The American Journal of Managed Care

Original Research Categories

CLINICAL manuscripts examine the health and/or economic impact of specific medical interventions. The merit of clinical manuscripts is judged on the significance of the clinical question, the strength of the study design, and the potential impact of the results on clinicians' practice or health plan policies. We are not of the opinion that the only acceptable study design for clinical articles is a randomized trial. We encourage the submission of studies that use other established methodologies, such as observational studies, decision analysis, and meta-analyses. For example, we hope to continue to attract high-quality studies that use computer simulation methods. Given the hypothesis-generating value (instead of hypothesis testing) of decision analysis, we would like to emphasize the importance of highlighting sensitivity analyses when uncertainly exists regarding the value of certain model inputs. We feel that in many cases the results of sensitivity analyses are more meaningful to decision makers than the base case results. Although rare exceptions may exist, we strongly recommend that papers submitted to this category compare the effect of an intervention to available alternatives (eg, avoid placebo comparators when other treatments are available). Such studies are increasingly desirable relative to purely descriptive papers that report outcomes attributable to one clinical strategy. The use of such comparative studies by managed care organizations, pharmacy benefit managers, and others has grown rapidly over the past few years and should only continue into the future.

MANAGERIAL manuscripts address the clinical or economic impact associated with managerial interventions implemented by clinicians or health plans to alter the care delivery process. These include a wide range of studies such as those examining the influence of changes in benefit design, referral rules, formulary requirements, reimbursement policy, and disease management programs on the quality and cost of care. Studies may report empirical results or provide conceptual analyses of issues relevant to managerial interventions or health plan design. As with the clinical manuscripts, our evaluation will focus on the importance of the issue and credibility of the findings, which depend on the quality of the research design and analysis. Several of the most influential AJMC manuscripts published to date fall into this category. It is our hope that we continue to be a leading forum to publish rigorous evaluations of interventions aimed to improve the quality of clinical care or promote the efficient use of healthcare resources.

POLICY manuscripts address the influence of the regulatory environment on the quality, delivery and financing of healthcare. Manuscripts that assess statutes such as the Employee Retirement Income Security Act or the Health Insurance Portability and Accountability Act would fit into this category, as would papers that inform policy issues such as analysis of potential Medicare prescription drug benefit plans, Food and Drug Administration regulation and behavior, or the recommendation for a national smallpox vaccination program. These articles might also provide analysis of managed care topics in a context relevant to policy makers, such as determinants of healthcare cost growth or the impact of managed care penetration on clinical outcomes. It is our opinion that a much-needed dialogue between clinical decision makers and policy makers has not been adequately established. Thus, we intend to focus more attention to the policy arena, particularly as it impacts the day-to-day practice of clinical medicine.

METHODS manuscripts comprise papers that introduce innovative methodological approaches or describe advances to existing health services research techniques. We expect submissions in this area to report on topics such as quality of life assessment, risk-adjustment methods, or approaches to measure health plan quality. Advances in quantifying resource utilization, such as accounting for lost worker productivity, would also be welcome. Since we are not inclined to publish highly technical articles, papers in this category must be written in a straightforward style that would be viewed as relevant by our readers.

With this outline loosely describing the types of articles we are looking for, it is also worth pointing out the types of articles that we are less inclined to publish. Studies that simply report the clinical and/or economic ramifications of a specific disease (ie, a "burden of illness" study) are of minimal interest to us, unless they convincingly discuss how an intervention may directly impact the burden. Our lukewarm attitude extends to studies that examine a specific treatment using a "before and after" design and that do not include a meaningful comparator or control group. 
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