The PIC identification number appears after the Federal contact's phone number. For information about using PIC resources, please contact the following:
Policy Information Center
Office of the Assistant Secretary of Planning and Evaluation
Department of Health and Human Services
Room 438F, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201
(202) 690-6445
National Technical Information Service
Department of Commerce
5285 Port Royal Road
Springfield, VA 22161
(703) 487-4650
Child Maltreatment 1993: Reports From the States to the National Center on Child Abuse
Children on Hold: Improving the Response to Children Whose Parents Are Arrested and Incarcerated
Demonstration Partnership Program Projects: Project Design and Evaluation Guidebook (Third Revised Edition)
Demonstration Partnership Program Projects: Self-Sufficiency Project Implementation Manual
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From 1990--Homeless and Youth at Risk
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Case Management/Family Development
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Micro-Business and Self-Employment
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings from FY 1991--Minority Males
Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Youth at Risk
Evaluation of the Key States Initiative
Foster Youth Mentors
Increasing Participation in Work and Work-Related Activities: Lessons From Five State Welfare Reform Demonstration Projects (Two Volumes)
Low-Income Energy Assistance Program: Report to Congress for Fiscal Year 1993
Matching Opportunities to Obligations: Lessons for Child Support Reform From the Parents' Fair Share Pilot Phase
Outcomes of Permanency Planning for 1,165 Foster Children
Selected Annotated Bibliography on Youth and Gang Violence Prevention, Community Team Organizing and Training, and Cultural Awareness Curriculums
Something Old, Something New: A Case Study of the Post-Employment Services Demonstration in Oregon
Strengthening Families and Neighborhoods: A Community-Centered Approach--Final Report on the Iowa Patch Project
Study of the Impact on Service Delivery of Family Substance Abuse
Update From the Multistate Foster Care Data Archive: Foster Care Dynamics 1983-93
Youth With Runaway, Throwaway, and Homeless Experiences:
Prevalence, Drug Use, and Other At-Risk Behaviors (Three Volumes)
TITLE: Child Access Demonstration Projects: Final Wave I Report
ABSTRACT NUMBER: 001
ABSTRACT: Since the passage of the 1984 Child Support Enforcement amendments and the 1988 Family Support Act, courts and child support agencies have vastly increased their efforts to establish a child's paternity and establish and enforce child support orders. However, many noncustodial parents' groups have complained that there has not been a parallel increase in enforcement of their rights to parental access. This report presents information from child access demonstration projects in Florida, Idaho, and Indiana that began in October 1990 (wave I). These projects were designed to determine whether mediation services for child access problems would reduce parent conflict; reduce interference with visitation rights; and encourage full, voluntary compliance with child support obligations. The report finds that (1) problems with parental access to children arise frequently (12 to 24 percent in Florida and Idaho), primarily in divorce cases; (2) access problems are more complex than visitation denial; (3) disagreements about visitation seem to increase over time; (4) mediation produced an agreement between parents in about two-thirds of cases, but this conclusion is complicated by the fact that a high proportion of cases assigned to mediation were never attended; and (5) there is no way to tell how long mediated agreements between parents might last. The project was extended through June 1996. (Final report 239 pages, plus appendixes.)
AGENCY SPONSOR: Office of Child Support Enforcement
FEDERAL CONTACT: David Arnaudo
PHONE NUMBER: 202/401-5364
PIC ID: 5972
PERFORMER ORGANIZATION: Policy Studies, Inc., Denver, CO;
Center for Policy Research, Denver, CO
TITLE: Child Maltreatment 1993: Reports From the States to the National Center on Child Abuse
ABSTRACT NUMBER: 002
ABSTRACT: The National Child Abuse and Neglect Data System (NCANDS) collects data on child maltreatment reported from States, territories, and other jurisdictions. This study presents data collected from reports of child maltreatment investigated by States in 1993. NCANDS compiles aggregate data from States in its Summary Data Component (SDC) and also contains case-level data that allow more detailed analyses in its Detailed Case Data Component (DCDC). Pilot testing of the DCDC data collection instrument has been completed, and the DCDC is being phased in nationally. An analysis of the data from the first 10 participating States was to be available in late 1995. The study finds that (1) almost 2 million reports of child abuse and neglect were received by child protective service agencies and referred for investigation in 1993; (2) 1993 is the first year since 1976 in which the rate of reported child abuse and neglect cases has not increased; (3) 53 percent of all reports come from professionals, including educators, law enforcement and justice officials, medical professionals, social service professionals, and child care providers; (4) 18 percent of all reports come from family members; (5) 38 percent of the 1.6 million investigations of alleged abuse or neglect resulted in a disposition of substantiated or indicated child abuse; 53 percent were not substantiated or indicated child abuse; and (6) neglect is the most common type of maltreatment, followed by physical, sexual, medical, and emotional abuse.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Gail Collins
PHONE NUMBER: 202/205-8087
PIC ID: 5387.1
PERFORMER ORGANIZATION: Bowers and Associates, Reston, VA;
American Humane Association, Englewood, CO
TITLE: Children on Hold: Improving the Response to Children Whose Parents Are Arrested and Incarcerated
ABSTRACT NUMBER: 003
ABSTRACT: An estimated 1.5 million children in the United States have an incarcerated parent. As a result of "get tough on crime" policies, the number of incarcerated women has tripled. It is estimated that, on any given day, 167,000 children have mothers in prisons and jails. This report explores what communities are doing nationwide to meet the needs of children whose caretakers are arrested or incarcerated. The report finds that the typical incarcerated woman is likely to be young, single, unemployed, and African-American or Hispanic, with limited education, job skills, and income; a history of drug abuse; and two to three young children. The report uses national telephone surveys of 500 law enforcement, child welfare, and corrections officials in 100 counties. It examines survey responses from patrol officers, narcotics officers, child protective services, foster care parents, and corrections staff. It reports on site visits to communities with exemplary responses to children whose parents are arrested: Galveston, Texas; Mobile, Alabama; San Antonio, Texas; and St. Louis, Missouri. Site visits to exemplary programs for children whose parents are incarcerated are reported on for Albany, New York; Bethel Bible Village, Tennessee; San Antonio, Texas; and San Francisco, California. (Final report 288 pages, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 5853
PERFORMER ORGANIZATION: American Bar Association, Center
on Children and the Law, Chicago, IL
TITLE: Demonstration Partnership Program Projects: Project Design and Evaluation Guidebook (Third Revised Edition)
ABSTRACT NUMBER: 004
ABSTRACT: The Demonstration Partnership program (DPP) represents the first formal research and development component within the Community Service Block Grant. Federal guidelines require that the projects funded under DPP include a strong third-party evaluation component to determine whether they are worthy of replication. The objectives of the program are to (1) stimulate community action agencies to develop new approaches that provide for greater self-sufficiency among the poor; (2) test and evaluate new approaches; (3) disseminate project results and evaluation findings; and (4) strengthen the ability of eligible entities to integrate, coordinate, and redirect activities that promote maximum self-sufficiency among the poor. DPP grants are made to innovative projects that can be coordinated with a grantee's ongoing program. The projects can also combine resources, including partnerships with other community agencies. This guidebook is intended to help grant applicants and grantees understand the role of evaluation in the grants process, in selecting and working with a third-party evaluator, and in preparing the required evaluation reports. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 4336.4
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Self-Sufficiency Project Implementation Manual
ABSTRACT NUMBER: 005
ABSTRACT: "The Self-Sufficiency Project Implementation Manual" is a synopsis of lessons drawn from 8 years of DPP projects. DPP projects were designed to demonstrate the effectiveness of innovative services that promote self-sufficiency among low-income individuals and families who rely on or are at risk of relying on public assistance. DPP has concentrated on five issues in its projects: (1) case management; (2) micro-enterprise development; (3) minority male employment; (4) homelessness; and (5) youth at risk. The implementation manual presents generic models for establishing effective community-based programs in these areas and offers ideas on evaluating such programs. All models are presented in the form of logic models for consistency. Each section of the manual is organized into general lessons and specific lessons learned regarding each of the five project types. The manual is designed for use by community action agencies, community-based organizations, and local community program planners who are interested in developing a self-sufficiency project.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 4336.3
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From 1990: Homeless and Youth at Risk
ABSTRACT NUMBER: 006
ABSTRACT: This report presents the findings from three grants that focused on homeless adults and youth at risk. Two of the projects addressed the needs of homeless adults, while one concentrated on homeless youths. The projects focused on adults were directed toward very different populations. The Tacoma, Washington program worked with adult males who, while homeless, were generally free from most problems that prevent reintegration into the workplace. The project had considerable success in collecting data and in moving clients to the workforce. At follow-up, 80 percent of the case-managed group had jobs. About one-third of these jobs included benefits, and 50 percent were permanent. Half of the clients who were homeless at the beginning of the project were not at follow-up. Unlike the Tacoma project, the Duluth, Minnesota project, which targeted residents of low-income housing, did not exclude residents with special problems, such as a history of mental illness, drug abuse, or criminal involvement. This project was less successful in collecting data and in integrating clients into the workforce. However, participants achieved significantly higher incomes than the control group, although their wages were still low. The project targeted to youth was located in Portland, Oregon. It focused on helping homeless youth at risk find a more stable environment. Many of the youths were using illicit drugs, had criminal histories or mental problems, and came from violent homes. Stabilizing the youths and meeting their emergency needs were the first priorities of the project. The project had problems tracking clients, since many of the youths did not follow up with counselors. Many did not return to the program out of fear that their parents might be contacted. As a consequence, the outcome analysis was difficult to develop. Despite these difficulties, some conclusions were reached, such as: (1) 75 percent of the youths who completed the program have a stable residence unconnected to street life; and (2) 83 percent of those who completed the program are employed, are participating in an educational or vocational training program, or are serving in the Armed Forces. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6056.1
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Case Management/Family Development
ABSTRACT NUMBER: 007
ABSTRACT: This report describes two efforts designed to increase the self-sufficiency of public assistance recipients through case management. The two DPPs were located in DuPage, Illinois, and Stevens Point, Wisconsin. In each project several agencies cooperated to provide coordinated, integrated, and appropriate services to individuals or families receiving public assistance. A case manager coordinated the care received by clients. The target population in DuPage was single-parent families; and in Stevens Point the target population was families whose total income was below 125 percent of the poverty level. Both projects were intended to increase the economic self-sufficiency of clients. The DuPage project included 83 participants in its experimental group. Despite numerous attempts to engage them, about 45 percent of the treatment group never presented themselves for service, never followed up, or were unable to participate because of mental health problems. The Stevens Point program focused on helping working poor families pursue home ownership. Three groups were compared: a control group, a comparison group of participants in a low-income buyers group, and a target group who were enrolled in the home-buyers group and receiving integrated case-management services. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6054.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Micro-Business and Self-Employment
ABSTRACT NUMBER: 008
ABSTRACT: This report presents the results of three programs designed to help low-income individuals start their own business or pursue self-employment to achieve economic self-sufficiency. Two of the programs, one located in Ukiah, California, and one on Wetumpka, Alabama, were relatively close to major urban centers. The third program in Bozeman, Montana, by contrast, was located in one of the more sparsely populated areas of the United States. The populations served by the three programs were quite dissimilar: Ukiah targeted only women; Bozeman targeted only Aid to Families with Dependent Children (AFDC) and food stamp recipients; and Wetumpka targeted a blue-collar and semirural population of mixed gender and race. The Ukiah program was a great success, forcing some participants to wait several weeks before receiving services. Unfortunately, some participants that could not be served immediately did not return to the program when space became available. The Bozeman project assisted low-income individuals in obtaining small business loans. By the end of the project, 39 loans had been awarded to 37 recipients. Additionally, the program awarded loans to 12 Native Americans, or 86 percent of the goal. All programs were relatively successful and had positive impacts on their communities. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6055.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Minority Males
ABSTRACT NUMBER: 009
ABSTRACT: This report presents the results of three DPPs focused on minority males. Two of the projects, located in Milwaukee, Wisconsin, and Boston, Massachusetts, organized their approaches around a combination of a job club and case management. The third project, located in Lexington, Kentucky, used a combination of mentoring and case-management support. The important differences between the programs lay in their target audiences. The Milwaukee and Lexington projects focused almost exclusively on African-Americans, while the Boston project expanded this focus to include Hispanics. Participants' ages ranged from 14 to 34 years; the Lexington project focused on the younger end of the spectrum, the Boston project on the middle, and the Milwaukee program on the older group. The Milwaukee program concentrated on issues of racial bias in education and employment as a means to reduce minority male unemployment. Individual training and education was also used to lessen the negative effects of family and community dysfunction. In Lexington, problems included a lack of suitable mentors. Only 10 percent of 300 possible mentors completed the application, and this number was further reduced after a check of police records. However, the program demonstrated that mentors and participants must be matched one-to-one. The Boston program achieved a 58 percent completion rate. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058.
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6058
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Demonstration Partnership Program Projects: Summary of Final Evaluation Findings From FY 1991--Youth at Risk
ABSTRACT NUMBER: 010
ABSTRACT: This report presents the findings from four types of youth-at-risk projects funded under DPP: school-based, teen parents, employment training, and homeless youth. Regardless of the approach taken, all products had some core service components in common, including case management, social support services, educational services, and employment training. Four projects were school based. The Yakima, Washington, program targeted low-income high school youth to increase their educational success and wage rates and to reduce their reliance on public assistance. The Morristown, Tennessee, program provided school-based interventions to 148 preteen girls to reduce adolescent pregnancy rates. The Greenfield, Massachusetts, program provided case-management services, as well as nontraditional interventions (cooperative games, outdoor challenge activities). The Everett, Washington, program helped teenage mothers increase their education and job readiness. Two projects focused on employment training (Tacoma, Washington, and Austin, Texas). The Tacoma program served JTPA youths aged 17 to 21 at risk of gang or drug involvement or dropping out of school and eligible for Job Training Partnership Act services. The second project was intended to increase the potential for self-sufficiency and to strengthen service linkages. See also the series under PIC ID 4336, 6054, 6055, 6056, 6057, and 6058. (Final report variously paginated.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Richard Saul
PHONE NUMBER: 202/401-9341
PIC ID: 6057.2
PERFORMER ORGANIZATION: BHM International, Inc., Silver
Spring, MD
TITLE: Evaluation of the Key States Initiative
ABSTRACT NUMBER: 011
ABSTRACT: After passage of the Refugee Act of 1980, it became apparent that a large percentage of refugee families were remaining in welfare programs for extended periods of time. In response, the Office of Refugee Resettlement implemented the Key States Initiative (KSI) in fiscal 1987. The initiative was intended to increase employment among the refugee community and reduce dependence on welfare. Eight States emerged with high welfare dependency characteristics, and of these States, five chose to participate in this new program: Minnesota, New York, Pennsylvania, Washington, and Wisconsin. For each State, the report provides information on program design features, program participant characteristics, program outcomes, and lessons learned. The report also discusses the conclusions that can be drawn from a composite view of KSI program principles. The report finds that (1) programs that emphasize self-sufficiency goals, such as welfare termination, are more successful than those focusing only on job placement; (2) employment-related services provided to all potential wage earners in the family increased the odds that the family would leave the welfare rolls; (3) results-oriented vocational training programs worked better when they obtained employer commitments to training, program design, teaching resources, and job placement; and (4) clients are more cooperative with staff who have cultural backgrounds similar to their own.
AGENCY SPONSOR: Office of Refugee Resettlement
FEDERAL CONTACT: Loren Bussert
PHONE NUMBER: 202/401-5364
PIC ID: 5959
PERFORMER ORGANIZATION: Office of Refugee Resettlement,
Washington, DC
TITLE: Foster Youth Mentors
ABSTRACT NUMBER: 012
ABSTRACT: The University of Illinois Urbana-Champaign School of Social Work examined the factors characteristic of successful relationships between foster youths and older citizen mentors. The program compared 250 successful mentor/foster youth matches with 250 unsuccessful matches. Data focused on the characteristics of the mentors, the foster youths, and the mentoring program. The study also includes evaluations of each match from both participants. Study samples were taken from programs that offer mentoring as part of their service delivery. Programs include The Peoria Children's Home Association (Illinois); Covenant House Rites of Passage (New York); Judge Baker Children's Center; Fairfax County Mentor Program (Virginia); and various mentoring programs from Montana, New Hampshire, Alabama, and Kentucky. Project findings were disseminated to independent living programs throughout the United States in order to facilitate the use of mentors in efforts to transition older youths from foster care.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 4388
PERFORMER ORGANIZATION: University of Illinois, School of
Social Work, Urbana, IL
TITLE: Increasing Participation in Work and Work-Related Activities: Lessons From Five State Welfare Reform Demonstration Projects (Two Volumes)
ABSTRACT NUMBER: 013
ABSTRACT: This study uses data from State and local officials, case record reviews, and management reports to examine key implementation and operational issues in five States currently conducting welfare reform demonstration projects: Colorado, Iowa, Michigan, Utah, and Vermont. Reforms in these five States emphasize strategies designed to increase participation in work and work-related activities. Specifically, the report looks at (1) the strategies States use to increase participation in the Job Opportunities and Basic Skills (JOBS) training program (or similar programs); (2) the role of child care in increasing program participation; (3) the extent to which the culture of welfare offices has changed from one of check issuance to one of finding employment for recipients; and (4) the early lessons to be drawn from the experiences of these States. The report finds that States use many strategies to increase participation, including (1) reducing exemptions and serving more participants; (2) redefining participation to include unsubsidized employment and activities, such as substance abuse and mental health counseling and parenting classes; and (3) increasing penalties for nonparticipation. All five States budgeted for additional expenditures for staff and child care. All States reported that it is extremely difficult to change the culture of welfare offices. Volume 2 presents a site visit summary for each State. (Final report: volume 1, 96 pages; volume 2, 174 pages.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Peter G. Germanis
PHONE NUMBER: 202/401-9316
PIC ID: 5815
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Low-Income Home Energy Assistance Program: Report to Congress for Fiscal Year 1993
ABSTRACT NUMBER: 014
ABSTRACT: This report examines how States used funding they received under the Low-Income Home Energy Assistance Program (LIHEAP), describes trends in home energy consumption, reviews demographic data on LIHEAP beneficiaries, and assesses State compliance with the LIHEAP legislation for fiscal 1993. During that year, States spent $1.525 billion from LIHEAP, 86 percent of which came from Federal net allotments. States used the funds to provide heating and cooling assistance, energy crisis intervention or assistance, low-cost home weatherization, or other energy-related home repairs. The report finds that (1) 32 percent of home energy is used for space heating or cooling; (2) low-income households are more likely to heat with fuel oil, kerosene, or liquified petroleum gas and are less likely to heat with electricity; (3) low-income households consume less energy than other households (about 10 percent less for heating, 32 percent less for cooling, 17 percent less for appliances, and 5 percent less for water heating); (4) although these households consume less energy, a greater percentage of their annual income is spent on energy needs; (5) about 20 percent of those households eligible for LIHEAP received assistance in 1993 (they were among the poorest of all eligible households); and (6) States generally comply with requirements for setting benefit levels and legibility. See also PIC ID 4638. (Final report 37 pages, plus appendixes.)
AGENCY SPONSOR: Office of Community Services
FEDERAL CONTACT: Donald Sykes
PHONE NUMBER: 202/401-9333
PIC ID: 4638.1
PERFORMER ORGANIZATION: Office of Community Services,
Division of Energy Assistance, Washington, DC
TITLE: Matching Opportunities to Obligations: Lessons for Child Support Reform From the Parents' Fair Share Pilot Phase
ABSTRACT NUMBER: 015
ABSTRACT: The Parents' Fair Share (PFS) demonstration program requires that the noncustodial parents of children on welfare participate in employment related and other services when they are unemployed and unable to meet child support obligations. This study evaluates the operational feasibility of the PFS approach, ascertains whether a full-scale evaluation is warranted, and studies the target population. This effort studied 4,000 noncustodial parents in nine States who were not able to meet their child support obligations. Baseline data from enrollment forms, management information data, child support payment records, child support orders, site visits, peer support feedback forms, and participant and staff interviews were used to evaluate the pilot phase. The report finds that (1) the PFS program appears to be operationally feasible and shows enough promise to warrant a full-scale evaluation of its impacts and cost-effectiveness; (2) the program shows most ability to effect changes in individuals in poor support groups with a set curriculum; (3) cases received attention that were neglected prior to PFS; (4) employment and training systems were more difficult to change because of institutional barriers and limitations in program design choices, but the number of options in this area increased over time; and (5) many PFS parents appeared to be living in poverty, but most saw their children regularly and wished to support them. See also PIC ID 5952.1.
AGENCY SPONSOR: Office of Child Support Enforcement
FEDERAL CONTACT: Mark Fucello
PHONE NUMBER: 202/401-4538
PIC ID: 5952
PERFORMER ORGANIZATION: Manpower Demonstration Research
Corporation, New York, NY
TITLE: Outcomes of Permanency Planning for 1,165 Foster Children
ABSTRACT NUMBER: 016
ABSTRACT: This report presents the findings of a study of 1,165 children in foster care. It examines the distribution of the children in four permanency planning (PP) exit categories after up to 18 months in care, and any changes in the child's PP status within 12 months of leaving the foster family. The report gives information on the demographic characteristics of the children, the reasons for their removal from the family, and characteristics of their stays in foster care. The report finds that many significant differences among children in the two study sites (San Diego County, California, and Pierce County, Washington) are explained in part by differences in child and family characteristics, but also by differences in the service systems in the sites. Pierce County's system has greater judicial system involvement, greater use of voluntary placements, and administrative rather than court reviews. The report also finds that the over-representation of minority children calls for an ethnicity-sensitive practice in child welfare systems. Furthermore, the large number of children with mental health, physical health, and behavioral problems in the study population reveals the need for appropriate services for this population. The report also finds that (1) two-thirds of children in both sites were reunited with their families; (2) adoptions were more frequent in Pierce County than in San Diego County, while long-term foster care was more frequent in the latter site; and (3) guardianship was used sparingly in both sites.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Cecelia Sudia
PHONE NUMBER: 202/205-8764
PIC ID: 5874
PERFORMER ORGANIZATION: San Diego State University, Child
and Family Research Group, San Diego, CA; Manpower Demonstration
Research Corporation, New York, NY
TITLE: Selected Annotated Bibliography on Youth and Gang Violence Prevention, Community Team Organizing and Training, and Cultural Awareness Curriculums
ABSTRACT NUMBER: 017
ABSTRACT: This report is intended as a resource for youth-serving organizations, as well as individuals, researchers, and policymakers concerned with youth issues. This annotated bibliography provides brief summaries of materials ranging from reports and monographs to curriculums, training manuals, articles, and other literature and products. The entries in the bibliography were selected in a search of local and national print and electronic libraries and databases. Items were selected, annotated, and organized in the following general sections: (1) youth violence/gang violence; (2) youth violence prevention programs; (3) youth violence, gang, and drug prevention curriculums; (4) interpersonal skills training; (5) peer mediation; (6) multicultural awareness curriculums and cultural sensitivity training; (7) immigrants; (8) team organizing; (9) community collaboration; (10) interagency cooperation and partnerships; (11) community empowerment; and (12) training methodologies and strategies. Author, subject, geographic area, organization, project, and center indexes are provided. See also PIC ID 5875 and 5875.1. (Final report, 172 pages.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Terry Lewis
PHONE NUMBER: 202/205-8102
PIC ID: 5875.2
PERFORMER ORGANIZATION: Development Services Group, Inc.,
Bethesda, MD
TITLE: Something Old, Something New: A Case Study of the Post-Employment Services Demonstration in Oregon
ABSTRACT NUMBER: 018
ABSTRACT: The Federal Post-Employment Services Demonstration (PESD) was initiated in response to indications that many people who leave welfare for work lose their jobs fairly quickly and return to the welfare rolls. The demonstration is intended to help those who become employed keep their jobs, to help those who lose their jobs return to work quickly, and to reduce the amount of time families receive Aid to Family with Dependent Children (AFDC). PESD operates in Riverside, California; Chicago, Illinois; Portland, Oregon; and San Antonio, Texas. This report provides an indepth look at the program's operations in Oregon, gives the background for PESD and contrasts it with programs such as JOBS, which focuses on preemployment services. It describes the AFDC/JOBS program in Oregon and the State's postemployment initiative, the JOBS Employment Retention Initiative (JERI). The report then describes early patterns of job loss and reemployment in JERI, finding that job turnover is significant for participants (61 percent lost their first jobs during the first year of the demonstration). However, participants who lose their jobs return to work fairly quickly. The report describes the structure of the JERI program and makes general recommendations about how States might move from a preemployment services model to a post-employment services model. (Final report 48 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Research, and Evaluation
FEDERAL CONTACT: Nancye Campbell
PHONE NUMBER: 202/401-5760
PIC ID: 6002
PERFORMER ORGANIZATION: Project Match, Erikson Institute,
Chicago, IL
TITLE: Strengthening Families and Neighborhoods: A Community-Centered Approach--Final Report on the Iowa Patch Project
ABSTRACT NUMBER: 019
ABSTRACT: The Iowa Patch project, modeled on the British patch system of community-centered service delivery, was an innovative method of testing services improvement in a distressed urban neighborhood in Linn County, Iowa. The project attempted to overcome categorical barriers that prevent the pooling and use of informal and formal resources needed for flexible social services. The project ran in tandem with, and was supported by the Linn County Decategorization project, an Iowa initiative merging child welfare funding streams and involving the community in comprehensive services planning. The project showed that, overall, services were integrated and improved using the patch model. The project overcame normal turfism to successfully collocate an interagency team of human services workers; it successfully devolved responsibility for service delivery to the team and to line workers on the team; and it shifted the workers' practice from a deficit and crisis orientation to one that is proactive, preventive, and holistic. Services were more accessible and workers were more approachable and were able to develop informal relationships with consumers and local helping networks. Workers also did more in-home work with consumers. The Patch project has developed well beyond the level of a demonstration program and has been integrated with other agencies in Linn County's Family Research Center program. (Final report 148 pages, plus appendix.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Dolson
PHONE NUMBER: 202/401-0133
PIC ID: 5977
PERFORMER ORGANIZATION: University of Iowa, Iowa City, IA
TITLE: Study of the Impact on Service Delivery of Family Substance Abuse
ABSTRACT NUMBER: 020
ABSTRACT: This report was originally intended to provide the Administration on Children, Youth and Families (ACYF) with information on the incidence of family drug abuse, and the effects of this abuse on ACYF programs. The comprehensive survey and study first planned was not approved by the Office of Management and Budget. Therefore, the scope of the study was reduced to include a literature review of relevant research from 1986 through 1994 and intensive case studies of the effects of family alcohol and other drug (AOD) abuse on ACYF-funded programs. The literature review and site visits show that (1) Child Protective Services (CPS) are the ACYF programs most seriously negatively affected by family AOD abuse, followed by foster care, Head Start and other early childhood education programs, runaway and homeless youth (RHY) programs, and adoption services; (2) front-line staff in most ACYF-funded programs are ill-equipped and poorly trained for dealing with substance-abusing families; (3) ACYF-funded programs that effectively intervene in cases of family AOD abuse are significantly hampered by the lack of appropriate AOD treatment outlets; and (4) family AOD abuse has resulted in new challenges to all ACYF-funded programs in meeting their mandated functions, including accelerated termination of parental rights policies, postadoption and foster placement support programs, and modification of the Head Start program to address the needs of nonparental caretakers. (Final report 33 pages, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Dolson
PHONE NUMBER: 202/260-6165
PIC ID: 4399
PERFORMER ORGANIZATION: Cygnus Corporation, Inc.,
Washington, DC
TITLE: Update From the Multistate Foster Care Data Archive: Foster Care Dynamics 1983-93
ABSTRACT NUMBER: 021
ABSTRACT: The Multistate Foster Care Data Archive contains foster care career histories for all children who have been in State-supervised substitute-care living arrangements. The data for the archive are extracted directly from the administrative data systems operated by each State's child welfare agency. The information is comprehensive and longitudinal at the individual level. Five States participated in the original archive: California, Illinois, Michigan, New York, and Texas. These States provide services to almost one-half of the total child substitute-care population in the United States. This report covers 1983-93, updating a 1994 report examining foster care dynamics between 1983 and 1992. The report is descriptive and is not a policy analysis. The report finds that (1) the five States described here have different levels of child care placement activity; (2) the trend in each of the States has been one of significant growth in the numbers of children receiving State-supported care; (3) admissions have been far greater than discharges, and most episodes of rapid caseload change follow a shift in admission levels; (4) most child care placement activity was concentrated in major urban centers; (5) much of the recent growth in foster care has involved the placement of children with relatives, while the number of children placed in institutional and group care settings has remained stable; and (6) infants and young children are the fastest growing age groups in the foster care population.
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: Penelope L. Maza
PHONE NUMBER: 202/205-8172
PIC ID: 5885.1
PERFORMER ORGANIZATION: Chapin Hall Center for Children,
University of Chicago, Chicago IL
TITLE: Youth With Runaway, Throwaway, and Homeless Experiences: Prevalence, Drug Use, and Other At-Risk Behaviors (Three Volumes)
ABSTRACT NUMBER: 022
ABSTRACT: This report is the first national study of substance use, suicide attempts, and other at-risk behaviors among youth with runaway, throwaway, or homeless experience. Information comes from four sources: youths in shelters, youths on the street, youths in households, and directors of youth shelters. The survey of youths and youth shelter directors shows that (1) these youths are exposed to high-risk environments before as well as after they leave home; (2) about half of the youths classified as runaways could also be considered throwaways by their families; (3) these youths are much more likely than youths in general to engage in problem behaviors, including substance abuse, suicide attempts, unsafe sexual behavior, and criminal activity; (4) the youths from families who use drugs are particularly likely to engage in high-risk behaviors; (5) a high proportion of these youths spend time in institutions such as foster homes, psychiatric hospitals, and juvenile justice facilities; and (6) these youths are more likely to engage in many problem behaviors after leaving home than before, perhaps because doing so is a means of survival. The report recommends improvements in services for youths with these experiences. It notes that services must address all needs, from primary prevention to intervention and treatment. Furthermore, services must be community based, accessible, and comprehensive. (Final report three volumes variously paginated, plus appendixes.)
AGENCY SPONSOR: Administration on Children, Youth and Families
FEDERAL CONTACT: James Griffin, Ph.D.
PHONE NUMBER: 202/205-8138
PIC ID: 3871
PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC
Real People, Real Problems: An Evaluation of the Long-Term Care
Ombudsman Programs of the Older Americans Act
TITLE: Quality of Long-Term Care in Home and Community-Based Settings: Defining the Issues
ABSTRACT NUMBER: 023
ABSTRACT: This study is the first step in implementing the 1992 amendments to the Older Americans Act, which authorize the Department of Health and Human Services to conduct two studies. The first study is on the quality of care provided by board and care (B & C) facilities, while the second study is on home care services for older and disabled individuals. The study listed here developed the conceptual framework and provisional design for the two mandated studies.
AGENCY SPONSOR: Office of Program Operations and Development
FEDERAL CONTACT: James Steen
Room 4262, Cohen Building
PHONE NUMBER: 202/619-0075
PIC ID: 5962
PERFORMER ORGANIZATION: National Academy of Sciences,
Institute of Medicine, Washington, DC
TITLE: Real People, Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act
ABSTRACT NUMBER: 024
ABSTRACT: The long-term care ombudsmen program, administered by AoA, provides ombudsmen who advocate to protect the health, safety, welfare, and rights of the institutionalized elderly in nursing facilities and board and care homes. This report examines (1) State compliance with program mandates; (2) conflicts of interest; (3) effectiveness of the program; and (4) adequacy of resources for the program. The report finds that (1) the ombudsman program as a whole has not been fully implemented with regard to the provisions of the Older Americans Act; (2) not all residents of long-term care facilities have meaningful access to ombudsmen, and many are not aware of the program's existence; (3) ombudsmen provide timely responses to complaints; (4) implementation of the ombudsman program for residents of nursing facilities is uneven, and for residents of B&C homes it has not been implemented in any meaningful way; (5) because the ombudsman program is part of State government and its hierarchy, conflicts of interest and loyalty exist within the program, yet regulations do not reflect this reality; and (6) the ombudsman programs function well in many States, serving many thousands of institutionalized elderly, despite the obstacles of inadequate funding, staff shortages, low salary levels, and conflicts of interest. The report recommends improvements in each of the main areas it discusses. (Final report 248 pages, plus appendixes.)
AGENCY SPONSOR: Office of Program Operations and Development
FEDERAL CONTACT: Nancy Wartow
PHONE NUMBER: 202/619-1058
PIC ID: 5819
PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC
Developing Quality and Utilization Review Criteria for Management of Cataracts in Adults: Phase II Final Report
Developing Quality and Utilization Review Criteria for Pressure Ulcers in Adults: Phase II Final Report
Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology
Design of a Survey to Monitor Consumers' Access to Care, Use of Health Services, Health Outcomes, and Patient Satisfaction: Final Report
Overcoming Barriers to Implementation and Integration of Clinical Information Management Systems: Feasibility Study
Practice Patterns and Expenditures in Managed Care and Indemnity Plans: A Condition-Specific Analysis
Directory of Minority Health and Human Services Data Resources
Development of Designs for Evaluation of the Process of Clinical Guideline Development
Users' Perceptions of Four Clinical Practice Guidelines and Their Development Process
Setting Priorities for Clinical Practice Guidelines
AHCPR Clinical Practice Guideline Program: Report to Congress
TITLE: Develop, Apply, and Evaluate Medical Review Criteria and Educational Outreach Based Upon Clinical Practice Guidelines: Acute Postoperative Pain and Urinary Incontinence
ABSTRACT NUMBER: 025
ABSTRACT: This project, a contract with the Center for Clinical Quality Evaluation in Washington, DC, was designed to translate three AHCPR-supported clinical practice guidelines into tools that could be used to evaluate quality of care. Using the methodology developed in "Using Clinical Practice Guidelines to Evaluate Quality of Care: Issues and Methods" (AHCPR Publication Numbers 95-0045 and 95-0046), the project developed quality/utilization review criteria and clinical performance measures based on three guidelines: urinary incontinence; acute postoperative pain; and benign prostatic hyperplasia, or BPH. The project used five Medicare Peer Review Organizations to develop and test the criteria and performance measures. These criteria and measures were used to assess the care provided to a sample of randomly selected cases of Medicare patients. The peer review organizations also played an integral role in developing, implementing, and evaluating alternative educational outreach strategies based on the BPH guideline.
The project found that it is possible to develop valid and reliable guideline-based performance measures from AHCPR-supported guidelines. The structure of guideline recommendations can strongly influence the development of clinical performance measures. The project also found that targeted educational efforts based on the BPH-supported guidelines resulted in improved performance on specified measures. (Final report 107 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5973
PERFORMER ORGANIZATION: Center for Clinical Quality
Evaluation, Washington, DC
TITLE: Developing Quality and Utilization Review Criteria for Management of Cataracts in Adults: Phase II Final Report
ABSTRACT NUMBER: 026
ABSTRACT: This project developed and tested quality and utilization review criteria and review systems based on AHCPR-supported clinical practice guidelines on cataracts in adults. The project included two phases. In phase I, project teams developed and tested initial drafts of review criteria and review systems. These drafts were then refined and key components tested again in phase II. Conclusions from phase I are (1) guideline-based review criteria and systems can be developed and used in reviewing quality and utilization in a range of health care delivery settings; (2) review criteria derived from a guideline can be organized into many types of review systems with different goals and purposes; (3) guidelines must contain several critical elements to be useful for clinical decisionmaking and for development of review criteria and review systems; (4) operationalization and measurement are key challenges in review system development. Phase II conclusions are (1) the medical record-based review system designed to assess adherence to AHCPR-supported cataract guidelines is feasible and useful; (2) guidelines must be more specific and have more comprehensive information to optimize their development; and (3) use of a review system may improve documentation practices and adherence to recommendations.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5633
PERFORMER ORGANIZATION: Rand Corporation, Santa Monica, CA
TITLE: Developing Quality and Utilization Review Criteria for Pressure Ulcers in Adults: Phase II Final Report
ABSTRACT NUMBER: 027
ABSTRACT: This project developed guideline-based quality and utilization review criteria that can be used to assess clinical care to prevent pressure ulcers. These criteria can be used to assess conformance with recommendations in clinical practice guidelines and to target areas for clinical quality improvement. The project developed and tested measures that can be used to assess aspects of care that may be related to the development of pressure ulcers. The measures included the development of care plans and nutritional assessments, as well as care behavior related to positioning patients, alleviating pressure, and cleansing and moving patients. The focus of the review system is on patients with limited mobility, specifically patients with stroke or hip fracture. However, the review system can be adapted for use with other patient groups. The review system based on the pressure ulcer guideline was designed in collaboration with the Department of Veterans Affairs (VA) and focused on testing the review criteria for use in both VA and non-VA hospitals. The criteria will be used as part of future collaborative research between AHCPR and the VA. AHCPR and the VA are involved in a VA-wide effort to disseminate the guideline to 45 hospitals.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5634
PERFORMER ORGANIZATION: Rand Corporation, Santa Monica, CA
TITLE: Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology
ABSTRACT NUMBER: 028
ABSTRACT: Clinical performance measures are instruments that estimate the extent to which a health care provider (1) delivers appropriate clinical services in a safe, competent, and timely manner; and (2) achieves desired outcomes in terms of patient health and satisfaction. This project formulates a typology for analyzing the properties and uses of clinical performance measures that have been developed by government and nongovernment organizations, including AHCPR. The report stresses that the typology developed does not classify measures in terms of good and bad, but rather according to the setting for which they were developed, the purpose for which they were developed, and the properties that relate to the measures' potential suitability for its original or other purpose. The report also discusses using performance measures for quality improvement and consumer education. It discusses the use of performance measure sets, ranging in size from less than 10 measures to hundreds. Furthermore, the report examines the desired properties of measures, including (1) detailed specifications to ensure uniformity of application; (2) testing for reliability and validity as measures of performance; (3) allowance for patient differences in making comparisons; and (4) well-planned graphical displays of comparisons. Finally, the report discusses making the measures affordable and offers possible uses for them. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5630
NTIS ACCESSION NUMBER: PB 96-144639
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Design of a Survey to Monitor Consumers' Access to Care, Use of Health Services, Health Outcomes, and Patient Satisfaction: Final Report
ABSTRACT NUMBER: 029
ABSTRACT: This project developed survey instruments to be used by health plans, employers, health alliances, States, accrediting agencies, the Federal Government, and others. The surveys measure consumers' assessments of their health insurance plans, in order to provide meaningful and useful information to other consumers choosing a health insurance plan. The report presents a set of prototype instruments containing an initial set of questions and procedures to assess a range of consumer issues. The report also contains an overview of the conceptual development process and the rationale for the current survey design. The methods and results of cognitive testing are described, as is the logic and evolution of the items contained in the prototype survey. The report concludes with a discussion of the prototype survey's strengths and limitations and a brief overview of recommendations for additional development and testing. (Final report 85 pages, plus appendixes.)
AGENCY SPONSOR: Center for Quality Measurement and Improvement
FEDERAL CONTACT: Sandra Robinson
PHONE NUMBER: 301/594-1352
PIC ID: 6011
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Overcoming Barriers to Implementation and Integration of Clinical Information Management Systems: Feasibility Study
ABSTRACT NUMBER: 030
ABSTRACT: Clinical information systems capture and retrieve information at the point of health care delivery, display clinically meaningful results from multiple services, display chronological histories of patients' medical interventions, compare data on patients with similar characteristics, and share information between sites of care. Although such systems are commercially available, hospitals have been slow to implement them. This report examines the sociological, organizational, technological, and financial barriers to the implementation and optimal use of integrated clinical information systems. The report provides details on the feasibility of a study of 8 to 16 sites representing 4 to 8 major vendor products. It also provides details on site selection, research design, and a data collection plan. The report finds that the study should use focused case studies to carry out four main objectives: (1) identify target systems and provider site characteristics; (2) identify and recruit provider sites; (3) identify and solicit vendor participation; and (4) design an evaluation plan for the study, including a process and structure evaluation and an outcomes study. The report also gives a schedule for the implementation of the study. (Final report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5039
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge,
MA
TITLE: Practice Patterns and Expenditures in Managed Care and Indemnity Plans: A Condition-Specific Analysis
ABSTRACT NUMBER: 031
ABSTRACT: This project studied overall costs and utilization in managed care settings and how differences in practice patterns affect these variables. The project focused, in particular, on differences in practice patterns in managed care settings. The project assessed the use of selected tests and procedures for patients with heart attacks, congestive heart failure, delivery, back pain, or asthma. One of the conclusions of the project was that although the volume of claims studied was enormous, the coding used on the claim forms appeared to allow the selection of specific target procedures and tests. Also, the prevalence of such interventions was enough to detect important differences in practice patterns. In general, the use of claims to assess differences in practice patterns seems promising. However, during the project, problems continued in the receipt of usable data, causing one of the three participating carriers to withdraw from the project. This withdrawal terminated the project because confidentiality could no longer be guaranteed. General lessons from these experiences relate to project design and data management. For example, projects of this sort should be segmented, with initial data acquisition and cleaning coming first. Thus, carriers will be participating in a funded project, but large amounts of resources will not be expended until all the data are acquired.
AGENCY SPONSOR: Center for Primary Care Research
FEDERAL CONTACT: Linda A. Siegenthaler
PHONE NUMBER: 301/594-1357
PIC ID: 5664
PERFORMER ORGANIZATION: University of California, San
Francisco, San Francisco CA
TITLE: Directory of Minority Health and Human Services Data Resources
ABSTRACT NUMBER: 032
ABSTRACT: This directory is intended for use by policymakers, researchers, and the public as a reference to resources within the Department of Health and Human Services that contain race and ethnicity data. Databases with broad utility, from ongoing departmental data projects to program administrative or evaluation activities, are included in the directory. The directory includes information from the Office of the Secretary, the Administration for Children and Families, the Health Care Financing Administration, the nonindependent Social Security Administration, and the Public Health Service. Each entry includes the following information: (1) the title of the data source; (2) the sponsoring office; (3) an abstract summarizing key characteristics of the database; (4) the race and ethnicities categorized in the database; (5) data limitations; (6) other data; (7) the program supported by the data project or system; (8) the general purpose of the database; (9) the status of the database; (10) the start date, start date period, or start/end dates; (11) the availability of the database; (12) constraints on use of the database; (13) the data media; (14) the distributor of public use files; (15) the agency contact person; and (16) the available data products. (Final report 278 pages.)
AGENCY SPONSOR: Center for Information Technology
FEDERAL CONTACT: Harvey Schwartz
PHONE NUMBER: 301/594-1483
PIC ID: 5911
PERFORMER ORGANIZATION: Moshman Associates, Inc.,
Bethesda, MD
TITLE: Development of Designs for Evaluation of the Process of Clinical Guideline Development
ABSTRACT NUMBER: 033
ABSTRACT: This project was a response to AHCPR Reauthorization Act of 1992. The project focused on the development and testing of designs to evaluate AHCPR's process for guideline development. The project identified key dimensions of the process of clinical practice guideline development and compared these dimensions among AHCPR and non-AHCPR-funded guidelines. The key dimensions selected were chosen because they varied across guideline development efforts; and they were viewed by experts as likely to affect the quality of guidelines and their acceptance by clinicians and other targeted audiences. The report recommends that AHCPR (1) consider pursuing its legislative mandate to review and assess guidelines developed by other organizations using appropriate methodologies; (2) examine mechanisms to streamline the organizational arrangements of expert panels (one of two types of panels used by AHCPR); (3) consider the development of standing panels, each addressing a broad class of conditions or technologies; (4) consider obtaining some front-end external review during the guideline development process to obtain information that could enhance the usefulness of the guideline to clinicians; (5) consider identifying and training a small pool of consumer representatives who could serve on multiple panels; and (6) undertake research to determine how the development process relates to the use of guidelines by key end users.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5629
PERFORMER ORGANIZATION: George Washington University
Medical Center, Washington, DC
TITLE: Users' Perceptions of Four Clinical Practice Guidelines and Their Development Process
ABSTRACT NUMBER: 034
ABSTRACT: Clinical practice guidelines assist practitioners, health care providers, and consumers in making decisions about health care interventions for specific clinical circumstances. This report determines if aspects of various guideline development processes are associated with typical users' perceptions about the guideline's validity, reliability, cost, and utility. The report finds that (1) clinical applicability and ease of use are two major criteria by which participants assess the potential value of clinical guidelines and upon which they base their decisions to adopt and use them; (2) most participants want guidelines that help them solve problems in a clinical setting by updating their knowledge, outlining the latest developments, or providing guidance in areas where the participants' experience is limited; (3) panel selection, topic selection, and literature review are critical to a guideline's validity; (4) participants believe that recommendations made in the clinical guidelines must be verified by their own judgment and experience; and (5) some participants also feel that inappropriate implementation of clinical guidelines can have a negative impact on practice. The report recommends that (1) AHCPR continues to develop--under rigorous conditions--guidelines that reflect changes in the field of medicine. (Final report 110 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Irma Arispe
PHONE NUMBER: 301/594-1455
PIC ID: 5956
PERFORMER ORGANIZATION: American Institutes for Research,
Washington, DC
TITLE: Setting Priorities for Clinical Practice Guidelines
ABSTRACT NUMBER: 035
ABSTRACT: This project described and evaluated possible methods for setting priorities for guideline topics. The report concludes that the current priority-setting approach used by AHCPR is relatively open, fairly explicit, and generally defensible. The report recommends that six general criteria be applied in considering topics for guidelines and technology assessment: prevalence of the problem; burden of illness imposed by the problem; cost; variability in practice; potential of a guideline or assessment to improve health outcomes; and the potential of a guideline or assessment to reduce costs. The report recognizes that the data used to score particular topics on these six criteria will often be incomplete. The report recommends possible ways to improve the procedures used in setting priorities for clinical practice guidelines. These recommendations focus on (1) methods for obtaining expert judgment and developing consensus positions; and (2) the desirability of a basic procedure manual. The report also recommends that AHCPR more precisely and narrowly define the topics selected for guideline development. The report concludes that AHCPR could play a useful role as a clearinghouse that collects and disseminates guidelines developed by other organizations. It also concludes that AHCPR needs an explicit, open, and defensible process for assessing the soundness of guidelines developed by other organizations.
AGENCY SPONSOR: Center for Primary Care Research
FEDERAL CONTACT: David Lanier, M.D.
PHONE NUMBER: 301/594-1357
PIC ID: 5631
PERFORMER ORGANIZATION: Institute of Medicine, Washington,
DC
TITLE: AHCPR Clinical Practice Guideline Program: Report to Congress
ABSTRACT NUMBER: 036
ABSTRACT: The AHCPR Reauthorization Act of 1992 (Public Law 102-410) required that AHCPR report to Congress on three aspects of its clinical practice guideline program: methods for selecting guideline topics, methods for developing guidelines, and methods for assessing guideline quality. This report summarizes AHCPR's clinical practice guideline program to date in areas including guideline development, research and evaluation activities, and analyses of the guideline program conducted by organizations such as the Physician Payment Review Commission and the Office of Technology Assessment. It also examines potential directions for the future. (Final report 39 pages, plus appendixes.)
AGENCY SPONSOR: Office of the Forum for Quality and Effectiveness in Health Care
FEDERAL CONTACT: Kathryn Rickard
PHONE NUMBER: 301/594-1455
PIC ID: 5949
PERFORMER ORGANIZATION: Agency for Health Care Policy and Research, Rockville, MD
Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report
Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention (CLPP)
Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)
Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)
Evaluation of the Content and Conduct of Health Examination Surveys
Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado
Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component
Evaluation of the Feasibility of an Injury Risk Factor
Evaluation of the Impact of a Diabetes Guide for Patients
Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers
Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools
Final Report: Assessment of CDC's Press Relations Functions
Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities
Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)
Rapid Assessment of Influenza Vaccination in the United States
Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data
Working With Community-Based Organizations To Advance the
Childhood Lead Poisoning Prevention Agenda
TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Final Report.
ABSTRACT NUMBER: 037
ABSTRACT: This project develops a comprehensive evaluation strategy to be incorporated into planning, budgeting, and legislative decisionmaking processes of the National Center for Chronic Disease Prevention and Health Promotion. The final report discusses the major findings of a 1993 review of the planning and evaluation environment at NCCDPHP. It finds that (1) getting programs into the field is a higher priority at CDC than is assessing the efficacy and effectiveness of these programs; (2) funding decisions are unrelated to evaluation; (3) there is little connection between planning and evaluation at NCCDPHP or CDC; and (4) a stronger commitment to evaluation is needed. A pilot test of the evaluation strategy developed by the project shows that (1) data transfers between Federal, State, and local levels are costly and imperfect, and they require an approach linked to public health objectives; (2) States are concerned that program performance indicators fail to capture the complexity of the States' problems and accomplishments; (3) a too-detailed and overly specific evaluation methodology poorly assesses State and local implementations of chronic disease prevention programs; and (4) the Government Performance and Review Act and block grant funding will have a substantial impact on NCCDPHP programs. The report recommends a flexible approach to evaluation for NCCDPHP. See also PIC ID 4746. (Final report 95 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Lisa Daily
PHONE NUMBER: 770/488-5706
PIC ID: 4746.1
PERFORMER ORGANIZATION: Battelle Corporation, Arlington,
VA
TITLE: Development of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Evaluation for Decisionmaking Strategy: Interim Final Report
ABSTRACT NUMBER: 038
ABSTRACT: This project develops a comprehensive evaluation strategy that can be incorporated into planning, budgeting, and legislative decisionmaking processes at NCCDPHP. This strategy will provide direction on whether Center programs can be evaluated. It will guide decisions about which program components should be evaluated, will provide direction regarding the scope of the evaluation, will clarify the types of data that should be routinely collected to support planning and evaluation activities, and will indicate when and how evaluation results should be fed back into the decisionmaking process. A six-step iterative process was used to develop the Evaluation for Decisionmaking Strategy. The strategy incorporates the views of public health stakeholders and was developed with the advice of NCCDPHP managers, policymakers, and evaluators. The final concept for the strategy attempts to balance the scientific rigor needed for proper evaluations and the flexibility required when dealing with real programs. The strategy links evaluation to the decisionmaking process by defining five program decision points that are associated with stages of program development. These decision points are (1) identification of needs; (2) examination of the policy context; (3) program design; (4) program implementation; and (5) program maintenance. A user's guide is provided to help NCCDPHP planners and evaluators implement the strategy. (Interim report 73 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Lisa Daily
PHONE NUMBER: 770/488-5403
PIC ID: 4746
PERFORMER ORGANIZATION: Battelle Corporation, Arlington,
VA
TITLE: Effect of Mandated Managed Care for Medicaid Populations on the Practice of Public Health: The Example of Childhood Lead Poisoning Prevention
ABSTRACT NUMBER: 039
ABSTRACT: This report examines how the move toward managed care by State Medicaid programs affects the provision of the major service components of CDC Childhood Lead Poisoning Prevention (CLPP) programs. It also examines how CLPP programs have responded to the challenges of managed care. Site visits to Florida, Indiana, Minnesota, Rhode Island, and Tennessee were conducted. The report finds that (1) managed care will affect all components of CLPP programs because it leads to decentralization and privatization of functions that are currently centralized; (2) State and local health departments will spend less time on assurance and more on assessment and policy development under managed care, and they will also have a diminished role in direct service delivery; and (3) many of the changes in the managed care environment may make it difficult to obtain the sort of data needed to perform new functions such as assessment and quality assurance. The report discusses several strategies that CDC can use to adapt to the managed care environment. In general, these strategies are in the areas of (1) maintaining public sector service delivery; (2) building a legal infrastructure, whether this involves a screening law, a reporting law, or an enforcement of protocols and data collection to support enforcement; and (3) funding core public health functions. See also PIC ID 4373 and 4373.2. (Final report 29 pages.)
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Nancy Tips
PHONE NUMBER: 770/488-7277
PIC ID: 4743.1
NTIS ACCESSION NUMBER: PB 96-144670
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Evaluation of External Cause-of-Injury Codes: Final Report (Three Volumes)
ABSTRACT NUMBER: 040
ABSTRACT: This report evaluates the current system used to classify external causes of injury in order to facilitate the correct use of the International Classification of Diseases "Supplemental Classification of External Causes of Injury and Poisoning" (E-Codes). The study evaluates the E-Code tabular list and alphabetical index and recommends improvements; (2) evaluates existing E-Code coding guidelines and recommends improvements; (3) evaluates E-Code training materials and recommends improvements; and (4) develops and evaluates prototype training materials, including a model training syllabus for E-Code use. E-Code stakeholders were asked to participate in the evaluation by serving on a technical advisory panel. The panel evaluated and recommended changes to the E-Code tabular list and alphabetical index. These changes were field tested by training 138 subjects: medical record department coding staff from eight hospitals (four trauma hospitals and four community hospitals); and health information management students. Test sites in four States were used. The field test demonstrated that experienced coders liked the revisions and could use the new codes with minimal training. Participants praised expanded guidelines, the addition of clarifying examples, the new alphabetic index, and the new tabular list. (Final report three volumes, variously paginated, plus appendixes.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Perrianne Lurie
PHONE NUMBER: 301/436-4216
PIC ID: 4742
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Evaluation of the Activities of the Medical Examiner/Coroner Information-Sharing Program (MECISP)
ABSTRACT NUMBER: 041
ABSTRACT: Of all deaths in the United States, about 20 percent are investigated by medical examiner or coroner (ME/C) offices. In all, more than 2,200 jurisdictions are responsible for death investigation and certification. Records from these jurisdictions are timely and detailed, and constitute the ultimate source of information on sudden and unexpected deaths. CDC established MECISP in 1987 to coordinate these data for researchers and public health officials. MECISP's main product is a database containing data collected from ME/C sites. MECISP also produces a biannual directory listing ME/C jurisdictions and summarizing death investigation laws.
This report reviews the activities at MECISP in order to evaluate and suggest improvements to the process of sharing information on death investigation in the United States. The report finds that (1) MECISP's main role is to be a broker between death investigators and people who can best use data from these investigations to improve public health; (2) death investigation data, particularly MECISP data, are underused, because of problems with access, visibility, relevance, coverage, and quality; and (3) correcting these problems requires resources that MECISP does not have, such as staff with technical expertise in the area. The report makes several recommendations, chiefly one that calls for greater resources.
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Gib Parrish, M.D.
PHONE NUMBER: 404/488-3310
PIC ID: 5350
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Evaluation of the Content and Conduct of Health Examination Surveys
ABSTRACT NUMBER: 042
ABSTRACT: The Third National Health and Nutrition Examination Survey (NHANES III) is the seventh in a series of surveys with health examination components conducted by the National Center for Health Statistics (NCHS) since 1960. The survey asked 30,000 persons about their demographic, socioeconomic, dietary, and health history. An examination component for each participant includes phlebotomy, as well as examinations by a physician, a dentist, specialized interviewers, and health technicians. About 5,000 sample persons are examined each year in two 3-year cycles of data collection. NCHS is considering a design for NHANES-97 that includes recurring 2-year data collection cycles, which will examine a sample of about 7,500 each year (a 50 percent increase). This report (1) explores methods for increasing the sample size by 50 percent; (2) examines the core content of the examination; (3) evaluates other health examination studies; and (4) discusses the feasibility of collecting specified nutrition assessment measures in a setting other than a mobile examination center. For each of these tasks, the report presents objectives, methodology, and major findings and recommendations. This report is available from NTIS only. (Final report two volumes, variously paginated.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Natalie Fuller-Dupree
PHONE NUMBER: 301/436-7080
PIC ID: 5512
NTIS ACCESSION NUMBER: PB 95-221974
PERFORMER ORGANIZATION: Westat, Inc., Rockville, MD
TITLE: Evaluation of Encarguese de Su Diabetes: Una Guia Para Su Cuidado
ABSTRACT NUMBER: 043
ABSTRACT: This project evaluated a pilot edition of a Spanish-language diabetes patient guide targeted to Hispanic populations. This guide, "Encarguese de Su Diabetes: Una Guia Para Su Cuidado," was developed by staff of the Division of Diabetes Translation at CDC. The rationale for this evaluation was to ensure that the final guide would be culturally relevant and readable for individuals with at least a sixth-grade level of education. Specifically, the project used focus group discussions to determine the understandability, relevance, usefulness, and adaptability of the guide among diverse Hispanic populations in the United States. The focus group discussions were held throughout the United States. Phase I of the project resulted in a revised Spanish-language version of the guide, and phase II was directed at refining issues related to finalization, production, and distribution of the guide.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Patricia Mitchell
PHONE NUMBER: 770/488-5015
PIC ID: 5352
PERFORMER ORGANIZATION: Casals and Associates, Arlington,
VA
TITLE: Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Dissemination Component
ABSTRACT NUMBER: 044
ABSTRACT: FACE identifies and investigates fatal occupational injuries, with the goal of preventing them. It identifies work situations at high risk for fatal injury and formulates and disseminates prevention strategies to those who can intervene in the workplace. This report assesses the effectiveness of information dissemination for FACE programs in three States. The report (1) describes communication channels and information users; (2) identifies prevention efforts resulting from information provided by FACE; (3) assesses indicators of changed work behaviors that might be attributed to the program; and (4) assesses the potential effectiveness of specific dissemination strategies within each of the three States. The report finds that (1) employers generally assess the program favorably; (2) some employers are concerned that the inclusion of specific points might cast an unfavorable light on their companies, and that some recommendations are economically or technically unfeasible; (3) most employers who have made workplace changes did so immediately following a fatality, and many reported these changes to other managers in the company; (4) FACE materials are widely used for professional education, public information, advocacy, regulation, surveillance, and vocational training; and (5) organizational and economic influences govern the dissemination of FACE materials. The report concludes that the program is effective and of high quality in each State reviewed.
AGENCY SPONSOR: National Institute of Occupational Safety and Health
FEDERAL CONTACT: Theodore Pettit
PHONE NUMBER: 304/284-5796
PIC ID: 5506
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Evaluation of the Feasibility of an Injury Risk Factor
ABSTRACT NUMBER: 045
ABSTRACT: This report evaluates the feasibility of a national telephone survey as (1) a surveillance system for injury risk factors; (2) a means through which to monitor progress toward injury objectives for the year 2000; and (3) a tool for evaluating injury control programs. A national telephone survey of 5,238 adults was conducted. The response rate for the survey was 54 percent of households determined to be eligible for the study. While telephone response rates have been declining over the past decade, the 29 percent refusal rate for this survey was higher than anticipated. Analyses suggest that neither the sampling methodology nor the survey length were related to problems with response rates; but instead that these problems were related to (1) the perceived (rather than actual) length of the survey; (2) sensitivity of topics; and (3) informed consent procedures.
AGENCY SPONSOR: National Center for Injury Prevention and Control
FEDERAL CONTACT: Jeffrey Sacks, M.D.
PHONE NUMBER: 770/488-4652
PIC ID: 4522
PERFORMER ORGANIZATION: Battelle Corporation, Arlington,
VA
TITLE: Evaluation of the Impact of a Diabetes Guide for Patients
ABSTRACT NUMBER: 046
ABSTRACT: This project provided information to CDC's Division of Diabetes Translation about how different dissemination approaches affected the behavior of providers, and how health care practice was impacted when the guides were presented to primary care practitioners as part of a specialized training seminar at community health centers. The study recommended that (1) programs have a champion at each local intervention site; (2) an adequate market for the intervention be present prior to program implementation; (3) sources of capital be targeted and linked to the unit of analysis; (4) agreements with each intervention site be obtained to ensure necessary levels of human and structural support; and (5) sufficient time be allowed for system change.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Dawn Satterfield
PHONE NUMBER: 770/488-5020
PIC ID: 5934
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Evaluation of the Impact on Practice of the Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers
ABSTRACT NUMBER: 047
ABSTRACT: In 1991, CDC's Division of Diabetes Translation published two guides for diabetes care. One, "The Prevention and Treatment of Complications of Diabetes: A Guide for Primary Care Providers," was aimed at health care providers. The second, "Take Charge of Your Diabetes: A Guide for Care," was aimed at patients. This project provides information to the Division of Diabetes Translation on the dissemination approaches for the provider guide. Three urban community health centers served as intervention sites. Two of them received the provider guide and a 4-hour education and activation program; one of these two also received the patient guide. The third center received the provider guide without explanation. The project determined how different dissemination approaches affect the behavior of providers, and how health care practice is impacted when the guides are presented to primary care practitioners as part of a specialized training seminar. The report finds no conclusive evidence that the intervention had a strong effect on practitioner behavior. Although there were some improvements, these could not be traced to the intervention. Furthermore, the intervention may not have been strong enough to affect provider behavior, especially given the high staff turnover rates at these centers. (Final report 56 pages, plus appendixes.)
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Dawn Satterfield
PHONE NUMBER: 404/488-5020
PIC ID: 4108
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Evaluation of the Policies, Practices, and Implementation of HIV Education Programs in Schools
ABSTRACT NUMBER: 048
ABSTRACT: This project evaluated the progress and activities conducted by the 71 HIV education programs funded by CDC's Division of Adolescent and School Health (DASH). These programs are funded through cooperative agreements with State and local education agencies. Data elements were obtained from reading the program file documents and were abstracted for each funded year of the 5-year period, 1987-92, for each program. A database was composed from these elements that will allow CDC to answer specific evaluation questions regarding the development of programs and the extent to which CDC policies and guidelines were followed during the funding period.
AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion
FEDERAL CONTACT: Peter Hunt
PHONE NUMBER: 404/488-5343
PIC ID: 6070
PERFORMER ORGANIZATION: MACRO International, Inc.,
Atlanta, GA
TITLE: Final Report: Assessment of CDC's Press Relations Functions
ABSTRACT NUMBER: 049
ABSTRACT: CDC's News Division within the Office of Public Affairs (OPA) was established in 1987 to handle inquiries from the press. The volume of calls to this office has more than doubled between 1991 (8,000 inquiries) and 1994 (more than 20,000 inquiries), but the number of press officers available to respond to calls has remained constant. This report examines OPA's News Division and its relationship with CDC centers, institutes, and offices (CIOs) and with the press. The key finding is that the News Division is understaffed for the volume of calls. The report also finds that some CIOs recognize that OPA is overwhelmed, yet they are pleased with the services it provides; others are generally dissatisfied and desire more proactive media relations services. Reporters say that they have difficulty reaching the News Division and that their inquiries are not answered in a timely way. Furthermore, a review of external press offices finds that OPA staff handle more than twice the number of inquiries than do staff of comparable organizations. The report recommends that (1) communications technology such as voice mail, batch faxing, electronic mail, and automated tracking of press inquiries be instituted; (2) staffing levels be increased to 9 or 10 press officers; (3) internal policies and procedures guiding current and future activities be developed; and (4) individual CIO needs be determined and met.
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: Helen T. Kuykendall
PHONE NUMBER: 404/639-3286
PIC ID: 5915
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Final Report: A Blueprint for CDC's Office of Women's Health: Functions, Strategies, and Activities
ABSTRACT NUMBER: 050
ABSTRACT: CDC established the Office of Women's Health (OWH) in 1994. This report identifies the role, functions, strategies, activities, and benchmarks for OWH. The report maintains that OWH has five key functions: (1) leadership; (2) advocacy; (3) internal coordination; (4) external relationship building at the national, State, and local levels; and (5) research and program development. The report also discusses the guiding principles of OWH and suggests how it should position itself in light of these principles. For example, the report stresses that OWH must have the goodwill of other offices within CDC, and suggests that the Associate Director for Women's Health be made a member of CDC's senior management team in order to highlight the vital role OWH will play. The report suggests that OWH (1) create a vision at CDC for women's health; (2) increase the visibility of women's health programs within CDC and to external audiences; (3) develop formal, systematic communication mechanisms for internal exchange of information about CDC's women's health activities; (4) facilitate coordination and collaboration between CDC and other Public Health Service offices that deal with women's health; and (5) dedicate allocated funding to support projects that address priorities and gaps in women's health efforts. The report also discusses such issues as building relationships, staffing, and priorities for the coming year. (Final report 24 pages, plus appendixes.)
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: Wanda Jones
PHONE NUMBER: 404/639-7230
PIC ID: 5913
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Final Report: Evaluation of the Operating Processes, Communication Techniques, and Management Approaches in the National Immunization Program (NIP)
ABSTRACT NUMBER: 051
ABSTRACT: Three events have placed significant demands upon CDC's National Immunization Program: (1) the measles outbreak in the late 1980's and early 1990's, which brought the importance of childhood immunization to the forefront of public attention; (2) the President's Childhood Immunization Initiative (CII) of 1994, which made the immunization of preschool children a key health priority; and (3) mandates to eliminate indigenous cases of specific vaccine-preventable diseases and to increase vaccine coverage to at least 90 percent among 2-year-old children. An increase in the NIP operation budget of 160 percent and a staff increase of approximately 50 percent occurred between fiscal 1993 and 1995. This report examines NIP's management structure and style, its communication and decisionmaking processes and strategies, its patterns of authority, and its delegation of work and responsibility. The report offers recommendations in the following areas: (1) strategic planning, (2) day-to-day management, and (3) staff issues. (Final report 43 pages, plus appendixes.)
AGENCY SPONSOR: National Immunization Program
FEDERAL CONTACT: Victoria Westberg
PHONE NUMBER: 404/639-8204
PIC ID: 5916
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Rapid Assessment of Influenza Vaccination in the United States
ABSTRACT NUMBER: 052
ABSTRACT: This project determines the 1992-93 and 1993-94 influenza vaccine coverage in sites where CDC plans to conduct active surveillance for Guillain-Barre syndrome (GBS). This determination should permit CDC to (1) assess whether receipt of influenza vaccine in these years was associated with an increased risk for GBS; (2) determine whether a change in recommendations for influenza vaccination is warranted; and (3) provide insight into usage patterns of influenza vaccination.
AGENCY SPONSOR: National Immunization Program
FEDERAL CONTACT: Robert Chen
PHONE NUMBER: 301/402-3497
PIC ID: 5894
PERFORMER ORGANIZATION: MACRO International, Inc.,
Atlanta, GA
TITLE: Report of Completion for the Automated Analysis on National Center for Health Statistics (NCHS) Data
ABSTRACT NUMBER: 053
ABSTRACT: This project was intended to improve the analysis of NCHS data. The project evaluated NCHS's present analytical methods and developed a prototype automated data analysis system, the Automated System for Survey Information and Statistical Tools (ASSIST). During the project, ASSIST was used as a communications tool between NCHS analysts and the contractor staff to explore and assess data access. NCHS also considered the accessibility of the data to users whose computing expertise ranged from novice to expert. The prototype was also used in (1) evaluating and assessing problems associated with multiple data set storage; (2) determining the requirements for the use of data across data systems; and (3) determining whether both user and provisional data should be employed. (Final report five pages.)
AGENCY SPONSOR: National Center for Health Statistics
FEDERAL CONTACT: Marcus Sanchez
PHONE NUMBER: 301/436-7904
PIC ID: 3575
PERFORMER ORGANIZATION: American Management Systems, Inc.,
Arlington, VA
TITLE: Working With Community-Based Organizations To Advance the Childhood Lead Poisoning Prevention Agenda
ABSTRACT NUMBER: 054
ABSTRACT: As public health services evolve, CDC must recognize that at least three important changes in emphasis must occur within its CLPP programs. These three changes are (1) a shift from direct service delivery to assessment, policy development, and quality assurance; (2) a shift from secondary prevention to primary prevention; and (3) a new goal of coordinating the care and followup of lead-poisoned children and their families.
Joining into partnership with community-based organizations (CBOs) may help ease the impact of these changes. This report is intended to help CLPP grantees and local health departments build better relationships with CBOs and to provide suggestions as to how they can broaden their mission to include a community-based prevention agenda. The report gives examples of successful collaborations and concludes that (1) grantees may have difficulty finding appropriate CBOs to work with, since not all CBOs will be interested in preventing lead poisoning; (2) CBOs have a different accountability and organizational structure than public sector organizations and may have different working styles; (3) grantees should choose long-established CBOs with good records in the community; (4) CBOs, like the public sector, must compete for limited resources; and (5) CBOs may have high staff turnover and little institutional memory. See also PIC ID 4743 and 4743.1. (Final report 22 pages.)
AGENCY SPONSOR: National Center for Environmental Health
FEDERAL CONTACT: Nancy Tips
PHONE NUMBER: 404/488-7277
PIC ID: 4743.2
NTIS ACCESSION NUMBER: PB 96-144688
PERFORMER ORGANIZATION: MACRO International, Inc., Silver Spring, MD
Nationwide Evaluation of X-Ray Trends (NEXT)
Third Annual Performance Report on the Prescription Drug User Fee
Act of 1992: Fiscal Year 1995 Report to Congress
TITLE: Assessment of the Mammography Quality Standards Act of 1992 (MQSA)
ABSTRACT NUMBER: 055
ABSTRACT: FDA is charged with ensuring that accessibility to quality mammography services is maintained for all facilities performing mammographies, in accordance with MQSA. Under this statute, FDA is required to certify and annually inspect over 10,000 mammography facilities. Prior to the passage of 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 quality standards developed by FDA if these facilities are to obtain certification by the Agency. FDA is concerned that recent trends by third-party payers to captivate 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. It also develops a cost model that will be used to predict the impact of proposed standards on the costs of providing mammography. This project addresses these issues by collecting and analyzing data from facilities that provide mammography services.
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Steve Tucker
PHONE NUMBER: 301/443-1839
PIC ID: 6080
PERFORMER ORGANIZATION: Eastern Research Group, Inc.,
Rosslyn, VA
TITLE: Nationwide Evaluation of X-Ray Trends (NEXT)
ABSTRACT NUMBER: 056
ABSTRACT: NEXT is a collaborative program conducted jointly between FDA and State radiation control agencies. The study estimates the radiation dosage from diagnostic X-ray examinations, using data collected from previous NEXT surveys of different types of X-ray examinations. The study generates data on image quality, photographic processing quality, and types of practice. The data are used by public health and professional organizations to set policy. The studies are conducted in cooperation with the Conference of Radiation Control Directors. Products generated in the study include (1) "National Survey of Mammographic Facilities," in 1985, 1988, and 1992; (2) "Mammography (and Radiology?) Is Still Plagued With Poor Quality in Photographic Processing and Darkroom Fog"; (3) "Assessment of Skin Entrance Kerma in the United States: The Nationwide Evaluation of X Ray Trends (NEXT)"; (4) "How Good (or Bad) Is Film Processing?"; and (5) "Automatic Film Processing: Analysis of 9 Years of Observations."
AGENCY SPONSOR: Center for Devices and Radiological Health
FEDERAL CONTACT: Orhan Suleiman
PHONE NUMBER: 301/594-3332
PIC ID: 4984
PERFORMER ORGANIZATION: Conference of Radiation Control
Directors, Washington, DC
TITLE: Third Annual Performance Report on the Prescription Drug User Fee Act of 1992: Fiscal Year 1995 Report to Congress
ABSTRACT NUMBER: 057
ABSTRACT: Fiscal 1995 marked the third year of the 5-year implementation of the Prescription Drug User Fee Act (PDUFA) of 1992. This Act authorized the collection of fees from the pharmaceutical industry in order to facilitate FDA's timely review of human drug applications. The Act mandates that FDA prepare yearly reports for each fiscal year in which fees are collected. This third annual report, for fiscal 1995, was prepared in response to that mandate. It presents findings as to how well FDA has accomplished its performance goals for fiscal 1995. These performance-related goals were jointly established by FDA and the pharmaceutical industry and fall into three main categories: eliminating overdue backlogs, building excellence into the review process, and achieving high performance. The report finds that (1) New Drug Applications (NDAs) approval was 23 percent higher after PDUFA's enactment than in the 2 years prior; (2) a high percentage of first reviews were accomplished within the 12-month timeframe specified in the PDUFA; and (3) other reasons for quicker approval times include high rates of affirmative first actions, quick action on approvables, and effective "refuse-to-file" screening. (Final report 24 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning and Evaluation
FEDERAL CONTACT: Paul Coppinger and Kate McEvoy
PHONE NUMBER: 301/443-4230
PIC ID: 6079
PERFORMER ORGANIZATION: Office of Planning and Evaluation, Food and Drug Administration, Rockville, MD
Evaluation of the Maryland Access to Care Demonstration: Managed Care for Medicaid Recipients
Evaluation of the Medicaid Extension Demonstrations
Evaluation of United Mine Workers of America Demonstration
Expanded Cross-Cutting Evaluation on Medicare Prevention Demonstrations Under Consolidated Omnibus Budget Reconciliation Act
Final Evaluation Report of the 1989 Grant Program for Rural Health Transition: Send Us More Doctors, Please
Interim Report of the Evaluation of the Essential Access Community Hospital/Rural Primary Care Hospital Programs
Medicare Participating Heart Bypass Center Demonstration: Appropriateness Study
Medicare Participating Heart Bypass Center Demonstration: Data Collection Design
Medicare Participating Heart Bypass Center Demonstration: Evaluation Design
Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume One, The First Three Years
Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume Two, Marketing Activities of Participating Hospitals
Medicare Risk Program for HMOs: Final Summary Report on Findings From the Evaluation
Monitoring the Impact of Medicare Physician Payment Reform on
Utilization and Access
TITLE: Comparative Study of the Use of Early and Periodic Screening, Detection, and Treatment and Other Preventive and Curative Health Care Services by Children Enrolled in Medicaid
ABSTRACT NUMBER: 058
ABSTRACT: This project was comprised of a series of individual research projects that studied the effect of the changes in the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program introduced by the Omnibus Budget Reconciliation Act of 1989 on the process of providing health services to children and on the appropriateness of expenditures for the services provided in Tennessee, Georgia, Michigan, and California. These projects compared Medicaid-enrolled children in four EPSDT programs with other Medicaid-enrolled children in the four States who are not receiving EPSDT services, regarding enrollment patterns, service utilization, and expenditures, with a particular emphasis on preventive health services. They also compared Medicaid-enrolled children with non-Medicaid-enrolled children, insured and uninsured, on the use of and expenditures for preventive services and other health care services, using national survey data.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Feather Ann Davis, Ph.D.
PHONE NUMBER: 410/786-6590
PIC ID: 6236
PERFORMER ORGANIZATION: SysteMetrics Division of MedStat,
Inc., Ann Arbor, MI
TITLE: Evaluation of the Maryland Access to Care Demonstration: Managed Care for Medicaid Recipients
ABSTRACT NUMBER: 059
ABSTRACT: The Maryland Access to Care (MAC) demonstration became operational in December 1991 and eventually covered about two-thirds of Medicaid recipients in the State. The targeted population was Aid to Families with Dependent Children (AFDC) recipients, Supplemental Security Income (SSI) participants, and Sixth Omnibus Budget Reconciliation Act-eligible children. The MAC program was mandatory for recipients in the MAC-eligible categories. The program matched MAC recipients with a primary medical provider (PMP) that acted as the recipient's gatekeeper to the health care system. These PMPs also continued under the standard Medicaid fee-for-service reimbursement systems, but, to encourage their participation, Medicaid fees for primary care services were increased by an average of 50 percent under the MAC program. Specialists were reimbursed for nonemergency specialty care provided to MAC patients only if these services were referred by the patients' PMPs. The evaluation employed a pre-/post-test comparison and a post-test description of program operations. The data came primarily from Medicaid enrollment and claims files and from provider surveys. The project was extended to allow the performance of additional analyses to compare the performance of office-based and hospital outpatient providers under the MAC program.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Paul J. Boben, Ph.D.
PHONE NUMBER: 410/786-6629
PIC ID: 6235
PERFORMER ORGANIZATION: People-to-People Health
Foundation, Inc., Bethesda, MD
TITLE: Evaluation of the Medicaid Extension Demonstrations
ABSTRACT NUMBER: 060
ABSTRACT: This project was an evaluation of three demonstrations mandated under section 6407 of the Omnibus Budget Reconciliation Act of 1989. They evaluated alternative models for extending health insurance coverage to children under 20 years of age who lacked insurance. The demonstrations occurred in the States of Florida, Maine, and Michigan. Each State used a different strategy for providing the new coverage. Florida tested the effectiveness of marketing a school-based affordable insurance package that delivers services through a managed care network. Maine conducted a statewide program that subsidized comparable private employer-based group coverage, where such insurance was believed to be cost effective. Michigan tested the effectiveness of a public/private partnership between the State and Michigan Blue Cross and Blue Shield, using donated funds to subsidize a mainstream outpatient insurance package. The evaluation examined the effect of these demonstrations on various outcome and process measures of access to care, private insurance coverage, and cost of care. The methodology took into account the distinctiveness of the three demonstrations while incorporating a strategy that allowed for comparisons between programs in terms of penetrating the eligible population. Case studies were coupled with analysis of program data to describe the structure and processes of the demonstrations. In addition, primary data were collected through surveys of both program participants and controls. Separate analyses of program costs and program effectiveness were included.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Paul J. Boben, Ph.D.
PHONE NUMBER: 410/786-6629
PIC ID: 6234
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge,
MA
TITLE: Evaluation of United Mine Workers of America Demonstration
ABSTRACT NUMBER: 061
ABSTRACT: This is an evaluation of the United Mine Workers of America (UMWA) Health and Retirement Funds (the UMW Funds) Medicare Part B capitation demonstration. This demonstration replaced the Funds' Health Care Prepayment Plan arrangement with the Health Care Financing Administration (HCFA), in which it had been reimbursed for Medicare Part B services on a cost basis. In its place, the Funds assumed risk for Medicare Part B services under a capitated payment mechanism. The evaluation addressed the cost-effectiveness of capitation based on an analysis of changes in utilization and cost resulting from the demonstration. It also undertook a detailed case study describing the cost management programs and changes occurring in the organization as a result of the demonstration. Based on this approach, the evaluation was unable to discern a causal relationship between the demonstration and the events that occurred subsequent to its implementation. Events that happened during the demonstration may have been independent or could have been related in complicated ways. Thus, in an interim report the evaluation concluded that the demonstration had no measurable operational effect on the Funds beyond the obvious effect of ending the reimbursement dispute between HCFA and UMW Funds. The final report indicated that there was no evidence to clearly support a conclusion about the cost-effectiveness of capitation for UMW Funds' beneficiaries.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Ronald W. Lambert
PHONE NUMBER: 410/786-6624
PIC ID: 6233
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge,
MA
TITLE: Expanded Cross-Cutting Evaluation of Medicare Prevention Demonstrations Under Consolidated Omnibus Budget Reconciliation Act
ABSTRACT NUMBER: 062
ABSTRACT: This project was a cross-cutting evaluation of the five Medicare prevention demonstrations mandated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. These demonstrations tested the effectiveness of providing disease prevention and health promotion services to Medicare beneficiaries. Congress stipulated that the preventive health service package was to include health screenings, health risk appraisals, immunizations, and counseling and instruction in diet and nutrition, stress reduction, exercise programs, sleep regulation, injury prevention, substance abuse and mental disorders prevention, self-care (including medication use), and smoking cessation. In May 1988, cooperative agreements were awarded to five schools of public health to implement the demonstrations. Waivered services were provided between May 1989 and April 1991. A preliminary Report to Congress was submitted in July 1989. While the original legislation mandated 4-year demonstrations, the Omnibus Budget Reconciliation Act (OBRA) of 1990 extended them to 5 years. This extension allowed for an additional year of followup for purposes of evaluation, added an interim Report to Congress (which was submitted in September 1993), and required that the final Report include a comprehensive evaluation of the long-term effects of the demonstration.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Deborah C. Van Hoven
PHONE NUMBER: 410/786-6625
PIC ID: 6237
PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge,
MA
TITLE: Final Evaluation Report of the 1989 Grant Program for Rural Health Transition: Send Us More Doctors, Please
ABSTRACT NUMBER: 063
ABSTRACT: This report evaluates the impact of the Rural Health Care Transition (RHCT) grant program on the cohort of 181 rural hospitals that received grants in September 1989. The report uses three methods to evaluate the program: (1) a trend analysis of all grantees to determine whether the program improved their utilization rates and finances; (2) a pregrant/postgrant comparison to examine managerial improvements; and (3) a case study, descriptive analysis of projects implemented. The report finds that (1) the grant program does not seem to affect hospital finances or managerial capacity in a measurable way, but it does help some hospitals and areas where the majority of patients served would have had to travel or go without services in the absence of the grant program projects; (2) adult day care programs are least likely to be implemented and, if implemented, to be retained; (3) patient services such as community education programs are fairly easy to implement, but are likely to be abandoned because of high cost; and (4) outpatient, home health, emergency rooms, and emergency transportation programs are most frequently implemented and retained. The report concludes that the grant program does not address fundamental problems facing rural hospitals. The program cannot change the hospitals' financial weakness, their high numbers of uninsured patients, the low demand for their services, the high cost of providing low-volume emergency services, or the shortage of rural physicians. (Final report 168 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Siddhartha Mazumdar
PHONE NUMBER: 410/786-6673
PIC ID: 5283
NTIS ACCESSION NUMBER: PB 94-142312
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Interim Report of the Evaluation of the Essential Access Community Hospital/Rural Primary Care Hospital Programs
ABSTRACT NUMBER: 064
ABSTRACT: This report documents the initial development of the Essential Access Community Hospital (EACH) and the Rural Primary Care Hospital (RPCH) programs, which are Federal-State initiatives to maintain access to health care services in rural areas by developing rural health networks and by integrating health care. Through qualitative and quantitative analysis of background information provided by program grantees, secondary data from HCFA's Medicare Cost Reports (1987-89) and Market Area File (1988-89), and site visits to State agencies and hospitals in California, Colorado, Kansas, New York, North Carolina, South Dakota, and West Virginia, the report examines program development at the State and local levels. It finds that (1) States have made uneven progress in program development; (2) program planning and network development are difficult, labor intensive, and time consuming; and (3) the program has encouraged the development of other non-EACH, non-RPCH networks. However, the report also finds that (1) hospital commitment to RPCH conversion is weak; (2) financial stresses encourage hospitals to convert; (3) networks are shaped by competitive relationships between hospitals and by local circumstances; and (4) physicians' support, or at least their nonopposition, is critical to the success of the program. (Final report 115 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Sheldon Weisgrau
PHONE NUMBER: 410/786-6675
PIC ID: 5200
NTIS ACCESSION NUMBER: PB 94-117959
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Medicare Participating Heart Bypass Center Demonstration: Appropriateness Study
ABSTRACT NUMBER: 065
ABSTRACT: This series of reports was prepared as part of the preapproval package for HCFA's Medicare Participating Heart Bypass Center Demonstration. The reports in this series deal with the appropriateness of coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) surgery prior to approval of the demonstration. The reports in this series include "Model for the Use of CABG and PTCA"; "Appropriateness Rating Scale for CABG and PTCA"; "Indications for Coronary Artery Bypass Graft Surgery"; "Review of Literature for Efficacy and Risks of CABG Surgery"; and "Review of Literature for Efficacy and Risks of PTCA." See also PIC ID 5958-5958.3.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.
PHONE NUMBER: 410/966-6672
PIC ID: 5958.4
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicare Participating Heart Bypass Center Demonstration: Data Collection Design
ABSTRACT NUMBER: 066
ABSTRACT: This report provides information on the data collection methodology to be used in the HCFA Medicare Participating Heart Bypass Center Demonstration. This report presents the rationale for the evaluation, the data elements required, and the procedures for collecting them. It discusses several economic issues of interest to HCFA, including sources of volume increases at the demonstration sites and the relevant savings to the Medicare program (if any), and the demonstration administrative costs anticipated at the original four participating hospitals. The report also presents data collection related to the evaluation of the appropriateness of coronary artery bypass graft surgery. Finally, the report discusses the assessment of the hospitals' marketing activities in order to measure their varying levels of success at promoting the demonstration. See also PIC ID 5958-5958.2 and 5958.4. (Final report 32 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.
PHONE NUMBER: 410/966-6672
PIC ID: 5958.3
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicare Participating Heart Bypass Center Demonstration: Evaluation Design
ABSTRACT NUMBER: 067
ABSTRACT: This report provides information about the design of the evaluation of HCFA's Medicare Participating Heart Bypass Center Demonstration. The report summarizes the nature of the demonstration, the number of sites that will participate, and other background information. It also discusses how the evaluation will measure (1) the economics of the demonstration; (2) the quality and appropriateness of care received under the demonstration; and (3) the marketing of the program carried out by the participating hospitals. Three primary data collection efforts are proposed, including (1) onsite case studies; (2) beneficiary telephone surveys; and (3) referring physician telephone surveys. The report also explicates a model of behavior under a global payment mechanism. See also PIC ID 5958-5958.1 and 5958.3-5958.4. (Final report 56 pages.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.
PHONE NUMBER: 410/966-6672
PIC ID: 5958.2
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume One, The First Three Years
ABSTRACT NUMBER: 068
ABSTRACT: This report presents findings from the first three years of the Medicare Participating Heart Bypass Center Demonstration. This program is one of HCFA's cost-containment demonstrations. It was implemented to test the feasibility and cost-effectiveness of a negotiated package price for coronary artery bypass graft (CABG) surgery. Hospitals and physicians participating in the demonstration received a global payment for all hospital and physician services related to CABG surgery. The report finds that (1) the Medicare program saved $15.3 million on bypass patients treated in four of the seven participating hospitals from May 1991 through December 1993; (2) beneficiaries and their insurers saved another $2.3 million in Part B coinsurance payments during this same period; (3) no statistically significant trend in inpatient mortality rates was found (holding many patient risk factors constant); and (4) 97.7 percent of demonstration patients were treated appropriately with CABG surgery (assuming that none of the patients was a candidate for angioplasty--if all were assumed to be angioplasty candidates, then only 72.7 percent of the surgeries would have been considered appropriate). The report concludes that the results of the demonstration were mixed: only two of the four hospitals increased their market shares for CABG surgery, but hospital costs were significantly reduced. See also PIC ID 5958.1-5958.4.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.
PHONE NUMBER: 410/966-6672
PIC ID: 5958
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicare Participating Heart Bypass Center Demonstration: Final Evaluation Report--Volume Two, Marketing Activities of Participating Hospitals
ABSTRACT NUMBER: 069
ABSTRACT: This report presents information on the marketing activities of hospitals participating in the Medicare Participating Heart Bypass Center Demonstration program, in which Medicare was charged a global fee for all hospital and inpatient physician services related to coronary artery bypass graft surgery. Seven hospitals participated in the demonstration. The report presents an overview of the participating hospitals and the markets in which they are located; the focus, structure, and content of the hospitals' marketing programs; patient volume and physician referral patterns; and consumer satisfaction. The report finds that (1) all seven hospitals have developed and are implementing marketing plans for their CABG surgery programs to increase community awareness of their institutions and promote the benefits of choosing their facilities for CABG surgery; (2) the hospitals have not addressed product attributes, price, and consumer needs and desires, but have changed the ways in which they define the content and duration of services provided in conjunction with CABG surgery; and (3) while hospitals want to use their participation in the demonstration to increase their general standing in the community and to increase patient volumes in every category, HCFA wants to determine if the program can attract CABG patients away from higher priced competitors. See also PIC ID 5958 and 5958.2-5958.4.
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.
PHONE NUMBER: 410/966-6672
PIC ID: 5958.1
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Medicare Risk Program for HMOs: Final Summary Report on Findings From the Evaluation
ABSTRACT NUMBER: 070
ABSTRACT: Since the early 1980's, HCFA has been encouraging health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries in return for fixed prepaid premiums. This report evaluates these Medicare risk plans and their impacts on beneficiaries, the Federal Government, and participating plans. The report finds that (1) risk plans attract healthier-than-average Medicare beneficiaries, thus saving the program less than expected--in fact, HCFA paid HMOs approximately 5.7 percent more than it would have spent for these patients under a fee-for-service (FFS) plan; (2) HMOs reduce the number of hospital days and average lengths of stay, but do not reduce admissions; (3) Medicare risk plans increase the likelihood that beneficiaries receive some services, but reduce intensity or frequency of the service; (4) risk plans may spend about 10 percent less than HCFA would spend for all medical services; (5) HMOs and FFS plans produce similar outcomes for inpatients, but HMOs use fewer resources; (6) HMOs provide comparable access to ambulatory care and produce similar patient results, with fewer resources; (7) HMO enrollees are somewhat less satisfied with their care than others, but are happier with costs and benefit coverage; and (8) one-half of HMO risk plans appear to be profitable. (Final report 192 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: James Hadley
PHONE NUMBER: 410/786-6626
PIC ID: 5957
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Monitoring the Impact of Medicare Physician Payment Reform on Utilization and Access
ABSTRACT NUMBER: 071
ABSTRACT: This report monitors changes in use of and access to physician services by population groups, geographic areas, and types of services. It also monitors possible sources of inappropriate use. The report seeks to discover whether reforms in Medicare physician payment policies have negatively influenced use of and access to services. Several measures are used to discover whether access to care has been affected, and several vulnerable population groups are monitored. The report finds that (1) the introduction of the Medicare fee schedule (MFS) has resulted in a relative increase in allowed charges for visits and consultations and a relative decrease in allowed charges for procedure-based services; (2) MFS has not caused new barriers to care for vulnerable populations, although these groups still face difficulties in accessing and using services; (3) MFS has resulted in a move away from delivery of physician services in the inpatient setting to delivery of those services in the outpatient setting; (4) the disabled have a higher percentage of those needing medical care and not receiving it than any other group; (5) vulnerable populations are at risk of not receiving Medicare-covered preventive services; and (6) beneficiaries who live in low-income areas or who are eligible for Medicaid are likely to be in poor health, and many need more continuous and appropriate ambulatory care to avoid hospitalization. (Final report 47 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research and Demonstrations
FEDERAL CONTACT: Marian Gornick
PHONE NUMBER: 410/786-6686
PIC ID: 5493
PERFORMER ORGANIZATION: Health Care Financing Administration, Baltimore, MD
Bureau of Primary Health Care User Manual: Uniform Data System
Community and Migrant Health Centers and the Assessment of and Response to Mental Health and Developmental Needs in Primary Care Patients (Three Volumes)
Community Health Centers' Performance Under Managed Care
Development of Integrated Requirements for Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, and Physicians
Enrolling Minorities, Women, and Children/Adolescents Into NIH AIDS Clinical Trials: Models and Practices
Evaluation of Maternal and Child Health Bureau Childhood Injury Prevention Implementation Incentive Grants
Health Services Utilization and Costs to Medicaid of AFDC Recipients in New York and California Served and Not Served by Selected Community Health Centers
HMO Primary Care Staffing Patterns and Processes: A Cross-Site Analysis of 23 HMOs
Impact of FQHC Implementation on Community and Migrant Health Center Revenue and Utilization
Impact of Ryan White CARE Act Title I on Capacity Building in Latino Community-Based Organizations: Findings From a Study of Two Cities
Impact of Ryan White Title III(b) Funding on the Provision of HIV Primary Care
Infant Mortality Among U.S. Women of Mexican Descent: Evaluating the Validity of Current Estimates
Linkages Between Federally Qualified Health Centers and Hospitals: A Guide
National Practitioner Data Bank: User Satisfaction With Reporting and Querying and Usefulness of Disclosure Information for Decisionmaking 1992-94
Performance Indicators for GPRA: Initial Assessment of HRSA Programs (Final Report)
Ryan White CARE Act Title I Strategies for Underserved African-Americans: Methods, Analysis, and Interpretations of Four Cities
Second National Primary Care Conference: Executive Summary
Second National Primary Care Conference: Proceedings--Volume I
Second National Primary Care Conference: Proceedings--Volume II, Case Studies
Uniform Reporting System Field Test
Ryan White Title IV Program for Children, Youth, Women, and
Families: National Evaluation
TITLE: Bureau of Primary Health Care Evaluation Strategy: Design of the User and Visit Surveys
ABSTRACT NUMBER: 072
ABSTRACT: This project was a pilot study in preparation for a study of Community Health Centers. The pilot had two components: a personal interview survey of health center users, and a separate, medical record-based study of visits to health centers. HRSA's Bureau of Primary Health Care developed an agreement with the National Center for Health Statistics to assist in the design of the personal health interview survey modeled after the National Health Interview Survey (NHIS) and the medical record-based study of visits based on the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final survey design resulted from visits to seven Community Health Centers to develop, evaluate, and revise the survey instruments and procedures. Lessons learned from the pilot test strengthened the design of the full survey. Based on the pilot test results, a contract for full implementation of the Community Health Center User and Visit Survey was awarded in September 1994. (Final report 28 pages, plus attachments.)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jerrilynn Regan
PHONE NUMBER: 301/594-4280
PIC ID: 5613
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Bureau of Primary Health Care User Manual: Uniform Data System
ABSTRACT NUMBER: 073
ABSTRACT: This report reviews the existing reporting requirements for grantees of HRSA's Bureau of Primary Health Care (BPHC). It also provides a structure for the Uniform Data System (UDS), which integrates reporting for five primary care programs: the Community Health Center Program; the Migrant Health Center Program; the Health Care for the Homeless Program; the Outreach and Primary Health Services for Homeless Children Program; and the Public Housing Primary Care Program. The study developed a manual for using UDS. UDS consists of two components: the "Universal Report," which has nine tables and is required of all grantees; and the "Grant Reports," which repeat three of the Universal Report tables to provide comparable data on characteristics of users whose services fall within the scope of a project funded under a particular grant. The report notes that UDS will replace other reporting requirements for the programs and that its implementation is planned to facilitate transition to the new system. Instructions for each table are given, as are appendixes dealing with personnel and service definitions. UDS is being implemented, with the first data collection covering calendar year 1996. The first reports are due on March 31, 1997. (Final report 70 pages, plus appendixes.)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Jerrilynn Regan
PHONE NUMBER: 301/594-4280
PIC ID: 5611
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Community and Migrant Health Centers and the Assessment of and Response to Mental Health and Developmental Needs in Primary Care Patients (Three Volumes)
ABSTRACT NUMBER: 074
ABSTRACT: This study explores the extent to which Community and Migrant Health Centers (C/MHCs) provide screening, assessment, and treatment for the mental health and developmental needs of primary care patients. For this study, 25 health centers in 10 States were chosen to represent geographic diversity and different approaches to Medicaid coverage of mental health services. Structured telephone interviews were conducted at these 25 centers. Case studies written for each State describe selected characteristics of the health center and how the center conducts screening, assessment, treatment, and followup for the mental health and developmental needs of both children and adults. The study found that most of the C/MHCs provide some level of mental health screening and treatment. The study also found that (1) C/MHCs identified a broad range of mental health problems as prevalent in their patient populations and viewed these problems as interfering with the patient's health, quality of life, and ability to benefit from primary care; (2) in response to the mental health needs of their patients, C/MHCs took approaches that were distributed over a continuum from screening to provision of comprehensive mental health services onsite; and (3) States that reimburse for services delivered by a broad range of mental health professionals in different settings facilitate C/MHC delivery of mental health services, either directly or by referral. The final report has been distributed to primary care organizations and primary care associations that can use the successful models to improve the delivery of mental health services in underserved communities. A manuscript is being developed for submission to a professional journal. Volume One contains the final report, while Volumes Two and Three contain appendixes detailing case studies.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: James Macrae
PHONE NUMBER: 301/594-4315
PIC ID: 5617
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Community Health Centers' Performance Under Managed Care
ABSTRACT NUMBER: 075
ABSTRACT: This study examined the effects of managed care on seven Community Health Centers (CHCs) with varying degrees of managed care experience. The sites selected had prepaid managed care arrangements involving some financial risk. The study chose centers with significant managed care enrollment and several years' experience with managed care contracts. An important determinant in choosing the final site cohort was whether the HMOs that had contracted with the selected CHCs were willing to participate in the study. The study found that (1) CHCs perform as well as or better than comparable providers in their network based on key utilization and financial indicators; (2) the CHCs studied offer strong primary care services accompanied by cultural sensitivity that is highly valued by HMOs; and (3) CHCs need to pursue changes in their operations more aggressively to better accommodate managed care. Health centers have used the findings of this report to negotiate with managed care organizations and with State Medicaid agencies. An article on the report has been published in the July 1995 issue of the Journal of Ambulatory Care Management. (Final report 44 pages, plus appendixes.)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Bethann Tutunjian
PHONE NUMBER: 301/594-4060
PIC ID: 5596
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Development of Integrated Requirements for PAs, NPs, CNMs, and Physicians (MDs and DOs)
ABSTRACT NUMBER: 076
ABSTRACT: This project developed a personal computer-based model to forecast national integrated requirements for physicians, physician assistants (PAs), nurse practitioners (NPs), and certified nurse-midwives (CNMs) who deliver primary health care services. The Integrated Requirements Model provides estimates of practitioner needs under varying scenarios regarding managed care, insurance coverage, and alternative staffing configurations. The model comes prepackaged with six scenarios based on differing sets of assumptions concerning potential changes in primary care delivery. Users of the model can develop an unlimited number of scenarios by editing the projection measures underlying the assumptions. Study results are being used by the Council on Graduate Medical Education and the National Advisory Council on Nursing Education and Practice to form recommendations for data and education program development. The model is also being used by a number of external entities, including the Utah State Health Department, the Virginia Medical College, and the Wisconsin Consortium for Primary Care. Findings were presented at a conference, and a manuscript is planned for submission to a professional journal. (Final report variously paginated, plus appendix.)
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Edward Sekscenski
PHONE NUMBER: 301/443-6663
PIC ID: 5745
PERFORMER ORGANIZATION: Vector Research, Inc., Ann Arbor,
MI
TITLE: Enrolling Minorities, Women, and Children/Adolescents Into NIH AIDS Clinical Trials: Models and Practices
ABSTRACT NUMBER: 077
ABSTRACT: This study qualitatively documented the HRSA-funded Clinical Trials Linkage Projects. This funding was awarded to eight Ryan White Title III(b) sites to increase the enrollment of persons from underserved NIH-sponsored populations (ethnic/racial minorities, women, children, and adolescents) in HIV/AIDS clinical trials sponsored by the National Institutes of Health (NIH). Enrollment was increased by establishing linkages between primary care clinics and clinical trials research sites. Each of the eight sites (called Linkage Projects) were visited. The report concluded that, while the Linkage Projects were successful in establishing a working relationship between a primary care facility and a clinical trials research center, the recruitment efforts depended on the natural constituency of the primary care institution. One of the major recommendations was to expand outreach and education efforts to improve client recruitment for and retention in clinical trials. Based on study findings and related workshops, more than 90 percent of Title III(b) grantees now refer clients to a local clinical trial unit. (Final report 95 pages, plus appendixes.)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Deborah Parham
PHONE NUMBER: 301/594-4444
PIC ID: 6099
PERFORMER ORGANIZATION: LTG Associates, Inc., Turlock, CA
TITLE: Evaluation of Maternal and Child Health Bureau Childhood Injury Prevention Implementation Incentive Grants
ABSTRACT NUMBER: 078
ABSTRACT: HRSA's Maternal and Child Health Bureau (MCHB) awarded incentive grants in 1987 and 1988 to seven States to develop programs in childhood injury prevention. This study analyzed and compared the State strategies for establishing and maintaining focal points for injury prevention after Federal funding ended. Site visits to each State included document review and interviews with injury prevention personnel. Findings show that, in general, recipients of the implementation incentive grants exhibited a considerable increase in injury prevention capacity. All seven States increased their dedicated injury prevention staff during the grant period and six have maintained or increased that staffing level. Advocacy for injury prevention has increased. Several respondents credit the MCHB program with enabling them to acquire funding from other Federal and State sources. Most also greatly increased their capacity to collect and use injury morbidity and mortality data, but have not fully incorporated data analysis into the process of planning injury prevention programs. These findings will be used by policymakers and HRSA program personnel in considering future allocations of program funding. Volume one contains the final report, and volume two contains a cross-site analysis report. (Final report 5 pages, plus appendix; cross-site analysis report variously paginated, plus appendixes.)
AGENCY SPONSOR: Maternal and Child Health Bureau
FEDERAL CONTACT: David Maglott
PHONE NUMBER: 301/443-2778
PIC ID: 5599
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: Health Services Utilization and Costs to Medicaid of AFDC Recipients in New York and California Served and Not Served by Selected Community Health Centers
ABSTRACT NUMBER: 079
ABSTRACT: This report presents the findings from studies of the use of Medicaid-covered services and costs to Medicaid for Aid to Families With Dependent Children (AFDC) and AFDC-like recipients living in the service areas of four selected Community Health Centers in California and six in New York. The California study was based on calendar year 1989 Medi-Cal eligibility, claims, and payment data, while the New York study used Federal fiscal 1991 Medicaid data. The hypotheses tested in the study were that (1) patterns of use would differ among recipients who use CHCs as their customary source of primary care and those who do not; and (2) regular users of CHCs would experience reduced inpatient hospital care and would incur lower costs to Medicaid. The study confirmed this second hypothesis, finding statistically significant reductions in use (hospital admissions and inpatient days) and costs to Medicaid for regular CHC users, compared with nonusers. In California, regular CHC users incurred costs to Medicaid that were 14 percent lower than for nonusers; if maternity cases are excluded, the costs were 33 percent lower; and for maternity cases alone, the costs were 9 percent lower. In New York, these figures were 24 percent, 30 percent, and 12 percent, respectively. The report concludes that CHCs are cost-effective, perhaps because of organized utilization review, case management, and preventive services.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Judy Rodgers
PHONE NUMBER: 301/594-4343
PIC ID: 6001
PERFORMER ORGANIZATION: Center for Health Policy Studies,
Columbia, MD
TITLE: HMO Primary Care Staffing Patterns and Processes: A Cross-Site Analysis of 23 HMOs
ABSTRACT NUMBER: 080
ABSTRACT: This study examined HMO primary care staffing patterns and the decisionmaking processes used to establish them. The study design consisted of onsite interviews with senior health plan officials in 23 HMOs nationwide. The study found that the three key factors that affect how HMOs determine the number of primary care physicians they need are (1) current growth in enrollment and opportunities for further growth; (2) enrollee experience with access; and (3) employer desires and requirements. Although generally successful in recruiting the desired number of primary providers (some plans expressed recruiting difficulties in rural and underserved urban areas), plans report that new graduates who join are not well-prepared for practice in either managed care settings or primary care settings more generally. To address this problem, HMOs typically monitor new recruits closely. The sampled plans included five with Medicaid enrollment at 25 percent or more of total enrollment. The purpose was to investigate how needs for primary care staffing might change if managed care becomes more dominant for low-income populations. Although utilization differs for the Medicaid population--relative to other enrollees, Medicaid enrollees have higher walk-in and no-show appointment rates, higher hospital admission rates, and underutilize preventive health care services--the organizations did not plan their primary care staffing very differently. But HMOs serving Medicaid populations place providers near these enrollees, provide outreach services, and seek providers with experience in treating Medicaid beneficiaries. Findings from this study will improve the ability of HRSA managers and the public health community to forecast work force needs and to ensure an adequate supply of practitioners. (Final report 118 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Jessica Townsend
PHONE NUMBER: 301/443-1900
PIC ID: 5606
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Impact of FQHC Implementation on Community and Migrant Health Center Revenue and Utilization
ABSTRACT NUMBER: 081
ABSTRACT: This study assessed the impact of the Medicaid Federally Qualified Health Center (FQHC) legislation on Community Health Center (CHC) revenue and utilization of services. Multivariate analysis was used to examine the experience of federally funded CHCs between 1989 and 1992. Analyses suggest that the FQHC legislation, in the Omnibus Budget Reconciliation Act of 1989, had a positive impact on health center financing and on access to care for both Medicaid recipients and the uninsured. Study results also suggest that FQHC impact on service utilization differed according to center size. In particular, for smaller centers experiencing significantly higher growth rates for all insurers and for Medicaid users, higher reimbursement rates under FQHC may have provided an incentive to increase the center's Medicaid beneficiaries. Conversely, larger centers experienced significantly greater absolute increases in Medicaid beneficiaries, but not in total user populations. It was also found that centers in States with fast-growing Medicaid programs experienced significantly higher increases in the number of Medicaid beneficiaries than centers in other States. Study results are being used in the program planning process to shape policy directions at the agency and departmental levels, and within States. (Final report 94 pages, plus appendixes; executive summary, 31 pages, separately bound.)
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Ronda Hughes
PHONE NUMBER: 301/594-4120
PIC ID: 5616
PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
TITLE: Impact of Ryan White CARE Act (RWCA) Title I on Capacity Building in Latino Community-Based Organizations: Findings From a Study of Two Cities
ABSTRACT NUMBER: 082
ABSTRACT: This study was designed to develop and test a methodology for evaluating whether and how CARE Act Title I funds have helped develop, expand, or enhance HIV/AIDS services to Latino community-based organizations (CBOs). Information for the study was gathered from surveys and key informant interviews conducted at Latino CBOs in two eligible metropolitan areas: San Diego and Boston. The study found that 29 percent of the Latino CBOs in the study areas received Title I funding and that an atmosphere of openness and inclusiveness in the planning process was critical for Latino CBOs to feel that they were full participants. The majority of persons with HIV/AIDS served by the Latino CBOs were Spanish speaking, emphasizing the need for linguistically and culturally appropriate services. Study participants noted that receipt of Title I funding is critical for enhancing and expanding services. Recommendations were for HRSA to (1) develop incentives for eligible metropolitan areas to increase Latino CBO representation on planning councils; (2) create active outreach mechanisms to engage nonmedical agencies; (3) fill data gaps for planning council directors regarding service and capacity needs of communities of color; (4) develop clear guidelines for capacity-building activities that should be funded under the Ryan White CARE Act; and (5) conduct studies that investigate factors that impede or facilitate participation of ethnic minority CBOs in the RWCA planning process. The findings from this study are being used to provide technical assistance to grantees on issues regarding capacity building in both minority and nonminority CBOs.
AGENCY SPONSOR: Bureau of Health Resources Development
FEDERAL CONTACT: Gloria Weissman
PHONE NUMBER: 301/443-3478
PIC ID: 6197
PERFORMER ORGANIZATION: Boston University, School of
Public Health; The National Coalition of Hispanic Health and
Human Services Organizations
TITLE: Impact of Ryan White Title III(b) Funding on the Provision of HIV Primary Care
ABSTRACT NUMBER: 083
ABSTRACT: The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 authorizes a variety of grants. These grants include AIDS Early Intervention Services grants to community-based primary care facilities under Title III(b). This study assessed the impact of Title III(b) funding in terms of HIV-related services, models of service delivery, and the utilization of Title III(b) funds. The study was based on a mail survey of all organizations participating in the Title III(b) program. Survey data indicate that the client populations served by Title III(b) are changing. Nearly 60 percent of respondents reported serving more women; 29 percent reported serving increased numbers of injection drug users. Fifteen percent of respondents reported increased numbers of African-American or Hispanic clients. Many grantees attribute the shift in population mix to substantial outreach efforts launched under Title III(b). The survey also found that Title III(b) funds have enabled HIV projects to increase the number of sites by nearly 60 percent. In addition, the projects were able to add or expand medical, social, and support services. Funds have also allowed grantees to address and overcome many of the traditional barriers to health care, including inadequate transportation; cultural and language barriers; lack of client financial resources; and client, provider, and community ignorance about and denial of AIDS/HIV. Title III(b) funds have also helped projects establish and maintain linkages with health care and social services, and responding Title III(b) grantees have established collaborative relationships with over 1,300 agencies.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Thomas M. Coughlin
PHONE NUMBER: 301/594-4450
PIC ID: 5597
PERFORMER ORGANIZATION: CDM Group, Inc., Chevy Chase, MD
TITLE: Infant Mortality Among U.S. Women of Mexican Descent: Evaluating the Validity of Current Estimates
ABSTRACT NUMBER: 084
ABSTRACT: Researchers and HRSA policymakers have been puzzled for a number of years by the anomalously low infant mortality rate (IMR) reported for the Mexican-American community. If IMRs are used as measures of medical underservice, the low IMRs for Mexican-Americans will mean that fewer resources will be channeled to areas with large Mexican-American populations. An analysis of NCHS matched birth-death data tapes for 1983-87 indicate that the rate of very low and low birthweight infants for Mexican-Americans (5.7 percent) is about the same as that of non-Hispanic white infants but significantly lower than those of non-Hispanic black infants (13 percent). The difference in IMRs between first and later generation Mexican-American infants indicates that attachment to Mexican culture may be a reasonable explanation for low infant mortality. With the exception of congenital anomalies and short gestation/low birthweight, first generation infants have a lower IMR than later generation infants. The study suggests that ethnic misclassification and underreporting may be less serious problems than some observers believe. The approaches used to analyze the NCHS 1983-87 data are now being applied to the newly available 1988-90 linked birth-death records. Two journal manuscripts are being developed based on this study and the 1988-90 linked birth-death records.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Barbara Wells
PHONE NUMBER: 301/594-4284
PIC ID: 6053
PERFORMER ORGANIZATION: The George Washington University,
Center for Health Policy Research, Washington, DC
TITLE: Linkages Between Federally Qualified Health Centers and Hospitals: A Guide
ABSTRACT NUMBER: 085
ABSTRACT: Hospitals and community-based primary health care centers of all types, including Community and Migrant Health Centers (C/MHCs) and other Federally Qualified Health Centers (FQHCs), are increasingly entering linkages that go beyond traditional arrangements in which center physicians have admitting privileges and can follow their patients while they are inpatients in local hospitals. This study suggests both legal and organizational approaches to these new relationships. Four factors have led to these increased linkages: (1) recognition by most providers that their survival is best assured within the system of care rather than as freestanding, limited service providers; (2) pressure from purchasers of care to build integrated delivery systems; (3) implementation of cost-based reimbursement for Medicaid and Medicare beneficiaries in FQHCs; and (4) the presence of new opportunities resulting from State or private financial incentives. Five sites (Albany, Georgia; Plainfield, New Jersey; Blossburg, Pennsylvania; Erie, Pennsylvania; and Seattle, Washington) were selected to collect the experiences of FQHC or hospital networks, ranging in joint activities and organizational forms. The study found that FQHCs and hospitals should determine the purpose of their linkage before they determine the organizational form that will legally embody agreed-upon activities. The report is in the form of a guidebook for staff and board members of FQHCs who are considering linkages with hospitals. Study results are being used to identify legal and financial issues that FQHCs should consider in forming vertical arrangements with hospitals.
AGENCY SPONSOR: Bureau of Primary Health Care
FEDERAL CONTACT: Ronda Hughes
PHONE NUMBER: 301/594-4120
PIC ID: 5615
PERFORMER ORGANIZATION: The George Washington University,
Center for Health Policy Research, Washington, DC
TITLE: National Practitioner Data Bank: User Satisfaction With Reporting and Querying and Usefulness of Disclosure Information for Decisionmaking 1992-94
ABSTRACT NUMBER: 086
ABSTRACT: This study represents phase II of an evaluation study to assess the impact of the National Practitioner Data Bank (NPDB). Phase I developed the survey instrument under HRSA Contract No. 240-91-0017, Delivery Order No. 240-92-0508. The primary purpose of the Phase II study was to implement the evaluation methodology. NPDB's impact was assessed in terms of its ability to serve as a national repository and to distribute useful information effectively. The telephone survey found that (1) most entities had a high level of satisfaction with NPDB's reporting form and had a favorable reaction toward implementing technical advances; (2) querying entities generally found the information they received to be useful; (3) approximately one-fourth of entities received new information from NPDB responses; (4) three-quarters of malpractice insurers indicated that NPDB had impacted claims resolution between 1992 and 1994; (5) not all State licensing boards received adverse action reports to pass through to NPDB between 1992 and 1994; (6) hospitals are required to query NPDB, but HMOs, State boards, group practices, PPOs, and professional societies had voluntary query rates during the study period of from 7 percent to 58 percent. The report also provides information on costs, disclosures, and decision making based on NPDB information. Study results have been used to design NPDB's second generation system, and have been made available to medical malpractice insurers, State health care practitioner licensing boards, hospitals, and other health care entities that query and report to NPDB, and the general public. (Final report 111 pages, plus appendixes.)
AGENCY SPONSOR: Bureau of Health Professions
FEDERAL CONTACT: Robert Oshel
PHONE NUMBER: 301/443-2300
PIC ID: 5609
PERFORMER ORGANIZATION: Walcoff & Associates Inc.,
Fairfax, VA
TITLE: Performance Indicators for GPRA: Initial Assessment of HRSA Programs (Final Report)
ABSTRACT NUMBER: 087
ABSTRACT: The Government Performance and Results Act of 1993 requires that each Federal agency develop comprehensive strategic plans, annual performance plans that set specific performance goals for each program activity, and annual reports on the actual performance achieved compared with the performance goals. This study assessed HRSA ability to develop and implement a system of performance measurement and management as of summer 1995. The report focuses on individual programs or program clusters identified in the President's budget for fiscal 1996. The study used a literature review, background research, and interviews within HRSA to assess program clusters, programs, and budget line items and to develop a technical assistance plan that identifies what is needed to further help HRSA develop and implement a performance management system. The study found that (1) HRSA's current program structures and measurement efforts form a base for a HRSA-wide measurement system; and (2) indicators common to many programs could be used to measure agencywide performance. The performance measurement strategy should stress (1) primary emphasis on a coordinated, interdependent system of health care resources, rather than a disparate set of programs; (2) links between the measurement strategy, strategic planning, program activities, evaluation planning and findings, and budgeting; and (3) incremental development of the system. This study has served as the basis for technical assistance to all HRSA Bureaus, designed to meet their individual needs in performance measurement. (Final report 68 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.
PHONE NUMBER: 301/443-7718
PIC ID: 5954
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Ryan White CARE Act Title I Strategies for Underserved African-Americans: Methods, Analysis, and Interpretations of Four Cities
ABSTRACT NUMBER: 088
ABSTRACT: This study was intended to provide a better understanding of the local strategies currently being used by Ryan White CARE Act grantees to reach and serve African-Americans living with HIV. A secondary aim of the study was to assess the suitability of using qualitative data collection methods to identify local service delivery strategies that could be applied to other underserved populations. The study was designed to capture the social and organizational contexts in which HIV service strategies emerged in local communities. The study uses indepth, semistructured discussions with key stakeholders, including grantees, service providers, and people living with HIV. Study respondents identified three types of service strategies to increase the number of underserved African-Americans living with HIV: improving administrative procedures, building service capacity, and raising public education and awareness. An essential component of effective strategies was working through and with African-American institutions to develop a comprehensive system of quality care. Study findings will be presented at the 1996 International AIDS and American Public Health Association conferences. (Final report 93 pages, plus appendixes.)
AGENCY SPONSOR: Bureau of Health Resources Development
FEDERAL CONTACT: Moses B. Pounds
PHONE NUMBER: 301/443-6560
PIC ID: 5734
PERFORMER ORGANIZATION: MACRO International, Inc., Silver
Spring, MD
TITLE: Second National Primary Care Conference: Executive Summary
ABSTRACT NUMBER: 089
ABSTRACT: This executive summary provides information on the Second National Primary Care Conference, which was held September 11-13, 1994, in Dallas, Texas. The conference was designed to answer questions and to generate understanding on the following primary care topics: (1) the training, composition, and preparedness of the primary care work force; (2) the formation, responsiveness, and comprehensiveness of the primary care delivery system; and (3) the relationship between primary care and special populations. The executive summary describes the events that took place during the conference, and includes summaries of plenary speeches and panel presentations. Copies of the conference program, a list of program participants, and a letter to conferees from First Lady Hillary Rodham Clinton are also included. See also PIC ID 4435, 5750.1, and 5750.2. (Executive summary 47 pages.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Pearl Perry
PHONE NUMBER: 301/443-1126
PIC ID: 5750
PERFORMER ORGANIZATION: Social and Scientific Systems,
Inc., Bethesda, MD
TITLE: Second National Primary Care Conference: Proceedings--Volume I
ABSTRACT NUMBER: 090
ABSTRACT: This report provides details of the Second National Primary Care Conference, held in Dallas, Texas, on September 11-13, 1994. The report includes (1) a letter to conferees from First Lady Hillary Rodham Clinton; (2) the executive summary; (3) the conference program; (4) the keynote address delivered by the Honorable Richard D. Lamm; (5) plenary speeches presented by Ron J. Anderson, M.D., Paul M. Ellwood, M.D., Neal Vanselow, M.D., and Bruce Vladeck, Ph.D.; (6) a list of program participants; and (7) a list of conference attendees. See also PIC ID 4435, 5750, and 5750.2. (Final report 152 pages.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Pearl Perry
PHONE NUMBER: 301/443-1126
PIC ID: 5750.1
PERFORMER ORGANIZATION: Social and Scientific Systems,
Inc., Bethesda MD
TITLE: Second National Primary Care Conference: Proceedings--Volume II, Case Studies
ABSTRACT NUMBER: 091
ABSTRACT: This report presents case studies used in panels at the Second National Primary Care Conference held in Dallas, Texas, on September 11-13, 1994. The case studies cover a range of topics, such as the Adirondack Rural Health Network, the California Cultural Competency Task Force, the Changing Role of Academic Health Centers Under Health Care Reform, Linking School-Based Programs and Primary Care, and Using Quality to Build Capitated Delivery Systems, among others. See also PIC ID 4435, 5750, and 5750.1. (Final report 233 pages.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Pearl Perry
PHONE NUMBER: 301/443-1126
PIC ID: 5750.2
PERFORMER ORGANIZATION: Social and Scientific Systems,
Inc., Bethesda, MD
TITLE: Uniform Reporting System Field Test
ABSTRACT NUMBER: 092
ABSTRACT: In September 1992, HRSA began a year-long field test of a Uniform Reporting System (URS) that was intended to obtain data on the populations reached by Ryan White CARE Act Title I and Title II services providers, and on the types and amounts of services delivered to clients. This study assessed (1) the feasibility of unduplicated, client-level reporting; (2) the value of the resulting information; (3) the level of effort and costs required of all participants; (4) the adequacy of measures; (5) the types and amounts of technical assistance HRSA would have to provide; and (6) the refinements needed in URS data elements or procedures. Analysis of the field test, which included 15 grantees, shows that (1) URS client-level data systems are feasible and valuable; (2) effective implementation of URS client-level reporting would require significant effort by grantees and service providers; and (3) a high level of technical support from HRSA would be needed for full implementation of URS nationwide. Based on these conclusions, HRSA submitted to the Office of Management and Budget a request for approval of mandatory implementation of the Annual Administrative Report calling for aggregated data. HRSA also decided to proceed with client-level URS reporting on a voluntary basis and to establish demonstration sites for client-level URS reporting. Eight Title I and Title II grantees are conducting the demonstration for a 3-year period.
AGENCY SPONSOR: Bureau of Health Resources Development
FEDERAL CONTACT: Robert Baitty
PHONE NUMBER: 301/443-0652
PIC ID: 4916
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Ryan White Title IV Program for Children, Youth, Women, and Families: National Evaluation
ABSTRACT NUMBER: 093
ABSTRACT: The purpose of this project was to assess the effectiveness of HRSA's Grants for Coordinated Services and Access to Research for Children, Youth, and Families, authorized by Title IV of the Ryan White Comprehensive AIDS Resources Emergency Act. The study was focused on the following questions: Have systems of care been established, improved, maintained, or expanded? Do the systems have the desired attributes? Are the systems reaching and serving intended unserved or underserved target populations? Are multidisciplinary providers accessible, available, and trained to serve the target populations? Are clients receiving the array of medical and social services they need? Has the program had an impact on increasing participation in clinical drug trials? Has the program had a positive impact on client and family satisfaction? Methodologies included review of grant applications, self-study questionnaires from grantees, site visits to 18 grantees, and focus groups in ten sites. Findings confirm that the Title IV program has established, improved, maintained, or expanded systems of care that provide family-centered, culturally competent, and community-based services to the target populations. Multidisciplinary providers are accessible and available, and are specifically trained to meet client needs. Clients reported that they generally receive the array of services they need, though some gaps exist. The program has led to increased participation in clinical trials. Finally, the program has had a significant and lasting impact on client and family satisfaction. Results have supported targeted program planning to fill service gaps identified through this first national snapshot of the Title IV program. Information about barriers to and successes in building models for enhanced access to services and research is being used by other Ryan White programs.
AGENCY SPONSOR: Maternal and Child Health Bureau
FEDERAL CONTACT: David Maglott
PHONE NUMBER: 301/443-2778
PIC ID: 5600
PERFORMER ORGANIZATION: Macro International, Inc., Silver Spring, MD
Evaluation of Diabetes Services Provided by IHS Model Diabetes Program: Final Report
Evaluation of IHS Midlevel Health Providers: Final Report
Phase III Final Report: Child Abuse and Neglect in American
Indian and Alaska Native Communities and the Role of the Indian
Health Service
TITLE: Case Study of Family Violence in Four Native American Communities: Final Report
ABSTRACT NUMBER: 094
ABSTRACT: This study examines family violence on four American Indian reservations (the Confederated Tribes of Warm Springs, the Eastern Band of Cherokee, the Navajo Nation, and the Rosebud Sioux). It uses a case study approach to collect primary and secondary data about the nature and prevalence of family violence, and the intervention and prevention measures planned or in place on each reservation. The report's strengths include the broad range of informants interviewed, the wide variation in characteristics of the sites, and the objectiveness used by the contractor to gather data. Its limitations include the facts that case study data, by nature, are not representative and that informants feel pressure not to disclose unfavorable information. The report finds that the eight components of family violence interventions include (1) adoption of a family violence code, with mandatory arrest and incarceration or treatment of offenders; (2) establishment of a victim support system; (3) institution of new police procedures for dealing with family violence; (4) increase in community education and involvement; (5) coordination of resources and programs across agencies; (6) development of an information tracking system; (7) staff training initiatives; and (8) establishment of an abuser treatment protocol. The report also offers six recommendations based on these interventions. See also PIC ID 6000.1. (Final report 52 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Leo Nolan
PHONE NUMBER: 301/443-4700
PIC ID: 6000
PERFORMER ORGANIZATION: Indian Health Service, Office of
Planning, Evaluation, and Legislation, Rockville, MD
TITLE: Evaluation of Diabetes Services Provided by IHS Model Diabetes Program: Final Report
ABSTRACT NUMBER: 095
ABSTRACT: This project evaluates the IHS diabetes model projects. It uses data from 634 patient medical records, 4 focus groups, and 20 information interviews to describe these projects and to examine their effects on patient health outcomes, blood sugar control, and hospitalizations. Two diabetes project sites (Winnebago, Nebraska, and Fort Totten, North Dakota) and on "usual care" site (Rosebud, South Dakota) were selected for the evaluation. Data from the 1993 Diabetes Program Audit were used to assess whether the findings from this evaluation could generally represent other diabetes team approaches in other IHS areas. The report finds that (1) patients followed at diabetes project sites experienced lower rates of poor blood sugar control than patients followed at the usual care site; (2) patients at the project sites were at reduced risk of having a first diabetes-related hospitalization over a followup period than patients at the usual care site; (3) data from the 1993 audit cannot provide a clear answer about whether the results from this evaluation can be generalized to the larger IHS service population, but projects in general seem to be similar in their rates of poor control and diabetes care characteristics; and (4) focus groups and informant interviews indicated that patients desired more education and that medical staff believe that patients' refusal to accept their diagnosis is a barrier to their adherence to a care regimen. (Final Report variously paginated, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Frank E. Marion
PHONE NUMBER: 301/443-4700
PIC ID: 6005
PERFORMER ORGANIZATION: Native American Consultants, Inc.,
Washington, DC
TITLE: Evaluation of IHS Midlevel Health Providers: Final Report
ABSTRACT NUMBER: 096
ABSTRACT: IHS must determine its needs for midlevel health providers (MLHPs), such as physician assistants, nurse practitioners, certified nurse midwives, and clinical nurse specialists, through the year 2000 and must address recruitment and retention of these professionals. A survey of 254 MLHPs and 25 primary care managers and visits to three sites yielded responses from 119 MLHPs (47 percent of the current MLHPs) and 14 primary care managers. The report finds that MLHPs say that the key retention points in their consideration to remain with IHS are increases in salaries, Continuing Medical Education benefits, and recognition as health care professionals with policymaking privileges. Serious dissatisfaction in these areas indicates a need for IHS action. The report also finds that (1) the quality of health care in clinics will deteriorate significantly if sufficient MLHPs are not provided by the year 2000; (2) the recruitment of more local Native Americans will bolster this already good situation; (3) significant decline in the numbers of IHS physicians will negatively impact physician performance; and (4) more administrative support will be required to free MLHPs for almost exclusive attention to primary health care duties. The report provides several recommendations. (Final report 15 pages, plus appendixes.)
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Frank E. Marion
PHONE NUMBER: 301/443-4700
PIC ID: 6013
PERFORMER ORGANIZATION: Native American Consultants, Inc.,
Washington, DC
TITLE: Phase III Final Report: Child Abuse and Neglect in American Indian and Alaska Native Communities and the Role of the Indian Health Service
ABSTRACT NUMBER: 097
ABSTRACT: In 1990, IHS instituted a study of its response to child abuse and neglect in American Indian and Alaska Native communities. This report provides a comprehensive assessment of the effectiveness and impact of IHS policies, procedures, and protocols in this area. It also evaluates the capacity of IHS personnel to recognize and treat the abuse and neglect of American Indian and Alaska Native children and proposes a culturally sensitive intervention program to address child abuse and neglect in these communities. The report finds that (1) 34.4 percent of American Indian and Alaska Native children are at risk of abuse, neglect, or both, according to IHS and Bureau of Indian Affairs estimates; (2) staff are reluctant to report abuse, even though reporting is mandatory for Federal employees; (3) staff lack adequate training and computerized record systems; (4) a disproportionate number of abuse and neglect victims are under age 5, and although boys and girls are equally likely to be victims of physical abuse and neglect, girls are more likely to be victims of sexual abuse; and (5) abusers are equally likely to be male or female, although sexual abusers are more likely to be male. A model intervention program of the secondary prevention type has been piloted and includes home visitor services, the promotion of healthy child growth and development, and other key program elements. The report concludes that IHS can profoundly reduce the incidence of abuse and neglect in its role as a public health provider.
AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation
FEDERAL CONTACT: Leo Nolan
PHONE NUMBER: 301/443-4700
PIC ID: 6009
PERFORMER ORGANIZATION: National Indian Justice Center, Petaluma, CA
Career Development Applications and Awards: Medical Department Sources and Patterns of NIH Funding
Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector
Directions in Nursing Research Training
Evaluation Design Study for the National Research Service Awards (NRSA)
Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment
Measuring Social Inequalities in Health
Report on Outreach Activities of the National Library of Medicine: A Five-Year Review
The Status of Biomedical Research Facilities
Study of the Minority Access to Research Careers Honors Undergraduate Research Training Program
Support for Bioengineering Research
TITLE: Cancer at a Crossroads: A Report to Congress for the Nation
ABSTRACT NUMBER: 098
ABSTRACT: This evaluation of the National Cancer Program (NCP) was undertaken at the request of Congress to assess the achievements of NCP, identify barriers to reducing the burden of cancer, and make recommendations for future research and program directions. NCP comprises not just the cancer research community, but government at all levels, business and industry, the total health care system, and every United States citizen. The report concludes that the strongest strategy for a renewed war on cancer should include three essential elements: (1) applying currently available knowledge about cancer prevention and care to all segments of the population; (2) increasing support for translational research that develops basic cancer knowledge into preventive strategies, new technologies, and effective treatments; and (3) increasing support for basic cancer research to ensure continued new discoveries that lead to better cancer prevention and care. The report notes that six major issues must be addressed to mount an effective war on cancer: (1) need for health care reform with universal cancer care coverage written in statute; (2) absence of coordination in NCP; (3) inadequate cancer care: (4) current laws, policies, and regulations that hinder the development of effective cancer treatments; (5) lack of support for translational research; and (6) need to increase basic science research. (Final report 34 pages, plus appendixes.)
AGENCY SPONSOR: National Cancer Institute
FEDERAL CONTACT: Cherie Nichols
PHONE NUMBER: 301/496-5515
PIC ID: 6008
PERFORMER ORGANIZATION: National Cancer Institute,
Bethesda, MD
TITLE: Career Development Applications and Awards: Medical Department Sources and Patterns of NIH Funding
ABSTRACT NUMBER: 099
ABSTRACT: This study was undertaken to find out, first, if the graduate medical school and residency enrollment in departments that have been sources of National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other NIH Career Development (K) awards and applications has continued to increase over time, or is leveling off or decreasing; and second, to examine whether that potential supply of applicants is in fact reflected in applications received and applications funded by NIDDK and by other institutes. The supply of potential applicants for K awards may be leveling off or decreasing, based on 1994 data of the American Medical Association, but an encouraging aspect of these data is that enrollment in postdoctoral programs in departments from which NIDDK applicants have come is not decreasing, for the most part. Applications to NIH for individual support by K awards have increased in the last 8 years, but this increase is primarily from clinical sciences departments. Applications from basic sciences have declined slightly. The relative standing of NIDDK among NIH ICDs, with respect to applications received, applications funded, and both received and funded in proportion to agency budget, has remained constant. NIDDK is third or fourth among ICDs by these criteria, and its support of Career K trainees is consistently above the NIH average.
AGENCY SPONSOR: National Institute of Diabetes and Digestive and Kidney Diseases
FEDERAL CONTACT: Carol Feld
PIC ID: 6019
PHONE NUMBER: 301/496-6623
PERFORMER ORGANIZATION: National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD
TITLE: Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector
ABSTRACT NUMBER: 100
ABSTRACT: The Medications Development Division (MDD) at the National Institute on Drug Abuse (NIDA) was established to coordinate and encourage academic, private, and Federal regulatory involvement in developing and bringing to market new medications to treat drug abuse. This report examines MDD's progress and explores the factors that hinder the development of antiaddiction medications. The report finds that pharmacotherapy for the treatment of drug addiction has received little attention. In fact, despite the success of methadone for the treatment of opiate addiction, only two additional drugs have been approved, both of which were developed in the late 1960's and early 1970's. Furthermore, there is still no approved medication for the treatment of cocaine addiction. The report also finds that the major disincentives to pharmaceutical research and development for antiaddiction medications include (1) an inadequate scientific base on the mechanisms of addiction and on the prevention of relapse, particularly for cocaine addiction; (2) lack of financing for treatment and trained treatment specialists; (3) narrow Federal and State regulations; (4) relatively small market for such drugs; (5) pricing issues and social stigma against drug abusers; (6) liability issues and difficulties in conducting clinical research; and (7) lack of sustained Federal leadership. The report provides recommendations to help remove these barriers. (Final report 199 pages, plus appendixes.)
AGENCY SPONSOR: National Institute on Drug Abuse
FEDERAL CONTACT: Laura Rosenthal
PHONE NUMBER: 301/443-6487
PIC ID: 5831
PERFORMER ORGANIZATION: National Academy of Sciences,
Institute of Medicine, Washington, DC
TITLE: Directions in Nursing Research Training
ABSTRACT NUMBER: 101
ABSTRACT: The National Institute of Nursing Research (NINR) supports mechanisms to permit nurse scientists to follow research career paths. This report summarizes information on NINR's funding of these efforts, its recommendations for nursing research training in a National Research Council report, and the views and recommendations of the scientific community. This report also discusses research training issues in the broad context of Federal and academic perspectives. The report finds that (1) during its formative years, NINR placed a high priority on training at the predoctoral level in order to ensure a beginning cadre of nurse scientists; (2) the numbers of Nursing Research Service Awards (NRSA) applications and part-time enrollment are decreasing for most nursing doctoral students; (3) the number of NRSA full-time training positions must increase in the next 5 years; (4) NINR and the nursing research community must design and implement creative research training programs to ensure that scientists in nursing research have access to high-quality training in research-intensive environments. The report recommends that NINR (1) disseminate this report widely; (2) analyze the research career paths of NINR trainees and fellows to determine the criteria for successful training experiences; (3) emphasize the need to increase the number of nurses with doctoral degrees; and (4) support research consortia and partners. (Final report 19 pages.)
AGENCY SPONSOR: National Institute on Nursing Research
FEDERAL CONTACT: Suzanne L. Feetham
PHONE NUMBER: 301/402-1446
PIC ID: 6051
PERFORMER ORGANIZATION: National Institute of Nursing
Research, Bethesda, MD
TITLE: Evaluation Design Study for the National Research Service Awards (NRSA) (Volume I)
Description of National Research Service Awards Program (Volume II)
ABSTRACT NUMBER: 102
ABSTRACT: The NRSA program is designed to meet the need for scientists and institutions to carry out the Nation's biomedical research agenda. This evaluation design study provides a detailed plan for the evaluation of career outcomes of predoctoral and postdoctoral trainees and fellows and the NRSA programs in which they have participated. The design study is divided into three parts: the first part describes the program and its history; the second part details previous evaluation efforts; and the third part discusses the proposed evaluation design. The report finds that (1) in 1994, NRSA provided $373 million, distributed among 2,356 individual fellowships and 12,032 traineeships awarded by institutions; (2) approximately 15 percent of the graduate students in the biomedical and behavioral science area are supported by NRSA funds; and (3) NRSA is the largest research training program in the United States. The evaluation design study proposes three approaches for the evaluation: (1) an analysis of existing databases to provide initial data, to help define sampling strategies, and to be the basis for comparisons between NRSA participants and nonparticipants; (2) a survey of prior NRSA recipients and of institutions; and (3) site visits to institutions. See also PIC ID 6012.1. (Final report 75 pages.)
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: John Uzzell
PHONE NUMBER: 301/496-9285
PIC ID: 6012
PERFORMER ORGANIZATION: National Institutes of Health,
Division of Strategic Evaluation, Bethesda, MD
TITLE: Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment
ABSTRACT NUMBER: 103
ABSTRACT: When fetal alcohol syndrome (FAS) was first described in published medical literature, hopes were high for its prevention. However, preventing this condition has been very complicated. This report responds to the mandate of Congress in the ADAMHA Reorganization Act that a study of FAS and related birth defects be carried out. The committee convened to write the report has members whose expertise includes pediatrics, developmental psychology and neurology, obstetrics, nosology, teratology, epidemiology, substance abuse prevention and treatment, and psychiatry. The committee was charged with improving the understanding of available research knowledge and experience on diagnosis, prevalence, surveillance, and prevention and treatment of FAS and related birth defects. The committee-revised diagnostic criteria aim to increase clarity, rigor, and consistency by expanding the traditional designations of FAS and other alcohol-related effects. Recommendations include: (1) cross-sectional and longitudinal research to assess the characteristics and clinical expression of these syndromes across the patient's life span; (2) research to identify potential structural or functional brain abnormalities that may be associated with FAS and related birth defects; (3) further clinical research on the adverse developmental effects of prenatal alcohol exposure; and (4) the development of more specific biologic diagnostic markers. (Prepublication report 40 pages, plus appendixes.)
AGENCY SPONSOR: National Institute on Alcohol Abuse and Alcoholism
FEDERAL CONTACT: Lora Abbott, M.S.
PHONE NUMBER: 301/443-2369
PIC ID: 6006
PERFORMER ORGANIZATION: National Academy of Sciences,
Institute of Medicine, Washington, DC
TITLE: Measuring Social Inequalities in Health
ABSTRACT NUMBER: 104
ABSTRACT: This report presents the findings of a conference held in Annapolis, Maryland, in September 1994. The conference provided the conceptual background for measures of socioeconomic gradients in federally supported health data sets and recommended improvements. It also recommended methods for implementation in the context of data gathering under health care reform. The socioeconomic gradients under consideration were those used in federally supported surveys, vital statistical and disease registries, and hospital discharge data. These gradients are subsequently used to evaluate programs or as variables to help assess factors affecting health outcomes. The conference made very specific recommendations for improving existing measures or adding new ones in ongoing general purpose surveys. It evaluated current measures and recommended modifications to the vital statistical and disease registries and to hospital discharge data critical to future health care reform discussions. The conference also provided investigators wanting to apply for NIH funds with improved tools for implementing the newly revised guidelines for the inclusion of women and minorities in clinical research. The most important recommendation made was that the availability of existing social class data be advertised and that researchers be encouraged to analyze them. (Final report 5 pages.)
AGENCY SPONSOR: National Institute of Child Health and Human Development
FEDERAL CONTACT: Nancy Moss
PHONE NUMBER: 301/496-3136
PIC ID: 6020
PERFORMER ORGANIZATION: National Institute of Child Health
and Human Development, Bethesda, MD
TITLE: Report on Outreach Activities of the National Library of Medicine: A Five-Year Review
ABSTRACT NUMBER: 105
ABSTRACT: In October 1987, Congress encouraged the National Library of Medicine (NLM) to develop an outreach program to transfer the latest scientific findings to all health professionals. Congressional concern was underscored in 1988 when the Senate Subcommittee on Appropriations expressed particular interest in the development of an outreach program for rural and remote health care professionals. This report evaluates NLM's outreach efforts between 1990 and 1994. The report finds that (1) the number of outreach projects increased from 16 in 1989 to almost 300 at the end of 1994; (2) in 1989, approximately 30,000 user codes had been issued, and by 1994, user codes numbered close to 100,000; (3) in 1989, there were 4 million searches of the NLM databases, and in 1994, there were 7 million searches; (4) similar changes have occurred in the use of Grateful Med; and (5) although these increases in use are impressive, and although measurement of the precise number of users of NLM's information systems from all sources is not yet available, it is reasonable to postulate that the number of users is far short of the total population of United States health care professionals who could benefit from such use. The study was carried out jointly by NLM, the University of Texas Health Science Center/San Antonio, Texas, Meharry Medical College, and Oak Ridge Associated Universities in Tennessee. (Final report 100 pages.)
AGENCY SPONSOR: National Library of Medicine
FEDERAL CONTACT: Karen Wallingford
PHONE NUMBER: 301/496-2311
PIC ID: 6010
PERFORMER ORGANIZATION: National Library of Medicine,
Bethesda, MD
TITLE: The Status of Biomedical Research Facilities
ABSTRACT NUMBER: 106
ABSTRACT: The National Science Foundation (NSF) has been authorized and directed by the House of Representatives in H.R. 1210 to "design, establish, and maintain a permanent data collection and analysis capability for the purpose of assessing and identifying the research facilities needs of universities." This survey is conducted every 2 years, and the results are reported to Congress by September 1. In order to meet NIH needs, additional samples of medical schools, hospitals, and independent research organizations were added to NSF's sample of research universities. This arrangement is efficient and cost-effective for NIH because of the overlap between NSF's needs and those of NIH. NIH has input on all aspects of the biomedical facilities survey and complete control of the biomedical facilities report. "The Status of Biomedical Research Facilities" was prepared for NIH, assessing trends in aspects of extramural research facilities. The results were used by the Director of NIH, other HHS agencies, and the Office of the Secretary to plan research programs and review current policies regarding construction programs.
AGENCY SPONSOR: Office of the Director
FEDERAL CONTACT: Paul Seder, Ph.D.
PHONE NUMBER: 301/496-5011
PIC ID: 3562.1
PERFORMER ORGANIZATION: National Science Foundation,
Washington, DC
TITLE: Study of the Minority Access to Research Careers Honors Undergraduate Research Training Program
ABSTRACT NUMBER: 107
ABSTRACT: The National Institute of General Medical Sciences (NIGMS) sponsors the Minority Access to Research Centers (MARC) Honors Undergraduate Research Training Program. Under the program, highly qualified minority institutions receive support to provide science courses and research training for honors students in their third and fourth years of college. Each year, there are 60 to 70 undergraduate training programs supporting approximately 560 trainees. This report presents the results of a survey on the outcomes of the MARC program and the training pathways of MARC students. The survey included all 3,062 former MARC students: those who had received support prior to, but were no longer receiving it in, fiscal year 1994. The report finds that: (1) a substantial number of former students (over 700) have already obtained research or clinical doctorates; (2) since the program began in 1977, about 1,400 blacks, Hispanics, and Native Americans obtained a bachelor's degree and had received a Ph.D. in the biological sciences by the end of the 1993 school year; (3) 92.2 percent of former MARC students had received bachelor's degrees and almost one-half of these entered graduate programs and one-third entered medical school; and (4) MARC students have pursued and obtained Ph.D.s, M.D.s, and other doctoral degrees at greater rates than minority biology and chemistry students who did not participate in the MARC program. See also PIC ID Nos. 4462.1 and 4462.2. (Final report 50 pages plus appendix.)
AGENCY SPONSOR: National Institute of General Medical Sciences
FEDERAL CONTACT: James Onken
PHONE NUMBER: 301/594-2764
PIC ID: 4462
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Support for Bioengineering Research
ABSTRACT NUMBER: 108
ABSTRACT: The NIH Revitalization Act of 1993 mandated that the HHS Secretary, acting through the NIH Director, conduct a study of support for bioengineering research. The legislation directed evaluations of the Federal commitment to innovation, the Federal role for enhancing innovation, and the coordination among Federal agencies and between the public and private sectors. NIH is the largest source of support for bioengineering research within the Federal Government. It conducted a detailed inventory of sources and amounts of public and private funding for basic bioengineering research for fiscal 1993. To assist in understanding how innovation in bioengineering proceeds, a case study was conducted in a representative field of bioengineering: implantable prostheses. Data were collected on the science base, patents, and new health care products. One of the most important findings of the effort was that relevant data are inadequate to assess the innovation process with confidence. The report recommends that NIH (1) establish an interagency Bioengineering Coordinating Committee; (2) include basic bioengineering research within appropriate intramural programs; and (3) provide, through the Federal Register, a "comment period" notice to solicit research topics suggested for inclusion in the annual Small Business Innovation Research Omnibus solicitation. See also PIC ID 5581.1. (Final report 11 pages.)
AGENCY SPONSOR: National Heart, Lung, and Blood Institute
FEDERAL CONTACT: John T. Watson, M.D.
PHONE NUMBER: 301/496-1586
PIC ID: 5581
PERFORMER ORGANIZATION: National Heart, Lung, and Blood Institute, Rockville, MD
Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy, and Parenthood
Case Management in Service Integration: An Annotated Bibliography
Child Support Enforcement
Evaluation of Transition To Work Demonstration Projects Using a Natural Supports Model
Exploratory Study of the Barriers and Incentives To Improving Labor Force Participation Among Persons With Significant Disabilities
Family and Community Violence Prevention Program: Evaluability Assessment and Technical Assistance Conference
Fifty-State Health Reform Database
Final Report of the Task Force on the Privacy of Private Sector Health Records
JOBS Evaluation: Early Findings on Program Impacts in Three Sites
JOBS Evaluation: How Well Are They Faring? AFDC Families With Preschool-Aged Children in Atlanta at the Outset of the JOBS Evaluation
JOBS Evaluation: Monthly Participation Rates in Three Sites and Factors Affecting Participation Levels in Welfare-to-Work Programs
Managed Care for People With Disabilities: Developing a Research Agenda
Minnesota Learning Readiness Initiative: Reforming the Delivery of Social Services to School-Aged Children and Families in Hennepin County, Minnesota
New Approaches To Evaluating Community Initiatives: Concepts, Methods, and Contexts
Noncustodial Parents' Participation in Their Children's Lives: Evidence From the Survey of Income and Program Participation
Options for Full-Day Services for Children Participating in Head Start
Patterns of Substance Use and Substance-Related Impairment Among Participants in the Aid to Families With Dependent Children Program
Performance Measurement for the U.S. Department of Health and Human Services, the Administration for Children and Families, and Its Other Operating Divisions
Report to Congress on Out-of-Wedlock Childbearing
Review of Family Preservation and Family Reunification Programs
Simulation of Trends in Employment, Welfare, and Related Dynamics
Sources of Support for Young Latina Mothers
Substance Abuse Among Women and Parents
Systematic Thinking About Government Programs for Children With Disabilities: Size, Participation, Benefits, and Expenditures
Child Support Payment Patterns Among AFDC Mothers in Massachusetts and Implications for TRIM2
Use of Administrative Data Kept by States To Study the Duration
of Program Participation
TITLE: Adolescent Time Use, Risky Behavior, and Outcomes: An Analysis of National Data
ABSTRACT NUMBER: 109
ABSTRACT: This report uses several large-scale databases to examine the time-use patterns of United States adolescents in the late 1980's and early 1990's. The report compares these patterns with those exhibited by young people 10 to 20 years ago, and tests whether participation in extracurricular activities reduces the chances that they will engage in various risky behaviors. The report finds that (1) most teenagers have a lot of unfilled discretionary time; (2) teenagers use this time to watch television, talk on the telephone, gather with friends in malls or other local hangouts, or work at low-skill jobs; (3) compared with earlier cohorts from the mid-1970's or early 1980's, teenagers spend no more time doing homework--despite supposedly more rigorous courses--they read fewer books, do fewer household chores, attend fewer religious services, and participate less in traditional school-based activities; (4) students who spend no time in extracurricular activities are 57 percent more likely to have dropped out of school by senior year, 49 percent more likely to have used drugs, 37 percent more likely to have become teen parents, 35 percent more likely to have smoked cigarettes, and 27 percent more likely to have been arrested than those who spend 1 to 4 hours per week in extracurricular activities; and (5) the effectiveness of organized youth activities depends upon the extent to which the activities develop skills, create challenges, and provide fulfilling experiences for participants. (Final report 64 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Emily Novick
PHONE NUMBER: 202/690-5937
PIC ID: 6014
PERFORMER ORGANIZATION: Westat, Inc., Rockville, MD
TITLE: Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy, and Parenthood
ABSTRACT NUMBER: 110
ABSTRACT: This series of three reports discusses trends in adolescent sexual behavior and fertility, as well as trends in adolescent pregnancy prevention programs. The reports discuss recent trends in sexual behavior among this population, its use of contraceptives, and outcomes of pregnancy. The reports highlight findings in the following areas: (1) sexual intercourse among teens; (2) contraceptive use; (3) pregnancy outcomes; and (4) prevention programs. The reports find that the rate of sexual intercourse among teens is increasing, but that contraceptive use is consistently low. The reports stress that the younger a teen is at the time of sexual initiation, the more likely the experience is to have been coercive, and the more likely it is that the teen will become pregnant or contract a sexually transmitted disease. The reports also note that many factors, such as race, family income, developmental characteristics, educational success and goals, and neighborhood mores, influence the age of first sexual intercourse. The reports indicate that contraceptive use among teens varies: older teens are more likely to use contraceptives than are risk-taking teens; contraceptive methods requiring male involvement, such as condoms and withdrawal, are more common at first intercourse, while female-based methods are more common in longer standing relationships. Furthermore, there is generally a lag time between first sexual intercourse and obtaining contraceptive services. The reports note that prevention programs emphasizing behavioral skills-oriented sex education and recommending abstinence and consistent contraceptive use are most effective, as are other programs that address alternate life options for teens. However, most of the prevention and intervention strategies designed to affect the teen birth rate are small, ad hoc, and poorly designed short-term projects lacking a useful evaluation strategy.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Elisa Koff and Amy Nevel
PHONE NUMBER: 202/690-5880
PIC ID: 5877
NTIS ACCESSION NUMBER: PB 95-256475; PB 95-256483; PB 95-256491
PERFORMER ORGANIZATION: Child Trends, Inc., Washington, DC
TITLE: Case Management in Service Integration: An Annotated Bibliography
ABSTRACT NUMBER: 111
ABSTRACT: Case management is integral to many service integration projects and programs, which use case managers as the primary link between clients and services. While no standard definition of case management exists, some consensus on a case manager's functions is emerging. These functions include (1) assessing client needs; (2) creating an action plan; (3) brokering services; and (4) ensuring that appropriate services are accessed and delivered. This annotated bibliography includes information on (1) case management practices and case manager functions; (2) evaluations that consider the process and outcomes of case management; and (3) case management operations. The articles and books selected focus on practices that cross organizational boundaries and that generally include young children in the population served. Items included in the bibliography were published after 1983 and are currently in print and available through public libraries or for purchase. The bibliography excludes works dealing with geriatrics, mental illness, or medical care. The abstracts do not critique or analyze the works described. See also PIC ID 5307-5307.9 and 5307.B-5307.C. (Annotated bibliography 35 pages.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Richard Silva
PHONE NUMBER: 202/690-6805
PIC ID: 5307.A
PERFORMER ORGANIZATION: National Center for Children in
Poverty and National Center for Service Integration, New York, NY
TITLE: Child Support Enforcement
ABSTRACT NUMBER: 112
ABSTRACT: This report examines the problem of child support enforcement and its impact on welfare reform. The report was prepared by the interagency Working Group on Welfare Reform, Family Support, and Independence. It presents information on the state of child support enforcement in the Nation and provides a rationale for reform of the system. The report finds that (1) a gap exists between current child support collections and the amount that, theoretically, could be collected (this amount is about $33.7 billion); (2) this gap exists because not all child support awards are paid, awards are generally inadequate, and many eligible custodial parents do not have a child support order or award in place; (3) the number of children potentially eligible for child support has grown, primarily because of out-of-wedlock births; and (4) there have been some improvements in collection of child support payments (for children eligible for AFDC) and in paternity establishment. However, the report also asserts that fundamental system reform is needed; children have the right to receive support from both parents, and reform will save welfare dollars. This reform should be effected through universal, immediate paternity establishment; standardization of child support awards throughout the Nation (regularly updated); and vigorous interstate enforcement of child support orders. (Final report 18 pages, plus appendix.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Paul Legler
PHONE NUMBER: 202/690-7507
PIC ID: 5777
PERFORMER ORGANIZATION: Working Group on Welfare Reform,
Family Support, and Independence, Washington, DC
TITLE: Evaluation of Transition To Work Demonstration Projects Using a Natural Supports Model
ABSTRACT NUMBER: 113
ABSTRACT: This report describes and evaluates the methods used by six demonstration projects to help schools and adult providers obtain integrated employment using natural supports for students with very severe disabilities (severe mental retardation, autism, learning disability, or other condition). The major categories of service provided include (1) student-centered planning, which helps the student identify goals and interests and assesses the behavior and knowledge the student needs to attain them; (2) community-based job experience; (3) job placements, ideally before the client has left school; and (4) transition out of the school system, including long-term vocational support and locating jobs when needed. The report also finds that (1) almost 335 persons with disabilities were identified as having participated in the projects; (2) sites attempt to select those with the most severe disabilities for inclusion; (3) most participants work less than half-time; (4) jobs are usually located by using direct telephone calls to potential employment sites; and (5) costs increase for schools using this method, but not for most parents and employers. The report details barriers encountered by sites, including difficulty in locating jobs, complex and rigid funding procedures, transportation problems, and staff turnover. The report suggests several areas for consideration in the future expansion and improvement of the program. (Final report variously paginated, plus appendix.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Richard Silva
PHONE NUMBER: 202/690-6805
PIC ID: 5836
PERFORMER ORGANIZATION: Pelavin Research Institute,
Washington, DC
TITLE: Exploratory Study of the Barriers and Incentives To Improving Labor Force Participation Among Persons With Significant Disabilities
ABSTRACT NUMBER: 114
ABSTRACT: In recent years, substantial interest has emerged in improving opportunities for people with disabilities to join, remain in, or return to the work force. Disability income support programs like Supplemental Security Income and Social Security Disability Insurance now have work incentive programs. The Americans With Disabilities Act has made it illegal for employers to discriminate against persons with disabilities. This report provides background information on the barriers and incentives to improving the work force participation of persons with significant disabilities. The report includes (1) a literature review on various aspects of the competitive labor market for persons with disabilities; (2) the use of personal assistance services and assistive devices by disabled workers; (3) the impact of welfare reform strategies on persons with disabilities; and (4) selected programs that offer comprehensive services to help persons with significant disabilities participate in competitive employment. The report also provides a research agenda, noting that a substantial amount is known about the employment of persons with disabilities, but much more information is needed to help the government analyze the impact of current policies on this population. More research would also assist in formulating policies that are designed to increase the participation of persons with disabilities in competitive employment. (Final report variously paginated.)
AGENCY SPONSOR: Office of Disability, Aging, and Long Term Care Policy
FEDERAL CONTACT: Kathleen Bond
PHONE NUMBER: 202/690-6443
PIC ID: 5757
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Family and Community Violence Prevention Program: Evaluability Assessment and Technical Assistance Conference
ABSTRACT NUMBER: 115
ABSTRACT: This report presents information about the Family and Community Violence Prevention Program workshop held in January 1995 in Washington, D.C., for a consortium of historically black colleges and universities (HBCUs). The consortium has been developing and demonstrating interventions aimed at curbing the incidence of family and community violence. Participants included 30 HBCU participants, 6 Federal personnel, and 8 members of the contractor's staff. Originally planned for HCBUs as a 1-day training session on evaluability assessment, the conference was extended to 1.5 days. The first day included a review of the goals of the training workshop, a viewing of antiviolence public service announcements, an overview of evaluability assessment, the identification of stakeholders and environmental factors surrounding the demonstration projects, and a review of evaluability assessment logic models. The second day offered an opportunity for HCBU participants to develop evaluability assessment action plans for use in their demonstration projects. After the conference, participants completed a process evaluation of the training workshop. Process evaluation results show that participants' expectations were reasonable and were met to their satisfaction. Participants gained an understanding of the need for evaluability assessments and were prepared to conduct them. After the conference, the contractor also offered technical assistance to all HCBUs, based on lessons learned during the conference.
AGENCY SPONSOR: Office of Health Policy
FEDERAL CONTACT: Burke Fishburn
PHONE NUMBER: 202/690-7807
PIC ID: 5789
PERFORMER ORGANIZATION: Macro International, Inc., Silver
Spring, MD
TITLE: Fifty-State Health Reform Database
ABSTRACT NUMBER: 116
ABSTRACT: This project constructed a database consisting of data elements related to health reform for all 50 States. This database supports the generation of customized State profiles for a variety of purposes. For example, Administration officials need information specific to each State in order to better support a State's health care reform efforts. The database will also allow comparison of individual State health care report efforts to the Federal effort and to each other. Some of the questions that can be answered by the database include (1) how many States have adopted small group market reforms or risk pools for uninsurables and (2) how Federal reform efforts might affect each State. The database has not been updated since the end of 1994, but can be updated for a small additional investment of resources.
AGENCY SPONSOR: Office of Health Policy
FEDERAL CONTACT: Sarah Jane Holcombe
PHONE NUMBER: 202/690-7804
PIC ID: 5394
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Final Report of the Task Force on the Privacy of Private Sector Health Records
ABSTRACT NUMBER: 117
ABSTRACT: The mandate of the Task Force on the Privacy of Private Sector Health Records was to examine the extent to which problems exist with the collection, storage, and use of health information in the private sector. The changing policy environment refocused the mission to include examination of ways to protect the privacy of all health care information within the context of health care reform and the development of electronic health information networks. The task force examined the social, legal, and economic issues affecting the privacy of people who use the health care system. It addressed several policy questions, including (1) the kinds of records to be protected; (2) the treatment of especially sensitive records; (3) the level of legislation that should enact privacy provisions; (4) the circumstances under which a record keeper should disclose health information; (5) the impact of automation on the privacy of health records; (6) the use of unique identifiers for health records; (7) the oversight structure needed to protect privacy, confidentiality, and security matters and violations; and (8) the training, education, and awareness programs needed for health care users and providers. The report recommends a coordinated Federal policy on the privacy of health care records; the use of universal identifiers; effective security standards and guidance; the establishment of a data protection entity; and an education program about the issue. (Final report 128 pages, plus appendix.)
AGENCY SPONSOR: Office of Program Systems
FEDERAL CONTACT: Joan Turek-Brezina
PHONE NUMBER: 202/690-6141
PIC ID: PIC 5879
PERFORMER ORGANIZATION: Kunitz and Associates, Inc.,
Rockville, MD
TITLE: JOBS Evaluation: Early Findings on Program Impacts in Three Sites
ABSTRACT NUMBER: 118
ABSTRACT: This report presents impact results of an evaluation of the Job Opportunities and Basic Skills Training (JOBS) program in three sites: Atlanta, Georgia; Grand Rapids, Michigan; and Riverside, California. The JOBS program examines two interventions: the labor force attachment (LFA) approach, emphasizing rapid job entry; and the human capital development (HCD) approach, which offers longer, skill-building education and training activities. Participants were randomly assigned to one of these approaches or to one of two control groups. The report is based on telephone and in-person surveys of 2,604 people in the three sites. The report finds that (1) the three sites successfully operated two distinct, well-run, and highly mandatory LFA and HCD versions of JOBS; (2) the LFA approach increased participation in job-search activities dramatically, slightly increased participation in other work-directed services, and resulted in a high rate of sanctioning (removal of a portion of welfare benefits because of nonparticipation); (3) the HCD approach also resulted in a high rate of sanctioning, and the basic services provided were primarily basic education and job search; and (4) the LFA approach substantially increased the number of people who found work and left the welfare rolls within 2 years, and the LFA's impact on AFDC receipts and payments and on earnings was substantial, while the HCD approach had not yet translated into higher earnings.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Audrey Mirsky-Ashby
PHONE NUMBER: 202/401-6640
PIC ID: 5776.4
PERFORMER ORGANIZATION: Manpower Demonstration Research
Corporation, New York, NY
TITLE: JOBS Evaluation: How Well Are They Faring? AFDC Families With Preschool-Aged Children in Atlanta at the Outset of the JOBS Evaluation
ABSTRACT NUMBER: 119
ABSTRACT: This report provides a descriptive summary of a Child Outcomes Study (a component of the larger JOBS program evaluation) in Fulton County, Georgia, near the start of the JOBS evaluation. The Fulton County JOBS evaluation uses a human capital development approach, a labor force attachment approach, and a control group. The descriptive sample included 790 respondents from the JOBS Child Outcomes Study in Fulton County. All respondents were mothers whose youngest child was between age 3 and 5 at the time of random assignment, all were 20 years of age or older, and 96 percent were African-American. The report finds that the mothers in the Fulton County sample are highly disadvantaged in many ways. Their reading and math literacy levels are low, they report minimal economic or other assistance from the fathers of their children, and they have high rates of depressive symptoms. On the other hand, most report social support from family and friends, have completed high school or the graduate equivalent degree, have positive attitudes about maternal work, and have taken steps toward limiting their childbearing. The children in the sample are also disadvantaged: their receptive vocabulary is substantially below the national mean and many lack the skills and knowledge needed for school readiness. Finally, the report notes that the heterogeneity of the sample mothers will lead to varied outcomes for their children.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Audrey Mirsky-Ashby
PHONE NUMBER: 202/401-6640
PIC ID: 5776.2
PERFORMER ORGANIZATION: Manpower Demonstration Research
Corporation, New York, NY
TITLE: JOBS Evaluation: Monthly Participation Rates in Three Sites and Factors Affecting Participation Levels in Welfare-to-Work Programs
ABSTRACT NUMBER: 120
ABSTRACT: The JOBS program provides an array of job search, work experience, education, and training services to families who receive AFDC. The program requires participation; those who do not participate are sanctioned with the loss of part of their welfare grant. The legislation authorizing JOBS also requires States to meet specific, and incrementally increasing, participation standards. This report uses data collected from the case files of 1,113 AFDC recipients in three JOBS evaluation sites (Atlanta, Georgia; Grand Rapids, Michigan; and Riverside, California) to examine participation rates. The report notes that the definitions of participation and the classes of people included in the measure greatly affect the feasibility of achieving a particular standard. The report finds that (1) only 5 to 10 percent of all single-parent AFDC clients participated in the JOBS program or worked the required hours during each week in a month; (2) including sanctioning in the definition of participation raises participation rates to between 9 and 21 percent; (3) using only JOBS-mandatory individuals in the measure increases the participation rate; and (4) if participation rates remained at 1992 levels at the sites, the rates would fall far short of the ultimate standards contained in the 1995 welfare reform bills, despite the JOBS program's tough standards, and its success compared with other programs. (Final report 59 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Audrey Mirsky-Ashby
PHONE NUMBER: 202/401-6640
PIC ID: 5776.3
PERFORMER ORGANIZATION: Manpower Demonstration Research
Corporation, New York, NY
TITLE: Managed Care for People With Disabilities: Developing a Research Agenda
ABSTRACT NUMBER: 121
ABSTRACT: This report provides background information for a meeting held on the subject of managed care and people with disabilities, hosted by the Office of the Assistant Secretary for Planning and Evaluation's Office of Aging, Disability, and Long Term Care Policy. The purpose of the meeting was to (1) review the implications of the movement toward managed health care for people with physical and mental disabilities; and (2) flesh out a research and demonstration program to improve the understanding of the impact of managed care on people with disabilities. The report highlights critical policy areas and related research issues around managed care and disability. These policy areas include (1) functional and demographic characteristics of persons with disabilities who receive managed care; (2) the impact of managed care, including how participation affects access to needed services; (3) targeting managed care plans to people who are disabled; (4) financing and reimbursement; (5) service coverage and organization of the delivery system; and (6) quality assurance. For each of these areas, the report discusses the policy issues involved, research completed and under way on the subject, and suggested directions for research. The report stresses that little information has been generated about how any of these areas affect persons with disabilities. The report also notes that many persons with disabilities fear the role managed care will play in their access to services and the quality of those services, and that some of these fears are justifiable. (Final report 28 pages.)
AGENCY SPONSOR: Office of Disability, Aging and Long Term Care Policy
FEDERAL CONTACT: Mary Harahan
PHONE NUMBER: 202/690-6172
PIC ID: 4927
PERFORMER ORGANIZATION: Office of the Assistant Secretary
for Planning and Evaluation, Washington, DC
TITLE: Minnesota Learning Readiness Initiative: Reforming the Delivery of Social Services to School-Aged Children and Families in Hennepin County, Minnesota
ABSTRACT NUMBER: 122
ABSTRACT: This report presents information on a major collaborative service integration initiative in Hennepin County, Minnesota. The two-track initiative was intended to mobilize community planning and collaboration around the development of school-linked services. The first track, the Learning Readiness Initiative, concentrated on research and development. The second track, the School Human Services Redesign Initiative, was a large-scale effort to reform delivery of social and other support services to families. The Learning Readiness Initiative began with a feasibility study, "When Kids and Systems Collide," which found that, despite over $1 billion spent on education and human services in Hennepin County, a massive policy collaboration was needed to make these services effective. The initiative used research and development-oriented grant making to develop new approaches and to foster collaboration. The School Human Services Redesign Initiative, begun while the Learning Readiness Initiative was still under way, had four goals: (1) to increase equity on all levels among students in school achievement, school service, and health outcomes; (2) to strengthen families' ability to support their children; (3) to enhance the responsiveness of human services and schools to the needs of students and families; and (4) to strengthen community bonds. (Final report 47 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Richard Silva
PHONE NUMBER: 202/690-6805
PIC ID: 5340
PERFORMER ORGANIZATION: Minneapolis Youth Coordinating
Board, Minneapolis, MN
TITLE: New Approaches To Evaluating Community Initiatives: Concepts, Methods, and Contexts
ABSTRACT NUMBER: 123
ABSTRACT: This report examines issues in evaluating comprehensive community initiatives (CCIs). CCIs have their origins in the settlement houses of the late 19th century and the War on Poverty, among other influences. Most CCIs seek to provide social and health care services to low-income communities, as well as improve general conditions in the communities. Most operate under the belief that authority and responsibility must reside at the local level, rather than with the municipal, State, or Federal governments. The report's introduction addresses several factors that make CCIs difficult to evaluate, including horizontal and vertical complexity; contextual issues, such as the macroeconomic climate that is out of the control of CCIs; flexible and evolving interventions; the broad range of outcomes sought; and the absence of a comparison community or control group. The articles included in the report attempt to address some of these difficulties. The article titles are (1) "Evaluating CCIs: A View From History"; (2) "Nothing as Practical as Good Theory: Exploring Theory-Based Evaluation for CCIs for Children and Families"; (3) "How Do Urban Communities Affect Youth? Using Social Science Research to Inform the Design and Evaluation of CCIs"; (4) "Problems in the Evaluation of Community-Wide Initiatives"; (5) "Using Community-Level Indicators of Children's Well-Being in CCIs"; and (6) "The Role of the Evaluator in CCIs." (Final report 225 pages.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Barbara Bromar
PHONE NUMBER: 202/690-6461
PIC ID: 5895
PERFORMER ORGANIZATION: Aspen Institute, New York, NY
TITLE: Noncustodial Parents' Participation in Their Children's Lives: Evidence From the Survey of Income and Program Participation
ABSTRACT NUMBER: 124
ABSTRACT: This study examines the relationship between noncustodial parental involvement, child well-being, child support, custody and visitation arrangements, parental income, and family structure. In examining these interactions, the report focuses on father involvement and child well-being. The report includes (1) a literature review and annotated bibliography and (2) a secondary analysis using the Survey of Income and Program Participation. Because the majority of noncustodial parents are fathers, it is hoped that the findings from this report will provide new insights for promoting father involvement for children in divorced, separated, and never-married families.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Anne Benson
PHONE NUMBER: 202/690-7409
PIC ID: 6158
PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
TITLE: Options for Full-Day Services for Children Participating in Head Start
ABSTRACT NUMBER: 125
ABSTRACT: This study examines full-day services offered by eight Head Start grantees that fund extended hours by combining resources from a variety of sources. Data were collected during 2-day site visits to each grantee. The grantees provide services in one of three ways: (1) wraparound care, which uses funding from sources other than Head Start to expand services; (2) wrap-in care, in which Head Start grantees contract with another provider and fund the set of services needed to bring the contracted program up to Head Start standards; and (3) connected care, in which grantees contract with existing child care programs to provide children with supervised care before and after the Head Start day. The report examines program differences in full-day services, funding, fiscal management, and collaboration. The report finds that grantees (1) develop innovative ways to train staff and to integrate parent activities and home visits into the full-day programs; (2) develop ways to allocate funding from various sources, but also deal with several funding issues, including parental loss of eligibility for full-day funding, retroactive reimbursements, and funding shortfalls; and (3) encounter quality assurance problems using wrap-in or connected care. The report lists several issues for consideration by Federal policymakers and points toward needed research. (Final report 47 pages, plus appendix.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Laura Feig
PHONE NUMBER: 202/690-5938
PIC ID: 5333
PERFORMER ORGANIZATION: Pelavin Research Institute,
Washington, DC
TITLE: Patterns of Substance Use and Substance-Related Impairment Among Participants in the Aid to Families With Dependent Children Program
ABSTRACT NUMBER: 126
ABSTRACT: This report was sponsored and performed jointly by ASPE, the Substance Abuse and Mental Health Services Administration (SAMHSA), and NIDA. This report provides data on substance use and substance-related impairments among participants in the AFDC program. The study uses data from the 1991 and 1992 National Household Surveys on Drug Abuse to gain information about the prevalence of substance abuse in the AFDC population and to investigate the rate of substance-related impairment in this population. Substance-related impairment is categorized as either "significant impairment," which may preclude participation in training or education activities, or "some impairment," which may require treatment concurrent with these activities. The report finds that (1) 4.9 percent of female AFDC recipients and 5.2 percent of all AFDC recipients report significant substance-related impairment; (2) an additional 10.6 percent of female AFDC recipients and 11.2 percent of all recipients report some impairment resulting from substance use; and (3) AFDC recipients have higher rates of substance use and substance-related impairments than the general population, but the vast majority of substance users and substance-related impaired people do not receive AFDC. See also PIC ID 5180 and 5180.1. (Final report 26 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Laura Feig
PHONE NUMBER: 202/690-5938
PIC ID: 5180.2
PERFORMER ORGANIZATION: Office of the Assistant Secretary
for Planning and Evaluation, Washington, DC
TITLE: Performance Measurement for the U.S. Department of Health and Human Services, the Administration for Children and Families, and Its Other Operating Divisions
ABSTRACT NUMBER: 127
ABSTRACT: This report presents illustrative, candidate sets of outcome indicators for Child Welfare and Child Health Services, as well as recommendations to the Department of Health and Human Services (HHS) to further develop outcome indicators. Indicators in the area of child health include (1) increasing the number of insured pregnant women and insured children; (2) increasing access and reducing barriers to services; (3) coordinating and simplifying programs and systems; (4) establishing quality standards; (5) implementing public health education; and (6) increasing the numbers of women and children receiving appropriate services. The report also indicates end goals for children's health. The child welfare outcomes goals are grouped in the areas of safety, permanency, child development, and customer service. These goals relate to home-environment safety; permanent placement for children; school-based performance and age-appropriate growth and behavior; and State-, child-, and family-level satisfaction with services. The recommendations presented in the report are clustered around the major elements that should be included in a plan for a departmentwide or operating divisionwide performance measurement process. These elements are (1) establishing high-level policy and working committees to oversee the effort; (2) undertaking comprehensive implementation; and (3) providing training and technical assistance to programs. (Final report variously paginated.)
AGENCY SPONSOR: Office of Program Systems
FEDERAL CONTACT: Mike Herrell
PHONE NUMBER: 202/690-5739
PIC ID: 5081
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Report to Congress on Out-of-Wedlock Childbearing
ABSTRACT NUMBER: 128
ABSTRACT: This report was prepared in response to the Violent Crime Control and Law Enforcement Act of 1994, which requires that HHS prepare an analysis of the increases in nonmarital births. A Department working group was formed of staff from ASPE, NCHS, and NICHD. The report examines the trends in, consequences of, and causes of out-of-wedlock childbearing. The report finds that (1) in 1993, nearly one-third of all births occurred outside of marriage; (2) less than one-half of nonmarital births were first births, but teenagers account for about one-half of all nonmarital first births; (3) nonmarital birth rates are highest during the ages of 18-29, and tend to be higher among disadvantaged and less-educated women and women in urban areas; (4) the proportion of nonmarital pregnancies that ended in abortion declined from 60 percent to 46 percent between 1980 and 1991; and (5) the consequences and causes of nonmarital births are difficult to determine because most of these parents are disadvantaged before the birth. The report examines the role of welfare; economic opportunities; neighborhood influences; individual and family characteristics; and attitudes, values, and norms in the increase in nonmarital births. See also Call Number DOC.HE 20.6202:C43/x in PIC book collection.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Elisa Koff
PHONE NUMBER: 202/690-5880
PIC ID: 5910
PERFORMER ORGANIZATION: National Center for Health
Statistics, Hyattsville, MD
TITLE: Review of Family Preservation and Family Reunification Programs
ABSTRACT NUMBER: 129
ABSTRACT: This report describes the state of the family preservation field and examines in greater depth the characteristics and operations of family preservation programs that are potential sites for future outcome evaluation. The report looks at placement prevention programs in 26 States. Of these States, 22 have one or more statewide models (Colorado, Florida, Iowa, New Hampshire, and Oregon use two family preservation models). Four of the 26 states do not have a specific program model; they make funds available to counties and allow the counties determine their own models. The report also analyzes these family preservation programs' characteristics, including (1) program models; (2) referral sources; (3) referral practices, including definition of imminent risk, decisionmaking processes, and exclusion criteria; (4) program maturity; (5) service providers; and (6) program statistics. The report also discusses family reunification programs. There were 26 such programs on the State and county levels in 15 of the 26 States contacted. Reunification programs that are part of a more general family preservation approach indicate that only a small percentage of cases served are reunification cases. These programs generally provide aftercare services and do not differentiate between preservation and reunification cases. (Final report 82 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Matt Stagner
PHONE NUMBER: 202/690-5953
PIC ID: 5337
PERFORMER ORGANIZATION: Westat, Inc., Rockville, MD
TITLE: Simulation of Trends in Employment, Welfare, and Related Dynamics
ABSTRACT NUMBER: 130
ABSTRACT: The Simulation of Trends in Employment, Welfare, and Related Dynamics (STEWARD) model was developed to inform the debate on welfare policy by simulating policy options that reflect several key questions: How will policies intended to encourage work affect the duration of welfare dependency? How will education and training programs reduce the duration of welfare receipt? How will AFDC costs and caseloads change as a result of reforms, and in what time frame? This report describes the STEWARD model, including (1) its development; (2) its unique features; (3) the kinds of policy options it can model; (4) the concept of the model; (5) how the concept is translated into an operational model; (6) the sources of key empirical estimates; (7) an overview of the impact measures routinely presented in the model output tables; and (8) the model database. The report describes three scenarios that are simulated by STEWARD: (1) a baseline case that simulates welfare caseloads, dynamics, and costs for a baseline period (here, 1992) under actual policies in effect at the time; (2) what welfare caseloads and costs would have been had the policy changes that have been enacted recently been implemented in the baseline year; and (3) what welfare caseloads and costs would be if welfare reform policies were enacted on top of current policies. (Final report 103 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Don Oellerich
PHONE NUMBER: 202/690-5877
PIC ID: 5882
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: Sources of Support for Young Latina Mothers
ABSTRACT NUMBER: 131
ABSTRACT: In 1992, the total Latina fertility rate was 3.04 births per woman, compared with 1.94 for all non-Latina women. Since 1980, Latina total fertility has risen by about 20 percent, and teen Latina birth rates have increased by 30 percent. These figures contrast sharply with fertility rates of less than 7 percent for all non-Latinas since 1980 and 6 percent for non-Latina teens. This report examines the support strategies used by young Latina mothers in the United States in order to identify Latina subgroups in greatest need of additional support. Using data from the 1990 census, the report considers (1) the young mother's living arrangements and (2) how she supports herself and her child (through employment and public assistance). The report finds that (1) Puerto Rican mothers are less likely to be married or to be living with parents or other adults and are more likely to be living in poverty and receiving welfare; (2) Cuban mothers have the highest household incomes and the lowest rates of receiving welfare; (3) Mexican and Central and South American mothers are similar to Whites in terms of their marriage patterns and living arrangements, but have much higher poverty rates; (4) foreign-born mothers are considerably more likely than their U.S.-born counterparts to use family or kin resources, and they appear to use this strategy rather than welfare; and (5) the most vulnerable mothers are teens raising children alone. (Final report 12 pages, plus appendix.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Elisa Koff
PHONE NUMBER: 202/690-5880
PIC ID: 5917
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Substance Abuse Among Women and Parents
ABSTRACT NUMBER: 132
ABSTRACT: This report uses data from the 1991 National Household Survey on Drug Abuse and the 1991 Drug Abuse Warning System to examine the prevalence of substance abuse by women of childbearing age and by parents. The report also examines the number of children potentially at risk because of parental drug abuse. The report finds that (1) 5.7 percent of women age 15-44 years with children living in their households report past-month illicit drug use, compared with 11.2 percent of women in the same age bracket without children living in their homes, and the rates for men show similar patterns; (2) approximately 6 million children (9 percent) under age 18 have parents who have used illicit drugs in the past month, most commonly marijuana; (3) substance abuse varies little by urban/suburban/rural residency; (4) the prevalence of drug abuse among parents shows similar demographic patterns, as does drug use in the general population; (5) 4 percent of mothers and 13 percent of fathers report consumption of 5 or more alcoholic drinks at one time on at least 3 occasions in the past 30 days; and (6) children of drug-using parents tend to be younger than children overall--20 percent of children of both past-year and past-month drug users are under 3 years old, whereas 17 percent of all children are in this age group. See also PIC ID 5180 and 5180.2. (Final report 51 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Laura Feig
PHONE NUMBER: 202/690-5938
PIC ID: 5180.1
PERFORMER ORGANIZATION: CSR, Incorporated, Washington, DC
TITLE: Systematic Thinking About Government Programs for Children With Disabilities: Size, Participation, Benefits, and Expenditures
ABSTRACT NUMBER: 133
ABSTRACT: According to one source, about 4.5 million children in the United States have a disability. Furthermore, measures of the prevalence of disabilities among children and adolescents have been growing over time, possibly because of changes in data collection, increased survival of low birth-weight infants and children with terminal chronic illnesses; increased responsiveness to programs that provide assistance; and greater parental, educational, and medical awareness and detection of disability in children. This report attempts to provide a better understanding of how various Federal, State, and local programs serving children with disabilities have evolved and how they fit together. The report contains information on the participation, benefits, and expenditures of major programs serving this population. The report finds that (1) at the Federal level, the largest programs for children with disabilities are Supplemental Security Income (SSI) and Medicaid; (2) participation in SSI has increased 150 percent since 1989, and, since SSI recipients are automatically eligible for Medicaid in most States, the number of children with disabilities receiving Medicaid has also increased; (3) the largest State and local program serving this population is special education, which provides educational and other services (speech therapy, counseling, and physical therapy, among others); and (4) data on this population is limited and hampers policymakers' ability to serve the population. (Final report 119 pages, plus appendixes.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Barbara Broman
PHONE NUMBER: 202/690-6461
PIC ID: 5950
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Child Support Payment Patterns Among AFDC Mothers in Massachusetts and Implications for TRIM2
ABSTRACT NUMBER: 134
ABSTRACT: AFDC and the Federal Child Support Enforcement Program (Title IV-D) are closely linked. In fact, the Title IV-D program was originally established to stem escalating AFDC costs. Two surveys, the Current Population Survey and the Survey of Income and Program Participation collect data on child support collections. However, these self-reported data are subject to limitations endemic to this kind of information. This report presents an analysis of data collected on the State level (in this case, Massachusetts) for a random sample of at least 2,400 AFDC cases covering 12 consecutive months and having at least 1 month in which child support was due during 1993. The sample was reduced to 2,364 cases because of data limitations for some cases. The report presents analyses of these data by ethnic/racial group; marital status and education of the mother; and amount of child support due, the amount paid, and the percent of amount due that was paid. The report then considers the implications of these analyses for the Transfer Income Model-Number 2 (TRIM2) microsimulation model. It describes how TRIM2 models child support awards and payments, and how Title IV-D/AFDC data might be used for TRIM2 validation and improvement. The report concludes that State-level Title IV-D/AFDC data provide a rich source of information on the child support characteristics of families receiving AFDC, and that additional analyses of State Title IV-D/AFDC data could prove very useful for validating and improving the child support simulation procedures in the TRIM2 model. (Final report 45 pages.)
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Linda Mellgren
PHONE NUMBER: 202/690-7507
PIC ID: 4942
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
TITLE: Use of Administrative Data Kept by States To Study the Duration of Program Participation
ABSTRACT NUMBER: 135
ABSTRACT: This study assesses whether administrative data kept by States can be used to study the duration of program participation in the AFDC, food stamps, medical assistance, and Title IV-D programs. The need for longitudinal data is compounded by recent efforts to reform welfare that limit the duration of a welfare spell to 24 months. Two types of data may be obtainable: retrospective data that are currently available, including case histories; and prospective data that are assembled as events occur. Of 15 States contacted, 4 (California, Georgia, New York, and Texas) were selected for the collection of detailed information on their respective data systems. The report finds that California and Texas offer the best possibilities for collecting retrospective data, while New York and California offer the best possibilities for collecting prospective data. The report offers two options for assembling longitudinal data about program participation on the State level: (1) asking States to produce these files themselves and providing them the funding to do so and (2) asking States to provide administrative data in whatever form it exists to a third party, who will assemble the longitudinal files. The report considers the positive and negative aspects of each of these options and concludes that the second option is better from a research standpoint. Under this option, data are more likely to be usable to address relevant policy questions and to make State comparisons. Furthermore, economies of scale are expected to make this option more cost-effective over time. The report notes that if neither option is considered viable, California and Texas have data available that may be examined, but these data lack information about all programs. Finally, the report cautions that new longitudinal data will not be available for at least 9 months from the date of funding.
AGENCY SPONSOR: Office of Human Services Policy
FEDERAL CONTACT: Linda Mellgren
PHONE NUMBER: 202/690-7507
PIC ID: 4945
PERFORMER ORGANIZATION: Urban Institute, Washington, DC
Breast and Reproductive Cancer Screening Project for Women 40 Years of Age and Older
Consequences of Whistleblowing for the Whistleblower in Misconduct in Science Cases
Evaluation and Enhancement of Primary Care Research in Community, Migrant, and Homeless Health Centers in the Public Health Service, Region VI
Federal Regulation of Methadone Treatment
Financing of Academic Medical Centers and Graduate Medical Education Under Competitive Systems With Managed Care (Two Volumes)
HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
Improving the Supply, Training, and Distribution of Primary Care Providers Under Federal Health Care Reform
Measuring Expenditures for Essential Public Health Services
Minority HIV/AIDS Programs Community-Based Organization Evaluation: HIV/AIDS Education/Prevention Grant Program 1988-89, A Cross-Site Evaluation
Region IX Hepatitis B Project Final Report
Review of the Fialuridine (FIAU) Clinical Trials
TITLE: Baseline Data on the Delivery of Clinical Preventive Services Provided by Nurse Practitioners
ABSTRACT NUMBER: 136
ABSTRACT: This report obtains baseline data on the disease-prevention activities of nurse practitioners as primary care providers and compares the findings with target goals from 17 objectives of Healthy People 2000: National Health Promotion and Disease Prevention Objectives. The study surveyed 1,310 nurse practitioners. The 892 respondents reported spending 50 percent or more of their time providing primary care, and it appears that nurse practitioners are closer to the Healthy People 2000 target percentages for assessment services than for intervention services (that is, nurse practitioners exceeded assessment goals with regard to preconception care, family planning, and emotional and behavioral functioning; however, they exceeded the intervention goals only in the areas of preconception care and family planning). With regard to the provision of screening and immunization services, nurse practitioners working in pediatrics and family medicine exceeded the target percentages for scheduled hemoglobin and hematocrit testing; blood pressure monitoring; height and weight checks; and diphtheria, pertussis, and tetanus vaccinations. Concerning the provision of cancer screening services, nurse practitioners in obstetrics/gynecology and family medicine exceeded the objectives for breast exams, Pap smears, and mammograms. See also PIC ID 4962.1-4962.3. (Final report 42 pages, plus appendixes.)
AGENCY SPONSOR: Office of Disease Prevention and Health Promotion
FEDERAL CONTACT: Deborah R. Maiese
PHONE NUMBER: 202/401-5809
PIC ID: 4962
PERFORMER ORGANIZATION: National Alliance of Nurse
Practitioners, Washington, DC
TITLE: Breast and Reproductive Cancer Screening Project for Women 40 Years of Age and Older
ABSTRACT NUMBER: 137
ABSTRACT: This project evaluated the impact of factors that impede the implementation of breast and reproductive cancer prevention efforts at nine C/MHCs located in California. This report reviews screening, referral, diagnosis, treatment, and case management protocols in the nine C/MHCs. Federal funding requires that C/MHCs file programmatic assurances stating that such protocols are on file. Two sources of established guidelines, the American College of Obstetricians and Gynecologists clinical guidelines and the California State Breast and Cervical Cancer Control Program clinical guidelines, were used as the basis of comparison for the C/MHC guidelines. Eight of the nine C/MHCs submitted protocols; the ninth submitted a letter listing the routines they followed for women over 40. The report finds that, of the protocols submitted, all are either developed by other organizations or developed specifically for the C/MHC. All included information on women over the age of 40. However, several weaknesses existed: (1) community education and outreach was lacking among the majority of C/MHCs; (2) only one of the nine C/MHCs designated staff in the protocols who would be performing the different care duties; (3) no ethnic, culturally specific barriers were addressed in protocols submitted by any of the C/MHCs; and (4) the C/MHCs fail to understand the content of protocols or their importance. (Final report 16 pages, plus appendix.)
AGENCY SPONSOR: Public Health Service, Regional Office IX
FEDERAL CONTACT: Irene Reed
PHONE NUMBER: 415/556-7009
PIC ID: 5625
PERFORMER ORGANIZATION: Associated California Health
Centers, Inc., Lamont, CA
TITLE: Consequences of Whistleblowing for the Whistleblower in Misconduct in Science Cases
ABSTRACT NUMBER: 138
ABSTRACT: Whistleblowers in scientific misconduct cases are highly likely to experience one or more negative consequences as a result of their whistleblowing. This report presents the results of a mail survey of those individuals listed in the Office of Research Integrity files as having made allegations of scientific misconduct. Only individuals involved in closed cases were contacted for the study. Of the 127 individuals eligible to be surveyed, 105 whistleblowers were located and mailed a survey. Of these, 89 responded, of whom 68 completed the surveys. Survey results show that (1) most whistleblowers believe that the negative consequences they have experienced as a result of their actions have had a neutral impact on their careers, professional activities, and personal lives; (2) 69 percent report experiencing at least one or more negative outcomes, while 31 percent experienced none; (3) 25 percent report serious consequences, such as the loss of position or denial of tenure, promotions, or salary increases; (4) whistleblowers attribute negative consequences to institutional officials, respondents, colleagues, and professional societies; (5) most consequences were experienced during the response to the allegations and after the inquiry was completed; and (6) despite the negative consequences cited, 68 percent of respondents said they would make another allegation, 10 percent were uncertain, and 10 percent would not. (Final report 61 pages, plus appendixes.)
AGENCY SPONSOR: Office of Research Integrity
FEDERAL CONTACT: Lawrence J. Rhoades, Ph.D.
PHONE NUMBER: 301/443-5300
PIC ID: 5659
NTIS ACCESSION NUMBER: PB 96-200449
PERFORMER ORGANIZATION: Research Triangle Institute,
Research Triangle Park, NC
TITLE: Evaluation and Enhancement of Primary Care Research in Community, Migrant, and Homeless Health Centers in the Public Health Service, Region VI
ABSTRACT NUMBER: 139
ABSTRACT: This project assessed the level of interest in primary care practice-based research in PHS Region VI. The project (1) ascertained and evaluated past and present activities and potential sources for primary care research in Region VI; (2) developed and enhanced primary care research linkages; and (3) promoted interest in primary care research and clinical networking in Region VI. Surveys were mailed to the medical director and the executive director in each of nine sites chosen from C/MHCs in Region VI. Analysis of survey responses shows that (1) clinicians are interested in primary care research, electronic mail, and clinical bulletin board systems; (2) respondents are more interested in research on preventive and lifestyle factors than on clinical diseases; and (3) only a minority of clinicians have access to computer lists of patient diagnoses and ordered tests. Significant barriers to research include (1) lack of research skills and expertise; (2) too many clinical responsibilities; and (3) lack of access to research consultation. The report recommends that (1) further evaluation of PHS and non-PHS clinic sites in Region VI be carried out to determine topics of interest; (2) collaborative arrangements with academic researchers be developed; and (3) possible electronic forums for clinician use be investigated. (Final report 10 pages, plus appendixes.)
AGENCY SPONSOR: Public Health Service, Regional Office VI
FEDERAL CONTACT: Robert A. Sappington
PHONE NUMBER: 214/767-3719
PIC ID: 5914
PERFORMER ORGANIZATION: Migrant Clinicians Network,
Austin, TX
TITLE: Federal Regulation of Methadone Treatment
ABSTRACT NUMBER: 140
ABSTRACT: Methadone hydrochloride (methadone) has been used to treat opiate addiction since 1972. Unlike other controlled substances, methadone use is controlled by a many-tiered system of regulations. FDA, the Drug Enforcement Administration, NIDA, and SAMHSA provide Federal oversight to methadone programs, while State and local agencies may also regulate them. This report examines current HHS standards for methadone programs and evaluates the effects of Federal regulations on the provision of methadone treatment services. The report also explores options for modifying these regulations. It finds that the underlying ideology of methadone regulations is that the societal risks of methadone outweigh the benefits to such an extent that its use must be extraordinarily regulated. The report contends that this belief is not valid in the current environment and that the stringent regulation of methadone removes power from the hands of clinicians in determining the best course of a patient's treatment and causes unintended negative impacts. The report recommends that the scope of Federal regulations be scaled back to allow greater clinical discretion, and that opiate-addicted patients be regarded holistically by methadone programs and other health and human services providers. (Final report 237 pages.)
AGENCY SPONSOR: Office of Public Health and Science
FEDERAL CONTACT: Carol Roddy
PHONE NUMBER: 202/205-0152
PIC ID: 5627
PERFORMER ORGANIZATION: National Academy of Sciences,
Institute of Medicine, Washington, DC
TITLE: Financing of Academic Medical Centers and Graduate Medical Education Under Competitive Systems With Managed Care (Two Volumes)
ABSTRACT NUMBER: 141
ABSTRACT: This report examines how the growth of competitive health care financing and service delivery systems based on managed care have affected or could affect the financial support available to academic medical centers (AMCs) and graduate medical education (GME). Case studies of AMCs in Minneapolis/St. Paul, San Diego, and Washington, D.C., and a review of the literature, as well as the results of an ongoing study of the related financial performance of AMCs nationwide, produce several findings. These findings include the following: (1) AMCs tend to be more expensive than other hospitals, although the extent to which this higher cost is attributable to GME is unclear; (2) implicit subsidies for these higher costs through patient care revenues are becoming less available; (3) relatively few short-term adverse effects on AMCs from the growth of competitive systems can be found, but AMCs are concerned that long-term effects will arise; (4) to the extent that managed care penetrates more heavily into the Medicare market, impacts on AMCs are likely to be intensified; and (5) AMCs are attempting to reduce costs and develop affiliations useful to a managed care environment, even though they are concerned that doing so will detract from their unique missions. The report concludes that, while there is considerable support for pooled funding for GME among diverse parties, AMCs have not reached a consensus about its details. (Volume One final report 15 pages; Volume Two appendixes variously paginated.)
AGENCY SPONSOR: Office of Public Health and Science
FEDERAL CONTACT: Carol Roddy
PHONE NUMBER: 202/205-0152
PIC ID: 5722
PERFORMER ORGANIZATION: Mathematica Policy Research, Inc.,
Plainsboro, NJ
TITLE: HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
ABSTRACT NUMBER: 142
ABSTRACT: FDA has regulatory authority over blood plasma collection establishments, blood banks, and all blood products. The Centers for Disease Control and Prevention is responsible for surveillance, detection, and warning of potential public health risks within the blood supply. NIH supports these efforts through fundamental research. These Federal entities, as well as the plasma fractionation industry, community blood banks, and other groups, have responsibilities to protect the supply of blood from communicable disease. This report examines the behavior of these entities in response to a threat to the blood supply that emerged in the early 1980's--HIV. The report relates the history of the disease and the bureaucratic response to it in four areas: (1) blood product treatment; (2) donor screening and referral; (3) regulation of the removal of contaminated products from the market; and (4) communication to physicians and patients. The report concludes that (1) the system did not deal well with blood safety issues such as hepatitis and was not prepared for the much greater threat of HIV; (2) strong leadership must counteract legal and competitive concerns that may inhibit effective agency action when a crisis is not well-defined; and (3) agencies need to formulate a systematic approach to advisory committees and should not rely on the entities they regulate for data analysis or modeling.
AGENCY SPONSOR: Office of Public Health and Science
FEDERAL CONTACT: Carol Roddy
PHONE NUMBER: 202/205-0152
PIC ID: 5896
PERFORMER ORGANIZATION: National Academy of Sciences,
Institute of Medicine, Washington, DC
TITLE: Improving the Supply, Training, and Distribution of Primary Care Providers Under Federal Health Care Reform
ABSTRACT NUMBER: 143
ABSTRACT: This project analyzes issues related to proposals for improving the supply, training, and distribution of primary care providers as part of health care reform. Many reform proposals considered by Congress include provisions that would change the mechanism used in decisions to fund graduate medical education, thus changing the numbers and types of new physicians. Information provided in this report includes (1) a chart book on the supply, training, and distribution of physicians; (2) technical papers providing background on the need for increased numbers of generalist physicians; (3) the rationale for proposals to control the supply of new physicians; (4) proposals for an all-payer pool for GME; (5) estimates of the number of physicians in research training tracks funded by NIH and elsewhere; and (6) preliminary estimates of the number of advanced practice nurses and physician assistants that would be needed to substitute for physicians if the number of physician residents were reduced.
AGENCY SPONSOR: Office of Public Health and Science
FEDERAL CONTACT: Carol Roddy
PHONE NUMBER: 202/205-0152
PIC ID: 5666
PERFORMER ORGANIZATION: Center for Health Policy Research,
Washington, DC
TITLE: Measuring Expenditures for Essential Public Health Services
ABSTRACT NUMBER: 144
ABSTRACT: The purpose of this project is to develop a tool for collecting data on Federal, State, and local public health expenditures that uses the terminology of the essential services of public health. The goal of this effort is to document the relative investment in public health in the United States, laying the groundwork for a system to track these expenditures over time and across agencies and levels of Government. Another purpose of this project is to provide the financial data to relate to public health outcomes, public health infrastructure, and work force measurement. Nine States participated in this effort: Arizona, Illinois, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas, and Washington. On June 29, 1995, 75 State, local, and Federal officials met to discuss and plan the collection of data on public health expenditures. After a plenary session with presentations on several public health initiative projects, the participants from public health, mental health, substance abuse, and environmental agencies met in separate work groups to discuss the tools for estimating expenditures for the essential services of public health. Data collection instruments were distributed to State health officials in September 1995. State health officials coordinated the data collection for State and local public health, substance abuse, and environmental agencies. At the request of the mental health agencies, data collection was coordinated using 1993 data from the National Association of State Mental Health Program Directors.
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: Minority HIV/AIDS Programs Community-Based Organization Evaluation: HIV/AIDS Education/Prevention Grant Program 1988-89, A Cross-Site Evaluation
ABSTRACT NUMBER: 145
ABSTRACT: This evaluation study uses a multiple case study approach to assess 9 of 38 projects awarded grants in 1988 and 1989. The study documents, describes, and assesses the effectiveness of community-based projects that address HIV and AIDS prevention within minority communities. The grant program was designed to support innovative approaches that minority programs use when targeting their communities and at-risk populations. This report assesses the effectiveness of these projects. The results and findings of this evaluation will be used by the Office of Minority Health and other agencies to identify successful practices and common themes that could be used as innovative community-based risk-reduction strategies. The study compares various community-based approaches to disease prevention and the impact of those approaches on minority communities. Results of the study show that successful prevention models include (1) funding agencies that give priority to community-based organizations (CBOs) with a history of meeting community needs; (2) CBOs with local representation at all levels of program decisionmaking; (3) funding agencies that provide site visits, responses to program reports, and ongoing communication with program managers; and (5) funding agencies that set aside resources for technical assistance. (Final report 121 pages, plus appendixes.)
AGENCY SPONSOR: Office of Minority Health
FEDERAL CONTACT: John Walker, III
PHONE NUMBER: 301/594-0769
PIC ID: 5618
PERFORMER ORGANIZATION: Tonya, Inc., Washington, DC
TITLE: Region IX Hepatitis B Project Final Report
ABSTRACT NUMBER: 146
ABSTRACT: Approximately 300,000 people are infected with the hepatitis B virus (HBV) each year, and about 1 million are infectious HBV carriers. Of these, over 50 percent are Asians or Pacific Islanders. Carrier rates for Asians range from 8 to 15 percent, and for Pacific Islanders, from 5 to 10 percent, while rates for the total U.S. population are 0.2 percent. This report assesses HBV education and outreach efforts among Region IX primary care centers serving Asians and Pacific Islanders. The report summarizes the programs at five centers. These centers completed and returned a self-assessment tool, the results of which show that staffing is the strongest component of HBV education and outreach programs. Programs with bilingual medical staff or medical interpreters, with materials written in patients' languages, and with a high-profile, integrated approach are generally more successful than others. The report finds that media-based outreach is the weakest aspect of the programs. Information gathered in two site visits is also presented. The report covers the following areas: clinic/client profiles; staffing; health education materials; clinic-based, media-based, and community-based outreach and education; and networking and linkages. The report also provides information on the barriers to effective HBV outreach and education, including cost, cultural health beliefs, and lack of personnel and awareness. It provides recommendations to improve HBV education and outreach for Asians and Pacific Islanders.
AGENCY SPONSOR: Public Health Service, Regional Office IX
FEDERAL CONTACT: George Nakama
PHONE NUMBER: 415/556-4926
PIC ID: 5681
PERFORMER ORGANIZATION: Association for Asian Pacific
Community Health Organization, Oakland, CA
TITLE: Review of the Fialuridine (FIAU) Clinical Trials
ABSTRACT NUMBER: 147
ABSTRACT: In June 1993, 1 of 15 HBV outpatients taking part in an NIH clinical drug trial was hospitalized with liver failure. Shortly thereafter, six more patients also developed severe toxicity. Five patients eventually died, and two more were saved from death only by a liver transplant. All of these patients were taking the experimental drug fialuridine (FIAU). The Institute of Medicine (IOM) examined the clinical trials involving FIAU and its parent drug, fiacitabine, to determine whether any rules governing the trials process should be changed, and what burdens or costs these changes might place on future clinical trials. Their report presents the history of clinical trials of the drugs, beginning with trials that showed promise in the treatment of HBV and ending with the trial in which several people died from toxic effects of FIAU. It also carefully examines the clinical background for the trials, the informed consent process, and the conduct of the investigators. The IOM found that the entire set of trials reviewed was an ethically sound clinical research project designed and carried out by highly competent investigators who frequently exceeded requirements of regulations imposed by institutional review boards. Furthermore, the IOM report discusses conclusions and recommendations issued by the FDA. The IOM generally concurs with the recommendations without ascribing blame for the tragedy to any party.
AGENCY SPONSOR: Office of Public Health and Science
FEDERAL CONTACT: Carol Roddy
PHONE NUMBER: 202/205-0152
PIC ID: 5660
PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC
TITLE: Evaluation of Mental Health Service Delivery Systems for Children and Adolescents
ABSTRACT NUMBER: 148
ABSTRACT: This issue of the Journal of Emotional and Behavioral Disorders is dedicated to a special series on research projects supported by the Center for Mental Health Services (CMHS) within SAMHSA. The first article summarizes the recent history of research on the service delivery system for children and adolescents who have serious emotional disabilities, and the other articles examine the effectiveness of specific interventions for individual populations. Articles include "Building the Research Base for Children's Mental Health Services"; "Multisystemic Family Preservation Therapy: Preliminary Findings From a Study of Rural and Minority Serious Adolescent Offenders"; "Improving Adjustment Outcomes for Foster Children With Emotional and Behavioral Disorders: Early Findings From a Controlled Study on Individualized Services"; "Effectiveness of Intensive Case Management for Homeless Adolescents: Results of a 3-Month Followup"; "Development and Evaluation of Treatment Foster Care and Family-Centered Intensive Case Management in New York"; "Connecting Low-Income Families to Mental Health Services: The Role of the Family Associate"; "The Vanderbilt School-Based Counseling Program: An Interagency, Primary-Care Model of Mental Health Services"; and "The Challenges of Child Mental Health Research." (Journal articles 71 pages in total.)
AGENCY SPONSOR: Center for Mental Health Services
FEDERAL CONTACT: Diane Sondheimer
PHONE NUMBER: 301/443-1333
PIC ID: 6152
PERFORMER ORGANIZATION: Center for Mental Health Services, Rockville, MD