SGIM FORUM Society of General Internal Medicine TO PROMOTE IMPROVED PATIENT CARE, RESEARCH, AND EDUCATION IN PRIMARY CARE Volume 25 • Number 4 • April 2002 2002 ANNUAL MEETING: A PREVIEW TEN REASONS TO ATTEND THE 25 TH ANNIVERSARY MEETING Jeff Jackson, MD, MPH, and Ellen F.T. Yee, MD, MPH continued on page 8 Contents 1 Ten Reasons to Attend the 25th Anniversary Meeting 2 SGIM Leaders Make a Difference! 2 Members Urged to Complete EBM Web Site Survey 3 President’s Column 4 External Funds Task Force Seeks Member Comments 4 Draft Policy on Acceptance and Disclosure of External Funds—March 3, 2002 5 President’s Budget Cuts Funding for AHRQ and Title VII 5 Health Policy Addition to SGIM Web Site Debuts 6 SGIM’s Women’s Caucus: Looking Ahead as SGIM Turns 25 6 IOM Tackles Health Disparities 7 Research Funding Corner 7 Practice-Based Research Networks: Growing the Evidence for Primary Care 16 Classified Ads O ur first meeting was held in 1978. At that time SGIM was known as the Society for Research and Edu- cation in Primary Care Internal Medicine (SREPCIM). All 178 attendees were given membership in the new society. The next year, the meeting received 38 sub- missions and had eight oral presentations. Now SGIM celebrates its 25th anniver- sary meeting in Atlanta, May 2–4, 2002. This milestone commemorates a quarter century of dedication to patient care, teaching, and research in general inter- nal medicine. Over the years SGIM has grown. We now have 2,743 members, and 1,500 attendees are expected at the meet- ing. This year, a record 1,206 scientific abstracts, clinical vignettes, and innova- tions in education and practice manage- ment were submitted, in addition to 134 workshops and 44 precourses. By meeting’s end, over 1,000 of our members will have presented in some venue. More than any other professional gathering, SGIM’s Annual Meeting is by and for its members. Come celebrate with us. This year’s theme is “The Next 25 Years: Emerging Issues for Generalists.” Highlights of this landmark meeting follow. ◆ Peterson Lecture — This year’s Peterson Lecture will be given by Deborah Prothrow-Stith, MD, Profes- sor of Public Health Practice and As- sociate Dean for Faculty Development, Harvard School of Public Health. Her topic will be “Violence Prevention: A Public Health Mandate.” Dr. Stith is a nationally recognized public health leader, with applied and academic ex- perience as a practicing physician in neighborhood clinics and inner city hospitals, a state commissioner of health, and now Director of the Divi- sion of Public Health Practice at the Harvard School of Public Health. In her address, she will describe the problem of youth violence in the United States as a major public health epidemic. She will promote understanding of the fac- tors leading to violence, the context in which policies have been framed, and public health strategies for society and communities to quell the epidemic. We are honored that she will share her vi- sion and passion with us. ◆ Theme Plenary Session — A special theme plenary session, entitled “Look- ing Back, Moving Forward,” will fea- ture the best four scientific abstracts on emerging issues in general internal medicine. This session also will include a presentation by Robert Centor, MD, Director, Division of General Internal Medicine, and Associate Dean, Univer- sity of Alabama, and President, Asso- ciation of Chiefs of General Internal
Transcript
SGIM
FORUMSociety of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE
Volume 25 • Number 4 • April 2002
2002 ANNUAL MEETING: A PREVIEW
TEN REASONS TO ATTENDTHE 25TH ANNIVERSARYMEETINGJeff Jackson, MD, MPH, and Ellen F.T. Yee, MD, MPH
continued on page 8
Contents1 Ten Reasons to Attend the
25th Anniversary Meeting
2 SGIM Leaders Make a Difference!
2 Members Urged to Complete EBM WebSite Survey
3 President’s Column
4 External Funds Task Force SeeksMember Comments
4 Draft Policy on Acceptance and Disclosureof External Funds—March 3, 2002
5 President’s Budget Cuts Funding for AHRQand Title VII
7 Practice-Based Research Networks:Growing the Evidence for Primary Care
16 Classified Ads
Our first meeting was held in 1978.At that time SGIM was known asthe Society for Research and Edu-
cation in Primary Care Internal Medicine(SREPCIM). All 178 attendees weregiven membership in the new society. Thenext year, the meeting received 38 sub-missions and had eight oral presentations.Now SGIM celebrates its 25th anniver-sary meeting in Atlanta, May 2–4, 2002.This milestone commemorates a quartercentury of dedication to patient care,teaching, and research in general inter-nal medicine. Over the years SGIM hasgrown. We now have 2,743 members, and1,500 attendees are expected at the meet-ing. This year, a record 1,206 scientificabstracts, clinical vignettes, and innova-tions in education and practice manage-ment were submitted, in addition to 134workshops and 44 precourses. Bymeeting’s end, over 1,000 of our memberswill have presented in some venue. Morethan any other professional gathering,SGIM’s Annual Meeting is by and for itsmembers.
Come celebrate with us. This year’stheme is “The Next 25 Years: EmergingIssues for Generalists.” Highlights of thislandmark meeting follow.� Peterson Lecture — This year’s
Peterson Lecture will be given byDeborah Prothrow-Stith, MD, Profes-sor of Public Health Practice and As-
sociate Dean for Faculty Development,Harvard School of Public Health. Hertopic will be “Violence Prevention: APublic Health Mandate.” Dr. Stith is anationally recognized public healthleader, with applied and academic ex-perience as a practicing physician inneighborhood clinics and inner cityhospitals, a state commissioner ofhealth, and now Director of the Divi-sion of Public Health Practice at theHarvard School of Public Health. In heraddress, she will describe the problemof youth violence in the United Statesas a major public health epidemic. Shewill promote understanding of the fac-tors leading to violence, the context inwhich policies have been framed, andpublic health strategies for society andcommunities to quell the epidemic. Weare honored that she will share her vi-sion and passion with us.
� Theme Plenary Session — A specialtheme plenary session, entitled “Look-ing Back, Moving Forward,” will fea-ture the best four scientific abstracts onemerging issues in general internalmedicine. This session also will includea presentation by Robert Centor, MD,Director, Division of General InternalMedicine, and Associate Dean, Univer-sity of Alabama, and President, Asso-ciation of Chiefs of General Internal
Gary E. Rosenthal, MD • Iowa City, [email protected] • (319) 356-4241
Harry P. Selker, MD, MSPH • Boston, [email protected] • (617) 636-5009
EX OFFICIORegional CoordinatorJane M. Geraci, MD, MPH • Houston, [email protected] • (713) 745-3084
Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, [email protected] • (410) 955-9868
Bradley Houseton and I hope thatyou saw our update on the SGIM“Make a Difference!” Campaign
in the February issue of Forum, ac-knowledging the generosity of themembers who had already made apersonal contribution to the campaign.Since that update, more of you haveresponded with contributions to theCampaign. On behalf of SGIM, I wantto extend my sincere appreciation tothose who have given and to those whoare planning to give.
What is especially impressive to usis how quickly the SGIM Councilresponded to this campaign. Less thanthree months after launch, 87% of thecurrent Council had already madepersonal contributions. This high-levelparticipation is symbolic of theCouncil’s commitment to support thecontinued growth and development ofthe Society’s goals and strategic values.During their tenure as SGIM leaders,they have seen SGIM grow in size,organizational complexity, scope ofactivities, and vision. Because ofevolving philosophies on externalfunding, Council understands howimportant this campaign is to ourSociety, as it seeks to diversify itsresources for support of special pro-grams.
At the end of February, nearly fourmonths into the Campaign, a total of 59SGIM members, two foundations, andone geriatrics/GIM division havecontributed a total of $63,310. One ofthe goals of the Campaign—to endowthe Eisenberg Award for CareerAchievement in Research—has beenattained, but we are far from finishedoverall.
Speaking frankly, this is a smallnumber of participants for an organiza-tion of our size. In spite of their modestnumbers, these contributors havemobilized significant funds. In part, they
have taken the Campaign to a higherlevel by leveraging their own supportfrom a variety of non-member sources.One member secured a $25,000 contri-bution from a family foundation tojump-start the endowment for theEisenberg Award. Another membertook advantage of his institution’s“matching gift” program and increasedhis personal contribution by 75%.Finally, a third member arranged for hisgeriatrics/GIM division to make a$5,000 contribution to this campaign inthe name of the founding director of hisdivision.
At last year’s Annual Meeting somemembers passionately articulatedopposition to accepting pharmaceuticalfunding. In the Council town meeting,they expressed a concern that thesources of such financing—howeverlaudable SGIM’s goals for the use of thefunds—did not fully share members’values. Receipt of these funds ran therisk of incorporating conflicts of interest
The Evidence-Based Medicine (EBM)Task Force is developing a Web site
to meet the needs of members who areinterested in learning and teachingabout EBM. To learn more about thoseneeds and how the Web site mightaddress them, the EBM Task Force hasprepared a brief, online survey (www.insitefulsurveys.com/index.asp?a=s_1052-14). Members who respond byApril 30, 2002, will be entered into adrawing for a Palm Pilot. Please com-plete the EBM Web site survey as soonas possible. We need your input! SGIM
Members Urged toComplete EBM WebSite SurveyKaren Lencoski
3
PRESIDENT’S COLUMN
SGIM
FORUM
Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor in directing a piece to the editor to whom its content is most appropriate.The SGIM World-Wide Website is located at http://www.sgim.org
VALEDICTORYKurt Kroenke, MD
continued on page 9
EDITOR
David R. Calkins, MD, MPP • Boston, [email protected] • (617) 432-3666
Ellen F. Yee, MD, MPH • Los Angeles, [email protected] • (818) 891-7711 Ext. 5275
In my final column as President, Iwould like to focus on SGIM as anorganization and, specifically, in a
forward direction. This year marks the25th anniversary of our Society. Indeed,I prefer the term society in describingSGIM to the more bland word organiza-tion. The dictionary defines society as“a group of human beings broadlydistinguished from other groups bymutual interests, participation incharacteristic relationships, sharedinstitutions, and a common culture.”More than half of the words in thisdefinition conjure up in me powerfulsentiments regarding SGIM. Terms likemutual interests, participation, relation-ships, shared institutions, and commonculture ring true. Life has many organi-zations but few societies.
So what does a silver anniversarysignify? While in marriage it representsa substantial milestone, 25 years issimply the first stage in an organization’slife history. SGIM has survived itsadolescence, a grace period of limitedresponsibilities and modest expecta-tions. Maturation now raises the ante.What might the next quarter centurybring? No soothsayer, I offer instead apersonal vision, or rather a “wish list,”for the next two and half decades. It is abalance between future and past, sinceembracing one at the expense of theother may sacrifice the unique value ofeach.
Encourage partnerships to flourishSGIM’s census is deceptive. Ourinfluence exceeds what a simple headcount might suggest. Members provide adisproportionate share of direct patientcare and medical education in academicinstitutions. They provide leadership ininterdisciplinary research, not only inhealth services but also encompassingclinical investigation that includes aswell as transcends organ systems.
Additionally,SGIM’s rostercontributessubstantially tothe nationalthink tank inareas like healthpolicy, biomedicalethics, doctor-patient communi-cation, geriatrics,medical decision-making and numerousother domains. To leverage its impact inall of these areas, SGIM must partnerwith other organizations wheneverthere is a common agenda. This doesnot mean compromising our position onan issue but rather joining together withothers when joint advocacy is a win-winsituation.
Keep the Annual Meet-ing flame burningThe Annual Meeting isour Olympic torch,differentiating SGIM’smeeting from that of manyother organizations. Manyattendees want more thansimply feeding at the CMEtrough. They also desire toparticipate actively in
presenting abstracts, posters, vignettes,workshops, or precourses. Even whenone is a passive recipient of education atthe SGIM meeting, there is a DisneyWorld quality: so many attractions andso little time. One “ride” competes withmany others. The energy at the AnnualMeeting is palpable, attendees freneti-cally moving among options in a type of
4
SGIM FORUM
External Funds Task Force Seeks Member CommentsMichael J. Barry, MD
Draft Policy on Acceptance and Disclosure ofExternal Funds—March 3, 2002
continued on page 10
Since last year’s Annual Meeting, anExternal Funds Task Force,appointed by SGIM President,
Kurt Kroenke, has been working on arevision and consolidation of theSociety’s documents related to theacceptance and disclosure of externalfunding. Perhaps no issue has engen-dered more debate in SGIM in recentyears than the issue of external funding,particularly from the pharmaceuticalindustry. The draft policy that followsrepresents the Task Force’s attempt tobalance the “benefits and harms” ofexternal funding for worthwhileendeavors, particularly educational andresearch projects. Simplistically, a moreliberal external funding policy wouldmean that SGIM could support agreater variety of worthwhile programsand maintain lower annual dues andmeeting fees. However, concern aboutpotential conflicts of interest anddependence, among other things, wouldbe greater. A more conservative policyon accepting external funding probablywould mean that SGIM could supportfewer worthwhile programs, and duesand meeting fees would be higher. Onthe other hand, there would be lessconcern about conflicts of interest ordependence. Currently, about 80% ofSGIM’s operating budget comes from itsmembership (primarily through duesand meeting registration fees). Someprofessional organizations derive a muchsmaller proportion of revenues fromtheir members. Our relative dependenceon funding from members has led tosubstantial increases in membershipdues and meeting registration fees overthe past five years.
The Task Force welcomes feedbackfrom members on any and all aspects ofthe draft policy. However, we especiallywould like feedback about thosequestions that engendered the mostdebate:
� What are the percentages of theSociety’s operating budget derivedfrom all external funding sources andfrom any one for-profit source thatwould engender concern aboutexcessive dependence on thosefunding sources?
� Given that SGIM cannot do every-thing, what are the types of researchand educational projects that SGIMis particularly well suited to conduct?
� When does SGIM conducting aresearch or educational projectrequiring external funding create“undue” competition with the effortsof individual members to obtainfunding for their own work?
We really need your input at thisjuncture! Comments may be sent to theTask Force at [email protected]. Members also may offercomments in person at a special opensession with the Task Force and theCouncil at the upcoming AnnualMeeting in Atlanta. The Task Forcewill submit its final recommendations toCouncil shortly after the AnnualMeeting. The Council hopes to adopt afinal policy statement at its summerretreat.
Editor’s Note—Additional informationabout the Task Force is in the July 2001issue of Forum.
Introduction
The primary goal of the Society ofGeneral Internal Medicine is to
support its members in their efforts topromote improved patient care, teach-ing, and research in general internalmedicine. The SGIM Council maypromote these goals by acceptingexternal funds, such as grants, sponsor-ships, or gifts, in support of activities.This policy provides guidance for thenegotiation and acceptance of allexternal funding and is not limited tocommercial relationships. Individualsand groups who solicit funds on behalfof SGIM should be familiar with thisdocument. This policy has evolved fromthe original SGIM Policy RegardingAcceptance of External Funds, whichwas approved on January 6, 1994, andamended on December 3, 2000. It alsosubsumes two previous appendices tothat document adopted February 10,2000, and March 3, 2000.
BackgroundExternal funds may help SGIM pursueits mission in several ways. Examplesinclude:� Helping SGIM undertake initiatives
to promote patient care, teaching,and research in general internalmedicine;
� Improving the quality of SGIMmeetings by allowing the Society toreimburse speakers, provide hono-raria, furnish amenities, give scholar-ships and awards, or offer generalprogramming that might otherwise beunavailable; and
� Helping SGIM provide services ofvalue to members that advance thegoals of the Society, such as theSGIM Web site, e-mail, and listserversystems.
In short, external funds potentiallyallow SGIM to pursue worthwhileactivities that it might otherwise haveto forgo.
5
PRESIDENT’S BUDGET CUTSFUNDING FOR AHRQ ANDTITLE VIIJennifer Jenkins
continued on page 14
Health PolicyAddition to SGIMWeb Site DebutsMark Liebow, MD, MPH
continued on page 8
President Bush released his fiscalyear (FY) 2003 budget onFebruary 4, 2002, starting what
already appears to be a contentiousbudget process. The environment isunprecedented: the United States is atwar and is defending homeland security;it is an election year; the government isfacing deficit spending rather thansurpluses; and the House of Representa-tives and the White House are con-trolled by Republicans, while theDemocrats hold a one-seat majority inthe Senate.
The Administration’s budgetdecreases funding to several programs ofgreat importance to SGIM, includingthe Agency for Healthcare Researchand Quality (AHRQ) and the Title VIIhealth professions education programsof the Health Resources and ServicesAdministration (HRSA). Securingstable funding for AHRQ and Title VIIis a top priority for SGIM’s HealthPolicy Committee and governmentaffairs staff. We are working indepen-dently and through relevant coalitionsto assure continued support for theseprograms.
SGIM supports a $390 millionfunding level for AHRQ in FY 2003, anincrease of $91 million. The Adminis-tration, however, proposes $251 millionfor AHRQ, a $48 million (16%)decrease from AHRQ’s 2002 budget of$299 million. Under this plan, AHRQwould not be able to fund any newresearch or training grants, and fundingfor current unprotected grants would bereduced by 46%. (Patient safety grantsare protected.)
SGIM supports $550 million for theTitle VII and VIII health professionsprograms for FY 2003, including $40million for grants in general internalmedicine and general pediatrics. ThePresident’s proposal cuts Title VII andVIII programs by 75%, eliminating all
programs except the Scholarships forDisadvantaged Students and the TitleVIII nursing programs. The President’sbudget offers the following rationale forthese cuts.
Despite 40 years of funding, most ofthe health professions grants have notproven to be effective, because theydo not accurately address currenthealth professions problems. Forexample, since 1993, the number ofresidents enrolled in primary special-ties has grown, but the demand forprimary care physicians is still acutein health professional shortage areas.Over the last two decades, almost $7billion has been invested in healthprofessions training grants, and duringthis time the population of areas withshortages of primary care healthprofessionals has increased by 140percent.
The President’s budget is a guide toCongress and is not binding. SGIM hasjoined other organizations in askingCongress to increase support for AHRQand Title VII. SGIM leaders andgovernment affairs staff have met withkey staff on Capitol Hill. SGIM’sadvocacy efforts will be more effective,however, if they are reinforced bypersonal messages from SGIM members.Accordingly, the Health Policy Com-mittee encourages all SGIM members,especially AHRQ and Title VII grant-ees, to contact members of Congress tosupport the proposed funding levels forAHRQ and Title VII. SGIM memberscan use our new, Web-based AdvocacyAction Center, launched earlier thisyear, to e-mail members of Congress.The Advocacy Action Center allowsmembers to view SGIM LegislativeAlerts, identify members of Congress,and review the status of key legislativeissues. It also provides tips on communi-cating with legislators. The Advocacy
The long-awaited (at least by HealthPolicy Committee members) health
policy addition to the SGIM Web sitedebuted in January, as part of the newSGIM Web site. It can be reached bygoing to www.sgim.org and clicking onAdvocacy. We hope the addition will behelpful to policy novices as well aspolicy wonks.
The site has five sections. The firstsection is the Advocacy Action Center.The Advocacy Action Center allowsyou to identify your elected federalofficials and important legislative issuesof interest to SGIM. It includes legisla-tive alerts and updates, the status ofcurrent legislation, how your legislatorshave voted on important issues, andinstructions on how to communicatewith members of the House or Senate.It also has schedules for the House, theSenate, and Congressional committees.We hope that this will make communi-cation by SGIM members to govern-ment officials on policy issues muchsimpler. SGIM may post legislativealerts, asking you to be in touch with anelected official on an issue. When thishappens, sample messages will beavailable to send. These will usually bee-mailed, though they will sometimes befaxed to members of Congress or to theWhite House. You can download theseand send the message on your ownstationery as well. Of course, these canbe modified and personalized as needed.In the future this section of the Website will be password-protected andavailable only to SGIM members.
The second section is Health PolicyClusters. This section describes the nineclusters of SGIM’s Health PolicyCommittee. It identifies the chair ofeach cluster and provides a briefsummary of each cluster’s purpose.
The third section is Where WeStand. Currently, this section has two
6
SGIM FORUM
SGIM’s Women’s Caucus: LookingAhead as SGIM Turns 25Anuradha Paranjape, MD, MPH, and Rowena J. Dolor, MD, MHS
continued on page 14
IOM Tackles HealthDisparitiesJoseph R. Betancourt, MD, MPH
continued on page 14
The SGIM Women’s Caucus wasfounded in 1987, the product of abreakfast discussion at the Annual
Meeting the year before. In the earlyyears of SGIM, women formed a smallproportion of SGIM members. Seniorwomen colleagues report that theCaucus was an important voice forissues of interest to women withinSGIM and a forum for sharing ideas,networking, mentoring, and collabora-tion. Over the last 15 years, the Caucushas indeed met that need effectively.The Caucus has sponsored severalworkshops and precourses, typically onissues dealing with women’s health orfaculty development. These sessionshave been well received and havecontributed positively to the content ofthe Annual Meeting as a whole.Networking and collaboration at theCaucus’ annual Interest Group meetingshave resulted in the formation of twoother Interest Groups, namely Physi-cians Against Violence and Women’sHealth Education. Like the SGIMWomen’s Caucus, both Interest Groupscollaborate on educational workshops atthe Annual Meeting.
As SGIM meets in Atlanta for its25th Annual Meeting, it is evident thatSGIM and the Women’s Caucus havegrown significantly. Women are nolonger an invisible presence withinSGIM. The efforts of the Women’sCaucus have heightened the involve-ment of women members withineducational, research, and leadershipcomponents of SGIM. Now newermembers wonder why the Women’sCaucus exists and are surprised to learnabout how invaluable the Caucus hasbeen to the growth of several seniorwomen leaders in SGIM.
While many of the challenges thatconfront women in academic medicinehave evolved over the last decade, someremain unaltered. To better understand
the needs of women members of SGIMand help guide the Caucus in continu-ing to be an effective forum for theirgrowth and promotion, we mailed asurvey to all 1,050 women members ofSGIM identified by the National Officein 2000. A total of 121 surveys werereturned. Among respondents, 55%were current members of the Women’sCaucus, 12% were former members, and17% had never been Caucus members.Over half of the respondents (52%)classified themselves as clinician-educators, 16% were in training(students, residents, and fellows), 17%were clinician-researchers, and 9% wereclinician-administrators.
The survey assessed involvement inthe Annual Meeting ( includingplanning committee member, mentor inthe One-on-One Mentoring Program,or professor in a Meet-the-Professorsession), preferences for the agenda ofthe annual Interest Group meeting,ideas for speaker presentations, andcommunication. Respondents wereactive in submitting abstracts to theAnnual Meeting: 79% had submitted atleast one abstract, 64% had made posterpresentations, and 48% had made oralpresentations. Participation inprecourses and workshops also was high:32% and 49% respectively. Of note,while 18% of respondents had served onan abstract selection committee, only5% had served as a mentor, 6% hadspoken at a Meet-the-Professor session,6% had served on the program commit-tee, 7% on a precourse committee, and7% on a workshop committee. Agendapreferences for the annual CaucusInterest Group meeting included timefor networking (59%); identification ofcollaborative groups in research, clinicalpractice, or education (58%); speakerpresentation (54%); mentoring (50%);exchanging or updating address lists
The prestigious Institute of Medicine(IOM) of the National Academy of
Sciences, chartered by Congress toadvise the federal government on issuesof medical care, research, and educa-tion, has taken on health disparities aspart of its recent charge. Two studieswill be released this year that directlyaddress key aspects of this nationalcrisis.
Since the President’s Initiative onRace was set forth in 1998—of whichthe elimination of racial and ethnicdisparities in health was a majorcornerstone—the federal governmenthas been actively engaged in fosteringefforts to understand better the rootcauses of disparities, while also trying todevelop interventions to eliminatethem. Examples have included theExcellence Centers to Eliminate Ethnic/Racial Disparities (EXCEED), funded bythe Agency for Healthcare Researchand Quality (AHRQ), and the Racialand Ethnic Approaches to CommunityHealth (REACH) projects, supportedby the Centers for Disease Control andPrevention (CDC).
Although progress is being madeand researchers are digging deeper, morequestions seem to arise and the com-plexities underlying health disparitiesare being revealed. As a result, in early2000 the Office of Minority Health ofthe U.S. Department of Health andHuman Services commissioned the firstIOM study on disparities, entitledUnequal Treatment: Confronting Racialand Ethnic Disparities in Health Care. Acommittee of academicians, medicaleducators (including SGIM members),health services researchers, healthpolicy makers, economists, socialpsychologists, social scientists, lawyers,practicing physicians, and nurses wasassembled to tackle the issue of healthdisparities. The charge to the commit-
7
RESEARCH FUNDING CORNERJoseph Conigliaro, MD, MPH
continued on page 13
This month’s Research FundingCorner highlights the TranslatingResearch into Practice program of
the Agency for Healthcare Researchand Quality (AHRQ) and the HealthServices Research and DevelopmentService (HSR&D), Department ofVeterans Affairs (VA), and careerdevelopment awards in patient safetyoffered by AHRQ.
Translating Research into PracticeOn February 19, 2002, AHRQ andHSR&D issued a new program an-nouncement (PA), Translating Re-search into Practice (TRIP) (PA-02-066). This PA will use the R01 awardmechanism for applicants applying toAHRQ. The PA expires on July 24,2004 (for R01s).
The TRIP program will supportinnovative and rigorous research andevaluation projects that deal with thetranslation of research findings intomeasurable improvements in quality,patient safety, health care outcomes,cost, use, and access. Two categories ofapplications are eligible for consider-ation: 1) comparative studies, con-ducted concurrently in VA and othersettings, and 2) translation studies,which may be done in either VA ornon-VA settings. If a VA setting isincluded in an application, the investi-gator must meet the eligibility require-ments of the VA to receive VA fundingfor the VA site. To be eligible for studiesin the VA, principal investigators (PIs)and co-PIs must have a VA appoint-ment (minimum of 5/8ths time). Non-PI investigators who collaborate on theproject do not need a VA appointment.
AHRQ and HSR&D are especiallyinterested in recommendations, tools,and strategies that can be used toimplement research findings acrossmultiple levels of health care deliveryand multiple types of health care-
related systems. This PA will supportresearch that not only identifies andtests new methods for translatingresearch into practice, but also expandsthe use of tested methods of translatingevidence-based information acrosslarger populations, different health caresystems, or different clinical situations.
This PA is available at grants.nih.gov/grants/guide/pa-files/PA-02-066.htm. Further information abouteligibility to be a VA investigator isavailable at www.va.gov/publ/direc/health/direct/195036.htm andwww.va.gov/resdev/directive/VHA_Handbook_1200.15_Eligibility.doc.
Career Development Grants inPatient SafetyOn December 20, 2001, AHRQreleased a notice (NOT-HS-02-001)announcing its intention to fund careerdevelopment (K) awards for investiga-tors who want to develop researchcareers in areas related to patient safety.Applications for these awards must
include projects that will address keyunanswered questions about how errorsoccur and provide science-basedinformation on what patients, providers,hospitals, policymakers, and others cando to make the health care system safer.Research should identify strategies thatwork in hospitals, doctors’ offices,nursing homes, and other health caresettings across the nation.
This notice is available atgrants.nih.gov/grants/guide/notice-files/NOT-HS-02-001.html. Addi-tional information about AHRQ’sresearch agenda in patient safety may befound at www.ahrq.gov/qual/errorsix.htm. Additional informationabout AHRQ-sponsored career develop-ment grants is available atwww.ahrq.gov/fund/training/trainix.htm##.
Please contact me by e-mail [email protected] for anycomments, suggestions, or contributionsto this column. SGIM
Practice-Based Research Networks: Growingthe Evidence for Primary CareJohn G. Ryan, DrPH
Primary care practices and patientspresenting to these practices
represent a genuine conundrum forresearchers. They are a potentialgoldmine of data with which to exam-ine the structure, processes, andoutcomes of primary care, the level atwhich people interact most often withthe U.S. health care system. It is inprimary care practices that evidence canpotentially be acquired with which toaddress important health care issuesthat cause significant morbidity:asthma, diabetes, back pain, headache,and the common cold. It is in primary
care practices that we can potentiallytranslate research into practice, bridgethe performance gap, answer “real-world” research questions, improve thequality of health care in America, andprevent avoidable hospitalizations.However, it is in primary care practicesthat researchers are less able to controlfor confounders, standardize patients,and acquire statistically rigorous samplesizes in reasonable timeframes.
The untapped potential of primarycare practices has been recognized bythe giants in our field: Will Pickles,
8
SGIM FORUM
TEN REASONS TO ATTENDcontinued from page 1
Medicine. Dr. Centor will discussbriefly the history of academic generalinternal medicine in the UnitedStates. Though general internalmedicine is now an establisheddiscipline, it was not until the 1970’sthat separate divisions were startedanew. We look forward to hearing Dr.Centor discuss the forces that haveand will shape modern generalinternal medicine as we look towardsthe future.
� Award Abstract Sessions — Newthis year are special abstract sessionsfor finalists for the Hamolsky JuniorFaculty and Lipkin Associate MemberResearch Awards. These sessions willinclude the 12 top-rated abstractssubmitted by junior faculty andAssociate Members. Come and rootfor your favorite finalist. See if youagree when the winners are an-nounced at the Saturday morningplenary.
� Pre-Meeting Reception — A pre-meeting reception will be held in thelobby of Grady Memorial Hospital onWednesday, May 1, 2002. We inviteall members to join us for this openreception. The history of this previ-ously segregated public hospital andits role in the integration of medicinein the South will be discussed andrefreshments provided. Van transpor-tation will be available for those whodo not wish to walk or take publictransportation. Though the meetingprecourses will not start until Thurs-day, we welcome all those in Atlantaon Wednesday to come on by andenjoy this unique event. Please besure to register for this free event, sowe’ll know how many to count on!
� Evidence-Based Updates — As inthe past, there will be evidence-basedupdates on General Internal Medi-cine, Women’s Health, Geriatrics,HIV/AIDS, and the work of the U.S.Preventive Services Task Force. Inaddition, there will be new updateson Minority Health and Community-Based Preventive Services. TheClinical Crossroads will feature Dr
Harold G. Koenig, MD, MHSc, whowill discuss how patients’ spiritualitycan interface with their medical care.
� 5K Run — Put on your runningshoes and crawl out of bed earlySaturday morning for a 5K run. It’s fora good cause, and we’ll give you anice shirt. Even if you wind uprunning one block and walking therest, it’ll be a great way to start theday. Ellen and Jeff promise that noone runs slower than they do!
� New traditions — We will continuepopular features introduced at recentAnnual Meetings, such as an Un-known Clinical Vignette session ledby eminent generalists and sessionson Innovations in Medical Educationand Practice Management.
� Old traditions — The meeting willinclude 23 stellar precourses, 65interesting workshops, and 726exciting abstract presentations.Several sessions will be devoted to ourtheme.
� Other special programs and features— Other offerings include Meet-theProfessor sessions, One-on-OneMentoring, Interest Groups, and anew Student/Resident/Fellow (SRF)program. The SRF program isdesigned to encourage careers ingeneral internal medicine, and enrich
learning experiences at the meeting.In addition to a First-Time AttendeesReception, there are speciallydesignated learning/activity tracks,and a SRF lounge for networking,visiting, or relaxing.
� Music — We are recruiting some ofour more talented members to providemusic at the breaks and prior to ourmeals. If you are blessed with musicaltalent and/or lack of inhibitions aboutsharing your talents, please contactLinda Pinsky, MD([email protected]),Eric Whittaker, MD([email protected]),Jeff Jackson, MD, MPH([email protected]), orEllen Yee, MD, MPH([email protected]).
On behalf of our President, KurtKroenke, the Program Committee, andover 245 dedicated SGIM members thathave worked to bring you this program,we invite you to join us in Atlanta. Weplan to showcase the best that ourdiverse Society members have to offer.Whatever your interest, be it clinicalmedicine, administration, education, orresearch, we believe you will findsomething in our program that appealsto the passion in your heart! We lookforward to seeing you in Atlanta. SGIM
Action Center is described in moredetail by Mark Liebow in anotherarticle in this issue of Forum. SGIMmembers can access the AdvocacyAction Center at www.capwiz.com/sgim/home/ or through the Advocacy linkon the SGIM Web site (www.sgim.org).
SGIM will hold a “Hill Day” onMay 15, 2002. On this day SGIMmembers will meet with key legislatorsand their staff to discuss funding forAHRQ and Title VII. Members whowish to participate in Hill Day shouldcontact David Calkins, Chair, Title VIICluster, Health Policy Committee
([email protected]), orJenn Jenkins, SGIM GovernmentAffairs Representative ([email protected]). SGIM membersalso may contact Ms. Jenkins if theywould like to meet with a legislatorduring a visit to Washington, DC, or ifthey would like to set up a visit at homeduring a Congressional recess. SGIMmembers who want to hone theiradvocacy skills are encouraged toparticipate in the precourse “HealthPolicy Advocacy in the 21st Century”at the Annual Meeting. SGIM
BUDGET CUTScontinued from page 5
9
Brownian motion. In short, activeinvolvement and frenzied education aretwo characteristics of an SGIM meet-ing. A third is the contagious nature ofthe meeting for newcomers. I remembermy first Annual Meeting in 1984.Coming from a small teaching hospitalthat was not affiliated with a medicalschool, I felt a little like an immigrantchecking into Ellis Island. By the timethe meeting ended, however, I feltconnected to others who were commit-ted to generalist practice, teaching ofstudents and residents, and atypical butexciting types of clinical research. Inshort order, I had become a first-generation SGIM-er. Thus, I amconvinced the Annual Meeting is oneplace we must always make the new-comer feel welcome and the establishedmember feel wanted. SGIM is of coursemuch more than its Annual Meeting.But the Annual Meeting must remain amountaintop experience for first-timeattendees and rejuvenating for thosewho return.
We need not look like our childhoodpictureIn just over a decade, general internistshave experienced the wide temperatureswings of the primary care movement,which has gone from cold to hot tolukewarm. They have experiencedcompetition from medical subspecialistsas well as other generalists, includingfamily physicians, nurse practitioners,and physician assistants. New move-ments continue to emerge, such ashospitalism and medicine-pediatrics.There have been struggles with man-aged care. Who knows where thependulum will swing next? We mustregularly reinvent ourselves, rather thanreactively respond in a sporadic orerratic fashion. Adaptation is a continu-ous process akin to quality improve-ment. Our individual and organizationalidentity must be redefined periodicallyand open-mindedly. While holding fastto nonnegotiable values, we must benimble enough to let go of ballast thatmay be dated and holding us back.
Focus in moderationPrioritize, but not obsessively. Acceptthe two-edged sword of generalism. Thevalues of breadth, holism, expansive-ness, comprehensiveness, and eclecti-cism are usually the blessing butoccasionally the bane of generalinternal medicine. Both as individualsand as an organization, we must avoidthe excesses of generalism that tries tobe all things to all people. As academicphysicians we deal with the paradox ofneeding to specialize within GIM, be itin education, a clinical area, or a type ofresearch. Some of us must becomespecialists-generalists or, to borrow aphrase coined some years ago in anSGIM President’s column, “specialoids.”Likewise, SGIM must pick its targetsselectively, so it has adequate resourcesto accomplish some things exception-ally well.
At the same time, we are general-ists and SGIM is a generalist organiza-tion. We chose this career and conse-quently this Society because we pre-ferred the broad and meandering trail tothe straight and narrow highway. Thebig picture captivates us, with itspanoramic view. I think of that type ofphotograph in which objects of varyingdistances are all part of the print. Noone image is in perfect focus, yetmultiple depths are exposed, developed,and framed together.
Don’t retreat from complex issuesAccept the fact that tough decisionsmay sometimes be polarizing. Whateverthe outcome on a particular issue,continue to welcome a loyalist opposi-tion. A family is strengthened byworking through disagreements andeven at times by accepting that alterna-tive but valid viewpoints might need tocoexist peacefully. Just as heterogeneityin the gene pools strengthens thespecies, so too does dialogue, delibera-tion, debate, and honest differencesenrich a society. SGIM needs to remaininterdisciplinary, multigenerational,demographically diverse, and a meltingpot of ideas, attitudes, and pathways.
There is a phrase, “all on the samepage.” Although this is often somethingdesirable to strive for, I would also arguethat a variety of different pages canlikewise make an interesting chapter.
More is moreOne of my favorite quotations is “less ismore” by the minimalist modernarchitect, Mies van de Rohe. It is sageadvice for teachers preparing lecturesand handouts, fellows preparing postersor 10-minute talks for scientific meet-ings, or researchers simplifying theirhypotheses or study designs. However,in terms of member involvement inSGIM, I believe “more is more.” TheAnnual and Regional Meetings are onevenue. Another is a proliferation in thenumber and the size of our InterestGroups. Service on an SGIM Commit-tee or Task Force is yet a third waymembers can become actively engagedin the Society. Thus, the architecturalmetaphor I prefer here is not modernbut baroque: a style exuberant, prolificin variety and details, busy. SGIMshould continue to be not only itsmembers’ primary organization but alsoone in which they actively engage in away salient to their career. An identi-fied niche for each member coupledwith enhanced electronic communica-tion capabilities will accelerate SGIM’saim of meeting members “where theyare” on a year-around basis.
Heraclitus, the ancient Greekphilosopher, said: “You can never stepinto the same river twice.” The paradoxis that although the river as a whole isone, each time you step in the river theformer water has moved on and yourfeet are surrounded by new eddies. Ipredict that this metaphor, which hascharacterized SGIM since its inceptionin 1977, will continue to be a portrait ofour Society as we move forward in the21st century. SGIM
VALEDICTORYcontinued from page 3
10
SGIM FORUM
Notably, any financial relationshipwith an external funder may create apotential conflict of interest for SGIM.Conflicts of interest are common andnot by themselves unethical. Regardlessof whether the conflict of interestresults in inappropriate action, theappearance of a conflict of interest maybe damaging to SGIM’s reputation.Concerns that the acceptance ofexternal funds creates an inappropriateconflict of interest, with the greatestpotential for inappropriate action, areparticularly acute in two situations:when external funding is from for-profitcompanies (or not-for-profit entitiesfunded largely by for-profit companies);and when the amount of externalfunding, particularly from a singlesource, becomes large enough to createdependence.
With these observations of thebenefits and risks of external funding inmind, SGIM has established thefollowing guidelines for the acceptanceof external funds.
Guidelines for the Acceptance ofExternal FundsProjects in General. SGIM shouldaccept external funds only for highquality projects that are:� consistent with the SGIM mission,
“To promote improved patient care,teaching and research in primary careand general internal medicine”;
� judged to be particularly well suited tobe carried out by SGIM as an organi-zation (especially in contradistinctionto individual Society members orgroups of members working throughtheir own institutions), especially ifSGIM is to be the primary recipientof external funds for the proposedproject; and
� judged to be unlikely to create unduecompetition with individual SGIMmembers’ pursuits of funding for theirown research or educational projects.
The authors of this policy acknowl-edge that there will be subjectivity indecisions regarding which projects areparticularly well suited to be carried out
by SGIM (particularly as primaryrecipient of external funding) andwhich projects are unlikely to causeundue competition with its members forfunding. In general, projects for whichSGIM is particularly well suited createthe opportunity for participation oflarge numbers of SGIM members inways that would be difficult or impos-sible to arrange through standardmechanisms of funding to hospitals anduniversities. Undue competition is morelikely to be a problem when SGIMresponds to requests for proposals andapplications from funders which are alsolikely to attract proposals and applica-tions from individual members or groupsof members. When more than oneSGIM member independently ap-proaches the organization regardingobtaining funding for a project of asimilar nature, and particularly whenSGIM’s participation would be mutuallyexclusive, every effort should be madeto foster collaboration among theinterested individuals so that a singleproject proposal results. If, despite theseefforts, more than one proposal issubmitted for a similar project, andSGIM’s participation is mutuallyexclusive, these projects would bereviewed in parallel, with heightenedconcern about undue competition.
In addition, SGIM should notaccept external funds, either directly orindirectly as a subcontractor to anotherentity, from for-profit companies (ornot-for-profit entities funded largely byfor-profit companies) for research oreducational projects related to specificpharmaceuticals, medical devices,diagnostics, or any other productpurported to have direct health benefitsto patients (regardless of whether theproducts are sold by that particularexternal funder). In addition, SGIMshall not accept external funds fromcompanies that make or sell tobaccoproducts.
Finally, dependence is potentiallycreated when SGIM’s core operationsbecome too reliant on external funding.External funds that “pass through”
SGIM to other individuals and groupsfor the accomplishment of specificprojects or for awards do not createdependence, nor do funds that are savedby SGIM for future disbursement forthese purposes. The SGIM operatingbudget best reflects expenses for coreactivities; it is the proportion ofexternal funds that comprises theoperating budget that, if too high, raisesconcerns about dependence. In thiscontext, “internal” funds are consideredrevenues from dues, meeting and courseregistrations, serial publications, sales ofproducts and services to members, andmember donations. “External” funds arerevenues from all other sources. Exter-nal funds used specifically for theSociety’s operations and included in theannual operating budget should notcomprise more than approximately 25%of the Society’s annual operatingbudget, and no more than approxi-mately 5% of the Society’s operatingbudget should be derived from anysingle for-profit source of externalfunding (see Appendix 1 for details onthis calculation).
Educational Projects. SGIM mustretain ultimate control over educationalcontent, selection of speakers, review ofeducational materials, selection ofresearch for presentation, or otheractivities with scientific content thatare financed with external funds.
Research Projects. SGIM willretain control of the selection of projectpersonnel and other activities for theconduct of research activities for whichthe Society accepts external funding.
Use of Human Subjects. If anexternally funded research or educa-tional project involving SGIM requiresuse of human subjects in any way, it isthe responsibility of the project’sproponents to obtain appropriate IRBapproval(s). SGIM will not maintain acentral IRB.
Freedom to Publish Results. Theproponents of any externally fundedresearch or educational project involv-ing SGIM shall have the right to
ACCEPTANCE AND DISCLOSURE OF EXTERNAL FUNDScontinued from page 4
continued on next page
11
publish their findings without interfer-ence from the external funder. Onlynonbinding, expeditious review andcomment on written results by theexternal funder is acceptable. TheSociety encourages but neither requiresnor commits to publication of theresults of these projects in the Journal ofGeneral Internal Medicine.
Intellectual Property. When SGIMserves as the primary entity acceptingexternal funds for a research or educa-tional project, SGIM reserves the rightto all intellectual properties resultingfrom the project. When SGIM collabo-rates with another entity that is theprimary recipient of funds for theproject, that entity, usually the projectproponent’s academic institution, willgenerally have the right to all intellec-tual properties resulting from theproject. In the latter case, an agreementregarding intellectual property must bedocumented in writing between theconcerned institutions and SGIM andapproved by Council.
Budgets. When externally fundedresearch or educational projects requireusing SGIM resources at the NationalOffice, a budget for those activitiesshould be negotiated between theExecutive Director and the SGIMmembers responsible for the project tocover the direct costs of SGIM’sparticipation. In general, to coverSGIM’s indirect costs, an additionalpercentage reflecting the Society’soverhead costs as negotiated with theFederal government (currently 30%)will be added to the budgeted directcosts (but not to other funds that “passthrough” SGIM to other parties forcompletion of the project). The finalbudget for each project, including anydeviations from the usual overhead rate,must be approved by the SGIM Trea-surer. External funds for awards or prizeswhich reflect acknowledgment forcompleted work (rather than grants fornew work), and which require minimaluse of resources at the SGIM centraloffice, as judged by the ExecutiveDirector, do not require a specific
budget. Rather, a reduced overhead rateof 10% will be added to the totalamount of the award to account for theSociety’s costs for publicizing, selecting,and administrating the award.
Competitive Projects. WhenSGIM accepts external funds forresearch or educational projects thatinvolve a selection process withsubmitted proposals, the external fundercan have limited input in the selectioncriteria for which proposals will receivefunding, and will receive informationabout which proposals did and did notreceive funding. However, final fundingdecisions will be made by a groupdesignated by SGIM, independent fromthe external funder. This group mayinclude both SGIM and non-SGIMmembers.
Awards. When SGIM acceptsexternal funds for awards that reflectacknowledgment for work alreadycompleted, awardees will be selectedbased on criterias, established by SGIM.The sponsor may have limited input inthe selection criteria, but SGIM retainsultimate control over selection of theaward recipient. The sponsor canimpose no obligations on the recipientof an award.
Access to SGIM Members. Accessto SGIM members or to recipients ofexternal funds shall not be a conditionof support from an external funder,including access through talks byrepresentatives of the external funder atregional or national meetings.
Disclosure. SGIM should discloseall sponsored activities that are partiallyor completely financed by externalfunds, including but not limited toresearch grants, presentations andpublications, and support of policyefforts (see subsequent section ofprocedures for disclosure).
Business Relationships. SGIM mayestablish a business relationship with anindividual, group, or organization toendorse, develop, distribute, or sellproducts or services, for example,journals, books, software, or othereducational products. However, accep-
tance of any funds that come to SGIMfrom these relationships will be gov-erned by these guidelines for externalfunding of projects. For example, SGIMshall not receive funding to endorse,develop, distribute, or sell products suchas pharmaceuticals, medical devices,diagnostics, or other products purportedto have a direct health benefit topatients. In addition, SGIM shall notenter business relationships withcompanies that make or sell tobaccoproducts.
Acknowledgments. Tastefulacknowledgment of external fundersmay be made in the Society’s publica-tions, meeting materials, or reports ofproject results, as appropriate. Theseacknowledgments should not advertiseany products or services of the funder.Ultimate decisions about the tasteful-ness and appropriateness of any ac-knowledgments of external funding restswith the Society.
Advertising. The Journal of GeneralInternal Medicine may accept advertise-ments for medically related productsand services. Final judgment regardingthe appropriateness and acceptability ofadvertisements rests with the Journal’seditorial staff. Advertising (except forclassified advertising of positionsavailable and announcements) will notbe accepted for the Society’s otherpublications, including the SGIMForum and Web site.
Because the opportunities forexternal funding for valuable projectsare varied and to some extent unpre-dictable, exceptions to these guidelinesmay be appropriate in some circum-stances. Any exceptions, however, mustbe approved by the SGIM Council. Ascircumstances may also change overtime, this policy should be reviewed atleast every three years by Council andamended if necessary.
Procedures for ReviewingExternal FundingAll SGIM members, staff, or consult-ants involved in negotiations with
ACCEPTANCE AND DISCLOSURE OF EXTERNAL FUNDScontinued from previous page
continued on next page
12
SGIM FORUM
external funders should be familiar withthis policy. The initiation of theapproval process should begin early inany quest for external funding, ideallywhen an SGIM member or group ofmembers first conceives of a projectrequiring SGIM’s participation andexternal funding, or when an SGIMmember or group of members is firstapproached by an external funder abouta potential project requiring SGIM’sparticipation.
General contributions, includingcontributions for awards, will behandled directly by the DevelopmentCommittee. All general contributions,except unrestricted educational grantsless than $5,000, will also be reviewedby the chair of the Ethics Committee.Any general contribution that raisesconcerns will undergo a full EthicsCommittee review (see below).
Proposals for research or educa-tional projects requiring externalfunding and for which the applicant(s)request SGIM’s involvement shouldcome from an SGIM member or groupsof members (with one member desig-nated as the main point of contact).
At minimum, proposals for researchor educational projects should include astandard cover page and a three- tofour-page abstract describing theproject’s objectives, methodology,timetable, the estimated budget andproposed source of external funding,human subjects/IRB issues, and how itsatisfies the SGIM guidelines for theacceptance of external funds. Abiographical sketch of each key partici-pant should be included. Additionalsupporting materials may be included. Atemplate for proposals for externallyfunded research or educational projectsis included as Appendix 2 of this policy.
Proposals for research or educa-tional projects should be submitted tothe SGIM Development Director, whowill triage them as follows:� Research projects will go to the Chair
of the Research Committee.� Educational projects will go to the
Chair of the Education Committee.
The Chairs of these committeeswill preliminarily review the proposal(in consultation with the ExecutiveDirector), focusing on compliance withthe external funding guidelines andfeasibility of the project, and eitherreject the proposal, return the proposalto the applicant(s) for revision, orforward the proposal for a full review.Full review would be undertaken by asubcommittee of each committeeconsisting of three members, withapproval to move the project forwardrequired from at least two of the threemembers. Reviewers would be asked todeclare any potential conflicts ofinterest in their evaluation of assignedproposals; occasionally, such a declara-tion may lead the committee chair toreplace a reviewer.
Each proposal for external fundingfor research or educational projectsforwarded for a full review by theResearch or Education Committee willalso be reviewed in parallel by the Chairof the Ethics Committee. If any con-cerns are raised, the Chair of the EthicsCommittee will appoint three EthicsCommittee members to perform a fullethics review. Once again, approval tomove the project forward would berequired from at least two out of thethree members.
During the period of full review, theproposal would be posted on the SGIMWeb site, and all SGIM members withactive e-mail addresses in the Society’smembership database would receive abrief message about the nature of theproject under review, referring them tothe full proposal. Any concerns ofindividual members, especially regard-ing competition with their own efforts,should be communicated to the Chairof the Research or Education Commit-tee within two weeks of the posting.These messages would in turn beforwarded to the committee membersperforming the full review, and consid-ered in the deliberations regardingproject approval.
In parallel with the committeereviews described above, the proposal
would be reviewed by the SGIMTreasurer to determine whether the newfunding would bring the total amount ofexternal funding above acceptablethresholds for the year(s) when theproject would be conducted. Projectsapproved to move forward by either theEducation or Research Committee andthe Ethics Committee, with assuranceby the SGIM Treasurer that the newfunding does not violate the acceptableexternal funding limits, would beforwarded to the SGIM Council forfinal approval at a monthly conferencecall or meeting. The goal of the entirereview process should be to accept orreject proposals within 60 days ofsubmission.
SGIM acknowledges that occasion-ally opportunities for externally fundedresearch or educational projects may betime-limited. If a decision on SGIM’sparticipation must be made in less than60 days, a letter requesting an expeditedreview can accompany the proposal.Decisions regarding the desirability,practicality, and mechanisms of anexpedited review will be made by theExecutive Director, in consultation withthe chairs of the appropriate committees(Research or Education and Ethics).
If a proposal is not recommended forfurther consideration at any stage of theprocess, the proponents may appeal thedecision in writing to the SGIM Execu-tive Committee. The Executive Commit-tee may confirm or override the originaldecision; in the latter case, the proposalwould proceed to (but not circumvent)the next step in the review process.
Procedures for Disclosure of Exter-nal FundingWhen external funding supportspresentations or awards at regional orannual meetings, the program for themeeting should indicate the sources andnature of external support. Speakersshould disclose whether any part oftheir presentation resulted fromexternal funding and whether they haveany personal financial interest in the
continued on next page
ACCEPTANCE AND DISCLOSURE OF EXTERNAL FUNDScontinued from previous page
13
subject matter of the presentation.All externally funded research and
educational projects will be posted onthe SGIM Web site by leaving theproject descriptions, originally postedfor member review and comment, onthe site with an indication that fundingwas ultimately accepted for the project.
The SGIM Treasurer will preparean annual report on the sources andamounts of external funding at the endof each fiscal year, along with a calcula-tion of the proportion of the operatingbudget for the fiscal year derived fromexternal funding. The report, whenaccepted by Council, will also be postedon the SGIM Web site.
Appendix 1. Calculation of theproportion of the SGIM operatingbudget attributable to externalfundingThe denominator of this calculationwill be the total operating budget forthe fiscal year, including contract offsets(deducted from expenses). The numera-tor of this calculation will be theamount of the total actual operatingbudget derived from all external sources(and, separately, from any one for-profitsource), other than membership dues,membership list sales, member contribu-tions, interest income, submission andregistration fees for the Annual Meet-ing, newsletter income, JGIM income(including Editor’s Office revenues androyalties), and funds transferred fromreserves.
ExampleThe actual operating budget for SGIMfor a given fiscal year is $1,900,000(including contract offsets deductedfrom expenses). Of this amount, a totalof $275,000 (14.5% of the actualoperating budget) is derived fromcontributions and income from externalfunders, including royalties, contribu-tions, exhibit fees, and contract offsets.The largest source of revenue, a for-profit entity, contributed $65,000 (3.4%of the actual operating budget) inroyalties. Neither percentage is high
enough to raise concerns about depen-dence (see guidelines).
Appendix 2. Template for proposals
ACCEPTANCE AND DISCLOSURE OF EXTERNAL FUNDScontinued from previous page
to SGIM for research or educationalprojects requiring SGIM’s participa-tion and external funding.(To be developed) SGIM
RESEARCH NETWORKScontinued from page 7
John Fry, Curtis Hames, Paul Nuttingand Larry Green, to name a few. Thedilemma has always been how toharvest the rich data that are availablewhile overcoming the difficulties ofpursuing scientific endeavors in primarycare medicine. In the 1980’s, LarryGreen, Paul Nutting, and others becamevocal advocates for a concept thatwould overcome some of the difficultiesof investigating health care issues ingeneral outpatient practices. Theyrecommended that primary carephysicians emulate the methods longapplied in Europe, whereby general,community-based, primary care prac-tices formed de facto national or regionalnetworks of practices by virtue of theirinformation infrastructure. For example,the British have a rich history ofexamining large health care data setsdescribing patients presenting tonumerous primary care practices. Basedon this model, the Ambulatory SentinelPractice Network (ASPN) was estab-lished as a means of bringing togetherprimary care physicians, mostly familyphysicians, from the United States andCanada in the form of a network ofphysicians interested in doing somethingdifferent in their practices. Their commonbond was their commitment toproactively ask and discern the answers toquestions that could help them providebetter medical care to their patients.
In recent years, the concept ofpractice-based research networks(PBRNs) has grown significantly,propelled forward in large part by theCommittee on the Future of PrimaryCare, convened by the Institute ofMedicine. The Committee’s 1996 reportis considered seminal because of itsupdated definition of primary care andits endorsement of PBRNs. The
Committee described PBRNs as “themost promising infrastructural develop-ment that [the Committee] could findto support better science in primarycare.” Many academic primary caredepartments, particularly in familymedicine, successfully developedregional or statewide PBRNs as plat-forms upon which to build a researchinfrastructure. Today, regional andnational PBRNs are offering criticalcontributions to the evidence base offamily practice, general pediatrics, andgeneral internal medicine.
In 1995, a core group of networkdirectors affiliated themselves in anumbrella organization, the Federation ofPractice-Based Research Networks(FPBRN). The mission of FPBRN is toexpand the number of PBRNs in theU.S., provide technical assistance tonew networks, promote network-to-network collaboration, and fostergreater appreciate of the uniquecapabilities and infrastructure needs ofnetworks among government andprivate funding agencies.
The seeds planted through theadvocacy efforts of numerous primarycare researchers, organizations repre-senting primary care physicians, and theFPBRN appear to be bearing fruit.Through a Request for Applications(RFA) published in early 2000, theAgency for Healthcare Research andQuality (AHRQ) provided competitivefunding to support the infrastructureneeds of 19 PBRNs. AHRQ released asecond RFA in 2001 to provide AHRQ-supported networks with funding forresearch in bioterrorism. More recently,other sponsors have endorsed PBRNs,including the National Cancer Instituteand the Robert Wood Johnson Founda-
continued on page 15
14
SGIM FORUM
HEALTH POLICY ADDITIONcontinued from page 5
components: Health Policy News andIssue Briefs. In Health Policy News youwill find legislative updates on topics ofinterest to SGIM, as well as a summaryof SGIM’s advocacy activities on thesetopics. In Issue Briefs you will findbackground material on the topics thatare the focus of the Health PolicyCommittee’s nine clusters. In the futureWhere We Stand will add two addi-tional components: Letters to Congressand Administration, and PositionPapers. Letters to Congress and Admin-istration will include letters sent bySGIM as well as letters sent by otherorganizations in which SGIM partici-pates (e.g., Friends of the Agency forHealthcare Research and Quality,Health Professions and Nursing Educa-tion Coalition). Position Papers willprovide access to documents outliningSGIM policy on specific issues (e.g.,access to care).
The fourth section, Health PolicyDiscussion Group, has not beencompleted yet. When it is functional(in a few months), it will be a bulletinboard for health policy topics of interestto SGIM members. The Health PolicyCommittee will monitor the bulletinboard from time to time and will try toanswer questions as well as contribute tothe discussion. The Health PolicyDiscussion Group will not be a chatroom and so will be available at anytime for asynchronous discussion. Thissection also will be password-protected.
The fifth section, SGIM Govern-ment Affairs Staff, identifies SGIM’shealth policy consultants at MedicalAdvocacy Services, Inc. (MASI).
The Health Policy Committeebegan work on this Web site addition in1999. Jenn Jenkins from MASI and staffin the SGIM National Office, especiallyKay Ovington, have been extremelyhelpful in making it a reality. Wewelcome comments on and questionsabout the addition. There will be aformal evaluation available online andthrough the Forum within the next fewmonths. SGIM
(26%); and identification of meetingleaders (23%). Respondents most oftenrequested speaker presentations onfaculty development (85%), women’shealth education (43%), and genderissues/sexual discrimination in medicine(36%). To continue communicationbetween Annual Meetings, mostrespondents preferred quarterly updatesvia electronic mail.
Reviewing the survey results andpast accomplishments of the Caucuscalls attention to a few issues. TheWomen’s Caucus remains an invaluableresource for collaboration andmentorship for SGIM’s women members.In addition, while women are a morevisible group within SGIM, promotionand leadership are still important issuesfor most women in academic medicine.
We encourage all members to viewinformation about the Women’s Caucuson the SGIM Web site (www.sgim.org). The Web site includes thearticle, “The First Decade of the SGIMWomen’s Caucus,” that was originallypublished in the November 1996 issueof the Forum. It lists important mile-stones in the work of the Caucus sinceits inception. It also allows members tojoin the Caucus listserve or pay annualdues. (Note: The annual dues letter onthe Web site replaces the annual duesletter that was previously sent by mail.)
We also invite members to attendthe Women’s Caucus Interest Groupmeeting at the Annual Meeting inAtlanta. The Interest Group meeting isFriday, May 3, from 7:00 to 8:30 p.m. Apanel of Caucus members will sharetheir views on issues for women inleadership positions in academicmedicine. Participants will include FranBrokaw, Sandra Fryhofer, KatherineKahn, Ann Nattinger, and JudithWalsh.
We hope that during the next 25years SGIM will continue to have anactive Women’s Caucus with programsthat appeal to the unique careerdevelopment needs of women withinSGIM. SGIM
SGIM’S WOMEN’S CAUCUScontinued from page 6
HEALTH DISPARITIEScontinued from page 6
tee was three-fold: to determine thepresence and extent of racial/ethnicdisparities in health care, to identifypotential root causes other than accessto care, and to provide recommenda-tions for strategies to eliminate dispari-ties. Given that the charge was limitedto disparities in health care (versus thelarger issue of health outcomes) onceaccess had been achieved, specific areasof exploration included health systemfactors (e.g., financial and institutionalarrangements, structural processes ofcare) and provider level factors (e.g.,communication in the medical encoun-ter, the effect of race/ethnicity onclinical decision making). To carry outits responsibilities over the 18 monthsof the study, the committee reviewed asignificant amount of evidence, includ-ing a literature review of over 600manuscripts, commissioned papers (ontopics ranging from an exploration ofhealth disparities to the economic,ethical, and legal ramifications ofdisparities in health), and experttestimony. In addition, the IOMcommissioned focus groups of patientsand providers, and sponsored a publicworkshop on the issue of healthdisparities. The report was released onMarch 20.
A second IOM study dealing withdisparities was commissioned in late2001. The goal of the Committee onDeveloping a National Health CareDisparities Report is to advise AHRQon the format and content of an annualreport to be submitted to Congress onprevailing disparities in the quality ofhealth care based on access (uninsuredversus underinsured versus insured),race/ethnicity, geography (rural versusurban versus suburban), and socioeco-nomic status. This annual report will bean adjunct to the National Health CareQuality Report and will serve as abarometer by which to gauge progress inimproving the performance of thehealth care delivery system in consis-tently providing high-quality healthcare. Similar tools are used in other
continued on next page
15
HEALTH DISPARITIEScontinued from previous page
areas to track the state of the economyand to help shape economic policies(e.g., the Consumer Price Index andother economic indicators issued by theBureau of Labor Statistics).
The Committee on Developing aNational Health Care DisparitiesReport is also composed of experts(including SGIM members) in healthservices research and health policy, whowill be reviewing evidence such ascommissioned papers, expert testimony,and the findings of a public workshop.They will focus on measures that spanpreventive care, acute care, chroniccare, and long-term care, all groundedwithin the principles of effectiveness,safety, patient-centeredness, timeliness,efficiency, and equity—the pillars ofquality proposed by an earlier IOMreport, entitled Crossing the QualityChasm.
What does this mean for academicgeneralists? Clearly, both IOM reportswill have a great impact on how wedevise our health care delivery system(including, for example, data collectionand quality improvement) and how wepractice medicine. Having a greaterunderstanding of the root causes ofdisparities should allow us to interveneaccordingly, whether in our roles asopinion leaders, administrators, teach-ers, or caregivers. The IOM reports willprovide a well thought out blueprint fordetermining where we’ve been, wherewe are, and where we need to go as itrelates to health disparities. They willhelp in designing interventions toreduce disparities.
Needless to say, disentangling themultifactorial and complex causesunderlying racial and ethnic disparitiesis extremely challenging. The literatureis expansive, yet, as one might expect,imperfect, given how difficult it is tostudy these issues in a clear and simplefashion. Actors within the health caresystem hold steadfast to their specificperspectives on the causes of disparitiesand strategies to eliminate them, yet allagree that something must be done toaddress this national problem. Measure-
ment of our progress to eliminatedisparities is equally difficult andchallenging, yet absolutely required ifwe are to chart our movement anddocument our successes. The two IOMcommittees have taken their collectiveresponsibilities to address these impor-tant tasks very seriously. Their reportsshould help guide future efforts toeliminate racial and ethnic dispartitiesin health care. SGIM
RESEARCH NETWORKScontinued from page 13
Editor’s Note—Joseph Betancourtand Thomas Inui, members of the IOMCommittee on Understanding andEliminating Racial/Ethnic Disparities inHealth Care, will join other experts inminority health in leading a workshopentitled “The IOM Report on Racial/Ethnic Disparities: Findings, Recommen-dations, and Concrete Next Steps” at theSGIM Annual Meeting, Saturday, May 4,2002, 10:00–11:30 a.m.
tion. On February 6, 2002, AHRQreleased a new RFA to develop orenhance PBRNs (RFA-HS-02-003,described in the March 2002 issue ofForum). Applications are due May 14,2002. On February 19, 2002, AHRQand the Health Services Research andDevelopment Service (HSR&D),Department of Veterans Affairs (VA),issued a new program announcement(PA), Translating Research intoPractice (TRIP) (PA-02-066, describedelsewhere in this issue of Forum). TRIPis also network-friendly.
More information about theresource needs for developing andmanaging a regional PBRN may beobtained from FPBRN (www.aafp.org/research/fpbrn/) or from the author([email protected]). FPBRN
also sponsors preconference workshopsat annual meetings of the NorthAmerican Primary Care ResearchGroup (NAPCRG). The 2002NAPCRG Annual Meeting will bein New Orleans, Louisiana, November17–20. Meeting information is availableon NAPCRG’s Web site www.napcrg.org. SGIM
Editor’s Note—Dr. Ryan is AssistantProfessor and Director, Division ofPrimary Care/Health Services Researchand Development, Department of FamilyMedicine and Community Health,University of Miami School of Medicine.He is also Vice-Chair, FPBRN.
into SGIM’s operations. I don’t want tore-open that dialogue in this report;there will be another town meeting atthe upcoming Annual Meeting inAtlanta to continue the discussion. I dowant to remind us all that campaigncontributions to SGIM are revenuesthat, without question, reflect ourshared values and interest in SGIM’sfuture. This campaign will strengthenthe relationship between the Society
LEADERS MAKE A DIFFERENCEcontinued from page 2
and its members. It is a substantialopportunity to shift from potentialconflicts of interest to a confluence ofinterest. I encourage you to join yourcolleagues who have already made acontribution and “Make aDifference!” SGIM
Editor’s Note—Tom Inui is a Past-President of SGIM and Chair of the“Make a Difference!” Campaign.
Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037
SGIM
FORUM
CLASSIFIED ADS
Positions Available and Announcementsare $50 per 50 words for SGIM members and$100 per 50 words for nonmembers. Thesefees cover one month’s appearance in theForum and appearance on the SGIM Web-site at http://www.sgim.org. Send your ad,along with the name of the SGIM membersponsor, to SGIM Forum, AdministrativeOffice, 2501 M Street, NW, Suite 575,Washington, DC 20037. It is assumed thatall ads are placed by equal opportunityemployers.
ACADEMIC PHYSICIAN TO DIRECTHOSPITALIST PROGRAM. Assistant Professor(CHS): Extraordinary opportunity for a physician2–3 years into their career to head up our estab-lished hospital-based program at the University ofWisconsin, Department of Medicine. Position in-cludes 30–40% protected scholarly time (first twoyears) in the areas of patient safety/quality improve-ment, informatics and administrative responsibili-ties as Director of the Program; 4–5 months of in-patient responsibilities; 1–2 half-days/week of out-patient work; educational opportunities to teachmedical students and residents; and, ongoing in-volvement in career development of otherHospitalist Program faculty. The UW-Madison isbuilding a culturally diverse faculty and stronglyencourages applications from minority candidates.The UW Madison is an EEO/AA employer. Pleasesend letters of interest and CV to Dr. Juanita Halls,University of Wisconsin-Madison, Clinical ServicesChief, Section of General Internal Medicine, 2828Marshall Ct., Suite 100, MC 9054, Madison, WI53705.
GENERAL INTERNAL MEDICINE FELLOW-SHIP AT NEW YORK UNIVERSITY/BELLEVUE: NYU’s recently funded Division ofPrimary Care’s 2-year Fellowship Program has open-ings for candidates for academic year 2002–2003. Fel-lows prepare for academic general internal medi-cine careers through formal training and practical,
mentored experience in clinical research and medi-cal education, including courses on research meth-ods, clinical epidemiology, health policy, clinicalteaching, curriculum design, leadership, psychoso-cial medicine, cross-cultural medicine/immigranthealth and quality improvement. Masters degreesare optional. For inquires, Dr. Mark Schwartz,[email protected]. For applications,[email protected] or 212-263-8 8 9 5 .
TRAINING IN FACULTY DEVELOPMENT. TheStanford Faculty Development Center (http://sfdc.stanford.edu) is accepting applications forthree, month-long, facilitator-training programs.The training prepares faculty to conduct a facultydevelopment course in one of three content areas
Geriatric Educational Tools18 Resources for Primary CareResidency Programs �
• Consultation services• Stand-alone teaching aids• Geriatric curriculum manuals• Faculty development programs• Packaged methods for teaching geriatric skills
Developed by �
• Baylor College of Medicine • Harvard University
• Johns Hopkins University • Stanford University
• University of California, Los Angeles
• University of Chicago • University of Connecticut
• University of Rochester
• American Academy of Family Physicians
The John A. Hartford Consortium forGeriatrics in Residency Training
Stanford University Geriatric Education Resource Centerphone: 650.723.8559 fax: 650.723.4312order from �
Now Available
http://sugerc.stanford.edu
�
Online Orderingand
Digital Distribution
for faculty and residents at their home institutions.(1) The Clinical Teaching course introduces a 7-component framework for analyzing and improv-ing teaching. (2) The End-of-Life Care course isdesigned to increase physicians’ competence in thedelivery and teaching of end-of-life care. (3) TheGeriatrics in Primary Care course enhances primarycare physicians’ ability to care for older patients andteach geriatrics to medical trainees. 2002 programdates: End-of-Life Care (September 3–27), Geriat-rics in Primary Care (September 3–27), ClinicalTeaching (September 30-October 25). Applicationdeadline: June 15, 2002. Please contact: GeorgetteStratos, PhD, Co-Director, Stanford Faculty Devel-opment Center, 700 Welch Rd., Suite 310B, PaloAlto, CA 94304-1809. Telephone (650) 725-8802;E-mail [email protected].
