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Objective. To discuss different types and forms of interorganizational linkages involved in the provision of primary care to older Americans, along with their distinguishing characteristics. Research Strategy. To take advantage of these linkage characteristics. The strategy requires a partnership with health services organizations and providers actually involved in the provision of services along with a planned sequence of activities involving hypotheses and methods development, intervention trials, and finally, demonstration and implementation. Conclusion. Because older Americans are frequent users of health services, their need for continuity and access provides an opportunity to examine changes to the delivery system and to monitor the system's capability for meeting their healthcare needs. Key Words. Interorganizational linkage, alliances, intervention trials, healthcare needs of the elderly, access, continuity of care, Mrs. Dorothy Peterson is a 72-year-old woman living in a retirement community. On February 1st, she was found unconscious in her apartment, and was taken to the emergency room of [...]

Objective. This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. Data Collection Methods. Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. Methods of Analysis. Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. Results. Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. Conclusion. Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment. Key Words. Colonic neoplasms, therapy; practice characteristics; medical decision making, Colorectal cancer, a major public health problem in the United States, is the second most common cancer and in cancer mortality is surpassed only by lung cancer (Garfinkel 1991). The [...]

Clinical trials are useful in evaluating health-care technology. The National Cancer Institute's Community Clinical Oncology Program (CCOP) is a national network of clinical trials established to reach the community were patients receive care with the latest cancer treatment, prevention and control. The ability of CCOP to contribute to patients to the Breast Cancer Prevention Trial is presented.

Objective. This study examines how "strategic partnerships" between community-based consortia of oncologists and hospitals (CCOPs) and clinical cooperative groups emerge, develop, and influence patient accruals (i.e., the number of patients enrolled in clinical trials) over time. Data Sources and Study Setting. Study analyses are based on 65 pairwise relationships that 38 CCOPs established with eight clinical cooperative groups in September 1983 and maintained through February 1989. Data are drawn from grantee applications and progress reports. Study Design. The study examines how different types of CCOP-cooperative group exchange relate to one another and to CCOP patient accruals over six time points. Key independent variables include resource dependence, information exchange (i.e., meeting attendance and committee membership), and protocol exchange (i.e., the number of different protocols used). Data Collection Methods. Data extracted from secondary sources were entered in a data base. Principal Findings. The number of CCOP physicians and support staff who attend cooperative group meetings during the first two years of a clinical research partnership has a significant influence on meeting attendance and protocol use in later years. Two-thirds or more of the variance in patient accruals at each time point can be explained by the number of different protocols used and the number of CCOP representatives serving on cooperative group committees (or attending cooperative group meetings). Conclusions. The findings highlight the importance of historical relationships and anticipated resource dependence in shaping initial exchange patterns. They also suggest that strategic partnerships need to emphasize structures and processes that encourage early involvement in collaborative activities and that reward participants for maintaining high levels of interaction., In recent years, health services researchers and practitioners have noted the proliferation of "strategic partnerships" in the health services sector. These partnerships include hospital and health service alliances, organ procurement [...]

The Community Clinical Oncology Program was evaluated on the basis of patient response to the National Cancer Institute-approved treatment protocols. It was shown that environmental and organizational influence significantly affects alliance performance. Proper screening of organizations and establishment of guidelines for operations are therefore necessary in the success of patient accrual to national programs., Increasingly, it is recognized that strategic alliances represent a form of service delivery that may resolve many of the existing problems facing health services. Alliances provide a mechanism for addressing [...]