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SAHSRP 1
SAHSRP 2
Top photo: SAHSRP research team members are (from left)
Dennis Duchon, Ruben Martinez, Miguel Bedolla, Cynthia
Perez-McCluskey, and Frank Moore. Sitting (from left) are
Michael Parchman, Donde Plowman and Miguel Bedolla.
Bottom photo: At a SAHRSP reception at UTSA are (from left)
Michael Parchman, Raymond T. Garza and Miguel Bedolla.

CPI awarded $1.3 million health services grant

By Chris Johnson
Culture and Policy Institute

(April 3, 2006)--The UTSA Culture and Policy Institute (CPI) recently was awarded a $1.3 million research grant by the Agency for Health Research and Quality, part of the U.S. Department of Health and Human Services.

The new grant underwrites the San Antonio Health Services Research Program (SAHSRP), a major collaborative effort involving faculty and research associates at UTSA, the UT Health Science Center at San Antonio (UTHSCSA) and the UT School of Public Health, San Antonio Regional Campus.

Research collaborations such as this provide opportunities to dovetail with the vision of the San Antonio Life Sciences Institute, which, through Texas Legislature approval in 2001, paved the way for the development and administration of joint research programs between UTSA and UTHSCSA.

By bringing together health services researchers from UTSA and UTHSCSA in joint research projects, SAHSRP exemplifies the massive research potential available in San Antonio and serves as a potential catalyst for future collaborative ventures between the two institutions.

The initiative is intended to enhance the capabilities of faculty conducting health services research, increase the number of faculty and graduate students involved in health services research, and fortify ties between health services researchers at UTSA and UTHSCSA.

Raymond Garza, UTSA professor of psychology and executive director of the Culture and Policy Institute, will serve as director and principal investigator on the grant. Donde Plowman, UTSA professor of management, will serve as co-principal investigator.

“This is a great opportunity for UTSA to establish new ties and strengthen existing ties with UTHSCSA in the area of health services research,” said Garza, who was notified several weeks ago of the award.

By providing complimentary expertise to this research endeavor, Garza and Plowman make a unique leadership team. Garza has an extensive extramural funding-track record and currently directs several million dollars of research grants, while Plowman has a number of significant publications in various health services outlets, including Health Services Research, Hospital & Health Services Administration, and Health Care Management Review.

“Receiving this grant is an important step toward establishing a health services research program at UTSA and with UTHSCSA,” said Plowman. “It also is important to the management doctoral program in the College of Business because we will be able to support doctoral students and research assistants through this grant.”

Four research projects are funded through the new grant, each of which focuses on a critical health services issue while aligning researchers from the two institutions. The projects tap areas of expertise of faculty members from a variety of disciplines.

The first project, “Direct Observation of Competing Demands for Diabetes Care: Understanding Ethnic Disparities in Care for Hispanics”, will be conducted by Bob Ferrer, UTHSCSA associate professor and deputy chair and director of research in the Department of Family and Community Medicine, Dorothy Flannagan, UTSA associate professor of psychology and dean of graduate programs, and Michael Parchman, UTHSCSA associate professor of family practice.

To be conducted over a 24-month period, the study will investigate how competing demands impact the quality and outcomes of care for Mexican-American patients with type 2 diabetes in primary care settings.

A team of three trained observers, all UTSA graduate students, will directly observe and record data on 100 diabetic patients during the patients' visits over a 12-month period. The team will to monitor the nature and types of competing demands including changes in health-habit counseling received by the patient, intensity of therapy for diabetes, adequacy of self-care support provided by primary care providers, and screening for and modification of risk factors such as blood pressure as well as screening for and detection of end-organ damage.

Trained observers also will audiotape each provider-patient visit to obtain information about self-care behaviors and knowledge and attitudes about diabetes. Patient interviews then will be conducted up to 12 months after patient enrollment.

In the second project, Garza; Stella Garcia-Lopez, associate professor of psychology; and Cynthia Perez-McCluskey, associate professor of criminal justice, will focus on “Enhancing Health-Conscious Attitudes and Behaviors Among Hispanic Youth.”

Because Hispanic children are an at-risk population in terms of health because of socioeconomic, educational and other factors, the ultimate goal of the research project is to promote healthy attitudes and behaviors among preadolescent and adolescent Mexican-American children.

The project aims to reduce the prevalence and prevent the onset of cigarette smoking and alcohol use; adopt nutritional eating habits while modifying unhealthy eating habits associated with obesity and diabetes risk; and increase physical activity.

Attitudes and behaviors regarding health and risk behaviors initially will be assessed among Hispanic youth, ages 10-14. Adoption of healthy lifestyles, attitudes and decisions among Hispanic youth most likely will reduce the demands on our health care system, curb health disparities and, in the long run, increase healthy life expectancy among Hispanics. Additionally, minority students will benefit by participating in the project providing opportunities for minority students to benefit in their participation in this project may in turn lead to careers in fields related to health services research and application.

The third study, conducted by Plowman, Dennis Duchon, professor of management, and Frank Moore, associate professor at the UT School of Public Health, San Antonio Regional Campus, will explore “Organizational Complexity and Decision Making in Health Facilities and Services in Relation to Quality Improvement, Patient Safety, and Human Resources”.

Project researchers seeks not only to understand the changes that health care organizations make in response to rapidly changing and turbulent environments, but also to develop an evidence-based system of decision-making to better meet goals of delivering the best possible patient care.

Examining the ways in which health care organizations are structured and how scarce and costly organizational and human resources are allocated most likely will serve as a key to improving safety, quality, productivity and worker morale in health care institutions that have an explicit focus on health issues related to priority populations.

These include racial and ethnic minorities, women, children, older adults, inner city and rural populations, low-income groups, and individuals with special health care needs, including those with disabilities as well as individuals in need of chronic or end-of-life health care.

Finally, Ruben Martinez, interim chair of the Department of Criminal Justice and professor of public administration, and Miguel Bedolla, UTHSCSA associate professor of family and community medicine, will research “Decision Making at the End of Life in Mexican American Elderly.” This study aims to fill the knowledge void concerning the views that Mexican American elders have regarding end-of-life support treatments (such as respirator and resuscitation) and physician-assisted suicide.

Through interviews with 300 Mexican American elders, the project will explore how socioeconomic status, acculturation, depression, capacity to perform daily living activities and religiosity are related to attitudes toward life support treatment and physician-assisted suicide at the end of life.

While increasing numbers of patients are dying at home, the majority of deaths continue to occur in hospitals, where patients may be subjected to aggressive life-sustaining therapies they may not have chosen had they known the range of options available to them.

Because many people make choices that avoid risk with regard to gains, and seek risk with regard to losses (for example, they are likely to pursue treatments that work over others that might not, and will pursue or accept risky treatments if they believe they will otherwise lose), the way in which end-of-life choices are framed can dramatically change patient decision-making and will be taken into account as a moderating factor in this project.

SAHSRP is the third current federally funded grant awarded to the Culture and Policy Institute, which also has secured funds for the South Texas Initiative for Mental-Health Research (STIMHR) and the Hispanic Leadership Program in Agriculture and Natural Resources (HLPANR).

CPI uses multidisciplinary approaches to conduct research in the areas of community development, health, literacy and the environment with an emphasis on how culture impacts and informs the dynamics within each of these areas in addition to policy development and analysis. The institute offers a variety of services to campus and community stakeholders, including research services and faculty grant development and implementation.

For more information on the San Antonio Health Services Research Program or the Culture and Policy Institute, call (210) 458-2650 or e-mail cpi@utsa.edu.

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