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Fiscal Year 1999

Research on Child and Adolescent Health: New Starts

In building on its research on child health, the Agency for Healthcare Research and Quality (AHRQ) funded grants starting in Fiscal Year 1999 that focus on outcomes; quality; and cost, use, and access. AHRQ was formerly the Agency for Health Care Policy and Research.

Outcomes

Asthma School Initiative: Evaluating Three Models of Care
Description: This research will use children's functional status, school days missed, and resource use to evaluate the impact of expanding primary care delivery to use school-based health centers (SBHCs) for the care of asthma.
Principal Investigator: Mayris P. Webber, Montefiore Medical Center, New York, NY
Grant No.: R18 HS10136 (9/01/99-8/31/02)

Commercial Telephone Triage vs. Physician On-call Advice
Description: This study will compare the telephone triage of a commercial service versus a traditional physician on-call in a prospective, randomized trial of pediatric patients, who represent the majority of calls for medical advice.
Principal Investigator: Larry J. Baraff, University of California at Los Angeles, CA
Grant No.: R01 HS10604 (9/30/99-9/29/00)

Evidence-based Surfactant Therapy for Preterm Infants
Description: This study uses a randomized controlled trial to evaluate a coordinated, multi-faceted intervention designed to close the gap between the evidence on effectiveness of surfactant therapy and its current use in clinical practice.
Principal Investigator: Jeffrey D. Horbar, University of Vermont, Burlington, VT
Grant No.: R01 HS10528 (9/30/99-9/29/02)

Impact of a Telecommunication System in Childhood Asthma
Description: This study is assessing the effectiveness of Telephone-Linked Communications for Asthma (TLC-Asthma) in the care of children with symptomatic asthma. The system monitors asthma symptoms, quality of life, and asthma knowledge and self-care behavior.
Principal Investigator: Robert Friedman, Boston Medical Center, MA
Grant No.: R01 HS10630 (9/30/99-9/29/03)

Infant Feeding Method and Medicaid Service Utilization
Description: This study will use Medicaid claims from a group of infants linked to vital statistics and Women, Infant, and Children (WIC) files to determine the impact of feeding method on health services utilization and costs among infants enrolled in Medicaid at 6, 12, and 24 months after birth, determine factors which influence choice of feeding method in this population, and identify factors which determine the duration of breastfeeding for mothers enrolled in Medicaid and WIC.
Principal Investigator: Aylin A. Riedel, University of Minnesota, Minneapolis, MN
Grant No.: R03 HS10163 (7/01/99-6/30/00)

Outcomes of Legislated Increases in Maternity Stays
Description: This study will evaluate the effects of two successive policies regarding hospital care for childbirth: Harvard Pilgrim Health Care's program to reduce inpatient stay and Massachusetts legislation mandating that health insurance cover at least 48-hour stays after normal deliveries.
Principal Investigator: Stephen B. Soumerai, Harvard Pilgrim Healthcare, Brookline, MA
Grant No.: R01 HS10060 (5/01/99-4/30/01)

Rational Therapeutics for the Pediatric Population
Description: The Program on Health Outcomes at UNC will establish a Center for Education and Research in Therapeutics (CERT). The goals are to focus the expertise of a diverse and unique clinical, research, and education community on the needs of children and adolescents (birth to 18 years) and to achieve optimum outcomes from the use of drugs and devices in this population.
Principal Investigator: William Campbell, University of North Carolina, Chapel Hill, NC.
Grant No.: U18 HS10397 (09/30/99-09/29/02)

School Mental Health: Quality Care and Positive Outcome
Description: This project will test and refine several measures for assessing child outcomes (including satisfaction and resilience), conduct focus groups with clinicians aimed at refining both clinician and youth-report instruments, and track quality and outcomes for children receiving school mental health services over time.
Principal Investigator: Laura A. Nabors, University of Maryland, Baltimore, MD
Grant No.: R03 HS09847 (9/01/99-8/31/01)

Seeking and Denying Antibiotic Treatment in Pediatrics
Description: This project will examine physician perceptions of and responses to parental preferences for antibiotic prescriptions, parental statements of concern and formulation of their child's medical problem, and aspects of physicians' information provision and parental behaviors that reveal preferences for antibiotic prescription.
Principal Investigator: Tanya J. Stivers, University of California at Los Angeles, CA
Grant No.: R03 HS10577 (9/30/99-8/31/00)

Treating Teenage Depression in Managed Care Practices
Description: This study will examine the effectiveness of cognitive-behavioral therapy when used as an adjunct to antidepressant medication therapy to treat adolescents ages 12-18 who experience depression for the first time.
Principal Investigator: Gregory N. Clarke, Kaiser Permanente Center for Health Research, Portland, OR
Grant No.: R01 HS10535 (6/01/99-5/31/03)

Quality

Conditional Length of Stay (CLOS): A Pediatrics Outcome Measure
Description: This study will develop a new class of outcomes measures for quality of care measurement purposes for use in pediatrics. The construct validity of the measure will be demonstrated by defining the relationship between CLOS and other outcomes measures, such as death and complications.
Principal Investigator: Jeffrey H. Silber, Children's Hospital of Philadelphia, PA
Grant No.: R01 HS09983 (9/01/99-8/31/02)

Do Urine Tests Increase Chlamydia Screening in Teens?
Description: This study will determine whether a systems-level intervention, involving nurse managers, results in an increased rate of urine-based screening in asymptomatic sexually active adolescents in pediatric clinics compared to a traditional physician-based screening program for sexually transmitted diseases.
Principal Investigator: Mary-Ann Shafer, University of California-San Francisco, San Francisco, CA.
Grant No.: R01 HS10537 (09/30/99-09/29/02)

Evaluating a Decision Tool for Prenatal Testing
Description: This randomized controlled trial will pilot-test, refine, and evaluate a computerized tool for assisting pregnant women and their partners. The study will measure the effect of the tool on knowledge about prenatal testing and its outcomes, satisfaction with decisionmaking, and use of prenatal diagnostic tests.
Principal Investigator: Miriam Kupperman, University of California, San Francisco, CA
Grant No.: R18 HS10214 (9/30/99-9/29/02)

Evaluating Quality Improvement Strategies
Description: This study will compare the effects of office-based quality improvement with regular practice on processes and outcomes of care for children with asthma ages 2 to 18. Effectiveness and cost-effectiveness will be evaluated in this managed care setting.
Principal Investigator: Charles J. Homer, Children's Hospital, Boston, MA
Grant No.: R01 HS10411 (9/30/99-9/29/02)

Managed Care and Quality: Children with Chronic Conditions
Description: This study will examine how the structural characteristics, incentives, and quality assurance efforts of managed care organizations affect quality of care among children with one of four conditions: asthma, diabetes mellitus, low birthweight, and cerebral palsy. Includes children, but is not entirely child-focused.
Principal Investigator: Frederick A. Connell, University of Washington, Seattle, WA
Grant No.: R01 HS09948 (7/01/99-6/30/02)

Measuring the Quality of Care for Diabetes
Description: This project uses Medicaid data, including data on children, to develop and test measures of quality of care for people with diabetes. Includes children, but is not entirely child-focused.
Principal Investigator: Jack Needleman, Harvard University, MA
Grant No.: R01 HS10332 (9/30/99-9/29/01)

Measuring the Quality of Care for High Risk Infants
Description: This project aims to:

  1. Develop new quality of care measures for very low birth weight (VLBW) infants that overcome the problems of small sample size, bias from patient mix, and the multidimensional nature of quality.
  2. Apply these methods to estimate past quality of care and predict future quality.

Principal Investigator: Jeannette A. Rogowski, RAND Corporation, Santa Monica, CA
Grant No.: R01 HS10328 (9/30/99-9/29/02)

Measuring Quality of Care for Vulnerable Children
Description: This project aims to use data on structure and process of care to validate an existing pediatric health-related quality-of-life instrument, the PedsQL, as an outcomes measure of quality of care. This field test will be incorporated into an evaluation of HealthLink, a partnership of health care providers and the San Diego school system, which educates an ethnically diverse population.
Principal Investigator: Michael Seid, Children's Hospital Research Center, San Diego, CA
Grant No.: R01 HS10317 (9/30/99-9/29/01)

Pediatric Emergency Care: Severity and Quality
Description: This study will validate a pediatric emergency department severity system, and apply the system in an evaluation of quality of care in the pediatric emergency department setting. The study will also analyze a set of institutional factors and clinical factors (including severity) to identify correlates of hospital admission.
Principal Investigator: Murray M. Pollack, Children's Research Institute, Washington, DC
Grant No.: R01 HS10238 (9/30/99-9/29/01)

Quality Measures for Severe/Persistent Mental Illness
Description: This project will identify quality of care measures for severe and persistent mental illness and develop an inventory that will be incorporated into AHRQ's CONQUEST database. A stakeholder panel will then work with investigators to develop a conceptual framework for measure development, and further develop and test a subset of measures. Includes children, but is not entirely child-focused.
Principal Investigator: Richard C. Hermann, Harvard University, Boston, MA
Grant No.: R01 HS10303 (9/30/99-9/29/01)

Using Census Data To Monitor Care to Vulnerable Groups
Description: This study will attempt to develop a series of practical, clinically relevant indicators that are sensitive to differences in quality of care provided to socioeconomically vulnerable populations, and determine the extent to which socioeconomic measures based on census data account for disparities in the quality of care provided to African-American and Hispanic patients. Includes children, but is not entirely child-focused.
Principal Investigator: Kevin Fiscella, Highland Hospital of Rochester, NY
Grant No.: R01 HS10295 (9/30/99-9/29/01)

Cost, Use, and Access

Access and Quality of Care for Low-Income Adolescents
Description: This is a study of the impact of the organizational features of Florida's State Children's Health Insurance Program (SCHIP) plans and providers on adolescents' access to and quality of care, health and functioning, and expenditures, including a comparative analysis of minority and non-minority youths.
Principal Investigator: Elizabeth A. Shenkman, University of Florida, Gainesville, FL
Grant No.: U01 HS10465 (9/30/99-9/29/02)

Analysis of Fee-For-Service vs. Managed Care for Children with Special Health Care Needs
Description: This study will:

  1. Document baseline patterns of service utilization for 12 common chronic conditions.
  2. Identify diagnoses, utilization patterns and sociodemographic characteristics associated with voluntary managed care enrollment.
  3. Compare the utilization and cost of services for the 12 diagnoses.

Principal Investigator: Janet Zimmerman, Michigan Public Health Institute, Ann Arbor, MI
Grant No.: U01 HS10441 (9/30/99-9/29/02)

Children's Health Insurance Coverage in Massachusetts
Description: This project will use the administrative and claims files and telephone survey data on a sample of participants in Massachusetts' Children's Medical Security Plan (CMSP) to determine the relationship among insurance status, unmet health needs, and health services utilization; assess the impact of CMSP on access to care; and determine the extent to which crowdout is occurring in the CMSP.
Principal Investigator: Emily Feinberg, Harvard University, Boston, MA
Grant No.: R03 HS10207 (7/01/99-6/30/00)

Evaluation of Kansas HealthWave
Description: This study will examine the features of the SCHIP in Kansas that impact health care access, quality, utilization, and satisfaction on low-income children who remain uninsured after program implementation, enrollees in HealthWave over time compared to traditional Medicaid enrollees, vulnerable groups of children, and the health care system.
Principal Investigator: Robert F. St. Peter, Kansas Health Institute, Topeka, KS
Grant No.: U01 HS10536 (9/30/99-9/29/02)

Health Care Access, Quality and Insurance for Children with Special Health Care Needs
Description: This study uses Indiana's two-phased approach to SCHIP to study structural, organizational, and implementation features of SCHIP that facilitate coordination and collaboration of services for optimal outcomes for children with special health care needs.
Principal Investigator: Nancy L. Swigonski, Indiana University, Indianapolis, IN
Grant No.: U01 HS10453 (9/30/99-9/29/02)

Hospital Industry Restructuring: Impact on Safety Net
Description: This project will study factors that affect participation of safety net hospitals in hospital systems or network, the influence of affiliation on safety net hospitals' solvency, and the degree to which affiliation affects Medicaid patients' travel patterns for care. Includes children, but is not entirely child-focused.
Principal Investigator: Larry Manheim, Northwestern University, Chicago, IL
Grant No.: R01 HS10040 (9/30/99-9/29/01)

Hospital Profiling of Maternity Length of Stay
Description: This study will use a three-level, hierarchical regression technique for obstetric deliveries in Arizona, with the goal of developing a statewide hospital profiling methodology in the analysis of variations in obstetric hospital length of stay. The study will also use the results to develop hospital profiles on the basis of the regression results.
Principal Investigator: Denise F. Giles, University of Alabama, Birmingham, AL
Grant No.: R03 HS10569 (9/30/99-9/29/00)

Impact of Publicly Funded Programs on Child Safety Nets
Description: This project will describe the relationship between characteristics of publicly funded programs and survival/financial viability of pediatric safety net providers; and determine the differential effects of Medicaid managed care and the SCHIP for pediatric safety net providers relative to pediatric federally qualified health centers.
Principal Investigator: Peter P. Budetti, Northwestern University, Evanston, IL
Grant No.: U01 HS10423 (9/30/99-9/29/02)

Implementing Family Programs in Psychiatric Settings
Description: This project will investigate the factors that influence whether families of psychiatric patients receive interventions when their relative is either hospitalized for an acute episode of schizophrenia or bipolar disorder, or is receiving long-term management in a community-based treatment setting. Includes children, but is not entirely child-focused.
Principal Investigator: Linda E. Rose, Johns Hopkins University, Baltimore, MD
Grant No.: R03 HS10378 (9/30/99-9/29/00)

Medicaid vs. Premium Subsidy: Oregon's SCHIP Alternatives
Description: This project will study Oregon's SCHIP program and identify factors associated with the decision of parents to enroll their children in SCHIP, and which type of plan is chosen. The project will also study the impact of these insurance decisions on access to care for children.
Principal Investigator: Janet B. Mitchell, Center for Health Economics Research, Waltham, MA
Grant No.: U01 HS10463 (9/30/99-9/29/02)

New York's SCHIP: What works for vulnerable children
Description: This evaluation will measure:

  1. SCHIP enrollees' experience with access, utilization, and quality, by structural health features (insurance plan type, provider factors, geography, and patient characteristics, including special needs children).
  2. SCHIP selection efforts.
  3. Continuity of insurance (including crowdout).
  4. Two aspects of community impact.

Principal Investigator: Peter G. Szilagyi, University of Rochester, NY
Grant No.: U01 HS10450 (9/30/99-9/29/02)

Online Commentary Use and Antimicrobial Prescribing
Description: This study will analyze pediatric acute care encounters to gain a better understanding of how physicians use online commentary in response to both explicit and perceived parental expectations for antimicrobials in the pediatric outpatient setting.
Principal Investigator: Rita M. Mangione-Smith, University of California, Los Angeles, CA
Grant No.: R01 HS10187 (7/01/99-9/30/00)

Provider Participation and Access in Alabama and Georgia
Description: This project will analyze Medicaid claims data to relate the introduction of primary care case management in Medicaid and the availability of SCHIP to:

  1. Changes in availability of Medicaid providers across ZIP Codes in Alabama and Georgia.
  2. Changes over time and differences across plans in children's use of medical care.

Principal Investigator: Janet M. Bronstein, University of Alabama, Birmingham, AL
Grant No.: U01 HS10435 (9/30/99-9/29/02)

Faculty Development Awards

Faculty Development for General Pediatrics Faculty Teaching in Community-Based Settings. AHRQ and the Health Resources and Services Administration's Bureau of Health Professions supported the following 1999 Ambulatory Pediatric Association's Primary Care Pediatrics Research Awards:

  1. Chris Feudtner, University of Washington, "Hospital Epidemiology of Pediatric Complex Chronic Conditions: A Study of Hospital Admission Secular Trends and Case Mix."
  2. Jill Hoube, UCLA Rand, "The Relationship of Health System Structure to Outcomes in Low Birth Weight Infants."
  3. Marielena Lara, UCLA Rand, "Ethnicity in Childhood Asthma: What Accounts for the Variation Among Hispanic Children."

Evidence Reports Begun in Fiscal Year 1999

Child-Specific:

Otitis Media with Effusion. Southern California Evidence-based Practice Center-RAND Corporation, Santa Monica, CA

Include children, but are not entirely child-focused:

Criteria for Referral of Patients with Epilepsy. MetaWorks, Inc., Boston, MA
Refinement of HCUP Quality Indicators. University of California, San Francisco, CA, and Stanford University, Stanford, CA
EPC Technical Support for National Institute of Dental and Craniofacial Research. Research Triangle Institute and University of North Carolina at Chapel Hill, NC
Management of Chronic Asthma. Blue Cross/Blue Shield Association Technology Evaluation Center, Chicago, IL

Additional Information

For additional information, contact:

Denise Dougherty, Ph.D.
Senior Advisor, Child Health
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: (301) 427-1868
Fax: (301) 427-1561
E-mail: Denise.Dougherty@ahrq.hhs.gov

Current as of February 2000
Internet Citation: Fiscal Year 1999: Research on Child and Adolescent Health: New Starts. February 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/children/new-starts/1999.html