Views of diverse primary care patients on the roles of healthcare providers and staff and the influence of other variables in their weight management.

The prevalence of overweight/obesity is disproportionately higher among racial/ethnic minority and low-income patients. The purpose of this study was to survey racially diverse, low-income patients regarding their experiences with and desires regarding their providers' involvement in weight management. Adult patients (N = 529), including mostly African American (42.7%), White (44.6%) and low-income (55.5% with incomes <$30 000) patients from 7 Patient-Centered Medical Homes voluntarily completed a brief anonymous survey while waiting to see their providers. Only 19.8% of the patients said that their primary care provider frequently or very frequently talked with them about their weight. Older patients as compared to younger patients, as well as males compared to females, were more likely to have their primary care provider talk to them about their diet and physical activity during the last year. It was also found that 56.9% of the patients were interested in getting help from their doctor to connect with resources for weight management in their community. African American patients, as compared to White patients, were more interested in getting such help. These results suggest that there is a need to establish healthcare policies and training in primary care settings that are designed to ensure that primary care providers routinely talk with all of their patients, including their female and older patients, about their weight and weight management services. Additionally, primary care administrators need to play an increased role in identifying, developing, and advocating for affordable weight management services, particularly in African American and low-income communities.

Utilization management and information technology: adapting to the new era.

Overuse of clinical laboratory services has been written about for many years (1), but remedies that easily could be implemented and effective over the long term have been in short supply. This issue has been acute for CLS, Inc., which is wholly owned by a managed care organization (HIP Health Plan of New York). Because CLS is assessing the possibility of acquiring a new laboratory information system, we reviewed past reports on approaches to utilization management (UM) and considered how developments in information technology (IT) may affect the latter. We feel there is a distinct possibility for implementation of UM in real time, and we propose this as a new paradigm whose realization has implications for choice of IT and for how clinical laboratories operate in the future.

The role of reflexive (algorithmic) testing in laboratory medicine: adapting to the new era.

Centralized Laboratory Services, Inc. (CLS) is a large, freestanding laboratory that is an affiliate of the Health Insurance Plan of New York, a managed care organization with more than 1 million members in New York and New Jersey. The laboratory work for this membership is consolidated at CLS, which thus serves an ambulatory patient population. The Medical Director at CLS is charged with optimizing laboratory utilization by clinicians who are part of the system.

Selection factors in the choice of immunoassay technology: implementing technology in the new era.

Centralized Laboratory Services, Inc. is a large, freestanding laboratory that underwent a major equipment reconfiguration for the performance of endocrine/tumor marker/anemia assays (N = 15) in August 1995. Before the transition these assays were done on six instruments, none of which were computer interfaced. All assays were subsequently consolidated on four ACS-180+ instruments (Chiron Diagnostics, Norwood, MA), which were interfaced to our laboratory information system (Cerner Corp, Kansas City, MO). Our experience suggests that significant increases in productivity and reductions in cost are possible through instrument upgrades. Both laboratory-specific and analytical system-specific factors were found to be important in the optimal selection of immunoassay technology. As laboratorians necessarily adjust to changing economic and organizational circumstances and are compelled to "do more with less," technology assessment will become an increasingly important function for senior laboratory management.