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Effective Clinical Practice

March/April 2000

ORIGINAL ARTICLES

Skin Cancer Prevention in Outdoor Recreation Settings: Effects of the Hawaii SunSmart Program
Karen Glanz, Robert A. Lew, Valerie Song, and Lynn Murakami-Akatsuka

Creative, engaging multicomponent skin cancer programs aimed at children and their parents can have modest effects on sun-protection behaviors.
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The Influence of Organizational Structure on Physician Satisfaction: Findings from a National Survey
Pat LePore and John Tooker

Physicians are more likely to be satisfied with managed care if they are plan employees or have a single managed care contract. Physicians with multiple contracts are least satisfied with managed care organizations and most likely to question these organizations commitment to quality.
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PATTERNS OF PRACTICE

Variations among Hospitals in the Quality of Care for Heart Failure
Jean-Cristophe Luthi, William M. McClellan, Dawn Fitzgerald, Jeph Herrin, Richard J. Delaney, Harlan M. Krumholz, Dale W. Bratzler, Kurt Elward, Charles B. Cangialose, and David J. Ballard

Patients with congestive heart failure are treated differently in different hospitals. The proportion of patients receiving assessment of left ventricular function, a prescription for ACE inhibitors, and counseling on diet and daily weight monitoring at discharge, varies substantially from hospital to hospital.
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BACK OF THE ENVELOPE

When Should We Stop Screening?
J. Scott Rich and William C. Black

The subject of when to start screening is a constant source of debate; however, when to stop has received little exploration. Most of the benefit of screening occurs before age 70, and the small benefit in older persons must be weighed against the harms: anxiety, additional testing, and unnecessary treatment.
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UNANSWERED QUESTIONS: RESEARCH UNDER CONSTRUCTION

Grading the Evidence for Diabetes Performance Measures
Sheila H. Roman, Stacey B. Silberzweig, and Albert L. Siu

The hierarchial grading system popularized by the U.S. Preventive Services Task Force cannot adequately characterize available evidence. The descriptive typologic system proposed in this article is less likely to understate existing evidence and may help to identify areas in need of increased attention.
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EDITORIALS

The Bright Side of the Managed Care "Dark Side" Demon
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Arguing about Grades
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Primer on Interpreting Surveys
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POLICY MATTERS

If You Care about Women's Health, Perhaps You Should Care about the Risks of Direct Marketing of Tamoxifen to Consumers
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LETTER

Vaccines and Immunization Performance Measures
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