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PubMedDate not supplied

Performance indicators for assessing competencies of preventive medicine residents.

Heightened national interest in population-based medicine, clinical preventive services, and health care management underscores the current need for definition and assessment of physician competency in these areas. This article describes a project sponsored by the Health Resources and Services Administration (HRSA) to develop competencies for each of the three specialty areas in preventive medicine and appropriate measures for the achievement of those competencies. We discuss fundamental issues surrounding assessment that helped guide the process, types of measurement strategies, and criteria for effective competencies and performance indicators. The article also explains the Work Group process used to reach consensus and identifies concerns and challenges raised during this process. We include the list of specialty competencies and performance indicators developed by the project. The project, entitled "Improving Training of Preventive Medicine Residents through the Development and Evaluation of Competencies," served as a model for interorganizational collaboration between the federal government (HRSA); a specialty society, the American College of Preventive Medicine (ACPM); and a preventive medicine residency program, State University of New York (SUNY) at Stony Brook. The commonality of competencies expected of residents in all three specialty areas of preventive medicine--occupational medicine, general preventive medicine and public health, and aerospace medicine--reaffirmed the rationale for including all of these areas within the single specialty of preventive medicine.

Aerospace Medicine↗
PubMed2001

Premium subsidies for employer-sponsored health coverage: an emerging state and local strategy to reach the uninsured.

With nearly 75 percent of the uninsured living in households with at least one full-time worker, there has been renewed policy interest in strategies to expand coverage by subsidizing employer-sponsored insurance. Six of the 12 nationally representative communities that the Center for Studying Health System Change (HSC) tracks have premium assistance, or subsidy, programs planned or underway. Policy makers are enthusiastic about the potential to expand coverage through these programs, but enrollment has been modest to date. This Issue Brief examines operational challenges facing subsidy programs, such as how to structure a benefits package within budgetary and regulatory constraints and how to attract employers and employees without displacing existing private contributions to premiums. It also discusses the trade-offs policy makers may face to resolve these challenges in the context of rising premiums and a slowing economy.

Financing, Government↗
PubMed2003

The changing environment of graduate and postdoctoral training in drug metabolism: viewpoints from academia, industry, and government.

This article is an invited report of a symposium sponsored by the Drug Metabolism Division of the American Society for Pharmacology and Experimental Therapeutics held at Experimental Biology 2002 in New Orleans. The impetus for the symposium was a perceived shortage in the supply of graduate students qualified for drug metabolism research positions in industry, academia, and government. For industry, recent hiring stems largely from the expansion of drug metabolism departments in an effort to keep pace with the demands of drug discovery and new technologies. In turn, regulatory scientists are needed to review and verify the results of the increased number and volume of studies required for drug development and approval. Thus the initial source of training, academia, has been forced to recognize these external hiring pressures while trying to attract and retain the faculty, postdoctoral scientists, and students necessary for active teaching and research programs. The trend of the expansion of the interdisciplinary nature of traditional drug metabolism to include emerging technologies such as pharmacogenetics, transporters, and proteomics and the implications for future needs in training and funding were acknowledged. There was also consensus on the value of partnerships between academia and industry for increasing student interest and providing training in disciplines directly applicable to industrial drug metabolism research. Factors affecting the sources of these trainees, such as federal funding, the number of trainees per institution, and recent issues with immigration restrictions that have limited the flow of scientists were also discussed.

Education, Graduate↗
PubMed1998

Infertility treatment: lack of consensus plagues an unregulated field.

Each year, in an attempt to stimulate journalism students' interest in medical writing, CMAJ sponsors the Amy Chouinard Memorial Essay Prize. The $750 award is in memory of Amy Chouinard, a longtime and valued contributor to CMAJ and the Canadian Journal of Surgery. Students from any recognized journalism program at a Canadian college or university are eligible to enter, and the deadline for 1998 entries is June 1. The 1997 winner, Megan Easton, presents a well-written and thorough account of the issues surrounding infertility treatment. Interest in the topic came naturally enough--her father, Dr. William Easton, is a urogynecologist in private practice in Scarborough, Ont.

Biomedical Research↗
PubMed2006

Government reform of the National Health Service: implications for radiologists and diagnostic services.

Demand for radiology services within the National Health Service (NHS) continues unabated and current NHS operations cannot keep up with demand. Therefore, to meet this demand, the government has decided to outsource a significant number of investigations to the independent sector and will actively promote patient referrals to the new government sponsored Treatment Centres as they become available. This presents opportunities to patients, but threatens existing public sector providers (including doctors) as competition for radiology services may result in both loss of patient referrals and revenue to these providers. This article is a personal opinion and will focus on the current challenges facing the provision of radiology services in the NHS. I will suggest the possible negative outcomes for providers (NHS hospitals and staff alike) and will offer strategies, tactics and tools that can be employed to counter the threat to their existing services.

Diagnostic Services↗
PubMed2005

The Community Physicians' Network (CPN): an academic-community partnership to eliminate healthcare disparities.

INTRODUCTION: Disparities in health care are maintained by three primary factors: 1) patient factors which include multiple risk factors and comorbidities; 2) healthcare practitioner factors comprising inconsistent application of practice guidelines due to a limited database of clinical trials of effective therapies in African Americans and other underrepresented minorities; and 3) barriers in the healthcare delivery system resulting in poor access to care. The Morehouse School of Medicine Community Physicians' Network (CPN) was established to address disparities in health care by focusing on provider-specific strategies. OBJECTIVES: To: 1) use disease-specific registries to identify treatment gaps and facilitate quality improvement processes among CPN practices; 2) develop practice-specific and guideline-based educational messages to promote quality care; 3) engage and train CPN-physicians for participation in approved NIH, other government, and industry-supported clinical protocols; and 4) develop a data repository of all CPN-sponsored clinical trials that include significant numbers of African Americans and other underrepresented minorities. METHODS: The disease-specific outpatient registries will have the following features: 1) data structures and data elements will use standard database codes and a data dictionary; 2) HIPPA-compliant data abstraction and data transfer tool; 3) baseline chart review to establish practice patterns and provide practice-specific feedback; 4) annual update of registry; 5) data registry and repository maintained on Morehouse School of Medicine's secure servers; 6) registry publications will include only aggregate data, without identification of contributing practices; 7) an electronic medical records platform will be encouraged as the ultimate data management tool for CPN practices. In addition, up to three continuing medical education (CME) programs each year will feature national speakers and promote evidence-based practice guidelines. RESULTS: Eighty-five primary care and subspecialty practices are actively enrolled in CPN with a total of 385,000 annual outpatient visits. The makeup of insurance status is: HMO/PPO (45%); Medicare only (19%); Medicare HMO (11%); Medicare plus (8%); Medicaid (6%); Uninsured (11%). CONCLUSIONS: The Community Physicians' Network will address specific gaps in the health care of African-American and other minority patients by promoting quality care among its members and by facilitating participation in approved clinical trial protocols. The unique academic community partnership is consistent with the NIH roadmap goal of eliminating healthcare disparities.

Black or African American↗
PubMedDate not supplied

Design and implementation issues in Swedish individual pension accounts.

Sweden's new multipillar pension system includes a system of mandatory fully funded individual accounts. The Swedish system offers contributors more than 600 fund options from a variety of private-sector fund managers. However, in the most recent rounds of fund choice, more than 90 percent of new labor market entrants have not made an active choice of funds and thus have ended up in a government-sponsored default fund. The Swedish system offers a number of lessons about implementing a mandatory individual account tier. Centralized administration keeps administrative costs down but requires considerable lead time. A very large number of fund options are likely to be offered unless strong entry barriers are in place. Engaging new labor market entrants in fund choice is likely to be difficult. A significant percentage of those making an active fund choice may choose funds that are very specialized and risky. Finally, special care must be devoted to designing a default fund and continual consumer communication.

Choice Behavior↗
PubMed1993

Prostate cancer: screening, diagnosis, and management.

OBJECTIVE: To provide physicians with a review of diagnosis, screening, staging evaluation, treatment options, prognosis, psychosocial issues, economic considerations, and future research directions in the management of patients with all stages of prostate cancer. DATA SOURCES: A MEDLINE search of articles relating to the diagnosis, staging, screening, surgery, radiation therapy, medical management, and research in prostate cancer. Emphasis on information reported from government- and nongovernment-sponsored large cooperative trials, consensus development conferences, and proceedings of prostate cancer organ site workshops. STUDY SELECTION: Results of randomized treatment trials and consensus summary statements are reported where long-term results (> 5 years follow-up) are available for localized prostate cancer treatment and where survival outcomes are available for metastatic disease treatment. DATA SYNTHESIS: Both qualitative and quantitative data are reported. Information on staging, management, and prognosis of localized prostate cancer is based on studies that are predominantly nonrandomized, include heterogeneous patient groups, and often use differing outcome measures. Information on management of metastatic prostate cancer is more quantitative and includes side effects of treatment and survival results obtained from randomized, prospective, multi-institutional studies. CONCLUSIONS: Despite the increase in prostate cancer incidence and detection, substantial controversy still exists about the advisability and effectiveness of screening programs, the most appropriate staging evaluation, and the optimal management of patients with all stages of prostate cancer. Although randomized, prospective studies attempt to address some of these issues, physicians must appreciate inherent ambiguities involved in recommending staging and treatment choices.

Humans↗
PubMedDate not supplied

Risk sharing between competing health plans and sponsors.

In many countries, competing health plans receive capitation payments from a sponsor, whether government or a private employer. All capitation payment methods are far from perfect and have raised concerns about risk selection. Paying health plans partly on the basis of capitation and partly on the basis of actual costs ("risk sharing") reduces plans' incentives for selection but sacrifices some incentives for efficiency. This paper summarizes our empirical research on Dutch health plans with respect to various forms of risk sharing. All sponsors can improve their payment systems by either implementing or changing their form of risk sharing.

Capitation Fee↗
PubMed2005

Harnessing genomics to improve health in the Eastern Mediterranean Region - an executive course in genomics policy.

BACKGROUND: While innovations in medicine, science and technology have resulted in improved health and quality of life for many people, the benefits of modern medicine continue to elude millions of people in many parts of the world. To assess the potential of genomics to address health needs in EMR, the World Health Organization's Eastern Mediterranean Regional Office and the University of Toronto Joint Centre for Bioethics jointly organized a Genomics and Public Health Policy Executive Course, held September 20th-23rd, 2003, in Muscat, Oman. The 4-day course was sponsored by WHO-EMRO with additional support from the Canadian Program in Genomics and Global Health. The overall objective of the course was to collectively explore how to best harness genomics to improve health in the region. This article presents the course findings and recommendations for genomics policy in EMR. METHODS: The course brought together senior representatives from academia, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics covered included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. RESULTS: A set of recommendations, summarized below, was formulated for the Regional Office, the Member States and for individuals.* Advocacy for genomics and biotechnology for political leadership;* Networking between member states to share information, expertise, training, and regional cooperation in biotechnology; coordination of national surveys for assessment of health biotechnology innovation systems, science capacity, government policies, legislation and regulations, intellectual property policies, private sector activity;* Creation in each member country of an effective National Body on genomics, biotechnology and health to:- formulate national biotechnology strategies- raise biotechnology awareness- encourage teaching and training of biotechnology- devise integration of biotechnology within national health systems. CONCLUSION: The recommendations provide the basis for a road map for EMR to take steps to harness biotechnology for better and more equitable health. As a result of these recommendations, health ministers from the region, at the 50th Regional Committee Meeting held in October 2003, have urged Member States to establish national bodies of biotechnology to formulate a strategic vision for developing biotechnology in the service of the region's health. These efforts promise to raise the profile of genomics in EMR and increase regional cooperation in this exciting new field.

Editorial↗
PubMed2002

Working families' health insurance coverage, 1997-2001.

Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.

Adult↗
PubMed1998

Eradication, control or neither? Hookworm vs malaria strategies and Rockefeller Public Health in Mexico.

Malaria's epidemiological importance in Mexico greatly exceeded that of hookworm, but the Rockefeller Foundation (RF) paid far more attention to hookworm. Although the RF collaborated with malaria campaigns around the world, malaria was only incidental to the RF's activities in Mexico. The hookworm campaign, on the other hand, involved the RF at every stage, from conceptualization and design to financing, hiring, and day-to-day administration. This paper seeks to understand why the RF's involvement in Mexico differed for the two diseases and what the organizational, political, and health implications were for these divergent approaches. Beginning in the mid 1920s the Mexican government developed a modest anti-larval service, periodically draining and filling ditches and swamps, dusting Paris green, petrolizing stagnant water, and administering quinine. Following the RF's 1927 shift towards scientific investigation, it began to sponsor small-scale malaria research, collecting climatological, entomological, epidemiological, and clinical information. The Mexican government eagerly petitioned the RF to join a national effort, but it was reluctant to become involved. A National Malaria Campaign was established in 1935 under President Lázaro Cárdenas to coordinate education, sanitary engineering, and treatment. The popular Campaign followed RF strategies even without its direct participation. Meanwhile, the RF avidly pursued modest malaria research in Mexico, funding U.S. investigators to conduct experiments on pesticides, mosquito-trapping, and controversially, watering methods for rice. These efforts culminated in the world's first field trial of DDT against louse-borne typhus and later as a residual spray for malaria. In the end the RF used Mexico as a convenient locale for scientific research that had global implications but only an incidental relationship to Mexico's own Malaria Campaign. Likewise, the RF's much more active hookworm program was more a means than an end, leading not to eradication of the disease, but to Mexico's commitment to modern public health organization and methods.

Animals↗
PubMed2003

Rekindling reform: principles and goals.

Members of the Rekindling Reform Steering Committee collaborated over a period of several months in early 2002 to develop a set of principles and goals to help guide and define the group's efforts for comprehensive health care reform in the United States. The next step is to circulate this document to the sponsoring organizations for their approval. This document is, then, a work in progress, subject to revision as the process of discussion and review continues. These principles provide a sense of the lessons members of the Rekindling Reform Steering Committee have learned from their study of other countries' universal health care systems, and how those lessons have informed their thinking about the nature of the health care reform needed in United States.

Benchmarking↗
PubMed2005

Managed care and long-term care: a potential solution?

This brief summarizes research by Sparer (2003) and Hughes (2002) on managed care issues for people with long-term care needs. Managed care has been proposed as a solution to the difficult problem of managing the health of this complex population. Sparer's research examines the reasons behind the failure of states' attempts to encourage commercial managed care plans to take on this task. He argues that understanding these reasons can yield important lessons for the mostly provider-sponsored plans that currently serve the long-term care population, as well as for states, that aim to save money and better serve this population. Hughes' evaluation of a small, provider-sponsored organization found that when the organization became a managed care provider, it faced significant organizational challenges that forced it to become more efficient. Importantly, it showed that the use of capitation reimbursed the plan more effectively than fee for service, increased the range of services provided to clients, and maintained client satisfaction; however, capitation did not affect the rate of nursing home admission.

Capitation Fee↗
PubMed2000

NCI cooperative research and development agreements.

The Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) currently sponsors more than 160 Investigational New Drug applications (INDs), and is involved in approximately 1,600 active protocols. It is also currently involved in more than 50 collaborative agreements with pharmaceutical companies. These agreements consist of cooperative research and development agreements (CRADAs) and clinical trials agreements (CTAs). A CRADA is a detailed contract between the NCI and a pharmaceutical company for the clinical co-development of an investigational agent, and may include preclinical development that stipulates terms for a broader scope of research than that covered by a CTA. The CTEP/Investigational Drug Branch is currently involved in a number of oxaliplatin (Eloxatin) protocols under the CRADA program.

Clinical Protocols↗
PubMed2001

Employer health insurance premium subsidies unlikely to enhance coverage significantly.

State and local efforts to reduce the number of uninsured workers include three major approaches: public insurance expansions, subsidies paid directly to low income workers to help pay their share of employer-sponsored insurance premiums or buy individual insurance and subsidies paid directly to small employers to reduce the cost of health insurance premiums. Based on a national study by the Center for Studying Health System Change (HSC), premium subsidies paid directly to small firms are unlikely to significantly reduce the number of uninsured. About 16 million people work in firms with fewer than 50 workers that do not offer health insurance. A hypothetical 30 percent premium subsidy targeted to the employers of these workers--slightly more generous than the average in existing small firm subsidy programs across the country--would extend coverage to only about half a million uninsured workers if implemented nationally.

Financing, Government↗
PubMed1976

Status of marine biomedical research.

A meeting on Marine Biomedical Research, sponsored by the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health and the Smithsonian Institution Museum of Natural History, was attended by approximately 125 scientists, directors and representatives from many of the country's marine biological laboratories, and government agencies whose interests and responsibilites are in the marine biology and health areas. The purpose of the meeting was to explore the undeveloped research opportunities in the area of marine biology for the advancement of our understanding of human health problems and to provide information on the current status of marine biology laboratories. The meeting was devoted to presentations and discussions in four general areas: (1)Marine Species as Models for Human Disease; (2)Environmental Carcinogenesis and Mutagenesis; (3)Human Health and the Marine Environment--infectious agents and naturally occurring and foreign toxins; and (4)Drugs from the seas. Representatives from twelve of the country's approximatley 40 marine laboratories discussed their organization, developmental history, scientific programs, facilities, and present status of their support. The presentations served as a background and stimulated very lively analytical and constructive discussions of the undeveloped research and education potential residing in the marine environment and biological laboratories for a better understanding of many human health problems; some scientific areas that should be developed to realize this potential; and the needs and problems of marine laboratories that require attention and support if they are to survive and realize their possibilities.

Animals↗
PubMed1983

U.S. National Bureau of Standards/Atomic Industrial Forum radioactivity measurements assurance program.

With the above exceptions, the participants as a whole have done very well during the past 8 years and their measurements should continue to show improvement. Since mid-1981, the agreement between AIF and NBS has been modified to recover the cost of an SRM production program over the next two or three years in order for the program to eventually become self-supporting. This will benefit not only the current sponsors of the program, but also hospitals and other users of NBS radiopharmaceutical SRMs by having these standards available to the public on a regular continuing basis. The participants in this program have derived many benefits since its inception in 1975. Through the measurement of blind samples which demonstrate traceability to NBS, the companies have made it easier to comply with some of the regulatory requirements of the FDA and NRC when applying for new drug applications. They also receive monthly feedback on their measurement procedures so that they can promptly determine if their measurement procedures or instruments have gone awry. If the results are satisfactory, they receive reassurance and confidence that they are making good measurements and providing accurately dispensed products.

Government Agencies↗