The EQ-5D provides valid general HrQOL measurement post-MI.

OBJECTIVE -To describe decisions made by primary care providers on elevated HbA 1c results and their reasons for not intensifying therapy.RESEARCH DESIGN AND METHODS -In this cross-sectional study, a provider survey was administered in two practice-based research networks when HbA 1c results were reviewed on all nonpregnant patients Ͼ18 years old with type 2 diabetes. Univariate and Mantel-Hantel analyses assessed associations between patient characteristics and clinical decisions.RESULTS -A total of 483 surveys were completed by at least 88 providers at 19 clinics. Most patients were female (62.5%), mean age was 60 years, and 28.6% were Hispanic. The overall action rate on HbA 1c results Ն7% (n ϭ 294) was 70.7%. Patients who were black or had Medicare without medication insurance had lower rates of action on HbA 1c Ն7 and Ն8%, respectively (P Ͻ 0.05). The most common reasons providers reported for inaction were "patient improving/doing well," "competing demands," and "hypoglycemic risk." CONCLUSIONS -Primary care providers generally adhere to national glycemic control guidelines, although there may be disparities in black patients and patients without medication insurance coverage. A variety of reasons were given when control was not intensified.

PURPOSE We wanted to explore potential effects of the Health Insurance Portability and Accountability Act (HIPAA) on research activities of practice-based research networks (PBRNs). METHODSTo understand the approaches PBRNs are using to advance their research while adhering to HIPAA standards, we combined a literature review, our experiences, and discussions with local HIPAA offi cers, PBRN researchers in the United States, and individuals involved in drafting HIPAA.RESULTS HIPAA requires researchers to pay special attention to how they handle patients' protected health information (PHI). For researchers working within PBRNs, which collect information from patients and health care professionals in multiple institutions, the HIPAA Privacy Rule presents additional challenges. PBRN researchers can obtain patient authorization to use PHI, but this process is diffi cult and may taint the fi ndings of some research studies. Some institutions may allow patients to provide a blanket authorization for study recruitment. PBRNs additionally can collect only "de-identifi ed" data (data with identifying information removed) or, with a data use agreement, can work with a limited data set. PBRNs that blend quality improvement and research can work with PHI, but the researcher and practices must enter into a business agreement. PBRN researchers may need to play active, educational roles in institutional privacy boards to facilitate their research. CONCLUSIONSThere are a number of ways for PBRN researchers to comply with HIPAA short of obtaining patient consent and authorization for every study. Careful planning and consideration of HIPAA issues during study design can go a long way toward reducing frustration later. INTRODUCTIONT he Health Insurance Portability and Accountability Act (HIPAA) was intended to improve and simplify the movement of individual patients' protected health information (PHI) between health care professionals as well as to other entities that require the information, such as insurance companies. The act was written to accelerate the development of data standards for the transmission of health information, but it was quickly apparent that transmitting health information electronically presented hazards that required special attention. A pair of rules guide the implementation of HIPPA. The Health Insurance Reform: Security Standards, known as the Security Rule, describes standards for the security of electronic PHI. The Standards for Privacy of Individually Identifi able Health Information, generally known as the Privacy Rule, lays out specifi c processes to prevent potential abuse of electronically stored data, and especially abuse of easily linked PHI repositories. The requirements of the Privacy Rule have dominated the discussions of the legislation since its initial drafting and are the focus of this article.Other authors have described some of the implications the HIPAA Privacy Rule has for general health services researchers 1 and specialist researchers. 2,3 These authors acknowledge that dat...

Sensitive research issues call for anonymous questionnaires. This makes accurately matching pretests with posttests difficult or impossible. Various subject-generated coding schemes have been developed, but their accuracy has been unknown. This anonymous study, with 745 students, used subject-generated coding to match pretests with posttests. The matching was verified for accuracy with the use of a collateral, anonymous, sticker identification system. The coding system was able to accurately match 75.2% of all the pretest-posttest pairs. An additional 22.1% of the pairs were left unmatched and only 2.7% were matched incorrectly. Subject-generated coding systems can be very effective where confidentiality is important to protect.