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Improving the Health and Health Care of Older Americans

A Report of the AHRQ Task Force on Aging (continued)

Individual Postdoctoral Fellowship (F32) Training

AHRQ funds individual postdoctoral training of approximately four to six scholars annually through individual National Research Service Award postdoctoral fellowships. The following individual fellowship has a research focus in gerontology:

Fellowship: Unmet Needs in Medicare Beneficiaries With Diabetes
Principal Investigator: Arleen Brown, University of California, Los Angeles; F32 HS00132
Description: Examines the role of financial and organizational arrangements on access to and quality of care for Medicare beneficiaries who have diabetes.

(Note: There are other currently AHRQ-supported postdoctoral fellows whose research topics are examining issues of relevance to older adults. These include, for example, one project that is examining treatment options and quality of care for patients with diseases such as emphysema and colon cancer and another project that is assessing factors associated with long-term mortality from community-acquired pneumonia.)

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Dissertation Grants (R03)

AHRQ funds individual dissertation research training of approximately 15 predoctoral students annually through individual small grant awards (R03 grants). Recent aging-related research includes the following:

Study: Beneficiary Use of Quality Reports for Medicare Plans
Principal Investigator: Jennifer Uhrig, Pennsylvania State University; R03 HS10797
Description: Examines whether providing comparative quality information affects choice of health plan by Medicare beneficiaries.

Study: Cost Effective Nutritional Well-Being in Older Adults
Principal Investigator: Elizabeth Gollub, Florida International University; R03 HS10787
Description: Compares quality-of-life, nutritional, and cost outcomes of a group of elderly persons enrolled in the Elderly Nutrition Program who receive a noon meal with those in an intervention group who also receive breakfast.

Study: Effect of Community Pharmacists on Adult Immunization
Principal Investigator: John Grabenstein, University of North Carolina at Chapel Hill; R03 HS10021
Description: Examines the effect of vaccine immunization by community pharmacists on pneumococcal and influenza immunization rates among adults.

Study: Effect of Formal Home Care Services on Caregiver Burden
Principal Investigator: Andrea Weiner, University of Minnesota; R03 HS10794
Description: Examines how community and home care services moderate the effect of care recipient impairment and other stressors on caregiver burden for low-income and frail elderly individuals living in the community.

Study: Effects of State Home Medicare Maximization Plans
Principal Investigator: Wayne Anderson, University of North Carolina at Chapel Hill; R03 HS11262
Description: Measures the amount of home health care costs transferred from Medicaid to Medicare from 1992 to 1997 and identifies individual and State-level attributes that predict the such transfers.

Study: Expectation Measurement for Person With Hip Replacement
Principal Investigator: Mary Milidonis, Case Western Reserve University; R03 HS11272
Description: Develops an instrument that measures expectation beliefs of persons who undergo elective total hip replacement and examines the association between expectations, confirmation of those expectations, and outcomes.

Study: Family Cares' Response to Home Tube Fed Older Adults
Principal Investigator: Heidi Silver, Florida International University; R03 HS11276
Description: Examines the effects, including health status and quality of life, of extended home tube-feeding on elderly recipients and their caregivers.

Study: Long-term Care Decisionmaking Among Korean American Elderly
Principal Investigator: Jong Min, University of California, Los Angeles; R03 HS10785
Description: Examines the perceptions of Korean-American elderly of the concept "long-term care" and the preferences for long-term care services for those elderly experiencing physical and cognitive impairment.

Study: Making Care Decisions for Cognitively Impaired Parents
Principal Investigator: Katharine Cook, University of Virginia; R03 HS10762
Description: Describes the decisionmaking experience of adult children of parents with cognitive impairments regarding placement of the parents into long-term care settings.

Study: Patient Outcomes Related to Discharge Planning Collaboration
Principal Investigator: Willam Corser, University of Wisconsin, Madison; R03 HS10792
Description: Investigates the relationship between hospital professionals' ratings of their discharge planning collaboration and occurrence of postdischarge clinical and utilization outcomes later experienced by a sample of elderly hospital patients.

Study: The PPS Impact on Hospital-Based Skilled Nursing Units
Principal Investigator: Stuart Hagen, University of Chicago; R03 HS09676
Description: Examines whether passage of the Prospective Payment System (PPS) caused hospitals to open skilled nursing units and whether ownership of such units affects hospital length of stay and choice of discharge disposition for Medicare patients.

Study: Predictors of Quality Care in CA Nursing Homes
Principal Investigator: Mary Dellefield, University of California, Los Angeles; R03 HS10022
Description: Develops a risk-adjustment model of indicators of variation in nursing home quality of care.

Study: Risk Selection and Medicare HMOs.
Principal Investigator: Jason Brown, Stanford University; R03 HS11268
Description: Using discrete choice models of consumer demand, determines the existence of risk selection in Medicare managed care plans through the supplemental benefits packages offered.

Study: The Value of Independence in Assisted Living Facilities
Principal Investigator: Paula Carder, Portland State University; R03 HS09886
Description: Examines how the Sate agency responsible for licensing and monitoring assisted living arrangements implements residents' desires for independence.

Appendix C: Selected Aging-Related Projects Recently Implemented by AHRQ that Address Task Force Recommendations

Since the Task Force on Aging submitted its initial report to the Director in early FY 2000, AHRQ has implemented a number of activities and projects which address some of the Task Force recommendations. Some of these are briefly described below.

Funding Solicitations

In June 2000, AHRQ published a new Health Services Research Program Announcement (PA-00-111) reaffirming the agency's commitment to the elderly as a priority population. Among the research interests specifically listed in the PA are:

  • Developing cost-effective models of care in all settings (including informal) that improve the health and functioning of the elderly.
  • Understanding how best to integrate and coordinate the delivery of care across multiple sites and settings.
  • Assessing the outcomes and effectiveness of clinical, organizational, and social interventions that improve or delay decline of functional status.

In addition, the PA also details AHRQ's interest in research on how to provide appropriate "end-of-life" care for patients living with serious chronic diseases, such as cancer, stroke, dementia, and congestive heart or lung failure—conditions which disproportionately affect older people.

Other recent Program Announcements and Requests for Applications that specify the elderly as a priority population for research have included the following:

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Evidence Reports

The systematic evidence reviews conducted by AHRQ's Evidence-based Practice Centers (EPCs) serve as the scientific base for private-sector development of clinical practice guidelines and treatment recommendations in important clinical areas. In November 2000, AHRQ published a notice in the Federal Register requesting nominations for new topics of study. Areas of special clinical interest include those significant to the elderly population, including the Medicare and Medicaid programs.

Several evidence reports on topics relevant to the health of older people have been recently published or are in process. These include:

  • Anesthesia management during cataract surgery.
  • Use of physician services by the Medicare population.
  • Management of coexisting cataract and glaucoma.

Other reports, although not focusing solely on conditions pertaining to older people, nevertheless address clinical areas that affect the elderly in significant numbers. Among these topics are:

  • Diagnosis and treatment of congestive heart failure.
  • The impact of cancer-related decision aids.
  • Blood pressure monitoring outside the clinic setting.

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Infrastructure Building

In FY 2000, AHRQ's efforts to enhance data and research capacity in order to answer important questions about the health of various population groups, including the elderly, included the following:

  • State Ambulatory Surgery Databases (SASD). Part of the Healthcare Cost and Utilization Project, the SASD are a set of databases from data organizations in participating States that capture surgeries performed on the same day in which patients are admitted and released.
  • Integrated Delivery System Research Network (IDSRN). A new model of field-based research designed by AHRQ, the network links the Nation's top researchers with some of the largest health care systems to conduct cutting-edge research on an accelerated timetable. As a group, the IDSRN provides health services in varied organizational care settings to over 34 million Americans, including Medicare and Medicaid patients.
  • Primary Care Practice-Based Research Networks. Funded in FY 2000, this project aims to build collaborative research networks of office-based primary care practices dedicated to improving health care at the community level.

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Research Agenda-Setting Conferences

In October 2000, AHRQ convened a meeting of experts in aging issues to inform the development of future research initiatives for improving health status in the elderly. Entitled Improving Functional Outcomes in Older People: Prioritizing a Research Agenda, the meeting was devoted to identifying the clinical and organizational interventions and financing mechanisms through which the U.S. health care system can most cost-effectively prevent disability, reduce functional decline, and extend life expectancy in older people. Cosponsored by the John A. Hartford Foundation, the Health Care Financing Administration, the Health Services Advisory Group, and the National Institute on Aging, it brought together nationally recognized experts in medicine, nursing, behavioral and social science, and health economics along with representatives of Federal agencies and private foundations to help refine and prioritize the research agenda.

The meeting complemented two earlier expert meetings convened by AHRQ in October 1999 and June 2000. The first meeting, entitled Future Directions for Residential Long-term Care Health Services Research , examined research issues—including cost effectiveness, care equity and access, and market incentives—as well as methodological concerns and alternative approaches to sample design and data collection in long-term care research in residential settings. The later meeting, entitled Future Directions for Community-Based Long-term Care Health Services Research, focused on similar research and policy questions, data gaps, and HHS data integration strategies for long-term care research in community-based settings.

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Interagency Collaboration to Enhance Research and Data Development

Several recent activities have provided AHRQ with input on developing a long-term care research and data plan to foster research that answers high-priority research and policy questions.

  • Beginning in February 2000, representatives from AHRQ, NCHS, HCFA, and ASPE have met several times to discuss what was learned from long-term care expert meetings convened by AHRQ and NCHS.
  • Working through AHRQ's User Liaison Program workshop on long-term care in September 2000, AHRQ asked State agency staff and State policymakers to prioritize their research needs in this area.
  • AHRQ has held discussions on research and data development with the National Advisory Council as well as with staff of other agencies (e.g., AoA and NIA), HHS committees (Provider Information Data Work Group [PIDWG], Essential Provider Information Circle [EPIC], and the Data Strategy Group), and other private sector organizations.

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Aging Research on AHRQ's Web Site

AHRQ's Internet site was redesigned in FY 2000 to include pages devoted to "Elderly Health Care" and "Long-term Care." Online visitors can read research findings from AHRQ-supported studies abstracted from AHRQ's newsletter and other information releases as well as other AHRQ reports and data relating to improving the health and health care of older Americans.

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Clinical Prevention

AHRQ provides administrative oversight and program support for the U.S. Preventive Services Task Force (USPSTF). In January 2000, AHRQ, the Health Resources and Services Administration, and the American Association of Retired Persons published Staying Healthy at 50+ for the USPSTF's Put Prevention Into Practice (PPIP) program. Already in development prior to the recommendations from the Task Force on Aging, the booklet gives information on healthy lifestyle choices, screening tests that help detect health conditions at treatable stages, and immunizations to help prevent diseases for which older people are at high risk.

Also, the USPSTF is currently reviewing the latest scientific evidence on a number of areas which are of concern to older people. Topics include:

  • Screening for depression and diabetes.
  • Risks of hormone replacement therapy.
  • Use of vitamin supplementation.

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Page last reviewed May 2001
Internet Citation: Improving the Health and Health Care of Older Americans: A Report of the AHRQ Task Force on Aging (continued). May 2001. Agency for Healthcare Research and Quality, Rockville, MD.