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The analysis upon which this publication is based was performed under Contract 500-96-P603, entitled, "Utilization and Quality Control Peer Review Organization for the State of Delaware," sponsored by the Health Care Financing Administration (HCFA), Department of Health and Human Services. The content of this publication does not necessarily reflect the views of or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the Health Care Quality Improvement Program initiated by HCFA, which has encouraged the identification of quality improvement projects derived from analysis of patterns of care, and therefore, required no special funding on the part of this Contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcome.