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Withdrawal/Redaction Sheet Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. talking points Personal (Partial) (1 page) ca. 1995 P6/b(6) COLLECTION: Clinton Presidential Records First Lady's Office Domestic Policy Council (Karen Guss) OA/Box Number: 5931 FOLDER TITLE: Epidemiology [2] 2012-0820-S ms480 RESTRICTION CODES Presidential Records Act - |44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information ((a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office ((a)(2) of the PRAJ b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRAJ an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy ((b)(6) of the FOIA] personal privacy [(a)(6) of the PRA b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions |(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells |(b)(9) of the FOIA] RR. Document will be reviewed upon request. AHCPR Article Reprint Agency for Health Care Policy and Research Methodological Challenges and Innovations in Patient Outcomes Research SERVICES. INDIAN USA U.S. Department of Health and Human Services HEALTH Public Health Service 8 Agency for Health Care Policy and Research MEDICAL CARE Volume 32, Number 7, PP JS13-JS21, Supplement © 1994, J.B. Lippincott Company Methodological Challenges and Innovations in Patient Outcomes Research CLAIRE W. MAKLAN, PHD, MPH, RICHARD GREENE, MD, PHD, AND MARY A. CUMMINGS, DRPH, RN Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying out their individual 5-year research plans, and through collaborative work of six Inter-PORT Work Groups, PORTs have contributed to methodological advances related to their specific clinical focus and to out- comes research in general. Each of the PORTs has followed a standard re- search model, involving the application of: systematic literature review, measurement of outcomes, analysis of cost and claims data, decision analy- sis, and strategies for disseminating findings. This article reports what has been learned by individual PORTs, and by AHCPR, regarding the usefulness of each of these methodologies, both for the ongoing projects and for the next generation of effectiveness research. Examples from individual PORTs and work groups illustrate some of the methodological gains that have been made in effectiveness research and provide a glimpse of the work that re- mains to be done. Key words: patient outcomes research; medical effective- ness research; effectiveness research methods. This supplement addresses some of the tient Outcomes Research Teams (PORTs), major methodological challenges in patient have been on the leading edge of methodo- outcomes/medical effectiveness research as logical developments for health services re- carried out under the auspices of the Agency search in general, and outcomes research in for Health Care Policy and Research (AHCPR). particular. In the case of PORTs, researchers It presents an inside look at collaborative ac- have been challenged to explore, adapt, and tivities that have helped pioneers in outcomes sometimes invent methods for dealing with research grapple with the difficult issues that new concepts and complex data. they faced in common. To address these challenges, while work- Many AHCPR investigators, and especially ing on their individual PORTs, repre- those involved in the projects known as Pa- sentatives of each PORT have participated in six "Inter-PORT Work Groups." These work groups are organized around research From the Agency for Health Care Policy and Research, activities in which all PORTs are engaged, Center for Medical Effectiveness Research, Rockville, namely: the measurement of outcomes, Maryland. analysis of the utilization and costs of health Address correspondence to: Claire W. Maklan, PHD, MPH, Agency for Health Care Policy and Research, care, systematic literature review, decision CMER, Suite 605, 2101 East Jefferson St., Rockville, MD modeling, and dissemination of research 20852. findings. The following six papers, by par- JS13 MAKLAN ET AL. MEDICAL CARE ticipants in each work group, describe and mately $48 million in fiscal year 1994. To discuss PORTs' collaborative deliberations date, these funds have supported over 150 on shared methodological problems and research projects. their individual solutions. The experience of PORTs are AHCPR's largest extramural re- PORTs is relevant to the next generation of search investments. The "PORTfolio" consists medical effectiveness research and to ongo- of 14 five-year projects (10 grants and 4 con- ing discussions about the need to tie health tracts) with average annual budgets of one care reform to a strong base of evidence re- million dollars. PORTs are multi-discipli- garding effective practice. nary, multi-faceted, multi-method, and multi- site. Each project focuses on a clinical condi- Medical Treatment tion or procedure(s) and tries to relate Effectiveness Program different patterns of clinical practice to differ- ent patient outcomes. The research teams in- Under the Medical Treatment Effective- clude both academicians and practicing clini- ness Program (MEDTEP), AHCPR carries cians, with expertise in the clinical subject as out a significant program of clinically ori- well as other pertinent disciplines and meth- ented extramural research. These studies ods, usually including epidemiology, statistics, break with both traditional health services economics, decision modeling, and outcomes research and with traditional clinical "effi- assessment. PORTs are distinguished from cacy" studies. As a result, they entail differ- other MEDTEP projects in part by their size ent types of data and methodological ap- and scope and in part by the expectation that proaches. MEDTEP research shifts the focus each will carry out a series of activities that in- of health services research from issues of or- cludes: systematic literature review and formal ganization and process to the outcomes of analysis; analysis of variations in practice pat- health care. Moreover, concern is with out- terns and patient outcomes; and dissemina- comes in the real world. MEDTEP research tion of findings and evaluation of the effects. is expected to address questions about what clinical interventions work best for typical Systematic Literature Review and Formal patients, cared for by typical health care Analysis providers. Another major new feature is MEDTEP's emphasis on outcomes that pa- PORTs carry out comprehensive reviews tients understand and care about. Thus, im- of the literature on the clinical condition or portant outcomes include quality of life, procedure(s) under study. If possible, one or functional capacity, symptom relief, and cost more quantitative synthesis (or meta-analy- (in contrast to physiological measures and sis) is conducted. The literature review has parameters that focus more on organs than multiple uses, including refinement of re- their owners). Questions of cost effective- search hypotheses, testing hypotheses, in- ness and appropriateness of treatment deci- put to decision models, and assessing qual- sions are other basic themes in this research. ity of the evidence. The substantive and methodological contributions of MEDTEP research have Analysis of Variations in Practice Patterns begun to emerge. The recognized potential and Patient Outcomes for policy-relevant findings has been a major factor in the substantially increased PORT investigators conduct extensive federal support. From fiscal year 1990, the analyses of clinical, administrative, and first full year of the program, the MEDTEP patient-reported data. Secondary data, espe- research budget has grown steadily from cially claims data from Medicare and other approximately $22 million to approxi- payors, are used to address questions of JS14 Vol. 32, No. 7, Supplement CHALLENGES IN OUTCOMES RESEARCH practice patterns, costs of care, and selected established. Each work group consisted of outcomes. Primary data (usually prospec- a primary and alternate representative tive) are collected to provide details of clini- from each of the PORT projects and two cal care and information about patient out- members of AHCPR staff. Over their more comes, including quality of life and physical than 4-year history, the work groups have and psychosocial functioning. carried out their activities through peri- odic conference calls and occasional face- Dissemination of Findings and to-face meetings. Evaluation of the Effects PORT and Inter-PORT work group expe- rience is now considerable. Four of the 14 MEDTEP places major emphasis on the PORTs are in their fifth (and final) year of importance of effective dissemination of work; seven more are in their fourth year. In research findings. Each PORT is expected this supplement, they share their experience to disseminate its findings to providers, with the broader community of researchers, patients and the public in a systematic and especially in terms of what has been learned scientific manner. The effects of the dissemi- about the adaptability and varied uses of nation are then evaluated in terms of "PORT methods" in effectiveness research change in practice patterns and, if possible and the contributions of PORTs to the de- within the funding period, in terms of pa- velopment of these methods. tient outcomes. In considering these issues, we take the view of program administrators who can Inter-PORT Work Groups step back from the individual work groups and from individual PORTs and attempt to In fall 1989, soon after award of the first draw general conclusions that reflect our PORTs, AHCPR sponsored a meeting for in- awareness of success and failure, competing vestigators on the four new projects, i.e., the objectives, hopes for the future, and the ad- PORTs on acute myocardial infarction, cata- vantage of hindsight. We will discuss some ract, low back pain, and prostate disease. of the accomplishments of individual work Participants held in-depth discussions re- groups and relate these to the continuing garding the data and methods necessary to evaluation and development of AHCPR's carry out their research. They concluded that medical effectiveness research program. it would be beneficial for the investigators, and helpful to AHCPR, for PORTs to main- Outcomes Assessment: Coming to Terms tain contact and exchange information With the Terms of Effectiveness Research across projects. To accomplish this, the PORTs proposed establishment of inter- At the heart of every PORT is the critical PORT working groups. These committees and difficult task of accurately identifying would serve to augment the talent of the in- and measuring the outcomes in terms of dividual PORTs with additional expert re- which treatment effectiveness is to be as- sources and perspectives, to facilitate con- sessed. All PORTs measure multiple out- sultations to complement that expertise comes, and they obtain these data from when necessary, and to provide forums for multiple sources, reflecting multiple per- discussion of common issues. spectives. In general terms, PORT outcomes Initially, five work groups were formed: Lit- typically include survival, morbidity, compli- erature Review and Meta-Analysis, Use of cations, physical functioning, and resource Claims Data, Decision Modeling, Outcomes use (cost, readmissions), as well as "softer" Assessment, and Cost of Care. In October outcomes such as overall health status, 1990, the Dissemination Work Group was symptom relief, role functioning, and satis- JS15 MAKLAN ET AL. MEDICAL CARE faction with care. Some outcomes data are of clinical conditions, and permit longitu- necessarily provided by physicians or payors dinal follow-up of individuals makes these and reflect their definition of the problem data extraordinary. But, PORT experience and their abstract experience of the patient's has tempered early enthusiasm about the condition. Other important outcomes are ability of claims data to answer effective- known only by patients, so pertinent infor- ness questions. mation must be obtained from them. The problems and potential of administra- The Outcomes Assessment Work Group tive data, especially Medicare data, have has focused its attention on these issues and been the focus of the Cost of Care and the influence of the clinical condition being Claims Data Work Groups. Although their studied on selection of measures, study de- specific interests are different, the experi- sign, data collection method, and data inter- ence of both groups has been a similar mix pretation, in particular. Underlying much of of frustrations and accomplishments. A ma- this group's activity is the early conclusion that jor problem affecting all PORTs is that the none of the existing measures of general only outcomes addressed in Medicare data health status or quality of life is clearly the are survival, subsequent morbidity (espe- "best" measure, i.e., no one measure is useful cially in terms of subsequent admissions, in all outcomes research. The most widely diagnoses and procedures), and costs. An- used and tested general measures, the Sick- other general problem, the limited informa- ness Impact Profile (SIP), the MOS Short- tion about the patient's clinical condition, Form General Health Survey (SF-36), and in- either at the time of treatment or sub- dices of activities of daily living, all have both sequent to it, precludes accurate classifica- strengths and weaknesses. This conclusion tion of patients with the same diagnosis by "freed" the PORTs to create new condition- severity, procedure, or resource use. For ex- specific measures and new versions of existing ample, the Medicare coding rules for acute measures for assessing outcomes in many myocardial infarction (AMI) lump together clinical entities. However, it also provides fur- patients admitted as "rule out AMI," pa- ther indication of the challenges that still lie tients with small infarcts and normal car- ahead, especially in view of proposals for a diac function, and patients with massive "health care report card." AMIs who are in extremis. Because the pa- tients may not be comparable, it is risky Claims Data Analysis and Cost of Care: to draw conclusions about observed vari- Secondary Data Take Second Place ations in the few outcomes that are cap- tured. All PORTs that deal with inpatient condi- PORTs quickly identified other serious tions affecting adults (11 of the 14 PORTs) limitations of the Medicare data, including have utilized Medicare claims data to de- the fact that bilateral anatomical structures scribe variations in practice and have tried (e.g., eyes, hips, knees) are not coded as to associate practice with outcomes. This left or right, and that for many important ef- approach is principally the result of opti- fectiveness questions, untreated patients mism about the usefulness and relatively cannot be identified at all. For example, al- low cost of secondary data in general, and though all Medicare patients who under- Medicare administrative data in particular, went gallbladder surgery can easily be iden- which is reflected in AHCPR's authorizing tified for any given time period, there is no legislation. The fact that the Medicare data- way to identify comparable patients who bases represent essentially the entire U.S. had symptoms of gallbladder disease, but population older than age 65, provide infor- who were treated conservatively or who mation about resource use for a vast array were not treated at all. Similarly, Medicare JS16 Vol. 32, No. 7, Supplement CHALLENGES IN OUTCOMES RESEARCH cost data only address Medicare-covered technique is extraordinary, because it can services, so there are no data, for example, elicit outcomes information from a sample on the use of outpatient drugs. of Medicare beneficiaries representative of PORTs have developed substantial exper- whatever characteristics are reported in the tise in building and linking complex patient- Uniform Hospital Discharge Summary. The specific administrative databases. Sharing of fact that the PORT was able to obtain a 92% experience and expertise within the Claims response rate in their survey further argues Data Analysis and Cost of Care Work Groups for this use of Medicare claims data.² has enabled PORTs to deal successfully with many tricky problems in these data: codes that Literature Review: You Can't Tell a Book (or change over time, idiosyncratic coding con- Journal) by Its Cover ventions, missing data, linking problems, and the logistics of managing enormous data sets. PORT literature reviews brought several PORTs have taken these data to their limits surprises. First, in carrying out systematic re- and, although those limits have been disap- views of published (and, occasionally, unpub- pointing in some cases, analyses of these data lished) studies pertinent to their topics, have also led to some very important findings. PORTs found that studies often failed even The Cataract PORT provides a good illus- the simplest tests of quality with regard to de- tration of innovation in the use of available sign. The Prostate Disease PORT performed a data. The PORT's analyses of Medicare data structured literature review to determine the suggested that the risk of retinal detachment, clinical course of localized prostate cancer, the while remaining low, is significantly in- effectiveness of radical surgery and radiation creased in cataract patients who sub- therapy, and treatment complications. Al- sequently undergo a procedure known as though they could compare complications as- Nd:YAG laser capsulotomy.¹ The lack of de- sociated with different treatments, they were tailed clinical information in the Medicare not able to determine the effectiveness of data precluded direct confirmation of this treatment for localized prostate cancer be- possibility, but these same data do afford a cause of methodologic inadequacies in the re- unique opportunity for examining some out- viewed literature.³ Other PORTs that con- comes of treatment. First, the vast number of ducted formal assessments of the quality of cases in the Medicare dataset enabled the the literature also found it very disappointing. PORT to identify individuals with this seri- PORT documentation of inadequacies in pub- ous, but very rare complication. This, in turn, lished studies are accompanied by specific made it possible to obtain medical records recommendations regarding the design and re- for these patients. With these detailed clinical porting of research (that may contribute even- records, it will be possible to test directly the tually to overall improvement in the litera- link between laser capsulotomy and elevated ture).4,5 risk of retinal detachment. Another surprise for some would-be Another very important use of Medicare meta-analysts was the result of different re- claims data was developed by the Prostate search traditions within various clinical ar- Disease PORT when they created a repre- eas. In the entire English language literature, sentative sample of Medicare beneficiaries there exists only one randomized controlled with early or localized prostate cancer who trial comparing radical prostatectomy to had undergone radical prostatectomy. The watchful waiting in localized prostate cancer PORT surveyed this cohort 2- to 4-years patients. The PORTs on Biliary Tract,* Total post-surgery to ascertain the prevalence of serious adverse effects of surgery such as in- Personal communication with Jesse Berlin, Biliary continence and impotence. The power of this Tract Disease PORT. JS17 MAKLAN ET AL. MEDICAL CARE Knee Replacement and Low Back Pain numbers of clinical trials. After carrying out found no relevant randomized clinical trials both traditional and cumulative meta- for certain common procedures.⁶ Thus, for analyses, the investigators concluded that some PORT conditions, statistical pooling of cumulative meta-analysis of a set of small data from published clinical trials to produce therapeutic trials can produce statistically new information could not be done, at least significant evidence of efficacy in advance of not in the conventional way. Although it is definitive large scale trial results. 8 extremely important to define rigorously the limited knowledge on treatment effective- Decision Analysis: Healthy Decision Trees ness in some fields, clinical literature con- Provide More Light than Shade sisting mostly of descriptive studies does not support definitive conclusions about the Each of the PORTs has developed (or is effectiveness of treatment. The results of developing) a decision model to help define PORT systematic literature reviews chal- the optimal path to the desired outcome, lenge directly "the inevitable tendency to let through a vast number of patient charac- sleeping dogmas lie."7 teristics and treatment options, and modi- As described in the paper by the Litera- fied by probabilities, patient utilities, risks, ture Review/Meta-Analysis Work Group, and costs. These complex models, which PORTs have been innovative in their use of may incorporate data from literature re- this relatively new research method. All views, claims data analysis, chart abstrac- PORTs have extended "formal" literature re- tion, and surveys, are designed to predict view approaches and criteria far beyond the various outcomes and/or costs for patients narrow range of traditional meta-analysis. with the same disease or clinical problem, Although the specific features that distin- but who present with different charac- guish the type of formal literature reviews teristics and who undergo different man- being carried out by PORTs are numerous agement strategies. For example, the model and subject to debate, several elements developed by the Ischemic Heart Disease stand out. Unlike the reviews that preface PORT examines the treatment alternatives most research reports (and grant applica- following cardiac catheterization, including tions), these reviews are distinguished by medical management, percutaneous trans- the fact that they are critical, systematic, luminal coronary angioplasty (PTCA), and usually quantitative and, at least theoreti- coronary artery bypass graft (CABG) sur- cally, reproducible. A full record of the meth- gery; and predicts the outcomes of each. ods and decision criteria, as well as the iden- The decision model of the Prostate Disease tity of the studies that were reviewed and PORT focuses on the expected length of life their place in the synthesis permits prospec- for men older than 65 with early prostate tive users of the review to assess the com- cancer who have a radical prostatectomy. prehensiveness of the search and the valid- Projections based on this model can con- ity of the conclusions. tribute to patient decisions relative to sur- Another innovative approach to literature gery vs. watchful waiting.9 The decision review advanced through PORT work fo- analysis being done by the Cataract PORT cuses on "cumulative" meta-analysis. will help to define strategies for managing Among PORTs, the literature review work cataract patients that optimize the tradeoff of the Acute Myocardial Infarction PORT between effectiveness and cost. This model was distinguished by the existence of large will project the impact of anticipated t Personal communication with Chris Callahan, Total $ Personal communication with John B. Wong, Is- Knee Replacement PORT. chemic Heart Disease PORT. JS18 Vol. 32, No. 7, Supplement CHALLENGES IN OUTCOMES RESEARCH changes in the demographic distribution of The Low Back Pain PORT has designed a the U.S. population on the cost-effectiveness program of continuing medical education of cataract care over the next 30 years. and "study groups" focused on informing The newness of applying decision model- primary care physicians, surgeons, and hos- ing and analysis to effectiveness research pital administrators about variations in rates prompted the Decision Modeling Work of surgery for low back pain. For patients, Group to develop a guide for selecting an ap- the PORT has developed an educational propriate model based on characteristics brochure and, in collaboration with investi- (e.g., acute VS. chronic, linear vs. nonlinear gators at Dartmouth Medical School, Mas- course of disease, anticipated outcomes, etc.) sachusetts General Hospital, and the Foun- of the clinical problem being studied and for dation for Informed Medical Decision assessing critical elements within the model. Making, an interactive video disk to provide Using each other's work as subjects of cri- information pertinent to treatment options. tique, PORT investigators compared and The effects of these diss emination strategies contrasted the benefits, strengths, limita- on practice patterns are being tested in a tions, and liabilities of alternative modeling randomized community-based study in strategies, including Markov models, deci- which five communities receive the inter- sion trees, and simulations. The framework vention and five serve as controls. that they developed, and present in their pa- Another avenue of PORT information dis- per, will assist reviewers in judging the ade- semination is through involvement in the quacy of decision models and will aid other development of AHCPR-sponsored clinical investigators in selecting an appropriate practice guidelines. The PORTs on Prostate strategy for building new models. Disease, Low Back Pain, and Cataract have all made important contributions to AHCPR Dissemination: Lost Findings guideline work in their respective clinical Lead Nowhere areas. 11,12 Exceeding the usual research expectation Conclusions of preparing results for the academic community, PORTs are also actively dis- In applying similar methods to distinct seminating their findings to community research questions, each PORT has faced a practitioners, patients, policymakers, and unique set of challenges, and, in the end, the public at large. Moreover, as described in each will have a different story to tell. A full the paper by the Dissemination Work Group, evaluation of the PORT approach must PORTs are using a variety of creative ap- await completion of the projects. Although proaches to accomplish effective dissemina- the work has gone along smoothly, there tion and assimilation, i.e., not merely to dis- have been some surprises and some disap- tribute materials. pointments. PORTs have dealt with these The Prostate Disease PORT has pioneered creatively, assisted in part by the Inter-PORT the use of interactive video disk technology Work Groups. Moreover, we all stand to to inform patients of the risks and benefits benefit from PORT and work group feed- of surgery and alternative treatments. Early back: the clinical literature can improve, results of the PORT's evaluation of this changes can be made in administrative data, method of disseminating information indi- and government programs can evolve to re- cate that patients with benign prostatic hy- flect experience and emerging needs. pertrophy, who have seen the video, tend to The now ample evidence of the worth of choose watchful waiting or conservative the PORT approach can be illustrated by medical treatment over surgery. 10 accomplishments of the Prostate Disease JS19 MAKLAN ET AL. MEDICAL CARE PORT. The work that has been completed to consensus in the United States that a ran- date illustrates how the individual compo- domized trial is needed to compare radical nents of the PORT model fit together to surgery to watchful waiting for men with lo- build complementary evidence and how this calized cancer. Although the PORT meth- multi-method approach can have enlarged ods, by themselves, do not resolve the effec- impact. In its examination of localized pros- tiveness question, they have uncovered an tate cancer treatment, the PORT has com- epidemic of radical surgical intervention pleted a comprehensive and critical review that is not supported by scientific evidence of the clinical literature; an analysis of Medi- of effectiveness. care data to reveal patterns of treatment in The strengths and limitations of the PORT elderly males in the United States; a 2- to model have been analyzed by AHCPR in 4-year post-operative survey of a repre- conjunction with PORT investigators, work sentative sample of men who were treated group members, and outside methodolo- with radical prostatectomy; and a decision gists. The methodological lessons, in par- model that weighs risks and benefits of radi- ticular our fuller understanding of the spe- cal prostatectomy as a function of patient cific possibilities and problems inherent in age. Each of these approaches has led to im- individual PORT methods and the total portant findings, as follows: PORT model, are reflected in our plans for the next generation of medical effectiveness The scientific literature provides no research. A new set of grants, the "PORT-IIs" hard evidence that radical prostatectomy that will be funded starting in mid 1994, will is an effective treatment for localized prostate cancer.³ continue the PORT tradition by tackling im- portant clinical questions and breaking new (In spite of this lack of evidence for methodological ground. 14:15 They will incor- clinical effectiveness), Medicare data show that the rate at which U.S. men older porate what has worked best in the original than 65 underwent radical surgery for PORTs into new research strategies that are prostate cancer increased more than 500% tailored to determining effective and inef- between 1984 and 1990. There was a fective therapies for a new set of common greater than 20-fold variation in radical clinical conditions. PORT-IIs will make ad- prostatectomy by state. 13 ditional methodological advances by apply- PORT data from a national survey of ing a broad set of research tools to measur- men who underwent radical prostatec- tomy reveal a much higher rate of serious ing the effectiveness of different clinical complications 2- to 4-years post-surgery strategies. The challenge for PORT II and for (e.g., 63% incontinence and 89% impo- the effectiveness research field is to design tence) than has been published in surgical research approaches that have both a high case series.² degree of internal validity and generalizabil- The PORT decision model shows ity. We have learned from the first 14 PORTs that, for men older than 70, even the that there is no simple formula for answer- most optimistic claims of benefit of radical prostatectomy treatment would ing medical effectiveness questions and that not result in significant enhancement in research methods must be tailored to each survival. Yet, half the prostatectomies specific problem. performed on Medicare patients are on As we eagerly await the final products of men age 70 and older.⁹ our original PORTs and look forward to PORT-IIs, we will continue to evaluate and Collectively, these powerful results have refine the strategies for effectiveness re- shaken complacent views about the effec- search when warranted. Through this con- tiveness and appropriateness of radical sur- tinuous, critical approach, we will build gery for prostate cancer. They have led to a both the quantity and quality of evidence JS20 Vol. 32, No. 7, Supplement CHALLENGES IN OUTCOMES RESEARCH on the effectiveness, appropriateness, and 6. Turner JA, Ersek M, Herron L, et al. Patient out- cost effectiveness of clinical interventions comes after lumbar spinal fusion: A comprehensive lit- and, simultaneously, we will strengthen the erature synthesis. JAMA 1992; 268:907. methods and measures for additional 7. Grimes DA. Technology follies: The uncritical ac- ceptance of medical innovation. JAMA 1993;269:3030. research. 8. Lau J. Antman EM, Jimenez-Silva J. et al. Cumula- tive meta-analysis of therapeutic trials for myocardial in- Acknowledgments farction. N Engl J Med 1992;327:248. 9. Fleming C, Wasson JH, Albertsen J, et al. A decision The authors thank Ira E. Raskin, PHD, and Risa J. Lavizzo-Mourey, MD, for their helpful comments. analysis of alternative treatment strategies for clinically localized prostate cancer, prostate patient outcomes re- search team. JAMA 1993;269:2650. References 10. Kasper JF, Mulley AG, Wennberg JE. Developing shared decision-making programs to improve the quality 1. Javitt JC, Vitale S, McBean AM, et al. National out- of health care, QRB 1992;18:183. comes of inpatient cataract extraction. 1. Retinal detach- 11. Clinical Practice Guideline, No. 4., Cataract in ment following inpatient surgery. Arch Ophthalmol 1991;98:896. Adults: Management of Functional Impairment, AHCPR Pub. No. 93-0542, Feb. 1993. 2. Fowler FJ Jr., Barry MJ, Lu-Yao G, et al. Patient- reported complications and follow-up treatment after 12. Clinical Practice Guideline, No. 8, Benign Pro- radical prostatectomy, the national Medicare experience: static Hyperplasia: Diagnosis and Treatment, Pub. No. 1988-1990. Urology 1993;42:622. 94-0582, Feb. 1994. 3. Wasson JH, Cushman CC, Bruskewitz RC, et al. A 13. Lu-Yao GL, McLerran D, Wasson J. et al. An structured literature review of treatment for localized assessment of radical prostatectomy: Time trends, prostate cancer. Arch Family Med 1993;2:487. geographic variation, and outcomes. JAMA 1993;269:2633. 4. Carson CA, Fine MJ, Smith MA, et al. Quality of published reports on the prognosis of community 14. Agency for Health Care Policy and Research, acquired pneumonia. J Gen Intern Med 1993;9:13. Medical Treatment Effectiveness Research: PORT-II. 5. Powe NR, Tielsch JM, Schein OD, et al. Rigor of re- Grant Announcement, August 1993. search methods in studies of the effectiveness and safety 15. Agency for Health Care Policy and Research, of cataract extraction with intraocular lens implantation. Medical Treatment Effectiveness Research: PORT-II. Arch Ophthalmol 1994;112:228. Grant Announcement, May 1994. JS21 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Executive Office Center, Suite 501 2101 East Jefferson Street Rockville, MD 20852 Official Business Penalty for Private Use $300 AHCPR AHCPR Pub. No. 94-0113 September 1994 AHCPR grant announcement Agency for Health Care Policy and Research August 1994 Executive Office Center, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. (301) 594-1360 Medical Treatment Effectiveness Research - Summary national activity for setting priority areas. AHCPR Ongoing Announcement urges applicants to submit grant applications with relevance to the specific objectives of this initiative. Agency for Health Care Policy and Research Potential applicants may obtain a copy of "Healthy People 2000" (full report: stock No. 017-001-00474-0 PA: PA-94-074 or summary report: stock No. 017-001-00473-1) from PT: 34; K.W. 0730021, 0408006 the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15205-7954; or by contacting the Purpose Government Printing Office order desk at telephone: (202) 783-3238. The Agency for Health Care Policy and Research (AHCPR) has ongoing interest in research under the Eligibility Requirements Medical Treatment Effectiveness Program (MEDTEP). Applications may be submitted by domestic and This grant announcement outlines the common themes foreign nonprofit organizations, public and private, inherent in all MEDTEP projects and identifies major including universities. clinics; units of State and local ongoing areas of research. MEDTEP research governments, nonprofit firms, and nonprofit encompasses three main areas of emphasis: foundations. Applications from minority and women (1) determining what clinical interventions are most investigators are encouraged. Foreign applicants are effective, cost effective, and appropriate: advised to contact the AHCPR Grants Management (2) methods and data to advance effectiveness Officer regarding limitations and special requirements research; and (3) dissemination and evaluation of the (see "Inquiries"). impact of research findings on clinical practice and outcomes. This announcement serves as a general Mechanisms of Support reference for other publications and contacts regarding The research project grant (R01) mechanism is the current MEDTEP research interests and award principal mechanism of support for MEDTEP research. mechanisms. The small grant (R03) mechanism is available for Healthy People 2000 projects that do not exceed 2 years and $50,000 in total direct costs for the entire project period. Responsibility The Public Health Service (PHS) is committed to for planning, direction, and execution of the proposed achieving the health promotion and disease prevention project is solely that of the applicant. objectives of "Healthy People 2000," a PHS-led In addition, AHCPR may issue requests for Note: This grant announcement amplifies a program applications (RFAs) and program announcement (PAs) announcement that appeared in the "NIH Guide for Grants and that announce new MEDTEP program interests and/or Contracts." Vol 23, No. 22, on June 10. 1994. It supersedes the "Medical Treatment Effectiveness Research" announcement the availability of other mechanisms of support for published in the "Federal Register" of August 14, 1990 (FR 55. MEDTEP research. For further information, contact 33170-33172). SERVICES. HUMAN USA U:S. Department of Health and Human Services Public Health Service the Center for Medical Effectiveness Research Multidisciplinary: MEDTEP research requires (CMER), the Center for Research Dissemination and theoretical and practical understanding of a wide range Liaison (CRDL), and/or the Center for General Health of clinical and nonclinical variables that determine the Services Extramural Research (CGHSER). Please structure, processes, and outcomes of health care. refer to the "Inquires" section for contact information Studies typically involve a team of researchers who (i.e., names, addresses, and telephone numbers). bring the knowledge and methodological expertise of both the clinical and social sciences, plus Research Objectives understanding of the perspectives of patients, MEDTEP Research Themes providers, and policymakers. Medical effectiveness research is a major component Types of Studies of the health services research agenda of AHCPR. MEDTEP research encompasses three main areas of MEDTEP grew out of awareness of significant emphasis: (1) determining what clinical interventions unexplained variations in clinical (medical, nursing, are most effective, cost effective, and appropriate; and allied health) practice and the inadequacy of (2) methods and data to advance effectiveness scientific evidence to support many practices and research; and (3) dissemination and evaluation of the procedures. MEDTEP projects assess the relative impact of research findings on clinical practice and effectiveness, cost effectiveness, and appropriateness outcomes. of available strategies for the prevention. diagnosis, treatment, and management of illness, in terms of 1. Clinical Studies patient outcomes. While MEDTEP research projects All MEDTEP clinical studies address the basic vary in focus, size, scope, methods, and complexity, all MEDTEP themes described above to obtain evidence are expected to be: for. or against. the effectiveness, cost effectiveness, Generalizable: "Effectiveness" research is and/or appropriateness of available interventions. concerned with the outcomes that can be expected in Most focus on a particular disease or clinical condition typical patients, receiving care in typical clinical and assess the outcomes associated with different situations, not with outcomes that can only be achieved interventions that are available for its prevention. in selected patients and in controlled clinical situations. diagnosis, treatment, and/or management. Some MEDTEP clinical studies focus on an established Thus. a critical feature of all MEDTEP projects is that the questions have broad applicability and the research technology or procedure. Of interest are conditions or design supports wide generalization of the findings. procedures that are common and costly, either in the Pragmatic: MEDTEP projects address questions general population or in a major subpopulation. Major categories of MEDTEP clinical studies are described that have high clinical and policy significance and are below: designed with attention to the eventual implementation Patient Outcomes Research Teams (PORTs) and of findings. They obtain empirical evidence or PORT-IIs. Between 1989 and 1992, AHCPR awarded strengthen the science base in ways that can directly 14 special MEDTEP projects known as Patient contribute to improved patient outcomes and Outcomes Research Teams (PORTs). PORTs are decisionmaking processes (including clinical practice distinguished from other MEDTEP clinical studies by guidelines). and to a more equitable and cost-effective their broad scope, multimethod approach to patient health care system. The usefulness of MEDTEP outcomes questions, and by the standard 5-year model research stems, in part, from MEDTEP's requirement they follow. AHCPR does not anticipate award of that the clinical problems and practices addressed are additional projects that use the PORT model. common and costly, and from attention to the realities In July 1993, AHCPR issued an RFA initiating a new of clinical practice. generation of MEDTEP research. called "PORT-II," Patient-centered: MEDTEP research evaluates with the first of these grants awarded in summer, 1994. health care in terms of outcomes that emphasize the An ongoing PA, "Medical Treatment Effectiveness patient's experience and perspectives. In addition to Research - PORT-II," was published in the NIH survival, morbidity, and complications, MEDTEP Guide for Grants and Contracts, Volume 23, Number studies consider patient-reported symptom relief, 18. on May 13, 1994. PORT-IIs continue the PORT functional capacity, quality of life, satisfaction with tradition by addressing important clinical questions and care, and economic burden. Demographic, social and breaking new methodological ground. They are cultural characteristics, as well as personal preferences distinguished from the original PORTs by their are important independent variables. individualized research strategies and from other 10 MEDTEP clinical projects by the expected direct effectiveness and cost effectiveness of care for impact of the empirical evidence they obtain on clinical conditions that are often undifferentiated, as they practice, patient outcomes, and health care policy. present in unselected or nonreferred populations, in PORT-IIs are not feasible or desirable in all clinical primary care settings, and the role of primary care areas. There must be sufficient existing information to physicians in enhancing the effectiveness and cost permit the formulation of effectiveness questions and effectiveness of care. For information, contact design of a research strategy tailored to the clinical CGHSER, Division of Primary Care, Dr. Carolyn problem and the population at risk, so that convincing Clancy, Director, telephone: (301) 594-1357, ext. 137. evidence of optimal patient care can be realistically expected within the project period. PORT-IIs focus on 2. Methodological Studies the establishment of direct linkages between practice Effectiveness research frequently requires new kinds and outcomes and on research methods that facilitate of data and analysis, and new applications of existing direct comparisons of two or more distinct clinical tools. MEDTEP supports projects that aim to strategies, e.g., medical vs. surgical treatment. For strengthen or define the limits of existing data and information on MEDTEP clinical studies, including develop or test measurement and data collection PORT-IIs, contact CMER. instruments, and analytic methods useful for outcomes Other MEDTEP Clinical Studies. The majority of research. For example, MEDTEP projects may MEDTEP clinical studies are designed to build the develop new outcomes measures, methods for linking science base in areas where a PORT-II is not currently or enhancing existing databases, methods to assess feasible or desirable. This includes research designed patient preferences, or methods for cross-cultural or to document patterns of practice, describe the natural international comparisons of patient outcomes. history of diseases, synthesize the evidence for various Methodological work may be the main focus of a clinical strategies, or answer relatively discrete project or may be embedded in a larger project. For effectiveness questions. Major ongoing program areas information on these studies, contact CMER or focus on pharmaceutical therapy, minority health, and CGHSER. primary care. 3. Dissemination and Evaluation Studies AHCPR's program of studies on pharmaceutical therapy, established in 1992. focuses on the Some MEDTEP projects focus on approaches or effectiveness and cost effectiveness of available technologies for achieving optimal dissemination and pharmaceutical interventions. especially the integration of new knowledge into practice. This relationships among drug therapy. other pharmaceutical includes research. demonstrations. and evaluations that services, and patient outcomes. Studies address examine issues of diffusion. awareness, acceptance, preventive. acute. or chronic treatment in inpatient, and adoption of research findings and clinical practice ambulatory. or long-term care settings. For further guidelines by health care providers and consumers. guidance, contact program staff in CMER (see For example, projects may examine the role of opinion "Inquiries"). leaders and practitioner study groups in influencing In 1991. AHCPR established a research program practice, or various approaches to enhancing patient focused on the effectiveness of current clinical practice participation in health care decisions. for health conditions of special significance among MEDTEP also supports studies to develop and racial and ethnic minorities. This program is evaluate clinical practice guidelines, information highlighted by the 11 MEDTEP Research Centers on systems, and clinical evaluation tools designed to help Minority Populations. which train minority practitioners and consumers make better health care investigators to develop and conduct effectiveness decisions. Contact CRDL regarding dissemination research. Although additional MEDTEP Minority studies. Contact CGHSER regarding evaluation Centers are not anticipated, AHCPR has continuing studies. interest in studies of the effectiveness of care related to Research Methods special problems in minority populations. For information, contact Dr. Miriam Kelly, CMER, MEDTEP studies draw on a wide range of research telephone: (301) 594-1485; or the Associate methods, especially those used in the clinical, Administrator for Minority Health, Dr. Morgan evaluative, and social sciences. The research design Jackson, telephone: (301) 594-6665. may he experimental, quasi-experimental, AHCPR's program of primary care research includes, observational. or a combination of designs. Any but is not limited 10, effectiveness research topics. appropriate type(s) of statistical analysis, modeling, or MEDTEP primary care studies focus on the synthesis may be proposed. Types and sources of data 3 may include: new, established, or adapted surveys of "Inquiries." AHCPR program staff also may provide patients or providers; clinical data obtained additional relevant information concerning this policy. prospectively, or from clinical registries, practice-based networks, or other health care providers; administrative Application Procedures data maintained by providers, insurers, or institutions; Applications are to be submitted on the grant and published research findings. Laboratory-based application form PHS 398 (rev. 9/91). They will be studies are not appropriate. accepted at the standard application deadlines indicated Applications must be explicit and detailed in in the application kit. (Until further notice, these dates describing data, methods, and tools for data collection are: February 1, June 1, and October 1.) State and and analysis. The research plan must be justified in local governments may use form PHS 5161 and follow terms of potential for answering the research questions accompanying requirements for copy submission. under study. Application kits are available at most institutional Applicants who propose to use Medicare or Medicaid offices of sponsored research or from the Office of data must specify the required data files and explore Grants Information, Division of Research Grants, NIH, the availability and cost of obtaining these data with Westwood Building, Room 449, Bethesda, MD 20892, the Health Care Financing Administration (HCFA). telephone: (301) 594-7248. For AHCPR, applications The estimated cost must be presented, along with may also be obtained from: documentation from HCFA, as part of the grant application. This cost should not be included in the Global Exchange, Inc. total budget request for the project. For more 7910 Woodmont Avenue, Suite 400 information about data budgets, contact AHCPR's Bethesda, MD 20814-3015 Grants Management Officer (see "Inquiries"). Telephone: (301) 656-3100 Fax: (301) 652-5264 Study Populations Inclusion of Women and Minorities in To receive a copy of an announcement referred to above, please contact Global Exchange. Or. if you Research Involving Human Subjects have a fax machine with a telephone handset, you may It is the policy of AHCPR that women and members use the AHCPR InstantFAX system. Dial (301) 594- of minority groups must be included in all AHCPR- 2800 and use the key pad on your receiver when supported health services research projects involving responding to prompts from this system. The human subjects, unless a clear and compelling rationale requested announcement will be faxed at the end of the and justification are provided that inclusion is ordering process. inappropriate with respect to the health of the subjects The completed. signed. original application and five or the purpose of the research. legible copies must be sent or delivered to: A new National Institutes of Health (NIH) policy resulting from the NIH Revitalization Act of 1993 Division of Research Grants (Section 492B of Public Law 103-43) supersedes and National Institutes of Health strengthens NIH's previous policies (concerning the Westwood Building. Room 240 inclusion of women and minorities in study Bethesda, MD 20892 populations), which were in effect since 1990 and The Division of Research Grants (DRG) will not which AHCPR had adopted. The new NIH policy accept any application in response to this contains some provisions that are substantially announcement that is essentially the same as one different from the 1990 policies. AHCPR plans to currently pending initial review, unless the applicant publish guidelines specific to AHCPR. In the interim, withdraws the pending application. The DRG will not AHCPR will follow the NIH guidelines. as applicable. All investigators proposing research involving human accept any application that is essentially the same as subjects should read the "NIH Guidelines for Inclusion one already reviewed. This does not preclude the of Women and Minorities as Subjects in Clinical submission of substantial revisions of applications Research," published in the Federal Register on March already reviewed, but such applications must include 9, 1994 (FR 59, 11146-11151) and reprinted in the NIH an introduction addressing the previous critique. Guide for Grants and Contracts, Volume 23. Number *Note: This mailing address is the central mailing address for 11. on March 18, 1994. NIH. Applicants who use express mail or a courier service are Investigators also may obtain copies of the NIH advised 10 follow the carrier's requirements for showing a street address. The address for the Westbard Building is: 5333 Westbard policy from AHCPR program staff listed under Avenue, Bethesda, MD 20816. 4 Review Procedures Direct inquiries regarding primary care, Upon receipt, applications will be reviewed for methodological studies, and evaluation studies to: completeness by the referral office, DRG. Incomplete Norman W. Weissman, Ph.D. applications will be returned to applicants without further consideration. Director, Center for General Health Services General review criteria for all grant applications are: Extramural Research (CGHSER) significance and originality from a scientific and Agency for Health Care Policy and Research technical viewpoint; adequacy of the method(s); Executive Office Center, Suite 502 availability of data or adequacy of plan to collect 2101 East Jefferson Street required data; qualifications and experience of the Rockville, MD 20852 principal investigator and proposed staff; adequacy of Telephone: (301) 594-1349, ext. 106 the plan for organizing and managing the project; reasonableness of the proposed budget; and adequacy Direct inquiries regarding dissemination studies to: of the facilities and resources available to the applicant. Phyllis M. Zucker An appropriate peer review group will evaluate Director, Center for Research Dissemination applications for scientific/technical merit in accordance and Liaison (CRDL) with the general criteria stated above, and any special Agency for Health Care Policy and Research review criteria applicable to an individual mechanism Executive Office Center, Suite 501 or as listed in specific announcements. 2101 East Jefferson Street Applications requesting total direct costs in excess of Rockville, MD 20852 $250,000 will be reviewed by AHCPR's National Advisory Council for Health Care Policy, Research, Telephone: (301) 594-1360 and Evaluation. The Council also may review Direct inquiries regarding fiscal matters. including applications requesting total direct costs in excess of budget justification for HCFA data. to: $50,000. Special Review Criteria Ralph L. Sloat Grants Management Officer Applicants are advised to refer to individual announcements and to contact the staff offices listed in Agency for Health Care Policy and Research Executive Office Center, Suite 601 the next column regarding special review criteria. 2101 East Jefferson Street Award Criteria Rockville. MD 20852 In making funding decisions, AHCPR will consider: Telephone: (301) 594-1447 quality of the proposed project as determined by peer review, program balance, and availability of funds. Authority and Regulations Inquiries This program is described in the Catalog of Federal As indicated above, several AHCPR offices are Domestic Assistance, Nos. 93.180 and 93.226. Awards involved in MEDTEP extramural research. Those are made under authorization of the Public Health considering applying in response to this announcement Service Act, Title IX 142 U.S.C. 299-299c-6 and are strongly encouraged to discuss their project with Section 1142 of the Social Security Act (42 U.S.C. appropriate AHCPR program administrators. AHCPR 1320b-12). Awards are administered under the PHS welcomes the opportunity to clarify any issues or Grants Policy Statement: and Regulations 42 CFR Part questions from potential applicants. 67, Subpart A; and 45 CFR Part 74 (45 CFR Part 92 For MEDTEP clinical studies, including PORT-IIs, for State and local governments). This program is not pharmaceutical outcomes, and other MEDTEP clinical subject to the intergovernmental review requirements studies; and related methodological studies. contact: of Executive Order 12372. Richard J. Greene, M.D., Ph.D. Director, Center for Medical Effectiveness The Public Health Service (PHS) strongly Research (CMER) encourages all grant recipients to provide a Agency for Health Care Policy and Research smoke-free workplace and promote the nonuse Executive Office Center, Suite 605 of all tobacco products. This is consistent with 2101 East Jefferson Street the PHS mission to protect and advance the Rockville, MD 20852 physical and mental health of the American Telephone: (301) 594-1485 people. 5 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Executive Office Center, Suite 501 2101 East Jefferson Street Rockville, MD 20852 Official Business Penalty for Private Use $300 AHCPR AHCPR Pub. No. 94-0089 August 1994 Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001. talking points Personal (Partial) (1 page) ca. 1995 P6/b(6) COLLECTION: Clinton Presidential Records First Lady's Office Domestic Policy Council (Karen Guss) OA/Box Number: 5931 FOLDER TITLE: Epidemiology [2] 2012-0820-S ms480 RESTRICTION CODES Presidential Records Act - (44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] PI National Security Classified Information |(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA| P2 Relating to the appointment to Federal office |(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency ((b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute |(b)(3) of the FOIA] financial information [(a)(4) of the PRA| b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors (a)(5) of the PRA b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA| b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. Talking Points for American Academy of [001] Otolaryngology - Head and Neck Surgery Thank you. It is a pleasure 10 be here leon Penetta asked me to let you know how sorry he is that he couldn't join you. P6/b(6) P6/b(6) can tell you that there are few people in this world who appreciate your work more than I do THE CLINTON ADMINISTRATION CONTINUES TO FIGHT FOR REAL HEALTH CARE REFORM. As you know, last year the Clinton Administration fought hard for health care reform. While we could not reach agreement on legislation, there can be little disagreement that the problems remain. Nearly 40 million Americans have no health insurance and millions more are just one pink slip or illness away from losing it. Eighty-four percent of the uninsured in 1993 were in working families. and more that 55 percent lived in families headed by full-time workers. And while health care costs have begun to slow down, they are continuing to rise at three times the rate of inflation. As the President said in his State of the Union address and in his December letter to the Congressional Leadership, we remain firmly committed to guaranteeing health security to all Americans and to containing health care costs for families, businesses and Federal, state and local governments. The President believes that we should take a step-by-step approach. This year, we can take the first steps. The Congress can and should: Reform the insurance market -- so that people don't lose their insurance when they lose their job or change jobs or a family member falls ill, and so that small businesses can afford to buy insurance for their workers. Make coverage affordable for and available to children. Help workers who lose their jobs keep their health insurance. Level the playing field for the self-employed by giving them the same tax treatment as other businesses. Help families provide long-term care for a sick parent or a disabled child. 1 Because their constituents are demanding action. some Republicans have begun to respond to the President's challenge by coming forward with proposals and bills. We look forward to working with them to take the first steps this year. Eut as we continue to work toward health reform. we must continually rémember that we have the highest quality of care. the most talented and dedicated health professionals. and the most advanced research institutions in the world. All health reform proposals must be measured by their ability both to fix what is wrong and to preserve what is right about our health care system. THE CLINTON ADMINISTRATION IS FIGHTING BACK TO PROTECT DOCTORS AND PATIENTS FROM SEVERE CUTS IN MEDICARE AND MEDICAID. cuttay Unfortunately, for too many Republicans in Congress, "health reform" has turned into the code word for slashing Medicare and Medicaid to pay for tax cuts for the number wealthy Republicans in the House and the Senate have talked about cutting both of Medicare and Medicaid by hundreds of billions of dollars: appears to slated Republicans have signaled their intention to out Medicare about $300 for billion between now and 2002. appomath Republicans have suggested cutting Federal Medicaid at least berry $180 to $190 billion between now and 2002. tageted spending cuts fir It's not hard to figure out what that means for the doctors and hospitals who treat patients receiving benefits under these programs, and for the patients themselves. It means significant cuts in payments to hospitals. physicians and other providers. additional the It means shifting a staggering financial burdens to elderly and disabled Medicare beneficiaries. Or to small businesses and families who will pay higher premiums and fees if these programs are slashed without overall reform. cut In many states. foreing them diap It means dropping coverage or shrinking. benefits for mothers and children on Medicaid. Or it means asking States to pick up the tab to preserve the Medicaid program, and in doing so, forcing them to raise taxes or slash set spending for services like education and public safety. As you have all said, spending cannot be ratcheted down without affecting access to and quality of care for mothers and children, and for the elderly and disabled. 2 The President presented a responsible budget to Congress -- a budget that made tough choices to get our rising deficit under control. but a budget that protected hard-working Americans and investments in our children. Now it is Congress' turn to act. To detail where they will get the cuts they need to pay for their tax cuts for-- the wealthy. To step forward with their plan for deficit reduction. The President has consistently said that we cannot get a hold of the deficit without passing meaningful health reform. Over the next five years alone, almost 40 percent of the growth in total Federal spending will come from rising costs in Federal health care programs. We must contain costs in these programs. But we must do it as we reform our health care system as a whole -- not by arbitrarily cutting programs that serve the most vulnerable Americans. That is not to say that these programs cannot and should not be improved. The Clinton Administration is committed to continuing to give States flexibility to reduce costs while maintaining coverage in their Medicaid programs. And we are committed to continuing to reduce regulatory burdens, streamline administration, and improve cost effectiveness in the Medicare program while increasing choices for beneficiaries and ensuring that quality of care is protected. These are the kind of changes that the Clinton Administration is doing now. And these are the kind of changes that we look forward to working with Congress on in the coming months. To note at the end: Unfortunately, I am on my way to another event so I will not be able to take questions. 3 Additional Notes for Speech 1. Anti-Smoking As you know, more than 400,000 smokers die each year from smoking-related illnesses. Tobacco use kills more people each year in the United States than AIDS, car accidents, alcohol, homicides, illegal drugs, suicides and fires combined. And the real tragedy is that these deaths are preventable. The Clinton Administration is committed to the nation's campaign against smoking and tobacco use. The Administration has a number of initiatives -- across a wide range of departments -- aimed at increasing awareness about the harmful effects of tobacco use and second-hand smoke and at preventing smoking. To take just a few examples. The Centers for Disease Control and the National Cancer Institute provide funds to States for education and prevention programs. The Environmental Protection Agency and HHS have united to voice support for the scientific evidence on the dangers of second-hand smoke. Armed with this evidence, the Public Health Service is working -- with health professionals -- to increase public awareness about the impact of second-hand smoke in the home on children's health. The Department of Labor is working against occupational exposure. The Department of Defense has banned smoking indoors in military installations. And, as I am sure you know, the Food and Drug Administration has undertaken a review to determine whether nicotine should be regulated as a drug. Perhaps most tragic is the epidemic of youth addiction to nicotine. A casual decision at a young age to use tobacco products can lead to addiction and serious disease. The Department of Education is spearheading efforts to educate children, particularly adolescents, about the dangers of tobacco use -- in order to prevent kids from smoking, hopefully before they start. In addition, our Goals 2000 legislation requires all schools to be smoke-free -- which will provide cleaner learning environments for all of our children. Your concern and leadership on tobacco issues has been extremely important and I urge you to continue those efforts. 2. Regulatory Reform I thought that all you should say about regulatory reform is what I included on the second page under the part about improving the Medicare and Medicaid programs. You could add that this is part of the Administration's overall regulatory review initiative to reduce the burdens of government and make it more responsive to its customers -- in this case the doctors and patients who must manage the maze of Medicare and Medicaid -- while ensuring health and safety. I am reluctant to include the specifics, because Elaine has been clear that this will be unveiled in a coordinated way. As you know, we are considering proposals to: (1) eliminate the physician attestation form; (2) change CLIA significantly; and (3) move to performance standards in reviewing and certifying hospitals, home health agencies and ESRD facilities (but not-nursing homes). 3. Medical Liability Reform We have not changed our policy from last year on medical liability reform, but, as you know, we have not yet discussed our position going forward. This group was not satisfied with the "modest" reforms in the Health Security Act (especially because we did not include caps on damages). I would not raise this issue in light of the debate this week on the Republicans' Common Sense Legal Reform Act and our strong public position against it. 4. Antitrust Relief Physicians want clear antitrust exemptions so that they can better compete in a marketplace increasingly dominated by managed care organizations and other insurance companies. As with medical malpractice, we have not changed our position, but we have not yet developed a policy for the coming months. The Justice Department has shortened review times and released nine antitrust policy statements to guide physicians and hospitals (i.e., describing joint ventures that will not violate antitrust laws). The physician and hospital groups see these policy statements as a good first step but believe that we have not gone far enough. Last year. a number of Republicans supported stronger antitrust relief (best known was the Hatch-Archer bill which delineated safe harbors for certain activity and provided for streamlined antitrust review). 03/29/95 11:19 202 219 6064 DOL OSHA A/S 0 001 U.S. Department of Labor Assistant Secretary for Occupational Salerv and Meann 01/07/ E Washington. D.C. 20210 THIRED STATES SEPARTMENT FACSIMILE TRANSMISSION DATE: MARCh 29, 1995 TO: Karen Goss FAX NUMBER: 456-7431 TELEPHONE NUMBER: NUMBER OF PAGES. INCLUDING COVER SHEET: 4 FROM: Nelson Reyneri TELEPHONE NUMBER: 2022196027 FAX NUMBER:- 202 219 6064 SPECIAL INSTRUCTIONS: 03/29/95 11:19 202 219 6064 DOL OSHA A/S 002 Susan Harwood Adam Finkel (202) 219-7075 Talking Points for Carol Rasco Society for Healthcare Epidemiology of America OSHA Regulations SHEA was an active participant in the development of the Bloodborne Pathogens Standard, published in 1991, and they have been involved in OSHA's ongoing activities related to occupational exposure to tuberculosis. We should acknowledge their participation and active involvement. Occupational Exposure to TB The regulatory activities of primary concern to this group are those that relate to occupational exposure to tuberculosis. At present, OSHA has two parallel activities: Ongoing enforcement activity Beginning in October of 1993, OSHA began nationwide enforcement activities to respond to the hazard of occupationally-acquired tuberculosis. This ongoing activity is based on OSHA's General Duty clause as well as other existing OSHA regulations. Guidance for many of the protective measures to be taken is found in the CDC guidelines for control of tuberculosis. Development of a TB standard OSHA is currently developing a proposed standard for occupational exposure to tuberculosis. OSHA recognizes the significance of CDC's TB guidelines and anticipates that they will serve as one of the primary bases for the proposed standard. We anticipate that the proposed standard will be published in Octobere of this year if there is no regulatory moratorium. Red Flag for TB The type of respirator required is far and away the most controversial issue related to this hazard. Both CDC and OSHA say that respirators are necessary under certain circumstances when the employee has contact with a person who has active TB. For example, if an infectious TB patient is in a hospital isolation room, employees entering the room must wear a respirator. 03/29/95 11:19 202 219 6064 DOL OSHA A/S 003 Question: Why does OSHA require expensive, uncomfortable HEPA respirators when there is no scientific evidence that they are necessary and that lighter, less expensive respirators work just as well? Answer: At present, the minimum respirator that meets the recommendations of the CDC TB guidelines is a high-efficiency particulate air (HEPA) respirator. This is currently the only respirator which is certified to filter out airborne particles in the size range of those which contain the tuberculosis organism. When the National Institute for Occupational Safety and Health (NIOSH) completes the revision of its respirator certification procedures, additional respirators may become available. Question: When will the revised NIOSH certification regulations be published and go into effect? Answer: (HHS will have to supply the answer.) Occupational Hepatitis B The following is information about a hazard that has been addressed by OSHA's standard for Bloodborne Pathogens. Since it is based on data from the CDC, it is important that we get agreement from HHS before this information is used by Carol Rasco in her speech. As soon as we have gotten agreement from HHS, we will let you know. In 1986, there were approximately 12,500 hepatitis B infections in high risk healthcare workers (those with frequent blood exposure) This dropped to 8, 8,700 in 1987, when CDC published its recommendations for the prevention of HIV transmission in the health care setting which included rigorous adherence to precautions designed to prevent exposure to blood. In 1987 and, to a greater extent, in 1988, OSHA began responding to complaints concerning occupational exposure to these hasards. In December of 1991, OSHA published the Loodborne Pathogens standard that went into effect the following year. By 1993, the number of hepatitis B infections in this group had dropped to 1, 450. This approximately 90% decrease in occupationally related hepatitis B infections over a seven year period is the result of the combined efforts of all those involved, including the exposed healthcare workers, the committees and individuals responsible for implementing precautions in the workplace, as well as CDC and OSHA. will In 1993, the most recent year that statistics were available, the Center for Infectious Diseases at CDC reported that the number of cases of hepatitis B in occupationally exposed workers had been reduced to 727. The primary factor enabling the reduction of occupationally related hepatitis B was in promulgation of OSHA's Bloodborne Pathogens Standard. Clearly, individuals such as the 03/29/95 11:20 202 219 6064 DOL OSHA A/S 004 members of SHEA have made a significant contribution to this reduction through your implementation of and commitment to programs designed to reduce exposures and to intervene when accidental exposures take place. This is a result we can all be proud of. Note: There will be individuals at this meeting who feel that OSHA's regulation had no impact, wasted money and they will get up and say so. The information above is taken directly from the revision from Health People 2000 and the individuals at CDC involved with this information are in agreement with the information. TEL: Mar 24 95 10:17 No.001 P.01 TRALTH PUBLIC PUBLIC SERVICE 'S'n 1798 DEPARTMENT OF HEALTH AND HUMAN SERVICES U.S. PUBLIC HEALTH SERVICE Agency for Health Care Policy and Research Office of Program Development Program Planning, Research Development, and Evaluation Branch Executive Office Center 2101 East Jefferson Street, Suite 603 Rockville, Maryland 20852 (301) 594-1455 TO: FAX number: 202 456-7431 Name: Karen Guss Organization: Old Executive Office Building Telephone: 202 456-7431 FROM: Name: Irma E. Arispe, Ph.D. Evaluation Officer FAX Number: (301) 594-2157 Number of pages including this page: 5 MESSAGE: March 24, 1995 TEL: Mar 24 95 10:17 No. 001 P.02 RUMAN SERVICES UNA DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service MIALIN 2 Agency for Health Care Policy and Research Rockville MD 20852 NOTE TO: Karen Guss, Assistant 10 the First Lady From: Irma Arispe, Evaluation Officer, Agency for Health Care Policy and Research Date: March 24, 1995 This note responds to your request for information to assist in the preparation of a speech for the Society for Healthcarc Epidemiology of America, Inc. (SHEA). If you have any questions about this information, please contact mc or Jill Bemstein at 301 594-1455. The Agency for Health Care Policy and Research (AHCPR), is an agency of the Public Health Service. Its primary mission is quality measurement and improvement. AHCPR works to improve quality of care by analyzing variations in current medical practice and examining the effectiveness of alternative treatments (through outcomes research, technology assessments, and the development of clinical practice guidelines) and developing mcasures of quality (clinical quality indicators for providers as well as quality measures for consumers and health care purchasers). Claire Maklan has provided you with information on outcomes research. The remainder of this note provides information on AHCPR's quality measurement and improvement activities. Defining Clinical Quality. Clinical performance measures (also sometimes called clinical quality indicators) allow you to answer questions such as - Was effective care provided to each patient? - Was it provided safely and in an appropriate time frame for each patient? - Was the outcome as good as could be expected given the patient's condition and personal characteristics and the current state of medical science? - Was care delivered, outcomes achieved, and pertinent information communicated in a manner that mccts patient's needs and expectations? Understanding and Choosing Clinical Quality Indicators AHCPR, working with the Center for Quality of Care Research and Education at the Harvard University School of Public Health and the Center for Health Policy Studies of Columbia, Maryland, has recently issued a report, "Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology." I enclosed a TEL: Mar 24 95 10:18 No 001 P.03 copy of the report with the packet of information prepared for you by Claire Maklan. The first chapter of the report provides a nice overview. The purpose of this project is to collect and analyze clinical performance measures currently used by public and private organizations. The federal government, and AHCPR in particular, has funded the development of many of the indicators and measurement tools used by public and private organizations to assess the quality of medical care. In addition, many private organizations have developed quality indicators. However, until now, there has been no single source of information on clinical quality measures, nor have there been any generally accepted criteria for evaluating the validity or usefulness of various measures. The "Measurement Typology Project" fills this gap. This is a two step project: 1. to collect clinical performance measures currently in use and create a classification system for describing and evaluating the incasures, and 2. 10 expand and validate the system to create a more comprehensive source of information on quality measures. The first step, which is completed, tells us what measures exist and are in use and provides ways to assess the validity and usefulness of quality measures. The project has identified over 1200 clinical performance measures used by government organizations (such as HCFA, the Department of Veterans Affairs, and AHCPR), - accrediting organizations (such as the Joint Commission on Accreditation of Healthcare Organizations and the National Committee on Quality Assurance), and private organizations such as the Bay Area Business Group on Health and United Health Care). The project develops a standard method for describing the measures, and this will facilitate a uniform system of quality measures. (See incoming letter from the Society for Healthcare Epidemiology). This report is available from the AHCPR Clcaringhouse at 1-800-358-9295. AHCPR will also make this report available through NTIS (the National Technical Information Service). The next step, which will begin next month, will expand, validate, and refine this classification scheme. AHCPR will be working in partnership with organization like the Joint Commission on Accreditation of Healthcare Organizations (mentioned in the SHEA 2 TEL: Mar 24 95 10:18 No 001 P.04 letter) to identify and promote valid quality incasures that permit systematic comparison of health care organizations. Developing New Quality Indicators. AHCPR is also sponsoring projects to develop clinical quality indicators. An important part of our research involves translating clinical practice guidelines into guideline-based incasures of quality. AHCPR has contracted with the American Medical Review Rescarch Center (AMRRC) to develop quality and utilization review criteria and performance measures based on three AHCPR-supported clinical practice guidelines (for urinary incontinence, acute postoperative pain, and benign prostatic hyperplasia or BPH). These measures have been tested in random samples of medical records of Medicare patients and have successfully targeted quality improvement opportunities. For example, the acute pain guideline recommends the development of a preoperative pain management plan in collaboration with the patient so that the patient will understand the surgical procedure, the type of pain he or she is likely to experience, and the methods available for relieving pain and the use of a scaled pain assessment tool to regularly cvaluate the patient's pain symptoms. The project found that typically these recommendations were not followed, yet hospital length of stay was significantly lower among patients whose care complied with these two guideline recommendations. By examining clinical performance using these guideline based measures, health care providers can identify ways to improve care. AHCPR is also working with Rand to develop clinical quality indicators based on the guidclines for cataract in adults and prediction and prevention of pressure ulcers. Quality Indicators for Consumer Choice. AHCPR's work has also shown that patients can provide information on the quality of care they receive. AHCPR has sponsored a number of consumer quality initiatives including a model survey to assess consumer attitudes about the accessibility, quality and effectiveness of health care they receive. Health Plans, employers, consumer advocacy groups, alliances, government agencies, and others will be able to use this survey to provide valid and comparable information from consumers about their health plans and providers. 3 TEL: Mar 24 95 10:19 No 001 P.05 a patient based tool to assess clinical quality, called "Patient Reports on System Performance" or PROSPER. This project collects objective information from patients on time to receive services ( access to care), communication between providers (coordination of care), and follow up after tests and treatment (continuity of care). These projects, which create rates of consumer satisfaction, consumer access, and clinical performance will also facilitate clinical qualtiy improvement. 4 Booom I Contacts Bob Irwin CDC CDC 6908598 Nelson Reynev, OSHA 219 6064 AHCPR Irma Asperi Arispe 301 594 5941455 NIOSH Sharon Morse, KathySybes respirators Jill Hargas, HHS 6906133 I Q & A Q: You mentioned the Administration's response to the risk of occupational exposure to tuberculosis. Physicians and other health care professionals are extremely worried about the spread of tuberculosis in hospitals. To protect themselves, they are supposed to wear TB respirators. However, the respirators that are approved for use in hospitals today are unsatisfactory. HEPA respirators, or "pappers" are so cumbersome and expensive that few people actually use them. The other type of approved respirator has been shown to leak in laboratory tests. The National Institute for Occupational Safety and Health has drafted regulations that will update the process by which TB respirators are tested. Under the proposed process, a new generation of respirators would be approved. These respirators will be extremely effective and less expensive than today's respirators. The health care industry, respirator manufacturers, and labor unions and other affected constituencies support the new regulations. Yet, due to the current anti-regulation climate, the Department of Health and Human Services and the Office of Management and Budget have failed to sign off on the new regulations so that they can go into effect. In the meantime, thousands of health care professionals are at risk of infection. What is being done to address this problem? A: I fully understand your concerns about the TB respirator regulations. I can assure you that the Administration is working hard to get the new regulations finalized and ready to go. Q: The Centers for Disease Control and Prevention are the world's leading authority on using epidemiology to improve public health. So why is CDC not involved the study of health care quality indicators, a very important aspect of epidemiology? A: Of course, CDC is very interested in health care quality management as part of its mission to control and prevent disease. For example, as you know, the National Center for Infectious Disease can play an important role in controlling the spread of infections in hospitals and other health care settings. CDC is also working with other agencies within the Public Health Service to develop a uniform set of performance indicators to be used in assessing the quality of health care in programs currently funded through block grants. However, healthcare quality management has aspects that go beyond control and prevention, so the agencies of the Department of Health and Human Services believe that spreading its healthcare quality management efforts around works best. Under the current system, AHCPR focuses on medical effectiveness and health services research. The Health Resources and Services Administration (HRSA), which is concerned with maternal and child health programs, rural and migrant health, and the care of persons with AIDS, focuses on the implementation of quality measures in health care settings 8 where these services are delivered. HRSA is also involved in the development of the health professions, and it concerns itself with integrating quality management into health education. The Substance Abuse and Mental Health Services Administration works on implementing quality measures related to the prevention and treatment of addictive and mental disorders. The Health Care Financing Administration applies quality indicators in its quality oversight and quality improvement efforts in the Medicaid and Medicare programs. And of course, all of these agencies are in communication with one another through Public Health Service workgroups. Q: I have heard that there have been many problems with the immunization program. Is this true, and if so, what is being done to fix the problems? A: Most of the President's Childhood Immunization Initiative have progressed quite smoothly. As I mentioned before, we've helped states extend clinic hours and made it easier to keep parents and providers on the appropriate vaccination schedule. The Vaccines for Children program has been attacked by some on Capitol Hill and by some vaccine manufacturers. But we are working out issues in the program including those related to the complaints of vaccine manufacturers that they must sell too much vaccine at a discounted price. At the same time, evidence of the program's effectiveness is becoming available -- a recent study revealed that the Vaccines for Children program in New York has allowed the state to provide more vaccinations to children in the primary care setting where they first receive care. And more and more public and private health care providers are getting involved. By January 1995, 20,000 private provider sites and 8,000 public provider sites were already enrolled. And 36 states have reported that they have centralized distribution systems in place to ship vaccines to public and private providers, with the remaining participating states and the District of Columbia distributing vaccines to a portion of enrolled providers. We remain committed to this program, and we invite you all to get involved. So I want to remind you that National Infant Immunization Week -- a week of community outreach highlighting the role we can all play in protecting our children from disease - - is coming up at the end of April. 9 The White House withing mm <<<<<<<<0 <<<<<<<< <<<<<<<< ####### name <<<<<<<01 #### DOMESTIC POLICY FACSIMILE TRANSMISSION COVER SHEET TO: Dr. Yamauchi FAX NUMBER: 501 320 3418 TELEPHONE NUMBER: FROM: Karen GUSS TELEPHONE NUMBER: 202 2/4 456-5603 PAGES (INCLUDING COVER): COMMENTS: Carol asked me to let you know how flattered we are that you are interested in having this speech! Karen Talking Points for Society for Healthcare Epidemiology of America, Inc. Thank you for that kind introduction. It is truly a pleasure to be here and to visit with you all and with my dear friend Dr. Yamauchi. As I'm sure you all agree, Dr. Yamauchi is a credit to the medical profession and to this association. His tireless efforts in the areas of children's health and AIDS, the depth and breadth of his knowledge on a variety of topics, his dedicated public service, and his good humor have all been an inspiration to me at one time or another. Dr. Yamauchi and I spent a great deal of time working together -- and battling the state legislature together -- when we both worked for Bill Clinton in the Governor's office in Arkansas, and I can tell you, it would be wonderful to have him as an on-the-scene ally in Washington today. So thank you all for having me here. I want to touch on about four different areas today that I think will be of interest to you. I am going to talk about health care reform, quality management research within the Clinton Administration, our efforts to fight the on-the-job infection of health care workers and the President's Childhood Immunization Initiative. THE CLINTON ADMINISTRATION CONTINUES TO FIGHT FOR REAL HEALTH CARE REFORM. As you know, last year the Clinton Administration fought hard for health care reform. While we could not reach agreement on legislation, there can be little disagreement that the problems remain. Nearly 40 million Americans have no health insurance and millions more are just one pink slip or illness away from losing it. Eighty-four percent of the uninsured in 1993 were in working families, and more that 55 percent lived in families headed by full-time workers. And while health care costs have begun to slow down, they are continuing to rise at three times the rate of inflation. As the President said in his State of the Union address and in his December letter to the Congressional Leadership, we remain firmly committed to guaranteeing health security to all Americans and to containing health care costs for families, businesses and Federal, state and local governments. The President believes that we should take a step-by-step approach. This year, we can take the first steps. The Congress can and should: Reform the insurance market -- so that people don't lose their insurance when they lose their job or change jobs or a family member falls ill, and so that small businesses can afford to buy insurance for their workers. Make coverage affordable for and available to children. Help workers who lose their jobs keep their health insurance. Level the playing field for the self-employed by giving them the same tax treatment as other businesses. Help families provide long-term care for a sick parent or a disabled child. Because their constituents are demanding action, some Republicans have begun to respond to the President's challenge by coming forward with proposals and bills. We look forward to working with them to take the first steps this year. But as we continue to work toward health reform, we must continually remember that we have the highest quality of care, the most talented and dedicated health professionals, and the most advanced research institutions in the world. All health reform proposals must be measured by their ability both to fix what is wrong and to preserve what is right about our health care system. THE CLINTON ADMINISTRATION IS FIGHTING BACK TO PROTECT DOCTORS AND PATIENTS FROM SEVERE CUTS IN MEDICARE AND MEDICAID. Unfortunately, for too many Republicans in Congress, "health reform" has turned into the code word for cutting Medicare and Medicaid to pay for tax cuts for the wealthy. A number of Republicans in the House and the Senate have talked about cutting both Medicare and Medicaid by hundreds of billions of dollars. It now appears that Medicare will be slated to be cut by about $300 billion between now and 2002. It also appears that Medicaid is being targeted for at least $180 to $190 billion in spending cuts between now and 2002. It's not hard to figure out what that means for the doctors and hospitals who treat patients receiving benefits under these programs, and for the patients themselves. It means significant cuts in payments to hospitals, physicians and other providers. It means shifting additional financial burdens to the elderly and disabled. Or to small businesses and families who will pay higher premiums and fees if these programs are cut without overall reform. In many states, it means being forced to drop coverage or shrink benefits for mothers and children on Medicaid. Or it means asking States to pick up the tab to preserve the Medicaid program, and in doing so, forcing them to raise taxes or cut spending for services like education and public safety. 2 The President presented a responsible budget to Congress -- a budget that made tough choices to get our rising deficit under control, but a budget that protected hard- working Americans and investments in our children. Now it is Congress' turn to act. To detail where they will get the cuts they need to pay for their tax cuts for the wealthy. To step forward with their plan for deficit reduction. The President has consistently said that we cannot get a hold of the deficit without passing meaningful health reform. Over the next five years alone, almost 40 percent of the growth in total Federal spending will come from rising costs in Federal health care programs. We must contain costs in these programs. But we must do it as we reform our health care system as a whole -- not by arbitrarily cutting programs that serve the most vulnerable Americans. That is not to say that these programs cannot and should not be improved. The Clinton Administration is committed to continuing to give States flexibility to reduce costs while maintaining coverage in their Medicaid programs. And we are committed to continuing to reduce regulatory burdens, streamline administration, and improve cost effectiveness in the Medicare program while increasing choices for beneficiaries and ensuring that quality of care is protected. These are the kind of changes that the Clinton Administration is doing now. And these are the kind of changes that we look forward to working with Congress on in the coming months. THE CLINTON ADMINISTRATION'S EFFORTS TO IMPROVE THE HEALTH CARE SYSTEM ARE CONTINUING WITHIN THE HEALTH CARE AGENCIES. THIS WORK INCLUDES EFFORTS TO MAINTAIN AND IMPROVE THE QUALITY OF HEALTH CARE. Developing Quality Measures As you know, the Agency for Health Care Policy and Research (AHCPR), an agency of the Public Health Service, works to improve the quality of care by developing measures of quality both for health care professionals and for consumers. More than 1200 clinical performance measures are now in use. However, as you know, there has been no single source of information on clinical quality measures. Nor has there been a generally accepted criteria for evaluating the validity or usefulness of the various measures. An important project now underway to fill this gap is AHCPR's "Measurement Typology Project." 3 Working together with the Harvard School of Public Health and the Center for Health Policy Studies of Columbia, Maryland, AHCPR has collected the clinical performance measures being used by public and private organizations and has developed a standard method for describing them. Next, AHCPR will work with organizations like the Joint Commission on Accreditation of Healthcare Organizations to identify and promote the most valid of the quality measures they have found. This will facilitate the systemic and uniform comparison of health care organizations -- a vital task in today's changing health care industry. AHCPR is also developing new quality indicators based on adherence to clinical practice guidelines. Because practice guidelines are derived from scientific evidence of what really works for patients, these new quality indicators should prove to be extremely useful. In addition, AHCPR is working to help consumers make choices about health plans and providers by surveying consumers directly about the accessibility, quality, and effectiveness of the care they receive. Health plans, employers, consumer advocates, purchasing alliances and other consumers will be able to turn to this survey for information that will help them make their own informed decisions. By encouraging knowledgeable choices based on quality, these surveys will encourage clinical quality improvement. Evaluating the Effectiveness of Clinical Practices Besides developing measures of quality, the Clinton Administration is working to improve quality of care by examining the effectiveness of different clinical practices that are now being used. AHCPR's Medical Treatment Effectiveness Program -- MEDTEP -- is looking at the effectiveness of differing treatments for a wide range of conditions including cancer, heart and kidney disease, cataracts, childbirth, and schizophrenia. MEDTEP research is part of the shift in focus from issues of organization and process requirements to outcomes measures in health care. MEDTEP's concern is with outcomes in the real world -- what works best for typical patients cared for by real health care professionals. A major feature of MEDTEP research is its emphasis on outcomes that patients understand and care about. These outcomes include quality of life, functional capacity, symptom relief and cost. Other basic themes in this research include cost effectiveness and appropriateness of treatment decisions. 4 Learning what works from MEDTEP and other medical effectiveness research will continue to be important as we work to maintain and improve health care quality in the face of enormous health care cost pressures. THE ADMINISTRATION IS WORKING TO PROTECT THE HEALTH AND SAFETY OF HEALTH CARE PROVIDERS SHEA has actively participated in the Administration's efforts to fight the occupational hazards you and your colleagues face. We appreciate your assistance and expertise in this area and we hope that you will continue to be involved. Alongside health care professionals, we have fought occupational hepatitis B -- and between 1987 and 1993, the number of cases contracted by health care workers exposed on the job fell 77%. Today, we are working to contain the threat of on-the- job exposure to tuberculosis. The Occupational Safety and Health Administration (OSHA) has undertaken nationwide enforcement activities aimed at ensuring that employers are taking proper measures to protect their employees. Currently, OSHA is working to develop a standard for occupational exposure to tuberculosis. One of the primary bases for this standard will be the tuberculosis guidelines issued by the Centers for Disease Control and Prevention (CDC). We hope to publish OSHA's proposed standard in October. We are also continuing the process of finalizing for publication regulations that will change the method for testing TB respirators. As you know, under the new regulations, a new generation of better TB respirators are likely to become available. THE PRESIDENT'S CHILDHOOD IMMUNIZATION INITIATIVE IS DESIGNED TO STRENGTHEN EFFORTS TO IMMUNIZE CHILDREN AND TO REDUCE OR ELIMINATE VACCINE-PREVENTABLE DISEASES Another Clinton Administration health care initiative that I know many of you are interested in is the Childhood Immunization Initiative. The Initiative's goal is to immunize at least 90 percent of the two-year-olds in this country with the initial and most critical doses by 1996 and at least 90 percent of all two-year-olds with the full series of vaccines by 2000. The Childhood Immunization Initiative will: 5 Improve the quality and quantity of vaccination services: In 1993, the Federal government sent $129 million to states and local health departments to improve existing services. Each local area uses its own discretion to allocate these funds to meet local needs -- whether that means extending clinic hours or automating records. Reduce vaccine costs for parents: The Vaccines for Children program will reach more children with free vaccine than ever before, including many at their own doctor's offices. Sixty percent of our Nation's children will benefit, including the uninsured, those on Medicaid, Native American children, and children served by federally qualified health centers. Increase participation, education, and partnerships in communities: The Administration's plan sends outreach coordinators around the country to increase awareness of the importance of vaccinating children and to encourage health care providers to use every opportunity to vaccinate children in their care. Community and business groups, religious and service organizations, schools, and the media are joining community-based networks to increase infant vaccination efforts. For example, Gerber Products Company put an immunization message on the back of baby cereal boxes, Kiwanis International created a national public awareness campaign, including public service announcements, billboards, and posters, and McDonalds featured an immunization message in its tray liners. Better monitor diseases and vaccinations: We are creating a better system to monitor vaccine-preventable diseases so that we can spot problems early and prevent cases from escalating into epidemics. The Centers for Disease Control and Prevention are working to pinpoint the populations that are not receiving the benefits of infant vaccination. Improve vaccines and how they are used: We developed a single childhood immunization schedule by working with the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians. This single schedule simplifies what parents and providers must know to ensure proper immunization. 6 We are increasing applied research into new vaccines in an effort to reduce the number of shots children must receive and to ensure safe and effective vaccines. Finally, although available vaccines are very safe and effective, CDC is working with states and some providers to improve systems that detect those problems that do occur after a vaccination. 7 Simmons/Gelfand TEL 901-726-8249 Apr 05.95 10:57 No. 005 P.02 ary: Event file SHEA XC: Keein & Guss The Society for Healthcare Epidemiology of America, Inc. April 5, 1995 President (1/93 12/95) Bryan P. Simmons. M.D. FYI Memphis, Tennessee (901) 726-8823 (901) 726-8249 FAX Carol H. Rasco President-Elect 11/09 12/95) Assistant to the President for Domestic Policy William J. Martone, MD. The White House Allanta Georgia (404) 639 6400 1600 Pennsylvania Ave. (404) 639-6458 TAX Washington, DC 20500 Vice-I'resident (1NS 12/95) Robert A. Weinstcin, M.D. Dear Ms. Rasco, Chicago. Illinois (312) 633-3237 On behalf of SHEA, I want to thank you for your (312) 633-5187 FAX wonderful prescntation. J believe that you and Past Preddent President Clinton have an excellent healthcare (1/25 12/95) Person A. Chana. M.D. strategy, especially the emphasis on children. Your Hackensack. New Jersey talk was the highlight of SHEA'S Annual Meeting. I (201) 996-2013 (201) 487-0885 FAX will contact Terri Yamauchi shortly about the Secretary invitation to the White House to discuss a couple of 11/93 12/95) items that are important to many involved in Date N. Genting. M.D. Chicago. Illinois healthcare. 1 am eager to accept your invitation as (312)640-2193 soon as I can arrange a conference call with the SHEA (312) 640-2252 FAX Board, probably in the next 1-2 weeks. Treasurer 11/92 12/95) Blies Abrutys, M.D. Thanks again! Philadclphia, Pennsylvania (215) 823-5800 (215) 823-5168 FAX Sincerely, Academic Councilors (1AM -12/95) Bagan Summers Leigh n. Donowits. M.I. Charlotterille, Virginia (804) 92s 5896 Bryan Simmons, M.D. (804) 924-5284 FAX President, SHEA (1/95 12000 John W. Froggen, III. M.D. /ps Acheville. North Carolina (704) 299-2515 (704) 299.2502 FAX CC: Terri Yamauchi, M.D. Practice Councilors (1/94 12/05) Timothy W. Lane, M.D. Greensboro, North Carolium (VIO) 574-8062 (910) 574-8026 FAX 11/95 12/96) Deleard S. Wong. M.D. Richmond Virginia (801) 230-1365 (004) 230 6856 FAX EXECUTIVE OFFICE Presutive Director Coloy Lyons A73 Kings Highway Wondbury, NJ 08096-3172 (609) 845 1636 (609) 853-0411 FAX EXECUTIVE OFFICE OF THE PRESIDENT 13-Apr-1995 03:52pm TO: Karen R. Guss FROM: Carol H. Rasco Economic and Domestic Policy SUBJECT: see attached Anything you see in this based on your conversations with Tappan and others perhaps that raises red flags in your head? EXECUTIVE OFFICE OF THE PRESIDENT 13-Apr-1995 03:39pm TO: Carol H. Rasco FROM: Sally Katzen Office of Mgmt and Budget, OIRA SUBJECT: HHS/NIOSH Final Rule on Respirators attached is an e-mail report from my staff on the briefing from HHS. Its generally positive. HHS will likely send the revised rule over by the end of next week and we should be able to conclude review in several weeks (it alway S takes longer when we have to coordinate with other agencies). Let me know if you need more. Sally EXECUTIVE OFFICE OF THE PRESIDENT 10-Apr-1995 06:02pm TO: Sally Katzen FROM: Daniel J. Chenok Office of Mgmt and Budget, OIRA CC: James B. MacRae Jr. CC: John F. Morrall, III CC: Shannah Koss CC: Gary D. Rowe SUBJECT: HHS/CDC/NIOSH Briefing on Respirator final rule Linda Rosenstock, NIOSH Director, Claudia Cooley and their staff briefed Shannah and I today on their forthcoming respirator final rule. HHS expects to submit the rule within a week, and is asking for rapid action thereafter. In general, HHS has made reasonable changes from those proposed in the NPRM. They have loosened requirements on manufacturers in a number of areas, and will do more in this regard as a result of today's discussion. They made a convincing case that this rule will be welcomed by most of the affected parties, including workers using respirators, respirator manufacturers who currently live under a 1930s standard, and industrial users. They did indicate that some small firms may be disadvantaged, and will provide us with more data on employment effects in these firms. They argue that the rule is a cost saver, though total costs will depend on how OSHA applies the standard in various industrial settings; NIOSH has not prepared an economic analysis that demonstrates cost effects. Also, they have not included risk analysis language in the rule. They argue, and may be justified in doing so, that the dose-response data for respirators is not sufficiently developed to use in full-blown risk assessment. They will add language to the rule that bolsters their risk arguments and provides a more convincing case for not conducting the full assessment. They have coordinated the rule with OSHA, and we will follow up to ensure that OSHA is comfortable since OSHA will apply the NIOSH standard. The advance draft included some disclosure requirements for which clearance would be covered under the new PRA; HHS is considering whether to issue those as a separate paperwork requirement to speed publication of the rule. Last, HHS could publish two versions of the rule: a short version with only the new regulatory language, or a longer version with the whole rule. They say the Federal Register did not allow them to publish the short form for the NPRM, which would have incorporated by reference the existing language. Thought you would want to know this vis-a-vis you conversations with the Register. 004 02/12/95 16:19 K9ras.qxd Vol. 16 No. 9 INFECTION CONTROL AND HOSPITAL- BRIDEMIOLOGY Special Report Special Update on Healthcare Reform From The White House Keynote Address, SHEA Annual Meeting, April 1906 Carol H. Rasco INTRODUCTION don't lose their insurance when they lose their job or VI want to touch on four different areas today that change jobs or a family member falls ill, and so that I think will be of interest to you. I am going to talk small businesses can afford (1) buy insurance for their bullets) about healthcare reform, quality management workers. research within the Clinton Administration, our Make coverage affordable to: and available to, efforts to tight the on-thejob infection of healthcare children pay for tsmall workers, and the President's Childhood Help workers who lose their jobs to keep their Immunization Initintive. health insurance. Level the playing field for the self-employed by TIJE CLINTON ADMINISTRATION giving them the same lax treatment as other busi- CONTINUES TO FIGHT FOR REAL nesses. HEALTHCARE REFORM Help families provide long term care for a sick As you know, last year the Clinton parent or a disabled child. Administration fought hard for healthcare reform. Because their constituents are demanding While we could not reach agreement on legislation, action, some Republicans have begun to respond to there can be little disagreement that the problems the President's challenge by coming forward with remain. Nearly 40 million Americans have no health proposals and bills. Wc look forward to working with insurance, and millions more are just one pink slip or them to take the first steps this year But we con- illness away from losing their insurance. Eighty-four tinue to work toward health reform, WC must contin- percent of the uninsured in 1993 were in working ually remember that we have the highest quality of familics, and more than 55% lived in families headed care. the most talented and dedicated health profes- by full-time workers. And while healthcare costs have sionals, and the most advanced research institutions begun to slow down. they are continuing in rise at in the world. All health reform proposals must bc three times the ratc of inflation. measured by their ability both to fix what is wrong, As the President said in his State of the Union and to preserve what is right about our healthcare Address and in his December letter to the system. Congressional Leadership, we remain firmly commit- ted to guaranteeing health security 10 all Americans THE CLINTON ADMINISTRATION IS and to containing healthcare costs for families, bust- FIGHTING BACK TO PROTECT DOC- nesses, and federal, state, and local governments. TORS AND PATIENTS FROM SEVERE The President believes that we should take a CUTS IN MEDICARE AND MEDICAID step-by-etep approach. This year, we can take the first Unfortunately. for too many Republicans in steps. The Congress can and should: Congress, "health reform" has turned into the code Reform the insurance market. so that people word for cutting Medicare and Medicaid to pay for From The White House, Washington, DC. Address reprints to Carol H. Rasco, Assistant to the President for Domestic Policy, The While House, Washington, DC. 95-SK-107. Rasco CH. Special update on healthcare reform from the White House: heynote address, SHEA Annual Meeting, April 1995. Infect Costrol Hosp Epidemial 1995; Roman 02/12/95 16:20 005 2 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY September 1995 to tax cuts for the wealthy. Anumber of Republicans in months. of billions-- THE CLINTON ADMINISTRATION'S of-dollars. EFFORTS TO IMPROVE THE HEALTH- It appears that Medicare will bc slated-to-bc- CARE SYSTEM ARE CONTINUING $270 cut by about billion between now and 2002. -It WITHIN THE HEALTHCARE AGEN- also.appears-that-Mcdicaid is being targeted for at CIES. THIS WORK INCLUDES least S180 billion to-S190-billion in spending cuts EFFORTS TO MAINTAIN AND between now and 2002. It's not hard to figure out IMPROVE THE QUALITY OF HBALTH what that mcans for the doctors and hospitals who CARE existing quality measur 2 treat patients receiving benefits under these pro- grams and for the patients themselves. Developing Quality Measures your and It means significant cuts in payments to hospi- As you know, the Agency for Health Care tals. physicians, and other providers. Policy and Research (AHCPR) agency of the Public It means shifting additional financial burdens Health Service. works to Improve the quality of care to the elderly and disabled or to small businesses by developing incasures of quality both for health- new and families who will pay higher premiums and lees care professionals and for consumers. science- if these programs are cut without overall reform. More than 1,200 clinical performance measures based In many states, it means being forced to drop are now in use. However, 11:1 you know, there has coverage or shrink benefits for mothers and chil- been no single source of information on clinical dren on Medicaid. Or it mcans asking states to pick quality measures, nor have there been generally up the tab to preserve the Medicaid program, and in accepted criteria for evaluating the validity or use- doing so, forcing them to raise taxes or cut spending fulness of the various measures. An important Dro- for services like education and public safety. jeet now underway to fill this gap is AHCPR's The-Presldent-prescnled"aresponsiblerbudget "Measurement Typology Project." to-Congress=a'budgctthatmade-tough-choicesto Working together with the Harvard School of get.our-rising-deficit-under-conrol-but-a-budget Public Health and the Center for Health Policy fhat-protectel-hardworking-Amcricans and Invest- Studies of Columbia, Maryland. AHCPR has collect- our children. ed)the clinical performance measures beingused by act.to.detail-where-they-wilgel-the-cuts-they-ncedas public and private organizations and has developed E-equently to-pay-for-thcir-tax-cuts-for-le-wallyand-t-sterp0 standard method for describing them. such centrali: forward with their plan-for-deficit-reduction. of Ncxt, AHCPR will work with organizations like informati The President consistently has said that we can- the Joint Commission on Accreditation of on not gct ahold of the deficit without passing mean- Healdicare Organizations, to identify and promote the ingful health reform. Over the next 5 years alone, thc-moet-valid-of-the quality measures they have National almost 40% of the growth in total federal spending found. This will facilitate the systemic and uniform Committee will come from rising costs in federal healthcare comparison of healthcare organizations-a vital task programs. We must contain costs in these pro- in today's changing healthcare industry. regularres on Quality grams. But we must do it as we reform our health- AHCPR also is developing new quality indica- United Health care system as a wholc-not by arbitrarily cutting tore based on adherence-to clinical practice guide- care smottle programs that serve the most vulnerable Americans, lines. Because practice guidelines are derived from Health care (which-is-not-to.say-thatthese-programs canot-and-- scientific evidence as to what really works for -should-not-be*improved):- Finiancing patients, these new quality indicators should prove Advinistration The Clinton Administration is committed to to be extremely useful. continuing to give states flexibility to reduce costs In addition, AHCPR is working w help con- while maintaining coverage in their Medicaid pro- sumers make choices about health plans and granis. And, WC are committed LU reduce regulatory providers by-qurveving-consumers-directy-about to help burdens, streamline administration, and improve the accessibility, quality, and effectiveness of the costeffectiveness in the Medicare program while care they receive. Health plans, employers, con- increasing choices for beneficiaries and ensuring sumer advocates, purchasing alliances. and other allect that quality of care is protected. These are the kind consumers will bc able tosturn- to this survey-ford of changes that the Clinton Administration is doing information that will help them make their own now, and these are the kind of changes that we look informed decisions. By encouraging knowledgeable forward to working with Congress on in the coming choices based on quality, these Luse surveys will encour developing consumer survy hatcanasses survey 02/12/95 16:21 006 Specialritieport Vol 16 No.9 INFECTION Correct AND Hoornas TRIDEMOLOGY 3 age clinical quality improvement. Discase Control and Prevention (CDC). We hope to Health publish OSHA's proposed standard in October. Evaluating the liffectiveness We also are continuing the process of finalizing Practice for publication regulations that will change the Besides developing measures of quality. the method for testing TB respirators. As you know, Clinton Administration is working to improve quali- under the new regulations, a new generation of better ty of care by examining the effectiveness of different TB respirators likely will become available. clinical practices that are now being used. AHCPR's Medical Treatment Effectiveness THE PRESIDENT'S CHILDHOOD Program-MEDTEP-looks at the effectiveness of IMMUNIZATION INITIATIVE IS differing treatments for a wide range of conditions DESIGNED TO STRENGTHEN EFFORTS including cancer, heart and kidney disease, TO IMMUNIZE CIILDREN AND TO cataracts, childbirth. and schizophrenia. REDUCE OR ELIMINATE MEDTEP research is part of the shift in focus VACCINE-PREVENTABLE DISEASES from issues of organization and process require- Another Clinton Administration healthcare ini- ments to outcomes measures in health care. trative that I know many of you are interested in is the MEDTEP's concern is with outcomes in the real Childhood Immunization Initiative. The initiative's world-what works best for typical patients cared goal in to immunize at least 90% of the woycarlolds 2 IT for by real healthcare professionals. in this country. with the initial and most critical doses A major feature of MEMEP research is its by 1996, and at least 90% of all olds with the emphasis on outcomes that patients understand and full series of vaccines by 2000. The Childhood the care about. These outcomes include quality of life, Immunization Initiative will: year functional capacity, symptom relief, and cost. Other Improve the quality and quantity of vaccination basic themes in this research Include cost Effective- services. ness and appropriateness of treatment decisions. In 1993, the Federal government sent $129 mil- " Learning what works from MEDTEP and other lion to state and local health departments to improve medical effectiveness research will continue to be existing services. Each local area uses its own discre- important as we work to maintain and improve tion to allocate these funds to meet local healthcare quality in the face of enormous health- needs-whether that means extending clinic hours care cost pressures. (define, or automating records. Reduce vaccine costs for parents. THE ADMINISTRATION IS WORKING The Vaccines for Children program will reach TO PROTECT THE HEALTH AND more children with free vaccine than ever before, SAFETY OF HEALTHCARE PROVIDERS including many at their own doctors' offices. Sixty SHEA has participated actively in the percent of our nation's children will benefit, including Administration's efforts to fight the occupational the uninsured, those on Medicaid, Native American hazards you and your colleagues face. We appreci- children, and children served by federally qualified atc your assistance and expertise in Unis area, and health centers. we hope that you will continue to be involved. Increase participation, cducation, and partner Alongside healthcare professionals. we have ships in communities. fought occupational hepatitis B-and between 1987 The Administration's plan sends outreach coor- and 1993. the number of cases contracted on the job dinators around the country to increase awareness of by healthcare workers fell 77%. Today, WC are work- the importance of vaccinating children and to encour- ing to contain the threat. of occupational exposure to age healthcare providers to use every opportunity to tuberculosis. vaccinate children in their care. Community and busi- The Occupational Safety and Health ness groups. religious and service organizations. Administration (OSHA) has undertaken nationwide achoola, and the media are joining community-based enforcement activities aimed at ensuring that networks to increase infant vaccination efforts. For employers are taking proper measures W protect example, Gerber Products Company DUE an immu- their employees. nization message on the back of baby cercal boxes; Currently, OSHA is working to develop a stan- Kiwanis International created a national public aware- dard for occupational exposure to tubcrculosis. One ness campaign, including public service) announce- of of the primary bases for this standard will be the ments, billboards, and posters; and McDonald's fea- tuberculosis guidelimes issued by the Centers for tured an Immunization mcssage in its tray liners. 16:21 007 4 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY September 1995 Better monitor discasca and vaccinations. already We are creating я better system to monitor vac- uppheneted cine-preventable diseases SU that we can spot prob word lems early and prevent cases from escalating into ept demics. The Centers for Disease Control and Prevention is working to pinpoint the populations that are not receiving the benefits of inlant vaccina- Put in please more whole word down m This part up. columns Improve vaccincs and how they are used. We developed a single childhood immunization schedule by working with the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians. This single schedule simplifics what par- cnts and providers must know to ensure proper immunization. We are increasing applied research into new vac cines in an effort to reduce the number of shots chil- dren must receive and to ensure sale and effective vaccines. Finally, although available vaccines are very safe and effective, CDC is working with states and some providers 10 improve systems that detect those probleme that do occur after я vaccination. - 002 02/12/95 16:18 AUTHOR'S PROOF IMPORTANT Please review the enclosed proof carefully for any typographical errors. If proofs of photos and figures are included, review for correct orientation and compare with legends. Also check authors' names and affiliations and proofread tables carefully. Approval of the attached must be indicated by your signature below. Return one set of these galleys with your corrections no later than 7-20 or phone your corrections in to the number indicated below. Keep the second copy for your files. If your corrections are not received by mail or phone by the above date, your article will be printed as attached. The Publisher and Editor are not responsible for cor- rections not made because of the author's failure to meet this deadline. RETURN PROOFS TO: Susan Cantrell INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY Editorial Offices Vanderbilt University School of Medicine A-1131 Medical Center North Nashville, Tennessee 37232-2637 615-343-1095 Fax 615-343-1582 Author's Signature Date AHCPR/CMER TEL : 301-227-8211 Jul 1995 11:03 No 002 P.01 AGENCY FOR HEALTH CARE POLICY AND RESEARCH Center for Medical Effectiveness Research 2101 East Jefferson Street - Suite 605 Rockville, Maryland 20852 Phone: (301) 594-1485 Fax: (301) 594-3211 Date/Time: 7/19 10:55 AM To: Karen guse Fax: (202) 456-9439 7028 Phone: From: Claire W. Maklan, Ph.D., M.P.H. Message: as requested Please see "attached." Number of Pages (Excluding Cover Sheet): 3 AHCPR/CMER TEL 301-227-8211 Jul 19 95 11:03 No 002 P.02 July 19, 1995 NOTE TO KAREN GUSS. from Claire Maklan and Irma Arispe, AHCPR re: Requested comments on galleys AHCPR's emphasis on the need for good evidence of effectiveness as a scientific basis for valid and reliable measures of quality suggests the need to reverse the order of the two sections about AHCPR work. This could be done with only a few wording changes that should fit within the current space limits. Suggested modifications follow, with insertions and changes in bold: Under the existing heading, THE CLINTON ADMINISTRATION'S EFFORTS TO IMPROVE. P. 2, start with: Evaluating the Effectiveness and Quality of Health Care (delete: Clinical Practice) DELETE: "Besides developing measures of quality," The Clinton Administration is working to improve the quality of health care by examining the effectiveness and relative effectiveness of different clinical practices that are now being used. Responsibility for this rests with the Agency for Health Care Policy and Research (AHCPR), an agency of the Public Health Service, through its Medical Treatment Effectiveness Program (MEDTEP). MEDTEP looks at the effectiveness of different treatments for a wide range of common conditions and procedures, including cancer, heart and kidney disease, cataract, childbirth, schizophrenia, and hysterectomy. MEDTEP research reflects a shift in focus from issues of organization and process to evaluation in terms of patient outcomes. MEDTEP's concern is with and appropriateness of treatment decisions. Learning what works from MEDTEP and other medical effectiveness research will continue to be important as we work to define, maintain, and improve healthcare quality in the face of enormous health care cost pressures. AHCPR/CMER TEL 301-227-8211 Jul 19 95 11:04 No. 002 P.03 NOTE TO CLAIRE MAKLAN FROM: Irma Arispe DATE: July 19, 1995 RE: Comments on White House article for Infection Control and Hospital Epidemiology. Thank you for the opportunity to review this section of the article. Here are a few comments. All comments pertain to the section called "Developing Quality Measures", in which there is discussion of the typology project. 1. Page 2, First paragraph. Suggested Change: In addition to examining the medical effectiveness of various clinical practices, AHCPR works to improve the quality of health care by coordinating existing measures of clinical quality and by developing new science based measures of quality for both health care professionals and consumers. Rationale: This change assumes that the medical effectiveness section will precede the section on quality measures. 2. Page 2, Second paragraph under this section. Suggested Change: Change first sentence to, "There are literally hundreds of clinical performance measures now in use." Rationale: We identified over 1200 but we know there are hundreds (if not thousands) out there. 3. Page 2, Third paragraph Suggested Change: "Working together with AHCPR has collected a sample of clinical performance measures most frequently used by public and private organizations Optional Additional Change: After this sentence you may want to add the following, "The project has identified more than 1200 such measures." Rationale: The project focused on the most frequently used measures, but we know that many other measures exist. AHCPR is currently augmenting this inventory. 4. Page 2, Fourth paragraph, first sentence Suggested Change: Next AHCPR is working with organizations such as the Joint Commission on Accreditation of Health Care Organizations, the National Committee on Quality Assurance, private health care organizations such as United Health Care, and 2 AHCPR/CMER TEL : 301-227-8211 Jul 19 95 11:05 No. 002 P.04 government organizations such as the Health Care Financing Administration and the Department of Veterans Affairs to identify and centralize information on clinical performance measures. This will facilitate the systematic and uniform comparison Rationale: The project seeks to coordinate federal and private efforts at clinical quality measurement (to avoid duplication and to encourage public private partnership). By mentioning only the Joint Commission, one might misconstrue the paragraph as being a government and regulatory effort to impose certain types of measures. I suggest not using the word "promote" because the project does not impose a certain type of measure. It is a tool to provide information that will inform or assist in the selection of measures. 5. Page 2, Fifth paragraph, first sentence. Suggested Change: Delete the word adherence. Change sentence to: "AHCPR is also developing new quality indicators based on clinical practice guidelines Additional Suggested Change: After the second sentence, add: "The typology will include these new guideline based quality measures as they become available and this will health care providers, purchasers, and consumers in seeking better information on quality." Rationale: The word "adherence" connotes a very regulatory meaning to providers. The last sentence is intended to convey that the value of this government sponsored project is to coordinate information and develop tools that will assist in making this information available to health care providers, purchasers, and ultimately consumers. SENT BY:Xerox Telecopier 7020 ; 8-22-95 ; 14:28 : The White House- 67028;# 1 AUG-22-95 TUE 13:08 INFECT CTRL HOSP EPIDEM FAX NO. 8153431882 P.01 The Official Journal of The Society for thoure Epidemiology of America INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY FAX COVER SHEET Date: 8-22-95 To: Carol Rasco Karen 6055 Fax No: (202) 456-2878 From: Sussa Cashell Number of Pages Following This Page: 4 Comments: Per our previous fox (7.25.95) these are second page proofes. These profa are due back in our office at 2 pm (our time) tomorrow. As we mentioned, This is NOT a time -/o make change Normally we do Not send 2nd perofs to authors. Since your changes were so extensive, we are If you do not receive the entire fax or have other transmission problems, please call (615) 343-1095. Michael D. Decker. MD. MPH Editor sending These proofe for you to make Editorial Offices sure that the changes called in by Vanderbilt University School of Medicine Karen guss are on the proofs. Thank A-1131 Medical Center North Nashuille. TN 37232-2537 you for your kind attention to this important matter. Telephone (615) 343-1095 FAX (615) 343-1882 SENT BY:Xerox Telecopier 7020 ; 8-22-95 ; 14:29 ; The White House- 67028;# 2 AUG-22-95 TUE 13:09 INFECT CTRL HOSP EPIDEM FAX NO. 6153431882 P.02 526 INFECTION CONTROL AND HOSPITAL EPIDEMOLOGY September 1995 Special Report Special Update on Healthcare Reform From The White House Keynote Address, SHEA Annual Meeting, April 1995 Carol H. Rasco INTRODUCTION Reform the insurance market, so that people Today, I want to touch on four different areas don't lose their Insurance when they lose their jobs or that I think will be of interest to you. I am going to change jobs or a family member falls ill, and so that talk about healthcare reform, quality management small businesses can afford to buy insurance for their research within the Clinton Administration, our workers. efforts to fight on-the-job infection of healthcare Help workers who lose their jobs to pay for workers, and the President's Childhood their health insurance. Immunization Initiative. Level the playing field for the self-employed by giving them the same tax treatment as other busi- THE CLINTON ADMINISTRATION nesses. CONTINUES TO FIGHT FOR REAL Help families provide long-term care for a sick HEALTHCARE REFORM parent or a disabled child. As you know, last year the Clinton As we continue to work toward healthcare Administration fought hard for healthcare reform. reform, we must continually remember that we While we could not reach agreement on legislation, have the highest quality of care, the most talented there can be little disagreement that the problems and dedicated health professionals, and the most remain. Nearly 40 million Americans have no health advanced research institutions in the world. All insurance, and millions more are just one pink slip or healthcare reform proposals must be measured by illness away from losing their insurance. Eighty-four their ability both to fix what is wrong and to pre- percent of the uninsured in 1993 were in working serve what is right about our healthcare system. families, and more than 55% lived in families headed by full-time workers. While healthcare costs have PROTECTING MEDICARE AND begun to slow down, they are continuing to rise at MEDICAID three times the rate of inflation. The Clinton Administration is fighting back to As the President said In his State of the Union protect doctors and patients from severe cuts in Address and in his December letter to the Medicare and Medicaid. Unfortunately, for too Congressional Leadership, we remain firmly com- many Republicans In Congress, "health reform" has mitted to guaranteeing health security to all turned into the code word for cutting Medicare and Americans and to containing healthcare costs for Medicaid to pay for tax cuts for the wealthy. families, businesses, and federal, state, and local gov- Medicare will be cut by approximately $270 bil- ernments. lion between now and 2002. Medicaid is being tar- The President believes that we should take a geted for $182 billion in spending cuts between now step-by-step approach. This year, we can take the first and 2002. It's not hard to figure out what that means steps. Congress can and should: for the doctors and hospitals who treat patients From The White House, Washington, DC. requests Address reprints to Carol H. Rasco, Assistant to the President for Domestic Policy, The White House, Washington, DC. 95-SR-107. Rasco CH. Special update on healthcare reform from the White House: Asynote address, SHEA Annual Meeting, April 1995 Infect Control Hosp Epidemial 1995;16:526-529. SENT BY:Xerox Telecopier 7020 ; 8-22-95 ; 14:29 ; The White House- 67028:# 3 AUG-22-95 TUE 13:10 INFECT CTRL HOSP EPIDEM FAX NO. 6153431882 P. 03 Vol. 16 No.9 SPECIAL REPORT 527 receiving benefits under these programs and for quality measures, nor have there been generally the patients themselves. accepted criteria for evaluating the validity or use- It means significant cuts in payments to hospi- fulness of the various measures. An important pro- tals, physicians, and other providers. Ject now underway to fill this gap is AHCPR's It means shifting additional financial burdens "Measurement Typology Project." to the elderly and disabled or to small businesses Working together with the Harvard School of and families who will pay higher premiums and fees Public Health and the Center for Health Policy if these programs are cut without overall reform. Studies of Columbia, Maryland, AHCPR has collect- In many states, It means being forced to drop ed a sample of the clinical performance measures coverage or shrink benefits for mothers and chil- most frequently used by public and private organi- dren on Medicaid. Or It means asking states to pick zations and has developed a standard method for up the tab to preserve the Medicaid program, and in describing them. doing so, forcing them to raise taxes or cut spending Next, AHCPR will work with organizations for services like education and public safety. such as the Joint Commission on Accreditation of The President consistently has said that we can- Healthcare Organizations, the National Committee not get ahold of the deficit without passing mean- on Quality Assurance, United Healthcare, and the ingful health reform. Over the next 5 years alone, Healthcare Financing Administration to identify and almost 40% of the growth in total federal spending centralize information on the quality measures they will come from rising costs in federal healthcare have found. This will facilitate the systemic and uni- programs. We must contain costs in these pro- form comparison of healthcare organizations-a grams. But we must do It as we reform our health- vital task in today's changing healthcare industry. care system as a whole-not by arbitrarily cutting AHCPR also is developing new quality indica- programs that serve the most vulnerable tors based on clinical practice guidelines. Because Americans. practice guidelines are derived from scientific evi- The Clinton Administration is committed to dence as to what really works for patients, these continuing to give states flexibility to reduce costs new quality indicators should prove to be extremely while maintaining coverage in their Medicaid pro- useful. grams. And, we are committed to reduce regulatory In addition, AHCPR is working to help con- burdens, streamline administration, and improve sumers make choices about health plans and cost-effectiveness in the Medicare program while providers by developing a consumer survey that can increasing choices for beneficiaries and ensuring assess the accessibility, quality, and effectiveness of that quality of care is protected. These are the kind the care they receive. Health plans, employers, con- of changes that the Clinton Administration is doing sumer advocates, purchasing alliances, and other now, and these are the kind of changes that we look consumers will be able to use this survey to collect forward to working with Congress on in the coming information that will help them make their own months. informed decisions. By encouraging knowledgeable choices based on quality, these surveys will encour- QUALITY age clinical quality Improvement. The Clinton Administration's efforts to improve the healthcare system are continuing within the Evaluating the Effectiveness healthcare agencies. This work includes efforts to of Health Care maintain and improve the quality of health care. Besides developing measures of quality, the Clinton Administration is working to Improve quali- Developing Quality Measures ty of care by examining the effectiveness of different As you know, the Agency for Health Care clinical practices that are now being used. AHCPR's Policy and Research (AHCPR), an agency of the Medical Treatment Effectiveness Pro- close # Public Health Service, works to improve the qual- gram-MEDTEP-looks at the effectiveness of dif- up lose up ity of care by coordinating existing quality measures fering treatments for a wide range of conditions # and by developing new science-based measures of including cancer, heart and kidney disease, quality both for healthcare professionals and for cataracts, childbirth, and schizophrenia. consumers. MEDTEP research is part of the shift In focus More than 1,200 clinical performance measures from issues of organization and process require- are now In use. However, as you know, there has ments to outcomes measures in health care. been no single source of Information on clinical MEDTEP's concern is with outcomes in the real SENT BY:Xerox Telecopier 7020 ; 8-22-95 ; 14:31 The White House- 67028:# 5 AUG-22-95 TUE 13:12 INFECT CTRL HOSP EPIDEM FAX NO. 6153431882 P.05 528 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY September 1995 world-what works best for typical patients cared The Initiative's goal is to immunize at least 90% of the for by real healthcare professionals. 2-year-olds in this country, with the initial and most A major feature of MEDTEP research is its critical doses by 1996, and at least 90% of all 2-year emphasis on outcomes that patients understand olds with the full serles of vaccines by the year 2000. and care about. These outcomes Include quality of The Childhood Immunization Initiative will: life, functional capacity, symptom relief, and cost. Improve the quality and quantity of vaccination Other basic themes in this research include cost- services. more effectiveness and appropriateness of treatment *In 1993, the federal government sent $129 mil- italicized decisions. lion to state and local health departments to improve lined to Learning what works from MEDTEP and other existing services. Each local area uses its own discre- medical effectiveness research will continue to be tion to allocate these funds to mect local be first important as we work to define, maintain, and needs-whether that means extending clinic hours Sentence improve healthcare quality in the face of enormous or automating records. following healthcare cost pressures. Reduce vaccine costs for parents. bullet. The Vaccines for Children program will reach HEALTH AND SAFETY more children with free vaccine than ever before, The Administration is working to protect the including many at their own doctors' offices. Sixty health and safety of healthcare providers. SHEA has percent of our nation's children will benefit, including participated actively in the Administration's efforts the uninsured, those on Medicaid, Native American to fight the occupational hazards you and your col- children, and children served by federally qualified leagues face. We appreciate your assistance and health centers. expertise in this area, and we hope that you will con- Increase participation, education, and partner- tinue to be involved. ships in communities. Alongside healthcare professionals, we have The Administration's plan sends outreach fought occupational hepatitis B-and between 1987 coordinators around the country to increase aware- and 1993, the number of cases contracted on the job ness of the importance of vaccinating children and to by healthcare workers fell 77%. Today, we are work- encourage healthcare providers to use every oppor- ing to contain the threat of occupational exposure to tunity to vaccinate children in their care. Community tuberculosis. and business groupe, religious and service organiza- The Occupational Safety and Health tions, schools, and the media are joining community- Administration (OSHA) has undertaken nationwide based networks to increase infant vaccination efforts. enforcement activities aimed at ensuring that For example, Gerber Products Company put an employers are taking proper measures to protect immunization message on the back of baby cercal their employees. boxes; Kiwanis International created a national pub- Currently, OSHA is working to develop a stan- lic awareness campaign, including public service dard for occupational exposure to tuberculosis. One announcements, billboards, and posters; and of the primary bases for this standard will be the McDonald's featured an Immunization message it on tuberculosis guidelines issued by the Centers for its tray liners. Disease Control and Prevention (CDC). We hope to Better monitor diseases and vaccinations. publish OSHA's proposed standard in October. We are creating a better system to monitor vad stacked We also are continuing the process of finalizing cine-preventable diseases so that we can spot prob for publication regulations that will change the lems early and prevent cases from escalating into epti hyphens method for testing TB respirators. As you know, demics. The Centers for Disease Control and under the new regulations, a new generation of better Prevention is working to pinpoint the populations TB respirators likely will become available. that are not receiving the benefits of infant vaccina- tion. CHILDHOOD IMMUNIZATION (Improve vaccines and how they are used. INITIATIVE We developed a single childhood immunization Another Clinton Administration healthcare ini- schedule by working with the Advisory Committee tiative that I know many of you are interested in is the on Immunization Practices, the American Academy Childhood Immunization Initiative. The President's of Pediatrice, and the American Academy of Family childhood immunization initiative is designed to Physicians. This single schedule simplifies what par- strengthen efforts to immunize children and to ents and providers must know to ensure proper reduce or eliminate vaccine-preventable diseases. immunization. SENT BY:Xerox Telecopier 7020 ; 8-22-95 ; 14:30 ; The White House- 67028;# 4 AUG-22-95 TUE 13:12 INFECT CTRL HOSP EPIDEM FAX NO. 6153431882 P.04 Vol. 16 No.9 SPECIAL REPORT 529 We are increasing applied research into new able vaccines are very safe and effective, CDC is vaccines in an effort to reduce the number of working with states and some providers to shote children must receive and to ensure safe improve systems that detect those problems that and effective vaccines. Finally, although avail- do occur after a vaccination.