o A selection process for experts for consensus panels that minimizes bias and ensures appropriate representation. A panel process that maximizes exchange of ideas and minimizes A panel process that includes explicit consideration by Assurance that results of the process meet the criteria for Assurance that process results are reproducible, i.e., Acceptability to all interested parties--patients, physicians, Practicality, i.e., it can be replicated for a large number of operations at reasonable expense. Practice guidelines thus represent a marriage of evidence, experience, and opinion with the view toward outcomes that ultimately are important to the patient. Mr. Conte: Do you think these guidelines could be useful for consumer groups as well? Dr. Clinton: Ideally, decisions about medical practices should be made between physicians and their patients, with each decision tailored to fit the patient's problems and desires. This must explicitly involve the discussion of outcomes of medical care that are important to patients. However, to achieve this ideal, both physician and patient must have reliable, comprehensive information about the consequences of different choices and must be able to process that information accurately. Guidelines should not be developed in isolation from other initiatives to modify inappropriate practice. Consumer groups have a major role to play in the development, dissemination, use, and evaluation of practice guidelines. Mr. Conte: How will you disseminate these guidelines so that they are used, and not ignored, by the medical community. Dr. Clinton: The Agency's Medical Treatment Effectiveness Program (MEDTEP), which includes the development and dissemination of practice guidelines, will provide information that physicians want and need. We are working closely with the relevant health professions societies to develop these guidelines and we will work with them to ensure effective dissemination of our collaborative efforts. Strategies to disseminate scientific information to practicing clinicians will be geared to achieve positive change in physician behavior. Studies have shown that this can be attained by providing physicians with nonthreatening, educational feedback in a collegial setting and by continuing to reinforce the message. The AHCPR has arranged selected announcement and publication of findings by professional journals. For example, we now have a monthly column in the Journal of the American Medical Association (JAMA) to highlight results of guideline development, patient outcome research, and other research of interest to physicians. We are arranging for announcement or publication in key nursing journals of recommendations on nursing guideline development created through a recently convened ad hoc committee of nurse clinicians, educators, and policymakers. The AHCPR also is working with other agencies and organizations skilled in the dissemination of information to clinicians, particularly staff of the Health Resources and Services Administration (HRSA). The HRSA will assist in the assimilation of the results of medical effectiveness research and practice guidelines into medical practice. This will be facilitated by HRSA's long-standing support of medical education and curriculum development. The MEDTEP emphasizes the dissemination of findings to health care providers and all potential users of the information. The Agency is seeking innovative dissemination plans that include developing information into different formats for different audiences. Dissemination strategies also will be evaluated to determine effects on physician and patient behavior. The doctor/patient relationship should actually improve with a more informed patient who better understands the complexity of the clinical decisionmaking process and can ask questions that help to guide the clinician. YEAR 2000 HEALTH OBJECTIVES We as Mr. Conte: We have ten years left in this millennium. a nation have seen tremendous changes in our century in improving the health of our people. But so much remains to be done. The Year 2000 health objectives program is an appropriate vehicle to look at what needs to be done to improve the health of the disadvantaged, the poor, the homeless, the elderly, and minorities. What will the Office of Disease Prevention be doing to implement the Year 2000 health objectives? Dr. Mason: One of the most important steps toward implementation began with the planning process for developing the objectives, with the formation of a consortium of national membership organizations and State health departments to participate in that process. During the course of developing the year 2000 objectives, the consortium has met semiannually and had an essential role in ensuring broad participation. It has become clear that the success of implementation will depend heavily on the continued work of the consortium. For this purpose, PHS is discussing with the consortium at its March 1990 meeting the feasibility of continuing its existence in order to provide mutual support among members as they undertake to implement parts of the objectives relevant to their organizational missions or States' priorities. In addition to the consortium, the Office funded projects in FY National Medical Association for Black Americans American Indian Health Care Coalition for American American Association of School Administrators for Children/Schools American Medical Association for Adolescents American Association of Retired Persons for Older Adults National Civic League for Healthy Cities/Healthy Communities United Way of America for Community-Based Service American Association of University Affiliated Programs These organizations have begun initial plans for developing implementation strategies for their groups/purposes. Some of their planning will be unveiled at the time of release of the objectives in September 1990. The Office will initiate in 1991 the management/progress review system, using the year 2000 objectives, that has served as a tracking and management oversight tool during the course of the 1990 Health Objectives for the Nation. Periodic reports to the Nation on the status of the objectives are planned through the triennial "Prevention Profile" sections of Health United States and through a mid-decade complete review similar to The 1990 Health Objectives for the Nation: A Midcourse Review, published in 1986 to review the status of the 1990 objectives. Mr. Conte: These health and prevention goals have been evolving for quite some time. Can you share with us any major changes in the making on some of these goals? Dr. Mason: There are a number of ways that the year 2000 objectives and goals differ from those set for achievement by 1990. First, we are giving much higher priority to the needs of population groups at highest risk of premature death, disease, and disability. Depending on the specific health issue (e.g., nutrition, smoking behavior, pregnancy outcomes, infectious diseases, chronic diseases), particular minority, age, or incomelevel subpopulations may be disproportionately at risk. The year 2000 objectives focus on those groups whose health profiles call for most improvement. Second, we are making an attempt in the year 2000 objectives to shift the focus of our measurement of health status from one largely defined by death rates to include more attention to morbidity and disabling impairments, recognizing that prevention is much more than just avoidance of premature death and the measurement of prevention's effectiveness has to focus on reducing the occurrence of disease and injury that result in long-term, chronic suffering as well as death. Third, the year 2000 objectives contain priority areas that were not addressed in the 1990 objectives, including HIV infection, mental health, surveillance and data systems, health education and preventive services, cancer, and food and drug safety. Finally, I believe that we will be producing a set of objectives for the year 2000 that adhere to the principle of measurability more effectively than did the ones that we developed for accomplishment by 1990. We learned over the past decade that one of the powerful aspects of this goal- and objective-setting effort has to do with measurement of progress, or lack of progress, and resulting effects of such measurement on programmatic and resource allocation decisions. Mr. Conte: Is there an effort being made to see whether we are making progress towards the year 2000 goals? Dr. Mason: We will not publish the final set of year 2000 goals and objectives until September 1990, so we have not yet begun to track progress toward their accomplishment. We will, however, use the year 2000 objectives as a classic management-by-objective tool. I will hold regular progress reviews on the priority areas. We will publish periodic "health audits" that provide updates on what progress or lack of progress is occurring as we move toward the year 2000. NUTRITION AND HEALTH Can Mr. Conte: Dr. Mason, you mentioned in your written statement that implementing key provisions of the Surgeon General's Report on Nutrition and Health is going to be a priority of your office. you share with us what recommendations will you be pursuing from the Report? Dr. Mason: We have already begun several initiatives to implement recommendations contained in the Surgeon General's Report on Nutrition and Health. Among these are: A major review of food labeling policy, undertaken by the A project undertaken in cooperation with the American School Continuing collaboration with the U.S. Department of MINORITY HEALTH Mr. Conte: The budget is asking for a $12 million increase, for a total of $20 million, to strengthen minority health programs. $10 million of this increase would go to the Secretary's minority health improvement initiative, including the community coalition demonstration grants. What will be the criteria for selecting a particular community for the community coalition grants? Dr. Mason: To be eligible to receive funding under the community coalition grant program, applicants must be a coalition of organizations and institutions within a community which have come together to promote disease risk reduction efforts among minority populations of that community. In making grant awards, the Office of Minority Health will attempt to achieve equitable geographic and ethnic distribution of awards as well as cover the various health problems identified in the Task Force Report. There is no lower limit for the size of the population targeted by the applicant, but there must be a reasonable relationship between the level of effort involved in the coalition and the size of the target population and the health problem(s) to be addressed. Similarly, the geographic distribution of the target population must be such that effecting risk factor reduction is feasible. Mr. Conte: What effort is being made to coordinate minority health objectives among the several agencies involved? Dr. Mason: There are several mechanisms by which the Office of Minority Health (OMH) is coordinating minority health objectives. Foremost is the DHHS-wide coordinating process in which the OMH is developing a minority health strategic plan. This plan contains short- and long-range objectives encompassing all Public Health Service (PHS) activities related to minority health. PHS agencies are intimately involved in the development and finalization of this plan. OMH The OMH has also been involved in formulating and reviewing the Year 2000 Objectives for the Nation which contains objectives relevant to minority populations and their health status. staff also interact on a one-on-one basis with PHS agencies and other entities within the Department to implement these objectives. PRESIDENT'S COUNCIL ON PHYSICAL FITNESS AND SPORTS Mr. Conte: What new initiatives will the Council be doing to improve public awareness of physical fitness in the coming year? Dr. Mason: The President's Council on Physical Fitness and Sports (PCPFS) works closely with numerous organizations, but especially with the State Departments of Education and the Governors' Councils on Physical Fitness and Sports. PCPFS will continue to work with them and increase cooperative efforts at the grass-roots level. Some specific new initiatives which the Council will introduce to improve public awareness of physical fitness in the coming year include, but are not exclusive to, the following: Creation of State and Local Councils on Physical Fitness and Sports. We presently have 31 Governors' Councils on Physical Fitness and Sports. A local council on physical fitness and sports, made up of influential citizens, can do much to advance physical fitness in its populace for all of the ages. If we can advocate the need to reinstate physical fitness as a priority in our schools to the local officials, then perhaps we can reverse the trend when budgets get tight to reduce funding for quality physical education. These councils can also inform and educate the community on the benefits of being physically fit. The Goodwill Games and Sports Illustrated for Kids is a new joint project which will promote the President's Challenge Fitness Award Program and the Goodwill Games. Turner Broadcasting System will produce three versions of a promotion spot featuring a prominent Goodwill Games athlete informing youngsters of the importance of |