The Milbank Memorial Fund quarterly最新文献

{"title":"How Helpful Are Hospital Rankings and Ratings for the Public's Health?","authors":"C. Deangelis","doi":"10.1111/1468-0009.12227","DOIUrl":"https://doi.org/10.1111/1468-0009.12227","url":null,"abstract":"T he public must have better information to make sound decisions about which hospitals would be the best choices for themselves or for their families. Currently, many such decisions are based on where their physicians have admitting privileges, advice from friends who had prior experiences with specific hospitals, or the general reputations of hospitals and medical centers in the community. But to augment the bases for such important decisions, several elaborate hospital rankings and ratings have been developed. The two best-known evaluations of hospitals are those published by the US Centers for Medicare and Medicaid Services (CMS) and by the weekly news magazine US News & World Report. The CMS star rating, ranging from a rank of 1 (the lowest) to 5 (the highest), evaluates some 4,600 hospitals and is designed to provide comprehensive, quality information about patient care. It ranks hospitals on 64 quality measurements, including patient care for myocardial infarctions and pneumonia, post-surgical infection rates, joint replacement complications, and emergency room waiting times.1 However, the CMS rankings currently do not include data on the quality of care or patients’ health outcomes.2 The US News & World Report ratings evaluate some 5,000 medical centers based on such metrics as death rates, patient safety, and hospital reputation, which are reported by 30,000 physicians.3 In the 2016 CMS report, only 102 (2.2%) of the 4,600 hospitals received an overall rating of 5 stars, 934 (20.3%) received a 4-star rating, 1,770 (38.5%) received a 3-star rating, 723 (15.7%) received a 2-star rating, and 133 (2.9%) received a 1-star rating. An additional 937 (20.4%) received no rating because they either did not report, or did not have, the minimal amount of data required to make a decision. This last scenario might occur with the quality measurement of new or small hospitals or those admitting an insufficient number of patients.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"28 1","pages":"729-732"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74846633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Big Food\" Is Making America Sick.","authors":"L. Gostin","doi":"10.1111/1468-0009.12209","DOIUrl":"https://doi.org/10.1111/1468-0009.12209","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"13 1","pages":"480-4"},"PeriodicalIF":0.0,"publicationDate":"2016-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85457773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Public Health Is Purchasable\".","authors":"H. Markel","doi":"10.1111/1468-0009.12202","DOIUrl":"https://doi.org/10.1111/1468-0009.12202","url":null,"abstract":"A s I write these words in the early weeks of summer, the Ebola fever panic of 2014 has long since receded into our collective rearview mirror and the number of Zika virus cases, along with the discovery of more and more babies with Zika-induced microcephaly, is steadily increasing. By the time you read this column, swarms of Aedes aegypti and Aedes albopictus mosquitoes carrying the virus will have likely traveled from South America to points north, east, and west, accompanied by the predictable media hoopla that characterizes every American epidemic. Sadly, the interregna between the many contagious crises of the still young 21st century have been characterized by a global amnesia. As the “epi curve” of each scourge descends, public health officials, elected leaders, and the population at large turn their attention to other issues at the expense of planning for the next newly emerging infectious disease. And just as predictably, the appearance of each new pandemic or epidemic inspires a situation in which our public health officials must waste valuable time and energy securing adequate government funding to fight and contain the new threat. Ironically, in 1983, the US Congress established a public health emergency fund, much like the one for the Federal Emergency Management Agency (FEMA) uses to rapidly respond to natural disasters. Yet the balance of that federal public health emergency fund, as of June 2, 2016, was a mere $57,000! This sorry situation serves to remind us of, perhaps, the savviest paragraph on public health ever composed; it is one I will quote in 2 parts as this essay progresses. Let’s begin with the opening lines of what ought to be memorized as public health gospel:","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"32 1","pages":"441-7"},"PeriodicalIF":0.0,"publicationDate":"2016-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73510870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Affordable Care Act and Civil Rights: The Challenge of Section 1557 of the Affordable Care Act.","authors":"S. Rosenbaum","doi":"10.1111/1468-0009.12207","DOIUrl":"https://doi.org/10.1111/1468-0009.12207","url":null,"abstract":"I n May 2016, the Obama Administration issued longawaited regulations implementing §1557 of the Affordable Care Act (ACA).1 Broad in scope, §1557 does what virtually no civil rights law has done before: it extends the principle of nondiscrimination to the content of health insurance, that is, coverage standards themselves. At the same time, however, the challenge of insuring nearly all residents within the world’s costliest health care system, coupled with long-standing insurer traditions designed to shield companies, sponsors, and policyholders from excessive costs, underscores the many complexities involved in balancing coverage with equity. Section 1557 provides that no individual shall be barred from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity, any part of which receives federal financial assistance. The concept of federal financial assistance reaches not just grants or public insurance payments but also tax credits, government payment subsidies, and contracts of insurance. The principle of discrimination incorporates the cornerstones of US civil rights law—Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments of 1972 (sex), §504 of the Rehabilitation Act of 1973 (disability), and the Age Discrimination Act of 1975 (age). The reach of existing civil rights laws into health care has been considerable and transformative in its own right. But these laws were generally interpreted as falling short of reaching health insurance coverage itself.2 The US Supreme Court ruled that disability antidiscrimination law does not bar state Medicaid programs from imposing across-the-board limits on hospital coverage, even though such limits may leave people with disabilities without access to adequate treatment. Lower courts have similarly ruled in the past that disability nondiscrimination law does","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"37 1","pages":"464-7"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90947953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The VA Continues to Struggle-Especially in Terms of Improved Access.","authors":"G. Wilensky","doi":"10.1111/1468-0009.12204","DOIUrl":"https://doi.org/10.1111/1468-0009.12204","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"34 1","pages":"452-5"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89921185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Exnovation of Chronic Care Management Processes by Physician Organizations.","authors":"H. Rodríguez, R. Henke, S. Bibi, P. Ramsay, S. Shortell","doi":"10.1111/1468-0009.12213","DOIUrl":"https://doi.org/10.1111/1468-0009.12213","url":null,"abstract":"UNLABELLED\u0000Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations.\u0000\u0000\u0000CONTEXT\u0000Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time.\u0000\u0000\u0000METHODS\u0000Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians.\u0000\u0000\u0000FINDINGS\u0000Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse care management and registries were largely retained. Greater proportions of baseline Medicaid practice revenue (incidence rate ratio [IRR] = 1.44, p < 0.001) and increasing proportions of revenue from Medicaid (IRR = 1.02, p < 0.05) were associated with greater CMP exnovation by physician organizations on net. Practices with greater expansion of HIT functionality exnovated fewer CMPs (IRR = 0.91, p < 0.001) compared to practices with less expansion of HIT functionality.\u0000\u0000\u0000CONCLUSIONS\u0000Exnovation of CMPs is an important reason why the population-level adoption of CMPs by physician organizations has remained low. Expanded HIT functions and changes to Medicaid reimbursement and incentives may aid the retention of CMPs by physician organizations.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"181 1","pages":"626-53"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80245722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass Production of Systematic Reviews and Meta-analyses: An Exercise in Mega-silliness?","authors":"M. Page, D. Moher","doi":"10.1111/1468-0009.12211","DOIUrl":"https://doi.org/10.1111/1468-0009.12211","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"51 1","pages":"515-9"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83647354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-cigarette Policymaking by Local and State Governments: 2009-2014.","authors":"Elizabeth Cox, R. Barry, S. Glantz","doi":"10.1111/1468-0009.12212","DOIUrl":"https://doi.org/10.1111/1468-0009.12212","url":null,"abstract":"Policy Points: \u0000E-cigarettes are new products that are generating policy issues, including youth access and smokefree laws, for local and state governments. \u0000Unlike with analogous debates on conventional cigarettes, initial opposition came from e-cigarette users and retailers independent of the multinational cigarette companies. \u0000After the cigarette companies entered the e-cigarette market, the opposition changed to resemble long-standing industry resistance to tobacco control policies, including campaign contributions, lobbying, and working through third parties and front groups. \u0000As with earlier efforts to restrict tobacco products, health advocates have had the most success at the local rather than the state level. \u0000 \u0000 \u0000 \u0000Context \u0000E-cigarettes entered the US market in 2007 without federal regulation. In 2009, local and state policymakers began identifying ways to regulate their sale, public usage, taxation, and marketing, often by integrating them into existing tobacco control laws. \u0000 \u0000Methods \u0000We reviewed legislative hearings, newspaper articles, financial disclosure reports, NewsBank, Google, Twitter, and Facebook and conducted interviews to analyze e-cigarette policy debates between 2009 and 2014 in 4 cities and the corresponding states. \u0000 \u0000Findings \u0000Initial opposition to local and state legislation came from e-cigarette users and retailers independent of the large multinational cigarette companies. After cigarette companies entered the e-cigarette market, e-cigarette policy debates increasingly resembled comparable tobacco control debates from the 1970s through the 1990s, including pushing pro-industry legislation, working through third parties and front groups, mobilizing “grassroots” networks, lobbying and using campaign contributions, and claiming that policy was unnecessary due to “imminent” federal regulation. Similar to the 1980s, when the voluntary health organizations were slow to enter tobacco control debates, because they saw smoking restrictions as controversial, these organizations were reluctant to enter e-cigarette debates. Strong legislation passed at the local level because of the committed efforts of local health departments and leadership from experienced politicians but failed at the state level due to intense cigarette company lobbying without countervailing pressure from the voluntary health organizations. \u0000 \u0000Conclusions \u0000Passing e-cigarette regulations at the state level has become more difficult since cigarette companies have entered the market. While state legislation is possible, as with earlier tobacco control policymaking, local governments remain a viable option for overcoming cigarette company interference in the policymaking process.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"27 1","pages":"520-96"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87656692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Louisiana Tells Us About the ACA Medicaid Expansion.","authors":"J. Cohn","doi":"10.1111/1468-0009.12205","DOIUrl":"https://doi.org/10.1111/1468-0009.12205","url":null,"abstract":"O ne of the biggest health care stories these days doesn’t get nearly the attention it deserves. It is the slowbut-steady expansion of Medicaid, the program that’s been providing insurance to the poor since the 1960s, as part of the Affordable Care Act (ACA). If you follow the political debates about “Obamacare,” chances are you hear much more about changes to the private insurance market and what those changes mean for consumers. But the number of people who have coverage thanks to the law’s Medicaid expansion (roughly 15 million as of 2016) is actually a bit larger than the number getting coverage through the exchanges (roughly 13 million).1 The Medicaid expansion’s impact on economic security and public health is probably larger too. In June, I got an early glimpse of what a bigger Medicaid program could mean for Louisiana, thanks to a group visit for journalists organized by the Henry J. Kaiser Family Foundation. Until recently, Louisiana was among the states whose officials were refusing to expand Medicaid eligibility as the ACA’s architects had originally envisioned. But in 2015, John Bel Edwards ran for governor on a promise to join the expansion—that is, to make Louisiana’s version of Medicaid available to all people in households with incomes below 133% of the poverty line. (In 2016, that’s $15,800 for an individual and $26,813 for a family of 3.) Edwards won and on January 12, 2016, one day after taking office, he signed an executive order implementing the expansion. The ink was barely dry when state agencies began trying to sign up as many people as possible—by automatically enrolling those who were already receiving other forms of state assistance and by conducting outreach efforts through health clinics and other venues that serve lowincome communities. Coverage was set to begin paying for services on July 1, 2016. By the time of my visit, roughly 2 weeks before that start","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"42 1","pages":"456-9"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83601139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing HITECH Implementation and Lessons: 5 Years Later.","authors":"Marsha Gold, Catherine McLAUGHLIN","doi":"10.1111/1468-0009.12214","DOIUrl":"10.1111/1468-0009.12214","url":null,"abstract":"<p><strong>Policy points: </strong>The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain. The future of health information technology (health IT) support nationally is likely to depend on the ability of the technology to satisfy its users that its functionalities address the interests policymakers and other stakeholders have in using technology to promote better care, improved outcomes, and reduced costs.</p><p><strong>Context: </strong>The Health Information Technology for Economic and Clinical Health (HITECH) Act set ambitious goals for developing electronic health information as one tool to reform health care delivery and improve health outcomes. With HITECH's grant funding now mostly exhausted but statutory authority for standards remaining, this article looks back at HITECH's experience in the first 5 years to assess its implementation, remaining challenges, and lessons learned.</p><p><strong>Methods: </strong>This review derives from a global assessment of the HITECH Act. Earlier, we examined the logic of HITECH and identified interdependencies critical to its ultimate success. In this article, we build on that framework to review what has and has not been accomplished in building the infrastructure authorized by HITECH since it was enacted. The review incorporates quantitative and qualitative evidence of progress from the global assessment and from the evaluations funded by the Office of the National Coordinator for Health Information Technology (ONC) of individual programs authorized by the HITECH Act.</p><p><strong>Findings: </strong>Our review of the evidence provides a mixed picture. Despite HITECH's challenging demands, its complex programs were implemented, and important changes sought by the act are now in place. Electronic health records (EHRs) now exist in some form in most professional practices and hospitals eligible for HITECH incentive payments, more information is being shared electronically, and the focus of attention has shifted from adoption of EHRs toward more fundamental issues associated with using health information technology (health IT) to improve health care delivery and outcomes. In some areas, HITECH's achievements to date have fallen short of the hopes of its proponents as it has proven challenging to move meaningful use beyond the initial low bar set by Meaningful Use Stage 1. EHR products vary in their ability to support more advanced functionalities, such as patient engagement and population-based care management. Many barriers to inte","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"94 3 1","pages":"654-87"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88598353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}