DSM-IV criteria, patient placement using the American Society of Addiction Medicine criteria for level of care, treatment planning consistent with Joint Commission for the Accreditation of Health Care Organizations standards, and compliance with federal and state data reporting requirements (Dennis et al., 1997). This monitoring during and after treatment is expected to enhance clinical processes and improve outcomes. Although still in development and testing, the emphasis on clinical needs and client outcomes increases the potential value for consumers, counselors, management, and payers.

Developed with funding from NIAAA and CSAT, the Drug Outcome Monitoring System illustrates an important strategy for integrating services and research and meeting the needs for both sets of stakeholders. Because the data are of clinical value, counselors are likely to be more careful completing interviews and responding to data elements, thus enhancing data quality for research studies and policy analyses. Client subgroups are developed and benchmarks are established for levels of services and outcomes and postdischarge client tracking. The monitoring system engages clinicians and consumers in the process of tracking and recording clinical status and incorporates early reintervention protocols when postdischarge follow-up suggests that a client is in early relapse. The design of this system to be responsive to consumer and counselor needs contrasts with the top-down development of many administrative data systems that stress payer requirements and management needs.

Community Clinical Oncology Program

Initiated by the National Cancer Institute (NCI) in 1983, the goal of the Community Clinical Oncology Program (CCOP) has been to bring state-of-the-art cancer treatment, prevention, and control research to local communities. This is accomplished by involving community oncologists and community-based primary care physicians in NCI-approved clinical trials (Kaluzny et al., 1996).

CCOP is a strategic alliance among existing organizations. The three main organizations are: (1) NCI, which provides overall direction, funding, and program management; (2) NCI-designated cancer centers and clinical cooperative groups, which develop protocols, analyze data, and provide quality assurance; and (3) the community oncology programs composed of community oncologists, primary care physicians, and their clinical staff who are involved with the accrual of patients to approved treatment, prevention, and control protocols.

As of 1997, there were 51 CCOPs located in 30 states, with 300 participating hospitals where some 2000 physicians cooperate to enter patients and individuals at risk for cancer on NCI-approved clinical trials. An addi-



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