Ethical issues in informed consent. Research on medical cost containment

The decision to contain medical costs, which is a political and social decision, entails restriction of medical services. To guide public policy, research on the impact of such restriction must be carried out, but this type of research differs significantly from most other medical research. Difficult issues concerning informed consent arise, with potential conflicts among principles of maximization of good and minimization of harm to the patient, the patient's right to self-determination, and the utilitarian goal of maximization of collective welfare. We have discussed these principles in the context of relationships between patient and physician and between subject and investigator. Approaches considered include emphasis on retrospective studies, use of statistical techniques to formulate clinical decision-making rules on the basis of available data, three-celled randomization designs, and the role of the primary-care physician in maximizing patient autonomy and minimizing the potentially threatening aspects of informed consent for such studies.

Improving health care policy research

Interest in health care policy research has grown significantly over the past decade. This paper makes a number of suggestions for improving the quality of health care policy research and its influence on policymaking. These include suggestions for: 1) improving the way in which problems are identified and defined; 2) merging qualitative and quantitative approaches to study design, data collection, and analysis; 3) developing more integrative strategies for disseminating research results; 4) changing the reward structure to encourage health policy research; and 5) developing a stronger standby research capability. Specific examples of each of the above are presented. Throughout, the need for greater interaction among researchers, analysts, policymakers and practitioners is emphasized, along with specific suggestions for ways of bringing this about.

Potentials of local health surveys: a state-of-the-art summary

This paper provides a state-of-the-art summary of the potentials and limitations of local surveys for assessing health problems in local areas. The information they provide may be helpful for a variety of purposes such as measuring the need for services, planning programs to address these needs, and evaluating their impact. Particular advantages of surveys are that they: provide information on the needs of people who have not sought care; permit special studies of particular target groups; provide data on variables which are only available from "asking" people; enable information to be collected on a range of correlates and indicators of health care behavior; provide an opportunity for examining relationships among variables; and permit well-timed community estimates of the impact of experimental programs. Limitations include the validity and reliability of survey data, and the costs and other problems of survey implementation.

Postprofessional training in biostatistics and epidemiology for clinical research optometrists

Under modern concepts of clinically and community relevant health research, epidemiology is considered the basic science and biostatistics a vital allied science. This paper discusses advanced training programs in these two numerative sciences that are currently available to the clinical research optometrist.

The effect of inadequate language translation on Hispanics' responses to health surveys

Data bearing on the effect of language of the interview on Hispanics' responses to a health survey in which no back-translation was undertaken reveal both lower reliabilities and lower bivariate correlations among Hispanics interviewed in Spanish than among Hispanics interviewed in English. An independent back-translation aimed at creating an English version of the questionnaire that was linguistically equivalent to the Spanish version indicated several instances in which the Spanish version was unidiomatic. Differences between the Spanish and English version in the idiomatic quality of the interview items, while not affecting meaning, appear to have affected the seriousness with which the interview situation was perceived. These perceptions, in turn, appear to have led to the response discrepancies observed.

Household health interviews and minority health: the NCHS perspective

Efforts to identify information needs in the area of minority health have been paralleled by efforts within the National Center for Health Statistics (NCHS) both to improve the quantity and quality of minority health statistics and to increase the accessibility of these statistics to data users. This paper describes the context in which these objectives are pursued within NCHS. The paper also discusses problem areas which may confound the development and usefulness of minority health statistics derived from general-purpose, household interview surveys designed to produce descriptive estimates of morbidity and health services utilization at the national level. Developments within NCHS related to some of these problem areas are highlighted.

The health interview survey and minority health

This article emphasizes the advantages and disadvantages of the National Center for Health Statistics Health Interview Surveys (HIS) when applied to the needs of ethnic minorities at the local level. While HIS gives information on health status of minorities and their use of services at the national level, this information is of limited help to providers in local communities. In any national survey, the numbers of minority persons sampled will be very small and heterogeneous populations sharing a common language (for example, Spanish) may be aggregated though their characteristics may differ widely. Certain groups may be missed or their numbers greatly underestimated if they do not live in settled households, which form the unit of HIS. Pertinent examples are migrant farm workers and young adult black urban males. Other possible problems arise in the use of proxy respondents, in the HIS definition of acute illness, and in the rather infrequent use of linkage studies. While there are a number of important ways by which HIS surveys may be made more effective, special national surveys of specific minority groups and in-depth local surveys are needed to fill gaps in meeting minority needs.