apply" format; (2) women who report more than one race are more likely to enter two specific races rather than a term like multiracial; (3) among the mothers whose parents who were two or more races, self-reports of race on the last two birth records are inconsistent 25 percent of the time; and (4) self-reports of race are different 40 percent of the time between the birth record and the standard version of the mail survey. (Final report: 48 pages, plus appendices.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Susan Schechter-Ryan

PHONE NUMBER: (301) 436-7111

PIC ID: 5918

PERFORMER ORGANIZATION: Westat, Incorporated, Rockville, MD

TITLE: Management and Operational Impacts of HIV Prevention Community Planning: Lessons Learned at Mid-Course and Implications for Future Activities

ABSTRACT: HIV Prevention Community Planning, implemented in January 1994, represented a major policy change in Centers for Disease Control and Prevention funding policy. Prior to that time, State, territorial, and local health department grantees with prevention funds were required to spend most of their cooperative agreement funds on counseling and testing services. A new emphasis on planning through HIV Prevention Community Planning requires grantees to set their own HIV prevention priorities locally through a process that emphasizes input from the affected communities and relevant technical experts. This project broadly evaluated the policy impact of this new planning process on grantees' HIV prevention programs as demonstrated by budgetary and operational indicators. This is an issue of national importance, as the HIV prevention community planning process affects over $200 million dollars in HIV prevention funds across the country. This first phase of a two-phase project ascertained how community planning is confirming, enhancing, and changing HIV prevention programs. A methodology for obtaining information on the indicators for a retrospective study was also developed and piloted during this phase of the study. The report finds that (1) a prospective and iterative approach to planning, implementation, and assessment is the most valuable approach; (2) in a prospective approach, the baseline is the set of circumstances extant at the beginning of the process, and site-specific goals and objectives are developed and tracked; and (3) more detailed guidance addressing these issues could help operationalize this kind of approach. Finally, the report finds that the indicators offering the most promise are (1) correspondence between the community plan, proposed activities, and undertaken activities; (2) quality assurance for implementation; and (3) capacity building and infrastructure development. (Final report: 28 pages, plus appendices.)

AGENCY SPONSOR: National Center for HIV, STD and TB Control

FEDERAL CONTACT: Carol Robinson

PHONE NUMBER: (404) 639-0952

PIC ID: 5927

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: CDC's Early Implementation of GPRA: A Case Study--July 1995 to November 1996

ABSTRACT: The Government Performance and Results Act of 1993 (GPRA) stresses the importance of government agencies' monitoring their results or outcomes in order to improve their management of associated processes and outputs. GPRA mandates that each agency produce a 5-year strategic plan and a 1-year performance plan by September 1997. This report offers a record of the experience of the Centers for Disease Control and Prevention in its early implementation of GPRA. It documents the process, summarizes key findings, and recommends strategies and approaches for the ongoing implementation of GPRA. The report finds that (1) implementation during the study phase did not proceed at the anticipated rate (instead of a fully developed strategic plan and pilot performance plans, most of the effort has concentrated on a strategic plan that is not yet drafted-little attention has been paid to the performance plans); (2) the role and responsibilities of the GPRA Implementation Team (GIT) evolved over the study period; (3) the GIT suffered from shifting membership, lack of continuity in meeting attendance, and an overall insufficient level of effort; (4) more effective and comprehensive planning and coordination was needed; and (5) despite the large amount of time and effort devoted to GPRA, the levels and types of commitment and resources fell short of what was needed. The report also concludes that insufficient momentum, commitment, and resources were a greater problem than ineffective planning; the process could have benefitted from greater executive staff involvement early on; and the process was often frustrating for participants. The report recommends that (1) organizational change efforts be unified under a high-level champion or team; (2) the Office of Program Planning and Evaluation's charge of implementing GPRA requirements be maintained; (3) the GIT be revamped; and (4) realistic budget be developed, requested, and executed.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Wilma G. Johnson

PHONE NUMBER: (404) 639-7090

PIC ID: 5928

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

TITLE: Collaborating with Managed Care Organizations for Mammography Screening and Rescreening: Guidance for NBCCEDP Grantees

ABSTRACT: Clinical trials show that mammography screening among women aged 50-69 years can reduce mortality from breast cancer by as much as 30 to 40 percent. Thus, more complete mammography screening coverage is needed throughout the Nation. This project was undertaken with a dual purpose: (1) to evaluate strategies used in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach women 50 years and older for the early detection of breast cancer; and (2) to assess potential partnership opportunities between public health and managed care organizations to increase the coverage of mammography screening. Currently, all States, the 5 territories, and 25 American Indian tribes are funded by the NBCCEDP to establish and manage comprehensive breast and cervical cancer screening services for women who are minorities, low-income, and age 50 or older, a population that seeks mammography services less often than other women because of cost, knowledge, and other barriers. The report notes that the increased use of managed care organizations (MCOs) by State Medicaid programs offers new opportunities and incentives to build partnerships between NBCCEDP grantees and MCOs. The report finds that (1) because grantees give priority to women who are low-income, uninsured, racial minorities, or Native American, special attention must be paid to educating and building relationships with MCOs in outreach, case management, and followup; (2) both sectors will benefit from data partnerships and community collaborations; (3) most current MCO efforts in the area of breast and cervical cancer detection are data-driven and office-based; and (4) health plans target providers more than patients to increase their attention to the prevention effort. The report also addresses opportunities for collaboration, barriers to and facilitators of such collaboration, and strategies that programs might use to enhance screening efforts. See also PIC ID No. 6273.1.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Nancy Nowak

PHONE NUMBER: (404) 488-4306

PIC ID: 6273

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Reaching Women for Mammography Screening: Successful Strategies of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Grantees

ABSTRACT: This guide presents successful strategies used by grantees of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach women in need of mammography screening-in particular low-income women, underserved and uninsured women, and women from communities of color. This information is presented to help grantees reach these marginalized populations by sharing strategies that their peer grantees have found successful. This information will also be useful for private sector and other organizations that are working to provide prevention services to hard-to-reach groups. Five categories of strategies are examined: inreach, public education, outreach, policies and procedures, and coalition and partnership development. While all of these strategies are different, several common themes underlie them all: (1) organizations must consider broad partnerships to reach marginalized populations who, because of their complicated lives, may not seek out care for themselves; (2) aggressive outreach may be needed to work with agencies and individuals who are most frequently in contact with these populations; (3) organizations should consider their infrastructure, not just outreach, to bring women in (health care organizations or health plans with a designated group of clients will find inreach more effective than outreach in the short term); (4) while the natural tendency is to focus on the relationship between the direct caregiver (especially the physician) and the patient, women are more likely to return for rescreening and to comply with followup regimens if a welcoming atmosphere is created by the entire office; and (5) the successful strategies show that there are diverse resources available for programs, but that innovation is needed when developing partnerships. See also PIC ID No. 6273. (Final report: 104 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Nancy Nowak

PHONE NUMBER: (404) 488-4306

PIC ID: 6273.1

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Evaluation Design for the Business Responds to AIDS (BRTA) Program

ABSTRACT: The Business Responds to AIDS program (BRTA) is a public-private initiative partnership undertaken by the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention to help businesses create and implement comprehensive HIV/AIDS workplace programs. To better understand how worksites are engaged in health promotion efforts, the BRTA Program conducted a national probability survey (the BRTA Benchmark Survey) to track progress since 1992. This project conducts a secondary analysis of the BRTA Benchmark Survey in order to provide recommendations about future evaluation designs that rely heavily on national communication channels. While much of the survey addressed issues related to HIV/AIDS, a number of questions were included that help track trends in worksite policies, screening programs, and health promotion activities. Results from this survey were compared to those gathered in a 1992 Office of Disease Prevention and Health Promotion survey of health promotion and disease prevention in the worksite. The report finds that (1) recent trends in worksite health promotion efforts seem to show increases in worksite policies, but no changes or decreases in classes or screening programs; (2) having a worksite policy may be less costly to implement than classes or screening programs (these policy interventions may also be more cost-effective than other types of interventions); and (3) the downward trend may result from some measurement bias introduced by asking questions about health promotion classes and screening programs only of those respondents to the BRTA Benchmark Survey who said they had had some health promotion program in the past 12 months. (Final report: 14 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Cynthia Jorgensen

PHONE NUMBER: (404) 639-0952

PIC ID: 6277

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

TITLE: Case Studies of the Prevention Marketing Initiatives (PMI) Local Demonstration Site Projects: Experiences During Planning and Transition Phases

ABSTRACT: The Prevention Marketing Initiative (PMI) is a social marketing program intended to influence behaviors that contribute to the sexual transmission of HIV and other sexually transmitted diseases among young people below 25 years of age. PMI includes among its components locally funded demonstration sites, which combine community participation with social marketing and behavioral science methodology and theory in order to design, implement, and sustain viable prevention programs. The PMI case study gathered in-depth information at these sites to describe the experiences of program participants over a 2-year period spanning two major project phases: planning and transition to implementation. The study highlights participants' reflections on what was done to foster achievement of PMI's goals, as well as what could be avoided in the future. The qualitative information gathered will be used to contextualize quantitative evaluation data collected as sites move through the implementation phase of PMI. The report finds that PMI had the following effect: (1) increased collaboration among community organizations and individuals on HIV prevention; (2) increased youth involvement in planning HIV prevention activities after some initial floundering in this area; (3) there is some weak evidence of increased support for HIV prevention programs within the community; and (4) increased participants' knowledge of, and sensitivity to, social marketing methodologies. The report also makes several recommendations on two levels: those that can be applied to new PMI sites and to other community-based ventures and those that pertain to PMI in particular. A,ong these recommendations are (1) define and become familiar with the community, (2) learn to manage issues and be realistic, (3) maintain diversity and enforce rules, (4) be clear with the lead agency, and (5) have the staff in place to provide needed technical and management services. (Final report: 204 pages, plus appendices.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Nancy Cheal

PHONE NUMBER: (404) 639-7095

PIC ID: 6337

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Evaluability Assessment of CDC-Funded Traumatic Brain Injury and Spinal Cord Injury Programs

ABSTRACT: In 1988, the Centers for Disease Control and Prevention (CDC) created the Disabilities Prevention Program (DPP) to reduce the incidence and severity of primary and secondary disabilities in the United States and to promote the independence and productivity of persons with disabilities. This report was commissioned to assess the feasibility of conducting an evaluation of the traumatic brain injury and spinal cord injury (TBI/SCI) programs funded through the DPP, the National Center for Environmental Health, and CDC. Interviews were conducted with Federal and State staff with a background or interest in DPP, external stakeholders, and with program staff in eight States. Interview data were used to prepare a logic model of State-level TBI/SCI programs, along with a set of measurable program components that match the activities and the objectives set forth in the logic model. The report finds that (1) there is a consensus among all stakeholders on the goals, activities, and objectives of the TBI/SCI capacity building programs' intended goals and on indicators that can be used to measure attainment; and (2) identifying the logic model and framework of measurable components for these programs offers many benefits. In order to strengthen CDC-State partnerships, the report recommends: (1) an appropriate balance in the partnership that allows States to be flexible but also provides parameters to ensure consistency; (2) the provision of regular, consistent feedback on State plans, activities, quarterly reports, and surveillance data; (3) grounding program design and decisions on valid data, whenever possible (in the absence of data, programs should proceed with a phased approach involving both the CDC and the States in the evolutionary learning process); and (4) the expansion of partnerships at the Federal, State, and community levels. (Final report: 33 pages plus appendices.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Doug Browne

PHONE NUMBER: (404) 488-7098

PIC ID: 6338

PERFORMER ORGANIZATION: Susan Toal, Atlanta, GA

TITLE: Community Context Study: Minors' Access to Tobacco

ABSTRACT: This project represents the first phase of a national study designed to profile the relationship between youths' access to tobacco and the contextual variables that define communities' policies, attitudes, and activities regarding youth and tobacco. The results of the study have implications for local, State, and Federal policies and programs. The basic conceptual model postulates that community forces will initiate and/or enhance local enforcement efforts. Enforcement will affect vendor behavior, which will then restrict minors' access to-and thereby, use of-tobacco. To address the questions raised by the conceptual model, data collection and analysis for this project were conducted in three parts: (1) telephone interviews with tobacco vendors and community leaders, and purchase attempts in stores in 20 communities; (2) in-person interviews with community leaders in ten case-study communities; and (3) analysis of teen tobacco use data from the 1995 Youth Risk Behavior Study (YRBS), collected by CDC for the same 20 communities. The report finds that (1) adolescents have little difficulty buying cigarettes in retail outlets; (2) even in restrictive communities, some stores would sell tobacco to minors; (3) the most important deterrent of sales to minors is asking for proof of age; (4) the presence of tobacco sales warning signs is associated with a lower sale rate; (5) community support for tobacco control promotes merchant compliance with the law; and (6) even a perception of enforcement acts as a strong deterrent to selling tobacco to minors. The report recommends that (1) the study should be expanded as a followup to the 1997 YRBS in sampled communities, (2) a question about the location of sources of retail purchase should be added to the YRBS, and (3) the expanded community context study should be fielded as soon as possible. (Executive summary: 7 pages; final report: variously paginated, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Gary A. Giovino

PHONE NUMBER: (770) 488-5703

PIC ID: 6474

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Directions for Research on the National Immunization Survey: Final Report

ABSTRACT: The National Immunization Survey (NIS) measures the immunization levels among young children in each State and in large metropolitan areas on a quarterly basis. This survey recently came under review, and questions about the cost of the survey and the utility of the data were raised. This report reviews the survey and develops a plan for determining whether less expensive methods could be used and still yield a statistically sound survey that meets the needs of the National Immunization Program. The report finds that (1) the NIS is a well-designed response to a very difficult set of goals posed by the Centers for Disease Control and Prevention; (2) dramatic cost reductions (i.e., 30 percent or larger) could not be achieved without major changes in survey objectives or quality; (3) there is greater potential for cost savings in the area of data collection than in analysis, since the volume of the survey makes refined systems for data collection economically feasible; (4) the high data analysis costs for the survey are well justified; (5) the survey meets the need for monitoring trends at the national level and can also be used to identify Immunization Action Plan (IAP) areas with either very poor or outstanding immunization levels; and (6) the survey can differentiate the immunization rates for reasonably small demographic groups annually, and can be used to monitor immunization trends at the IAP level, but only on an annual or biennial basis. The report concludes that the relative emphasis on IAP-level statistics and on national statistics should perhaps be adjusted-in the justification of the survey, in the design of the household interview, and in the choice of statistics to publish. It recommends that the schedule for publication of IAP-level statistics be cut back to an annual schedule and that new publications on national statistics for domains of interest be developed to fill the publication schedule.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Jacquelyn Williams

PHONE NUMBER: (301) 443-4493

PIC ID: 6477

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

TITLE: In Her Own Words: A Focus Group Study of Risk and Protective Factors in Intimate Partner Violence

ABSTRACT: This study was designed to provide insights into how African-American and Caucasian women in urban and rural settings perceive the factors that placed them at risk for an abusive relationship, as well as the factors that protected them from further violence during and after the relationship. The model used as the conceptual framework for the study (Prochaska's and DiClemente's Transtheoretical Model) depicts a sequence of five stages that culminate in lasting behavior change. Twenty-two focus groups were conducted in urban and rural areas in Georgia, Illinois, Pennsylvania, and Oregon. One hundred and sixty-eight women participated in the study, ranging in age from 18 to 60; all had been out of their abusive relationships from 6 months to 24 years. The report finds that (1) the long-term effects of emotional and physical abuse are worse than the actual violence and resulting injuries themselves; (2) a wide range of psychologically and physically abusive acts were described by focus group participants, including abuse not only of themselves but also of children and of pets; (3) most focus group participants concluded that anything could be a trigger to violence, and that this realization was a significant contributor to the terror, fear, and desperation they felt in their relationships; (4) participants agreed that a number of problem behaviors, such as a history of violence at home, extreme charm, possessiveness, and explosive rage, are early warning signs of abuse; and (5) women describe the decision to leave the abusive relationship as the result of a breaking point. The report concludes that this study's findings should be validated in a national telephone survey of women's risk and protective factors for intimate partner violence. (Final report: 135 pages.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lynn Short

PHONE NUMBER: (770) 488-4285

PIC ID: 6515

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

ABSTRACT: In order to advance research in health promotion and disease prevention, the Centers for Disease Control and Prevention (CDC) established a program of university-based Centers for Research and Demonstration of Health Promotion and Disease Prevention. The prevention research center (PRC) program began in 1986 with funding to three universities; in 1996, there were 13 PRCs. This report examines the extent to which the PRC program is providing the public health community with workable strategies to address major public health problems in disease prevention and health promotion. The report finds that (1) by forging links with academia, CDC has created a gateway for access to a cadre of well-trained, university-based researchers who could serve to inform and collaborate with the agency and the public health community regarding health promotion and disease prevention; (2) the PRC has made substantial progress in advancing the scientific infrastructure in support of disease and health promotion policy, programs, and practices; (3) each of the centers has made some contributions toward one or more of the goals of the program (research, dissemination, and developing connections with the community and public health practitioners); (4) there are substantial differences among the PRCs in the kinds of activities they have undertaken and the success realized (only a few have made substantial progress in all areas); and (5) CDC's management of the program has been creative in the face of limited resources relative to its mandate-dogged in pursuing the mandate over a 10-year period in a bureaucratic environment that was not created or structured for the management of university-based research programs, and skilled in enhancing a sense of community and networking among the funded centers in a time of disappointing funding levels. (Final report: 67 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Patricia Riley

PHONE NUMBER: (770) 488-5277

PIC ID: 6535

PERFORMER ORGANIZATION: National Academy of Sciences, Washington, DC

TITLE: Syphilis in the South: A Case Study Assessment in Eight Southern Communities

ABSTRACT: This two-volume report presents the results of a comparative case study of local-level syphilis prevention efforts that are conducted as part of sexually transmitted disease (STD) prevention programs supported by the Centers for Disease Control and Prevention (CDC). The case studies were conducted in eight communities in four Southern States: Alabama, Mississippi, South Carolina, and Tennessee. The project investigated past and current responses of the public and private health sectors to a syphilis epidemic that occurred in the southern United States between 1990 and 1992. Study findings were developed around four key questions: (1) who is at greatest risk of syphilis infection and transmission, (2) what institutions are best able to reach those at greatest risk, (3) what are the barriers to syphilis prevention and control in communities, and (4) what innovative ways have been found to transcend these barriers? The report finds that (1) interviewees perceived African Americans to be the demographic group most at risk for infection and transmission of syphilis, especially those who exchanged sex for drugs, homeless people, and incarcerated individuals; (2) adolescent high-risk sexual behavior was of concern as a possible precursor to infection once practitioners reached their 20s; (3) local health departments are the only community organizations focusing directly on syphilis and other STD control and prevention; (4) public health agencies assigned priority to disease control and engaged in few agency-based prevention activities, and schools were limited in their ability to be venues for STD prevention messages due to the local restrictions on sexually explicit materials in health education curricula; and (5) barriers to those at greatest risk of syphilis infection are cultural, programmatic, and political. Recommendations are offered in a manner designed to allow practical implementation. (Vol. I: 121 pages, plus appendices; Vol. II: 100 pages.)

AGENCY SPONSOR: National Center for HIV, STD and TB Prevention

FEDERAL CONTACT: Janelle Dixon

PHONE NUMBER: (404) 639-8344

PIC ID: 6579

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (Baltimore, MD)

ABSTRACT: The three aims of this project were to (1) establish population-based surveillance for invasive Streptococcus pneumoniae infection; (2) evaluate the validity of the current Centers for Disease Control and Prevention (CDC) sentinel surveillance system; and (3) identify the optimal methods for determining antimicrobial resistance patterns in the United States. Active, population-based surveillance for invasive pneumococcal infection was established in all hospitals in the Baltimore metropolitan area over a 2-year period. Various additional data collection methods were employed, including bimonthly contact/followup to participating sites to obtain cases not reported spontaneously, yearly laboratory audits to identify cases not reported through active surveillance, and retrospective chart reviews. During the 2-year project period, 1,415 cases were reported: 685 in 1995 and 730 in 1996. Additionally, the contractor conducted two nasopharyngeal culture surveys of 300 children each in 5 pediatric clinics within the Baltimore metropolitan area. Sputum surveys were also conducted in three large Baltimore area hospitals. All data and isolates from the project have been sent to CDC. See also PIC ID Nos. 6580.1 and 6580.2. (Final report: 4 pages.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat

PHONE NUMBER: (404) 639-2215

PIC ID: 6580

PERFORMER ORGANIZATION: Johns Hopkins University, Baltimore, MD

TITLE: Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (San Antonio, TX)

ABSTRACT: Five major activities were conducted as part of this study to determine the effectiveness of the Centers for Disease Control and Prevention's (CDC's) current surveillance system for drug-resistant Streptococcus pneumoniae. These activities included (1) active population-based surveillance of invasive pneumococcal isolates in San Antonio and Bexar County, Texas for a period of 2 years; (2) microbiologic studies in which all isolates were submitted to a central laboratory for final identification, storage, and cataloging, and for eventual additional susceptibility testing; (3) microbiologic studies, in which 221 sputum isolates were collected and identified for Streptococcus pneumoniae and antibiotic resistance; (4) period prevalence surveys of non-invasive respiratory isolates; and (5) a case-control study among patients with invasive pneumococcal disease. Additionally, data were entered into appropriate data bases for further analysis at CDC. For example, invasive isolate data were entered into EpiInfo and microbiologic study data were entered into the Public Health Laboratory Information System. Results were disseminated to the community via hospital reports, local meetings, national and State meetings, manuscripts, and newsletters. See also PIC ID Nos. 6580 and 6580.2. (Final report: variously paginated.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat

PHONE NUMBER: (404) 639-2215

PIC ID: 6580.1

PERFORMER ORGANIZATION: University of Texas, Health Science Center, San Antonio, TX

TITLE: Assessment of the Programmatic Impact of One-Percent Evaluation Studies

ABSTRACT: This three-volume report provides a systematic evaluation of the programmatic impact of 1-percent evaluation studies carried out by the Centers for Disease Control and Prevention (CDC) between 1990 and 1995. The study was also designed to elicit information about what the Office of Program Planning and Evaluation could do to enhance the impact of 1-percent evaluation studies. The study resulted in findings in three major areas: (1) the perception at CDC of evaluation in general, (2) the perception at CDC of the 1-percent process in particular, and (3) the programmatic impact to date of 1-percent evaluation studies at CDC. Among the findings were that: (1) although pressure for program accountability is mounting, evaluation still engenders anxiety among some CDC program staff-although these attitudes are changing slowly; (2) program staff are concerned that the 1-percent evaluation process in particular is unpredictable-staff do not know from one year to the next how much 1-percent funding they will receive, and the time allowed between the issuance of 1-percent guidance and the deadline for submissions is perceived as too short; (3) despite numerous obstacles to implementation, nearly 70 percent of the recommendations developed in the evaluation studies examined for this report have been considered for implementation and about 50 percent have been implemented in some form; and (4) CDC evaluations have produced programmatic impact leading to changes in practices and procedures, activities, responsibilities, changes in full-time equivalents, budgets, organizational and administrative structures, and policy. Specific recommendations are made in the report and are arrayed according to project phases (study selection, design, implementation, recommendation, and dissemination stages). See also PIC ID No. 6581.1. (Final report: 69 pages, plus appendices A-E; Appendix F separately bound; Appendices G, H, and I separately bound.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Wilma G. Johnson

PHONE NUMBER: (404) 639-7090

PIC ID: 6581

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Directory of Evaluations Administered by the CDC Office of Program Planning and Evaluation 1990-1995

ABSTRACT: This directory is one of the products of a study conducted for the Office of Program Planning and Evaluation (OPPE) of the Centers for Disease Control and Prevention (CDC) entitled "Assessment of the Programmatic Impact of (CDC) One-Percent Evaluation Studies." During a process of reviewing nearly 50 CDC evaluations completed between 1990 and 1995 and about 40 additional studies in various stages of completion, it became apparent that these studies were important to CDC program staff in particular and to the field of public health in general. Many common themes ran through these evaluations: (1) the difficulties of monitoring the performance of public health programs; (2) the growing importance of community outreach and mobilization; (3) the evolving role of health communications in CDC's work; and (4) concerns over the impact of managed care on the public health sector. This directory includes both completed and in-process studies. Project summaries reflect a project's reported status as of August 1995. The volume is arranged according to the study ID number assigned to each project as it is initiated through OPPE. See also PIC ID No. 6581. (Final report: variously paginated.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Nancy Cheal

PHONE NUMBER: (404) 639-7095

PIC ID: 6581.1

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TOP OF DOCUMENT

FOOD AND DRUG ADMINISTRATION

Contents

Report of the Prescription Drug User Fee Act (PDUFA) of 1992-Fiscal Year 1997 Report to Congress

Economic Impact Analysis of Regulations Under the Mammography Quality Standards Act of 1992

Mammography Quality Standards Act: Second Annual Government Entity Declaration Program Audit

Product Review Performance Report

Evaluation of Device Performance in the Determination of Substantial Equivalence

Cost of Restrictions on Gulf Oyster Harvesting for Control of Vibrio vulnificus-Caused Disease

Health Transfers: An Application of Health-Health Analysis to Assess Food Safety Regulation

Preliminary Investigation into the Morbidity and Mortality Associated with the Consumption of Fruit and Vegetable Juices

TITLE: Report of the Prescription Drug User Fee Act (PDUFA) of 1992-Fiscal Year 1997 Report to Congress

ABSTRACT: Fiscal year 1997 (FY 97) marks the fifth and final year of the 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 FDA prepare yearly reports for each fiscal year for which fees are collected. The fifth annual report, prepared in response to that mandate, covers FY 97 and reports on how well the FDA has accomplished the performance goals it established for FY 97. These performance-related goals were jointly established by the FDA and the pharmaceutical industry and fall into three main categories: (1) elimination of overdue backlogs, (2) building excellence into the review process, and (3) achievement of high performance. Seven goals were in effect for FY 97. The findings in the report show that the successes reported last year have been confirmed and surpassed. The report finds that (1) PDUFA has resulted in more and better applications filed, which can be accepted immediately and reviewed and approved more quickly; (2) nearly all applications now go directly into the review process (due to the increased quality of the applications, very few are refused); (3) there are more approvals on first review, which demonstrates that submission quality is a key factor in achieving timely reviews; and (4) the ultimate approval time for applications in the PDUFA years has dramatically decreased. While only a preliminary performance assessment of FY 97 is possible at this time, it is clear that the Act's stringent review goals have assured that new pharmaceutical products are getting onto the market at an unprecedented rate without compromising safety. See also PIC ID Nos. 6079 and 6079.1. (Final report: 10 pages, plus appendices.)

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Dennis Hill

PHONE NUMBER: (301) 827-5255

PIC ID: 6079.2

PERFORMER ORGANIZATION: Office of Planning & Evaluation, Food and Drug Administration, Washington, DC

TITLE: Economic Impact Analysis of Regulations Under the Mammography Quality Standards Act of 1992

ABSTRACT: The Food and Drug Administration (FDA) is charged with ensuring that accessibility to quality mammography services is maintained for all facilities performing mammographies in accordance with the Mammography Quality Standards Act of 1992 (MQSA). Under this statute, the FDA is required to certify and annually inspect over 10,000 mammography facilities. Prior to the passage of the MQSA, FDA's oversight responsibility was limited to approving new mammographic processors, x-rays, and tubing. However, MQSA requires that facilities within its jurisdiction meet standards developed by the agency to ensure a reasonable level of quality in order to achieve certification by the agency. FDA is concerned that recent trends by third-party payers to attract payments for mammography services have severely limited the ability of facilities to absorb any cost increases caused by the quality standards. These cost increases, as well as excess capacity, may cause low-volume facilities to leave the industry. This project addresses these problems in two ways. First, it measures the effect of standards on patient access to mammography, especially in rural areas; second, it develops a cost model that will be used to predict the impact of proposed standards on the costs of providing mammography. The contractor reviewed records from over 10,000 facilities that had applied for accreditation and over 500 that had ceased operations. In the Spring of 1996, the contractor drafted the results of a cost-benefit analysis, which FDA managers will use to develop a performance-oriented regulatory policy that will be coordinated with existing customers.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Steve Tucker

PHONE NUMBER: (301) 827-5340

PIC ID: 6080

PERFORMER ORGANIZATION: Eastern Research Group, Incorporated, Arlington, VA

TITLE: Mammography Quality Standards Act: Second Annual Government Entity Declaration Program Audit

ABSTRACT: The Food and Drug Administration's (FDA's) Division of Mammography Quality and Radiation Programs requested that the Division of Planning, Analysis, and Finance conduct an audit of the Mammography Quality Standards Act (MQSA) Government Entity (GE) Declaration Program. There are two main goals of the audit: (1) to notify facilities that they will be held accountable for their self-certification of fee exemption, and (2) to determine the rate of compliance with the program. A random sample of 90 facilities out of the 989 claiming GE status was selected for examination, and a random sample of 20 (out of 72) new GE facilities was also examined. The audit revealed that (1) only 3 of the 90 GE facilities had claimed GE status incorrectly, and only 1 of the 20 new GE facilities had claimed incorrect status; and (2) the 3 GE facilities (as well as the one new GE facility) that did not meet FDA's fee-exempt status claimed that exemption based on funding from the Centers for Disease Control and Prevention (CDC) Breast and Cervical Cancer Prevention Program, which is the least common way to claim fee exemption. Based on these results, the audit concludes that the GE Declaration program appears to be quite effective. It also suggests several recommendations based on the findings of the audit. These include that: (1) the results should be published to allow the impact of the audit to reach many, if not all, the facilities, to discourage any future misrepresentations, and to demonstrate that FDA will exercise its authority; (2) the sample size of future audits should be smaller and should contain a larger portion of those facilities claiming fee exemption based solely on funding from the CDC; and (3) the MQSA contractor in charge of billing should continue to thoroughly examine each GE Declaration form to ensure that it identifies the body operating the facility. (Final report: 3 pages, plus appendices.)

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Stephanie Wilkinson

PHONE NUMBER: (301) 594-1284

PIC ID: 6730

PERFORMER ORGANIZATION: Center for Devices and Radiological Health, Rockville, MD

TITLE: Product Review Performance Report

ABSTRACT: This is the first annual report analyzing the Food and Drug Administration's (FDA's) performance in reviewing applications for human drugs, biological products, medical devices, food and color additives, and veterinary drugs. In the past, FDA has measured the length of review using measures that varied for different product categories, making it difficult to provide an agency-wide assessment of the FDA's performance. Responding to legislation such as the Prescription Drug User Fee Act of 1992 (PDUFA), as well as to requirements under the Federal Food, Drug, and Cosmetic Act, the FDA has developed clear performance goals for reviewing new product applications. Setting these goals has provided a valuable management tool for identifying performance expectations and assessing achievements, and for meeting the requirements of the Government Performance and Results Act of 1993. FDA has also developed performance measures and reporting conventions that can be used to report on product review performance consistently across product categories. The report looks at four different measures of the FDA's performance: (1) how often FDA is meeting statutory and nonstatutory time frames for review of each category of products, (2) the median length of time to approval for each product category, (3) the total number of products approved in each category, and (4) the number of applications for which an action was overdue at the end of the fiscal year (FY). It provides FDA's on-time performance for FY 1993, 1994, and 1995 and performance data for the other three categories for FY 1993 to 1996. The report finds that (1) for most categories of products, FDA has improved its performance since FY 1993; (2) the greatest improvements in performance have occurred for product reviews covered by PDUFA; (3) significant progress has been made in reviewing applications for medical devices; and (4) on-time performance for reviews of non-PDUFA applications should be improved.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Paul Coppinger

PHONE NUMBER: (301) 827-5292

PIC ID: 6731

PERFORMER ORGANIZATION: Food and Drug Administration, Rockville, MD

TITLE: Evaluation of Device Performance in the Determination of Substantial Equivalence

ABSTRACT: Many diagnostic medical devices that reach the market are based on diagnostic agreement with some device already on the market that targets the same attribute. Agreement is often assessed by side-by-side testing of the same subjects or specimens, even if the true disease status is unknown. If each new test is compared with the most recent predicate, what would be the effect on device performance over time? Would it deteriorate, remain the same, or improve? This analysis attempts to address these questions using statistical measures of sensitivity, specificity, and predictive values. A Monto Carlo simulation was used to study this question of "predicate (pre-Amendments or reclassified post-Amendments) creep." Contingency tables were randomly generated using a range of conditional probabilities and prevalence representing screening and confirmatory test data. When a new test was found to be equivalent to the current predicate, it became the new predicate. After 50 new predicates were found, a forecast procedure was applied to the sequence of 50 performance parameters in order to evaluate the long-term trend.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: John Dawson

PHONE NUMBER: (301) 827-0201

PIC ID: 6734

PERFORMER ORGANIZATION: Center for Devices and Radiological Health, Rockville, MD

TITLE: Cost of Restrictions on Gulf Oyster Harvesting for Control of Vibrio vulnificus-Caused Disease

ABSTRACT: This study for the Food and Drug Administration (FDA) estimates the costs of a seasonal harvesting restriction on Gulf of Mexico oysters and a seasonal marketing restriction on the sale of Gulf oysters for raw consumption. These measures would control oyster-related illnesses in humans known to be caused by the bacterial species Vibrio vulnificus, which naturally occurs in estuarine waters and is a normal flora for oysters. During this study, the 1995 Interstate Shellfish Sanitation Conference (ISSC) adopted a Vibrio vulnificus interim control plan for oysters and the report compares the costs of complying with the ISSC plan with FDA's suggested alternatives. The ISSC interim control plan (1) states that oysters must be under ambient refrigeration at 45 degrees Fahrenheit within a specified time if they are harvested from State waters that were the confirmed source for two or more Vibrio vulnificus illnesses; (2) establishes action levels for growing areas within affected States; and (3) varies the time-to-refrigeration requirement according to the average monthly maximum water temperature. The report estimates the economic impact of alternative remedies for controlling Vibrio vulnificus-related illnesses and concludes that (1) the in-shell marketing restriction might have imposed large economic impacts on the Gulf oyster industry and other related sectors of the economy; (2) the ISSC time and temperature controls would have smaller aggregate economic impacts than the marketing restriction option but the distributional effects of this policy should be considered; and (3) the ISSC impacts are sensitive to specific assumptions about enforcement of the rule and types of responses, engendered by the regulated entities. (Final report: variously paginated.)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Richard Williams

PHONE NUMBER: (202) 205-5667

PIC ID: 6856

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

TITLE: Health Transfers: An Application of Health-Health Analysis to Assess Food Safety Regulation

ABSTRACT: Public health policy decisions usually focus on reducing a target risk. However, complying with regulations to reduce a risk is expensive. Because income influences health, Health-Health Analysis (HHA) was developed to compare the targeted reduction in mortality to the induced mortality from income losses. This study applies HHA to assess a potential Gulf oyster harvesting ban to control mortality from the consumption of oysters contaminated by Vibrio vulnificus. The report estimates the induced deaths using Anderson et al.'s estimate of economic losses and Keeney's estimate of the functional relations between income and mortality. The report shows that while a 7-month Gulf oyster harvesting ban might eliminate the estimated 17 oyster-related deaths annually, it may also cause as many as 12 income-loss-related deaths. The induced deaths occur principally among white males and black females. The report concludes that (1) HHA may give decisionmakers reason to pause considering the high costs of a harvesting ban and that consumption of raw oysters is completely voluntary; and (2) this illustration shows that HHA serves as a useful policy analysis tool. (Final report: 26 pages.)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Richard Williams

PHONE NUMBER: (202) 205-5667

PIC ID: 6857

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

TITLE: Preliminary Investigation into the Morbidity and Mortality Associated with the Consumption of Fruit and Vegetable Juices

ABSTRACT: Americans consumed 2.3 billion gallons of the major fruit and vegetable juices in 1995. Recent outbreaks of illnesses associated with the consumption of juices demonstrate their potential as a human health hazard. As part of the cost-benefit analysis for both the Hazard Analysis and Critical Control Point (HACCP) and labeling rules associated with fruit and vegetable juices, the Center for Food Safety and Applied Nutrition's working group was asked to investigate the morbidity and mortality associated with human consumption of juice drinks. The standard procedure for estimating human health benefits is to (1) estimate the baseline numbers of illnesses and deaths associated with the compound to be controlled, (2) estimate the likely reductions in those illnesses and deaths associated with various proposed control options, and (3) estimate the values associated with the reduced illnesses and deaths. This report estimates the baseline numbers of illnesses and deaths likely to be associated with the consumption of juice products. The study (1) describes juice products, (2) estimates juice consumption, (3) discusses production methods, (4) explains how hazards might be introduced into juice, (5) discusses evidence on illness from consuming juices, (6) describes human health effects caused by selected microbial pathogens, and (7) discusses the physical and chemical hazards associated with juices. Juices accounted for 447 laboratory-confirmed cases of illness associated with microbial pathogens, according to Centers for Disease Control and Prevention outbreak data and U.S. Food and Drug Administration recall data from 1993 through 1996. The other hazards, mostly physical and chemical, that have been found in juices have been sporadic and associated with fewer cases than the microbial pathogens. (Final report: 65 pages, plus appendices.)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Richard Williams

PHONE NUMBER: (202) 205-5667

PIC ID: 6858

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

TOP OF DOCUMENT

HEALTH CARE FINANCING ADMINISTRATION

Contents

Limited-Service Hospital Pioneers: Challenges and Successes of the Essential Access Community Hospital/Rural Primary Care Hospital (EACH-RPCH) Program and Medical Assistance Facility (MAF) Demonstration

Comparative Study of the Use of EPSDT and Other Preventive and Curative Health Care Services by Children Enrolled in Medicaid: Final Project Synthesis Report

Costs and Consequences of Case Management for Medicare Beneficiaries: Final Report

Evaluation of the Utah Prepaid Mental Health Plan

Monitoring and Evaluation of the Medicare Cataract Surgery Alternate Payment Demonstration: Final Evaluation Report

Evaluation of the Demonstration to Improve Access to Care for Pregnant Substance Abusers

Evaluation of the Medicaid Uninsured Demonstrations

Access to Physicians' Services for Vulnerable Beneficiaries: Impact of the Medicare Fee Schedule

A Study of the Appropriateness, Process of Care, and Outcomes of Medical Care for Medicaid Patients

An Evaluation of Implementation of the Medicaid Community Supported Living Arrangements (CLSA) Program in Eight States

Evaluation of the Community Nursing Organization Demonstration Interim Evaluation Report

Evaluation of the Effectiveness of the Operation Restore Trust Demonstrations

The Impact of Report Cards on Employees: A Natural Experiment

Consequences of Paying Medicare HMOs and Health Care Prepayment Plans (HCPPs)

Toward a Prospective Payment System for Outpatient Services: Implementation for Outpatient Services-- Implementation of APGs by State Medicaid Agencies and Private Payers

Payment of Pharmacists for Cognitive Services: Results of the Washington State C.A.R.E. Demonstration Project

Assessing the Viability of All-Payer Systems for Inpatient Hospital Services

Second Update of the Geographic Practice Cost Index: Final Report

Validation of Nursing Home Quality Indicators Study

1995 Influenza Immunizations Paid for by Medicare: State and County Rates

Impact of the Medicare Fee Schedule on Teaching Physicians

TITLE: Limited-Service Hospital Pioneers: Challenges and Successes of the Essential Access Community Hospital/Rural Primary Care Hospital (EACH-RPCH) Program and Medical Assistance Facility (MAF) Demonstration

ABSTRACT: Small communities in rural America are struggling to maintain health care resources in the face of increasing competition and a dwindling population and economic base. In response to the threatened survival of small rural hospitals, the Health Care Financing Administration has supported two initiatives to introduce innovative limited-service hospitals: the Essential Access Community Hospital/Rural Primary Care Hospital (EACH-RPCH) program, implemented in seven States; and the Medical Assistance Facility (MAF) demonstration in Montana. Both establish a new Medicare provider that is exempt from specific key requirements of participation, and both offer enhanced reimbursement. Other States have looked to these two programs as possible models for their rural communities. This report documents the evaluation of the EACH-RPCH program from its start in October 1991 through September 1994. The report assesses the implementation process, initial operating experience, and potential impact of the programs on access and cost as related to limited hospital service. The introductory chapter reviews the background of the EACH-RPCH and MAF programs, discusses the evaluation issues to be examined, and summarizes the evaluation methodology and data sources. Chapters II and III examine the development of networks and the shift to limited service licensure under the EACH-RPCH program. Chapter IV reviews the implementation and operation of the MAF demonstration. Chapters V and VI focus on the two programs' impact on access to care and mechanisms for quality assurance, respectively. The report concludes with Chapter VII, which assesses the impact of both programs on facility finances and the Medicare program. (Final report: 260 pages, plus appendices.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sheldon Weisgrau

PHONE NUMBER: (410) 786-6675

PIC ID: 5200.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Comparative Study of the Use of EPSDT and Other Preventive and Curative Health Care Services by Children Enrolled in Medicaid: Final Project Synthesis Report

ABSTRACT: This report includes (1) a description of the Medicaid program in Michigan, Georgia, Tennessee, and California and these States' responses to the Omnibus Budget Reconciliation Act of 1989 provisions relating to children's and Medicaid coverage and on the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program; (2) results of analyses of the impact of these responses on participating providers and enrolled children; and (3) an assessment of the national context through a review of the national survey data analyses. It finds that (1) State efforts to increase provider participation in Medicaid and EPSDT included recruitment activities, training in billing, and increased fees; (2) the States' efforts were successful in increasing provider participation and average caseloads among all types of providers, except for dentists in Michigan, which declined 10 percent from 1989 to 1992; (3) these increases may not have been adequate to meet the increased demand from a growing caseload; (4) the ratios of Medicaid children to participating providers and the percentages of counties with provider shortages rose from 1989 to 1992 in all four study States; (5) counting all EPSDT and all other well-child visits paid for by Medicaid, only 42 to 54 percent of Medicaid children were recommended to have preventive care visits, and of these, only 36 to 59 percent made the recommended visits; (6) compared with other low-income children, Medicaid coverage increased service use and improved access to illness-related care; and (7) Medicaid children had very low completion rates for age-appropriate immunizations, from 48 percent in Michigan to 61 percent in Georgia in 1992. The report concludes that State efforts to expand the EPSDT provider base and to enhance outreach had significant impacts on the use of preventive, diagnostic, and treatment services. See also PIC ID Nos. 6236-6236.6 and 6236.8-6236.A. (Final report: 49 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Feather Davis

PHONE NUMBER: (410) 786-6590

PIC ID: 6236.7

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: Costs and Consequences of Case Management for Medicare Beneficiaries: Final Report

ABSTRACT: This report studies the appropriateness of providing case management services to beneficiaries with catastrophic illnesses and high medical costs. The study tests case management as a way of controlling costs in the fee-for-service sector. These demonstrations, mandated by the Omnibus Reconciliation Act of 1990, and are aimed at a number of chronic illnesses, including congestive heart failure. The resulting demonstrations were implemented in three sites, began operations in October 1993, and continued through November 1995. The target conditions and case management protocols differed in each site, though all three generally focused on increased education regarding proper patient monitoring and management of the target chronic condition. All three sites anticipated reduced hospitalizations and medical costs compared to the beneficiary control groups. (Final report: 216 pages, plus appendices.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Leslie M. Greenwald

PHONE NUMBER: (410) 786-6502

PIC ID: 6291

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Evaluation of the Utah Prepaid Mental Health Plan

ABSTRACT: This report is an evaluation of a demonstration project conducted in Utah, in which three mental health centers provided mental health services to all Medicaid beneficiaries in their catchment areas (these areas include over 50 percent of all Utah Medicaid beneficiaries). The hope was that this program would control the cost inflation and improve patient outcomes in mental health services. The evaluator examines three areas: (1) organizational and financial characteristics and evolution over time, (2) impact on the organization of service delivery and use of services, and (3) financial impact on providers and the Medicaid program in Utah. The development of the demonstration proceeded fairly smoothly, albeit somewhat more slowly than planned. Three centers chose to enter the demonstration and eight chose to not join. Several changes in the program's environment affected the development during the initial 3 years. (Final report: 68 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Paul J. Boben

PHONE NUMBER: (410) 786-6629

PIC ID: 6293

PERFORMER ORGANIZATION: University of Minnesota, Minneapolis, MN

TITLE: Monitoring and Evaluation of the Medicare Cataract Surgery Alternate Payment Demonstration: Final Evaluation Report

ABSTRACT: This report assisted the Health Care Financing Administration (HCFA) in tracking the 3-year demonstration that tested the concept of a single global Medicare payment for outpatient cataract procedures. The payment amount represented payment for the physician, facility, and intraocular lens costs. The analysis portion of the project tested whether there were any net savings to the Medicare program, changes in the use of services included and excluded from the bundle, beneficiary satisfaction, and quality of care. The evaluation found that the project was reasonably successful in encouraging provider flexibility and in managing the bundle of services. There was ample anecdotal evidence that the cost effectiveness incentives were working; e.g., cost reduction efforts by surgeons in the techniques and time required to perform the surgery and actions to standardize the interocular lenses and other supplies and materials. While the effort to become a part of the demonstration was substantial, once operations began, government activities related to pricing were greatly reduced and limited to simple verification and payment of the global fee. The evaluator was not able to measure appropriateness, but in terms of quality control and utilization review the demonstration was successful in that the outcomes were unchanged. The project did produce some insights into the strengths and weaknesses of particular incentives in encouraging providers to participate. However, it provided limited new information on what factors influenced beneficiaries to participate.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Cynthia K. Mason

PHONE NUMBER: (410) 786-6680

PIC ID: 6295

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Cambridge, MA

TITLE: Evaluation of the Demonstration to Improve Access to Care for Pregnant Substance Abusers

ABSTRACT: This report evaluates demonstration project effectiveness in (1) outreach and assessment; (2) expansion, integration, and coordination of program services; and (3) improvement of client case management. The evaluator examined access to prenatal care and substance abuse treatment services and assessed the effects of these services on the health of drug-addicted pregnant women and birth outcomes of their infants. The evaluation showed that the number of abusers enrolled in the demonstrations was low relative to all pregnant substance abusers in the area, since women were reluctant to be identified. The project found higher enrollment rates in States that implemented broad-based outreach efforts; higher levels of and greater retention in substance abuse treatment resulted in higher birth weight infants. (Final report: 104 pages, plus appendices.)

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Suzanne Rotwein

PHONE NUMBER: (410) 786-6621

PIC ID: 6297

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Washington, DC

TITLE: Evaluation of the Medicaid Uninsured Demonstrations

ABSTRACT: This project evaluated three demonstration project conducted in Maine, South Carolina, and Washington State. These demonstrations, implemented in response to a Congressional mandate under section 4745 of the Omnibus Budget Reconciliation Act of 1990, tested the effect of allowing States to extend Medicaid coverage to low-income families. The evaluation resulted in a series of annual reports, an interim and a final report to Congress, and a final evaluation report. The project examined intra- and inter-site processes and outcomes, including (1) the ability of the programs to enroll significant numbers of eligible persons; (2) conditions under which eligible persons and their families are willing to participate in such programs, given their scarce financial resources; (3) ability of the programs to induce adequate numbers of providers to ensure the availability of necessary services at appropriate utilization levels; (4) willingness of employers to participate in the programs and the conditions under which they participate or choose not to participate; (5) the program's effect on service utilization and health outcomes of participants; (6) the cost-effectiveness of such programs for the various public and private interests; and (7) the extent to which the demonstration's interventions could be applied nationally to assist in achieving program goals. An initial series of site visits was conducted during 1993. The first annual report in the series used data collected during these site visits and data from State-administered baseline surveys to describe the implementation phase and early operational phase of the demonstrations.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: James Hadley

PHONE NUMBER: (410) 786-6626

PIC ID: 6298

PERFORMER ORGANIZATION: Health Economics Research, Incorporated, Waltham, MA

TITLE: Access to Physicians' Services for Vulnerable Beneficiaries: Impact of the Medicare Fee Schedule

ABSTRACT: In 1992, Medicare introduced the Medicare Fee Schedule (MFS), which alters the relative prices paid to physicians for services and arguably the incentives to provide one service over another. This project evaluates the impact of the MFS on individual access to health care. Since the introduction of the MFS, the Health Care Financing Administration and the Physician Payment Review Commission have monitored access to physicians' services and have failed to document any barriers to health care access resulting from the MFS. This study builds on this work by (1) oversampling groups of beneficiaries thought to be particularly vulnerable to payment changes, (2) evaluating changes in treatment patterns for specific episodes of care, and (3) conducting multivariate analyses that measure actual payment changes over time rather than expected changes due to MFS. A stratified random sampling design took advantage of the differential impacts of the MFS across geographic areas and ensured adequate numbers of vulnerable beneficiaries. The study divided all geographic areas into six groups based on their expected 1992 payment changes under MFS, compared with the earlier payment scheme. The report finds that (1) there is little evidence that the MFS either improved or worsened health care access for Medicare beneficiaries; (2) while some vulnerable groups experienced MFS-related changes in access, the actual size of these changes is relatively small and is not consistently negative or positive; (3) substantial access gaps exist for vulnerable beneficiaries and there is evidence that access to primary care may have worsened for dual Medicaid-eligibles; and (4) Medicare beneficiaries reduced out-of-pocket payments over the 1991-1993 period, including lower copayments and lower extra billing liability. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Renee Mentnech

PHONE NUMBER: (410) 786-6692

PIC ID: 6301

PERFORMER ORGANIZATION: Center for Health Economics Research, Waltham, MA

TITLE: A Study of the Appropriateness, Process of Care, and Outcomes of Medical Care for Medicaid Patients

ABSTRACT: The Congress requires the Health Care Financing Administration to report on the relative quality of care in the Medicaid program. This study assesses the variation that exists in the rate of performance of selected treatments and procedures provided to Medicaid beneficiaries for small areas within and between States. The report's first phase shows that the overall rate of inpatient use in the Medicaid population is higher than the rate expected based on non-Medicaid utilization patterns. In the report's second phase, data are abstracted from medical records at 118 hospitals in California, Georgia, and Michigan for a selected series of index diagnoses: pediatric asthma, hysterectomy, and complicated labor and delivery. This second phase develops five indicators to assess quality: (1) appropriateness to hospitalize or perform a procedure, (2) process of care, (3) outcomes of treatments and procedures, (4) severity at time of admission, and (5) intensity of care. Medicaid-covered children in two States, and women in all three States, are younger and represent more minority groups than their privately-insured counterparts. The appropriateness of the decision to hospitalize a child with asthma, perform a hysterectomy, and do a Cesarean section in the presence of labor and delivery complications are comparable between Medicaid and privately-insured patients. Most important, the outcomes of care for the two groups were essentially similar, for each condition, across the three States. Medicaid patients were more seriously ill at admission, which suggests that the Medicaid-covered patients may not be practicing the same level of preventative care as their privately-insured counterparts. As a result, the differences in patient outcomes were not a result of the inpatient quality of care provided. The inpatient care for the Medicaid patients was considered adequate and comparable with care received by privately-insured patients. (Final report: 46 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Beth Benedict

PHONE NUMBER: (410) 786-7724

PIC ID: 6302

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: An Evaluation of Implementation of the Medicaid Community Supported Living Arrangements (CLSA) Program in Eight States

ABSTRACT: This report describes the effectiveness of developing a continuum-of-care concept as an alternative to the Medicaid-funded residential services provided to individuals with mental retardation and related conditions. The program serves individuals who are living in the community either independently, with their families, or in homes with three or fewer other individuals receiving the same services. These services were provided in eight States between fiscal years 1991 and 1995. By the end of the program only 73 percent of the expected number of individuals were receiving services in the Community Supported Living Arrangement (CSLA), and the expenditures were only 58 percent ($38.4 million) of the amount authorized. A number of factors contributed to this smaller-than-expected program: (1) late 1990 authorization of CSLA and subsequent delay in regulations, application procedures, and State selection put back the first program enrollments by 16-22 months; (2) simultaneously expanded Federal latitude allowed rapid growth of Medicaid Home and Community Based Services; (3) implementers found that planning and designing services "one person at a time" were slower than expected; (4) States experienced delays in establishing the new systems of quality assurance required by the CSLA program; and (5) recruitment was sometimes delayed by the inclusion of groups of persons who were not traditional users of developmental disabilities services and who were not already known to the system. The report concludes that specific financing problems limit the effectiveness of the program. (Final report: 54 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Samuel L. Brown

PHONE NUMBER: (410) 786-6667

PIC ID: 6304

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: Evaluation of the Community Nursing Organization Demonstration Interim Evaluation Report

ABSTRACT: This report examines a set of demonstration projects mandated in the Omnibus Budget Reconciliation of 1987. The legislation directed the establishment of demonstration projects to test a capitated, nurse-managed system of care. The two fundamental elements of the demonstration are capitation payment and nurse case management. It was designed to promote timely and appropriate use of community health services and to reduce the use of costly acute care services. By October 1995, more than 5,400 beneficiaries were enrolled in the four Community Nursing Organizations (CNOs). The evaluation report covers the first 15 months of operation. The applicants have been healthier and more independent, on average, than the general Medicare population in their respective market areas. Analyses of measures of death, physical functioning, and satisfaction with care detected no statistically significant differences. Analysis of a subsample of persons who were impaired in Activities of Daily Living indicated that members of the CNO treatment group were more likely to improve (or less likely to deteriorate further) than members of the control. An even stronger result, in the same direction, was found for individuals who were limited in Instrumental Activities of Daily Living. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Melissa Hulbert

PHONE NUMBER: (410) 786-8494

PIC ID: 6306

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Cambridge, MA

TITLE: Evaluation of the Effectiveness of the Operation Restore Trust Demonstrations

ABSTRACT: Operation Restore Trust (ORT) was jointly developed by the Office of Inspector General (OIG), the Administration on Aging (AoA), and the Health Care Financing Administration (HCFA) as a model to demonstrate improved methods for investigation and prosecution of fraud and abuse in health programs. ORT targets a set of initiatives that focus on a few States, a few areas of the Medicare benefit, and a few standard operating procedures (especially failures to coordinate among the most central agencies and to exploit available data resources). The report finds that (1) ORT is associated with a net increase of more than 100 percent in ORT-type cases investigated by the OIG; (2) these cases should generate substantial incremental receivables, some fraction of which will translate into true savings as collections are made; (3) HCFA and its contractors had a series of successful projects under ORT, with notably large collections or avoidances of payment accompanying many of these efforts, although it cannot be said with certainty that these savings would not have been realized without ORT; (4) ORT encourages several important policy changes made during, or immediately following, the demonstration; (5) ORT may have important "sentinel effects" (e.g., ORT may have deterred providers from certain kinds of suspect behavior); (6) there are considerable process effects of ORT; (7) giving the AoA a fraud and abuse mission led to active training, outreach, and education efforts; and (8) the infrastructure of information for combating fraud and abuse has significantly improved, although these improvements include many efforts outside ORT itself. The evaluation concludes that ORT turned around certain troubling trends of the early 1990s and has brought new vigor to government efforts to combat health care fraud and abuse.

AGENCY SPONSOR: Office of Financial Management

FEDERAL CONTACT: Edward Norwood

PHONE NUMBER: (410) 786-6571

PIC ID: 6311

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Cambridge, MA

TITLE: The Impact of Report Cards on Employees: A Natural Experiment

ABSTRACT: This report seeks to determine whether the dissemination of information about health plans to consumers (who choose health plans within a managed care competition framework) would influence their knowledge of plan characteristics, attitudes toward the plans, or choice of plan. Investigators found no "report card" effect on employees' knowledge of health plans, their attitude about quality of health plans, or their choices in selecting a managed care health plan. The study did find that certain health plan characteristics (such as price) were strongly related to health plan choice. The investigators suggest that the current versions of health plans are works in progress and that consumers do not seem to be influenced by the information in any of the ways measured in this study. (Final report: 41 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: (410) 786-6601

PIC ID: 6312

PERFORMER ORGANIZATION: Park Nicollet Medical Foundation, St. Louis Park, MN

TITLE: Consequences of Paying Medicare HMOs and Health Care Prepayment Plans (HCPPs)

ABSTRACT: This study examined the operational aspects of health care prepayment plans (HCPPs) and the cost-effectiveness of cost health maintenance organizations (HMOs) and HCPPs. The report contains a case study of HCPPs: it looks at plans' utilization management and quality assurance programs, marketing practices, and contingency plans in case of insolvency. It also examines the cost-effectiveness to the Health Care Financing Administration (HCFA) of cost HMOs and HCPPs with respect to the fee-for-service and risk contracting program during calendar year 1993. The report found that costs to HCFA increased substantially under both the cost HMO and HCPP programs. Cost increases relative to fee-for-service were larger than those relative to the risk-based approach. Only a handful of the 63 plans examined appeared to have generated savings for HCFA. The main reason for the cost increase appears to be a lack of incentive for plans to drive hard bargains with physicians on prices. Furthermore, the report found that most of the cost-based plans experienced favorable selection, where the relatively more healthy segments of the population are enrolled. (Final report: 178 pages, plus appendices.)

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Ron Lambert

PHONE NUMBER: (410) 786-6624

PIC ID: 6314

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Toward a Prospective Payment System for Outpatient Services: Implementation for Outpatient Services-Implementation of APGs by State Medicaid Agencies and Private Payers

ABSTRACT: This report studies a Medicaid outpatient prospective payment system, which groups patients for payment purposes rather than paying on a cost basis. These groups are similar in concept to diagnosis-related groups, which form the heart of Medicare's prospective payment system for inpatient care. It involved a case study of Iowa's implementation of the ambulatory patient group (APG) system and an analysis of the reimbursement methodology. This report has two components: an in-depth study of three operational APG systems (based on site visits) and telephone interviews with other payers that have implemented or planned to implement the system. All six payers with operational experience tailored their APG systems to their own priorities and markets. They all implemented the system without major incident. The payers reported success in reducing outpatient costs, where that was the immediate goal, and they believe the system encourages higher-cost facilities to reduce costs and rewards lower-cost facilities. Providers' views were more mixed. Though they reported generally adequate overall payment, they also viewed the system as complex, had difficulty calculating expected payment, and often let payer computer systems group related claims rather than consolidating them prior to submission, as was the intent of the system. No evidence was found of much behavioral response by providers, but that could change if the system is implemented by a large payer such as HCFA. (Final report: 78 pages.)

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Joe Cramer

PHONE NUMBER: (410) 786-6676

PIC ID: 6320

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Payment of Pharmacists for Cognitive Services: Results of the Washington State C.A.R.E. Demonstration Project

ABSTRACT: The Washington Cognitive Activities and Reimbursement Effectiveness (C.A.R.E.) Project was a demonstration authorized under the Omnibus Budget Reconciliation Act of 1990 to assess the impact of a financial incentive on pharmacists' performance of cognitive services. The premise of this demonstration was that direct reimbursement for pharmacists' cognitive services will remove financial barriers associated pharmacists' provision of these services and result in increased performance of cognitive services, with a subsequent impact on costs and outcomes. Data for the demonstration were drawn from three groups of pharmacies located throughout the State of Washington, each of which contained about 100 pharmacy sites. Pharmacists in the first two groups documented cognitive services for Medicaid patients using a problem-intervention-result format. The demonstration phase lasted from February 1994 through September 1995 and resulted in the documentation of 20,240 cognitive service events. The project found that (1) Group A pharmacists, who received financial incentives, consistently reported higher cognitive service intervention rates than did Group B, who did not receive financial incentives; (2) about half of all documented cognitive services problems were for patient-related problems, while 32.6 percent were for drug-related problems, 17.6 percent for prescription-related problems, and 1.4 percent for non-drug-related problems; (3) a drug therapy change occurred as a result of 28 percent of all cognitive services; (4) for each cognitive service associated with any type of drug therapy change, the average downstream drug cost savings was about $13, but these savings varied by type of drug therapy; and (5) the Medicaid program saved about $78,000 due to cognitive services resulting in drug therapy changes. The report concludes that the implementation of a prescription drug-related cognitive services documentation and reimbursement system is feasible and useful.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Jay Bae

PHONE NUMBER: (410) 786-6591

PIC ID: 6528

PERFORMER ORGANIZATION: University of Washington, School of Medicine, Seattle, WA

TITLE: Assessing the Viability of All-Payer Systems for Inpatient Hospital Services

ABSTRACT: This report explores the feasibility and possible structure of alternative approaches to developing an all-payer prospective system for reimbursing hospitals for inpatient care. The study tests the practicality of adapting or extending Medicare's Prospective Payment System (PPS) to either other payers or all payers as part of the health care reform legislation proposed by the Clinton Administration in 1993. The initial tasks were the development of data files necessary to construct such an all-payer PPS. The most basic components of a PPS are payment weights, rates, and adjustors. Separate analytic steps are required in order to derive each of these components, and several different types of data are required to complete each of these analytic tasks. Admission records are needed and must be categorized according to a specified classification system. Hospital-specific cost data by payer category are required to calculate costs per case, and hospital and area characteristic data are required in order to judge the need for and level of payment adjustors. Once these data were developed, they were used in two analyses: one addressing whether diagnosis-related group (DRG)-based payment rates for Medicare and non-Medicare patients should be adjusted based on hospital characteristics, and one focusing on an alternative approach to defining the Medicare standardized prospective payment rate. The report finds that current PPS rates are based on the mean adjusted cost for a given category of hospital, and that high-cost hospitals are penalized under the assumption that their costs are reflective of presumed inefficiency. The report develops hospital-specific measures of inefficiency and then excludes the costs of inefficient hospitals from the calculation of standardized payment rates. The report concludes that a frontier cost function model approach is superior to the current system and can result in substantial program savings. See also PIC ID No. 6594.1.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Jesse Levy

PHONE NUMBER: (410) 786-6600

PIC ID: 6594

PERFORMER ORGANIZATION: Urban Institute, Washington, DC

TITLE: Second Update of the Geographic Practice Cost Index: Final Report

ABSTRACT: The Geographic Practice Cost Index (GPCI) is an input price index used to adjust Medicare Fee Schedule (MFS) payments for area variations in physicians' cost of practice. The original GPCI was implemented with the MFS in 1992. In 1995 and 1996, the GPCI was updated with 1990 Decennial Census data. This report documents the second update of the GPCI, which is scheduled to be fully phased in on January 1, 1999. During the previous year, 1998, a transition will occur between the 1997 GPCI and the updated 1999 GPCI, with one-half the total change implemented in 1998. The comparison between the 1997 and the 1999 GPCIs shows that (1) there is no change between the physician work GPCI or the non-physician employee wage index of the practice expense GPCI except that they are reweighted with 1994 county relative value units (RVUs); (2) the office rental index of the practice expense GPCI is updated with fiscal year 1996 Fair Market Rents published by the Department of Housing and Urban Development; (3) county rental adjustment factors are eliminated for all metropolitan areas, except for the New York City Primary Metropolitan Statistical Area; (4) the malpractice GPCI is updated with 1992, 1993, and 1994 premium data, and specialty premiums are weighted by national RVU proportions rather than allowed charges; (5) there is no change in the GPCI cost shares, which measure the share of the various inputs in total practice revenues; and (6) the county RVUs used to weight averages of county input prices for each Fee Schedule Area (FSA) are updated from 1992 to 1994. The report also examines changes in the Geographic Adjustment Factor between 1999 and 1997. It determines that changes in MFS payments resulting from implementation of the 1999 GPCIs will be small (less than 2.5 percent for each FSA). See also 5764 series. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Benson Dutton

PHONE NUMBER: (410) 786-6603

PIC ID: 6611

PERFORMER ORGANIZATION: Health Economics Research, Incorporated, Waltham, MA

TITLE: Validation of Nursing Home Quality Indicators Study

ABSTRACT: This study developed a system by which a series of Quality Indicators (QIs) could be used in conjunction with claims data to monitor quality of care in nursing home facilities. Fifty QIs were developed and validated using a sample of nursing home residents' medical records for a 6-month period surrounding the time of nursing facility's Federal certification survey. The QIs focus on the occurrence of three broad potential problem areas, including adverse outcomes, lack of therapy, and inappropriate pharmaceutical treatments. The QI algorithm used ICD-9 CM diagnosis codes and CPT-4 and CRVS procedure codes to generate the QIs. These codes represent either medical or surgical conditions that define the indicator events (e.g., inpatient stay or emergency room visit), the covariant diagnoses, or case selection factors. It is anticipated that these validated QIs could be used as the basis for an automated system to continuously monitor the quality of care provided in federally certified nursing homes to assist Federal and State surveyors in implementing the survey process effectively. Such a system could contribute to lowering the costs of care and improving outcomes for Medicaid nursing home residents by reducing the incidence of potentially avoidable hospitalization and over-medication. The two volume report finds that (1) the utility of basing indicators of quality of nursing home care on Medicaid and Medicare claims data is clearly demonstrated; (2) the study QIs as a whole were generally better at predicting the absence of a quality issue, suggesting that the negative finding on the quality indicator represented the lack of a quality concern in the nursing home; and (3) using covariant diagnoses to adjust for the risk of a resident receiving a QI tag is useful. The report concludes with a discussion of the issues raised during the validation of the 50 QIs examined here. (Volume I: 88 pages; Volume II: appendices variously paginated.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Kay Lewandowski

PHONE NUMBER: (410) 786-6657

PIC ID: 6612

PERFORMER ORGANIZATION: MEDSTAT Group, Cambridge, MA

TITLE: 1995 Influenza Immunizations Paid for by Medicare: State and County Rates

ABSTRACT: In 1993, the Health Care Financing Administration began paying providers for influenza vaccine and its administration to Medicare beneficiaries aged 65 and older. This data book provides information about the national, State, and county rates of influenza vaccination in the Medicare fee-for-service (FFS) sector. Medicare-managed care beneficiaries are not counted. The data book presents maps that report rates as integers for ease of presentation. It also presents tables that measure rates to one tenth of one percent. State rates are also presented. The data book provides three tables for each State: (1) a table providing the State's rates and numbers of influenza immunizations for 1994 and 1995 according to age, gender, and race; (2) a table showing the State's number of elderly enrolled in Medicare Part B FFS and the number of individuals who received flu shots in 1995 according to race and county; and (3) a table presenting corresponding immunization rates for 1994 and 1995 according to race and county. The data show that (1) about 41 percent of elderly Medicare beneficiaries received an influenza vaccination in 1995 that was paid for by Medicare; (2) for all sectors of this population, there was an increase over 1994 immunization rates ranging from 2.3 percent to 6.4 percent, indicating progress toward the Healthy People 2000 goal of a 60 percent influenza immunization rate for this population; (3) African-American beneficiaries have an immunization rate one-half that of Caucasian beneficiaries, although between 1994 and 1995, the increase in the rate of immunizations was slightly greater for African Americans than for Caucasians; (4) there is no substantial variation in rates by gender; and (5) immunization rates are lowest for those beneficiaries 85 years and older. (Final report: 279 pages.)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Marsha Davenport

PHONE NUMBER: (410) 786-6693

PIC ID: 6615

PERFORMER ORGANIZATION: Health Care Financing Administration, Baltimore, MD

TITLE: Impact of the Medicare Fee Schedule on Teaching Physicians

ABSTRACT: Prior to the implementation of the Medicare Fee Schedule (MFS) in 1992, several studies were conducted to determine the impact of this payment change on various groups of physicians. However, no studies examined the potential impact of the MFS on teaching physicians, even though anecdotal evidence from academic practices suggested that these physicians would be particularly hard hit for four reasons (1) teaching physicians perform relatively more high-technology procedures and less primary care, which could result in disproportionate net losses for many academic practices; (2) teaching hospitals and medical schools tend to be located in large urban areas, where the Geographic Practice Cost Index portion of the payment is lower; (3) customary charges for teaching physicians may be higher than the area-wide historical payments calculated for fee schedule transition; and (4) a number of academic medical practices had not signed Medicare participation agreements. This study determines the impact of the MFS on teaching physicians and examines variations in the impact across academic medical centers, other major teaching hospitals, and minor teaching hospitals. The net effects of MFS price changes and any observed quantity changes on inpatient physician revenues were examined. A total of 720 hospitals were selected for this study, including all U.S. academic medical centers. The report finds that there is no evidence that teaching physicians have been adversely impacted by the MFS. Inpatient revenues per admission fell by the same percentage amount in all types of hospitals. Revenues fell because of a reduction in prices and in the quantity of services provided per admission. Thus, while the theoretical expectation was that teaching physicians would have experienced a disproportionately large reduction in their average price per service, in practice these physicians have altered that service mix by providing less RVU-intensive visits.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: William Buczko

PHONE NUMBER: (410) 786-6593

PIC ID: 6666

PERFORMER ORGANIZATION: Center for Health Economics Research, Waltham, MA

TOP OF DOCUMENT

HEALTH RESOURCES AND SERVICES ADMINISTRATION

Contents

Institutional Factors Which Influence the Likelihood of Living-Related Kidney Transplant Operations-- Phase II

Exploratory Study of Reasons Kidney Transplant Waiting List Patients are Unavailable for Organ Offers

Community Health Center User and Visit Study: Survey Methodology Report

Healthy Schools, Healthy Communities National Evaluation: Final Report

Exploratory Evaluation of Rural Applications of Telemedicine

Development of a Performance Management System for Ryan White Titles I, II, and SPNS

Development of a Performance Measurement System for the Division of Organ Transplantation

Profiles of Activities to Reduce Perinatal Transmission of HIV: Assessing the Response

Grantee-Level Evaluation Activities of the HIV/AIDS Programs of the Ryan White CARE Act

Bilingual Assistance Program Evaluation, Part I: Strategies for Reducing Cultural and Linguistic Barriers to Health Care for Hispanic and Asian/Pacific Islander Populations

Examining Relationships Between HIV/AIDS and Tuberculosis Programs in Title I Eligible Metropolitan Areas

Availability of Primary Care Services Under Medicaid Managed Care: How 14 Health Plans Provide Access and the Experience of 23 Safety Net Providers and Their Communities

The Registered Nurse Population, March 1996: Findings from The National Sample Survey of Registered Nurses

Service Integration for Multi-Risk Patients: Final Report

Measuring Expenditures for Personal Health Care Services Rendered by Public Health Departments

HIV Capitation Risk Adjustment Conference Report

TITLE: Institutional Factors Which Influence the Likelihood of Living-Related Kidney Transplant Operations-Phase II

ABSTRACT: Most transplant surgeons and physicians believe that kidneys can be obtained from live donors in a safe and effective manner, and that kidneys from live donors provide superior long-term graft survival rates for transplant recipients. Between 1987 and 1993, for example, the 1- and 2-year survival rates for patients who had received kidney transplants through living-related donations (LRDs) was superior to that of patients who had received cadaveric kidneys. The rate of living-related kidney transplantation varies considerably among States, however. This project assessed (1) the willingness of the transplant community to conduct, and the frequency with which it has conducted, kidney transplants from LRDs; (2) the medical and nonmedical institutional factors that influence decision making by transplant professionals about suggesting and conducting a living-related kidney transplant; (3) the range of transplant center responses to, and procedures for, living-related transplants; and (4) the circumstances and conditions under which a transplant team that does not encourage living-related transplants would refer a patient to another transplant center for evaluation. This study is based on a mail survey of kidney transplant centers in the Fall of 1995, which yielded an 80 percent response rate. A key finding is that while attitudes toward LRDs among transplant professionals are generally positive, survey respondents identified a number of deterrents to LRDs that are not related to characteristics or practices of individual transplant centers. Some of these factors relate to the characteristics of the individual patient and his or her family. Among the recommendations is that transplant centers distribute educationally and culturally appropriate materials about policies and procedures related to LRDs. (Executive Summary: 10 pages; final report: 78 pages, plus appendices.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: D. W. Chen

PHONE NUMBER: (301) 443-4111

PIC ID: 4917.1

PERFORMER ORGANIZATION: George Washington University, Washington, DC

TITLE: Exploratory Study of Reasons Kidney Transplant Waiting List Patients are Unavailable for Organ Offers

ABSTRACT: Studies conducted in the early 1990's to examine the efficiency of the organ allocation system identified an additional factor that might influence the equitability of allocation decisions: patient unavailability and refusal of an organ. This study (1) further examines the extent of the problem of patient unavailability for, or refusal of, an organ offer; (2) explores the reasons underlying patient unavailability and patient refusal when an organ offer is made; (3) highlights strengths and weaknesses in recordkeeping and reporting practices; and (4) makes recommendations for improving the procedures for notifying patients of an organ offer. The contractor conducted telephone interviews with three groups: transplant center staff who make organ offers, transplant waiting list patients who had refused an offer or had been unavailable when staff tried to make an offer, and recent transplant recipients. Interviews with study participants, drawn from 31 randomly selected transplant centers, were conducted between November 1995 and September 1996. The major finding was that both patient unavailability and refusal occur but are not significant issues at most centers. (Final report: 38 pages, plus appendix.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: D. W. Chen

PHONE NUMBER: (301) 443-4111

PIC ID: 5601

PERFORMER ORGANIZATION: Battelle Human Affairs Research Centers, Seattle, WA

TITLE: Community Health Center User and Visit Study: Survey Methodology Report

ABSTRACT: This project collects data on users of Community Health Centers (CHCs) and the services they use. The sample survey has two components: (1) a personal interview survey of 1,932 randomly selected patients at a representative sample of 48 CHCs, and (2) data extraction from 2,878 medical records concerning randomly selected encounters at the same centers. Clients and visits are surveyed using modified versions of two National Center for Health Statistics (NCHS) surveys: the National Health Interview Survey and the National Hospital Ambulatory Medical Care Survey, to capture the full range of users and services provided at a particular point in time. This approach allows for comparison of data on CHC populations with national estimates derived from the NCHS surveys. The project provides demographics of users, their reasons for seeking care, diagnoses, services used, and self-reported outcomes. The User and Visit Survey is part of an overall Health Resources and Services Administration (HRSA) evaluation strategy for collecting data regarding users, services, and outcomes of primary care programs. HRSA will be developing further reports based on the survey findings. (Final report: 147 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: (301) 594-4280

PIC ID: 5737

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Healthy Schools, Healthy Communities National Evaluation: Final Report

ABSTRACT: This project develops and implements a design to collect uniform data on access, use, and continuity of care in the Healthy Schools, Healthy Communities Program (HSHC). The Health Resources and Services Administration's (HRSA's) HSHC program is the first Federal categorical grant program specifically targeted to school-based health centers, and is jointly funded and administered by the Bureau of Primary Health Care and the Maternal and Child Health Bureau. The study includes the 25 (of 27) school-based health centers (SBHCs) funded initial projects that were first fully operational during the 1995-1996 school year. This evaluation, implemented concurrently with the HSHC program, was intended to document change in the students' ealth status, utilization of services, and outcomes related to the SBHC interventions. There are two data sources: a student-based clinical data system and a student/parent survey. Findings are informing the activities of participating grantees and the content of policies for grantees that join the program in FY 1998 or FY 1999. In addition, HRSA has gained new insights into collecting data from children and on working with school-based records.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: (301) 594-4450

PIC ID: 5739

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Exploratory Evaluation of Rural Applications of Telemedicine

ABSTRACT: The purposes of the Health Resources and Service Administration's (HRSA's) Rural Telemedicine Grant Program (RTMG) are (1) to facilitate the development of rural health care networks through the use of telemedicine, and (2) to develop a data base for systematic evaluation of rural telemedicine systems. This baseline study concerned (1) the current status of telemedicine in rural health; (2) the effects of telemedicine on access to care, practitioner isolation, and development of health care networks; (3) the organizational factors that aid or impede successful development and implementation of telemedicine systems; and (4) development, testing, and refinement of data collection instruments for use in subsequent evaluations. The study focused on telemedicine projects that link one or more rural hospitals or ambulatory sites ("spoke sites") with a multispecialty entity ("hub site"). A hub site might be a tertiary care hospital, a multispecialty clinic, or a set of facilities that, when combined, provide the required range of specialty consultations. In addition, the study was limited to systems that employ real-time or asynchronous video imaging systems. Data sources for the evaluation include three mail surveys to identify and describe telemedicine systems, and site visits to four networks. The report presents recommendations on the content of future evaluations and on data gathering approaches. Results have influenced the FY 1997 RTMG application guidelines and the content of authorizing legislation. The report has been distributed to other Federal agencies that fund telemedicine projects and to State Offices of Rural Health. Findings are being incorporated into the design of a common telemedicine evaluation instrument for use by HRSA grantees, and by other Federal funders at their option. Finally, five articles based on the study have been published and numerous presentations have been given.

AGENCY SPONSOR: Office of Rural Health Policy

FEDERAL CONTACT: Cathy Wasem

PHONE NUMBER: (301) 443-0835

PIC ID: 5749

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Cambridge, MA

TITLE: Development of a Performance Management System for Ryan White Titles I, II, and SPNS

ABSTRACT: In the public sector, efforts to monitor program effectiveness go under the rubric of "reinventing government." Several legislative and executive initiatives, particularly the Government Performance and Results Act of 1993 (GPRA), spur the movement to establish measurable performance goals that can be reported as part of the budgetary process, thus linking funding decisions to performance. GPRA requires each Federal agency to develop comprehensive strategic plans, annual performance plans with measurable goals and objectives, and annual reports on actual performance compared to goals. This report focuses on the response to GPRA undertaken by the Bureau of Health Resources Development (now called the HIV/AIDS Bureau) within the Health Resources and Services Administration (HRSA) in regard to Titles I, II, and Special Programs of National Significance (SPNS) of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. The major results of this project were the development and articulation of an interactive process to be used in the development of a performance measurement system. This process includes (1) a clear articulation of the purposes and objectives of Ryan White Titles I, II, and SPNS; (2) linkage of these purposes and objectives to the broader functions of HRSA; (3) using program purposes and functions, and a clear understanding of accountability, responsibility, and activity throughout the programs, to enable the performance measurement system to capture the individual properties and components of each; (4) developing standard performance terminology and definitions; (5) identification of seven performance dimensions and linking them to the purposes and functions of the programs; and (6) identifying and narrowing potential measures for program performance. The report concludes with several recommendations for implementing a performance measurement system for these three programs. See also PIC ID Nos. 5954 and 5954.2.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Katherine Marconi

PHONE NUMBER: (301) 443-6560

PIC ID: 5954.1

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Development of a Performance Measurement System for the Division of Organ Transplantation

ABSTRACT: The Government Performance and Results Act of 1993 (GPRA) links funding decisions to program performance by calling for the designation of measurable performance goals that can be reported as part of the budgetary process. GPRA requires each Federal agency to develop comprehensive strategic plans, annual performance plans with measurable goals and objectives, and annual reports on actual performance compared to goals. This report focuses on the response to GPRA undertaken by Division of Organ Transplantation (DOT) within the Health Resources and Services Administration. The report provides a conceptual framework for the organ and bone marrow transplantation programs; outlines a recommended performance management system (including an articulation of program purposes and functions, language and tools of performance measurement, criteria for selecting measures and indicators, and identification of potential measures); and recommends next steps. These next steps include (1) identification of a process for selection of measures and indicators for DOT programs, (2) selection of the most important measures from the potential group, (3) identifying supporting data and data needs and gaps, (4) preparing an annual performance plan designed to meet GPRA requirements, and (5) identifying technical assistance needs for making a performance management system operational. See also PIC ID Nos. 5954 and 5954.1. (Final report: 26 pages.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: Katherine Marconi

PHONE NUMBER: (301) 443-6560

PIC ID: 5954.2

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Profiles of Activities to Reduce Perinatal Transmission of HIV: Assessing the Response

ABSTRACT: In August 1994, the Public Health Service (PHS) published recommendations for the use of zidovudine (ZDV) to reduce perinatal transmission of HIV in response to findings from the Pediatric AIDS Clinical Trials Group (ACTG) 076 by the National Institutes of Health (NIH). In December 1995, the Health Resources and Services Administration (HRSA) issued a Program Advisory entitled "Use of Zidovudine (ZDV) to Reduce Perinatal HIV Transmission in HRSA Funded Programs," which provides background information and specific strategies and options for implementing the PHS recommendations. This study evaluates HRSA's activities in implementing the recommendations through case studies of Florida, Mississippi, Missouri, New Jersey, Puerto Rico, Texas, and Washington. Qualitative methods were used to describe the following for each site: (1) demographic and socioeconomic factors affecting HIV/AIDS prevention and care services, (2) nature of the HIV/AIDS epidemic, (3) structure of the public health system, (4) structure of the State health department, (5) structure of HIV/AIDS services, (6) issues affecting HIV/AIDS prevention and care services, (7) relevant policies and activities prior to the release of the ACTG 076 findings, and (8) specific responses to the ACTG 076 findings and PHS recommendations. The study finds that where providers have responded to the ACTG 076 findings, the results are extremely positive. Despite the complexities of the ZDV regimen, the majority of women elect to participate in the regimen after being informed about it, believing that the advantages outweigh the disadvantages. The study has been widely disseminated to HRSA HIV/AIDS and primary care providers and has been used in assessing the incidence of perinatal HIV transmission. (Final report: 101 pages, plus appendices.)

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds

PHONE NUMBER: (301) 443-6560

PIC ID: 6202

PERFORMER ORGANIZATION: U.S. Conference of Mayors, Washington, DC

TITLE: Grantee-Level Evaluation Activities of the HIV/AIDS Programs of the Ryan White CARE Act

ABSTRACT: This study provides a systematic review and synthesis of current Health Resources and Services Administration (HRSA) HIV-related evaluation activities conducted at the grantee level to identify gaps and set national funding priorities across HRSA HIV programs. The study, requested by the HRSA AIDS Advisory Committee, reviews grantee evaluation activities over the October 1995-October 1996 period. Studies are categorized by type (formative, process, outcome/impact, or economic). The information derived from this study is being used to improve the evaluation of HRSA HIV programs. One of the project outcomes is a current study to assess client satisfaction. In addition, HRSA is developing a series of technical manuals to assist grantees with issues of methodology and capacity for evaluation. The first of these manuals to be published, "Choosing and Using an External Evaluator," has been sent to all CARE Act grantees and will be made available to others upon request. (Final report: variously paginated.)

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds

PHONE NUMBER: (301) 443-6560

PIC ID: 6256

PERFORMER ORGANIZATION: Academy for Educational Development, Washington, DC

TITLE: Bilingual Assistance Program Evaluation, Part I: Strategies for Reducing Cultural and Linguistic Barriers to Health Care for Hispanic and Asian/Pacific Islander Populations

ABSTRACT: The Disadvantaged Minority Health Improvement Act of 1990 authorized the Bilingual Assistance Program, a 3-year initiative to improve the health status of racial and ethnic minorities. Under the program, the Health Resources and Services Administration (HRSA) awarded grants to three national organizations (the Association of State and Territorial Health Officials, the National Association of County Health Officials, and the U.S. Conference of Local Health Officials) which, in turn, awarded grants in 1993 to 13 State and local health departments. The purpose of the local projects, which were selected competitively, was to reduce cultural and linguistic barriers to health care among Asian/Pacific Islander and Hispanic populations. This study examines (1) factors that allow the local projects to leverage Federal funding and promote improved interagency working relationships; (2) realistic approaches to setting performance measures; (3) technical assistance needs of grantees, including exploring the use of national minority organizations and mentors; and (4) the replicability of the products or training curricula developed by the grantees. This is the first volume of a two-part final report; the second volume is entitled "Assessment of Three Training Curricula." The study was carried out through site visits conducted during April-June 1996 and a review of background documentation. HRSA's Office of Minority Health has shared the study products with interested groups. (Final report: variously paginated.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Laura Diaz-Baker

PHONE NUMBER: (301) 443-9966

PIC ID: 6356

PERFORMER ORGANIZATION: MDS Associates, Incorporated, Wheaton, MD

TITLE: Examining Relationships Between HIV/AIDS and Tuberculosis Programs in Title I Eligible Metropolitan Areas

ABSTRACT: This project (1) determines the extent to which specific Ryan White Comprehensive AIDS Resource Emergency (CARE) Act Title I grantees are providing guidance to funded providers on tuberculosis (TB) screening, prophylactic, and therapeutic regimes; and (2) describes working models of collaboration between human immunodeficiency virus (HIV) and TB control programs within individual Eligible Metropolitan Areas (EMAs). In March 1995, the 34 EMAs were asked to provide a brief description of TB epidemiology in the EMA, along with specific information regarding collaboration among programs to treat people co-infected with HIV and TB; 30 responded. A literature review provides background for site visits to seven EMAs. The visits were conducted to gain more detailed information about the nature of partnerships between TB and HIV/AIDS programs that result in the most successful models of TB prevention and control within Title I-funded programs, as well as to identify programmatic configurations that result in poorly implemented TB services at these sites. The study finds that TB was prevalent in EMAs, and that services vary across EMAs and across different care settings within them. Study results are being used in developing Title I program guidance and in planning for training and technical assistance. The report has been sent to CARE Act and TB control grantees.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: (301) 443-9052

PIC ID: 6359

PERFORMER ORGANIZATION: Matthew McClain, Philadelphia, PA

TITLE: Availability of Primary Care Services Under Medicaid Managed Care: How 14 Health Plans Provide Access and the Experience of 23 Safety Net Providers and Their Communities

ABSTRACT: This study examines strategies used by health maintenance organizations (HMOs) to generate access to health care services for Medicaid enrollees, who often live in inner city and rural underserved areas. The project also explores the implications of these strategies for overall access in underserved areas and for existing care providers. Third, the study considers how these strategies affect traditional Medicaid providers in the community. The study involved interviews and collection of secondary data at 14 HMOs with significant Medicaid enrollment, and at 23 traditional safety net providers, of which 13 were Community Health Centers. The study concluded that Medicaid managed care has had an overall positive effect on the availability of primary care to low-income residents in the 14 communities, and that the traditional safety net providers have not needed to reduce services. However, the future viability and range of services of public sector-supported providers might be endangered in a more competitive health system. The information derived from this study will be useful to policymakers concerned with the provision of appropriate care for vulnerable populations, providers in underserved areas, and those attempting to assure an adequate supply of health care personnel. The study has attracted attention in the professional community, as in a story in the American Medical News. In addition, an article under preparation for submission to a professional journal will reference this study, among other sources. (Appendices to the report are bound separately.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: (301) 443-0371

PIC ID: 6366

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Washington, DC

TITLE: The Registered Nurse Population, March 1996: Findings from The National Sample Survey of Registered Nurses

ABSTRACT: The Sixth National Sample Survey of Registered Nurses gathered data to evaluate trends in the number, characteristics, and distribution of registered nurses in the United States. This study builds on the sample design and procedures developed in earlier surveys. Sampling procedures are devised to assure (1) the cooperation of all States and the District of Columbia, and (2) an overall response rate of 80 percent. The study resulted in a data base of 29,950 coded individual record responses, with weights for estimating characteristics of the sample universe, estimates of variances for key variables, and a technical procedures report prepared by the contractor. Health Resources and Services Administration (HRSA) staff then analyzed the data and developed the report named above. Results from this study will (1) be used in biennial reports to Congress to describe characteristics of the registered nurse population, (2) contribute to the data base underlying models used to project nurse supply and requirements; and (3) serve as input to analyses and evaluation of HRSA's nursing education programs and plans for future Federal programs to assure appropriate nursing resources. In addition, the nursing community will use the data base, the most comprehensive source of statistical information on registered nurses in the United States. (Final report: 30 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Evelyn Moses

PHONE NUMBER: (301) 443-1451

PIC ID: 6367

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

TITLE: Service Integration for Multi-Risk Patients: Final Report

ABSTRACT: This study examines how selected community-based health care organizations integrate services for people with multiple risk factors (e.g., pregnancy, substance abuse, HIV/AIDS, and homelessness) for poor health outcomes. Since these conditions often overlap, the health care organization must integrate services to meet the needs of these individuals with multiple risks. This study targets six Community Health Centers and local health departments currently receiving funding from a combination of Health Resources and Services Administration (HRSA) programs. The report uses site visits, interviews, focus groups, and discussions to explore several topics, including (1) community-based health care organizations' use of multiple funding sources to provide integrated services to patients with multiple risk factors, (2) barriers to integration of services created by separate funding streams that target specific high-risk populations, (3) successful integration strategies used by organizations, and (4) ways in which HRSA might reduce barriers created through multiple funding streams. Based on these strategies, the report identifies characteristics of organizational approaches that facilitate integration and makes recommendations for addressing barriers to service integration. The report has been distributed to all the HRSA primary care grantees. Results will also be shared through articles in peer-reviewed journals. (Final report: variously paginated.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: (301) 594-4450

PIC ID: 6369

PERFORMER ORGANIZATION: MDS Associates, Incorporated, Wheaton, MD

TITLE: Measuring Expenditures for Personal Health Care Services Rendered by Public Health Departments

ABSTRACT: As changes to the health care delivery system continue to occur, the way in which public health departments provide services may be affected in a very significant manner, making it critical for policymakers, managers, and researchers to be able to assess the impact of these changes on the public health infrastructure. Therefore, the Health Resources and Services Administration commissioned this report, which develops a categorization schema for reporting comparable information on State and local health department personal health care services. The project initiates development and testing of a methodology to collect consistent and complete expenditure data on State and local health department services directed toward individuals. Officials from 11 State and local health departments and 1 State association of local health officials assisted in the development of a survey instrument, which was tested by State health departments in Arizona, Iowa, and Rhode Island and by local health departments in Austin/Travis County, Texas, and New York City, New York. The report finds that (1) the provision of personal health care services accounts for nearly 50 percent of the health department expenditures in Austin/Travis County and 57 percent in New York City; (2) participants considered the methodology generally clear and potentially useful, although problems were encountered in trying to fit personal health care services into some survey categories; (3) among the survey respondents, Austin/Travis County is closest to the managed care end of the service delivery continuum and Iowa is closest to the traditional approach of delivering all services directly, bundling no services, and not using capitation; and (4) Rhode Island contracts for 99 percent of its services, and New York and Austin/Travis County offer a similar mix of department-run and contracted services. (Final report: 29 pages, plus appendices.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Michael Millman

PHONE NUMBER: (301) 443-0368

PIC ID: 6636

PERFORMER ORGANIZATION: Public Health Foundation, Washington, DC

TITLE: HIV Capitation Risk Adjustment Conference Report

ABSTRACT: Widespread adoption of managed care by public insurance programs (such as Medicaid) has raised concerns about whether capitated reimbursement affects the quality of care provided, especially to people with chronic illnesses or other special health care needs. One way to address these concerns is to create risk-adjusted capitation rates to provide equitable reimbursement for care of patients with costly illnesses, an approach several States had proposed or implemented by 1997. In May 1997, HRSA convened an invited conference to examine issues surrounding risk adjustment for HIV/AIDS, in collaboration with ASPE, HCFA, The Henry J. Kaiser Family Foundation, and the National Academy of State Health Policy. Participants included people living with HIV/AIDS and their advocates, providers of care, managed care plans, and purchasers, including representatives of State Medicaid programs. The report presents findings and recommendations concerning various risk-adjustment methods and their evaluation, issues related to the implementation of risk adjustment, and further research needed in each of these areas. Conference findings have been used in technical assistance to States on coordinating CARE Act programs with managed care. HRSA has distributed the report to all CARE Act grantees and to State Medicaid directors; the Kaiser Family Foundation, which financed production of the report itself, has also distributed it widely.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser

PHONE NUMBER: (301) 443-3075

PIC ID: 6894

PERFORMER ORGANIZATION: The Henry J. Kaiser Family Foundation, Washington, DC

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INDIAN HEALTH SERVICES

Contents

Evaluation of the Impact of the Alaska Tribal Health Compact on Programs and Services in the Anchorage Service Unit, Alaska Area

Prior Trauma Care of Intoxicated Patients as a Predictor of Subsequently Fatal Injury

TITLE: Evaluation of the Impact of the Alaska Tribal Health Compact on Programs and Services in the Anchorage Service Unit, Alaska Area

ABSTRACT: This evaluation is the first research undertaken to systematically study the perceptions of a wide range of beneficiaries, officials, and employees of the Indian Health Service (IHS) and the tribal system regarding the Alaska Tribal Health Compact, Title III Self-Governance Demonstration Project. There are almost 200 federally recognized tribes in a single Area-wide Compact, organized via 13 separate consigners-each of which has its own Annual Funding Agreement. Seven of these consigners are in the Anchorage Service Unit, which is one of nine Service Units in the Alaska Area. The overall conclusion of the evaluation is that there are more village representatives who have seen either no change or a negative change in in-village services than those who have seen a positive change. The perceptions of the officials and employees of the Alaska Native Medical Center and the Alaska Area Native Health Service have revealed problems in staff morale and shifts in workload resulting from Compact consigners transferring patients to the Alaska Native Medical Center who were previously treated outside the Anchorage Service Unit. These changes are considered as having a negative impact on the Anchorage Service Unit. The "microcosmic" view from the Ahtna Region indicates that there is a distinct difference in the perception of those who are participating in the Compact and those who are not participating. The analysis of the village respondent data, comparing the information that came from the Title III villages with the information from the Title I villages, further solidified the conclusion that individuals in villages that are not served by a Compact consigner hold a consistently more negative view than those who live in villages that are serviced by a Compact consigner.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Leo J. Nolan

PHONE NUMBER: (301) 443-4245

PIC ID: 6407

PERFORMER ORGANIZATION: Alaska Native Health Board, Anchorage, AK

TITLE: Prior Trauma Care of Intoxicated Patients as a Predictor of Subsequently Fatal Injury

ABSTRACT: This study was undertaken to identify intervention opportunities associated with nonfatal, alcohol-related injury contacts in Indian Health Service emergency departments and clinics that could, over time, decrease alcohol-related injury deaths in the Billings Area Indian Health Services. The concept was to determine the frequency of injury treatment recidivism, both alcohol- and nonalcohol-related, and further to determine if patterns can be established to suggest that injury death is predictable based on those previous nonfatal contacts. The findings indicate a high degree of recidivism and a strong correlation between non-fatal incidents and eventual injury death. This study further reveals that there is a high prevalence of alcohol in nonfatal injury-related incidents among this cohort. There appears to be a strong relationship between repeated episodes of nonfatal injury with alcohol as a contributing factor and subsequently fatal events among this cohort. These nonfatal episodes should serve as warning signals and opportunities for the application of effective alcohol intervention strategies.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Leo J. Nolan

PHONE NUMBER: (301) 443-4245

PIC ID: 6451

PERFORMER ORGANIZATION: Billings Area Indian Health Service, Billings, MT

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NATIONAL INSTITUTES OF HEALTH

Contents

The Status of Biomedical Research Facilities 1996

Evaluation of the National Research Service Award Research Training Programs

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

Rare Diseases Clinical Research Data base

The National Survey of Laboratory Animal Use, Facilities, and Resources

Promoting Safe and Effective Genetic Testing in the United States: Final Report of the Task Force on Genetic Testing

National Cancer Institute: Characterization of User Population and User Satisfaction of the PDQ Data base-- Documentation for Tracking System

Bridges to the Future: Program Evaluation

Academic Research Instruments and Instrumentation Needs in the Biological Sciences

A Study to Determine the Changes of Physician Prescribing of Antimicrobial Agents, Omeprazole, and H2-Receptor Antagonists for Peptic Ulcer Disease Two Years Following the NIH Consensus Conference on Helicobacter pylori

Toxicology and Environmental Health Information Resources: The Role of the National Library of Medicine

Evaluation of the International Cooperative Biodiversity Groups (ICBG)

Federal Interagency Forum on Aging-Related Statistics: Data Base News In Aging

Finding the Balance: Report of the National Institute of Mental Health Intramural Research Program (IRP) Planning Committee

TITLE: The Status of Biomedical Research Facilities 1996

ABSTRACT: Since 1986, the National Science Foundation and the National Institutes of Health (NIH) have collected and reported to the Congress biennial information on the quantity and quality of biomedical research space. This report describes findings from the 1996 Survey of Scientific and Engineering Research Facilities at Colleges and Universities. The survey collected data from colleges and universities with research and development (R&D) expenditures exceeding $50,000, from Historically Black Colleges and Universities (HBCUs) with any R&D expenditures, and from a sampling of academic and nonprofit research organizations that received extramural research funding from NIH. The report found that (1) institutions performing biomedical research devoted approximately 67.4 million net assignable square feet to this work; (2) roughly half of survey respondents classified their medical science research space and/or biological science research space as inadequate; (3) expenditures to construct, renovate, and repair biomedical research space declined for the first time since NSF and NIH began collecting data; (4) the largest proportion of new construction was funded by State and local governments, while almost half of all institutions funded their own repair/renovation projects; and (5) 36 percent of all institutions with biomedical research space reported repair renovation projects that had to be deferred because funds were not available. In addition, the survey reported that HBCUs: (1) comprised 12 percent of the Nation's research-performing institutions, but contained only 1.8 percent of the national biomedical research space; (2) reported that 8 percent of their biomedical research space needed major repair/renovation to be used effectively; (3) have experienced a steady decline in new construction funding since the first survey in 1986 which reported expenditures of $42 million, to $0.2 million in 1994-5. (Final report: variously paginated.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Charles L. Coulter

PHONE NUMBER: (301) 435-0766

PIC ID: 3562.2

PERFORMER ORGANIZATION: National Science Foundation, Arlington, VA

TITLE: Evaluation of the National Research Service Award Research Training Programs

ABSTRACT: This project had several objectives. First, it conducted an evaluation design study, developing a detailed plan for a comprehensive evaluation of career outcomes of pre- and post-doctoral trainees and fellows and of the National Research Service Act (NRSA) programs in which they have participated. The evaluation developed recommendations promoting approaches that are successful in order to improve the return on Federal investment in research training. The second objective of the project was to characterize the nature and quality of the training actually experienced by the present and former trainees and fellows and to differentiate between a good training program and simply having good trainees. The project's third objective was to tap the perceptions of National Institutes of Health (NIH) staff, present and former NRSA trainees and fellows, and university employees about the nature and impact of the training program. The study developed performance indicators so that future evaluations may be based on data that are consistent across separate awards. The final report for this study will not be available until the Evaluation of NIH Post-doctoral Trainees and Fellows is completed in the summer of 1998. See PIC ID No. 6285.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Walter Schaffer

PHONE NUMBER: (301) 435-2770

PIC ID: 5571

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

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: 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 were 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 (R01s) funded under a Request for Applications (RFA) with individual research project grants funded from unsolicited applications. The methods, data bases, software, and results of this project will be used by other Institutes, Centers, and Divisions to evaluate their own funding mechanisms. The project examines the impact of NHLBI grants during the period 1982 through 1994 with respect to the number of biomedical research articles associated with grant programs, the number of subsequent citations to these articles, and the number of patent references to the original articles. The report finds that (1) about 12,500 grants resulted in over 90,000 research articles cited in over 2 million later articles; (2) 3,000 of the original articles are referred to in over 1,000 patents; (3) half of all cited articles are cited no more than 12 times over the 14-year period studied, although a few were cited over 1,000 times each; (4) two-thirds of articles referenced in patents appeared only once, although 3 articles are each referenced in over 20 patents; and (5) new RFAs result in higher than normal numbers of citations, but lower than normal number of patent references. (Final report: 11 pages, plus appendices.)

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: Rare Diseases Clinical Research Data base

ABSTRACT: The Rare Disease Clinical Research Data base (RDCRD) has been established by the Office of Rare Diseases (ORD), Office of the Director, National Institutes of Health (NIH). NIH made a commitment to the rare disease community and to the Congress to develop a mechanism for identifying and monitoring rare disease research supported by the NIH. The data base is similar in format to the Physician Data Query (PDQ) System of the National Cancer Institute. The International Cancer Information Center of NCI provided assistance in the development of the data base. Contact was made with 520 principal investigators and the 75 General Clinical Research Centers managers to determine those clinical trials in active states. The ORD retrieved 291 protocols from ongoing clinical trials to be included in the data base. Information from these protocols has been placed in abstracts and will be available from ORD's home page on the Internet. This development activity will continue, and the next two phases will include the development of information from clinical trials receiving support from the voluntary patient support organizations and the pharmaceuticals and biotechnology industries. ORD will continue to seek information from newly supported clinical trials receiving support from NIH. Information on specific rare diseases is difficult to locate; and, in many cases, the public, confronted with penetrating the NIH information system, reported difficulties gaining access to it. The RDCRD will eliminate this problem by providing an easy-to-use interface between the user and the data base information system. The data base contains up-to-date information that is easily accessible to a diverse user population. This information will facilitate patient and physician access to this information and lead to improved recruitment of patients with rare diseases or conditions into NIH-sponsored clinical trials. (Final report: 8 pages.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Stephen C. Groft

PHONE NUMBER: (301) 443-6156

PIC ID: 6043

PERFORMER ORGANIZATION: Oak Ridge Associated Universities, Oak Ridge, TN

TITLE: The National Survey of Laboratory Animal Use, Facilities, and Resources

ABSTRACT: This report summarizes the results of the survey conducted by the National Institutes of Health (NIH) on animal-based research for fiscal year (FY) 1993. NIH is responsible for oversight of the nationwide infrastructure required to pursue basic biomedical and behavioral research including laboratory animals, as well as the resources and facilities required to ensure their availability, appropriate use, and humane care. This study updates information gathered in the last national survey conducted in 1978. For FY 1993, the report finds that (1) of the 626 respondents, roughly half were academic institutions, and half consisted of research laboratories, independent hospitals, and government agencies; (2) there is a total census of approximately 2.5 million animals; (3) facilities reported acquiring 8.3 million animals, of which 29 percent were acquired through the facilities' own breeding; (4) respondent facilities made approximately 9 million vertebrate animals available for research, education or training, and testing, and animal species were used predominantly for research; (5) among directors of animal care and use programs, 74 percent had a doctoral-level degree; (6) among respondent facilities, 34 percent reported having space in need of renovation, 15 percent reported having space in need of replacement, and enclosed animal housing was the category most frequently cited as in need of replacement; and (7) the 559 respondents who provided cost information spent $521 million on animal care and reported that their costs had increased since FY 1991 by 25 percent. This report contributes to the understanding of the effects of Federal, State, and local laws, regulations, and policies enacted to ensure humane care and to regulate the supply and cost of laboratory animals. See also PIC ID Nos. 1506 and 2675. (Final report: 55 pages.)

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Anne Summers

PHONE NUMBER: (301) 496-5572

PIC ID: 6048

PERFORMER ORGANIZATION: Analytical Sciences, Incorporated, Durham, NC

TITLE: Promoting Safe and Effective Genetic Testing in the United States: Final Report of the Task Force on Genetic Testing

ABSTRACT: Genetic testing is the analysis of human DNA, RNA, chromosomes, proteins, and certain metabolites in order to detect heritable diseases. The Task Force on Genetic Testing was created by the NIH-DOE Joint Working Group on Ethical, Legal, and Social Implications of Human Genome Research (ELSI Working Group) to review genetic testing in the United States and to design policies to minimize the potential negative effects of genetic testing. Their final report recommends that (1) an advisory committee be established on genetic testing in the Office of the Secretary to implement the Task Force recommendations and to determine which genetic tests require stringent scrutiny; (2) protocols for the development of genetic tests that can be used to predict future disease in healthy people receive the approval of an institutional review board (IRB) when the intention is to make the test readily available for clinical use; (3) test developers submit their validation and clinical utility data to external reviewers as well as to interested professional organizations in order to permit informed decisions about their routine use; (4) the newly created genetics subcommittee of the Clinical Laboratory Improvement Advisory Committee consider the creation of a specialty in genetics that would encompass all predictive tests that satisfy criteria for stringent scrutiny; (5) curricula on genetics be incorporated into medical school and residency training; (6) hospitals and managed care organizations require evidence of competence before permitting providers to order predictive genetic tests or counsel about them; and (7) physicians have access to accurate information to enable them to diagnose rare diseases, to know where to turn for assistance in clinical and laboratory diagnosis, and to locate laboratories that competently test for rare diseases. (Final report: 88 pages, plus appendices.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Jean McKay

PHONE NUMBER: (301) 594-2740

PIC ID: 6090

PERFORMER ORGANIZATION: Johns Hopkins Medical Institution, Baltimore, MD

TITLE: National Cancer Institute: Characterization of User Population and User Satisfaction of the PDQ Data base-Documentation for Tracking System

ABSTRACT: This study examines the user population and users' satisfaction with the Physician Data Query (PDQ) data base. PDQ was originally targeted to physicians only, but the information included in the data base was recognized to be of value to the larger community of nurses, researchers, health educators, and librarians, as well as patients, their families, and friends. PDQ is distributed to these audiences by the original on-line services, CD-ROM, facsimile, hard copy, and electronic networks, including the Internet. The users surveyed for the study include both primary users, or those who access the PDQ data base to fulfill their own research needs, and secondary users, who only conduct searches for others. The report finds that (1) the data base is widely and repeatedly used and is highly regarded; (2) physicians, other health care professionals, and librarians/information specialists predominate among the user population; (3) patients and their families and friends are also recipients of the PDQ information, even when the National Cancer Institute (NCI) toll-free information center phone service is excluded; (4) users consistently see PDQ as an authoritative and dependable source of cancer information; (5) no sections of the data base are negatively regarded or go unused; and (6) many users share the information they access through PDQ with others. Several recommendations are developed as a result of this report. The report recommends that NCI's International Cancer Information Center should (1) establish formal licensing structures to strengthen its ability to require access to users from the vendors, (2) repeat this survey within three years, (3) consider creating a CD-ROM version of the data base on its own in order to reduce costs to consumers, and (4) work with distributors and intermediaries to develop mechanisms for gathering data on user access. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: National Cancer Institute

FEDERAL CONTACT: Bonnie J. Harding

PHONE NUMBER: (301) 496-7406

PIC ID: 6092

PERFORMER ORGANIZATION: Aspen Systems Corporation, Silver Spring, MD

TITLE: Bridges to the Future: Program Evaluation

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 two-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 two-year to four-year institutions, or from M.S. to Ph.D. programs; and (2) the retention of students in the educational pathway both prior to and after making the transition from one institution to another. Although the quantity and quality of the comparison data is 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: Academic Research Instruments and Instrumentation Needs in the Biological Sciences

ABSTRACT: This report examines the fourth cycle of a national instrumentation survey concerning scientific research instruments and the academic units in which they are found for a range of scientific fields. Conducted in 1994, the survey analyzes data from two distinct populations of institutions. The first population consists of 318 institutions performing more than $3 million in research and development (R&D) in 1991. The second population consists of 44 historically black colleges and universities (HBCUs) that reported R&D expenditures in 1994. The study, in results generalized to the first group, finds that in 1993 (1) expenditures for biological research instrumentation totaled $283 million; (2) Federal funding as a percent of total funds for the purchase of biological research instrumentation declined from 48 percent in 1983 to 39 percent: NIH was the single largest Federal funding source providing $85 million; (3) 67 percent of respondents reported an increase in instrumentation needs between 1992 and 1994; (4) the price tag for the three highest priority research instruments was $363 million; (5) 20,978 research instruments in the biological sciences had a purchase price of $20,000 or more; and (6) principal investigators report that only 28 percent of the biological instruments were state-of-the-art in meeting researchers' needs. For HBCUs, the study finds that (1) the purchase price of research equipment in 1993 was $4.9 million, of which 48 percent was spent on maintenance, repair, and operation costs of the instrumentation; (2) Federal funding provided 85 percent of funding, $4.2 million, to purchase research instrumentation, and NIH was the largest source of funds; and (3) 65 percent of respondents reported inadequate research equipment. See also PIC ID Nos. 2382, 2382.1, and 4659. (Final report: 99 pages, plus appendices.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Paul Seder

PHONE NUMBER: (301) 496-4418

PIC ID: 6121

PERFORMER ORGANIZATION: National Science Foundation, Arlington, VA

TITLE: A Study to Determine the Changes of Physician Prescribing of Antimicrobial Agents, Omeprazole, and H2-Receptor Antagonists for Peptic Ulcer Disease Two Years Following the NIH Consensus Conference on Helicobacter pylori

ABSTRACT: This study evaluates physicians' prescribing patterns for the treatment of peptic ulcer disease (PUD). Its particular focus is whether recommendations of a February 1994 National Institutes of Health (NIH) Consensus Development Conference advocating the use of antimicrobial agents for peptic ulcer patients with Helicobacter pylori infection were coincident with a change in physician prescribing patterns. The study uses computerized Pennsylvania Medicaid administrative data from January 1993 through February 1996 to evaluate prescribing patterns in the year prior and the two years following the NIH conference (12,737 patient records in all). Seven major therapeutic drug classes were analyzed: antimicrobial agents, H2-receptor antagonists, antisecretory agents, bismuth subsalicylate, sucralfate, misoprostol, and antacids. The report finds that (1) only 10 percent of prescriptions contained an antimicrobial agent, while 62 percent were for an H2-receptor antagonist only; (2) the two- and three-drug regimens recommended by the NIH conference were infrequently prescribed (1.1 percent and 0.9 percent, respectively); (3) younger and non-white PUD patients were more likely to receive a prescription for antimicrobial agents than older and white patients; (4) duodenal ulcer patients were more likely than non-duodenal ulcer patients to receive an antimicrobial prescriptions; and (5) the prescription of antimicrobial agents for the treatment of PUD significantly increased from 7 percent to 14.2 percent over the study period, while prescriptions for H2-receptor antagonists significantly decreased. The report concludes that, while there were increases in the prescription of antimicrobial agents to treat PUD over the study period, these could not be directly attributed to the NIH conference. Physicians do not appear to be using national recommendations.

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

FEDERAL CONTACT: Charles Sherman

PHONE NUMBER: (301) 496-5641

PIC ID: 6284

PERFORMER ORGANIZATION: Medical Technology and Practice Parameters Institute, Washington, DC

TITLE: Toxicology and Environmental Health Information Resources: The Role of the National Library of Medicine

ABSTRACT: This report examines the utility and accessibility of the National Library of Medicine's (NLM) Toxicology and Environmental Health Information Program (TEHIP). The TEHIP program encompasses 16 online data bases that contain bibliographic and factual information on environmental contaminants, including chemical properties, carcinogenicity, exposure levels, adverse health effects, emergency treatment protocols, and Federal regulations. The report notes that Federal appropriations for the TEHIP program have remained relatively constant over the past 29 years. However, the program's reimbursements from other agencies for collaborative projects have fluctuated. The report also notes that the TEHIP data base represents only a small subset of the many data bases containing information related to toxicology and environmental health. With this in mind, the report recommends that NLM consider expanding its traditional library services by organizing and cataloging the full spectrum of online toxicology and environmental health information resources. The report also recognizes that the health professional community does not have homogenous information needs and that there is wide variation in access to online data bases and other information resources. It recommends that the TEHIP program should set priorities that would allow efforts to be focused on those data bases that meet the information needs of the greatest number of health professionals and that NLM's training and outreach efforts be increased to improve awareness of the TEHIP program. The report notes that access to the data bases and difficulties in navigating the user interfaces are the two primary factors limiting use of the TEHIP data bases. The report also provides recommendations on programmatic issues and future directions for the TEHIP program. (Final report: 139 pages, plus appendices.)

AGENCY SPONSOR: National Library of Medicine

FEDERAL CONTACT: Susan Buyer

PHONE NUMBER: (301) 496-2311

PIC ID: 6534

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

TITLE: Evaluation of the International Cooperative Biodiversity Groups (ICBG)

ABSTRACT: This report evaluates the International Cooperative Biodiversity Groups (ICBG) program. Funded by the National Institutes of Health and the National Science Foundation, the ICBG is a program designed to protect human health, advance the conservation of biologically diverse ecosystems, and promote sustainable economic development through the search for drugs to control diseases of concern to both developed and developing countries. Since 1993, the program has funded five individual cooperative biodiversity groups around the world. The study design attempts to (1) accommodate the varied and nonstandard implementations of the ICBG concept, (2) obtain broad coverage in terms of respondents, (3) maximize response rates and data quality, (4) minimize burden on ICBG Group Leaders and other respondents, and (5) incorporate cost and time efficiencies wherever possible. Among the benefits for source countries, the report finds (1) that scientific capacity has been developed through training and equipment, (2) development of economic activities, (3) equitable financial return and the protection of intellectual property rights of source-country people, and (4) the potential sustainability of the individual ICBG projects is one of the strengths of the overall program. The report recommends that the ICBG program (1) develop systems of technical assistance based on a combination of outside expertise and lessons learned across programs; (2) improve communications among the ICBGs; (3) consider developing a cross-ICBG data base that includes work being done in collection, extractions, and drug development techniques; and (4) bring in the expertise of social scientists and source-country legal experts to the ICGB to ensure that the consensus-building, benefit sharing, and economic goals of this project are achieved as well. (Final report: 177 pages, appendices bound separately.)

AGENCY SPONSOR: Fogerty International Center

FEDERAL CONTACT: J. Kirby Weldon

PHONE NUMBER: (301) 496-2571

PIC ID: 6641

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Federal Interagency Forum on Aging-Related Statistics: Data Base News In Aging

ABSTRACT: This annual report highlights the aging-related surveys and products currently available from member agencies of the Federal Interagency Forum on Aging-Related Statistics. All Federal agencies are invited to contribute to the report and to participate in the Forum. Contributors to this report are (1) Department of Agriculture: Economic Research Service; (2) Department of Commerce: Bureau of the Census; (3) Department of Health and Human Services: Administration on Aging, Centers for Disease Control and Prevention, National Institutes of Health (NIH), Health Care Financing Administration, Agency for Health Care Policy and Research, and Office of the Assistant Secretary for Planning and Evaluation; (4) Department of Housing and Urban Development: Office of Policy Development and Research; (5) Department of Labor: Bureau of Labor Statistics; (6) Department of Veterans Affairs; (7) Federal Reserve System, Board of Governors; (8) Social Security Administration; and (9) the United Nations. Each survey or data base is listed with its sponsoring organization, purpose, description, current activity, plans for future activity, public use data files, and associated reports, if any. The report ends with a tabular listing of the data bases and surveys described in the report, which gives the latest year data were collected or whether data collection is ongoing, the year for which the most recent data were released, whether public use tapes or printed reports are planned or available, and information on the person to contact about the data base or survey. (Final report: 117 pages.)

AGENCY SPONSOR: National Institute on Aging

FEDERAL CONTACT: Gail Jacoby

PHONE NUMBER: (301) 496-3121

PIC ID: 6652

PERFORMER ORGANIZATION: Bureau of the Census, Washington, DC

TITLE: Finding the Balance: Report of the National Institute of Mental Health Intramural Research Program (IRP) Planning Committee

ABSTRACT: The Intramural Research Program (IRP) of the National Institute of Mental Health (NIMH) must be positioned to make scientific advances crucial to easing the burden of mental disorders. This report represents an active effort by the NIMH IRP Planning Committee to help the program make these advances. The Committee evaluated the rationale for the program's continuance, as well as its strengths and weaknesses. It solicited confidential letters from almost 1,000 IRP scientists and staff and met with National Institutes of Health (NIH) leadership, the IRP's past and present leadership, and advocacy organizations. It found strong justification for the continued existence of the IRP, as long as the research it produces is of the highest quality. The Committee also offered recommendations to revitalize the IRP. The report finds that (1) stable scientific leadership is crucial to revitalizing IRP science, thus the program must recruit a Scientific Director for the program; (2) the overall quality of IRP science has declined from its previous place at the top of the scientific endeavor-while there are some areas of research brilliance, some research is of lesser quality, according to members of the Board of Scientific Counselors and intramural and extramural scientists; (3) recruitment and retention of talented scientists is essential, but over the past five years, the program has recruited from outside of NIH only one of its four newly-tenured scientists; (4) the quality of the program's intramural training efforts is uneven; (5) the program should address the fact that post-doctoral fellows have difficulty competing for positions when they leave NIH due to a lack of sufficient grantsmanship and teaching experience; and (6) NIMH's IRP's clinical research program needs to be sustained and revitalized.

AGENCY SPONSOR: National Institute of Mental Health

FEDERAL CONTACT: Emily Gause

PHONE NUMBER: (301) 443-4335

PIC ID: 6697

PERFORMER ORGANIZATION: National Institute of Mental Health, Rockville, MD

TOP OF DOCUMENT

OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION

Contents

State Assisted Living Policy: 1996

Evaluation of the Minority Male Consortium for Violence Prevention

Determinants of AFDC Caseload Growth: Final Report

Informal and Formal Kinship Care

Approaches to Evaluating Welfare Reform: Lessons from Five State Demonstrations

Efforts by Child Welfare Agencies to Address Domestic Violence: The Experiences of Five Communities

Evaluability Assessment of Responsible Fatherhood Programs

Trends in the Well-Being of America's Children and Youth: '97

Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health

Registry of State-Level Efforts to Integrate Health Information

Implementing Welfare Reform Requirements for Teenage Parents: Lessons from Experience in Four States

Deriving State-Level Estimates from National Surveys: A Statistical Assessment and State Tabulations

Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities

Chapin Hall Center for Children at the University of Chicago: Administrative Data Guide

Iowa's Limited Benefit Plan

Role of Home- and Community-Based Services in Meeting the Health Care Needs of People with HIV/AIDS: Literature Review

Exploring the Feasibility of Linking Health Expenditure and Utilization Data

Public Health Laboratories and Health System Change

Framework for Assessing Insurer Responses to Health Care Market Changes

Establishing an Analytical Framework for Measuring the Role of Reinsurance in the Health Insurance Market

National Evaluation of Welfare-to-Work Strategies: Evaluating Two Welfare-to-Work Program Approaches: Two Year Findings on the Labor Force Attachment and Human Capital Development Programs in Three Sites

Improving Health in the Community: A Role for Performance Monitoring

Privacy and Health Research: A Report to the U.S. Secretary of Health and Human Services

State Regulatory Experience with Provider-Sponsored Organizations: Final Report

Indicators of Welfare Dependence and Well-Being: Interim Report to Congress

Setting the Baseline: A Report on State Welfare Waivers

Market Barriers to the Development of Pharmacotherapies for the Treatment of Cocaine Abuse and Addiction: Final Report

Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS

Programs Using Intermediary Service Organizations

TITLE: State Assisted Living Policy: 1996

ABSTRACT: Assisted living facilities are an expanding source of supportive housing and services, and represent a new model of long-term care. Consumer choice and control are central to assisted living models, which seek to allow consumers to control key features of their living environments and to direct their own receipt of services. This study reviews the assisted living and board and care policies in each of the fifty States. Fifteen States have existing licensure regulations for assisted living facilities and an additional nine States are developing regulations. Twenty-two States reimburse or plan to reimburse assisted living as a Medicaid service and six States provide Medicaid payments for services in board and care settings. Thirteen states have created a task force or a process within a State agency to make recommendations for the development of assisted living rules. One of the major difficulties associated with assisted living is the lack of a common or standard definition of this kind of care. However, State approaches share common components, including that (1) assisted living is characterized as residential, rather than institutional; (2) health or medical services are provided, either by facility staff or through contracts with community agencies; (3) assisted living is a model emphasizing consumer or resident independence, autonomy, dignity, privacy, and decisionmaking; and (4) many States attempt to combine minimum standards of safety and quality of care while also allowing market forces to shape quality. State policies generally address three major issues: (1) the requirement for a living unit, (2) admission and retention criteria, and (3) the level of services to be provided. The report provides specific information about policies in each State. See also PIC ID Nos. 4719-4719.2 and 4719.4-4719.5. (Final report: 225 pages.)

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

FEDERAL CONTACT: Robert Clark

PHONE NUMBER: (202) 690-6443

PIC ID: 4719.3

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

TITLE: Evaluation of the Minority Male Consortium for Violence Prevention

ABSTRACT: This project evaluated the Office of Minority Health Minority Male Consortium for Family and Community Violence Prevention Programs. At the time of this study, 19 historically black colleges and universities (HBCUs) were participating in this program. Features of violence prevention program models at 13 historically black colleges and universities/family life centers (HBCUs/FLCs) were synthesized to determine approaches that could prevent or minimize violence in communities committed on or by minority males. The contractor (1) performed an extensive literature review; (2) collected and analyzed relevant program documentation and materials; (3) conducted focus groups; (4) examined target populations; (5) developed a site visit discussion guide; (6) selected 10 HBCUs for site visits; (6) developed and executed an analysis plan; (7) interpreted analysis findings, including defining program models and analyzing HBCUs' organizational capacity; (8) held briefings with Consortium leaders, members, and government personnel; (9) reviewed the overall organization, design, and implementation of the programs; and (10) evaluated prevention strategies adopted by the HBCU/FLCs. Violence prevention programs suffer from an inability to produce valid performance data demonstrating that prevention investments pay off in the long run. The report recommends that (1) without completely centralizing the design process, the Federal government and the Consortium should move toward a consensus-seeking information model in which individual schools are no longer free to pursue independent designs; and (2) constraints should be introduced on which program models are implemented by which schools. See also PIC ID Nos. 5789 and 5789.1. (Final report: 68 pages, plus appendices.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Patricia S. Hazard

PHONE NUMBER: (202) 690-8291

PIC ID: 5789.2

PERFORMER ORGANIZATION: Macro International, Incorporated, Calverton, MD

TITLE: Determinants of AFDC Caseload Growth: Final Report

ABSTRACT: This project examined the dynamics of Aid to Families with Dependent Children (AFDC) caseload growth and analyzed the effects of economic, demographic, and programmatic changes at the State level on States' AFDC caseload from the early 1980's to the present. Analysis of economic factors included measures of both wages and unemployment; analysis of demographic factors includes an emphasis on nonmarital childbearing. Analysis of program effects included changes arising from national welfare legislation, changes in State welfare parameters, State waivers, and changes in other programs such as Food Stamps and Medicaid. The project addressed the interaction of these factors by analyzing the economic, demographic, and programmatic factors simultaneously. Compared to earlier studies of AFDC caseload determinants, many of which are outdated, this study focused much more on State-level indicators, and included a more comprehensive set of economic, demographic, and programmatic factors. Recently, many State policymakers have expressed concern over the effect of future recessions or nonmarital birth rates on their caseloads, and this study is intended to be a valuable tool to State policymakers as they continue to assume greater responsibility for their AFDC programs and consider new innovations.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: (202) 401-6634

PIC ID: 5953

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Informal and Formal Kinship Care

ABSTRACT: A growing number of States prefer to place children who have been removed from their homes of origin in the home of a relative. This practice is known as kinship foster care, and is a growing component of family foster care. It comprises between one-third and one-half of all foster care days provided in the States with the largest foster care populations. Many children, however, live with relatives who are not their parents in an informal relationship. In all, about 2.15 million children lived in the care of relatives without a parent present in 1994. This study uses several data sources to examine the characteristics of informal kinship care arrangements and how they compare with those initiated through or subsidized by the State child welfare system. It considers national patterns, examines living arrangement patterns by State for FY 1990, compares formal and informal kinship care in four States, and uses Illinois data to provide a more focused picture of kinship care. The two-volume report finds that (1) kinship care is more prevalent in the South and in non-metropolitan areas, and for older children; (2) about two-thirds of kinship caregivers are the child's grandparents-about half are currently married, and over 85 percent of single kinship caregivers are women; (3) kinship caregivers are more likely to be currently unmarried, to be less educated, to be poor, and to receive social welfare benefits than are live-in parents; (4) nationally, just over 2 percent of children lived with relatives not their parents (this percentage ranges by State from under 1 percent to well over 3 percent) (5) higher levels of kinship care (as well as single mother households) appear to be direct products of higher levels of social disruption and family disorganization; and (6) while informal kinship care patterns were roughly similar in the four States examined, the use of formal kinship care varies widely. (Vol. I: 80 pages; Vol. II-tables and figures-58 pages plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: (202) 690-5938

PIC ID: 6016

PERFORMER ORGANIZATION: University of Chicago, Chicago, IL; Urban Institute, Washington, DC

TITLE: Approaches to Evaluating Welfare Reform: Lessons from Five State Demonstrations

ABSTRACT: Most States have obtained waivers from Aid to Families with Dependent Children (AFDC) and Food Stamp Program rules in order to implement welfare reform. Between 1993 and 1996, the Clinton Administration approved waivers for 43 States. This project examined waiver demonstration projects in five States (California, Colorado, Michigan, Minnesota, and Wisconsin). Four of the five States used an experimental evaluation design, while the fifth used a quasi-experimental evaluation design. This two-volume report addresses issues in five areas: (1) the choice between an experimental and quasi-experimental evaluation design, (2) sample design, (3) implementation of experimental evaluations, (4) data collection, and (5) analysis methods. The report finds that: (1) most evaluations of State welfare reform demonstrations used an experimental design, which involved random assignment of cases to an experimental group subject to welfare reform or to a control group subject to pre-reform policies; (2) only one waiver (Wisconsin's) was approved with a quasi-experimental design, but this may become more common in a block grant environment; and (3) when designing a study sample, evaluation planners should ensure that the sample size is adequate and should design the sample so that applicant and recipient subgroups can support separate impact estimates (the sample should also be representative of the State as a whole). The report also finds that four aspects of the implementation of an experimental evaluation require special care: (1) the timing of the random assignment, (2) the method of the random assignment, (3) ensuring that control group policies remain unchanged, and (4) preventing experimental and control group cases from changing status. The report also discusses data collection and analysis. (Final report: Volume I: 128 pages, plus appendices; Volume II: 8 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: (202) 401-6640

PIC ID: 6050

PERFORMER ORGANIZATION: Urban Institute, Washington, DC

TITLE: Efforts by Child Welfare Agencies to Address Domestic Violence: The Experiences of Five Communities

ABSTRACT: Child protective services (CPS) and domestic violence services historically have not been closely linked. However, child welfare agencies across the country are beginning to consider how families in their child protection caseload are affected by domestic violence and are reexamining their policies accordingly. This report documents how child welfare agencies in five communities (Massachusetts; Michigan; San Diego County, California; Hilo, Hawaii; and Oregon) are attempting to integrate domestic violence concerns into their services. The communities were chosen for study because they are extending their services well beyond educating staff in domestic violence concerns. The report finds that (1) child welfare agencies have initiated changes from different organizational points within their agencies and have taken different approaches to changing case practice; (2) these agencies cannot make appropriate changes without major and continuing collaboration with community stakeholders who work with domestic violence victims and perpetrators; (3) chief among the concerns raised is the need to refrain from actions that further endanger mothers and children; (4) changes will also benefit from close collaboration with police, civil and criminal courts, corrections, the schools, and local clinics and hospitals; and (5) ongoing technical assistance to CPS staff after initial training in domestic violence services appears to make a more lasting difference on workers' ability to put the content of training into practice on a daily basis. The report closes with a general discussion of (1) approaches to addressing domestic violence within child welfare agencies; (2) the role of the larger community; (3) more complex policy questions, such as whether a child's witnessing of domestic violence is itself abusive; and (4) evaluating the effectiveness of these efforts. (Final report: 148 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Jerry Silverman

PHONE NUMBER: (202) 690-5654

PIC ID: 6155

PERFORMER ORGANIZATION: Urban Institute, Washington, DC

TITLE: Evaluability Assessment of Responsible Fatherhood Programs

ABSTRACT: Responsible fatherhood programs provide fathers, particularly those who are young, unmarried, and unemployed, with the support and skills to become active participants in their children's lives. An increased interest in fatherhood programs and a lack of information on their accessibility and effectiveness led to this evaluability assessment. This study visited five fatherhood program sites, selected as the most developed programs by HHS, in order to (1) assess the readiness of fatherhood programs for formal evaluation and identify obstacles to their evaluation in the future, and (2) illustrate the evaluation process and mechanisms that must be in place before a formal impact evaluation is undertaken. The project goal was to develop an evaluation design that could be used by HHS and other policymakers in the future to evaluate such programs. The report concludes that at this time formal program evaluation remains premature because the programs (1) are new and still at the stage of refining recruiting methods and program services, (2) lack automated systems for tracking and reporting on clients, and (3) serve a very small number of clients. In order to conduct a rigorous evaluation of fatherhood programs, the report suggests the development of (1) measurable outcomes; (2) defined service components and their hypothesized relationship to outcomes; (3) an established recruiting, enrollment, and participation process; (4) an understanding of the characteristics of the target population, program participants, and program environment; and (5) an ability to collect and maintain an adequate program size. The report concludes that to increase viability, fatherhood programs must (1) develop a core definition of what constitutes a responsible fatherhood program, (2) conduct process evaluations, (3) build basic management information system capacity, and (4) stabilize and enhance funding. (Final report: 114 pages, plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Linda Mellgren

PHONE NUMBER: (202) 690-6806

PIC ID: 6159

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Trends in the Well-Being of America's Children and Youth: '97

ABSTRACT: This is the second edition of an annual report from HHS on the well-being of children and youth in the United States. The report's purpose is to provide the policy community, the media, and all interested citizens with a statistical overview describing the condition of children. The report focuses on trends in the well-being of children and youth in five key areas: population, family, and neighborhood; economic security; health conditions and health care; social development, behavioral health, and teen fertility; and education and achievement. The report, as it pertains to teenagers, finds (1) a decrease in the pregnancy rate among young women aged 15-19 since 1991; (2) an increase in alcohol, cigarette, marijuana, and cocaine use in the 1990's; (3) a modest gain in math and science proficiency by 17-year-old students since the early 1980's; (4) a sustained increase in mortality for black youth aged 15-19 since 1991, while there was a decrease in mortality rates for white youth; and (5) a steady increase in receipt of early prenatal care by teen mothers. Federal statistical data lack (1) standardized measures of social development and health-related behaviors for very young and pre-teenaged children; (2) indicators that reflect important social processes affecting child well-being that go on inside the family and within the neighborhood; and (3) sufficient information on child abuse and neglect, youth violent crime, day care quality, learning disabilities, and measures of children in institutionalized care. The Federal Interagency Forum on Child and Family Statistics has adopted a mandate to improve the statistical system. As data become available they will be incorporated into new editions of this report. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Matthew Stagner

PHONE NUMBER: (202) 690-5653

PIC ID: 6170.1

PERFORMER ORGANIZATION: Urban Institute and Child Trends, Incorporated, Washington, DC

TITLE: Assessment of Performance Measures for Public Health, Substance Abuse, and Mental Health

ABSTRACT: The Panel on Performance Measures and Data for Public Health Performance Partnership Grants (PPGs) was established in order to examine the state-of-the-art in performance measurement for public health and to recommend measures that could be used to monitor the PPG agreements to be negotiated between each State and the Federal government. The panel considered performance measures in ten public health areas: chronic diseases, sexually transmitted diseases, human immunodeficiency virus infection and tuberculosis, mental health, immunization, substance abuse, sexual assault, disabilities, and emergency medical services. More than 3,200 measures were proposed to the panel through various outreach efforts. The panel used four guidelines for assessing the performance measures: (1) the measure should be specific and results oriented; (2) the measure should be meaningful and understandable; (3) data should be adequate to support the measure; and (4) the measure should be valid, reliable, and responsive. The measures that scored the highest are recommended for use in performance monitoring. They cover health status, social functioning, consumer satisfaction, and risk status. In assessing the adequacy of data for specific performance measures, the panel concluded that there are few available data sources that are ideal for performance monitoring. Many Federal efforts to collect health-related data provide national rates, but do not collect data that provide State-level rates, and much State-level data may not be comparable. The report also finds that many of the performance measures presented can and should be subdivided to focus on specific high-risk populations in a State. See also PIC ID No. 6200. (Final report: 54 pages, plus appendices.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Jeffery J. Koshel

PHONE NUMBER: (202) 401-8238

PIC ID: 6177

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

TITLE: Registry of State-Level Efforts to Integrate Health Information

ABSTRACT: In 1996, HHS contracted The Lewin Group to develop a registry of projects that integrates health information systems at the State level. The registry is located on the World Wide Web at

http://aspe.hhs.gov/statereg/index.htm. The home page compiles, abstracts, and indexes summary information on data integration projects for all 50 States and the District of Columbia. The purpose of the registry is twofold. First, the registry gives Federal policymakers a central source for researching the types of integration activities being pursued by individual States. Second, the registry facilitates communication among States regarding data integration activities and related data policy activities. The project (1) provides a resource for State and local policymakers as they seek to identify others who have pursued information integration activities; (2) facilitates information sharing and collaboration across States; and (3) assists Federal policymakers in monitoring, assessing, and supporting State-level integration activities. Relevant State integration projects were identified through: (1) contacts with State officials responsible for hospital discharge data bases, vital statistics, Medicaid data, and any other major information system or data-related offices; (2) conferences on State data integration activities; (3) grantee information related to specific funds which target information activity; (4) State health department websites; and (5) recommendations from people interviewed. A contract with The Lewin Group has been issued to organize and edit the materials that are submitted and encourage biannual updates of the site. The data base is administered by the Office of the Assistant Secretary for Planning and Evaluation. Final report is a web site: http://aspe.hhs.gov/statereg/index.htm.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Dale Hitchcock

PHONE NUMBER: (202) 690-5882

PIC ID: 6178

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Implementing Welfare Reform Requirements for Teenage Parents: Lessons from Experience in Four States

ABSTRACT: Federal welfare policy requires minor custodial parents receiving cash assistance to attend school and to live with their parents or in an adult-supervised setting; these requirements were established as part of the Personal Responsibility and Work Opportunity Reconciliation Act, which created the program for Temporary Assistance for Needy Families and abolished the Aid to Families with Dependent Children (AFDC) program. This two-volume report summarizes lessons learned from the operational experiences in four States (Arizona, California, Massachusetts, and Virginia) that implemented waivers requiring school attendance and certain living arrangements under the AFDC program. The report finds that (1) identifying teenage parents, particularly those who do not head their own cash assistance cases, can be a major challenge; (2) persistent staff training to correct errors, the use of alternative information sources to identify teenage parents, and establishing positive incentives for identifying and referring all teenage parents can help to address these challenges; (3) a range of education options, including GED programs, should be available; (4) programs must determine the focus and scope of case management in light of goals and costs; (5) monitoring school attendance increases welfare agency workload-sometimes substantially-and can complicate the relationship between welfare agencies and schools; (6) a very restrictive living arrangement requirement may create implementation difficulties; and (7) funding group homes may enable States to have fewer exceptions to the requirement, but despite their advantage for teen parents, many may not choose to reside in them. (Final report: Volume I, 50 pages; Volume II (case studies), 103 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: (202) 401-6634

PIC ID: 6228

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Deriving State-Level Estimates from National Surveys: A Statistical Assessment and State Tabulations

ABSTRACT: The Department of Health and Human Services (HHS) is changing its focus from the national to the State level. Landmark legislation eliminating entitlement to Aid to Families with Dependent Children benefits and block granting it to the States was passed at the time of this report. This project is one component of a larger HHS strategy to generate valid and reliable State-level estimates, which can be used to measure the impact of social policy interventions. This project (1) appreciates the statistical issues involved in addressing policy and research questions at the State level with national survey data; (2) assesses the current capabilities of these major surveys to provide answers to these questions at the State level; and (3) presents options for obtaining valid, reliable State-level data from relatively minimal enhancements and changes to the design of the surveys. The study focused on three major Federal surveys: the Survey of Income and Program Participation (SIPP); the Current Population Survey (CPS); and the National Health Interview Survey (NHIS). These surveys were selected for their widespread applicability, use, and potential for analyzing policy issues. The report evaluates statistical concerns to determine the suitability and potential of using the selected surveys for State-level estimates and to identify differences between States. These technical concerns included variance estimation, standard errors, the construction of State-level weights, minimum sample sizes needed, design effects, pooling several years of data, and longitudinal issues (e.g., response rates and weighting). The report recommends periodic redesign efforts and other survey enhancements.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: (202) 690-7794

PIC ID: 6380

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities

ABSTRACT: This report assesses unmet needs for supply-side information (information about health care providers and insurers) on the health system, focusing on helping the Department of Health and Human Services identify how information needs associated with a changing health care system are perceived by a wide variety of user groups and constituencies. Based on information gathered from over 50 individuals and a review of relevant literature and Web sites, the report examines perceived gaps, their causes, and the activities generated in response to those perceptions. It also considers, in a more comprehensive manner, information on a diverse group of 11 entities. The report finds that (1) the serious gaps in "supply-side" information on the health system have grown worse as the system has evolved, presenting major obstacles to stakeholders' ability to serve their constituency, address operational needs, and participate in policy decisions; (2) the growth of managed care and consolidation has contributed to the need for supply-side information, as has the growing interest in accountability, competition, and cost-containment; (3) stakeholders say they need better information on health insurers and plans and the ways in which providers are linked to plans and integrated systems; and (4) better transaction-level data are needed, as are data from the State and local levels. The report identifies 23 ongoing efforts within the private sector, States, and foundations to address these gaps, and studies 11 of these more thoroughly. The report concludes that private sector stakeholders and States alone cannot sufficiently address supply-side information needs, giving importance to Federal leadership and convening functions. (Final report: 61 pages, plus appendices.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Linda Sanches

PHONE NUMBER: (202) 690-7233

PIC ID: 6388

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Chapin Hall Center for Children at the University of Chicago: Administrative Data Guide

ABSTRACT: This contract produced a guide to the administrative data resources regarding health, social services, and related programs available through the Chapin Hall Center for Children at the University of Chicago. Each data section in the guide provides an overview of a particular dataset. The sections offer enough information for the researcher to gain a general understanding of the available variables and the types of analysis the data will support. Data Description and Limitation entries document the larger issues involved with analyses of the data and should not be considered exhaustive. The guide also includes information to assist the researcher in interpreting the data sections. The guide was designed for use by an audience of informed policy analysts in order to consider what data are available to answer particular policy questions. It is not intended that the guide be a detailed programmer's reference book to every code used in each data field, but rather that it describe the data sets available, the basic structure and topics covered by each, and the ability to match clients between the different programs' data. The goal of this guide is to enable the Office of the Assistant Secretary for Planning and Evaluation's policy and research analysts to better design relatively short-turnaround analyses on a variety of topics of current policy interest. The guide may also be useful to other researchers. (Final report: 110 pages, plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: (202) 690-5938

PIC ID: 6389

PERFORMER ORGANIZATION: Chapin Hall Center for Children, University of Chicago, Chicago, IL

TITLE: Iowa's Limited Benefit Plan

ABSTRACT: Iowa's Family Investment Program (FIP) replaced Aid to Families with Dependent Children in 1993. FIP participants who are able-bodied and not caring for children, yet who do not develop and carry out a Family Investment Agreement (FIA), are sanctioned with assignment to the Limited Benefit Plan (LBP); some clients may also choose LBP over FIP. LBP originally provided 3 months of benefits at FIP levels, followed by 3 months of reduced levels and 6 months of no cash benefits; the program was later changed to eliminate the original 3-month period. At the end of the 6-month period, the client can reapply for FIP, but must meet its requirements. This report present finding from a study of the original LBP, showing how some families enter the LBP and how their well-being changes after benefits are cut. It examines records for over 4,200 cases assigned to LBP records during 6 months in 1994 and 1995, a survey of 137 cases whose cash benefits were terminated, and case studies of 12 LBP families. The report finds that (1) most clients are assigned to LBP for failing to develop and sign an FIA, rather than for failing to carry it out; (2) slightly more than half of LBP clients subsequently meet FIP requirements and are reassigned to the program; (3) about half of LBP clients whose cash benefits have been terminated are employed immediately after cash benefits end, but about half are not; (4) 40 percent of these clients increase their monthly incomes by an average of $496 when their benefits end, but 47 percent see a decrease in their monthly incomes averaging $384; and (5) other government programs remain important sources of support for LBP families whose cash benefits have been terminated. The report notes that there are several features of the LBP program that mitigate against extreme deprivation when cash assistance has been terminated, and notes that the absence of these safeguards in a national welfare reform program could result in extreme hardship for many families. (Final report: 132 pages plus appendix.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: (202) 401-6634

PIC ID: 6390

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Washington, DC

TITLE: Role of Home- and Community-Based Services in Meeting the Health Care Needs of People with HIV/AIDS: Literature Review

ABSTRACT: This report provides an overview of the literature describing the delivery and financing of home- and community-based services for people with AIDS, focusing on the literature published since 1991. The literature review finds that (1) since the start of the epidemic, the AIDS population has been decreasingly made up of white male homosexuals and increasingly made up of people of color with low incomes and low educational levels; (2) new AIDS treatments combining protease inhibitors and other antiretroviral medications may increase life expectancy among some people with AIDS but annual costs range from $9,000 to $18,000 per person; (3) the lifetime cost of AIDS treatment has been rising, since drugs have been increasing life expectancy even before the introduction of protease inhibitors; (4) AIDS patients who experience periods of disability require nursing and support services to complement medical care, including assistance with daily living activities, child care, transportation, help applying for public assistance, and the like; (5) the increasing number of low-income people with AIDS places a heavier burden on public programs such as Medicaid and Ryan White CARE Act funding; (6) the Medicare program has borne a relatively small proportion of the burden for AIDS care, but this may increase as life expectancy increases; (7) rigorous evaluation of programs that provide home- and community-based services to people with AIDS appears to be lacking; (8) the literature provided little data describing current levels of use of and cost for home- and community-based services by people with AIDS; and (9) there is little information about how effectively managed care is meeting the need for these services. The review examines literature on the provision of these services to these elderly to draw inferences for their application to the AIDS population. See also PIC ID No. 6418. (Final report: 92 pages.)

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

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: (202) 690-6443

PIC ID: 6418.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Exploring the Feasibility of Linking Health Expenditure and Utilization Data

ABSTRACT: The Health Resources and Services Administration (HRSA) has the responsibility for assessing the adequacy of the Nation's supply of various health professions. HRSA commissioned a "General Services Demand Model" (GSDM) in 1994 to permit State-specific estimates of health utilization, which it then inputs into State-specific provider requirements forecasts. HRSA's GSDM predicts, for each State and the District of Columbia: bed days in short-term general hospitals for the under-65 and over-65 populations, outpatient visits, and emergency visits. HRSA then takes these predictions and estimates requirements for various health professions for each State. The estimates are typically based on assumptions about appropriate provider staffing/utilization ratios; for example, each primary care physician can perform 3,000 office visits in a year. From the data and assumptions, a set of State-specific provider requirement forecasts can be generated. In general, these forecast supply and demand for physicians by speciality type, as well as for registered nurses. The Health Care Financing Administration compiles national health account expenditures for hospital services, physician services, prescription drugs, and other areas. The goal of these projects is to link these two data bases over a 2 to 3-year period and then use the model to simulate the utilization and cost savings potential of reorganizing the delivery of care (for example, using HMO specialist/generalist staffing ratios versus the current fee-for-service norms). The ultimate model could be used to analyze utilization and expenditure patterns. We know, for example, that managed care enrollees, other things being equal, have 20 percent fewer beds and 10 percent fewer specialist visits than indemnity enrollees. The ultimate model could provide an estimate of utilization and cost-savings effects of HMOs entering and achieving a 30 percent share in, for example, Alabama over the next 5 years.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: (202) 690-7794 or 690-7804

PIC ID: 6425

PERFORMER ORGANIZATION: Urban Institute, Washington, DC

TITLE: Public Health Laboratories and Health System Change

ABSTRACT: All 50 States and the District of Columbia operate their own Public Health Laboratories (PHLs). Changes in the private health care delivery system, especially the growth of managed care organizations (MCOs), hospital consolidations, and large commercial laboratories are causing public health professionals to examine the viability of publicly funded laboratories in this new environment. The study identifies aspects of the public health infrastructure critical for developing assessment and evaluation tools. The report includes a literature review, interviews with stakeholders, an informal poll of State PHL directors, and detailed case studies of three States that have PHLs with relationships with MCOs and/or private laboratories. The report concludes that (1) PHLs are part of the broader public health infrastructure and, as such, must respond to changes in the health care marketplace; (2) services that are not commercially viable within the private sector, and those that are critical to identifying emerging diseases, should remain in the domain of PHLs; (3) assurance of quality and consistency of laboratory testing are critical functions of PHLs; and (4) policy development in laboratories needs to address the growth of managed care and changes in the health care delivery system. The study recommends increased Federal guidance in (1) assessing the regionalization of laboratory services, (2) supporting information infrastructure development, and (3) facilitating communication between private and public sectors. (Final report: variously paginated.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein Casnoff

PHONE NUMBER: (202) 690-6102

PIC ID: 6458

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: A Framework for Assessing Insurer Responses to Health Care Market Changes

ABSTRACT: Over the past 15 to 20 years, the health insurance market has changed dramatically. Where once a few large commercial carriers dominated the market with fee-for-service plans, there are now dozens of plans in most markets. In highly competitive markets, plans and carriers develop more sophisticated strategies and arrangements to identify and retain target markets. In order to successfully integrate government programs and develop public policy, insurers' business strategies need to be better understood. Understanding insurers' strategies is important for policy analysis because insurers are often regulated entities; and insurers' responses to changing market and regulatory conditions affect both patients' and providers' opportunities and outcomes. This report (1) identifies insurer and insurance market characteristics that are likely to be important determinants of insurers' response to policy changes (such as insurance market reform) and changes in local market conditions (such as aggressive entry of managed care plans), (2) identifies potential data sources and data needs for future empirical work, and (3) provides a better understanding of the operation of insurance markets and how insurers make business decisions based on the demand for insurance from employers and individuals. In order to improve the analysis of health insurance markets, the report recommends (1) measuring changes in the relative density of the health plan contour "web," (2) tracking premiums and loading factors, (3) monitoring the self-insured market, and (4) watching organized buyers. (Final report: 44 pages.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Stephen Finan

PHONE NUMBER: (202) 690-7387

PIC ID: 6572

PERFORMER ORGANIZATION: Urban Institute, Washington, DC

TITLE: Establishing an Analytical Framework for Measuring the Role of Reinsurance in the Health Insurance Market

ABSTRACT: Reinsurance is widely used by underwriters of health benefits to limit their risk exposure. Reinsurance contracts can be structured in many ways, and insurers can use it to limit their risk for an individual contract or exposure, for a group of contracts or exposures, or for a whole portion of the insurer's business. This report presents a limited analytical study of the level of risk borne by reinsurers in three markets: the indemnity insurance market, the managed care market, and the self-insured employer benefit plan market. The study focuses on three States using public and private data sources, including surveys, published private data, and information from filings made by private insurance companies. The purpose of the study is to determine to what extent these data can be used to measure the role of reinsurance in the various markets and to suggest ways whereby better assessments of reinsurance might be made. The report was generally unable to identify either data sources or existing research allowing quantification of the risk being ceded to reinsurers in the three markets. While a substantial amount of information is available about reinsurance in indemnity (non-HMO) health insurers, the data are aggregated in ways that make it difficult to specifically identify transactions related to primary health insurance offered to groups and individuals. Information from State HMO insurance filings is more useful, but lack of detail and inconsistencies in the way that HMOs report the information in their annual statements reduces its analytic potential. Finally, despite the substantial amount of information available about the prevalence of self-funding and the use of reinsurance by self-funded employers, there are virtually no reliable data about the level of risk being transferred to reinsurers in these arrangements. The report closes with suggestions for enhancing the data available on this subject. (Final report: 23 pages, plus appendices.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Stephen Finan

PHONE NUMBER: (202) 690-7387

PIC ID: 6573

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: National Evaluation of Welfare-to-Work Strategies: Evaluating Two Welfare-to-Work Program Approaches: Two Year Findings on the Labor Force Attachment and Human Capital Development Programs in Three Sites

ABSTRACT: This report is part of a larger study called the National Evaluation of Welfare-to-Work Strategies, formerly known as the JOBS Evaluation, which has randomly assigned more than 55,000 individuals in seven sites to groups eligible for specific welfare-to-work programs and to control groups that do not participate in these programs. This study compares two distinct welfare-to-work strategies-labor force attachment (LFA) and human capital development (HCD)-at each of three of sites: Atlanta, GA; Grand Rapids, MI; and Riverside, CA. At each site, Aid to Families with Dependent Children applicants were randomly assigned to one of three groups: a group subject to the LFA program, a group subject to the HCD program, or a control group not subject to any welfare-to-work program. This report presents findings on the implementation, participation patterns, and costs of the two types of programs operated at each site. Additionally, the report assesses the two program approaches in promoting employment and reducing welfare expenditures after 2 years. The study finds that (1) the LFA programs increased participation in the job search and HCD programs increased participation in adult basic education; (2) welfare sanction rates for nonparticipation were higher in the LFA and HCD programs than in previously studied programs, although higher sanction rates were not associated with higher rates of eventually participating in program activities; (3) the HCD programs cost about twice as much as the LFA programs; (4) both programs increased individuals' 2-year cumulative employment and earnings, and (5) both programs reduced welfare expenditures within the 2-year followup period. The report concludes that a period of 2 years is insufficient to make a credible comparison of the two approaches. See also PIC ID series 5776 and PIC ID Nos. 6576 and 6576.2. (Executive summary: 36 pages; final report: 276 pages, plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: (202) 401-6640

PIC ID: 6576.1

PERFORMER ORGANIZATION: Manpower Demonstration Research Corporation, New York, NY

TITLE: Improving Health in the Community: A Role for Performance Monitoring

ABSTRACT: This report draws on lessons from a number of current community health efforts to outline the elements of a community health improvement process, discusses the role that performance monitoring can play in this process, and proposes tools to help communities develop performance indicators. A recent emphasis on the interdependence of stakeholders requires collaborative efforts to improve community health: performance monitoring (a continuing process of selecting indicators that can be used to measure the process and outcomes of an intervention and making the results available to the community) has gained increasing currency as a way to do so. The report finds that a community health improvement process (CHIP) can be an important tool for developing a shared vision and supporting a planned and integrated approach to improving community health. The report suggests that a CHIP should include two principal interacting cycles based on analysis, action, and measurement: (1) a problem identification and prioritization cycle; and (2) the analysis and implementation cycle. This system differs from standard models primarily because of its emphasis on measurement to link performance and accountability on a community-wide basis. The report offers recommendations for implementing the CHIP concept: (1) communities should base a health improvement process on a broad definition of health and a comprehensive conceptual model of how health is produced within the community; (2) a CHIP should develop its own set of specific, quantitative performance measures and should seek a balance between strategic opportunities for long-term health improvement and short-term goals; (3) State and local health agencies should assure that an effective community health improvement process is in place in all communities; and (4) the Public Health Service should provide support and guidance in these efforts. (Final report: 179 pages, plus appendices.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James Scanlon

PHONE NUMBER: (202) 690-7100

PIC ID: 6583

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

TITLE: Privacy and Health Research: A Report to the U.S. Secretary of Health and Human Services

ABSTRACT: This report (1) identifies privacy issues surrounding research on personally identifiable health data, paying special attention to the international aspects; (2) reviews the ethical, legal, and general social context surrounding the privacy and confidentiality of health data; (3) describes relevant privacy-protection practices and problems, and identifies emerging issues; (4) analyzes the implications of the new European Union Data Privacy Directive and related policy and legal changes; and (5) recommends policy approaches and technical processes for ensuring that the privacy of individuals is respected. The report examines four major groups of issues that are growing rapidly in scale and complexity, and that must be urgently attended to: (1) secondary uses of data and data linking, (2) research on private-sector health data, (3) cybersecurity, and (4) genetic privacy. The report finds that (1) as data bases are maturing and increasing in size and quality, their appeal as research resources is also growing; (2) if personally identifiable data must be used in secondary research, consent will become the most difficult issue; (3) for many health data held in the private sector, few legal controls apply in theory or are enforced in practice regarding such matters as data-subject consent, public notification, or transfer of the data for secondary study; (4) protection of the confidentiality and security of health data, especially electronic data, is being reviewed worldwide; and (5) developing ethical guidance over genetic privacy is crucial to the future of both genetic research and applied genetics. The report also examines the international flow of data, new health data privacy laws in Europe, the United States' new "Health Insurance Portability and Accountability Act," and the need for dialogue between the United States and Europe. (Final report: 76 pages plus appendix.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: John Fanning

PHONE NUMBER: (202) 690-7100

PIC ID: 6605

PERFORMER ORGANIZATION: William W. Lowrance, Ph.D., Geneva, Switzerland

TITLE: State Regulatory Experience with Provider-Sponsored Organizations: Final Report

ABSTRACT: This report describes the experience of selected State governments in regulating provider-owned health care delivery systems that accept insurance risk for the provision or arrangement of health care services (provider-sponsored organizations, or PSOs). The States included in the study are California, Colorado, Illinois, Iowa, Minnesota, Ohio, Pennsylvania, Texas, and Washington. The report finds that the main models States use to regulate the activities of PSOs contracting directly with purchasers of health care (e.g., employers) are (1) licensing these organizations as they would a non-provider owned entity, and (2) creating a separate licensing category for risk-assuming PSOs. Regulators in States using the first model regulate the activity of risk assumption; in some cases, they apply regulation pertaining to non-provider managed care entities to all organizations seeking to seeking to provide or arrange for health care delivery. In States where PSOs are licensed separately from other managed care organizations, differences in the standards required for PSOs varied and there was little consistency about the rationale for having separate licensing. The report also finds that the States vary considerably in their regulation of PSOs that assume risk from self-funded, ERISA-exempt employer plans. Most consider the PSO as engaging in the business of insurance (thus they may be regulated by the State despite the plan's ERISA status). States also vary in their regulation of PSOs that accept risk downstream from licensed insurance carriers or managed care organizations: some do not regulate these relationships, while others require special licensing or impose substantial requirements governing risk transfer agreements. The report concludes that, since State policy toward PSOs is still in the early stages of development, the lessons to be drawn for Federal policymakers is limited; however, some observations are offered.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Lisa Rovin

PHONE NUMBER: (202) 690-7800

PIC ID: 6628

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Indicators of Welfare Dependence and Well-Being: Interim Report to Congress

ABSTRACT: The Welfare Indicators Act of 1994 directed the Secretary of Health and Human Services to conduct a study to determine which statistics would be most useful in tracking and predicting dependence on three means-tested cash- and nutritional-assistance programs: Aid to Families with Dependent Children, Food Stamps, and Supplemental Security Income. Enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 makes this task even more important. As this bill is implemented, traditional indicators of dependence may lose their meaning, making dependence more difficult to track over time. In response to these difficulties, this report recommends indicators that measure family well-being in addition to those that measure dependence. The report recommends two kinds of indicators: indicators of dependence, self-sufficiency, and family conditions; and indicators of child achievement, health, and well-being. In most cases, the recommended indicators should be tabulated separately for children, male non-elderly adults, female non-elderly adults, and other important population subgroups wherever possible. To measure dependence, self-sufficiency, and family conditions, the report recommends that indicators reflect points on a continuum from total dependence to complete self-sufficiency. Recommended indicators are grouped into several categories, including: (1) range of dependency, (2) work and job readiness, (3) poverty and deprivation, (4) family structure, and (5) parenting. To measure child achievement and health, the report recommends using indicators of infant and child mortality, low birthweight, child health limitations, teen birth rates, teen violent crime arrests, and others. Finally, the report discusses data needs for the recommended indicators. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Susan Hauan

PHONE NUMBER: (202) 690-8698

PIC ID: 6634

PERFORMER ORGANIZATION: Office of the Assistant Secretary for Planning and Evaluation, Washington, DC

TITLE: Setting the Baseline: A Report on State Welfare Waivers

ABSTRACT: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 eliminated the entitlement to Aid to Families with Dependent Children (AFDC) and replaced it with Temporary Assistance for Needy Families (TANF), a block grant which States can use to provide cash and services to low-income families with children. This report is one in a series designed to provide baseline information on the AFDC program as it existed prior to enactment of the new law. The report focuses on the waivers of AFDC requirements that were granted to States in the years preceding enactment of PRWORA. Between 1993 and 1996, waivers were granted to 43 States to help them reform their welfare programs. The report provides an overview of the types of waivers that States requested and received, and provides details on specific State policies. The report finds that, in many regards, the waiver programs were the first phase of welfare reform. States were required to conduct evaluations of waiver impacts, and had to ensure that the programs would be cost-neutral (that is, that they would not require additional Federal spending). This cost-neutrality could be achieved over the entire waiver period, rather than in each year, as had been previously required. This allowed States to make large up-front investments that they expected to gain back through reduced benefit payments in later years. The report provides valuable information about how specific States approached the AFDC program and what the Federal government authorized them to implement so that the effects of the TANF program can be measured State by State. Furthermore, the TANF program allows States to maintain their waiver programs or to delay implementation of certain TANF provisions until their waiver expires. The bulk of the report consists of tables presenting information on various aspects of the waiver programs. (Final report variously paginated.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Elizabeth Lower-Basch

PHONE NUMBER: (202) 690-6808

PIC ID: 6651

PERFORMER ORGANIZATION: Office of the Assistant Secretary for Planning and Evaluation, Washington, DC

TITLE: Market Barriers to the Development of Pharmacotherapies for the Treatment of Cocaine Abuse and Addiction: Final Report

ABSTRACT: This report presents an analysis of the market barriers to development of pharmacotherapies for substance abuse and addiction, particularly for abuse of and addiction to cocaine. There are more than 2 million addicted or "heavy" cocaine users. Of these, almost a million may enter treatment at least once in a given year. On any given day, about 10 percent of heavy cocaine users are enrolled in treatment programs. The report examines the development of pharmacotherapies for cocaine abusers in the light of the size of the potential market, estimates of market penetration, and the basic relationships between price, market size, and revenues. The report finds that there are several critical market barriers that must be taken into account. For example, there is a small and uncertain market for cocaine addiction and abuse pharmacotherapy. Although drug companies agree that the total number of cocaine users is significant, they believe that the feasible market for a cocaine abuse treatment is likely to be much smaller than the absolute number of people who use cocaine. Drug companies also anticipate that market penetration would be uncertain; potential patient compliance problems, limited access to patients, and the fact that most substance abuse treatment providers view drug use as a behavioral (rather than a medical) problem further exacerbate this uncertainty. Furthermore, the limited number and capacity of treatment facilities restricts market opportunities, as does the lack of medical treatment models. Finally, the substance abuse treatment market relies heavily on State and Federal reimbursement. Most substance abuse treatment services are subsumed under the mental health benefits of entitlement programs, and drug companies are reluctant to rely upon this kind of reimbursement in an age of shrinking budgets for mental health services.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: (202) 690-7272

PIC ID: 6694

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS Programs Using Intermediary Service Organizations

ABSTRACT: This study was undertaken by the Office of the Assistant Secretary for Planning and Evaluation (OASPE) to identify best practices for implementing consumer-directed personal assistance (CD-PAS) programs through the use of various intermediary service organization (ISO) models. This report provides practical advice to State program administrators about the design and implementation of CD-PAS programs with ISOs in order that: (1) they comply with Federal tax and labor laws; (2) they make available supportive services that some consumers may want or need; and (3) they allow for the application and enforcement of any limitation or restrictions on consumer direction that may be required by State laws and regulations. The report draws a number of conclusions that cut across ISO models, including (1) that the most successful State-ISO contract relationships are forged when the State has a clear understanding of the services that it wishes to purchase from the ISO; (2) that consumers' backup plans for relief attendants frequently fail, causing consumers to have a difficult time finding relief attendants over weekends, holidays, and when the primary attendant is absent for any reason; (3) that consumers are reluctant to initiate criminal background checks on prospective attendants because they do not know how to conduct them and they feel these checks compromise the consumer-attendant relationship; and (4) that a number of disability advocates and CD-PAS consumers expressed concern about the potential impact of managed care on the availability of CD-PAS to eligible consumers. The report also makes recommendations on how to address these problems. (Final report: 70 pages; appendices bound separately.)

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

FEDERAL CONTACT: Floyd Brown

PHONE NUMBER: (202) 690-6613

PIC ID: 6728

PERFORMER ORGANIZATION: SysteMetrics, Cambridge, MA

TOP OF DOCUMENT

OFFICE OF PUBLIC HEALTH AND SCIENCE

Contents

Measuring Expenditures for Essential Public Health Services

Evaluation of the HBCU Capacity Building Program

Environmental Health Data Needs: An Action Plan for Federal Public Health Agencies (Workshop Results, March 3-5, 1997-- Linthicum Heights, Maryland)

Stakeholders Revisit Healthy People 2000 to Maximize the Impact for 2010

Health of Washington Women

TITLE: Measuring Expenditures for Essential Public Health Services

ABSTRACT: In 1995, the Public Health Foundation, under contract to the U.S. Public Health Service (PHS), worked with State and local public health, mental health, substance abuse, and environmental agencies in nine States-Arizona, Illinois, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas, and Washington-and with Federal PHS agencies to develop and test a methodology for estimating investments in ten essential public health services. These services include both personal health services (care provided to individuals) and population-based health services (interventions that prevent disease and promote health among entire populations). The report finds that public health expenditures can indeed be defined, measured, and monitored according to the essential services framework. The report also produced State-level estimates of essential public health services spending. It finds that (1) more than 2 of every 3 dollars spent by the 9 States on essential public health services ($6.1 billion of $8.8 billion) was for personal health services; (2) population-based health services spending ($2.7 billion or $36 per capita) was only 1 percent of total health care expenditures in the participating States; (3) of the population-based expenditures, 26 percent was for enforcing laws and regulations protecting the health and safety of the public; (4) States were the largest funders of population-based health services, providing 50 percent of the total funding for these activities (Federal funding accounted for 32 percent, while local and other sources accounted for the remaining 18 percent); and (5) of the $7.1 billion PHS expenditures on essential public health services, $2.4 billion (34 percent) supported prevention-related research and $2 billion (29 percent) supported personal health services. The report makes recommendations to improve the methodology for future data collection. (Final report: 36 pages, plus appendices.)

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: Evaluation of the HBCU Capacity Building Program

ABSTRACT: In 1992, the Public Health Service (PHS) initiated the Historically Black Colleges and Universities (HBCUs) Capacity Building Program to increase HBCUs' involvement in health and social service programs funded by PHS and other Federal agencies. The hypothesis was that HBCUs could compete more effectively for grant monies if they had comprehensive and fully functional sponsored program offices (SPOs). This evaluation, conducted by the Office of Minority Health (OMH), addresses a series of questions regarding the appropriateness of program processes and the observable impacts of the program at four participating HBCUs. The OMH designed evaluation methods around a logic model that documents the links between program assumptions, activities, and final outcomes. The OMH collected data through questionnaires, site visits, and telephone interviews. The evaluation includes quantitative and categorical indicators of program implementation and outcomes, as well as comparisons of qualitative case histories. The report finds that the grant funds and technical assistance achieved many of the program's aims. An SPO was established at all four participating HBCUs, resulting in more structured and uniform procedures for obtaining and managing externally sponsored programs. Program impact data show that some desired outcomes, such as increased proposal submissions and awards, were partially achieved. The study concludes by highlighting major findings and recommendations related to program effectiveness, including the need for investments in programmatic, as well as administrative, infrastructure. (Final report variously paginated.)

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Joan Jacobs

PHONE NUMBER: (301) 443-9923

PIC ID: 6246

PERFORMER ORGANIZATION: Expand Associates, Silver Spring, MD

TITLE: Environmental Health Data Needs: An Action Plan for Federal Public Health Agencies (Workshop Results, March 3-5, 1997-Linthicum Heights, Maryland)

ABSTRACT: State and local public health agencies have had a long-standing role in monitoring the human health hazards of environmental factors. Public health agencies must be able to collect the necessary information to assess the impact of environmental hazards on community health. The Federal government can help State and local public health agencies in environmental surveillance by identifying the types of information and data necessary to successfully protect community health. This report presents the findings of a conference held in March 1997 to assess the environmental health information needs of State and local governments. The report finds that (1) resources should be used to improve existing data collection systems and to increase data accessibility and usability, rather than to create new data collection systems; (2) the integration of activities and electronic data among public health, environmental health, and environmental protection agencies is vital; (3) the usefulness of environmental health information systems can be enhanced through common data architecture, delineation of core baseline and sentinel data, and a comprehensive, central environmental health data repository; (4) these information systems must be evaluated based on their usefulness to State and local agencies in responding to community demands for timely, accurate, and reliable information, and in achieving their research, surveillance, intervention, and health education goals; and (5) full funding of these systems is necessary so that they may be built into a national network that meets the needs of a national environmental health research agenda. The workshop also developed seven key roles the Federal government could play in helping States and localities improve their environmental health surveillance. Finally, the workshop considered potential short-term strategies to help the Federal government fulfill these roles. (Final report: 12 pages, plus appendices.)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Dalton Paxman

PHONE NUMBER: (202) 205-5829

PIC ID: 6322

PERFORMER ORGANIZATION: Public Health Foundation, Washington, DC

TITLE: Stakeholders Revisit Healthy People 2000 to Maximize the Impact for 2010

ABSTRACT: The objectives articulated in Healthy People 2000 aim to improve the health of Americans through effective prevention strategies. They form a model framework for results-oriented performance measurement that can be made relevant to both population-based and individual health care initiatives. They also serve as a benchmark against which health improvement efforts across the Nation can be measured over time. The development of Healthy People 2010 provides an opportunity to consider the successes and failures of Healthy People 2000 in achieving these important goals. Based on experience with Healthy People 2000 and major changes since 1990 in the Nation's health and health care, this report explores new approaches for the development of Healthy People 2010. The perspectives of the Healthy People Steering Committee and the Healthy People Consortium, made up of 350 member organizations were sought. Through interviews with key Steering Committee members, a retreat for the entire Steering Committee, and seven focus groups of Consortium members, clear themes and suggestions emerged. The report finds that both Steering Committee and Consortium members valued Healthy People 2000 as a framework and a voice for public health concerns and issues. However, both groups had several suggestions for the next version. For example, (1) most members of the Steering Committee thought that the document should be reduced in size, (2) Steering Committee members were more interested than Consortium members in making major changes to the document, (3) Consortium members recommended that current information technology be used in order that the document reach the widest audience possible, and (4) health care purchasers and managed care plans thought that there should be fewer priorities and objectives in order to focus on a limited number of problems. The final stakeholders' report is available on the Internet at http://web.health.gov/healthypeople.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Deborah R. Maiese

PHONE NUMBER: (202) 401-5809

PIC ID: 6491

PERFORMER ORGANIZATION: Academy for State and Local Government, Washington, DC

TITLE: Health of Washington Women

ABSTRACT: This report examines the health and well-being of women in Washington State. A broad coalition of Washington's health care providers, researchers, and activists organized to implement this evaluation. To add to the quantitative data collected and analyzed, the report also includes qualitative information from focus groups of women from diverse geographical areas and economic and social strata. The focus groups were conducted to gather women's perceptions and satisfaction with the health care services they received throughout the State. The data show that the nearly 2.8 million women who live in Washington State are living longer lives, are making many positive decisions about their health, and experience, on average, a better standard of living than women in United States in general. The report finds that the overwhelming majority of women in the State are white and live in urban areas, but about 11.3 percent live below the poverty line. The report also finds that women reported more days of poor mental and physical health than did men, but that they are less likely than men to have a sedentary lifestyle, are less likely to smoke, and are more likely to eat healthy fruits and vegetables. Access to health care for Washington's women is relatively good, but about 10 percent did not participate in a health insurance plan in 1994 and 12 percent reported that they were unable to see a doctor because of the cost. Furthermore, elderly women, those with less than a high school education, and poor women were less likely to use mammography and have regular Pap smears. The report also examines rates of domestic violence and sexually-transmitted diseases, as well as mortality patterns and birth-related indicators. The report provides several policy recommendations to address problem areas for Washington women's health. (Final report: 68 pages, plus appendix.)

AGENCY SPONSOR: Regional Health Administrator-Region X

FEDERAL CONTACT: Karen Matsuda

PHONE NUMBER: (206) 615-2501

PIC ID: 6684

PERFORMER ORGANIZATION: Washington Women's Education Foundation, Seattle, WA

TOP OF DOCUMENT

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Contents

Findings from the Evaluation of the Faculty Development Program, Volume I: Final Report

Report on the CTS National Evaluation

CSAT Demonstration: Evaluation of Job Corps Drug Treatment Enrichment Program

NTIES: National Treatment Improvement Evaluation Study: Final Report

Evaluation of Model Projects for Pregnant and Postpartum Women and Their Infants

Final Report: Review of the CMHS Mental Health Care Provider Education in HIV/AIDS Program

TITLE: Findings from the Evaluation of the Faculty Development Program, Volume I: Final Report

ABSTRACT: The Health Professions Clinical Training Program in Alcohol and Other Drug Abuse (Faculty Development Program, or FDP) was established in 1989 and offers training to faculty from schools of medicine, nursing, social work, and graduate psychology programs. The purpose of the FDP was to enhance research, teaching, and clinical practices on issues of alcohol, tobacco, and other drugs (ATOD) within these fields. Specifically, the program seeks to (1) improve the knowledge and practice of participating faculty on ATOD-related issues; (2) incorporate ATOD-related issues into the curriculum at participating institutions; and (3) increase the level of institutional and professional support for ATOD in both policies and programs. The 5-year projects involved two phases: (1) faculty development and implementation efforts, and (2) an evaluation of the program's impact. The report finds that (1) all projects held meetings and seminars, provided mentoring to fellows, supported fellows' attendance at conferences and meetings, and promoted collaboration between fellows and other faculty members; (2) some project directors with extensive prior ATOD experience provided strong organizational leadership and fostered a group spirit among fellows, while others provided less direct guidance and worked with fellows individually; (3) less experienced directors tended to work with the fellows as peers in organizing activities and formulating a training program; (4) at least two-thirds of the fellows participated in all training activities (except for academic courses) during Years 1-3, while during Year 4, two-thirds continued to meet as a group, attended conferences, and engaged in independent studies; and (5) fellows noted three types of particularly helpful training experiences-literature collection and synthesis, participation in experiential learning, and collaborative curricula development and research. (Draft report: variously paginated.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Cynthia Prather

PHONE NUMBER: (301) 443-4969

PIC ID: 4510

PERFORMER ORGANIZATION: Cosmos Corporation, Bethesda, MD

TITLE: Report on the CTS National Evaluation

ABSTRACT: The Center for Substance Abuse Prevention national Training System (CTS) included the development and delivery of more than 30 distinct curricula on hundreds of occasions to more than 10,000 participants through 1996. Recipients included community teams, health professionals, State administrators, and a range of volunteers engaged in prevention activities. The report finds that CTS was innovative in several important ways, including (1) a focus on community coalitions and associations of health professionals that are responsible for planning and delivering prevention services, rather than concentrating on target populations; (2) curricula were developed quickly in response to emerging issues in the field; and (3) a continuing commitment to quality control and continual curricular improvement. The report also finds that, of three common levels of prevention training (introductory training, training directed at treatment providers and other health professionals, and approaches that contribute to broad systemic changes, usually directed at teams or coalitions), CTS was far more effective at delivering training at the lower two levels, given the complex nature of training for systemic change. The report then focuses on obstacles to training for systemic change, including (1) the difficulty of disseminating best practices, and (2) resistance to change by the prevention community. The report then discusses the principles of effective training. These include (1) attention to post-training application of the knowledge gained; (2) providing a blueprint or schema by which participants may understand the entire framework for a training effort; (3) focus on barriers to application, as well as advantages; (4) ensuring that training is culturally appropriate; and (5) training should encourage participants to use their intellectual and collective intellectual, verbal, emotional, artistic, and imaginative skills. See also PIC ID No. 4514.

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Gwyndolyn Ensley

PHONE NUMBER: (301) 443-0581

PIC ID: 4514.1

PERFORMER ORGANIZATION: Pacific Institute for Research and Evaluation, Bethesda, MD

TITLE: CSAT Demonstration: Evaluation of Job Corps Drug Treatment Enrichment Program

ABSTRACT: The Center for Substance Abuse Treatment within the Substance Abuse and Mental Health Services Administration sponsored a 4-year demonstration project of the Drug Treatment Enrichment Program (DTEP), which was put in place within the Department of Labor's Job Corps program. DTEP was implemented in four experimental Job Corps centers, which were matched with four control centers that provided the standard Job Corps Alcohol and Other Drugs of Abuse (AODA) program. The report finds that (1) the organizational location of DTEP within each Job Corps center's operations was problematic, since DTEP staff reported a lack of managerial support for the program, high staff turnover, and long periods for staff replacement; (2) the average cost per program participant for DTEP was twice the amount required for AODA; (3) DTEP reduced marijuana and crack/cocaine use post-Job Corps significantly more than did AODA; (4) DTEP students were less likely to engage in moderate to extensive use of marijuana or to use other drugs, but no differences were found for alcohol abuse; (5) DTEP improved students' mental health; (6) DTEP students were less likely to report selling or helping to sell drugs after Job Corps; (7) no differences between DTEP and AODA were found for other criminal activities; (8) DTEP students with mental health problems experienced a significantly higher job placement rate after Job Corps, although the program had no effect on job placement rates of other students; and (9) DTEP appeared to have no significant positive effect on duration of stay in Job Corps or on educational and vocational gains. The report makes recommendations regarding the integration of DTEP into Job Corps and other topics. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Ron Smith

PHONE NUMBER: (301) 443-7730

PIC ID: 4523

PERFORMER ORGANIZATION: Caliber Associates, Fairfax, VA

TITLE: NTIES: National Treatment Improvement Evaluation Study: Final Report

ABSTRACT: The National Treatment Improvement Evaluation Study (NTIES) is a comprehensive assessment of the results of 157 3-year demonstration grants and cooperative agreements funded by the Center for Substance Abuse Treatment within the Substance Abuse and Mental Health Services Administration beginning in 1990-1991. These grants were intended to improve alcohol and drug treatment in selected target cities with severe substance abuse problems; among critical populations such as minority groups and women; and in the criminal justice system. Based on a final sample of 6,600 clients, the evaluation produced several results. For clients who entered treatment for alcohol and illegal drug use, the evaluation found that the program produced (1) a 78-percent reduction in selling drugs and committing violent crimes; (2) a 56-percent reduction in high-risk sexual behaviors related to HIV transmission; (3) a 53-percent reduction in medical visits; (4) a 42-percent reduction in homelessness; (5) a 28-percent reduction in inpatient mental health visits; and (6) a 19-percent increase in employment. See also PIC ID No. 5346. (Final report: 310 pages, plus appendices.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Ron Smith

PHONE NUMBER: (301) 443-7730

PIC ID: 5346.1

PERFORMER ORGANIZATION: National Opinion Research Center (NORC), Chicago, IL

TITLE: Evaluation of Model Projects for Pregnant and Postpartum Women and Their Infants

ABSTRACT: In 1989, the Center for Substance Abuse Prevention (CSAP) implemented a national demonstration program to provide prevention, education, and intervention services to substance-abusing pregnant and postpartum women and infants (PPWIs). CSAP contracted this study in 1993 to (1) assess the effectiveness of the PPWI programs in enhancing services coordination and increasing the availability and accessibility of substance abuse prevention services delivered to clients; and (2) document the extent to which program models are effective in decreasing the use of alcohol and drugs among substance-abusing women and enhancing the healthy development of their children. Ten PPWI programs funded by CSAP in 1992 were selected to participate in a 4-year cross-site evaluation. The wide range of interventions and possible outcomes required that program evaluations were augmented by a process evaluation to explain the relationships between mediating variables and outcomes. The project found that (1) there were significantly lower prevalence rates in the use of alcohol, marijuana, crack, and other illicit substances in the treatment group from intake to delivery, and in recent (30 day) marijuana and crack use in the treatment group from intake to delivery (these differences disappeared by the 6-month postpartum followup); (2) the effect of PPWI treatment group membership for lower recent crack use appears to be attributable to participation in day treatment, rather than case management programs; and (3) in general, treatment and comparison group members gave birth to infants with similar birth-related outcome characteristics, but when the mother's crack use histories were taken into account, treatment babies had significantly higher birthweights than comparison group babies. (Final report: variously paginated, plus appendices.)

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Soledad Sambrano

PHONE NUMBER: (301) 443-9136

PIC ID: 5674

PERFORMER ORGANIZATION: Johnson, Bassin and Shaw, Silver Spring, MD

TITLE: Final Report: Review of the CMHS Mental Health Care Provider Education in HIV/AIDS Program

ABSTRACT: This report presents findings from a review of the Center for Mental Health Services' (CMHS) Mental Health Care Provider Education in HIV/AIDS Program, from its inception in 1986 through 1994. The program supports the provision of state-of-the-art training for (1) traditional mental health care providers (psychiatrists, psychologists, nurses, and social workers), (2) other first-line providers of mental health care services (primary care physicians and medical students), and (3) nontraditional providers of such services (clergy or alternative health care workers). The program also supports the development and dissemination of curricula and teaching materials for providing training on the mental health aspects of HIV/AIDS. The goal of the program is to improve access to appropriate and adequate mental health services for people living with HIV/AIDS and for their families and partners. The review examines the activities and outcomes of 27 projects funded by the program. The report finds that (1) the program has trained tens of thousands of mental health service providers, representing the full spectrum of assistance to persons infected with HIV and to their families; (2) training participants are likely to have increased their knowledge about the mental health aspects of the disease, their willingness to serve HIV-infected individuals, and their confidence that they can effectively do so; (3) program funding has served as a catalyst for systemic changes within teaching institutions and hospitals for the development of alliances with concerned groups; (4) the need for training in the mental health aspects of HIV/AIDS is needed throughout the country, especially as affected areas and populations change over time; (5) at the program level, there is a pressing need to obtain systemic knowledge about the efficacy of various approaches to training mental health providers; and (6) the program must identify its priorities and how different projects can meet them.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Martha Ann Carey

PHONE NUMBER: (301) 443-3653

PIC ID: 6695

PERFORMER ORGANIZATION: KRA Corporation, Silver Spring, MD