Effective Clinical Practice
New Journal Seeks Experienced Contributors
Many of you may be aware of the metamorphosis of HMO Practice to Effective Clinical Practice. This issue is the start of that process—a new cover, new fonts, and a new look. Over the next year, the associate editors and I plan to develop a new "feel" for the journal—as we seek a larger, more diverse audience. One element of HMO Practice I hope to retain, however, is the cadre of contributors who have been so important to the journal's development over the past decade.
In this brief editorial, I want to communicate directly to this group. Call it a recruiting editorial if you like (although no money, vehicles, or editorial board responsibilities will change hands).
First, I want to call your attention to the Guidance for Authors. Here, the associate editors and I begin to articulate the broad domains that will serve as the journal's foundation: "manuscripts that address questions about how much, how often, and how best to deliver medical care." We seek material that deals with the interface between health services research and clinical practice, which might include investigations addressing questions about the following areas:
- the frequency of various services (how often patients come to clinic or undergo screening, the effect of multiple medications)
- the effect of different care settings (home health, provider-initiated telephone calls)
- the organization of people engaged in care (the mix of providers, the role of ancillary support)
- the utility of information services (clinical prediction rules, electronic medical record)
- the efforts to engage patients in their own care (patient education, shared decision making).
We are especially interested in original investigations that adapt rigorous methods developed for highly controlled settings and apply them to the vagaries of actual clinical practice—those investigations that attempt to translate efficacy into effectiveness.
We understand that addressing these kinds of questions in the real world of the clinic can be extraordinarily difficult. We will not allow the "perfect" to impede the "possible"; therefore, good attempts at important questions will be highly valued. Rest assured that we are as interested in reporting failure as we are in reporting success.
Second, I want to call your attention to three special sections of Effective Clinical Practice that I am particularly excited about. (Truth be told, these are sections that I, as an author, have always wished existed.)
Back of the Envelope features simple, explicit estimates of how changes in medical practice will affect fundamental counts that relate to the cost and quality of health care (such as numbers of dollars, doctors, procedures, life-years, or patients). Although we welcome formal decision analyses, here all you need is a good idea, sound reasoning, a reliable data source, and perhaps a spreadsheet. Examples include how changing disease definitions (such as the threshold to diagnose diabetes or obesity) could affect the number of patients diagnosed, how a new operative approach (like endovascular abdominal aortic aneurysm repair) is likely to affect the number of procedures performed, and how new services and delivery models (such as disease management or hospitalists) might affect work-force requirements.
Patterns of Practice details what's really going on in current practice: patterns of testing (following screening exams or the workup of specific symptoms), medication use (antibiotics for otitis media, initial choice of antihypertensive agent), and procedures (breast conserving surgery, tympanostomy placement). Data sources may range from national/state claims data (Medicare, Medicaid) to careful chart review in defined populations.
Unanswered Questions: Research under Construction calls for manuscripts that articulate the case for studying a problem and outline one or more possible approaches and the associated limitations. This section offers researchers a venue for publication as they think about a research agenda or plan a particular investigation. We seek innovative approaches to important questions and offer investigators the opportunity for feedback from and collaboration with readers.
Finally, I close this recruitment with a commitment to the review process. First, if we tie up your time (and that of reviewers) by sending your manuscript for external review, then we are interested in publishing it. Manuscripts that do not interest us will be returned promptly. Second, for those manuscripts that are reviewed, our focus will be on suggestions for improvement—not on what's wrong. Although we can only request this of our reviewers, we can guarantee it from the editorial office. The associate editors and I are committed to synthesizing the reviews and offering specific recommendations for improvement.
We are extremely excited about our new journal and believe we have much to offer our future contributors. Please give us a try.
H. Gilbert Welch, MD, MPH
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