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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting For Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods is the third in a series of five brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report builds on the conceptual relationships and empirical associations between social risk factors and performance indicators used in value-based payment identified in the first report to provide guidance on which factors could be considered for Medicare accounting purposes, criteria to identify these factors, and methods to do so in ways that can improve care and promote greater health equity for socially at-risk patients.
Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors is the first in a series of five reports commissioned to provide input into whether socioeconomic status (SES) and other social risk factors could be accounted for in Medicare payment and quality programs. This report focuses on defining SES and other social factors for the purposes of application to Medicare quality measurement and payment programs.
More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death--and 2.5 times the national rate--for Native youth ages 15 to 24. Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012, by the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. This report summarizes the presentations and discussions from the workshop.
Advancing the Discipline of Regulatory Science for Medical Product Development: An Update on Progress and a Forward-Looking Agenda: Workshop Summaryby Engineering Medicine National Academies of Sciences
The field of endeavors known as "regulatory science" has grown out of the need to link and integrate knowledge within and among basic science research, clinical research, clinical medicine, and other specific scientific disciplines whose focus, aggregation, and ultimate implementation could inform biomedical product development and regulatory decision making. Substantial efforts have been devoted to defining regulatory science and communicating its value and role across the scientific and regulatory ecosystems. Investments are also being made in technology infrastructure, regulatory systems, and workforce development to support and advance this burgeoning discipline. In October 2015, the National Academies of Sciences, Engineering, and Medicine held a public workshop to facilitate dialogue among stakeholders about the current state and scope of regulatory science, opportunities to address barriers to the discipline's success, and avenues for fostering collaboration across sectors. Participants explored key needs for strengthening the discipline of regulatory science, including considering what are the core components of regulatory science infrastructure to foster innovation in medical product development. This report summarizes the presentations and discussions from the workshop.
Although it is becoming increasingly more common for clinicians to use genomic data in their practices for disease prevention, diagnosis, and treatment, the process of integrating genomic data into the practice of medicine has been a slow and challenging one. Some of the major barriers impeding the incorporation of new genomic technology into clinical practice are: the difficulty of changing routine medical practices to account for the use of genetic testing, the limited knowledge of patients and providers about genomic medicine, assessing sufficient evidence to support the use of genetic tests, privacy and data security issues, and uncertainty about reimbursement. The field of implementation science may be able to provide insights concerning efficient ways to incorporate genomic applications into routine clinical practice. The focus of implementation science studies is to identify integration bottlenecks and optimal approaches for a given setting and ultimately to promote the up-take of research findings. To explore the potential of implementation science to improve the integration of genomics into medicine, the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, in November 2015. Participants explored the challenges and opportunities of integrating genomic advances into the clinic through the lens of implementation science. This report summarizes the presentations and discussions from the workshop.
Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries: Workshop Summaryby Engineering Medicine National Academies of Sciences
Universal health coverage (UHC) has been recognized by the World Health Organization as a key element in reducing social inequality and a critical component of sustainable development and poverty reduction. In most of the world UHC is sought through a combination of public and private-sector health care systems. In most low- and middle-income countries health systems are evolving to increasingly rely on the private sector because the public sector lacks the infrastructure and staff to meet all health care needs. With growing individual assets available for private-sector expenditure, patients often seek better access to technology, staff, and medicines. However, in low-income countries nearly 50 percent of health care financing is out-of-pocket. With the expected increase in the overall fraction of care provided through the private sector, these expenditures can be financially catastrophic for individuals in the informal workforce. In the global workforce of approximately 3 billion people, only 10 to 15 percent are estimated to have some type of access to occupational health services. The informal workforce is growing worldwide, and the degree to which its occupational health needs are satisfied depends on the capabilities of the general health care system. In July 2014, the Institute of Medicine held a workshop on approaches to universal health coverage and occupational health and safety for informal sector workers in developing countries. This report summarizes the presentations and discussions from this workshop. Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries identifies best practices and lessons learned for the informal workforce in developing countries in the financing of health care with respect to health care delivery models that are especially suitable to meeting a population's needs for a variety of occupational health issues, including the prevention of or mitigation of hazardous risks and the costs of providing medical and rehabilitation services and other benefits to various types of workers within this population. These experiences and lessons learned may be useful for stakeholders in moving the discussions, policies, and mechanisms forward to increase equitable access to quality health services without financial hardship for the informal workforce.
Arthur M. Sackler COLLOQUIA OF THE NATIONAL ACADEMY OF SCIENCES: Self-Organized Complexity in the Physical, Biological, and Social Sciencesby Engineering National Academies of Sciences
The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. <P><P>Our books are unique in that they are authored by the nation's leading experts in every scientific field.
An Assessment of the National Science Foundation's Science and Technology Centers Program
Barriers and Opportunities for 2-Year and 4-Year STEM Degrees: Systemic Change to Support Students’ Diverse Pathwaysby Engineering Medicine National Academies of Sciences
Nearly 40 percent of the students entering 2- and 4-year postsecondary institutions indicated their intention to major in science, technology, engineering, and mathematics (STEM) in 2012. But the barriers to students realizing their ambitions are reflected in the fact that about half of those with the intention to earn a STEM bachelor's degree and more than two-thirds intending to earn a STEM associate's degree fail to earn these degrees 4 to 6 years after their initial enrollment. Many of those who do obtain a degree take longer than the advertised length of the programs, thus raising the cost of their education. Are the STEM educational pathways any less efficient than for other fields of study? How might the losses be "stemmed" and greater efficiencies realized? These questions and others are at the heart of this study. Barriers and Opportunities for 2-Year and 4-Year STEM Degrees reviews research on the roles that people, processes, and institutions play in 2-and 4-year STEM degree production. This study pays special attention to the factors that influence students' decisions to enter, stay in, or leave STEM majors--quality of instruction, grading policies, course sequences, undergraduate learning environments, student supports, co-curricular activities, students' general academic preparedness and competence in science, family background, and governmental and institutional policies that affect STEM educational pathways. Because many students do not take the traditional 4-year path to a STEM undergraduate degree, Barriers and Opportunities describes several other common pathways and also reviews what happens to those who do not complete the journey to a degree. This book describes the major changes in student demographics; how students, view, value, and utilize programs of higher education; and how institutions can adapt to support successful student outcomes. In doing so, Barriers and Opportunities questions whether definitions and characteristics of what constitutes success in STEM should change. As this book explores these issues, it identifies where further research is needed to build a system that works for all students who aspire to STEM degrees. The conclusions of this report lay out the steps that faculty, STEM departments, colleges and universities, professional societies, and others can take to improve STEM education for all students interested in a STEM degree.
Biological, Social, And Organizational Components Of Success: For Women In Academic Science And Engineeringby Engineering Committee on Maximizing the Potential of Women in Academic Science
During the last 40 years, the number of women studying science and engineering (S&E) has increased dramatically. Nevertheless, women do not hold academic faculty positions in numbers that commensurate with their increasing share of the S&E talent pool. The discrepancy exists at both the junior and senior faculty levels. In December 2005, the National Research Council held a workshop to explore these issues. Experts in a number of disciplines met to address what sex-differences research tells us about capability, behavior, career decisions, and achievement; the role of organizational structures and institutional policy; cross-cutting issues of race and ethnicity; key research needs and experimental paradigms and tools; and the ramifications of their research for policy, particularly for evaluating current and potential academic faculty. Biological, Social, and Organizational Components of Success for Women in Academic Science and Engineering consists of three elements: an introduction, summaries of panel discussions including public comment sessions, and poster abstracts.
Although the United States is currently capitalizing on its investment in science and technology effectively, there remains much room for improvement. This volume identifies the ingredients for success in capitalizing on such investments to produce national benefits, assesses current U.S. performance, and identifies future challenges. The book cites specific examples and examines several cross-cutting issues. It explores the possibility that the national research portfolio is losing diversity as a result of less long-term research in critical fields such as networking and materials. It also examines the implications of imbalances in the supply of and demand for science and engineering talent in emerging interdisciplinary fields such as bioinformatics.
As science and technology advance, the needs of employers change, and these changes continually reshape the job market for scientists and engineers. Such shifts present challenges for students as they struggle to make well-informed education and career choices. Careers in Science and Engineering offers guidance to students on planning careers--particularly careers in nonacademic settings--and acquiring the education necessary to attain career goals. This booklet is designed for graduate science and engineering students currently in or soon to graduate from a university, as well as undergraduates in their third or fourth year of study who are deciding whether or not to pursue graduate education. The content has been reviewed by a number of student focus groups and an advisory committee that included students and representatives of several disciplinary societies. Careers in Science and Engineering offers advice on not only surviving but also enjoying a science- or engineering-related education and career-- how to find out about possible careers to pursue, choose a graduate school, select a research project, work with advisers, balance breadth against specialization, obtain funding, evaluate postdoctoral appointments, build skills, and more. Throughout, Careers in Science and Engineering lists resources and suggests people to interview in order to gather the information and insights needed to make good education and career choices. The booklet also offers profiles of science and engineering professionals in a variety of careers. Careers in Science and Engineering will be important to undergraduate and graduate students who have decided to pursue a career in science and engineering or related areas. It will also be of interest to faculty, counselors, and education administrators.
One major goal of post-genomic biology is to understand the function of genes. Many gene functions are comprehensible only within the context of chemical communication, and this symposium seeks to highlight emerging research on genomics and chemical communication and catalyze further development of this highly productive interface. Many of the most abundantly represented genes in the genomes characterized to date encode proteins mediating interactions among organisms, including odorant receptors and binding proteins, enzymes involved in biosynthesis of pheromones and toxins, and enzymes catalyzing the detoxification of defense compounds. Determining the molecular underpinnings of the component elements of chemical communication systems in all of their forms has the potential to explain a vast array of ecological, physiological, and evolutionary phenomena; by the same token, ecologists who elucidate the environmental challenges faced by the organisms are uniquely well-equipped to characterize natural ligands for receptors and substrates for enzymes. Thus, partnerships between genome biologists and chemical ecologists will likely be extremely synergistic. To date, these groups have rarely had opportunities to interact within a single forum. Such interactions are vital given the considerable practical benefits potentially stemming from these studies, including the development of biorational products for agricultural and forest pest management, for disease treatment, and for improving the quality of ecosystem health.
Effects of the Deletion of Chemical Agent Washout on Operations at the Blue Grass Chemical Agent Destruction Pilot Plantby Engineering Medicine National Academies of Sciences
The United States manufactured significant quantities of chemical weapons during the Cold War and the years prior. Because the chemical weapons are aging, storage constitutes an ongoing risk to the facility workforces and to the communities nearby. In addition, the Chemical Weapons Convention treaty stipulates that the chemical weapons be destroyed. The United States has destroyed approximately 90 percent of the chemical weapons stockpile located at seven sites. As part of the effort to destroy its remaining stockpile, the Department of Defense is building the Blue Grass Chemical Agent Destruction Pilot Plant (BGCAPP) on the Blue Grass Army Depot (BGAD), near Richmond, Kentucky. The stockpile stored at BGAD consists of rockets and projectiles containing the nerve agents GB and VX and the blister agent mustard. Continued storage poses a risk to the BGAD workforce and the surrounding community because these munitions are several decades old and are developing leaks. Due to public opposition to the use of incineration to destroy the BGAD stockpile, Congress mandated that non- incineration technologies be identified for use at BGCAPP. As a result, the original BGCAPP design called for munitions to be drained of agent and then for the munition bodies to be washed out using high-pressure hot water. However as part of a larger package of modifications called Engineering Change Proposal 87 (ECP-87), the munition washout step was eliminated. Effects of the Deletion of Chemical Agent Washout on Operations at the Blue Grass Chemical Agent Destruction Pilot Plant examines the impacts of this design change on operations at BGCAPP and makes recommendations to guide future decision making.
Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.
Evaluating And Improving Undergraduate Teaching: In Science, Technology, Engineering, And Mathematicsby Technology Engineering Committee on Recognizing Evaluating Rewarding Developing Excellence in Teaching of Undergraduate Science Mathematics
Economic, academic, and social forces are causing undergraduate schools to start a fresh examination of teaching effectiveness. Administrators face the complex task of developing equitable, predictable ways to evaluate, encourage, and reward good teaching in science, math, engineering, and technology.Evaluating, and Improving Undergraduate Teaching in Science, Technology, Engineering, and Mathematics offers a vision for systematic evaluation of teaching practices and academic programs, with recommendations to the various stakeholders in higher education about how to achieve change.What is good undergraduate teaching? This book discusses how to evaluate undergraduate teaching of science, mathematics, engineering, and technology and what characterizes effective teaching in these fields.Why has it been difficult for colleges and universities to address the question of teaching effectiveness? The committee explores the implications of differences between the research and teaching cultures-and how practices in rewarding researchers could be transferred to the teaching enterprise.How should administrators approach the evaluation of individual faculty members? And how should evaluation results be used? The committee discusses methodologies, offers practical guidelines, and points out pitfalls.Evaluating, and Improving Undergraduate Teaching in Science, Technology, Engineering, and Mathematics provides a blueprint for institutions ready to build effective evaluation programs for teaching in science fields.
Although women have made important inroads in science and engineering since the early 1970s, their progress in these fields has stalled over the past several years. This study looks at women in science and engineering careers in the 1970s and 1980s, documenting differences in career outcomes between men and women and between women of different races and ethnic backgrounds.The panel presents what is known about the following questions and explores their policy implications: In what sectors are female Ph.D.s employed? What salary disparities exist between men and women in these fields? How is marital status associated with career attainment? Does it help a career to have a postdoctoral appointment? How well are female scientists and engineers represented in management?Within the broader context of education and the labor market, the book provides detailed comparisons between men and women Ph.D.s in a number of measures: financial support for education, academic rank achieved, salary, and others. The study covers engineering; the mathematical, physical, life, and social and behavioral sciences; medical school faculty; and recipients of National Institutes of Health grants.Findings and recommendations in this volume will be of interest to practitioners, faculty, and students in science and engineering as well as education administrators, employers, and researchers in these fields.
Future Directions for NSF Advanced Computing Infrastructure to Support U.S. Science and Engineering in 2017-2020by Engineering Medicine National Academies of Sciences
Advanced computing capabilities are used to tackle a rapidly growing range of challenging science and engineering problems, many of which are compute- and data-intensive as well. Demand for advanced computing has been growing for all types and capabilities of systems, from large numbers of single commodity nodes to jobs requiring thousands of cores; for systems with fast interconnects; for systems with excellent data handling and management; and for an increasingly diverse set of applications that includes data analytics as well as modeling and simulation. Since the advent of its supercomputing centers, the National Science Foundation (NSF) has provided its researchers with state-of-the-art computing systems. The growth of new models of computing, including cloud computing and publically available by privately held data repositories, opens up new possibilities for NSF. In order to better understand the expanding and diverse requirements of the science and engineering community and the importance of a new broader range of advanced computing infrastructure, the NSF requested that the National Research Council carry out a study examining anticipated priorities and associated tradeoffs for advanced computing. Future Directions for NSF Advanced Computing Infrastructure to Support U.S. Science and Engineering in 2017-2020 provides a framework for future decision-making about NSF's advanced computing strategy and programs. It offers recommendations aimed at achieving four broad goals: (1) position the U.S. for continued leadership in science and engineering, (2) ensure that resources meet community needs, (3) aid the scientific community in keeping up with the revolution in computing, and (4) sustain the infrastructure for advanced computing.
On March 10-11, 2016, the National Academies of Sciences, Engineering, and Medicine held a public symposium on potential U.S. government policies for the oversight of gain-of- function (GOF) research. This was the Academies' second meeting held at the request of the U.S. government to provide a mechanism to engage the life sciences community and the broader public and solicit feedback on optimal approaches to ensure effective federal oversight of GOF research as part of a broader U.S. government deliberative process. The first symposium, held in December 2014, examined the underlying scientific and technical questions surrounding the potential risks and benefits of GOF research involving pathogens with pandemic potential. The second symposium focused on discussion of the draft recommendations regarding GOF research of a Working Group of the National Science Advisory Board for Biosecurity. This report summarizes the key issues and ideas identified during the second symposium.
Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Research and Development of Medical Products are summarized in this report.
Optical science and engineering affect almost every aspect of our lives. Millions of miles of optical fiber carry voice and data signals around the world. Lasers are used in surgery of the retina, kidneys, and heart. New high-efficiency light sources promise dramatic reductions in electricity consumption. Night-vision equipment and satellite surveillance are changing how wars are fought. Industry uses optical methods in everything from the production of computer chips to the construction of tunnels. Harnessing Light surveys this multitude of applications, as well as the status of the optics industry and of research and education in optics, and identifies actions that could enhance the field's contributions to society and facilitate its continued technical development.
The Institute of Medicine Roundtable on Health Literacy convened a 1-day public workshop to explore the relationship between palliative care and health literacy, and the importance of health literate communication in providing high-quality delivery of palliative care. Health Literacy and Palliative Care summarizes the discussions that occurred throughout the workshop and highlights the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy in the United States.
In April 2015, the Institute of Medicine convened a workshop to explore the potential uses of simulation and other types of modeling for the purpose of selecting and refining potential strategies, ranging from interventions to investments, to improve the health of communities and the nation's health. Participants worked to identify how modeling could inform population health decision making based on lessons learned from models that have been, or have not been, used successfully, opportunities and barriers to incorporating models into decision making, and data needs and opportunities to leverage existing data and to collect new data for modeling. This report summarizes the presentations and discussions from this workshop.
The aging and evolving racial and ethnic composition of the U.S. population has the United States in the midst of a profound demographic shift and health care organizations face many issues as they move to address and adapt to this change. In their drive to adequately serve increasingly diverse communities, health care organizations are searching for approaches that will enable them to provide information and service to all persons, regardless of age, race, cultural background, or language skills, in a manner that facilitates understanding and use of that information to make appropriate health decisions. To better understand how the dynamic forces operating in health care today impact the delivery of services in a way that is health literate, culturally competent, and in an appropriate language for patients and their families, the National Academies of Sciences, Engineering, and Medicine conducted a public workshop on the integration of health literacy, cultural competency, and language access services. Participants discussed skills and competencies needed for effective health communication, including health literacy, cultural competency, and language access services; interventions and strategies for integration; and differing perspectives such as providers and systems, patients and families, communities, and payers. This report summarizes the presentations and discussions from the workshop.
The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.
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