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The Alberta clinical practice guidelines program is supporting appropriate, effective and quality medical care in Alberta through promotion, development and implementation of evidence-based clinical practice guidelines.

Enormous changes are occurring in the organization and financing of the U.S. health care system—rapid changes that are being driven by market forces rather than by government initiatives. Although it is difficult to predict what they system will look like once it begins to stabilize, the changes will affect all components of the health care workforce, and the numbers and types of health care professionals that will be needed in the future—as well as the roles they will fill—will surely be much different than they were in the past. Despite numerous studies in the past 15 years showing that we might have more doctors than we need, the number of physicians in residency training continues to grow. At the same time, there is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is taking place at a time when, coincident with the result of failure of comprehensive health care reform, there is no coordinated and widely accepted physician workforce policy in the United States. The present study examines the following three questions: (1) Is there a physician policy in the United States? (2) If there a surplus, what is its likely impact on the cost, quality, and access to health care and on the efficient use of human resources? (3) What realistic steps can be taken to deal with a physician surplus? December

Volume II of Medicare: A Strategy for Quality Assurance provides extensive source materials on quality assurance, including results of focus groups with the elderly and practicing physicians, findings from public hearings on quality of care for the elderly, and many exhibits from site visits and the literature on quality measurements and assurance tools. The current Medicare peer review organization program and related hospital accreditation efforts are comprehensively described as background for the recommendations in Volume I of this report. Like the companion volume, this substantial book will be a valuable reference document for all groups concerned with quality of health care and the elderly.

This book contains chapters and commentaries by members of the Institute of Medicine (IOM) committee and by outstanding practitioners, researchers, legislators, and policymakers about the IOM's proposals for new directions in quality assurance as specified in Medicare: A Strategy for Quality Assurance, Volumes 1 and 2. Sections of this new book address ideas about how to move toward increasing professionalism, implementing orgranization and system-focused quality improvement, better decision making by patients and clinicians, patient outcomes orientation, and public accountability and program evaluation. Other sections explore research questions and capacity building in the field of quality assessment and improvement, the epidemiology and quality problems, and legal issues in quality assessment.

Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base—as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systems—important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.