TITLE: Are Consortia/Collaboratives Effective in Changing Health Status and Health Systems? A Critical Review of the Literature

ABSTRACT: The purposes of this study were to: (1) review the evidence of consortium effectiveness; (2) identify factors and developmental stages associated with effective consortia; (3) discuss challenges in, and tools available for, measuring consortium performance; and (4) assess the potential implications for Health Resources and Services Administration (HRSA) programs. The study found few examples of consortia or coalitions that can claim to have effected change in health status or health systems, and that conditions such as strong leadership, excellent planning, community commitment and well-defined goals are needed. However, collaborative efforts may have such valuable byproducts as: (1) expansion of the ability of individuals and organizations to work together, (2) increased levels of trust, and (3) enhanced responsiveness of the organizations to community needs. The study indicated a need for further research to determine how collaborative efforts achieve long-term outcomes, given the requirements for consortia and other collaborative efforts in many Federal programs.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7062

PERFORMER ORGANIZATION: Health 2000, Inc., Atlanta, GA

Evaluations in Progress

Community Health Centers

TITLE: Analysis of CHC User/Visit Survey: Selected Conditions

ABSTRACT: This study is analyzing portions of the User/Visit Study (See PIC ID 5737) data in order to describe the process of care and outcome measures for Community Health Center (CHC) users with selected health conditions, in relation to their insurance status. The data on CHC users and visits are nationally representative and were gathered so as to be comparable to national estimates maintained by the National Center for Health Statistics (NCHS) through two periodic surveys: The National Health Interview Survey, and the National Ambulatory Medical Care Survey. Data collection was completed in 1995. In the current project, CHC users with diabetes and hypertension are being compared to users who do not have these conditions, and to the general population. Quality of care rendered by the CHC is also being assessed. A third analysis concerns care of CHC users who are uninsured. The Health Resources and Services Administration (HRSA) will use the findings in shaping program policy. An article based on each analysis will be submitted to a peer reviewed journal to facilitate broad dissemination of the results.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4283

PIC ID: 6805

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC

PROJECTED DATE OF COMPLETION: 2/4/99

Community Health Centers and National Health Service Corps

TITLE: Construction and Pretest of the Year 2000 User/Visit Survey

ABSTRACT: In 1997, the Health Resources and Services Administration (HRSA) completed a study (PIC ID 5737) to obtain nationally representative data about the users of Community Health Centers (CHCs) and the services provided to them. This study permitted a comparison of the CHC estimates with estimates derived from the National Health Interview Survey and the National Ambulatory Medical Care Survey administered by the National Center for Health Statistics (NCHS). The current study is developing the sampling frame and revising and pilot testing questionnaires in preparation for a second User/Visit Survey in the year 2000. The year 2000 survey will be the first in which information will be collected on National Health Service Corps (NHSC) users and visits. The HRSA's intent is to conduct this survey every few years to evaluate change over time within the CHC and NHSC programs, and in comparison with the general U.S. population as reflected in the NCHS estimates. Findings from the year 2000 survey itself will be used to measure program performance as required by the Government Performance and Results Act (GPRA).

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4280

PIC ID: 7128

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Effect of Medicaid Managed Care Beneficiary Enrollment and Autoassignment Practices on FQHCs and Their Patients

ABSTRACT: Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study is describing the impact of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. Autoenrollment practices are of interest to the Health Resources and Services Administration (HRSA) because of their possible implications for cultural and linguistic competence of providers, and for existing patient/provider relationships. This study is reviewing autoenrollment rates experienced across the U.S. in Medicaid waiver programs, and is examining Medicaid service areas where FQHCs have experienced high levels of patient dislocation due to State autoassignment and enrollment policies. Potential uses of the findings are: (1) to improve the accuracy and helpfulness of information on plans and providers given to beneficiaries, so that they will be better able to choose a plan; (2) develop strategies for improving the enrollment process; (3) identify common interests among the States, managed care plans, FQHCs and beneficiaries; and (4) generate collaborative problem solving between public and private policymakers.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Dana Jones

PHONE NUMBER: 301-594-4058

PIC ID: 6803

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99
 

TITLE: Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase

ABSTRACT: This comprehensive evaluation of the effectiveness and impact of Community Health Centers (CHCs), begun in 1994, has two components. The content of care component will assess CHC clinical performance and suggest indicators of targets of opportunity for improving patient health status. The Medicaid analysis portion of the study is using Medicaid claims data from seven States (one with Medicaid managed care) to examine three questions: (1) Is there a difference in case mix between Medicaid beneficiaries using CHCs and beneficiaries using other providers of primary care? (2) Are there differences in utilization and expenditures between CHC users and non-users, and what is the effect of adjusting for case mix on these differences? (3) How do CHC characteristics contribute to differences in use and expenditures among CHC users? The findings from this study will identify opportunities and challenges for health centers in both fee-for-service and managed care settings. (See PIC ID 4918)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Elizabeth Darling

PHONE NUMBER: 301-594-4308

PIC ID: 4918.1

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

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes

ABSTRACT: Community and Migrant Health Centers (C/MHCs) provide extensive enabling services to facilitate access to care for vulnerable populations. These services, which include transportation, translation, case management, health education, nutrition counseling and outreach, are not typically reimbursed under managed care. The purpose of this study is to analyze the types and levels of enabling services provided by C/MHCs, how these services have changed over time, and whether enabling services improve outcomes and reduce costs. Study findings will be used to inform national program expectations and to guide C/MHCs in structuring their enabling services to maximize access to primary care and preventive services.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7126

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

PROJECTED DATE OF COMPLETION: 12/15/99
 

TITLE: Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review

ABSTRACT: Through a review of medical records, this study will assess changes in health status among a sample of adult patients of Community Health Centers (CHCs). The conditions selected for evaluation are hypertension and diabetes mellitus. The methodology addresses: (1) the definition of a CHC "user"; (2) confirmation of a diagnosis; (3) patient stratification by severity and/or onset of the condition; (4) expected attrition rates; (5) inclusion of insurance/payer status as a control variable; (6) the time frame in which the two conditions will be measured; (7) protocol for sampling medical records; (8) development of an index of co-morbidities; (9) preparation of a taxonomy of CHC site characteristics; and (10) the appropriate instrument for extracting pertinent data. This project continues the HRSA's systematic effort to identify health status outcomes that may be used to measure the effectiveness of primary care programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6802

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/31/99
 

TITLE: Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma and Other Ambulatory Care Sensitive Conditions Using State Medicaid Research Files

ABSTRACT: A consensus conference in December, 1995 recommended the use of Medicaid data to examine changes in utilization patterns for Community Health Center (CHC) patients diagnosed with ambulatory care sensitive conditions (ACSC). These are conditions which frequently can be managed with timely and effective treatment in outpatient settings, thus preventing the need for hospitalization. The purpose of this study is to compare episodes of ambulatory care for CHC users to those of non-CHC users when both have been hospitalized with a primary diagnosis of diabetes, hypertension, asthma, or other ACSC, as well as when neither has been hospitalized. A previous study (See PIC ID 6001) showed that Medicaid beneficiaries who received most of their care from CHCs had a lower hospitalization rate for ACSCs than did non-CHC users. Findings of the current study will improve understanding as to why CHC users experience lower hospitalization rates for ACSCs, and may have different patterns of ambulatory care use. Findings should also identify the major strengths and limitations of the State Medicaid Research Files for examining episodes of care for a comparison of CHC users and non-CHC users.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 7127

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

PROJECTED DATE OF COMPLETION: 6/30/00

Health Professions

TITLE: Design for Evaluation of the NY Medicare Graduate Medical Education Payment Demonstration and Related Provisions in P.L. 105-33. BBA of 1997

ABSTRACT: The purpose of this study, which is jointly sponsored by the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration (HCFA) and managed by HCFA, is to develop: (1) a design for evaluating a demonstration financed by the HCFA in 1997 in selected New York State teaching hospitals, and (2) recommendations for evaluating Phase II of the demonstration, along with related provisions of the Balanced Budget Act (BBA). The 42 hospitals in the current demonstration volunteered to reduce the number of resident physicians in training by 20 percent or more over a five-year period, while maintaining or increasing the proportion in their primary care program. In return, the HCFA provides transition payments of $400 million over six years. The hospitals repay the payments if they fail to meet their reduction targets. The BBA provides similar options for hospitals in other States and modifies the transitional payment policies by eliminating payment for the first five percent reduction in the full-time equivalent residents. Evaluation objectives include: (1) performance in meeting targets for reductions, (2) impact on access and efficiency, and (3) potential spillover effects on non-participating hospitals.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7132

PERFORMER ORGANIZATION: Health Economics Research, Inc. Waltham, MA

PROJECTED DATE OF COMPLETION: 6/1/99
 

TITLE: Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program

ABSTRACT: Professional Nurse Traineeship (PNT) grants are awarded to eligible institutions for the support of students in advanced nursing education. Traineeships are then awarded by the institutions to individuals enrolled in masters and doctoral programs to prepare for practice as advanced practice nurses. These funds are distributed to institutions based on a formula that incorporates three statutory funding factors. The factor to be studied is the statutory general funding preference which is given to institutions that demonstrate either (1) a high rate of placing graduates in medically underserved communities (MUCs), or (2) a significant increase in the rate of placing graduates in such settings. Comparisons of employment sites of graduates in school receiving the preference with those of graduates in schools not receiving the preference will indicate the significance of a funding preference in promoting program objectives of increasing access to care in underserved communities. The data collected through this study will help to formulate programmatic and policy recommendations designed to strengthen and increase the effectiveness of the PNT program.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ayah E. Johnson, Ph.D.

PHONE NUMBER: 301-443-6315

PIC ID: 7130

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, DC

PROJECTED DATE OF COMPLETION: 4/28/00
 

TITLE: Effectiveness of Diverse Methods of Technical Assistance to Historically Black Colleges and Universities

ABSTRACT: The participation of Historically Black Colleges and Universities (HBCUs) in program activities is vital to the mission of the Health Resources and Services Administration (HRSA), given the traditional focus of HBCUs on providing outreach to low-income and minority communities for a wide range of educational and professional opportunities. However, HBCUs have often reported the need for a clearer understanding of the requirements associated with HRSA solicitations and approaches to meeting those requirements. This study will assess the relative merits of providing programmatic technical assistance through regional workshops, against provision through institution-specific guidance on site. This evaluation will help to highlight those technical assistance approaches that can enhance the participation of HBCUs in HRSA grant/contract programs.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Roscoe Dandy, Dr.P.H.

PHONE NUMBER: 301-443-6582

PIC ID: 7123

PERFORMER ORGANIZATION: Institute for College Research Development and Support, Silver Spring, MD

PROJECTED DATE OF COMPLETION: 12/31/99

HIV/AIDS Services

TITLE: Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources

ABSTRACT: The purpose of this study is to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Increasing demands for accountability, shifts in the populations affected by the HIV epidemic, and the development of effective combination therapies have been associated with increases in the number of people living with HIV who will need care for longer periods of time. While a great deal is known about the types of services and providers supported under the CARE Act, the demographic characteristics of, and services used by, patients are less clear because of a lack of client-level reporting mechanisms. The findings of this study will help to develop an empirical basis for program accountability and performance measurement.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser, Ph.D.

PHONE NUMBER: 301-443-3075

PIC ID: 7123

PERFORMER ORGANIZATION: Johns Hopkins Medical Institutions, Baltimore, MD

PROJECTED DATE OF COMPLETION: 7/31/99
 

TITLE: Development of Estimates of Unduplicated AAR Client Counts Based on Client Level Demonstration Projects

ABSTRACT: This study is developing a method for estimating unduplicated counts of clients served by Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title I and Title II grantees. Grantees use the Annual Administrative Report (AAR) to submit data about the demographic characteristics of organizations providing services under these Titles. Grantees obtain these data directly from providers, who provide unduplicated counts of the people they serve. However, since clients often visit multiple providers, duplication in counts inevitably results as grantees aggregate data across providers. Reliable estimates of unduplicated counts of CARE Act clients will provide a basis for preparing accurate budgets, performance plans, and other documents, and will provide a clearer picture of the scope of the population served by the CARE Act.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: John Milberg

PHONE NUMBER: 301-443-8729

PIC ID: 6808

PERFORMER ORGANIZATION: Harvard Pilgrim Health Care Boston, MA

PROJECTED DATE OF COMPLETION: 7/31/99

Managed Care

TITLE: Evaluation of Managed Care and Vulnerable Populations

ABSTRACT: This study concerns participation in and impact of Medicaid managed care on providers (and the populations they serve) funded under two Health Resources and Services Administration (HRSA) programs: the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, and the Maternal and Child Health Block Grant. The findings will be used to improve technical assistance and develop policies to better support these providers in managed care settings.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6816

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99
 

TITLE: Managed Care and the Safety Net Providers

ABSTRACT: This study is examining the impact of Medicaid managed care and other systemic changes in health care coverage on the future integrity and viability of safety net providers operating in primary care settings, including those funded by the Health Resources and Services Administration (HRSA). These HRSA programs include Community and Migrant Health Centers, Maternal and Child Health programs, and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. The study also includes public hospitals and health departments. Findings and recommendations will be disseminated nationally through a variety of mechanisms, including publication of the report and a series of public forums and workshops.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6815

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99

Maternal and Child Health

TITLE: National Evaluation of the Healthy Start Program

ABSTRACT: The Healthy Start program was launched in 1991 by the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates. The National Evaluation consists of a cross-site process study and an outcome study of the 15 original sites. The final report of the process evaluation, "The Implementation of Healthy Start: Lessons for the Future," was completed in FY 1998 (See PIC ID 5610.1). The outcome evaluation is assessing infant mortality and birth outcomes, including improvements in the adequacy of prenatal care, and the incidence of low and very low birth weight and pre-term deliveries compared to matched comparison communities. The final report will also include findings from a Survey of Postpartum Women, and from special reports on Fetal and Infant Mortality Reviews, Health Education, and Case Management. Study results will be used to improve the Healthy Start projects funded subsequently, and will be shared with the public health community for application in other settings.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/30/00

National Health Service Corps

TITLE: Effectiveness of the National Health Service Corps

ABSTRACT: The purpose of this project is to evaluate the effectiveness of the National Health Service Corps (NHSC), including examination of the various mechanisms for training and recruiting providers, placing them in underserved areas, and retaining them in primary care and related professions. Prior studies have tended to define NHSC "effectiveness" narrowly, e.g., using retention at a particular site as a measure. Current and alumni clinicians and administrators of sites staffed with NHSC clinicians are providing information for the study. Study findings will be used in policy development and program management, and in developing the proposal for new authorizing legislation, needed as of October 2000.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Richard Niska, M.D.

PHONE NUMBER: 301-594-4204

PIC ID: 6357

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/00

State Children's Health Insurance Program

TITLE: An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low-Income Children

ABSTRACT: Title XXI of the Social Security Act permits State Children's Health Insurance Programs (CHIP) to impose cost sharing on beneficiaries, when the program is not an expansion of the State's Medicaid program. Under Medicaid, cost-sharing for services to children is prohibited. This project analyzes cost-sharing models that can be used by States to track cumulative out-of-pocket expenditures for State CHIP activities and employer-based health insurance plans that participate in CHIP; and reviews findings from studies that examine the relationships among health insurance premiums, cost-sharing arrangements, and enrollment and utilization by low income families. Findings will inform guidance for States in designing cost-sharing provisions for the CHIP plans.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Marcia K. Brand, Ph.D.

PHONE NUMBER: 301-443-4619

PIC ID: 7129

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/99
 

TITLE: The Impact of the State Children's Health Insurance Program on Selected Community Health Centers and Maternal and Child Health Programs

ABSTRACT: This study is assessing: (1) the effect of the State Children's Health Insurance Program (CHIP) on the insurance status of children served by selected Community Health Centers (CHCs) and Maternal and Child Health (MCH) programs, and (2) the impact on the extent to which these children enter or remain in care at selected CHC and MCH sites. Issues to be addressed include: (1) the insurance history of children who have used or are new to the site; (2) the continuous nature and time span of the coverage; (3) insurance characteristics of, and source of care for, children who are no longer users; and (4) the characteristics of sites relative to their ability to enroll and/or retain newly insured children. Previous analysis of CHC encounter files documented significant volatility in coverage, with patients going on and off coverage as many as five times in a given year. Study findings will provide a framework for future investigation, develop a transferable methodology for use by States and sites, and help to assess the extent to which CHIP has affected the insurance coverage of children served by CHCs and MCH programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7125

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/00

Crosscutting

TITLE: A Pilot Study to Identify Infrastructure Building Across HRSA Programs

ABSTRACT: This pilot study has two purposes: (1) to describe how Health Resources and Services Administration (HRSA) programs contribute to the development of a health care infrastructure at the local level, and (2) to test the use of a site visit methodology to gather this information. Site visits to Boston, Cleveland and Phoenix are providing information on interactions among HRSA programs--that is, whether multiple programs combine in a mutually reinforcing fashion, operate independently, or work at cross-purposes. Among other topics, the study is also exploring whether the impact of HRSA investments is larger due to the presence of several programs, and is seeking suggestions from the field about ways that HRSA program management may be improved. Findings will improve HRSA's understanding of the interaction and effects of its programs in the context of health care system changes and shifting population needs, and will contribute to performance measurement.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 6814

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99
 

TITLE: Crosscutting HRSA-Wide Performance Strategy

ABSTRACT: Beginning in 1995, the Health Resources and Services Administration (HRSA) has conducted an extensive series of projects to identify meaningful performance indicators and develop related data sources as required by the Government Performance and Results Act (GPRA). Building on earlier program-specific work, this study is developing a structure for arraying performance goals and accompanying measures across the agency. Results will be used initially in drafting the FY 2001 performance plan and budget.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7131

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/99