Network News Excerpts
(EXCERPTS TAKEN FROM THE SPRING 2000
EDITION OF THE NETWORK NEWS)
From the Director
By Mort Wasserman, MD, MPH
Perilous PROS Predictions
Although I maintain, as many do, that the new millennium doesn't actually
start until next year, the fuss about the new digit in the thousands
place on our calendar has inspired me to contemplate the futures of
PROS and of primary care pediatrics. In the spirit of dedication and
optimism inherent to pediatrics and PROS, I hereby offer up 10 predictions
(5 for PROS and 5 for primary care pediatrics) for the coming decade.
For PROS
1. Randomized controlled trials (RCTs) will become a regular PROS
activity. This is a safe prediction, since such trials are in the
proposal pipeline. Nevertheless, RCTs represent a major step
for the network.
2. PROS will collect data for most studies electronically on user-friendly,
book-sized portable electronic screens that upload collected data
to the Internet and eliminate the pounds of paper that usually accompany
PROS studies. This technology currently exists, and as hardware costs
decrease and practitioners' and patients' comfort with technology
increases, electronic data collection will become a reality.
3. PROS will study different approaches to helping practitioners
improve care in their practices. The network will help to establish
and assess pediatric practice quality improvement within a rigorous
framework.
4. PROS will extend the reach of practice-based network research
to more practitioners who care for inner-city, under-served, and minority
populations. PROS currently has disproportionately few members who
care for these populations, making it a challenge to generalize from
PROS results to this important group of children.
5. Electronic mail and the World Wide Web will become the dominant
forms of communication within PROS, as practitioners who don't currently
use e-mail and the Internet either log on or retire (!).
For Pediatric Practice
1. Pediatric practitioners will adopt population-based approaches
to care, developing and implementing care systems oriented towards
groups of patients as a substitute for the patient-by-patient approach.
One example might be to establish registries of practice patients
with particular chronic health problems and tracking visits and procedures
for those patients.
2. Pediatric practitioners will begin routinely either to measure,
or subscribe to services that measure and report on the care that
they deliver. These measurement activities will be driven internally
by a desire to improve care rather than imposed externally in a punitive
context.
3. Pediatric practitioners will better coordinate and link office-based
care with community-based care. For example, pediatricians will work
with schools so that two sets of hearing and vision screens will not
need to be performed on the same child in the same year.
4. Pediatric practitioners will systematize the identification and
management of childhood behavioral problems, the commonest chronic
conditions of childhood.
5. Innovative pediatric practitioners will borrow a page from other
service industries (yes, that's what we are!) and implement routine
quality improvement activities in their offices.
Whenever the millennium actually begins, I hope that we all can work
together to transform these predictions into realities.
From The Steering Committee Chair
By Gordon Glade, MD
Serving as Chair of the PROS Steering Committee has been an invigorating
experience. I have been able to attend a few more meetings, read a few
more research proposals and interact a little more with the good people
at PROS Central. People back home in Utah have been real proud. I have
noticed, however, some misunderstanding about just what the PROS Steering
Committee does. I'd like to clarify that role as I understand it and
mention the names of the people on the Steering Committee so you can
feel free to contact any of us.
The Steering Committee is basically the governing body of PROS. Our
Rules of Governance assign us 13 different responsibilities, the most
important of which are determining "overall policy and direction
for PROS," and overseeing selection, implementation, publication
and dissemination of research studies and study results. Research projects
are presented to the Steering Committee before they are presented to
the Chapter Coordinators, and progress on various projects is monitored
in semi-annual meetings and by multimedia communications when face-to-face
meetings are not possible.
Both practitioners and consultants on the Steering Committee have become
more aware of the importance of staying very closely tuned into the
chapter coordinators. Furthermore, to better realize the potential impact
that PROS can have on improving the health of children, we need to stay
close to the practitioners who do studies but don't attend chapter coordinators
meetings and to pediatricians who are not in PROS.
Two Steering Committee members, who are full-time practicing pediatricians,
have been working on developing strategies to address these needs. Jim
Little, from Jackson Hole, Wyoming, has worked with PROS Central to
develop a way to assure that results from all PROS studies are disseminated
to as broad an audience as possible. Paul Bodnar, from Baltimore, Maryland,
has kept the question of the value of PROS to the practicing pediatrician
constantly on the minds of the Steering Committee and is developing
a study to better assess that value. Both of these pediatricians have
completed six-year terms on the Steering Committee. Both have agreed
to continue as consultants in regards to dissemination and enhancing
the value to PROS to practitioners.
Two new coordinators have accepted to serve as members of the Steering
Committee: Stephen Pearson, practitioner from Washington, and Lynne
Uhring, practitioner from New Mexico. They bring enthusiasm and particular
experience in dealing with underserved populations.
PROS doesn't look the same way that it did in 1986 when I attended
the first PROS Chapter Coordinators Meeting. It has grown to accommodate
its successes and challenges. I am particularly concerned that the
Steering Committee does a good job addressing the health care needs
of children and research questions of pediatricians. The more we hear
about how you feel PROS is doing the better we can "steer."
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