ensuring adequate databases for clinical research,
exploiting the unique advantages of managed care for surveillance and research, and
One hallmark of successful clinical practice is the adherence to preestablished guidelines. However, the adoption of standard guidelines among managed care organizations has been slow, as competing managed care organizations are often unwilling to share the data necessary to construct the guidelines. Even when the data are available, moreover, standardized clinical practice guidelines often have not been validated under sustained use in clinical settings. Furnishing managed care organizations with opportunities to implement and evaluate clinical practice guidelines will entail the involvement of providers and purchasers of health care to overcome both organizational and psychosocial barriers. The following challenges to and opportunities for the development of clinical practice guidelines in managed care organizations emerged during the presentations and discussions and are discussed in greater detail in this workshop summary:
developing clinical practice guidelines,
promoting adoption and use of guidelines in managed care organizations, and
involving clinicians in guideline development and implementation.
The surveillance and monitoring of emerging infections, including microbial resistance, in the managed care environment demand an effective partnership among health care providers, academic health centers, commercial laboratories, and the traditional public health system. Professional roles and responsibilities across the spectrum of infectious disease surveillance activities must be clearly understood and supported by all parties involved. The capabilities of public and private microbiology laboratories cannot be overlooked (and therein may lie a role for the Centers for Disease Control and Prevention in providing training for state laboratory personnel in the use of new molecular tests). Sharing data on rapid and accurate diagnosis and disease reporting will be at the heart of an effective partnership with managed care and public health systems to combat emerging infections. The following challenges and opportunities to disease surveillance and monitoring in the managed care setting are discussed in the text of this workshop summary: