Editorial - Vol 2, No 2:  Contributed Articles: Diabetes; Integrated Care; Co-ordinated Contracting

Evidence based medicine has become one of the "watch words" in the planning and delivery of health care. Much of the supporting information is derived from formal clinical trials, frequently randomised controlled trials, but increasingly from meta-analyses. The rigorous collection of information is key to the underpinning of evidence based care.

Increasingly, however, we must recognise that real world experience can differ markedly from the controlled conditions under which most clinical trials are conducted. Patients have conditions which are not easily categorised, polypharmacy complicates management and the psychosocial environment has significant impact. All of these factors act to modify the outcomes experienced in trials, and should lead us to evaluate the effectiveness of recommended evidence based approaches as experienced in the real world.

In a similar vein, the delivery of quality care requires a high degree of experience, which in a fast moving world is increasingly hard to acquire and remain up-to-date. Finding new ways to share experiences is going to be increasingly important. The Internet, as a communication medium, has much to offer in this regard.

One area where there is a notable lack of published material relates to experience gained through programmes or projects, which are not conducted as formal clinical trials. Such approaches are frequently evaluated for impact, implications and outcomes, yet the knowledge gained is limited in its dissemination.

Healthcare Review – Online^TM wishes to encourage the wider communication of this material, and starts this month, by publishing three articles which fall into this category but cover very different areas; experience of a diabetic foot clinic for native American people, practical experience of public / private integration in California, and a framework from New Zealand for facilitating integrated care - Co-ordinated Contracting.

We are keen to encourage submission of similar articles which relate to practical experience in delivering improved health care, both positive and negative experiences are equally valuable. The programme reported may be local or international, but should be described in a way which would assist interpretation of its relevance to different health care systems. We will index these in a way which will assist their recovery by those seeking similar information.

We look forward to receiving further submissions. Please contact us for more detailed information for authors.