The Commonwealth Fund Annual Report

A.A.R.P.
$149,366
Feasibility of Developing a Model Physician Directory for Medicare Beneficiaries
AARP, in collaboration with the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA), will test the feasibility of assembling a physician directory that meets the standards recommended by a Fund-supported, NCQA-convened panel of experts. The directory will include information about physicians within a single market who care for Medicare beneficiaries in that community, whether through a Medicare preferred provider organization, health maintenance organization, or other setting. NCQA will provide technical assistance for the development and maintenance of the directory and a user guide, as well as conduct consumer testing. The AARP team will promote and disseminate the model directory. To create a blueprint for others to follow, the costs and process of developing and maintaining the online directory will be documented. CMS and AARP will supply cofunding for the project.

Institute for Safe Medication Practices
$285,211
Assessing Improvements in Medication Safety: A Follow-Up Survey of Safe Medication Practices in U.S. Hospitals
Frances Cooke Macgregor Grant
In 2000, the Institute for Safe Medication Practices, the Health Research and Educational Trust (HRET), and the American Hospital Association conducted a survey of medication safety practices among U.S. hospitals. Most of the nearly 1,500 responding organizations achieved a score of less than 50 percent on the use of nationally recommended safe practices for drug storage and distribution, medication labeling, communication of medication orders, and patient education. In the three intervening years, patient safety has been at the forefront of public debate about health care reform, and a Fund-supported HRET project developed tools to assist hospitals in improving medication safety. This project will re-survey U.S. hospitals and evaluate the current status of medication safety practices. Results will indicate where and how progress has occurred, providing lessons and examples of activities required to realize further gains. Cofunding will be provided by HRET.

Massachusetts General Hospital
$302,552
The Commonwealth Fund Quality Improvement Colloquia, Series II
In 2002, The Commonwealth Fund began funding a series of Quality Improvement Colloquia to: 1) synthesize the work of Fund grantees and others on strategies for improving the quality of health care; 2) develop recommendations for public policy changes, institutional improvement strategies, and a future research agenda; and 3) establish a network of private and public sector leaders who would disseminate this work within their own professional circles and advise the Fund about program priorities. The first grant supported two colloquia, one in November 2002, 'The Business Case for Quality,' and another in May 2003, 'Accelerating the Adoption of Information Technology.' This second grant will support follow-up activities from the first two colloquia, a fall 2003 colloquium centered on overuse of health care services and the business case for quality, and a spring 2004 colloquium on the promises and pitfalls associated with the collection and use of performance data.

Midwest Business Group on Health
$91,599
Improving Online Physician Directories in Chicago
Thousands of physician directory websites have been developed by hospitals, physician groups, health plans, state medical boards, and other organizations. Previous Fund-supported work showed that most of these websites have missing or out-of-date information, as well as severely limited search capabilities. Recent Fund support enabled the National Committee for Quality Assurance (NCQA) to convene an advisory group to create standards for physician directories. Based on the advisors' recommendations, the Midwest Business Group on Health will conduct a demonstration project in which a group of Chicago-based health plans, hospitals, and physician organizations will implement the recommended standards and evaluate the cost and value of doing so. This work should yield a blueprint for creating physician directories that meet NCQA-recommended standards.

President and Fellows of Harvard College
$252,844
Determining Whether Pay-for-Performance Incentives Improve Health Care Quality in Medical Groups
There is little empirical information to support the assumption that pay-for-performance incentives will lead to improved quality of care. This project will evaluate the impact of the PacifiCare Health System's Pay-for-Performance program, which was launched in January 2003 in more than 200 group practices in California. The study will examine whether aligning payment with standards of care can: 1) improve mean performance for 10 quality measures; 2) reduce variation in quality among physician groups; and 3) have a spillover effect on other measures of quality not directly linked to financial incentives. Project staff will compare changes in the performance of group practices in California with practices in Oregon and Washington that are not exposed to such incentives.

The Regents of the University of California
$278,019
Costs and Benefits of Implementing Electronic Medical Records in Solo/Small Group Practices
Electronic medical records (EMRs) can enhance the quality of patient care by minimizing errors and improving efficiency and coordination. Physicians' adoption of this technology has been slow, however, in part because the benefits and costs that doctors can expect should they invest in it have not been well documented. In visits to 15 doctors' offices across the country, project staff will document how EMRs affect workflow and collect empirical data on their costs and benefits. The team will analyze accounting and other administrative data to estimate the overall financial impact, including the expenses of acquiring and maintaining EMRs and the revenue derived from changes in productivity. Barriers and facilitators to implementation will also be described. By addressing physicians' most frequent questions and concerns about EMRs, this study could contribute to the broader diffusion of a technology with great potential.

Trustees of Dartmouth College
$81,158
Disseminating a Community-Based Strategy to Improve Health and Health Care
Through its Small Grants Fund, the Fund has supported the Dartmouth COOP Clinical Improvement System in the development and validation of How's Your Health, a community-based approach to improving health. The model, which uses results from a patient-completed online survey to address specific health issues within a single city or region, is now ready to be implemented and diffused. This project will bring together five communities in a collaborative effort to implement How's Your Health. Each participant will commit to: 1) conducting a community assessment using the survey; 2) analyzing the results of the assessment; 3) conducting health interventions as appropriate; and 4) reporting on their impact through biweekly conference calls and online progress reports. Project staff will provide technical assistance to the communities, organize and moderate conference calls, and oversee online communications. A final report will describe the diffusion effort and its impact within the participating communities.

Trustees of the University of Pennsylvania
$275,627
Coordinating Care Between Hospital and Home: Translating Research into Practice, Phase 1
Discontinuity in care for patients discharged from hospitals significantly compromises quality of care. Elderly patients with multiple chronic conditions are particularly vulnerable. A multidisciplinary research team based at the University of Pennsylvania School of Nursing has developed and tested in controlled trials an innovative model of care coordination delivered by advanced practice nurses to high-risk older adults who are making the difficult transition from hospital to home. This project will translate the research into practice at a major health care insurer, Aetna. During Phase 1, the investigators will: 1) convert assessment tools and intervention protocols into Web-based modules that could be used by any insurer, including Medicare, to implement the model; 2) develop clinical information systems, marketing tools, and educational materials for insurers and providers; and 3) test and evaluate the model's effectiveness and economic feasibility in preparation for large-scale implementation in Phase 2. If the model is successful, it would generate cost savings for providers and insurers and enhance quality through better coordination of care.

University of Colorado Health Sciences Center
$299,067
Improving Transitions in the Care of Older, Hospitalized Patients
Improving the coordination of post-hospital care for elderly, chronically ill patients has proved difficult. A major reason is the dearth of quality-of-care measures to help pinpoint problems that occur during the transition from one site of care to another. This project will refine and test the Care Transitions Measure, a tool that assesses problems in care coordination from the patient's perspective so that hospital systems can develop targeted solutions. An advisory committee representing organizations involved in furthering quality improvement at the health system and policy levels will provide guidance in the refinement and testing processes, and later will promote the measure's use by health care providers.

University of North Carolina at Chapel Hill
$101,418
Identifying Payment Policies to Improve the Business Case for Quality, Phase 1
A previous Fund-supported project showed that although quality-enhancing interventions may save health care dollars over the long run, from the providers' perspective the business case for these efforts is weak or nonexistent. In the first phase of this project, investigators will develop a process to identify categories of improvements undertaken by hospitals or health systems that are likely to yield financial payoffs for insurers, employers, or health care providers. They will also identify payment reforms, such as 'gain-sharing,' that could help eliminate barriers to adoption. If this work proceeds satisfactorily, support for a second phase of work would help project staff quantify the financial gap that must be closed to make it feasible for a health care delivery system to invest in the selected interventions. Phase 1 will yield a robust method for analyzing the business case for quality improvements, as well as a set of interventions appropriate for in-depth financial analyses in Phase 2.

University of North Carolina at Chapel Hill
$396,415
Investigating the Business Case for Quality in Medicaid, Phase 2
Payment policies often discourage health care providers from investing in quality-enhancing interventions. For this project, investigators will conduct in-depth financial analyses of six to eight Medicaid managed care organizations or state primary care case management programs to quantify the financial gap that must be closed to make certain health care interventions feasible. Project staff will select interventions that have been scientifically proven to be effective and are likely to yield financial payoffs for at least one party-the provider, the plan, or the state. This work will yield a robust method for analyzing the business case for quality improvement generally, as well as recommendations specifically for eliminating barriers to improvement in Medicaid.

AcademyHealth
$40,000
Experiences and Challenges in the Coordination of Chronic Care in the U.S. and Germany

Bailit Health Purchasing, LLC
$12,000
Beyond ROI: A Framework for Establishing a Business Case for Quality

Bridges to Excellence
$50,000
Developing Valid Measures of Hospital Efficiency

Brigham and Women's Hospital
$44,367
The Cost of a National Health Information Infrastructure

President and Fellows of Harvard College
$14,427
Legal Implications of Individual Physician Clinical Performance Measurement

President and Fellows of Harvard College
$15,000
Building Consensus to Develop, Test and Report Outpatient Measures of Quality - A Meeting of Key Stakeholders

Health Tech Strategies, LLC
$7,500
2004 Capitol Hill Steering Committee on Telehealth and Healthcare Informatics

Harris Interactive, Inc.
$10,000
Strategic Health Perspectives

The Massachusetts Health Quality Partners, Inc.
$19,568
Achieving Effective Public Release of Health Quality Information in Massachusetts: A Conference to Understand the Issues and Build Consensus and Establish a Roadmap

National Committee for Quality Assurance
$48,220
Performance Benchmarking of Physician Offices: Establishing the Foundations

Pacific Business Group on Health
$39,785
Exploring the State-of-the-Art in Measuring an Improving Phusician Quality and Efficiency

Joint Commission on Accreditation of Health Care Organizations
$124,955
Understanding Adverse Medical Events for Minority Patients with Limited English Proficiency
Adverse medical events related to miscommunication between patients and providers frequently occur in minority populations. This project seeks to determine the nature of communication-related errors experienced by minority patients with limited English proficiency. The investigators will: 1) describe and classify known process errors and preventable adverse events associated with communication problems in hospital settings; 2) analyze data collected from accredited hospitals in four different regions of the country to determine the relative rates of medical error in hospitals, patterns and predictors of error, and language factors associated with them; and 3) identify methods to prevent medical errors related to limited English proficiency. This work will aid in the development of strategies, standards, and policies intended to correct inequities in the provision of safe patient care to limited-English patients.

Medical College of Wisconsin
$169,046
Using Parent Mentors to Manage Asthma Care for Urban Minority Children, Phase 1
Asthma, the most prevalent chronic childhood illness, disproportionately affects minority children. This project will conduct a community-based trial to test whether minority parents trained as mentors could successfully coach other minority parents in managing their children's asthma. Activities in the first phase will include recruitment and training of parent mentors and recruitment of families. Funding for subsequent phases to evaluate outcomes and summarize the experiences of children, parents, mentors, and physicians would be requested if initial work proceeds satisfactorily. If this mentoring model is shown to be effective and is disseminated broadly, it could help to reduce hospitalizations and emergency room visits, lower costs for asthma care, reduce asthma morbidity, empower parents to manage their children's condition, and, ultimately, reduce racial and ethnic disparities in asthma care outcomes. The Medical College of Wisconsin and Robert Wood Johnson Foundation will provide cofunding for all project phases.

National Council on Interpreting in Health Care
$62,058
Establishing National Standards of Practice for Interpreters in Health Care
Lack of qualified interpreters is frequently cited as the greatest barrier to health care for patients who are not proficient in English. At present, there are no national standards defining the characteristics and competencies of a qualified medical interpreter. This project will implement a consensus-building process to develop a set of practice standards for interpreters working in health care settings. Project staff will: 1) examine other standards that have been developed in this country and abroad; 2) conduct focus groups with language interpreters to collect information on their roles; and 3) convene a committee of experts from the National Council on Interpreting in Health Care to review the data gathered and draft an initial set of standards. National standards will provide guideposts for improving the training of health care interpreters, which in turn could lead to a reduction in medical errors arising from miscommunication. The California Endowment will cofund this project.

National Health Law Program
$120,000
Improving Language Services in Small Physician Practices and Health Care Benefit Offices
An executive order issued in 2000 requires that federal agencies and entities that receive federal funding take 'reasonable steps' to ensure that clients with limited proficiency in English are able to access services. Building on its earlier Fund-supported work, the National Health Law Program (NHeLP) will identify and describe current models and best practices for providing patients with interpretation and other language assistance in a cost-effective manner. The effort will focus on solo or small group physician practices-where the majority of doctors practice and where language barriers are especially acute-as well as state and local enrollment offices for Medicaid and the State Children's Health Insurance Program. To obtain this information, NHeLP will rely on its listservs and extensive network of advocacy organizations. At the project's conclusion, health care providers will have a step-by-step framework to help them establish language assistance programs for their patients.

New York Academy of Medicine
$123,481
Examining Disparities in the Use of High-Volume Hospitals in New York City
For a number of medical procedures and conditions, patient outcomes are often better at hospitals that perform these procedures or treat these conditions at high rates. There is some evidence indicating that for certain procedures and conditions, white patients receive care at high-volume hospitals at greater rates than minority patients do. For this project, researchers will investigate the scope of these disparities and identify a range of policy solutions. The study will determine: 1) if racial disparities in the use of high-volume hospitals in fact exists; 2) whether such differences are lower among patients enrolled in managed care plans; 3) what the distinguishing characteristics of high-volume hospitals are; and 4) whether disparities are less pronounced for those conditions for which designated 'centers of excellence' exist. The project team will share findings with patient advocates, hospital and managed care officials, purchasers, and others to encourage them to take action. This grant will supplement a new project being undertaken by the Agency for Healthcare Research and Quality.

New York University
$235,089
Remote Simultaneous Medical Interpreting: Assessing Medical Outcomes, Phase 2
Recognizing that language barriers can seriously compromise the quality of patient care, health care providers and researchers are working to identify effective language interpretation practices. In Phase 1 of this project, the investigators initiated a trial to determine the comparative effectiveness and cost of remote simultaneous medical interpreting (RSMI), which allows doctors and their patients to communicate through wireless headsets. Preliminary results indicate that use of RSMI reduced interpreting errors by at least one-half compared with interpreting provided by family members, nurses, or office staff; its use also substantially reduced the length of physician visits. In Phase 2, the project team will compare the medical outcomes of patients provided with RSMI services to patients who relied on customary interpreting practices. The team will also complete a cost analysis of RSMI. Findings will be disseminated through the New York City Health and Hospitals Corporation. The California Endowment will provide cofunding.

Summit Health Institute for Research and Education, Inc.
$150,000
Informing Policymakers About Racial and Ethnic Disparities in Health Care
In the fall of 2003, the congressionally mandated National Healthcare Disparities Report will be published. For this project, the Summit Health Institute for Research and Education, Inc., will inform key policymakers of the report's findings as well as findings from the Institute of Medicine's 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which stimulated little public discussion of solutions. The project will include dissemination of highlights from the two reports, press conferences, and a congressional briefing. The Summit Health Institute will also provide information and technical assistance to national advocacy organizations-expected to include the National Black Caucus of State Legislators, National Native American AIDS Prevention Center, Asian and Pacific Islanders American Health Forum, and National Hispanic Medical Association-which promote policies that address health disparities. These efforts will contribute to the development of concrete policy recommendations for the reduction of health care disparities in the United States.

The National Quality Forum
$125,000
Using Informed Consent to Improve the Safety of Care for Patients with Limited English Proficiency
To help ensure patients' safety and meaningful participation in health care decisions, it is critical that physicians obtain their fully informed consent. The National Quality Forum has recommended that health care providers ask patients to recount what they have agreed to as a way to confirm that informed consent has indeed been given. Implementing this practice is challenging, however, particularly for providers who serve patients with low literacy and limited English proficiency. Focusing on individuals undergoing invasive surgical procedures, this project will address obstacles to adoption of this practice and develop recommendations to surmount them. Activities will include: 1) self-assessments by providers who regularly obtain confirmation of informed consent, 2) interviews with providers who do not follow this practice; 3) a case study examining the experiences of providers following the practice; and 4) a workshop to discuss experiences of early adopters of the practice. Findings will be used to develop a guide to obtaining informed consent for dissemination to health plan administrators, hospital personnel, and outpatient surgery providers.

University of South Florida Research Foundation
$124,999
Hospital Care for Hispanic Children: Improving Parent-Provider Communication
Research has shown that patients who are not proficient in English receive inferior health care. Most studies, however, have focused on adult patients. This project will enable children's hospitals to measure and improve the quality and safety of care they provide for Hispanic children whose parents have limited English proficiency. Through focus groups, project investigators will identify communication problems between parents and physicians and assess their impact on care. This information will be used to develop a health care quality survey for parents that will help assess language-related problems and needs. Survey results will help hospitals design programs and procedures to improve care for Hispanic children. The survey and a technical guide will be distributed through the Children's Hospital Accountability Initiative and the National Association of Children's Hospitals and Related Institutions.

American College of Physicians
$20,000
Third Annual National Health Communication Conference

American Public Health Association
$10,000
National Public Health Week 2004: Racial and Ethnic Disparities

Association for Health Center Affiliated Health Plans
$24,573
Recruiting and Retaining Specialty Physicians in Medicaid Managed Care and Community Health Centers, A Study of Challenges and Best Practices

Foundation for Informed Medical Decision Making
$24,868.79
Evaluation of a Decision Aid for Breast Cancer in an Underserved Population

Research Foundation of State University of New York
$25,000
The Fourth National Conference on Quality Health Care for Culturally Diverse Populations: Integrating Community Needs Into the National Health Agenda

President and Fellows of Harvard College
$800,000
The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy: Support for Program Direction and Fellowships, 2004-05
Addressing pervasive racial and ethnic disparities in health and health care requires trained, dedicated physicians who can lead efforts to improve minority Americans' access to medical services and quality of care. The Fellowship in Minority Health Policy has played an important role in addressing these needs. Under the direction of Joan Reede, M.D., the program has provided young physicians with an intensive year of coursework in health policy, public health, and management at the Harvard School of Public Health or John F. Kennedy School of Government, as well as special program activities-all with an emphasis on minority health issues. Since 1996, a total of 35 fellows have successfully completed the program and received a master's degree in public health or public administration. In the coming year, the program will select a ninth group of four fellows while providing current fellows with an enriched course of study, career development, and program evaluation.

American Academy of Pediatrics, Inc.
$458,978
Training Office Staff to Improve Preventive and Developmental Services in Pediatric Practices
Improving the quality of preventive health care and developmental services for children will require substantial changes in how this care is provided, from revamped appointment systems to new screening procedures. To be successful, such an effort will require the involvement of the entire staff of pediatric practices, not only physicians. The American Academy of Pediatrics (AAP) has proposed a practice-based quality improvement program that will be developed and evaluated through a collaboration of teams of administrative and clinical staff from 12 practices within a single region. The program will use a modular curriculum and resource toolkit that is based on work completed by previous Fund grantees (e.g., the National Initiative for Children's Healthcare Quality). The final program, which will become part of the AAP's ongoing educational activities, will be widely disseminated through the federally funded, multidisciplinary Bright Futures initiative to promote a system of high-quality preventive care for children.

Connecticut Children's Medical Center
$239,868
Strengthening the Developmental Surveillance and Referral Practices of Child Health Care Providers
Young children with developmental problems, and children at significant risk for those problems, are not being identified and referred as early as possible to intervention programs by their health care providers. Consequently, many children begin school with problems that could have been prevented or ameliorated. This project will develop a training program for child health care providers in developmental surveillance and in the use of a new centralized referral and case management system for children in need of services. The system will be in effect throughout Connecticut and accessible by a toll-free number. A national training model and materials for replication are expected to be a result of this work.

George Washington University
$199,996
Determining How States Invest in Early Child Development Under Medicaid and CHIP
The Fund's work with George Washington University has provided states with valuable guidance on maximizing the potential of Medicaid and the State Children's Health Insurance Program (CHIP) to deliver a full range of preventive care and developmental services to young children from low-income families. This project will provide states with further guidance by analyzing how program investment and design can affect the delivery of these services. The George Washington team will first compare key components of each state's Medicaid and CHIP programs, including provider network specifications, compensation arrangements for preventive services, medical necessity definitions, and standards of care. If this first stage proceeds satisfactorily, project staff will then undertake a more in-depth review of five states to gauge the impact of their program choices on the pediatric care provided to low-income families. State Medicaid and CHIP administrators will be able to draw from the successful approaches highlighted by this work in their efforts to improve delivery of child developmental services.

Mathematica Policy Research, Inc.
$202,133
Partnering with External Quality Improvement Organizations to Enhance Preventive and Developmental Care for Low-Income Children
All state Medicaid programs that employ risk-based managed care plans must contract with an outside entity to monitor the quality of health care provided by the plans. These entities, called external quality improvement organizations (EQIOs), play an increasingly important role in assessing and improving the quality of care provided to low-income individuals. This project will identify ways that state Medicaid agencies can work effectively with EQIOs to enhance the quality of preventive and developmental services provided to young Medicaid-enrolled children. Recent EQIO reports to state Medicaid agencies will be analyzed to measure the extent and quality of EQIO work in this area, while information obtained from interviews with Medicaid and EQIO staff in five states will locate exemplary EQIO contributions to improving preventive and developmental care.

Oregon Health & Science University
$307,287
Developing a Performance Measurement Tool for Pediatric Practices, Phase 2
Recent studies point to a gap between the kinds of preventive and developmental services parents want for their young children and the care they actually receive from pediatric practices. To highlight and quantify this gap, the Fund previously supported creation of the Promoting Healthy Development Survey (PHDS), a validated measure of care quality based on parents' reports. In a recent project, Christina Bethell developed a version of the PHDS that could be used to measure the quality of care at individual practices. The instrument was successfully pilot-tested at two practices in Vermont. The proposed project will test the revised PHDS in 10 additional practices to confirm the measure's psychometric properties and to establish norms against which practices can assess their performance-both of which are critical for national dissemination. Project staff also will develop templates for reporting results to pediatricians and health plan administrators.

Stanford University
$145,529
Achieving Consensus on Best Office Practices in Well Child Care
A number of unique approaches are available to improve particular aspects of well child care, but there is no comprehensive plan for providing developmental and other preventive services in an efficient and effective manner. This project will produce a practical, authoritative physician guide to best office practices in well child care, including research-based, technology-driven strategies to achieve them. The investigators will consolidate information on the latest health care innovations and consult with pediatric experts in order to generate key concepts and specific strategies. The resulting guide will be disseminated to pediatric practices through the meetings and publications of the American Academy of Pediatrics, the National Initiative for Child Health Quality, and other national organizations and agencies. Project staff also will collaborate with members of a national, practice-based pediatric research network to develop plans for implementing best practices in physician offices and testing their feasibility.

Trustees of Dartmouth College
$265,817
Addressing Maternal Depression: A Screening Project
Depression in mothers is associated with the occurrence of developmental problems in their young children, including impaired cognitive function, depression, and behavioral problems. Depression may also affect mothers' confidence and parenting skills. Addressing maternal depressive symptoms has been shown to improve behavioral outcomes for both mothers and children, and new guidelines emphasize that pediatricians should play a role in detecting depression. For this project, investigators will develop, implement, and evaluate the effectiveness of a model for screening and referral of mothers for depression in five primary pediatric practices. The feasibility and cost of implementation will also be assessed. If the evaluation demonstrates the model's value, project staff will prepare technical assistance materials for providers and health plans to facilitate replication.

University of Rochester
$63,836
Evaluating the Receipt and Quality of Anticipatory Guidance Provided to Parents of Young Children
Anticipatory guidance provided during well-child care visits helps promote parents' awareness of their young child's developmental milestones and needs. Such counseling can lead to better health outcomes while increasing parents' satisfaction with their pediatric providers. More information is needed, however, to determine which topics are brought up when pediatricians talk to parents and whether parents view these interactions positively. For this project, investigators will analyze a special supplement to the national Medical Expenditure Panel Survey that focuses on children's preventive care services. They will examine parents' experiences with their child's primary pediatric clinician, their receipt of anticipatory guidance, and the relationship between the two. Dissemination of the findings is expected to draw national attention to variations in the quality of children's preventive services and inform efforts to improve care.

Since March 2000, the Fund's Assuring Better Child Health and Development initiative has been implementing an ambitious strategy to help state Medicaid agencies promote and improve the delivery of developmental services for low-income children.The National Academy for State Health Policy launched a second consortium of four states, listed below, to enhance the healthy mental development of young low-income children. These grants were awarded during fiscal year 2003-04, with funds authorized during the prior fiscal year, 2002-03.

California Department of Health Services
$50,000
Best-PCP-Behavioral, Developmental, Emotional Screening and Treatment by Primary Provider in Medi-Cal Managed Care

Iowa Department of Human Services
$55,000
Iowa's Care for Kids Healthy Mental Development Initiative

Minnesota Department of Human Services
$55,000
Great Start Minnesota

Utah Department of Health
$53,455.42
Enhancing Utah's Capacity to Support Children's Healthy Mental Development

AcademyHealth
$3,000
2004 Child Health Services Research Meeting

Center for Health Care Strategies, Inc.
$22,367
Modernizing EPSDT: Developing an Operational Prototype for a 21st Century Medicaid Program

Center for Health Care Strategies, Inc.
$10,000
Barriers and Solutions to Improve Developmental Services through Early and Periodic Screening Diagnosis and Treatment Program

Center for Health Policy Development
$16,800
Pre-Conference on Quality in Children's Health at 17th Annual State Health Policy Conference

Center for Health Policy Development
$20,132
Assuring Better Child Health and Development Initiative (ABCD II): Expanding the State Consortium to Include Illinois

Health Management Associates
$36,400
State Opportunities to Improve Health Care Quality for Children

Johns Hopkins University
$12,963
Incorporating a Child Developmental Focus in State Title V Needs Assessments

National Academy of Sciences
$13,615
Conceptualizing of Child Health and Its Implications for Services

National Initiative for Children's Healthcare Quality
$7,500
3rd Annual Forum for Improving Children's Healthcare Quality

Tufts-New England Medical Center
$49,181
Office-Based Prevention of Child Behavior Problems: An Urban Extension Project

AcademyHealth
$102,077
The Commonwealth Fund/AcademyHealth Long-Term Care Colloquium
Although demand for long-term care services continues to grow, this important health care sector has been a relatively low priority for both policymakers and health services researchers. In addition, meaningful communication between these groups and collaboration on work have been limited. This Picker Program Grant will plan the first in a series of colloquia on long-term care to be sponsored by the Fund and AcademyHealth over the next five years. The meetings' goals are to focus attention on critical long-term care issues and problems, foster discussion and consensus among state and local policymakers, practitioners, and researchers on potential solutions to those issues, and identify the information gaps and research needed to solve the problems. Proceedings, slides, and commissioned papers from the meetings will be posted on the AcademyHealth and Fund Web sites.

Consumers Union of United States, Inc.
$189,044
Drawing Lessons from the Nursing Home Watch List
With partial support from the Fund, Consumers Union published its Nursing Home Watch List in 2000, 2001, and 2002 to help consumers avoid the worst-performing facilities in their state. Many homes appeared on the list in more than one year, suggesting that the Centers for Medicare and Medicaid Services has not realized its goal of ensuring that facilities achieve compliance with federal quality standards. This Picker Program Grant will: 1) update the watch list; 2) investigate why some facilities appear on the list repeatedly; 3) examine the characteristics of poor-performing facilities and relate those findings to the state's use of the regulatory process; 4) sponsor a meeting with regulators to design strategies that states can use to help nursing homes achieve and maintain better quality; and 5) determine whether low-performing homes on the watch list lose market share to high-performing homes. Findings and recommendations will be widely disseminated to consumers, policymakers, and regulators.

Manhattan Retirement Foundation
$150,000
Developing Tools for Achieving Resident-Centered Care in Nursing Homes
Most nursing homes are regimented, medically oriented environments. To transform them into settings where the individual resident is the focus, nursing home executives and administrators need detailed guidance on creating and sustaining new clinical and management processes. This Picker Program Grant will develop a set of tools to effectuate change in nursing home culture. Employing a variety of information technology systems, they will include: a text on leadership development; specific operational policies, procedures, and programs; an integrated human resources system; and a comprehensive system of quality improvement. The tool set will be targeted to providers, administrators-in-training, nursing home consultants, and others seeking to improve the quality of life for residents in long-term care facilities. Cofunding will be provided by the Sunflower Foundation of Kansas and the Kansas Foundation for Medical Care; additional cofunding is being sought.

Regents of the University of Minnesota
$259,997
Evaluation of Small Group Homes for Nursing Home Residents
The physical structures of virtually all of today's nursing homes will be obsolete by the time baby boomers start to turn 85 in 2032. Recognizing the need to move away from the institutional model that prevails today, the investigators on this Picker Program Grant will test the feasibility of establishing small group homes for the elderly that are designed to foster more resident-centered care. Focusing on the Mississippi-based Green House Project, which has so far established four group homes of 10 residents each, the evaluation will examine the operational, financial, and regulatory issues associated with the small group design and assess its impact on staff and residents. Lessons learned from the evaluation will be used to enhance and refine the prototype, develop templates for replication and self-evaluation, and establish the business case for this new way of caring for frail elders.

Spragens and Associates, LLC
$200,000
Wellspring Innovative Solutions: Replicating the Model
Many nursing homes are looking for evidence-based models to improve the care they provide to their frail elderly residents. Wellspring is one such model. But if replication of this model is to proceed, Wellspring Innovative Solutions will require support to build its capacity to recruit nursing homes and serve new and existing members. This Picker Program Grant will provide the crucial support needed to attract an able leader for the dissemination effort, develop professional education and training capabilities, establish a formal mentoring program for new alliance leaders, and develop marketing capacities. If the project is successful, a program-related investment will be contemplated for next year to help the organization reach a goal of 18 alliances, of about 10 nursing homes each, by 2005. This level of activity will enable Wellspring to function as a financially independent, nonprofit service business in the field of nursing home quality improvement. Cofunding is being sought.

The Regents of the University of California
$281,484
Enhancing Performance of the Long Term Care Ombudsman Program
The Long Term Care Ombudsman Program, authorized under the Older Americans Act, is charged with protecting and representing the interests of nursing home residents. Ombudsmen visit nursing homes to resolve complaints and quality problems. In many cases, however, the program is not fulfilling its mandate. Focusing on local programs in California and New York, this Picker Program Grant will identify factors that affect program performance by interviewing ombudsmen, selected state officials, and federal experts, and by examining data from the National Ombudsman Reporting System. A set of recommendations and a toolkit for states will be developed and shared with state policymakers, local program officials, and other critical audiences to stimulate adoption of best practices.

University of North Texas
$167,654
Empowering in Nursing Home Staff: Measuring the Impact of Self-Managed Work Teams, Phase 2
Improving the quality of nursing home care is heavily dependent on raising the performance of nurses' aides, the employees who interact with residents most frequently. Self-managed work teams have emerged as a potential remedy for the rampant absenteeism and turnover plaguing nursing homes. This Picker Program Grant is the second phase of a project to measure the impact of staff empowerment on job satisfaction and retention. Self-managed work teams were implemented in five nursing homes in Phase 1. Continued data collection in the five experimental homes and in five other facilities where work teams are not in use will allow project staff to compare levels of employee satisfaction and retention. If the work teams are shown to have a positive effect on nursing home staff, project staff will develop training modules and a 'how-to' manual for dissemination to nursing home administrators and long-term care educators.