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A. FEDERAL NURSING HOME LEGISLATION--NURSING HOME REFORM ACT OF 1987Nursing homes receiving federal funds through Medicare and Medicaid must comply with federal laws requiring nursing homes to provide high quality care to residents.(20) Responding to the widespread nursing home abuse in the mid-to-late 1970s,(21) Congress enacted the Nursing Home Reform Act (NHRA) to reform the nursing home industry.(22) Included in the Omnibus Budget Reconciliation Act of 1987, this legislation specifies that nursing homes seeking reimbursement from Medicare and Medicaid must "care for residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident"(23) and "attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident in accordance with a written plan of care...."(24) Promulgated under NHRA, the "Requirements for Long Term Care Facilities"(25) regulation governs the operations of nursing homes with Medicaid patients and mandates residents'' rights and facility duties.(26)

Concern about limited resources and the high costs associated with new as well as existing medical treatments has placed greater emphasis on the evaluation of the cost-effectiveness of treatment alternatives. To be relevant to providers of care, "effectiveness" in economic evaluation must be clinically meaningful, that is, reflect important characteristics of the disease, be responsive to treatment effects, and represent aspects of health important to the patients themselves. To be suitable for modeling, the indicator must accurately and directly represent the appropriate health outcome, have the necessary temporal characteristics, and be interpretable within and across treatment groups. The purpose of this article is to propose a new approach for evaluating outcomes in clinical trials and cost-effectiveness studies of asthma.

These are Quality Practices, a set of easy-to-use, online workbooks written to educate the consumer about best practices, and My Quality Coach, an electronic approach to helping employees better understand their condition and manage their care.The Midwest Business Group on Health is a Chicago-based not-for-profit coalition of more than 90 members from an 11-state area. MBGH, which was founded in 1980, provides leadership and knowledge to employers working together to continuously improve the quality and cost-effectiveness of health services. A copy of the Dr. Data project report, "How We Choose Doctors - What Is and What Could Be" is downloadable from the reports section of the MBGH website - http://www.mbgh.org

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