Funded Grants Submitted by Nurses: 1980-2005 (continued)

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Principal Investigator: Sheryl Lacoursiere, M.S., M.S.N., R.N.
Institution: University of Connecticut
Grant No: R03 HS11937 (Dissertation)
Period: 2/1/02-1/31/03
Title: Telehealth Support in Cardiovascular Disease
Summary: The specific aims of the project are to: (1) Quantify the use of Internet telehealth nurse support cardiovascular services; (2) Measure psychological and physiological outcomes in a format for comparison with national norms; (3) Measure satisfaction with, and usage of, online nursing services, providing data for future patient-centered intervention; (4) Describe and categorize specific nurse support interventions provided to and requested by cardiac patients, which can be used in future program planning; (5) Provide data to assess feasibility of telehealth nurse support in future large-scale projects by agencies, health networks and insurers for patients at distant locations; and (6) Provide baseline and followup measurements to enable comparisons in processes and outcomes of support for other high morbidity diseases, such as cancer and diabetes. The long-term objectives of this project are to provide data on the feasibility of Internet health support interventions, and subsequent effects on health-related outcomes and effectiveness. By quantification of requested and provided interventions, classifications can be developed that can be incorporated into use for tracking and reimbursement. Success in this project will form the foundation for future cost-effective telehealth delivery intervention trials by practitioners, agencies, and health networks for persons at distant locations aimed to enhance health outcomes in cardiovascular disease.

Principal Investigator: Norma Lang, Ph.D., M.S.N.
Institute: University of Pennsylvania
Grant No.: R13 HS12058 (Conference)
Period: 9/30/01-9/29/02
Title: Measuring and Improving Health Care Quality
Summary: The University of Pennsylvania School of Nursing, with its partners, the American Academy of Nursing and the Annenberg Public Policy Center, will convene a state of the science invitational conference with participants from nursing, health services research, policy, and communications. Aims of the conference include identifying methodological and technical issues surrounding the definition and measurement of nursing care quality and resources available such as secondary data sources; development of recommendations for research and health policy; and dissemination to organizations and individuals who can use information to improve quality. Dissemination will include a journal supplement, executive summaries to be used by key individuals and organizations to make recommendations to Federal agencies, regulators and others, and Web sites.

Principal Investigator: Sun-Mi Lee, M.P.H., M.S.N.
Institution: University of Maryland
Grant No.: R03 HS13867 (Small Research Project)
Period: 7/1/03-6/30/04
Title: Bayesian Network Approaches to Study Health Outcomes
Summary: The purpose of this study is to explore the potential application of Bayesian networks to health outcomes by predicting outcomes using large healthcare databases. One area of particular interest to researchers, clinicians, and administrators is developing a better understanding of access to care. Sub-populations of HIV positive individuals in the U.S. are known to have decreased access to and use of care, which may contribute to increasing complications and mortality. The HIV Cost and Services Utilization Study (HCSUS) dataset has been used to examine access using traditional statistical modeling techniques, such as logistic regression. However, these techniques have limitations, particularly in untangling the complexity of predicting health service utilization. The specific aims of this study are to: 1) develop Bayesian network models predicting limited health service utilization using the HCSUS data; and 2) validate Bayesian network models by comparing them to the logistic regression models built in a previously published study. This study will provide researchers new insight into working with large datasets. The repeated testing and refinement of Bayesian network modeling techniques, particularly as they are applied to other health outcomes in large databases, contributes to knowledge discovery and promotes more sophisticated analyses.

Principal Investigator: Amanda J. Liddle, B.S.N., M.P.H.
Institution: University Of Alabama
Grant No.: R03 HS11259 (Dissertation)
Period: 09/30/00-09/29/01
Title: Time to Neonatal and Plostneonal Death U.S. 1985-1995
Summary: The purpose of this study is to: a) examine the temporal variations in the time to infant death, from perinatal related causes, by race, birth weight, and time period of birth; b) examine the assumption that the length of stay during the initial hospitalization after delivery and time to infant death from perinatal related causes are equivalent. Specifically, the study aims to 1) examine the temporal variations in time to infant death from perinatal related causes for each birth weight group and race group, between 1985 and 1995, 2) examine the association between the length of stay for the initial hospitalization of VLBW infants, and the time to their infant death from perinatal related causes, 3) examine the assumption that the length of stay of the initial hospitalization for VLBW infants and time to their infant death from perinatal related causes are equivalent, and 4) consider the implications of the findings for future perinatal policy and interventions.

Principal Investigator: Mary Lynn, Ph.D., R.N.
Institution: University of North Carolina
Grant No: R13 HS07519 (Conference)
Period: 3/1/93-2/28/94
Title: Quality, Cost and Delivery: Administrative Challenges
Summary: A total of 230 practitioners, researchers, educators, and graduate students attended the conference to share information about the current state of research in nursing administration on cost-related issues; quality care and nursing delivery systems; to learn more about analysis and interpretation of aggregated data; and to discuss the implications of the research for administrative practice. Consensus work was done by a panel of 12 nationally prominent nurse administration educators, researchers and practitioners on the nursing administration research prioritized for the 'Healthy People 2000' report.
Availability: NTIS Final Report Accession Number: PB95193660

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M

Principal Investigator: Carol L. MacNee, Ph.D., R.N.
Institution: East Tennessee State University
Grant No: R03 HS09834 (Small Research Project)
Period: 9/30/98-9/29/99
Title: Measurement of Homeless Patients' Satisfaction with Care
Summary: The purpose of this project is to develop a measure of satisfaction with primary health care which is appropriate for homeless clients. The measure which is developed will be compared with two existing measures which have been used to examine satisfaction with primary health care among populations who are not homeless. It will also be tested with two groups of homeless individuals, those living in a large city and those living in a more rural area.Patient satisfaction is recognized as an important outcome of primary health care which affects whether or not a client follows through on treatment or returns for additional care. Current measures of satisfaction with care were developed with middle class clients in mind and have shown a lack of variability or a skew in ratings when used with vulnerable populations.

Principal Investigator: Ruth E. Malone, M.S.N., R.N.
Institution: University of California
Grant No: R03 HS08412 (Dissertation)
Period: 8/1/94-6/30/96
Title: Heavy Users of Emergency Services: Multidimensional Study
Summary: The ethnographic study of two inner-city trauma center emergency departments (EDs) sought to increase understanding of the problem of heavy users (HUs) of hospital emergency services, a population whose utilization is regarded as problematic in an era of managed care, but whose economic and health status is marginal at best, desperate at worst. Three major findings of the study were (1) many HUs visit the ED primarily to meet nonmedical needs, although they also had multiple, frequently chronic, medical problems; (2) market-driven changes in the practice setting are contributing to disillusionment among clinicians as they are caught between system and patient demands; and (3) the ED fulfills multiple social roles beyond that of providing emergency medical care or even primary medical care. The study suggests that the ED must be viewed within the context of these larger roles and that the press for 'efficiency' and cost containment may actually engender resistance in the form of increased medicalization of social problems, and/or paradoxically contribute to increased visits and medical care costs as basic nonmedical needs go unrecognized and unmet.
Availability: NTIS Final Report Accession Number: PB96194063XSP

Principal Investigator: Barbara Maloney, M.S.N.
Institution: University of Massachusetts
Grant No: R03 HS07954 (Dissertation)
Period: 9/1/93-8/31/95
Title: Psychoactive Drug Use Post OBRA: Massachusetts
Summary: There were three aims to this study. The first was to evaluate the effects of these regulations in the use of psychoactive drugs in the year following implementation utilizing a sample of 5000 nursing home residents from the Massachusetts Medicaid Claims File. Regression discontinuity will provide the framework for looking at changes in use from 10-1-89 to 9-10-91. The second aim was to evaluate the compliance of prescribers with the OBRA regulation requiring diagnosis or behavioral justification for use. Utilizing a sample of 2000 cases from the Massachusetts case-mix data for 1991, logistic regression will model inappropriate psychoactive drug use at the individual level. Finally, in order to provide a grounded perspective to the entire study, data abstracted from a nursing home's resident records was utilized to evaluate changes in use of psychoactive drugs from 10-1-89 to 9-30-91. In addition, multiple regression was used to determine the effects of drug use changes on survival, hospitalization rates, ADL functioning and behavioral stability.

Principal Investigator: Ann Marchewk, M.S.N.
Institution: Heller School Brandeis University
Grant No: R03 HS06928 (Dissertation)
Period: 9/01/92-8/31/93
Title: Hospital Patterns of Nursing Personnel Substitution
Summary: Hospitals now employ more personnel to treat fewer patients than when the Prospective Payment System (PPS) was implemented in 1983. This increase becomes even more significant when the substitution of high skilled personnel for less skilled personnel is taken into consideration. The study analyzes hospital demand for registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and nursing assistants (N.A.s) using a cross-sectional sample of 524 hospitals from the American Hospital Association's Nursing Personnel Survey (1989). Findings revealed that hospital characteristics had little effect on nursing personnel wages. Although some monopsony influence was noted, wages were determined primarily in regional and hospital markets. Further, employment was positively associated with hospital output, yet proportionately, quantity of staff decreased suggesting hospitals were economizing on their use of nursing personnel. Employment estimates also indicated a pattern of substitution between R.N.s and N.A.s, but not between R.N.s and L.P.N.s.
Availability: NTIS Final Report Accession Number: PB94204286

Principal Investigator: Barbara Mark, Ph.D., R.N.
Institution: Virginia Commonwealth University
Grant No: R01 HS10153 (Research Project)
Period: 8/1/99-1/31/02
Title: Nursing Staffing, Financial Performance and Quality of Care
Summary: The aim of this project is to examine the relationships among nursing staffing, hospital financial performance, and quality. Nursing staffing will include R.N. per 1,000 casemix adjusted patient days, R.N.s as a percent of total hospital workforce, and R.N. FTEs per average adjusted daily census. Financial performance includes net patient revenue per discharge, expenses per discharge and cash flow per bed. Quality is defined as mortality, complications, and length of stay. This study is designed to examine the nature of the relationship between change in nurse staffing and change in quality of care; between change in financial performance and change in quality of care; and between change in hospital financial performance and change in nurse staffing.

Principal Investigator: Michelle L. Mayer, B.Sc.N.
Institution: University of North Carolina-Chapel Hill
Grant No: K02 HS13309 (Independent Scientist Award)
Period: 9/1/03-8/31/07
Title: The Effects of Medicaid Policy on Dentist Access to Pediatric Subspecialty Care in the USA
Summary: The specific aims of the current research plan are: 1) to depict the practice location of pediatric and adult subspecialists; 2) to explore the relationship between county characteristics and access to pediatric subspecialty care; 3) to ascertain the extent to which adult subspecialists expand access to care for children with rheumatic diseases; 4) to describe the practice patterns of subspecialists, their comfort with treating a variety of pediatric conditions, and the practice, provider, and market characteristics that influence their decisions to treat pediatric patients; and 5) to determine the independent effects of selected training, personal, and practice characteristics on the likelihood that an adult subspecialist treats pediatric patients. In addition, this research plan includes two pilot studies that explore the role of general pediatricians in treating children with rheumatic conditions and that compare care received across physician management types for children with JRA.

Principal Investigator: Michelle L. Mayer, B.Sc.N.
Institution: University of North Carolina
Grant No: R03 HS09330 (Small Research Project)
Period: 9/1/96-2/28/98
Title: The Effects of Medicaid Policy on Dentist Participation
Summary: This project used a modified time-series design to investigate: (1) effects of Medicaid policy changes on dentists' participation in North Carolina's Medicaid dental program, and (2) the relationship between Medicaid fee increases and charges to non-Medicaid dental patients. The investigator performed descriptive and trend analysis on Medicaid claims, eligibility and provider files, Medicaid enrollment, and non-Medicaid charges. The investigator explored the relationship between Medicaid policy and provider participation with multiple regression techniques; used a two-part model to investigate the effects of Medicaid reimbursement fee and enrollment increases on the likelihood of dentists' Medicaid participation; and used an ordinary least-squares regression to explore the relationship between Medicaid price increases and charges to non-Medicaid patients among participating dentists. Participation will be measured using Medicaid claims data from 1985-1992.

Principal Investigator: Ian W. McDowell, Ph.D., R.N.
Institution: University of Ottawa
Grant No: R01 HS06209 (Research Project)
Period: 8/1/89-7/31/90
Title: The "July Phenomenon" in the Twin Cities Teaching Hospital
Summary: The primary purpose of this project was to test the effectiveness of the CMLNP model using a quasi-experimental research design that employs measures of process, outcome and impact. In order to achieve this purpose a three level, community-based nursing care delivery model, The Comprehensive Multi-level Nursing Practice Model (CMLNP), was refined and implemented among Mexican Americans in four rural Arizona communities through La Programa de Enfermeria para la Salud (Nursing for Health Program) and La Programa de Enfermeria para la Salud is designed to improve the health of Mexican American, child bearing women and their families and Mexican American individuals, of both sexes, who are 65 years or older or approaching 65 years of age. The three model levels include (a) PERSONAL PREVENTIVE NURSING, which involves illness and wellness care provided to Mexican American individuals and families by a 3 member nursing team (including a family nurse practitioner, community heath nurse and traditional ethnic healer) through a neighborhood nursing center, (b) ORGANIZED INDIGENOUS CAREGIVING, which involves systematically organized "neighbors helping neighbors" through a modified block nursing program involving trained lay outreach workers, and (c) COMMUNITY EMPOWERMENT which involves a community intervention which is based on the locality development approach.

Principal Investigator: Bernadette Melnyk, Ph.D., R.N., C.P.N.P.
Institution: University of Rochester
Grant No.: R13 HS10968 (Conference)
Period: 9/30/01-2/28/02
Title: Third Annual Evidence-Based Practice Conference
Summary: The objectives of this conference is for nurses and other health care providers to learn skills needed to identify and evaluate the strength of evidence related to their practice and plan strategies to implement evidence-based care including the evaluation of the outcomes of this care. Particular attention will be paid to high-risk children and youth, older adults, and the acute/critically ill. While the primary target audience is nurses and researchers, physicians and physician assistants will also be included. Dissemination will include Web-based continuing education credits, publications in Pediatric Nursing Journal and Applied Nursing Research.

Principal Investigator: Bernadette Melnyk, Ph.D., R.N., C.P.N.P.
Institution: University of Rochester
Grant No.: R13 HS13817 (Conference)
Period: 9/30/02-9/29/03
Title: Fourth Annual Evidence-Based Practice Conference
Summary: The objectives of the fourth annual EBP conference were to assist nurses and other healthcare providers in learning the skills to: (a) search for the latest practice evidence, (b) critically appraise the strength of evidence that is relevant to their practice, (c) plan practice changes in response to critically appraised evidence, (d) overcome barriers in implementing evidence-based care, (e) plan strategies for evaluating the outcomes of evidence-based care, and (f) become knowledgeable of the most current evidence that is influencing the care of high-risk children and youth, older adults, and the acute/critically ill.

Principal Investigator: Lorraine Mion, Ph.D., R.N.
Institution: The Cleveland Clinic Foundation
Grant No: R01 HS09725 (Research Project)
Period: 6/1/99-5/31/01
Title: Effects of a Nursing-Based Intervention in Two EDs
Summary: The purpose of this study is to formally evaluate a recently awarded Robert Wood Johnson clinical demonstration grant (SIGNET), based in the ED and aimed at maintaining frail elderly in the community setting. The aims of the clinical trial are to compare the effectiveness of usual ED care (UC) to the comprehensive case finding, community-linkage ED intervention (SIGNET) on the following outcomes: subsequent ED use, unplanned hospitalizations, and/or nursing home services; community service use; perceived health status, satisfaction and cost-effectiveness. The secondary aims include identifying the feasibility, sensitivity and specificity of the screening processes and identifying individual predictors for utilization of community services. This study provides the opportunity to evaluate a funded intervention program, identify triage risk screening measures to identify at-risk elders in the ED, and identify factors influencing utilization of subsequent health care services, ranging from ED visits to home care visits.

Principal Investigator: Lorraine Mion, M.S.N., R.N.
Institution: Case Western Reserve University
Grant No: R03 HS06923 (Dissertation)
Period: 7/1/91-6/30/92
Title: Use of Physical Restraints for Elderly Patients
Summary: The purpose of this study was to investigate the decision to use physical restraints in the management of elderly patients at risk of falling through the application of clinical decision analysis. It was hypothesized that: (1) a greater proportion of nurses than elderly patients will favor physical restraints to alternative nursing management for the prevention of falling, and (2) more hospital nurses than nursing home nurses will favor the choice of physical restraint. The findings from this clinical decision analysis indicated that registered nurses and elderly patients would overwhelmingly choose an alternative nonrestraint approach to prevent falling. Neither of the hypotheses were supported. Sensitivity analysis demonstrated that nurses' and patients' perceptions of the quality of life of the patient outcomes following physical restraint use as compared to outcomes following nonrestraint strategies were the critical determinants in influencing the optimal choice.
Availability: NTIS Final Report Accession Number: PB94210390XSP

Principal Investigator: Patricia D. Moore, M.S.N.
Institution: Institution Name Unavailable
Grant No: R03 HS05011 (Small Research Project)
Period: 7/1/83-6/30/84
Title: Utilization of Ambulatory Health Services by Hispanics
Summary: With their young age profile and high birth rates, Mexican-Americans are a large and important component of the maternal and child population. In Arizona they comprise 19 percent of the population and 26 percent of all births in the State. Using data collected from household interviews, medical office records and birth certificates, this study explored the use of prenatal and infant care services by 308 Mexican-American and 312 white non-Hispanic Medicaid enrollees in a managed care system. Inclusion was limited to those enrolled at least by beginning of the sixth month of pregnancy and whose infants were continuously enrolled throughout their first year of life, so use of these important preventive services could be explored apart from issues of eligibility. Despite insurance coverage and a known provider, Mexican-American pregnant women made fewer prenatal visits and their infants made fewer visits and had lower immunization levels than their similarly enrolled white non-Hispanic counterparts. The relationship of sociodemographic, cultural, family support, health benefits, health status characteristics, and barriers to use of services were examined.

Principal Investigator: Donna Morris, Dr.P.H., C.N.M.
Institution: University of Texas Medical Branch
Grant No: R03 HS07692 (Small Research Project)
Period: 9/1/93-8/31/94
Title: Cervical Dysplasia Patient Outcomes by Type of Provide
Summary: This study sought to (1) establish the validity of practice standards, including measures of clinical efficacy and patient outcomes, and (2) determine the feasibility of implementing a multi-site longitudinal study on the effectiveness of nurse practitioner colposcopists (NPCs) in evaluating and treating cervical dysplasia. In judging the validity of practice standards, the investigator used ten specific measures to compare the performance of experienced, independent-practice NPCs with that of a convenience sample of obstetrician/gynecologists. NPC practices were deemed appropriate and safe, but substantial variations between NPCs' and physicians' practices would make" it difficult or impossible to establish universal practice guidelines.
Availability: NTIS Final Report Accession Number: PB95203857

Principal Investigator: Anne E. Mowery, M.N.
Institution: Iowa State University
Grant No: R03 HS06790 (Dissertation)
Period: 9/1/90-10/31/91
Title: Local and Non-Local Hospital Use by Rural Iowans
Summary: This study pursued an in-depth understanding of what affects a rural resident's decision to use or by pass the closest hospital. While a few studies have been done on bypassing, this one has several original features. A model was developed for examining the contribution of both patient and hospital characteristics to bypassing. Those rural residents who live closest to the type of rural hospital most vulnerable to failure are targeted for study. A broader scope of patient characteristics were explored than presented in other research. For instance, this study is unique in identifying how rural an area a patient lives or whether he or she lives in a county adjacent to an urban area. In addition, this study is the first to examine bypassing patterns among age groups and sources of payment. Rural health policy changes were recommended based on this study's findings about bypassing.

Principal Investigator: Mary E. Murray, Ph.D., R.N.
Institution: University of Wisconsin-Madison
Grant No.: R03 HS10667 (Small Research Grant)
Period: 9/15/00-8/31/02
Title: Outcomes of a Managed Care Cost Containment Strategy
Summary: The project aimed to investigate the effects of concurrent utilization review on the care of hospital patients. There were three specific questions. First, what are the effects of denials of care on the care of the patient. That is, if care is denied by concurrent review, is the care delivered anyway and financed by the hospital, paid for by a secondary payer, paid for by the patient, not performed, or performed at another site? Second, what is the cost to the hospital of care denied in concurrent reviews? Third, do the answers to the first two questions support the view that concurrent review is a form of cost shifting from managed care plans to hospitals? To study these questions, the project surveyed the nurse case managers responsible for conducting concurrent reviews in a large teaching hospital, contacting them each time a denial was received and asking about the impacts on patient care. Data on costs for patients denied care were derived from hospital databases. Some analyses were conducted for the entire hospital and other analyses were conducted by clinical service to see if the effects of care denials varied across units.

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Principle Investigator: Wendy Nehring, FAAN, Ph.D., R.N.
Institution: American Association on Mental Retardation
Grant No.: R13 HS14731 (Small Conference)
Period: 5/27/04-5/26/05
Title: Health Promotion for Persons with I/DD
Summary: The need for research on interventions and salutations for eliminating the health disparities that exist for persons with intellectual and developmental disabilities (I/DD) have recently been stressed. However, there exists no comprehensive review and analysis of the current literature and scientific evidence on health promotion issues as they relate to people with I/DD for researchers, educators, and clinicians to base curriculum or interventions. Thus, the members of the Health Promotion and Prevention Committee of the American Association on Mental Retardation (AAMR) have proposed a national conference to address the state of scientific evidence concerning health promotion topics as they relate to the population of persons with I/DD. The objectives of this conference are: (a) to identify leading topics of health promotion that affect both the general population and persons with I/DD, (b) to invite leading medical and research experts in health promotion and/or I/DD to present the current scientific evidence concerning these topics of health promotion as they relate to persons with I/DD, (c) to organize the current evidence in a systematic manner, in keeping with federal agencies and national organizations that have recommended such systems, (d) to make recommendations for future research and practice as dictated by the available literature and scientific evidence, and (e) to disseminate this information in an edited book consisting of the conference proceedings and published by AAMR, audiotapes of the conference, and a written synopsis of the conference. The methodology used for the preparation of the papers will be that used for the analysis of scientific evidence (AHRQ, 1997; Butler & Campbell, 2000). It is expected that this initial effort will address the absence of critical health promotion and prevention information and inform research initiatives, policy, clinical practice, and health care outcomes.

Principal Investigator: Kathleen F. Norr, Ph.D., R.N.
Institution: University of Illinois
Grant No: R01 HS07624 (Research Project)
Period: 6/1/93-5/31/97
Title: Health and Cost Impact of Maternal Child Advocate Services
Summary: This randomized clinical trial evaluated the REACH-Futures program for a sample of 613 low income inner city African-American and Latino women. The REACH-Futures program provides home visits to new mothers using a nurse-led team of trained community residents until one year after birth. Outcomes were assessed at intake and at 2, 6, 12, 18 and 24 months after birth. The REACH-Futures program has modest effects at 12 months. The intervention improved community life-skills for the Latinos but not African-Americans. For African-American infants only, several subscales of parenting attitudes and behaviors, verified communication rates and 12 month Bayley mental development scores were significantly higher in the REACH-Futures group. The intervention did not affect infant motor development, health problems or post- birth infant health costs. Several other hypothesized effects of the REACH-Futures program were not documented. The program was more successful in improving infant outcomes than maternal outcomes and African-American infants benefited more than Latinos. These findings suggest that home visit by trained community residents can improve infant health outcomes. Results must be interpreted with caution. The study continues to follow participants until the infant it two years old. At this point, the program impacts maybe clearer.
Availability: NTIS Final Report Accession Number: PB98163074

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Principal Investigator: Maureen M. O'Brien, M.S., R.N.
Institution: University of Colorado Health Science Center
Grant No.: R03 HS10839 (Dissertation)
Period: 06/15/00-06/14/01
Title: Processes Predictive of CABG Complications
Summary: The purpose of this study is to identify modifiable process of care variables that may improve patient outcomes. The three types of variables are preoperative, intraoperative, and the supervisor process of CABG surgeries. The study makes use of large existing databases from the Veterans Medical Centers (VAMCs).

Principal Investigator: Dorothy Oda, D.N.Sc., R.N.
Institution: University of California
Grant No: R01 HS06510 (Research Project)
Period: 2/1/91-1/31/94
Title: Nursing Effectiveness in a Preventive Child Health Program
Summary: The purpose of the randomized clinical trial was to determine if public health nursing (PHN) interventions (independent variable) had an effect on receipt of preventive health services (dependent variable) by children eligible for the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program. Families were randomly assigned to either of two experimental groups (telephone or home visits) or a control group; outcome was assessed for N=1654 children. The PHN intervention was applied using a checklist for consistency and state provider disbursements provided outcome data. Logistic regression models were used for the analysis and odds ratios and nominal 95 percent confidence levels determined effect. Results indicated there were no statistically significant differences among the three groups. Ethnicity was also not a significant factor.
Availability: NTIS Final Report Accession Number: PB94182029XSP

Principal Investigator: Roberta Oka, D.N.Sc., R.N.
Institution: University of California
Grant No: R03 HS08772 (Small Research Project)
Period: 7/1/95-6/30/97
Title: Home-Based Exercise in Patients with Heart Failure
Summary: The purpose of this randomized controlled study was to examine the effects of a 3-month supervised home based aerobic and strength training program on functional status, physical fitness and quality of life in 0 patients with New York Heart Association Class II-III heart failure due to left ventricular dysfunction (ejection fraction 23 percent). The mean age of this sample was 56 years, with 31 men and 9 women. Program adherence was excellent (95 percent). The authors found that while there were no statistically significant effects on physical fitness as measured by peak oxygen uptake and functional status as measured by the human activity profile, there were trends that suggest that given a larger sample size significant effects may be demonstrated with this program. While there were no statistically significant effects on physical fitness and self-rated functional status, arm strength and quality of life were improved. This program of exercise significantly reduced symptoms of dyspna and fatigue and improved emotional function and mastery. This study demonstrates that quality of life may be enhanced independent of changes in functional status and physical fitness although a larger sample size is needed to definitively answer this question.
Availability: NTIS Final Report Accession Number: PB98105067

Principal Investigator: Karen O'Connor, M.A., R.N.
Institution: American Nurses Association
Grant No: R13 HS06662 (Conference)
Period: 5/7/90-5/6/91
Title: Effectiveness / Outcomes Care Services
Summary: Efforts to improve and identify the effectiveness and outcomes of health care services have intensified; the formation of the Agency for Health Care Policy and Research (AHRQ) in 1989 reflects this growing interest. Because nursing care is central to the effectiveness and outcomes of health services, it is essential that nursing's contributions in these areas be identified. The purpose of this grant award was to support the conference 'Effectiveness and Outcomes of Health Care Services: Implications for Nursing.' The conference was held May 10-11, 1990 in Arlington, Virginia, and was attended by 196 nursing leaders, policy analysis experts, researchers and clinicians. The conference provided a forum for the sharing of information about current developments regarding the effectiveness and appropriateness of and payment for health care services and clarified methods to develop, coordinate, disseminate and evaluate practice guidelines for nursing.
Availability: NTIS Final Report Accession Number: PB94145489

Principal Investigator: Nancy G. O'Neil, R.N.
Institution: Florida International University
Grant No: R03 HS07467 (Dissertation)
Period: 9/30/92-9/29/94
Title: AIDS Workplace Policies: Local Government Response
Summary: The purpose of this research was to identify and describe the kinds of AIDS-related workplace policies, programs, and practices which exist in a large, urban government. The governmental agency is located in a geographical area which now has the second highest prevalence rate of HIV/AIDS infection in the nation. A determination was made if these various AIDS-related activities are uniform and centralized throughout the organization or if significant variation exists among and within selected departments. An exploration was made of the factors that have led to the adoption and implementation of these AIDS-related activities. At issue was the organizational response to the AIDS epidemic and the implications to its workforce. Important organizational decision-making, and particularly in the public sector, includes not only hiring practices and rising costs of employee benefits, but highly sensitive issues such as prison management and job safety for public employees such as police and paramedics. Relevant issues for both health and public policy should be enlightened by the study results.

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