Effective Clinical Practice: A New Journal, Another Point of View

In August 1998, a new journal, Effective Clinical Practice, appeared on the biomedical scene (1). With thousands of journals already out there, and health professionals struggling to stay ahead of the information explosion, why another journal at this time? The answer is that Effective Clinical Practice is not really new, just better. The Alliance of Community Health Plans (formerly the HMO Group), the major professional association of nonprofit managed care organizations, had for some years published the predecessor of Effective Clinical Practice, HMO Practice, which was distributed to about 15 000 physicians and other health professionals. As the managed care phenomenon evolved, it became clear to The Alliance of Community Health Plans several years ago that the journal needed a broader focus, as well as a revised approach to publication and distribution. This realization coincided with recognition in the American College of Physicians (now the American College of Physicians-American Society of Internal Medicine, or ACP-ASIM) of the growing impact of managed care. The College leadership decided (although not without vigorous debate along the way) that as an organization it had a professional obligation to contribute directly to the development of managed care systems, in addition to its efforts to deal indirectly with both the positive contributions and the distortion and damage created by those systems (2). This convergence of interests led to an agreement between the College and The Alliance of Community Health Plans to publish jointly a new, successor journal to HMO Practice. A makeover promptly ensued: new title, redesigned layout, new editor. The editor, H. Gilbert Welch, chosen after an extensive national search, has launched the reborn journal with great clat and vigor. He has focused his energies primarily on two aspects of the journal: its point of view and the way information is presented in its pages. Every biomedical journal has its own special point of view. Some, like Annals of Internal Medicine, always make an effort to look at the information they publish primarily from the clinician's perspective: How will, or should, this new information affect clinical practice? Others frame their content more in terms of biology, or epidemiology: What is its contribution to new knowledge? Effective Clinical Practice focuses primarily on the interface between health services research and clinical decision making: a murky and relatively unexplored area, much neglected in the past, but rapidly growing in scope and importance. Systems thinking, quality improvement, practice management, and related disciplines are all grist for this mill. Effective Clinical Practice is also interested in studies that examine the messy world of actual practice with scientific rigor, that is, studies of effectiveness in real-world settings, in contrast with studies of efficacy in controlled, research environments. And the journal will be on the lookout for clinical practices that should not be used, as well as those that should. As to innovations in the way information is presented to its readers, Effective Clinical Practice offers new features, such as Back of the Envelope, Patterns of Practice, and Unanswered Questions: Research Under Construction, along with Take-Home Points, glossaries, and the like. Questions about manuscript submissions and other editorial matters should be directed to Editor, Effective Clinical Practice, VA Outcomes Group-111ECP, White River Junction, VT 05009. Telephone, 802-296-5178; fax, 802-296-6325; e-mail, gilbert.welch@dartmouth.edu. Subscription information: Effective Clinical Practice, PO Box 1055, Ridgefield, CT 06877. Telephone, 203-894-1704; fax, 203-438-8232; Web site, ecp.acponline. org. We welcome our new sibling journal.