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Office of the Assistant Secretary for Planning and Evaluation |
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Policy Information Center |
MISSION: To improve the Nation’s health by assuring equitable access to comprehensive, culturally competent, quality health care for all.
Evaluation Program
The Health Resources and Services Administration (HRSA) supports a wide array of very different programs and activities that promote access to needed health care for all, including primary health care centers, the National Health Service Corps, HIV/AIDS programs, maternal and child health activities, health professions training, rural health programs, organ donation and transplantation initiatives, and telehealth activities. To provide underpinning for these efforts, HRSA’s evaluation program is designed to enhance strategic planning, strengthen budget and legislative development, and improve program performance.
HRSA’s evaluation priorities are in the following areas:
HRSA also supports activities to enhance the quality of evaluation agency-wide, such as funding short courses in evaluation for staff and expanding agency staff’s access to technical assistance on the conceptualization, design and implementation of evaluation activities. The broad dissemination of evaluation products and results is also an area of emphasis.
The purpose of this set of studies is to evaluate client- and system-level outcomes achieved as a result of services provided by Ryan White CARE Act (RWCA) grantees and providers. Priorities for evaluating the impact of the RWCA are responsive to grantee requests for assistance with evaluation, the Government Performance and Results Act (GPRA), and amendment to the CARE Act of 1996. Questions to be addressed include whether HRSA's HIV/AIDS programs are: 1) enrolling underserved and vulnerable populations in primary health care; 2) providing clients with quality/continuity of primary care similar to care received by other people living with HIV; 3) providing services that remove barriers to primary care services for CARE Act clients; 4) reducing morbidity and perinatal transmission of HIV disease; 5) reducing HIV-related mortality; and 6) adapting to change in health care (e.g., availability of anti-retroviral therapies and the growth of managed care). The California State Office of AIDS is investigating whether RWCA programs reduce opportunistic infections, and whether there are increased or slowed rates of decline in CD4 counts and declines in perinatal transmission of HIV disease. The New York University Medical Center is examining outcomes over three time periods: pre-RWCA funding (1985-1991), RWCA implementation (1992-1996), and RWCA maturity (1997-2000). The University of Pittsburgh is analyzing Pittsburgh AIDS Center for Treatment outcomes data during 1997-1998. The Washington University School of Medicine is studying patients enrolled during 1997-1998 in the Men's HIV Program and the Helena Hatch Special Care Center for adolescent and adult women with HIV.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Faye Malitz, 301-443-3259
PIC ID: 6177
PERFORMER: California State Office of AIDS, Sacramento, CA
The purpose of this study was to compare specific methodologies for setting capitation rates for people with HIV or AIDS and to analyze the predictive power of those payment models using data from the Medicaid program in Maryland. Specifically, the models tested were the current Maryland approach based on Ambulatory Care Groups, a payment model based on uniform payments for HIV-positive non-AIDS individuals, and a third model based incorporating information on co-morbidities. The three models were then evaluated by simulating payments under the three approaches and comparing them to actual costs of care under a range of different assumptions about the distribution of types of patients. The researchers conclude that the co-morbidity-based payment approach would more equitably reimburse managed care organizations for the costs of care for higher cost patients than the other two alternatives.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Richard Conviser, 301-443-3075
PIC ID: 7095
PERFORMER: Univ. of Maryland, Ctr. for Health Prog. Dev. Management, Baltimore, MD
The purpose of this study was to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. This study also reports on the clinical characteristics of patients attending a single practice which receives substantial support through Ryan White and assessed if there are differences in clinical outcomes based on payor status. Specifically, the report looks at the Johns Hopkins University AIDS Service (JHUAS), a large, urban, hospital-based clinical practice that has received funding through the Ryan White CARE Act to deliver HIV primary care and subspecialty services since 1990. The study tested these two hypotheses: 1) There are no differences in access to clinical services based on payor status, in particular, receipt of guidelines-recommended highly active combination antiretroviral therapy (HAART). 2) There are no differences in clinical outcomes based on payor status. In 1990, a clinical database was established within the JHUAS designed to capture comprehensive longitudinal data on patients attending this clinical practice. Payor status is assessed through the institution's visit registration database, which captures the method of payment for each completed visit. The results show some resource utilization differences and some differences in receipt of antiretroviral therapies based on payor status. However, in multivariate analysis, there were no differences in development of AIDS and survival among payor types.
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Richard Conviser, 301-443-3075
PIC ID: 7123
PERFORMER: Johns Hopkins Medical Institutions, Baltimore, MD
This report presents findings on the effects of Healthy Start on prenatal care utilization, key birth outcomes, and infant mortality in the 15 original project areas selected as demonstration sites by the Health Resources and Services Administration (HRSA). The principal findings are: (1) In eight of the 15 project areas, Healthy Start is associated with improved adequacy of prenatal care utilization. (2) Healthy Start is associated with increases in the adequacy of prenatal care initiation in 4 of the 15 project areas. (3) Healthy Start is associated with improved adequacy of the number of prenatal care visits in 9 of the 15 project areas. (4) Three project areas--New Orleans, New York City, and Philadelphia--show improvements in all measures of prenatal care as a result of Healthy Start. The report also statistically illustrates how Healthy Start contributed to declines in several birth outcomes such as Preterm Rate-- shows significant declines in four project areas; Low Birthweight-- Three projects with statistically significant reductions in the percentage of infants with birthweight less than 2,500 grams; and Infant Mortality Rate-- two project areas, New Orleans and Pittsburgh, Healthy Start is related to a statistically significant decline in the number of infant deaths per thousand live births. The report concludes that Healthy Start is particularly successful at linking women and their families to prenatal care, as shown by improvements in the adequacy of prenatal care utilization in 8 of the 15 original project areas.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Karen Thiel Raykovich, 301-443-0370
PIC ID: 5610.3
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
The purpose of this project was to study 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. This study again looks at the question of retention and sought answers to other vital questions as well. For example, To what extent has the NHSC fulfilled its mission of building self-sufficient health care delivery systems in areas where health care professionals are in short supply? To what extent do NHSC mentor or advocacy relationships help students and providers to practice medicine in underserved areas? Have NHSC providers improved clinical practice standards in underserved areas? The results presented in this report are based on two samples of alumni and current NHSC clinicians. The findings from the study indicate underserved areas continue to need NHSC placements if they are to provide basic health care to a growing and diverse population. The NHSC program not only provides services but also contributes in many ways to extending and expanding access to basic health care services and improving the health care delivery system in underserved communities.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Richard Niska, 301-594-4204
PIC ID: 6357
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
The purpose of this study was to conduct a comprehensive assessment of the level of participation of Historically Black Medical Colleges (HBMC) in HRSA-supported health professions training programs. The study involved an analysis of grant funding for the HBMCs as well as interviews with HRSA program staff and informants from the HBMCs. The final report is primarily narrative and presents 11 findings and 14 recommendations. Generally speaking, the report suggests that HRSA and HBMCs share complementary missions that serve as the basis for developing a stronger working relationship. The report recommends that the relationship be built around stable funding for those HBMCs that can demonstrate that they are producing measurable outcomes that are associated with clearly defined objectives. Those objectives should be related to production of health professionals who are committed to serving the medically under served.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Gwendolyn B. Clark, 301-443-5619
PIC ID: 7121
PERFORMER: Health Resources and Services Administration, Rockville MD
This project developed a discussion paper that addresses health and health care issues for Gay, Lesbian, Bisexual, and Transgender (GLBT) populations. The report discusses the lack of systematic information on the health of GLBT populations, and addresses what are called threshold issues for these groups, including the public health infrastructure, access to quality health services, health communication, and educational and community-based programs. Also reviewed are disease/condition-specific concerns of GLBT populations and other issues such as barriers to care. The report concludes with a review of the methodological challenges to studying Lesbian, gay, bisexual and transgender health.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Melissa Clarke, 301-443-5277
PIC ID: 6813
PERFORMER: Gay and Lesbian Medical Association, San Francisco, CA
This study examined how Medicaid managed care is affecting state agencies and local medical and social service providers funded under the Title V/MCH Services Block Grant program or the Ryan White CARE Act. Managed care has raised different issues for the two programs: for example, only the Title V/MCH program has had to address issues related to its public health role. Several themes repeatedly recurred during visits to Title V/MCH and Ryan White organizations, namely: Many Title V/MCH and Ryan White medical providers have been able to contract with managed care plans for at least some services; Whether providers receive any Medicaid reimbursement for case management depends largely on Medicaid program requirements; Providers contend that reimbursement rates are too low, regardless of whether they are reimbursed by managed care plans, the state Medicaid agency, or the Title V/MCH or Ryan White programs; Many social service providers lack the managed care expertise and staff resources to market their services to managed care plans; Providers that have managed care contracts are struggling with increased administrative demands; Program and provider staff believe that, in general, access to care and quality of care remain adequate, but fear that both may suffer if financial pressure continues to mount.
AGENCY SPONSOR: Health Resources and Services Administration
FEDERAL CONTACT: Alexander Ross, 301-443-1512
PIC ID: 6816
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
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, 301-443-0370
PIC ID: 5610
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
This project performed an assessment of three states' dental public health infrastructures using a variety of data sets collected from national, state and local sources, including Medicaid data, and data from the Area Resource File. The intent was to establish a baseline of information for future analyses of changes and trends. The project also tested the utility of GIS mapping as a tool for assembling and displaying information necessary for dental infrastructure assessment. The final report describes dental demand, supply and distribution in the study states. The project confirmed that acquiring local and national data, displaying the results on state and regional maps, and training state and regional dental health professions in the use of GIS is of value to the recipients and promotes ongoing integration of these tools into routine operations. A CD-ROM was produced to provide access to the database.
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: James N. Sutherland, 303-844-3204
PIC ID: 7242
PERFORMER: Quality Resource Systems, Inc., Fairfax, VA
The "Studies and Papers" series contains original papers contributed by Health Resources and Services Administration staff, as well as abstracts of papers previously published or presented at meetings. The publications cover a broad spectrum of programmatic and administrative activities including (1) health care delivery to underserved persons; (2) health services for Native Americans; (3) AIDS campaign; (4) organ transplants; (5) health professions training; (6) tracking of health professionals and monitoring of their competence by operating a nationwide data bank on malpractice claims and sanctions; and (7) monitoring of developments affecting health facilities, especially those in rural areas. The PIC collection of this series begins with the Summer 1987 issue.
AGENCY SPONSOR: Health Resources and Services Administration
FEDERAL CONTACT: Frank Sisk, 301-443-2086
PIC ID: 3094
PERFORMER: Office of Planning, Evaluation and Legislation, Rockville MD
The purpose of this study is to analyze the characteristics and health service use patterns of homeless people with special needs, and how the homeless population with alcohol, drug, and mental health problems compares to the general population. Issues to be addressed include: a) comparison of the rates of alcohol, drug, and mental health problems, and related treatment patterns with the general or low- income population; b) development of severity indexes on domains such as health, mental health, substance abuse, employability, and receipt of benefits; c) variation of service utilization patterns and their association with other significant variables (e.g., effect of Medicaid or other type of insurance on type and frequency of treatment); d) the relationship between severity indexes, service use patterns, and the history or nature of homelessness (e.g., relationship between treatment history and homelessness); and e) the factors associated with reported service needs and problems (e.g., reports of difficulty accessing primary/dental care). Core data (available in August 1999) will be drawn from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), the first national-level and comprehensive survey of homeless clients since 1987. The NSHAPC has data on providers in 76 U.S. geographic regions, 52 urban and 24 small/rural cities, and a nationally representative sample of clients served by these providers. It was conducted by the Census Bureau on behalf of 12 Federal sponsoring agencies.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Lynette Araki, 301-443-6204
PIC ID: 7250
PERFORMER: Westat, Inc., Rockville MD
The purposes of this study are to examine a) the characteristics/components of the domestic violence protocols used in HRSA-funded community-based primary health care centers; b) the effect that these protocols have on the reporting of violence, clinical diagnoses, and referrals to local community services among female clients; and c) how other BPHC-funded programs can develop domestic violence interventions in their organizations and communities. Health providers often treat abused women without recognizing or addressing the underlying causes of their health condition. A 1995 survey of 10 BPHC- funded primary health care sites found that only half had a formal tool for assessing domestic violence. This study will analyze time series data to compare the effects of incorporating a protocol on domestic violence. Statistical analysis will control for sociodemographic characteristics and other known confounders. In-depth telephone interviews will be conducted with health care center staff (protocol developers, trainers, and key program coordinators). Documentation, screening, and reporting procedures will be reviewed. Training and referral strategies will be analyzed. Nine sites will be selected for study based on a comprehensive literature review of domestic violence interventions during the past five years. A Steering Committee for Family and Intimate Partner Prevention Violence, comprised of HRSA staff, will provide advice on methods.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Kathleen Shannon, 301-594-3621
PIC ID: 7284
PERFORMER: North American Management Company, Alexandria, VA
This project is the initial phase of a longer-term effort to evaluate the effectiveness of HRSA's many efforts to disseminate information and provide education and training through various distance learning techniques. To inform this eventual assessment, this project will: (1) provide a review of relevant literature on the relative effectiveness of different distance learning approaches; (2) catalogue HRSA's dissemination and distance learning programmatic efforts to determine the methods and purposes for which they are used; (3) examine the data currently being collected on these efforts and the utility of those data; (4) determine additional data and analytical needs; and (5) recommend designs for an evaluative study.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Maternal and Child Health Bureau
FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011
PIC ID: 7114
PERFORMER: The Lewin Group, Falls Church, VA
The purpose of this study is to assess the effect of extending 12 months of continuous eligibility for Medicaid or CHIP on the administrative and service costs of caring for children. The Balanced Budget Act of 1997 authorized each State: 1) to provide twelve months of continuous Medicaid eligibility for children and 2) to increase the Medicaid match for continuous eligibility under CHIP. However, some States may consider this too expensive to implement versus a two to six-month Medicaid eligibility. Site visits will be made to four States and Medicaid administrative data will be analyzed. Monthly enrollment data and annual expenditure information from 1995 State Medicaid Research Files (SMRF) person summary files, supplemented with site visit information, will be used to estimate the costs of an additional month of coverage. Service cost estimates will be drawn from both fee-for-service and managed care sectors. Estimates of administrative savings will be based on interviews with State personnel and any reduction in the number of re-determinations of eligibility conducted by States (presumptive eligibility). Institutionalized children and children enrolled in the Supplemental Security Income program will not be included in the analysis.
EXPECTED DATE OF COMPLETION:12/31/2001
AGENCY SPONSOR: Maternal and Child Health Bureau
FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011
PIC ID: 7236
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
This is a multi-phase study that focuses on groups that have been in the forefront of interacting with the population affected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and three HIPAA related provisions: MHPA (Mental Health Parity Act of 1996), NMPHA (Newborns and Mothers' Health Protection Act of 1996) and WHCRA (Women's Health and Cancer Rights Act of 1998). The groups, i.e., State agencies, consumer advocacy groups or individual researchers, are being contacted and benefits, in terms of assisting individuals in obtaining coverage as guaranteed under HIPAA and related provisions, identified. Since strategy for implementation of HIPAA is technically based on State insurance regulatory models, the project will delineate and describe similar and/or differing effects as this model is applied at the Federal level. Evaluation results will lead to assisting CMS in the planning of any future endeavors in private health insurance regulation.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: James Fuller, 410-786-3365
PIC ID: 7420
PERFORMER: Arthur Andersen and Company, Washington, DC
The purpose of this study is to examine the impact of changes in environmental and management factors in the health care system on the revenues, service capacity, and payor mix of Community Health Centers (CHCs). A previous study found that nationally, Medicaid users have decreased, uninsured users have increased, and Medicaid revenues per user have decreased somewhat. This study will explore CHC- specific data in selected areas of the country. Independent variables to be studied include the percentage of Medicaid recipients in managed care and the overall managed care penetration; the percentage and growth of uninsured; the number and nature of HMOs providing Medicaid services; the safety net provider capacity; Medicaid enrollment; patient access/satisfaction; participation in integrated delivery systems and networks; extent of CHC participation in managed care and; CHC performance (based on nine measures used in BPHC's health center reinvestment process). Data will be drawn from the 12 areas in the RWJ Community tracking study, complemented by BPHC Market Place Analysis information for 4-5 areas. Relevant State Insurance Department and State Hospital Association data, and the Dartmouth Atlas will be reviewed. Data for CHCs will be drawn from BPHC's Uniform Data System.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Rhonda Hughes, 301-594-4280
PIC ID: 6784
PERFORMER: Zuvekas, Ann, Consultant, Annandale, VA
The purpose of this study is to develop a fourth edition of Big Cities Inventory, an inventory comparing mortality, natality, and morbidity data for the nation's large cities. Local health departments require comparative data to determine the relative progress in their population's health. Although county data are available, large city health departments often cannot distinguish their own performance from surrounding counties that may have very different socio-demographic and resource characteristics. Data needs will be identified in consultation with members of the National Association of County and City Health Officials (NACCHO) who are from big cities and the previous three editions of the Big Cities Inventory (Chicago Department of Public Health). Issues and barriers encountered in collecting and analyzing comparable data from national and local data sources will be documented. A plan for automating future editions of the Big Cities Inventory will be prepared, including approaches for using Web-based technology to disseminate the report.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Michael Millman, 301-443-0368
PIC ID: 7241
PERFORMER: Chicago Center for Health Systems Development, Chicago, IL
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 survey will help to formulate programmatic and policy recommendations designed to strengthen and increase the effectiveness of the PNT program.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Madeleine Turkletaub, 301-443-6193
PIC ID: 7130
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
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.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Fred Butler, 301-549-4281
PIC ID: 7126
PERFORMER: MDS Associates, Inc., Wheaton, MD
This project will compare the relative risk of inpatient hospitalizations for Community Health Center (CHC) users with non-CHC users for ambulatory care sensitive conditions. Ambulatory care sensitive conditions are those considered preventable, treatable, or controllable in an outpatient setting. The project will design and test a methodology using selected areas in selected states from the newly available State Medicaid Research Files (SMRF). Major research questions for the study include: (1) the best methodological design to assess relative risk of inpatient hospitalizations for selected ambulatory conditions; (2) the relative risk of inpatient hospitalizations.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, 301-594-4463
PIC ID: 6364
PERFORMER: MDS Associates, Inc., Wheaton, MD
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 (ACSCs). 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 ACSCs, 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 lower hospitalization rates 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.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, 301-594-4463
PIC ID: 7127
PERFORMER: MDS Associates, Inc., Wheaton, MD
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 review will address: (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.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells, 301-594-4463
PIC ID: 6802
PERFORMER: The Lewin Group, Fairfax, VA
The purpose of this study is to evaluate (a) the additional demands placed on the health care system by individuals living with HIV infection who have comorbid conditions and (b) the benefits and costs of integrating and coordinating treatment for these conditions. Two separate projects are underway. The Johns Hopkins University will describe and quantify the delivery of comorbidity services, compare this delivery with established guidelines and standards, and analyze the outcomes of the HIV infection and selected comorbidities (substance abuse, psychiatric illness, and hepatitis C). The Washington University School of Medicine will study comorbidities of adult and adolescent women with HIV. Conditions include chemical dependency, mental illness, TB, STD, cervical dysplasia and cancer, diabetes, hypertension, renal failure, and hepatitis B and C. Homelessness and encounters with the criminal justice system will also be explored. The project will analyze how many clients are receiving services for comorbid conditions and HIV, the standard of medical care for those with these conditions, and changes in this standard during 1996-1998. At least one publishable article is to discuss how grantees and planning bodies can use study findings to optimize the delivery of services under the Ryan White CARE Act.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Moses B. Pounds, 301-443-2894
PIC ID: 7267
PERFORMER: Johns Hopkins University School of Medicine, Baltimore, MD
The purpose of this project is to develop an approach to investigate factors associated with variations in hospital organ and tissue donation rates. Such factors include but are not limited to family request practices and hospital referral patterns for reporting deaths and imminent deaths to Organ Procurement Organizations (OPO). The goal is to be able to identify hospital and OPO practices that are associated with higher donor referral, consent, and recovery. Contingent upon the success of this design phase, a study will be implemented and information on best practices will be shared with the hospital and transplant communities to stimulate improvement in donation practices.
EXPECTED DATE OF COMPLETION:11/30/2001
AGENCY SPONSOR: Office of Special Programs
FEDERAL CONTACT: Mary Ganikos, 301-443-7577
PIC ID: 7288
PERFORMER: The Lewin Group, Falls Church, VA
The purpose of this study is to evaluate the impact of increased Medicaid dental fees on children's utilization of dental services and access to dental care in South Carolina. The study will also include an analysis of the supply of dentists that accept Medicaid and the geographic distribution before and after the fee increase. In addition, it will assess changes in the utilization patterns of preventive and restorative care, and will examine the feasibility of developing performance measures that could be tracked using Medicaid data. The study will involve analysis of Medicaid and other extant databases, and secondary analysis of a survey by the South Carolina Dental Association.
EXPECTED DATE OF COMPLETION:01/31/2002
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Raul A. Romaguera, 404-562-4180
PIC ID: 7196
PERFORMER: Medical University of South Carolina, Charleston, SC
The purposes of this study are to a) describe the relationship between characteristics of publicly- funded programs and the survival/financial viability of pediatric safety-net providers; b) determine the differential effects of Medicaid Managed Care (MMC) and the implementation of the State Children's Health Insurance Program (S-CHIP) for pediatric safety-net hospitals relative to pediatric Federally Qualified Health Centers (FQHCs); c) investigate institutional and organizational factors among pediatric safety-net providers; and d) examine the success and failures that these providers have experienced in confronting changes in their community. Improved understanding of the impact of major policy changes on the viability of community pediatric safety-net health care providers can facilitate program strategies to lessen adverse consequences for vulnerable children. Case studies and interviews will be conducted to examine changes in the financial status of these institutions. A logistic regression model will be used to estimate the impact of hospital, market, and policy factors on closure of safety-net providers. Hospital cost, revenue, and profit equations will be estimated using a fixed effects regression model.
EXPECTED DATE OF COMPLETION:09/30/2002
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Felicia L. Collins, 301-594-3732
PIC ID: 6039
PERFORMER: Northwestern University, Center for Health Services Policy, Evanston IL
The purpose of this collaborative project with CDC is to examine the impact of Ryan White CARE Act Title I funding on HIV service use and outcomes in newly eligible metropolitan areas (EMAs). Title I grants are expected to increase each EMA's financial base for planning, developing, and expanding HIV-related health and support services. This project will determine how these funds affect the availability, accessibility, quality, continuity, and integration of care, and HIV-related morbidity (e.g., the incidence of opportunistic infection) and mortality among underserved and vulnerable populations with HIV/AIDS. A cross-sectional pre- and post-analysis of the effects of Title I funding will be conducted in two new EMAs-- Las Vegas, Nevada and Norfolk- Newport News, Virginia. The analysis will provide additional information about the nature and magnitude of the impact of Ryan White program funding on health care services and outcomes for persons with HIV/AIDS.
EXPECTED DATE OF COMPLETION:09/30/2002
AGENCY SPONSOR: HIV/AIDS Bureau
FEDERAL CONTACT: Faye Malitz, 301-443-3259
PIC ID: 7215
PERFORMER: The Learning Group Corporation, Rockville MD
This study will examine the impact of Medicaid managed care and other 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), including Community and Migrant Health Centers, Maternal and Child Health programs, Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. 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.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Alexander Ross, 301-443-1512
PIC ID: 6815
PERFORMER: National Academy of Sciences, Institute of Medicine, Washington, DC
The purpose of this study is to identify patient outcome measures that are sensitive to variations in nurse staffing in acute care hospital settings. Changes in the health care system have raised questions about the quality of patient care. Recent reviews by the Institute of Medicine recommended research on the relationship between quality of inpatient care and level and mix of nurse staffing. Also, the Health Care Financing Administration has drafted proposed Conditions of Participation for Hospitals that must be met if hospitals are to participate in Medicare/Medicaid programs. This study will address these concerns in Phase I by identifying and assessing current studies/methods that are focused on patient outcomes that are sensitive to nurse staffing. Existing and pending data bases useful for conducting research on the sensitivity of patient outcomes to variations in nurse staffing will be identified as will alternative study designs that can provide nationally generalizable information. Phase II will involve acquiring data bases and conducting both descriptive and multivariate analysis of the relationship between nurse staffing and patient outcomes.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Evelyn Moses, 301-443-6315
PIC ID: 6864
PERFORMER: Harvard University, Holyoke Center, Cambridge MA
The purpose of this study is to evaluate the capacity of health departments, public hospitals, and other community-based, safety-net providers to serve the low-income uninsured. Evidence indicates that these safety-net providers are under increased financial pressure due to Medicaid managed care, reduced State funds for the direct delivery of health care services, and a continued rise in the number of uninsured and under-insured. The capacity of safety-net providers is to be measured in terms of change in revenues to serve the low-income uninsured (e.g., change in operating margins or limits on cash reserves), number and type of patient encounters, and the proportion of services provided. Secondary data analysis and site visits will be conducted in twenty communities, with both urban and rural locations. Secondary data will be drawn from AHA's and National Association of Public Hospitals' surveys, NACCHO's survey of local health departments, HRSA's data on community and migrant health centers, CDC's proposed tracking of health departments, and RWJ's Community Tracking Study of community-based providers. Time series analysis will include three years of the most recent available data. Site visits will collect information on State and local government policies that influence the safety net and the role of local provider organizations in the viability of the safety net. Focus groups and interviews with providers and local public health officials will be held in each of the sampled communities. With emphasis on HRSA-supported programs, this study will help policy makers to identify the impact of shifts in health care financing on services provided to low- income uninsured patients. Resources within HRSA's service delivery program can be reallocated to ensure that those most needing care are served.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of the Administrator
FEDERAL CONTACT: Alexander Ross, 301-443-1512
PIC ID: 7240
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
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 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.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jean Yoon, 301-594-6460
PIC ID: 7125
PERFORMER: George Washington University, Washington, DC
The purpose of this study is to conduct: 1) a personal interview survey of users of Community Health Center/Maternal and Child Bureau sites; 2) a separate record-based study of visits to these sites; and 3) a pilot test of the feasibility of a prospective sampling strategy for use in the Community Health Center and National Health Service Corps User/Visit Survey. The user and visit survey will provide in-depth information about the socio-demographic characteristics of users, their risk behaviors and health status, the reasons they seek care, most frequent diagnoses, satisfaction with care, monitoring of chronic conditions, and the services used in a medical encounter. Attention will be paid to whether the sites provide care that meet or exceeds the Healthy People 2000 and 2010 national objectives. A sample of 50-60 grantee health centers and 15 non-grantee, freestanding sites will be selected, and a sample of 40- 50 clients per center/site from medical records. Sampling from the 48 contiguous States will involve urban /rural and the West, Midwest, Northeast, and South Census regions. Questions will be taken from the National Health Interview Survey to allow comparisons with the national population. A retrospective sample of visits will be drawn to obtain a profile of the kinds of conditions treated and services provided.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jerrilynn Regan, 301-594-4283
PIC ID: 6811
PERFORMER: Research Triangle Institute, Research Triangle Park, NC