Edward J. Sondik

Status of Childhood Asthma in the United States, 1980–2007

Centers for Disease Control and Prevention data were used to describe 1980–2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7 million) currently had asthma in 2007. Ambulatory care visit rates fluctuated during the 1990s, whereas emergency department visits and hospitalization rates decreased slightly. Asthma-related death rates increased through the middle 1990s but decreased after 1999. Recent data showed higher prevalence among older children (11–17 years), but the highest rates of asthma-related health care use were among the youngest children (0–4 years). After controlling for racial differences in prevalence, disparities in adverse outcomes remained; among children with asthma, non-Hispanic black children had greater risks for emergency department visits and death, compared with non-Hispanic white children. For hospitalizations, for which Hispanic ethnicity data were not available, black children had greater risk than white children. However, nonemergency ambulatory care use was lower for non-Hispanic black children. Although the large increases in childhood asthma prevalence have abated, the burden remains large. Potentially avoidable adverse outcomes and racial disparities continue to present challenges. These findings suggest the need for sustained asthma prevention and control efforts for children.

Cancer surveillance in the U.S.

Cancer‐related services are consuming ever‐increasing health resources; along with this trend, health care costs are rising. As health care planners, researchers, and policymakers formulate strategies to meet this challenge, they are looking to cancer registries and the health information system built around them as collectors of the most extensive information regarding cancer treatment in the U.S. Currently, there are multiple programs collecting and reporting data regarding cancer incidence, morbidity, mortality, and survival. This report profiles cancer surveillance efforts in the U.S. and describes the National Coordinating Council for Cancer Surveillance, which was organized in 1995 to facilitate a collaborative approach among the organizations involved. Cancer 1998;83:1282‐1291.

Accrual of patients to randomized clinical trials: Factors affecting cancer prevention and control research

Clinical judgment is increasingly being challenged by the need for randomized clinical trials. The 1987 National Cancer Institute mandate--that the Community Clinical Oncology Program (CCOP) accrue patients to cancer control protocols--provided an opportunity to examine the factors that affect accrual performance. An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians (particularly those physicians, such as surgeons, who had access to patients), and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials.

Evaluating productivity in clinical research programs: the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP)

This paper outlines an approach to studying productivity in clinical research programs that incorporates environmental, organizational, provider, and patient specific factors in the model of production process. We describe how this approach has been applied to the National Cancer Institutes (NCI) Community Clinical Oncology Programs (CCOPs). Next, a practical evaluative model of the productive process in CCOPs is outlined and its use in evaluation and monitoring performance in CCOPs is discussed. Each level of the model is described and a number of factors potentially affecting each level are explored. Finally, we discuss the strengths and weaknesses of this approach and show how management can use it to study and improve the productivity of clinical research programs.

The role of thematic evaluation in program assessment: the case of the community clinical oncology program

The evaluation of programs with multiple, and potentially conflicting, goals requires the integration of measures of goal achievement that often are not easily combined. One approach is the development of analytical themes which span the various goals of a particular program. The themes provide a mechanism by which the policy concerns of individuals with varying perspectives can be integrated into the evaluation framework. As well, the themes allow for flexibility in the development of new analysis as the program matures and environments change. This paper describes the application of the thematic approach to the evaluation of a complex, community-oriented cancer research program.