Conference on smoking cessation focuses on implementing
AHCPR-sponsored guideline in the medical community
One in every five deaths in America is due to tobacco use, and the number of young people who
begin to smoke increases each year. To address this continuing problem, smoking cessation
experts and advocates met in Washington, DC, on September 17 and 18 to mobilize the medical
community to implement the smoking cessation guideline released in April 1996 by the Agency
for Health Care Policy and Research. The guideline, which was developed by a multidisciplinary
panel of experts, targets primary care clinicians, smoking cessation specialists and programs,
health care administrators, insurers, and large purchasers of health insurance (e.g.,
employers).
The guideline underscores the critical role that primary care clinicians can play by encouraging
patients to quit smoking, and it provides step-by-step directions on how to achieve this goal.
According to the guideline, physicians, dentists, nurses, and other caregivers should ask patients
at every visit whether they smoke, record this information in the patient's file, and offer to help
smokers quit. The guideline panel found nicotine replacement therapy (nicotine patches or gum),
skills training, and clinician counseling (even as brief as 3 minutes) to be most effective.
The September 1996 conference addressed such issues as barriers to changing a health systems
approach to tobacco dependence and to reaching the medically underserved, examples of how to
make smoking cessation work, and reactions of stakeholders such as health systems, purchasers
and employers, and consumers. Also addressed were ways to change provider behavior, as well as
financing and reimbursement issues.
The conference, "AHCPR Smoking Cessation Guideline—Goals and Impact," was
sponsored by
the Society for Research on Nicotine and Tobacco, with support from The Robert Wood Johnson
Foundation, the Centers for Disease Control and Prevention's Office on Smoking and Health, and
the National Cancer Institute. The guideline is available in several formats: as a detailed clinical
practice guideline, a consumer pamphlet, a primary care clinician pamphlet, and a quick reference
guide for smoking cessation specialists; select Smoking Cessation for more information.
Institute of Medicine calls for fundamental changes in primary
health care
Fundamental changes are needed to improve and expand primary health care in the United States
in order to address the many challenges facing the Nation's health care system, according to a
new report by an Institute of Medicine (IOM) committee. Rapid and profound alterations in the
organization and financing of health care in the United States are forcing a shift away from costly
care by specialists and toward primary care physicians, who can diagnose and treat a wide range
of problems, notes the IOM committee.
In its report, the IOM committee recommends steps to provide all Americans with primary care
services and details a plan for creating a well-trained primary care work force that would increase
access to high-quality health care. In explaining the need to reshape primary care, the IOM
committee notes that the only Federal group charged with expanding the knowledge base for
primary care practice is the Agency for Health Care Policy and Research's Center for Primary
Care Research, which was formally established in July 1995.
Among several recommendations by the committee is creation of a nonprofit consortium of
professional societies, private foundations, government agencies, health care organizations, and
representatives from the public to coordinate efforts that will promote and enhance primary
care.
The Institute of Medicine is a private, nonprofit organization that provides health policy advice
under a congressional charter granted to the National Academy of Sciences. The committee's
work was supported in part by AHCPR.
The IOM report, Primary Care: Americas Health in a New Era, is available in two volumes from
the National Academy Press, 2101 Constitution Avenue, N.W., Washington, DC 20418; phone
800-624-6242. The cost is $42.95 (prepaid) plus shipping charges of $4.00 for the first copy;
subsequent copies are available at a reduced price. Call the National Academy Press for more
information.
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Announcements
AHCPR releases first evidence report on colorectal cancer
screening
The Agency for Health Care Policy and Research has released the first evidence report under its
new Evidence-based Practice Initiative. According to the report, evidence has shown that
screening is effective in detecting early-stage colorectal cancers and their precursors. Early
detection and treatment are the primary means of preventing deaths from colorectal cancer.
Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of
cancer death in the United States. In 1996, an estimated 133,500 new cases of colorectal cancer
were diagnosed, and colorectal cancer accounted for 54,900 deaths.
This evidence report is expected to improve the early detection and treatment of colorectal cancer
by giving clinicians and others state-of-the-art information on screening and diagnostic tests to
help them reduce the morbidity and mortality associated with this deadly disease, according to
AHCPR's Administrator, Clifton R. Gaus, Sc.D. AHCPR's Evidence-based Practice Initiative,
established in October 1996, will provide medical societies, health care systems, purchasers,
health plans, and others with a scientific foundation for developing and implementing their own
clinical practice guidelines, performance measures, and other quality improvement tools. In
December 1996, AHCPR issued a Request for Proposals to fund Evidence-based Practice Centers
to produce future evidence reports and also published a notice in the Federal Register inviting
nominations for report topics.
The Colorectal Cancer Screening Evidence Report is based on a systematic review of 3,500
citations from the scientific literature published between 1966 and 1994. The review found
evidence that a reduction in deaths from colorectal cancer can be achieved through detection and
treatment of early-stage colorectal cancers and the identification and removal of adenomatous
polyps, the precursors of colorectal cancer. Other evidence showed that:
- Colorectal cancer incidence rises with age, beginning around age 40, and is higher in men
than in women (60.4 versus 40.9 per 100,000 per year).
- Survival from colorectal cancer is closely related to the clinical and pathological stage of
the disease at diagnosis. Up to 90 percent of patients with cancer limited to the bowel wall
will be alive 5 years after diagnosis, compared with 35 to 60 percent of patients with
lymph node involvement, and less than 10 percent of patients with metastatic disease.
- Racial differences in colorectal cancer survival have been observed. The 1983 to 1989
5-year relative survival for colon cancer was 61 percent among white men, 50 percent
among white women, 48 percent among black men, and 49 percent among black women.
Black men and women with colorectal cancer have a 50 percent greater probability of
dying of colon cancer than do white men and women.
- Well-established risk factors for colorectal cancer include older age, male sex, history of
inflammatory bowel disease, certain hereditary conditions, and a family history of
colorectal cancer. However, about 75 percent of all colorectal cancer occurs in people
with no known risk factors.
- Most Americans are not screened for colorectal cancer. More than two-thirds of patients
present with advanced disease. Information from the National Health Interview Survey
(NHIS) indicates that in 1992, only 17.3 percent of people aged 50 and older had
undergone fecal occult blood testing the previous year, and 9.4 percent had undergone
sigmoidoscopy in the previous 3 years.
- Screening with fecal occult blood testing has been shown to reduce colorectal cancer
mortality. Screening with flexible sigmoidoscopy can reduce colorectal cancer mortality
risk, but clinical trials have not been performed that directly assess mortality reduction.
- Double contrast barium enema and colonoscopy are proven methods of identifying polyps
and colorectal cancer, but they have not been studied as screening tests.
- Further research is needed to demonstrate the effectiveness of colorectal cancer screening
tests and determine proper intervals for such testing.
The information contained in AHCPR's evidence report is the basis for a clinical practice
guideline by the American Gastroenterological Association (AGA) on colorectal cancer screening
scheduled for publication in the February issue of Gastroenterology. AGA led a
consortium that
directed an AHCPR-sponsored clinical practice guideline panel on colorectal cancer screening.
Work on the AHCPR-sponsored guideline was discontinued when the Agency ended its clinical
practice guideline program and began developing evidence reports. AGA then decided to sponsor
its own science-based guideline on colorectal cancer screening.
An Executive Summary (AHCPR Publication No. 97-0302) of the Colorectal Cancer Screening Evidence Report is available from the AHCPR Publications
Clearinghouse. Select for the summary of the report online.
AHCPR plans conference for summer '97
Mark your calendars now—July 20-23, 1997, will be the dates for the AHCPR-sponsored
conference, "Translating Evidence into Practice," to be held at the Renaissance Hotel,
Washington, DC. The conference will focus on evidence-based practice, including implementation
of guidelines, development and implementation of other quality improvement tools, and related
legal and ethical issues.
AHCPR funds studies to examine patient referral patterns and
the use of computers in clinical decisionmaking
The Agency for Health Care Policy and Research recently funded 13 new primary care research
projects: eight projects to determine how the referral of primary care patients to medical
specialists and other specialized services affects the quality and cost of health care; and five
projects to improve primary care services overall. Other studies recently funded by AHCPR will
explore the benefits of using computerized decision-support systems in everyday clinical practice.
These new studies are described below.
Primary Care Research
More than half of all Americans are now covered by managed care plans, which often require the
use of a primary care physician or gatekeeper to manage the referral of patients from primary to
specialty care. To strengthen the scientific base underpinning the referral policies of health plans,
AHCPR issued a call in early 1996 for research applications on the referral of patients to
specialists.
The following eight studies, with total estimated funding of $4.79 million, were chosen from
among the applicants. Each study will run for 2 years.
- Nephrologist Care and Outcomes in Renal Insufficiency (AHCPR grant HS09398).
Jerome L. Avorn, M.D., Brigham and Womens Hospital, Boston, MA. Total estimated
funding: $634,179. To investigate the appropriate timing of patient referrals to a
nephrologist prior to the diagnosis of end-stage renal disease (ESRD); to examine how use
of a nephrologist affects the clinical course and outcomes of ESRD; and to investigate
other related issues.
- Specialty Care in Closed Versus Open Access HMOs (AHCPR grant HS09414).
Jose
Escarce, M.D., University of Pennsylvania, Philadelphia, PA. Total estimated funding:
$707,328. To examine the use of primary care and specialist services by patients in a
closed-panel gatekeeper HMO plan versus those in a point-of-service (POS) plan. To
investigate whether primary care physicians refer patients in the two plans at different
rates and the factors influencing the choice of specialists.
- Referrals in Primary Care (AHCPR grant HS09397). Peter Franks, M.B.B.S., M.S.,
Highland Hospital, Rochester, NY. Total estimated funding: $469,112. To examine
variations in referral rates among primary care physicians in a large managed care
organization, as well as the characteristics of the patients, physicians, and practices
associated with the variations and the impact of referral rate variations on costs and
patient outcomes.
- Unmet Need and Use of Vision Care by Medicare Beneficiaries (AHCPR grant
HS09424). Carol Mangione, M.D., University of California, Los Angeles, School of
Medicine. Total estimated funding: $694,285. To investigate how the use of specialist
referrals and services may be affected by payment organization and examine the use of
vision care services for Medicare patients in fee-for-service versus capitated managed care
settings.
- Patterns of Referral and Care for Children on Medicaid (AHCPR grant HS09416).
James Perrin, M.D., Massachusetts General Hospital, Boston. Total estimated funding:
$245,892. To examine the consequences of referring children enrolled in Medicaid to
pediatric specialists, compared with adult specialists, for common and uncommon chronic
pediatric conditions.
- Specialty Referrals Among California Physician Groups (AHCPR grant HS09372).
Joseph Selby, M.D., Kaiser Foundation Research Institute, Oakland, CA. Total estimated
funding: $725,925. To examine the determinants of referral among 6,300 adult California
managed care patients with one of three common chronic conditions; the possible effect of
plans financial arrangements and utilization management techniques on referral decisions;
and the possible association between referral patterns and quality of care.
- Managed Care and the Primary-Specialty Care Interface (AHCPR grant HS09377).
Barbara Starfield, M.D., M.P.H., Ambulatory Sentinel Practice Network, Denver, CO.
Total estimated funding: $909,794. To characterize referral patterns by primary care
physicians and determine how those patterns and the coordination of referrals are
influenced by financial incentives and organizational controls imposed by managed care
organizations.
- Analysis of Physician Referrals of Medicare Patients (AHCPR grant HS09439).
Bruce C. Stuart, Ph.D., Pennsylvania State University, University Park. Total estimated
funding: $403,397. To characterize patterns of physician referrals and consultations in the
treatment of noninstitutionalized elderly and disabled Medicare beneficiaries and identify
differences in costs and patient outcomes associated with specialist referrals for treatment
of cardiovascular disease in Medicare patients.
In addition, AHCPR has funded five other studies, with total estimated funding of $3.54 million,
to improve primary care. Project periods vary from 2 to 4 years.
They are:
- Prevention and Competing Demands in Primary Care Practice (AHCPR grant
HS08776), 1996-1999. Principal investigator: Benjamin F. Crabtree, Ph.D., University of
Nebraska Medical Center, Omaha. Total estimated funding: $879,978. To investigate why
primary care physicians do or do not provide preventive health services as part of their
practice, and to study the competing demands on physicians for the delivery of medical
and clinical preventive services.
- Effective Organization of Adolescent Health Services (AHCPR grant HS08192),
1996-1998. Principal investigator: Jonathan B. Klein, M.D., University of Rochester
School of Medicine, Rochester, NY. Total estimated funding: $311,642. To analyze how
the organization of adolescent health services affects teenagers' access to care.
- State Service-Contingent Programs for Health Providers (AHCPR grant
HS09165),
1996-1999. Principal investigator: Donald E. Pathman, M.D., M.P.H., University of North
Carolina, Chapel Hill. Total estimated funding: $546,766. To evaluate the effectiveness of
State service-contingent programs and the various methods they use to reduce shortages
and inappropriate distribution of primary care providers.
- Health Education in an HMO: Effectiveness and Efficiency (AHCPR grant
HS08641), 1996-2000. Principal investigator: Ronald W. Toseland, Ph.D., State
University of New York, Albany. Total estimated funding: $1.22 million. To compare the
short- and long-term effects of a managed care program to teach health education, coping,
and other skills to individuals who care for their frail elderly spouses and to examine the
impact of the training on caregivers' and care recipients' health care utilization and costs.
- Couples' Preference for Prostate Cancer Screening. (AHCPR grant HS08992),
1996-1998. Principal investigator: Robert J. Volk, Ph.D., University of Texas Medical
Branch, Galveston. Total estimated funding: $586,610. To determine the appropriateness
of prostate cancer screening from the perspectives of men who have the disease and their
spouses. To examine differences in prostate-cancer-screening preferences among
Mexican-American, black, and non-Hispanic white husbands and wives.
Computerized Support for Clinical Decisionmaking
AHCPR will spend a total of $4.55 million over the next 3 years to support a series of studies that
will explore the benefits of using computerized decision-support systems in everyday clinical
practice. AHCPR expects that these projects will move medical decisionmaking computer
software programs beyond the laboratory and into primary care networks. The studies are
intended to determine whether everyday use of these systems can improve health care quality,
efficiency, and effectiveness at a reduced cost. Each project will focus on a clinical area where the
diagnosis and management of illnesses are suboptimal.
This research is a component of AHCPR's participation, as one of 12 member agencies, in the
High Performance Computing and Communications Program of the United States (HPCC) and in
the National Information Infrastructure (NII), an initiative of President Clinton and Vice President
Gore. HPCC and NII promote increased speed and capacity of computers and electronic
networks, as well as make the transmission and storage of data more secure.
AHCPR aims to link HPCC technology to community health needs, specifically in the areas of
computer-based patient records, computerized decision-support systems, and telemedicine. With
its research in these areas, AHCPR is evaluating promising technologies for measuring outcomes,
access, and costs of health care and for delivering improved quality of care.
These newly funded, 3-year studies will use networks such as the Internet as vehicles for
extending the use of computer systems beyond academic medical centers and into the offices of
primary care physicians. The following five studies were funded:
- Computerized Decision Support for Posttransplant Care (AHCPR grant
HS09407).
Principal investigator: Keith M. Sullivan, M.D., Fred Hutchinson Cancer Research Center,
Seattle, WA. Total estimated funding: $1.51 million. To look at improving primary care
physicians abilities to manage postdischarge bone marrow transplantation patients by
developing, implementing, and evaluating a World Wide Web-based computerized
decision-support system. Such a system would facilitate information exchange and guide
interactions among physicians in different locations and centrally located experts in bone
marrow transplantation.
- Family Linkages Supporting Hyperbilirubinemia Guidelines (AHCPR grant
HS09390). Principal investigator: Charles J. Homer, M.D., Childrens Hospital, Boston,
MA. Total estimated funding: $726,589. To develop and implement a computer-based
decision-support system that will improve access to patient records and practice guidelines
to help providers identify and treat infants at risk for developing significant medical
problems associated with hyperbilirubinemia.
- Depression Care Using Computerized Decision Support (AHCPR grant HS09421).
Principal investigator: Bruce L. Rollman, M.D., University of Pittsburgh, Pittsburgh, PA.
Total estimated funding: $644,409. To develop and implement a computerized
decision-support system that prompts primary care physicians to implement treatment
recommendations based upon the AHCPR-sponsored practice guideline on depression in
primary care and, subsequently, to conduct a randomized clinical trial of the clinical
outcomes and costs of providing care this way. To evaluate the effects of disseminating
the depression guideline by computer on physicians' knowledge, attitudes, and practices.
- Evaluating Computer Decision Support for Preventive Care (AHCPR grant
HS09507). Principal investigator: Stephen M. Downs, M.D., University of North
Carolina, Chapel Hill. Total estimated funding: $878,855. To expand and modify for
everyday use in pediatric office practices an existing guideline-based computerized
decision system for childhood preventive services and evaluate the effects of the system on
processes of care and outcomes of patients in private pediatric practices.
- Interactive, Guideline-Based Decision Support on the Web (AHCPR grant
HS09436). Principal investigator: David F. Lobach, M.D., Ph.D., Duke University
Medical Center, Durham, NC. Total estimated funding: $785,343. To create a clinical
decision-support system that uses a World Wide Web-based guideline server which is
directly accessible from electronic medical records systems and protects patient
confidentiality. To study the increased use of guideline recommendations by clinicians who
have access to the decision-support system.
In addition, AHCPR has funded one other study on computerized decision support through an
interagency agreement with the National Library of Medicine. The study, "Computerized
Decision-Support Deployment in Diverse Clinical Settings," will be led by Michael G. Kahn,
M.D., Ph.D., Barnes Jewish Hospital, St. Louis, MO. In this study, researchers will implement
and evaluate two computerized drug monitoring systems—DoseChecker and ADE
Monitor—and
design and implement a drug alert notification subsystem in different clinical settings within the
Washington University and Barnes Jewish Hospital health system. The alert notification
subsystem will be evaluated for differences in expert system performance, physician acceptance,
and clinical impact.
Registration deadline nears for AAHP managed care
conference
The "Building Bridges III: Translating Research into Action" research conference, sponsored by
the American Association of Health Plans and the Agency for Health Care Policy and Research,
will be held April 3-4, 1997, at the Doubletree Hotel in New Orleans, LA. You must register by
Friday, March 21, 1997, in order to take advantage of a reduced registration fee.
This is the third conference in a series that is intended to build bridges between the research
community and those who use the results of managed care research. Some of the topics to be
covered in plenary and breakout sessions include an overview of current research activities; how
research is being used by health plans, purchasers, and the research community; how financing and
organization affect health care outcomes; research on special populations; mental health and
managed care; innovations in performance measurement; consumer survey research; collaborative
research; risk assessment and quality of care; guidelines; and future challenges in managed care
research.
The registration fee is $400 until March 21, 1997, and $450 thereafter, including on-site
registration. For more information, contact the AAHP Registrar, 1129 20th Street, N.W., Suite
600, Washington, DC 20036; phone (202) 778-3269, fax (202) 778-8506.
New publications available from AHCPR and NTIS
The following publications and final reports are now available from the Agency for Health Care
Policy and Research and the National Technical Information Service (NTIS).
Health Technology Assessment. AHCPR's Center for Health Care Technology recently
published a Health Technology Assessment and a Health Technology Review. These reports,
which are now available from AHCPR, are usually prepared to assist federally financed health
care programs, such as Medicare and CHAMPUS (Civilian Health and Medical Program of the
Uniformed Services), with coverage decisions. Health Technology Assessments present detailed
analyses of the risks, clinical effectiveness, and uses of medical technologies. Health Technology
Reviews are usually composed when the available medical evidence is limited and the published
medical or scientific literature is insufficient in quality or quantity for a detailed assessment.
Hotta, S.S. (1996). Living Related Liver Transplantation: Health Technology Review No.
13 (AHCPR Publication No. 96-0059).
Liver transplantation is a successful and accepted procedure for the treatment of selected patients
who have end-stage liver disease. Since the first successful living related liver transplantation
(LRLT) was accomplished in 1989, other LRLTs, in which a segment or lobe of the liver from a
living donor is transplanted into a recipient, have been performed in medical centers around the
world. Results of the limited number of LRLTs performed indicate that the patient and graft
survival rates are comparable to the outcomes of liver transplants performed using cadaveric
livers. Almost all of the recipients have been infants or young children. Parents or other family
members served as donors and recovered from the surgical procedures without notable
complications. The report is available from the AHCPR Publications
Clearinghouse.
Holohan, T.V. and Handelsman, H. (1996). Lung-Volume Reduction Surgery for
End-Stage
Chronic Obstructive Pulmonary Disease: Health Technology Assessment No. 10 (AHCPR
Publication No. 96-0062).
Lung-volume reduction surgery (LVRS) has been proposed as a palliative treatment for selected
patients with diffuse emphysema and end-stage chronic obstructive pulmonary disease who have
failed conventional therapy. A number of surgical techniques have been used that are designed to
reduce lung volume by surgical resection or laser plication (tucking and folding to reduce size).
These techniques are designed to restore previous compromised lung elastic recoil so that
expiratory airflow obstruction is reduced, respiratory mechanics are improved, and disabling
dyspnea (labored breathing) is relieved. Preliminary data derived from both published and
unpublished sources indicate some favorable short-term benefits of LVRS. However, objective
postoperative data are available for only a small proportion of patients, and long-term followup
data are not available. In addition, these surgeries are associated with significant morbidity (and
an estimated surgical mortality rate of 6 percent) and prolonged hospital stays in a substantial
percentage of patients. Patient selection criteria are not uniform, and they are changing. In
addition, controversy continues concerning the most appropriate surgical techniques for various
categories of patients. The current data do not permit a logical and scientifically defensible
conclusion regarding the risks and benefits of LVRS, according to the authors. The report is available from the
National Technical Information Service.
Information to Guide Physician Practice.
With the ever-increasing scope and complexity
of
clinical information, clinicians often find it hard to stay abreast of current medical knowledge. To
better understand the dynamic environment in which medical information is organized and
disseminated, the Agency for Health Care Policy and Research, in collaboration with the
Department of Health and Human Services' Office of the Assistant Secretary for Planning and
Evaluation, sponsored a study to analyze sources of information available to physicians.
Researchers from The Lewin Group, of Fairfax, VA, reviewed 233 articles from the literature
relating to the information environment faced by clinicians, synthesized major themes, and created
an interactive database to allow easy access to this literature. In addition, they reviewed online
electronic information sources. The researchers analyzed the mechanisms that physicians use to
determine which information is most valuable and the effects of information use on physician
behavior and clinical practice patterns. Project findings were tested in three focus groups: both
attending and resident physicians in an academic medical center, and health care providers in a
small rural practice. Select for a summary of the study.
A
full report of the study and a four-disk
database are available as a set from the National Technical Information
Service (NTIS accession
no. PB97-500250; 102 pp, $50.00 set)
Oregon Consumer Scorecard Project: Final Report.
The final report of the Oregon
Consumer
Scorecard Project describes the development and testing of prototype consumer-oriented health
plan scorecard materials that can be used by other States in developing materials for their
residents. It includes copies of the consumer guide developed by the consortium and the Oregon
Health Plan consumer satisfaction survey used in this project. The primary purpose of scorecards
is to aid consumers in choosing a health plan that best meets their individual needs and
preferences for how health services are delivered. Scorecards are intended to aid consumer
decisionmaking in two ways: one, by providing comparative health plan information that is based
on the expressed information preferences of consumers, and two, by serving as an educational
tool in those areas of health plan performance where consumers lack understanding on how
various plans "manage" health care. A secondary goal is that the scorecard be suitable for use as a
comparative performance measurement tool that provides feedback to health plans, purchasers,
and State policymakers about how well health plans are performing and meeting the expectations
and needs of consumers. The materials were developed, with AHCPR support (contract
282-93-0036), by the Oregon Consumer Scorecard Consortium. This public/private consortium
represents a partnership between more than 50 active members, including analysts from the health
services research community and experts in consumer information and quality performance
measurement, representatives from most of the plans that participate in the Oregon Health Plan
Medicaid Program, and members of the community at large.
A limited number of copies of the
Oregon Consumer Scorecard Project: Final Report (AHCPR Publication No. 97-N008) are
available from the AHCPR Publications Clearinghouse.
Additional copies of the report are
available from the National Technical Information Service (NTIS
accession no. PB97-117758;
142 pp, $31.00 paper, $14.00 microfiche).
Former Surgeon General Koop to be honored
The Royal Society of Medicine Foundation will honor former Surgeon General of the United
States C. Everett Koop, M.D., at the Richard T. Hewitt Award Dinner to be held April 6, 1997,
at the Cosmos Club in Washington, DC. The awards dinner honoring Dr. Koop will be held in
conjunction with "Charting the Future of the Doctor-Patient Relationship," an international
conference for physicians in academia, industry, government, and clinical practice interested in the
doctor-patient relationship. The conference is being sponsored by the Royal Society and will be
held April 6-8, 1997, also at the Cosmos Club.
For more information or to register, contact Mrs. Wilda Gallagher at the Royal Society of
Medicine Foundation, 16 East 69th Street, New York, NY 10021; phone (212) 396-1103, fax
(212) 396-1104.
AHCPR announces the availability of a workbook and
audiotapes from the User Liaison Program
The Agency for Health Care Policy and Research's User Liaison Program has prepared two new
products on managed care: a 275-page, spiral-bound workbook developed especially for local
health officials, and a set of 10 audiotapes of a recent AHCPR-sponsored workshop intended for
both State and local health officials.
The workbook, Assessing Roles, Responsibilities, and Activities in a Managed Care Environment:
A Workbook for Local Health Officials, highlights the issues and questions that can help local
officials assess and implement alternative roles, responsibilities, and activities for their local health
departments (LHDs) in a managed care environment. In addition, it identifies key policy initiatives
that may be important for local officials to consider as they carry out policy development efforts
for their LHDs. Each chapter identifies a series of important questions that local health officials
will need to answer in the process of developing a strategic plan for their LHDs. Most chapters
conclude with a broader set of questions/issues that should help users synthesize the information
they collect and identify key action steps to be taken or decisions to be made.
This workbook is the result of a collaborative effort between User Liaison Program
and a public health work group comprising representatives from the National Association of
County and City Health Officials, the Association of State and Territorial Health Officials, and the
Association of Maternal and Child Health Programs.
Copies of the workbook (AHCPR
Publication No. 96-0057) are available from the AHCPR Publications
Clearinghouse.
A set of 10 audiotapes captures the presentations and discussions from the recent
AHCPR-sponsored workshop for State and local health officials, "Local Health Departments in a
Managed Care Environment: Challenges and Opportunities," which was held December 2-4, 1996,
in St. Louis, MO. Topics covered by presenters include an overview of selected States policy
directions, strengthening collaborations between public health and personal health care systems,
LHD involvement in the direct delivery of personal health care services, assessing the impact of
managed care on a community's health, and other high priority issues facing State and local health
officials. These tapes are available as a set (AHCPR Audiovisual No. 97-AV01) from the
AHCPR Publications Clearinghouse.
Attention Researchers: Proceedings Available
Copies of the proceedings from the Sixth Conference on Health Survey Research Methods, held in Breckenridge, CO, June 24-26, 1995, are available free from the University of Illinois. This 238-page volume contains 29 presentations organized into five sessions, as well as two discussion papers and a summary paper for each session. The sessions follow:
- Measuring medical care and health status.
- Research on survey questions.
- Sampling and cooperation.
- Special populations and sensitive issues.
- Integrating surveys and other data.
Copies may be ordered from Bernita Rusk, Survey Research Laboratory, University of Illinois, 909 West Oregon Street, Suite 300, Urbana, IL 61801l; fax: (217) 244-4408; E-mail: hsrm6@srl.uic.edu.
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