Widespread adoption of information technology is now regarded as a pathway to improving health care and achieving the Institute of Medicine's highly regarded six aims for redesigning care. Achieving these aims requires fresh approaches to health system design, including continuous healing relationships between physicians and patients and provision of tools to help patients be more active participants in their own care. Personal health records (PHRs) might allow patients and providers to develop new ways of collaborating and provide the basis for broader transformation of the health care system. Federal policies can be key catalysts in accelerating PHR development and adoption.

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This study examined relationships between chronic pain patients' ratings of pain severity, and other patient ratings about severity of associated impairment, and a series of behavioral measures of health care utilization and activity patterns. Prior to being evaluated, a sample of 150 chronic pain patients completed diary forms on which they recorded severity of pain on a 0-10 scale. Subjects were divided into high-medium-low on mean pain ratings, and were compared on the other measures obtained either from diary forms or at time of evaluation. Patient generated statements about severity of pain and extent of functional impairment from pain interrelated positively. However, these measures showed few relationships to medication consumption, health care utilization, diary recorded activity level, or to patient reported frequency counts of engaging in a set of commonplace activities. The results were interpreted to suggest that, in chronic pain, there may be a questionable relationship between what people say about their pain and what they do. Accordingly, the evaluation of chronic pain should include analyses of patient behavior.

Among the common methodological problems in research on the addictions reviewed in this article are (a) selective, incomplete, or biased reviews of the body of prior research from which a study has arisen; (b) reliance on inadequate or incomplete diagnostic criteria in choosing subjects for study; (c) choice of inappropriate comparison groups for treatment outcome research; (d) use of inadequate alcoholic analogues when alcoholic subjects are unavailable; (e) failure to adequately account for treatment dropouts in analysis of treatment outcome data; (f) unwarranted choice of single-subject over group designs in addictions research and vice versa; (g) failure to ensure that comparably trained, equivalently committed therapists provide both experimental and control treatments in treatment outcome studies; (h) failure to ensure that patients in both experimental and control treatments receive treatments as therapist-and time-intensive; (i) failure to follow patients for adequate lengths of time posttreatment; (j) failure to provide for adequate, multidimensional treatment outcome measures tapping a full range of patient behavior; (k) failure to exercise restraint, scientific modesty, and criticality in reporting results of one's own research; and(1) failure to recognize important differences between statistical and clinical significance.This article identifies common problems in research on the addictions. It also offers suggestions for remediating these methodological problems. The addictions considered in the article include alcoholism and the drug dependencies. Because the literature on alcoholism is much more extensive than that on drug addiction, most of the common errors reviewed are drawn from the alcoholism literature. Despite 'this focus, there is enough commonality between methods of research on alcoholism and drug dependence that criticism in one research area almost always has relevance to the other.The first problems to be considered are those arising from inadequate, incomplete, or

We report three studies that examine the accuracy and usefulness of food records among dieting obese patients. In study 1 errors in quantity and calorie estimates for 10 common foods averaged 63.9% (quantity) and 53.4% (calories). The results of study 2 indicate that only 53% of entries in daily food records were specified enough to permit objective estimates of the calories consumed. In study 3, blind raters could not predict weight loss based on subjects' self-recorded behavior changes. Collectively, these results question the utility of food records for estimating energy intake or predicting weight loss.

A key strategy for driving improvements in health care quality is providing comparative quality information to consumers. This strategy will not work, and could even be counterproductive, unless (1) consumers are convinced that quality problems are real and consequential and that quality can be improved; (2) purchasers and policymakers make sure that quality reporting is standardized and universal; (3) consumers are given quality information that is relevant and easy to understand and use; (4) the dissemination of quality information is improved; and (5) purchasers reward quality improvements and providers create the information and organizational infrastructure to achieve them.

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Despite a growing consensus that serious quality problems afflict U.S. health care, state and federal governments have done little to improve the quality of care. Proposed health insurance reforms, including a Medicare prescription drug benefit and the use of tax credits for insurance expansion, could create a mechanism for stimulating and then monitoring improvements in quality. We propose legislative requirements that any new expenditure of federal funds for health benefits be accompanied by public disclosure of performance information regarding quality, effectiveness, and safety. Such disclosure could yield diverse public and institutional benefits.