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Provider cooperation is critical to the success of a probability sample study like HCSUS, but a compelling reason needs to exist for providers, some of whom are involved in other clinical investigations, to make their patients available to such a study.
Accordingly, AHCPR mandated the involvement of a broad team in HCSUS. The study team we assembled had very active participants across more than a dozen major institutions and occasional participants at a score of others.
To combat this, the HCSUS instrument design task group required research teams to develop research questions and candidate items.
This task group addressed methodological challenges that all research teams face and provided training in these techniques to the HCSUS Research teams.
Clearly, fulfilling this mandate means that even a very large-scale project such as the HCSUS must be able to get out important information quickly and broadly.
We learned a great deal from our efforts in implementing HCSUS that should inform future efforts to conduct a similar study.
When the federal government and the research and policy communities determine that it is important to collect unbiased national data on specific diseases, the paradigm used in HCSUS makes such studies more practical.
However, noting that the HCSUS used less than 3 percent of AHCPR's annual budget at its peak, we believe that there should be room for both kinds of efforts on the national health services research agenda.
The model used by HCSUS does not account for people not receiving care, is quite expensive, and is logistically very challenging.
Shapiro and Bozzette, HCSUS Office, RAND, 1700 Main Street, Santa Monica, CA 90407-2138.
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