State governments face issues similar to those of the federal government in that they devote significant percentages of their budgets to health care and are concerned about health care quality, cost, and access for their citizens. States have also been fertile grounds for progressive policymaking and legislation. They have played important roles in developing regional databases to monitor quality, manage costs, and assess clinical effectiveness.14 State governments, cabinet-level health officers, and groups such as the National Conference of State Legislators, Council of State Governments, Association of State and Territorial Health Officials, and National Association of Health Data Organizations could provide a regional perspective in national CPR efforts. In addition, states would be likely candidates for pilot regional studies or experimental prototypes.

Universities and Professional Schools

CPR systems offer several advantages to universities. For example, universities whose professional schools (i.e., schools of medicine, nursing, and dentistry) are involved in clinical research can benefit from the improved data likely to be available for analysis. Furthermore, CPR systems may give the schools a means of disseminating their results for application in clinical practice. (These benefits are likely to accrue to independent research centers as well.)

The interest of health professions schools in CPRs may be mixed, however. On the one hand, faculty members' concerns about threats to their expertise and professional roles might prompt negative reactions to the CPR. On the other hand, individuals in academic or research settings might be


The following descriptions are examples of the types of state activities already in progress (National Association of Health Data Organizations, 1988).

In 1977 New York established the Statewide Planning and Research Cooperative System (SPARCS), a public-private effort that provides a unified data system to gather information throughout the state regarding all hospital stays. SPARCS is a major management tool for assisting hospitals, agencies, and other organizations with decision making regarding the financing, planning, and monitoring of inpatient hospital services.

In 1985 the General Assembly of Colorado established the Colorado Health Data Commission to collect, analyze, and disseminate data as a way to encourage competition and informed decision making.

In 1986 the Pennsylvania Health Care Cost Containment Council was established through an act that mandates health care utilization and cost data collection and dissemination. Its central purpose is to increase purchaser and consumer knowledge of health care costs and quality.

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