Research utilization in the health administration profession.

The utilization of new research to affect treatment access, quality, and cost-effectiveness has become a major concern in the rapidly changing U.S. health care delivery system. Yet traditional health administration programs are more accustomed to focusing on the methodology of research than on its utilization. This article examines the growing interest in research utilization, presents three projects that illustrate different forms of the utilization of research findings, and offers suggestions on how health administration programs can prepare future health administrators to become more effective users of research.

Strategic management and health workforce policy.

Among the many consequences of health care restructuring is the impact such changes have on the training requirements for the health professions. Since workforce planning has been difficult and sometimes controversial in relatively stable times, it is likely to be even more problematic amid the turbulent changes ahead as the U.S. health care system restructures for the 21 century. Strategic management models emphasizing stakeholder involvement offer a middle ground between the extremes of government mandates and free markets by engaging a variety of participants with a stake in the planning outcome. The following report on the New Jersey effort to engage a variety of health care stakeholders in a participatory management process to shape the state physician workforce may provide useful insights for both managers and policy-makers.

Health reform planning models. The case of veterans hospitals.

As part of the national effort to reform healthcare, the Department of Veterans Affairs is undergoing a major reassessment of its healthcare mission. As Veterans Affairs prepares to meet the challenges of the twenty-first century, one underlying issue of critical importance is which planning assumptions will be selected and employed. Will historical patterns of veterans' use be interpreted as indicators of the market demand for Veterans Affairs healthcare services, or will estimates of disease prevalence among veterans be used as indicators of future healthcare need? If Veterans Affairs is to continue as a critical component of the nation's healthcare delivery system, its selection of a planning basis will have major implications for tomorrow's healthcare system.

Facilitating effective healthcare policy formulation.

Health policy is increasingly shaped by national, state, and local public advisory committees. Health professionals selected to serve on these committees must be prepared to deal not only with considerable amounts of data, but also with widely varying interpretations of those data. In addition, they must be prepared to deal with different political and personal perspectives, including those of nonhealth professionals. The successful management of that broad range of professional and cultural diversity affects the extent to which different perspectives are successfully integrated into final committee recommendations. This article offers suggestions to future advisory committee members on facilitating effective healthcare policy formulation.

Evaluating policy change in physician manpower planning.

The decade of the 1980s witnessed a revitalization of free-market interest in the use of incentives and voluntary participation to promote activities in a wide range of fields. Because of its history of decentralized control over physician residency training, the state of New Jersey found such an approach appealing when it sought to restructure its graduate medical education system. Two statewide task forces spent a year developing policy changes designed to produce voluntary changes in such areas as the size and growth of the state system. However, a 2-year follow-up survey of the directors of state residency programs revealed little perceivable change.

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A histological analysis of the early effects of alcohol and tobacco usage on human lingual epithelium.

Macroscopically normal tongues were examined from 161 necropsies. Two types of lingual epithelium were investigated by morphometry and the results were statistically analysed in relation to known levels of alcohol and tobacco usage in each case. Alcohol and tobacco were each associated with a reduction in epithelial thickness brought about by a reduction in the maturation layer due mainly to cell shrinkage. By contrast, the progenitor layer increased in size, due to hypertrophy rather than hyperplasia. Changes occurred in each type of epithelium and were more severe with alcohol. There was no significant interaction between alcohol and tobacco. The structural changes appeared to be non-specific reactions to local toxic effects of alcohol and tobacco. They could, if accompanied by equivalent functional decrements, indicate an increased vulnerability to carcinogens, whether or not these derive from alcoholic drinks or tobacco smoke.

Morphometric analysis of atrophic changes in human lingual epithelium in iron deficiency anaemia.

A stereological analysis of epithelial structure at the lateral surface of the tongue showed that iron deficiency anaemia was associated with reduced epithelial thickness despite the absence of overt mucosal abnormalities. The epithelial atrophy was entirely due to a reduction in the size and number of cells in the maturation compartment. By contrast, the progenitor cell compartment was increased in thickness due to an increase in the number of cells. This hyperplastic reaction may be a trophic response to the overall loss of epithelium in this condition.

A quantitative histological analysis of the effects of age and sex on human lingual epithelium.

After exclusion criteria had eliminated changes of pathological origin, tongues were obtained from 86 necropsies evenly divided by sex and age from 16-98 years. Epithelium was examined from two precisely defined sites on the lateral and dorsal lingual surfaces. Morphometric techniques were employed to determine various epithelial parameters. The epithelium was thicker in males but rates of ageing change between the sexes were similar. Generally, age changes were similar at each site: the mean epithelial thickness underwent a 30% reduction over the age range studied; the progenitor cell layer remained of constant thickness but its nuclear/cytoplasm ratio reduced significantly; significant reductions also occurred in the rete surface area of the lateral epithelium and in the papillary surface area of the dorsal epithelium. Although some of the parameters showed steeper rates of change in the younger half of the age range, the overall pattern of ageing in the lingual epithelium suggested a continuous trend towards atrophy and simplification of structure occurring evenly throughout the entire adult life span.