CONCLUSION: African Americans and Mexican Americans are less likely to report serum cholesterol screening than whites. Even when identified as requiring medication, African Americans and Mexican Americans were less likely than whites to be on cholesterol lowering agents. These disparities in primary prevention are likely to lead to an increase in the risk of coronary artery disease in these populations. To describe the outcome of the Institutional Review Board (IRB) process from a multi-site QI evaluation and to examine participation rates as a function of recruitment and informed consent procedures. METHODS: We analyzed participation rates from a patient survey and medical record abstraction from 1504 individuals with either congestive heart failure or diabetes treated at 13 clinical sites in the United States that had implemented an evidence based QI intervention. We used bivariate analyses to assess the effect of recruitment procedures and informed consent requirements on participation rates. RESULTS: Recruitment procedures mandating patient permission to be contacted about the study varied by clinical site (Table 1 ). Among the sites that required advanced permission, only 58% (584/1012) of potentially eligible participants granted permission to be contacted about the study. Participation rates varied significantly by the type of recruitment and informed consent procedures required ( Table 2) . CONCLUSION: We found substantial variation in provisions for subject recruitment and informed consent. These differences significantly impacted participation rates, and possibly the generalizability of this multi-site QI evaluation study. To describe the demographic characteristics of participants who completed a mailed survey as compared to those initial non-responders who completed the same survey over the telephone. METHODS: To better understand barriers to care for abnormal cervical cytology, we performed a cohort study of all women with an abnormal pap smear who received care at Kaiser Permanente Los Angeles Medical Center between July 1998 and October 1999. We administered a mailed survey with telephone follow-up for non-responders between April and August 2000. Potential participants were mailed an introductory letter and survey in both English and Spanish with a self-addressed stamped return envelope. If no response was obtained within three weeks, a second letter and survey were mailed. If no response was received within three weeks, a trained bi-lingual interviewer called potential participants and offered to complete the survey over the telephone. The survey asked questions regarding patient satisfaction, health beliefs, cancer knowledge, and socio-demographics characteristics. We used bivariate and multivariate analyses to describe the population characteristics of respondents who replied by mail as compared to those who completed the survey by telephone. RESULTS: Of the 1049 potentially eligible participants, 733 women completed the survey for an overall response rate of 70%. Thirty one percent (n = 226) of the surveys were received after the first mailing, 25% (n = 185) were returned after the second mailing, and 44% (n = 322) were completed over the telephone. Sixty seven percent of those who completed the survey in Spanish were obtained by telephone, compared to only 37% of the surveys completed in English. (p < .001) In multivariate analysis, Latinas who completed the survey in Spanish and African American women were significantly more likely to complete the telephone survey than their white counterparts. Telephone respondents were younger, had lower household incomes, and were significantly less satisfied with their health care than those who responded to the mailed survey. Women who completed the telephone survey had more misconceptions about cancer and were more likely to report no knowledge of having an abnormal pap smear. Harvard University, Boston, MA PURPOSE: Pharyngitis is the second most common presenting complaint in the primary care office. Since rheumatic fever has become uncommon in the United States while rapid streptococcal antigen test technology has improved and concerns over drug side effects have grown, we examined cost-effective diagnosis and treatment of patients with suspected GABHS pharyngitis. METHODS: We constructed a decision analysis model from a societal perspective to examine the short-term cost-effectiveness of five strategies for the management of adult patients with pharyngitis: 1) Observation without testing or treatment, 2) Empiric treatment with penicillin, 3) Throat culture using a two-plate selective culture technique 4) Optical immunoassay (OIA) followed by culture to confirm negative OIA tests, or 5) OIA alone. We obtained data on test characteristics and event probabilities from published studies. We estimated utilities from a published patient survey which used a time-tradeoff technique to measure perceptions of outcomes (mild penicillin reaction, severe penicillin rxn, acute rheumatic fever) expressed in pharyngitis day equivalents. Based on published studies in which patients assigned a utility of 0.95 to other common symptoms such as diarrhea and dyspepsia, we estimated phayngitis to be associated with a utility of 0.95. We estimated costs from our hospital's financial systems, prior publications, and Medicare reimbursement rates. We converted all costs to year 2000 dollars. In sensitivity analyses, we varied values for probabilities and costs across ranges that included all published values or across ranges of 50 ± 200% of our baseline estimates. RESULTS: At a baseline prevalence of GABHS pharyngitis of 9.7%, a culture alone strategy was both most effective and least expensive, resulting in an average of .2618 quality-adjusted life days (QALDs) lost and an average cost of $6.19 per patient. For our base-case analysis, average costs in dollars, effectiveness in lost QALDs, and incremental cost-effectiveness were as below (see table) . Our results were sensitive to the prevalence of GABHS, so that OIA followed by culture was most effective at a prevalence greater than 17%. Observation was least expensive at a prevalence less than 3% and empiric treatment least expensive at a prevalence greater than 75%. As the probability of allergic reactions was varied throughout a possible range from 0 to 5%, OIA with culture, culture, and observation were all optimal strategies. Our results did not change with variations in costs of diagnosis or treatment. CONCLUSION: We found that observation, culture, and two rapid antigen test strategies for diagnostic testing and treatment of suspected GABHS pharyngitis in adults were all very similar in terms of both effectiveness and costs, although culture was least expensive and most effective at our institution's GABHS prevalence of 9.7%. We did not find empiric treatment to be most effective or least expensive at any prevalence of GABHS seen in adult populations. METHODS: A population-based telephone survey of 1205 women from a combination of random-digit-dial and targeted listed household samples from lower income census tracts of Washington, D.C. was conducted from January ± March, 2000. Valid and reliable measures of specific aspects of primary care and of the physician ± patient relationship were used. RESULTS: The survey response rate was 85%. Socioeconomic characteristics of the respondents reflected success in reaching the population sought. Four attributes of primary care (continuity, organizational accessibility, comprehensiveness of services, and coordination of specialty care) were important positive correlates of all aspects of the patient ± physician relationship (trust, compassion and comprehension), regardless of insurance, demographics, socioeconomic or health status. For example, women with the highest level of comprehensiveness of services at their usual source of care, were 11 times as likely to trust their physician (p < .01) and 6 times as likely to find their physicians compassionate and communicative (p < .01), compared to those with the lowest level of comprehensiveness. Higher organizational accessibility was strongly associated with greater trust, compassion and communication aspects of the physician ± patient relationship. (OR 3.2, OR 7.4 and OR 6.9 respectively, p < .01 for each). CONCLUSION: Women in ambulatory care systems that most strongly exhibit the features of primary care report stronger physician ± patient relationships than women whose usual sources of ambulatory care lack those primary care features. Ambulatory care systems which are organized to be more accessible to consumers, which permit patients to see the same clinician for their visits, which provide more comprehensive services, and which allow clinicians to coordinate specialty services are more likely to foster strong relationships between their patients and physicians, and to have patients who are more satisfied with those relationships. We excluded studies based on previously published decision analyses. The articles were reviewed by 2 investigators who were blinded to author and journal. We extracted information necessary to determine if the search strategies and databases searched were reported, if reference lists were reviewed for additional studies, if a systematic effort was made to find relevant unpublished studies, and if an a priori selection criteria or any validity grading system was used. RESULTS: We identified 257 articles through our Medline search and 36 met our eligibility criteria. The search strategy, including databases searched, was reported in 9 (25%) of the articles. Reviewing the reference list for additional studies was reported by 5 (14%) of the articles. Though no article reported a systematic effort to locate unpublished studies, 3 articles did report using data from unpublished sources. Two studies (6%) reported using a selection criteria and one study (3%) a grading system for the quality of the evidence. CONCLUSION: Our study shows that only 25% of CDAs published in major medical journals reported their process for selecting and evaluating the data they used. This is very concerning in view of the importance these items play when readers must appraise the validity of a CDA.