• STD-related services in the public and private sector, are realized, the role of public STD clinics should be assessed.
• The CDC, in collaboration with state and local health departments, should ensure that services provided by dedicated public STD clinics are of high quality. This involves initiating the development of quality indicators and implementing and monitoring performance measures that reflect quality of services and health outcomes rather than program operation. quality standards are recommended in the following three general areas: (1) technical standards (e.g., diagnostic capability in STDs), (2) operational standards (e.g., hours of operation and convenience of services, staffing), and (3) program content standards (e.g., scope of services and referral networks). Quality standards for STD-related services should apply to services provided by both public and private sector health care professionals.

Some of the most promising models for STD prevention in the United States have involved collaborative efforts between local public health departments and academic medical centers. Several such models (e.g., Albuquerque, Birmingham, Baltimore, Boston, Cincinnati, Raleigh (NC), Chicago, Indianapolis, Minneapolis, New Orleans, San Francisco, St. Louis, Seattle) have involved joint health department/medical center recruitment and appointments of medical staff and collaborative training of medical students and house staff. In some cases, the health department has contracted with the medical center for delivery of medical services while retaining direct control of outreach and laboratory support services. Less extensive collaboration models have been established in many other cities to provide medical staffing, training, research, and reference laboratory capabilities. These models most closely parallel the pattern of delivery of clinical services in other developed countries.

Although it is difficult to measure the impact of the academic health center/public health department collaboration model on community STD rates, the apparent success of these models in the United States is evidenced by their relatively greater effectiveness in obtaining local, state, and federal funding for programs; their role in training clinical and public health leaders in STD and HIV prevention; their roles as regional training centers for public and private sector clinicians; their development and early adoption of innovative methods for diagnosis, treatment, and behavioral intervention; and their role in surveillance and early recognition of emerging STDs. Although such models are effective in areas where they are implemented, the model is less feasible for rural areas and small communities with more limited access to academic health centers. Nevertheless, these partnerships have steadily increased and, in nearly every instance, have resulted in improved patient care and training for health care professionals and have increased the number of high-quality public STD programs. Such collaborations