improvement. Yet, public disclosure of this data is voluntary. We sought to determine the association between HMO quality of care and willingness to publicly disclose quality of care scores. METHODS: We analyzed data from the National Committee for Quality Assurance's annual Quality Compass databases, including the Health Plan Employer Data and Information Set (HEDIS), a standardized set of quality of care measures (e.g. % of women > 50 who received biannual mammography). We determined how frequently HMOs that publicly disclosed HEDIS scores in 1997 or 1998 withdrew from public disclosure the subsequent year. We also assessed whether withdrawal from public disclosure was associated with being in the lowest (compared with the highest) tertile of plans ranked by HEDIS scores for 9 clinical quality measures, after adjustment for the method of data collection (administrative vs. medical record review). RESULTS: Of the 329 HMOs which publicly disclosed HEDIS scores in 1997, 161 (48%) withdrew from public disclosure in 1998. Of the 292 HMOs which publicly disclosed in 1998 (including newly disclosing plans), 67 (23%) withdrew from public disclosure in 1999. Quality varied greatly between plans with absolute differences in HEDIS scores between lowest and highest tertile plans ranging from 14.6 to 42.3 percentage points. When HEDIS measures were analyzed individually, HMOs ranked in the lowest (compared with the highest) tertile in 1997 were significantly more likely to withdraw from public disclosure in 1998 for 7 of the 9 measures (RR = 1.6 ± 2.7, p < 0.05 for all). In 1999, HMOs ranking in the lowest tertile in 1998 for 8 of the 9 measures were significantly more likely to withdraw from public disclosure (RR = 1.9 ± 7.0, p < 0.05 for all). When examined by average rank across all 9 measures, plans in the lowest tertile were significantly more likely to withdraw from public disclosure in 1998 ( Reprints and monographs were excluded. Clinical information was reviewed by two general internists and compared to information in Goodman s 9th edition textbook of pharmacology, in the pharmacology section of the UpToDate version 8.2, or in both. References cited were reviewed for correct citation and accessibility in any of the four major medical libraries in Buenos Aires. RESULTS: Of the 64 pieces of printed promotional materials collected, 30 were randomly selected and evaluated. In 21 (70%) of the thirty promotional printed materials evaluated the therapeutic effect promoted in the advertisement appeared in the references used. Only 18 (60%) had statements supported by cited references. From a total of 131 references cited in printed promotional materials, 60 (46%) were incorrectly listed according to the International Committee of Medical Journal Editors. These references were also inaccessible. Of the 71 references correctly cited, 49 (69%) were not available in any of the four major medical libraries in Buenos Aires and 8 (11%) were available in only two of the libraries. Twenty-two references were read, and in only 12 (54%) of these, did the objective of the research study concur with the statement of the printed promotional material. Adverse drug reactions, warnings about drug interactions and drug contraindications were absent from all printed promotional materials. CONCLUSION: The printed promotional materials distributed by pharmaceutical sales representatives in Buenos Aires are biased and provide misinformation more often than not. We recommend that practicing physicians should routinely disregard printed promotional materials as a source of clinical information. PURPOSE: Hospitalist physicians who specialize in inpatient care are rapidly increasing in number but there is limited evidence from randomized trials concerning their effects on resource utilization and outcomes or how they achieve their effects. This project aims to determine the effect of hospitalists on resource use and outcomes on a general medicine service in an academic medical center and the mechanism for their effects. METHODS: A longitudinal trial from July 1997 ± June 1999 with all patients admitted every fourth day assigned to teams led by hospitalist physicians (HPs) who care for inpatients 6 months per year versus teams led by non-hospitalist physicians (NHPs) who care for inpatients 1 or 2 months per year. Resource utilization was measured by length of stay and costs. Patient outcomes were measured by 30-, 60-, and 365-day mortality rates, readmission rates, reported physical function, and patient satisfaction. RESULTS: Of 6511 admissions to the general medicine service, 24.8% were to HPs and 75.2% to NHPs. Patients cared for by HPs and NHPs did not differ in age, race, gender, diagnosis mix, Charlson index, or payer mix. Average length of stay for the general medicine service was 4.7 days and average cost was $8517. In multiple regression analysis controlling for diagnosis with DRG weight and for comorbidity with Charlson index, HPs did not have different length of stay or costs than NHPs in year 1, but HPs had 0.5 day lower length of stay (p < 0.01) and $740 lower costs (p < 0.01) in year 2. There were no differences in mortality in year 1, but in year 2 HPs had lower mortality at 30 days (4.2% vs. 6.0% for NHP, p < 0.04), and 60 days (8.8% vs. 6.8%, p < 0.07). There were no statistically significant differences between HPs and NHPs in 365-day mortality rate, readmission rate, physical function, or overall patient satisfaction, but the trends favored HPs in all these measures. In analyses controlling for diagnosis-specific fixed effects, month of admission, total volume of patients seen by the physician to date, and total volume of patients with the same diagnosis seen by the physician to date, the effect of hospitalists on length of stay and costs, but not mortality, was explained by diagnosis-specific clinician volume to date. (1) preference rankings of reasons for selecting drugs in the treatment of patients with CAP, (2) knowledge and attitude questions regarding antimicrobial drug prescribing, and (3) measurement of thresholds for switching from hypothetical older drugs with increasing resistance to newer drugs with much less current resistance. Physicians were sampled from the AMA Masterfile and surveyed by mail with two follow-up mailings. Responses were calculated for the overall sample as well as stratified by clinical specialty. RESULTS: 833 out of 1582 physicians (53%) completed the survey. Response rates did not differ across specialty, gender, or US region. Overall, physicians ranked efficacy, severity of illness, and prior experience as the top reasons for selecting antimicrobial drugs, and this ranking was consistent across specialty. Concern over contributing to rising antimicrobial resistance was ranked low by both ID specialists and generalists. Although 88% agreed that`a ntibiotic resistance is a major health problem'' and 89% agreed that``over-prescribing antibiotics is a major cause of antibiotic resistance,'' only 54% agreed that``before prescribing an antibiotic, I weigh the potential benefit to the patient against the potential harm to society.'' In a hypothetical scenario for the treatment of an outpatient with CAP due to S. pneumoniae, 55% of generalists and 67% of ID specialists were unwilling to accept a 20% or greater level of resistance with an older drug before switching to a newer drug without resistance (p=.01). Physicians reported a higher threshold for switching to a newer antibiotic if they agreed that before prescribing an antibiotic, they weigh the potential benefits to patients against the potential harms to society. CONCLUSION: Many physicians report that societal issues created by antimicrobial drug resistance have at most a small impact on their prescribing decisions. These attitudes were generally consistent across different response tasks and between generalists and ID specialists. Since efforts to reduce antibiotic resistance focus on increasing provider knowledge about the societal risks of these drugs, these results suggest that such efforts alone will have limited success. PURPOSE: Primary care physicians have been the focus of efforts to improve the quality of preventive health care such as smoking cessation counseling. Many primary care practices have not implemented systematic protocols to identify patients who smoke or to encourage clinicians to provide smoking cessation counseling because such interventions are thought to be too time and effort intensive. With collaboration from Blue Cross Blue Shield of Massachusetts, we designed a project to assess the relative effectiveness, as compared with no intervention (usual care), of two brief primary care interventions on patient smoking cessation rates. We hypothesized that improved documentation would increase smoking cessation among patients. METHODS: We performed the study at the adult primary care practice of a large urban tertiary care center. We chose interventions that could be used routinely in a busy primary care practice, and which differed in the level of patient and physician involvement. Each intervention was implemented on a geographically separate``team'' consisting of 5 ± 6 attending physicians, 2 nurse practitioners, and 3 ± 5 residents. Three teams served as controls (usual care). Thè`m inimal'' intervention consisted of a smoking status``vital-sign'' stamp, which identified smokers and documented patient smoking status. The``enhanced'' intervention consisted of a simple, one page, 5-question form which identified smokers, assessed level of cessation readiness and motivation, and provided smoking cessation counseling prompts for clinicians. Outcomes were collected 8 ± 10 months after implementation of the interventions. Patients who had identified themselves as current smokers at the beginning of the study period and who had seen a clinician at least once during the study period were contacted and their smoking status assessed by self-report. Two individuals unaware of study design or purpose performed structured chart reviews to assess clinician documentation of patient smoking status and cessation counseling. RESULTS: Four hundred seven charts were reviewed for documentation assessment.