William J. Waters

The future of public health: a survey of the states.

A survey of state health agencies was conducted to determine agreement and disagreement of state health officers with the recommendations contained in The Future of Public Health issued by the Institute of Medicine in 1988. The survey also measured the extent to which the IOM recommendations were judged currently in place or in the process of being implemented in the states.The survey showed almost unanimous consensus among the nations state health officers for the vast majority of the recommendations. There was less consensus concerning the appropriateness of locating substance abuse, Medicaid, mental health, and regulation of health professions within state departments of health. However, a significant proportion of health officers favored a health agency location for these responsibilities (72 %, 52 %, 48 %, and 38 % respectively).

Methodological issues in public reporting of patient perspectives on hospital quality.

BACKGROUND Increasing attention is being focused on public reporting of patient satisfaction and experience with hospital care, both nationally and at the state level. Comparative reports on hospital patient satisfaction use a standard survey, but little is known about underlying methodological approaches for reporting these quality measures. METHODS Literature, Web sites, and key informants were used to identify nine public reports. In-depth reviews were conducted to determine approaches to collecting, analyzing, and publicly reporting comparative data. Data were grouped into four analytic categories: survey, sampling, computation of scores, and reporting of scores. RESULTS The reports were similar in response rates and sampling procedures but differed in the number of hospitals included, the survey instrument, and survey procedure. The reports varied considerably in the techniques for computing hospital scores and decisions about reporting scores. CONCLUSIONS Reports from nine locales illustrate the decision making necessary to produce comparative reports on hospital patient satisfaction. Differences stem from decisions about the survey instrument and statistical decisions about how to interpret and report data. These issues should be clearly delineated as part of any public reporting process.

Interventions to Increase Physician Participation in a Voluntary Reporting System: The Rhode Island Adverse Drug Reaction Reporting Project

AbstractThe voluntary reporting system for adverse drug reactions, operated by the US Food and Drug Administration (FDA), is an important component of the postmarketing surveillance process. Despite this, the system is under-used by the physicians upon whom it depends. The FDA contracted with the Rhode Island Department of Health in 1985 to conduct a pilot reporting project to investigate how physician participation in the voluntary reporting system could be increased. A variety of different educational interventions were directed at the Rhode Island physician community. By the end of a two year study period, reports had increased 17-fold. Evaluation of the interventions through a survey of Rhode Island physicians indicated that hospital presentations, a project newsletter and mailings were the most effective educational interventions. Conversely, journal articles, advertisements and articles in hospital newsletters were identified as the least effective interventions. This assessment of project intervent...

Spontaneous Reporting of Adverse Drug Reactions: Assessment of Physician Knowledge and Attitudes Before and after the Intervention of a State Health Agency

AbstractPhysician knowledge and attitudes relating to the spontaneous reporting of adverse drug reactions (ADRs) were investigated using a survey of Rhode Island physicians. The survey confirmed physician underutilization of the FDA reporting system. Respondents (75% response rate) displayed a poor knowledge and understanding of the system. A lack of availability of report forms, lack of certainty the drug caused the reaction, and a previous knowledge of the reaction were identified as the major impediments to reporting. Two years later, after the Rhode Island Department of Health implemented various interventions, physicians were resurveyed. At this time, respondents (69% response rate) displayed an improved knowledge and understanding of the ADR reporting system. Compared with the baseline survey all the major impediments, except for lack of certainty the drug caused the reaction, were dramatically reduced. Concern about legal liability and the time involved in reporting were important to a greater perc...

Certificate-of-Need: No Panacea but Not without Merit

ITH the current Administration in Washington promoting competition, the certificate-of-need (CON) program is experiencing critical scrutiny. The National Health t Vv 5 Planning and Resources Development Act of 1974, Public Law 93-641, required all states to establish certificatek c d of-need programs to control major hospital and nursing home construction, renovation, and development proposals. However, many states had certificate-of-need programs long before Public Law 93641 was enacted, and many are likely to maintain certificate-of-need programs for many years to come. An extensive literature has developed over the past few years regarding the effectiveness of certificate-of-need (i). While the empirical evidence is mixed, the current academic perspective appears to be largely negative on certificate-of-need. Evidently, certificate-of-need has enjoyed some success in restraining the number of hospital beds, but many researchers indicate that certificate-of-need has not been greatly successful in controlling health care costs. Apparently, in those areas where beds have been controlled, hospitals have shifted investment to service-intensifying expenditures. Many analyses point out the fact that a high percentage of all certificate-of-need applications are approved. However, most certificate-of-need analyses give little attention to three of its most important features: deterrence, guidance, and institutional planning. The very existence of certificate-of-need acts as a deterrent to frivolous or obviously misdirected projects. Few institutions are likely to expend the time, energy, and money to traverse the complex certificate-of-need process for a project that cannot withstand the test of public scrutiny. This is a powerful deterrent to unnecessary and inappropriate development in the health care industry.