The Milbank Memorial Fund quarterly最新文献

{"title":"Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries.","authors":"R. Puhl, J. Latner, K. O’Brien, J. Luedicke, Sigrún Daníelsdóttir, X. R. Salas","doi":"10.1111/1468-0009.12162","DOIUrl":"https://doi.org/10.1111/1468-0009.12162","url":null,"abstract":"CONTEXT\u0000People viewed as \"overweight\" or \"obese\" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination.\u0000\u0000\u0000METHODS\u0000Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries.\u0000\u0000\u0000FINDINGS\u0000The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws.\u0000\u0000\u0000CONCLUSIONS\u0000Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"10 1","pages":"691-731"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72672614","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":"How Effective Are Incident-Reporting Systems for Improving Patient Safety? A Systematic Literature Review.","authors":"C. Stavropoulou, C. Doherty, P. Tosey","doi":"10.1111/1468-0009.12166","DOIUrl":"https://doi.org/10.1111/1468-0009.12166","url":null,"abstract":"CONTEXT\u0000Incident-reporting systems (IRSs) are used to gather information about patient safety incidents. Despite the financial burden they imply, however,little is known about their effectiveness. This article systematically reviews the effectiveness of IRSs as a method of improving patient safety through organizational learning.\u0000\u0000\u0000METHODS\u0000Our systematic literature review identified 2 groups of studies: (1)those comparing the effectiveness of IRSs with other methods of error reporting and (2) those examining the effectiveness of IRSs on settings, structures, and outcomes in regard to improving patient safety. We used thematic analysis to compare the effectiveness of IRSs with other methods and to synthesize what was effective, where, and why. Then, to assess the evidence concerning the ability of IRSs to facilitate organizational learning, we analyzed studies using the concepts of single-loop and double-loop learning.\u0000\u0000\u0000FINDINGS\u0000In total, we identified 43 studies, 8 that compared IRSs with other methods and 35 that explored the effectiveness of IRSs on settings, structures,and outcomes. We did not find strong evidence that IRSs performed better than other methods. We did find some evidence of single-loop learning, that is, changes to clinical settings or processes as a consequence of learning from IRSs, but little evidence of either improvements in outcomes or changes in the latent managerial factors involved in error production. In addition, there was insubstantial evidence of IRSs enabling double-loop learning, that is, a cultural change or a change in mind-set.\u0000\u0000\u0000CONCLUSIONS\u0000The results indicate that IRSs could be more effective if the criteria for what counts as an incident were explicit, they were owned and ledby clinical teams rather than centralized hospital departments, and they were embedded within organizations as part of wider safety programs.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"32 1","pages":"826-66"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84034245","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":"David Sackett's Unintended Impacts on Health Policy.","authors":"J. Lavis, P. Tugwell","doi":"10.1111/1468-0009.12167","DOIUrl":"https://doi.org/10.1111/1468-0009.12167","url":null,"abstract":"David (Dave) Sackett’s death in May 2015 prompted much public reflection about his legacy for the practice of medicine, yet his legacy extends well beyond clinical practice to the fields of public health and health systems and the broad domain of health policy, including policies for clinical care (eg, listing prescription drugs on a public formulary), policies for public health (eg, mandating immunizations for toddlers), and policies for health systems (eg, setting the scope of practice for pharmacists). All these were topics that Dave never addressed directly, although many others did address them using approaches that he had pioneered or championed. Our focus here is on Dave’s legacy for health policy, which was, as far as either of us knows, both unintended and unappreciated by him. We cite 4 examples of how Dave’s contributions to the evidence-based medicine (EBM) movement1—which he would be the first to acknowledge that he made alongside many other giants in the field (a number of whom he trained and mentored)—cleared the path for what became the pursuit of evidence-informed health policymaking.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"4 1","pages":"867-70"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86539977","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":"Health Services Research, Medicare, and Medicaid: A Deep Bow and a Rechartered Agenda.","authors":"D. Berwick","doi":"10.1111/1468-0009.12154","DOIUrl":"https://doi.org/10.1111/1468-0009.12154","url":null,"abstract":"F rom their inception, Medicare and Medicaid have been shaped and guided by health services research (HSR) and its people. The linkages are numerous: ideas (like Diagnostic Related Groups, or DRGs, Resource-Based Relative Value Scale, or RBRVS, and Accountable Care Organizations, or ACOs), tools (like those from the RAND Health Insurance Experiment, the Medical Outcome Study, and the HCAHPS family), frameworks, and, of course, people who oscillated between academia and government, to the benefit of both. As administrator of the Centers for Medicare and Medicaid Services (CMS) from 2010 to 2011, I saw productive contributions of HSR to CMS policy, regulation, and operations every day. That is a track record to be proud of. But there are gaps, some big ones, and a rechartered agenda for HSR could help boost American health care to its next and needed levels of performance. The following are 10 suggested topics for HSR to focus on in the next decade, more understanding of which would help health care leaders, including CMS, to move more rapidly toward better care for individuals, better health for populations, and lower per capita cost through improvement: the “Triple Aim.”1,2","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"88 13 1","pages":"659-62"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84062483","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":"Last Call.","authors":"H. Markel","doi":"10.1111/1468-0009.12153","DOIUrl":"https://doi.org/10.1111/1468-0009.12153","url":null,"abstract":"T his past fall, I walked to my campus office filled with excitement and anticipation. September is, after all, the time of the year when college towns become alive again as the students return from their summer vacation and a new term approaches. Sadly, my professorial reverie ended abruptly upon crossing “Fraternity Row,” where I was forced to run the gauntlet of hundreds of fraternity and sorority kids bombed out of their skulls on alcohol, clogging the streets and sidewalks in a drunken and often-belligerent stupor. In Ann Arbor, as on many college campuses across the nation, the week before classes start has now become “Drinking Week.” If only this dangerous practice ended there. Unfortunately, many of my students admit to frequent episodes of drinking in a high-risk manner throughout the academic year. And as finals week approaches and ends this December, I have no doubt the partying will only escalate. What makes this scene so dangerous is that today’s kids drink far differently than their parents did, many who may have fond memories of college keggers and dorm room parties. Forty percent of all college students now “binge drink,” a practice defined as consuming 5 or more drinks in a row. Make no mistake, the goal of these bacchanalian exercises is not to feel buzzed; it is to get flat-out drunk and even black out.1,2 A little less than 5 months ago, in late July, at around 2 o’clock in the morning, a 21-year-old University of Michigan college junior met a young woman at a local bar. He had likely consumed more than 8 drinks over a relatively short time span, and she had had 2 glasses of champagne before going to the bar. Eventually they decided to go to his apartment. At some point on this journey, the couple decided to shimmy up the fire escape of an arcade building and walk across its glass rooftop. On the way back, one of the panes of glass gave way and the young man fell 3 stories to his death. Long before the results of the young man’s toxicology screen were announced, I would have bet my bottom dollar that alcohol (or some other","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"5 1","pages":"651-8"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82059195","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":"A Blueprint for Repair and Renovation of the ACA.","authors":"J. Cohn","doi":"10.1111/1468-0009.12156","DOIUrl":"https://doi.org/10.1111/1468-0009.12156","url":null,"abstract":"The Supreme Court’s decision in King v Burwell this past summer may turn out to be a watershed moment. The lawsuit, crafted by longtime opponents of the Affordable Care Act (ACA), challenged the federal government’s authority to offer health insurance subsidies in roughly two-thirds of the states. A decision for the plaintiffs would have crippled the law’s new private insurance marketplaces in those states, forcing millions of people to lose coverage. But the Court rejected the lawsuit, with 2 Republican appointees joining the 4-member Democratic minority.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"37 1","pages":"667-70"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79360511","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":"Walking the Line: Navigating Market and Gift Economies of Care in a Consumer-Directed Home-Based Care Program for Older Adults.","authors":"Jacqueline M. Torres, K. Kietzman, S. Wallace","doi":"10.1111/1468-0009.12163","DOIUrl":"https://doi.org/10.1111/1468-0009.12163","url":null,"abstract":"CONTEXT\u0000Paid caregivers of low-income older adults navigate their role at what Hochschild calls the \"market frontier\": the fuzzy line between the \"world of the market,\" in which services are exchanged for monetary compensation, and the \"world of the gift,\" in which caregiving is uncompensated and motivated by emotional attachment. We examine how political and economic forces, including the reduction of long-term services and supports, shape the practice of \"walking the line\" among caregivers of older adults.\u0000\u0000\u0000METHODS\u0000We used data from a longitudinal qualitative study with related and nonrelated caregivers (n = 33) paid through California's In-Home Supportive Services (IHSS) program and consumers of IHSS care (n = 49). We analyzed the semistructured interviews (n = 330), completed between 2010 and 2014, using a constructivist grounded theory approach.\u0000\u0000\u0000FINDINGS\u0000Related and nonrelated caregivers are often expected to \"gift\" hours of care above and beyond what is compensated by formal services. Cuts in formal services and lapses in pay push caregivers to further \"walk the line\" between market and gift economies of care. Both related and nonrelated caregivers who choose to stay on and provide more care without pay often face adverse economic and health consequences. Some, including related caregivers, opt out of caregiving altogether. While some consumers expect that caregivers would be willing to \"walk the line\" in order to meet their needs, most expressed sympathy for them and tried to alter their schedules or go without care in order to limit the caregivers' burden.\u0000\u0000\u0000CONCLUSIONS\u0000Given economic and health constraints, caregivers cannot always compensate for cuts in formal supports by providing uncompensated time and resources. Similarly, low-income older adults are not competitive in the caregiving marketplace and, given the inadequacy of compensated hours, often depend on unpaid care. Policies that restrict formal long-term services and supports thus leave the needs of both caregivers and consumers unmet.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"12 1","pages":"732-60"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81806034","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 Importance of Physicians' Financial Disclosure for the Public's Health.","authors":"C. Deangelis","doi":"10.1111/1468-0009.12159","DOIUrl":"https://doi.org/10.1111/1468-0009.12159","url":null,"abstract":"You might ask why it is important for the public’s health that physicians and other authors disclose their financial relationships with pharmaceutical and medical device companies when they publish in biomedical, health science, and policy journals. And why is it important that the public have access to payments made to physicians by pharmaceutical and medical device companies? The short answer is that while there is no ironclad guarantee, these critical disclosures help ensure that the authors whose articles are published in peer-reviewed journals are open and honest about the funders, connections, institutions or companies, and associations related to their studies. Equally important, these disclosures give some assurance that the prescribed medications, therapies, or devices recommended in these articles provide the best options for patients and, hence, the public’s health.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"41 1","pages":"679-82"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87008671","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":"Do March-In Rights Ensure Access to Medical Products Arising From Federally Funded Research? A Qualitative Study.","authors":"Carolyn L. Treasure, J. Avorn, A. Kesselheim","doi":"10.1111/1468-0009.12164","DOIUrl":"https://doi.org/10.1111/1468-0009.12164","url":null,"abstract":"CONTEXT\u0000The high cost of new prescription drugs and other medical products is a growing health policy issue. Many of the most transformative drugs and vaccines had their origins in public-sector funding to nonprofit research institutions. Although the Bayh-Dole Act of 1980 provides for \"march-in rights\" through which the government can invoke some degree of control over the patents protecting products developed from public funding to ensure public access to these medications, the applicability of this provision to current policy options is not clear.\u0000\u0000\u0000METHODS\u0000We conducted a primary-source document review of the Bayh-Dole Act's legislative history as well as of hearings of past march-in rights petitions to the National Institutes of Health (NIH). We then conducted semistructured interviews of 12 key experts in the march-in rights of the Bayh-Dole Act to identify the sources of the disputes and the main themes in the statute's implementation. We analyzed the interview transcripts using standard qualitative techniques.\u0000\u0000\u0000FINDINGS\u0000Since 1980, the NIH has fully reviewed only 5 petitions to invoke governmental march-in rights for 4 health-related technologies or medical products developed from federally funded research. Three of these requests related to reducing the high prices of brand-name drugs, one related to relieving a drug shortage, and one related to a potentially patent-infringing medical device. In each of these cases, the NIH rejected the requests. Interviewees were split on the implications of these experiences, finding the NIH's reluctance to implement its march-in rights to be evidence of either a system working as intended or of a flawed system needing reform.\u0000\u0000\u0000CONCLUSIONS\u0000The Bayh-Dole Act's march-in rights continue to be invoked by policymakers and health advocates, most recently in the context of new,high-cost products originally discovered with federally funded research. We found that the existence of march-in rights may select for government research licensees more likely to commercialize the results and that they can be used to extract minor concessions from licensees. But as currently specified in the statute, such march-in rights are unlikely to serve as a counterweight to lower the prices of medical products arising from federally funded research.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"150 1","pages":"761-87"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86661137","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":"An empirical study of the relationships of Catholic practice and occupational mobility to fertility.","authors":"H. Brooks, F. Henry","doi":"10.2307/3348555","DOIUrl":"https://doi.org/10.2307/3348555","url":null,"abstract":"MPIRICAL research in differential fertility as in other areas operates with two general types of independent variables: hypotheses variables and control variables. Interest is focused on the relationship of the hypothesis variable and the dependent variable, but a careful testing of the hypothesis demands that the influence of other relevant factors, the control variables, be eliminated or held constant. These variables have their origin in deductive theory and/or in empirical fact. Deductive theory usually contributes more heavily to hypotheses variables; empirical generalizations to control variables. Accordingly, this section presents a brief review of some of the literature on differential fertility as a source of control variables. Four topics are considered: the Catholic-non-Catholic fertility differential within the United States, the declining importance of this differential, fertility differentials within the Catholic population, and finally, fertility differentials within the general American population. The Catholic-non-Catholic Differential. In an early correlational analysis of the relationship of religion and fertility, Hornell Hart concluded from a study in Iowa that the \"tendency for married Catholics to have more children than married non-Catholics is offset by the fact that Catholics in Iowa","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"36 3 1","pages":"222-81"},"PeriodicalIF":0.0,"publicationDate":"2013-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2307/3348555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68555874","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}