How can we all work together to eliminate the avoidable injustices that plague our health care system and society?Health is determined by far more than a person's choices and behaviors. Social and ...political conditions, economic forces, physical environments, institutional policies, health care system features, social relationships, risk behaviors, and genetic predispositions all contribute to physical and mental well-being. In America and around the world, many of these factors are derived from a lingering history of unequal opportunities and unjust treatment for people of color and other vulnerable communities. But they aren't the only ones who suffer because of these disparities—everyone is impacted by the factors that degrade health for the least advantaged among us.In Why Are Health Disparities Everyone's Problem? Dr. Lisa Cooper shows how we can work together to eliminate the injustices that plague our health care system and society. The book follows Cooper's journey from her childhood in Liberia, West Africa, to her thirty-year career working first as a clinician and then as a health equity researcher at Johns Hopkins University. Drawing on her experiences, it explores how differences in communication and the quality of relationships affect health outcomes. Through her work as the founder and director of the Johns Hopkins Center for Health Equity, it details the actions and policies needed to reduce and eliminate the conditions that are harming us all. Cooper reveals with compelling detail how health disparities are crippling our health care system and society, driving up health care costs, leading to adverse health outcomes and ultimately an enormous burden of human suffering. Why Are Health Disparities Everyone's Problem? demonstrates the ways in which everyone's health is interconnected, both within communities and across the globe. Cooper calls for a new kind of herd immunity, when a sufficiently high proportion of people, across race and social class, become immune to harmful social conditions through "vaccination" with solidarity among groups and opportunities created by institutional and societal practices and policies. By acknowledging and acting upon that interconnectedness, she believes everyone can help to create a healthier world.Features• Raises readers' health care inequities literacy through an approachable narrative with specific examples• Introduces the concept of "herd immunity" as it applies to building communal awareness of systemic injustices• Features sections that underscore key takeaways• Includes contributions from the world's leading minds through their research findings and quotations• Guides readers on what can be done at an individual level as a patient, public health professional, and community member • Includes inspiring stories of effective health equity studies and practices around the world, from Ghana's ADHINCRA Project addressing hypertension control to Baltimore's BRIDGE Study for depression in African Americans and the Maryland and Pennsylvania–based RICH LIFE Project for hypertension, diabetes, and other medical conditionsJohns Hopkins WavelengthsIn classrooms, field stations, and laboratories in Baltimore and around the world, the Bloomberg Distinguished Professors of Johns Hopkins University are opening the boundaries of our understanding of many of the world's most complex challenges. The Johns Hopkins Wavelengths book series brings readers inside their stories, illustrating how their pioneering discoveries benefit people in their neighborhoods and across the globe in artificial intelligence, cancer research, food systems' environmental impacts, health equity, science diplomacy, and other critical arenas of study. Through these compelling narratives, their insights will spark conversations from dorm rooms to dining rooms to boardrooms.
The eighth edition of this best-selling text, valued for its concise and balanced introduction to the U.S. health care system, is entirely updated to reflect alterations to health care services, ...delivery, and financing resulting from the Affordable Care Act (ACA). The text describes how our health care system currently functions, the key forces that led to its structure, and the influences likely to shape the industry during the next 5 to 10 years. With an emphasis on policy development, the authors underscore the fluidity of the system and examine the debates and conflicts that have shaped health care changes and influenced American values and belief systems. Other new areas of focus include an assessment of who uses health care and in what way, health care trends, and a forecast for the health care system of the future.
The text elucidates the basic building blocks of the health care system, including its components, organization, services, and financing. It describes the ongoing evolution of the system since the passage of the ACA, development of accountable care organizations (ACOs), and uneven acceptance of Medicaid expansion by states. Organized to facilitate understanding of concepts at work, the text provides health care students with a clear road map of the field in which they will practice, so they can position themselves to navigate the upcoming changes.
Objective
To examine whether nurse practitioner (NP)‐assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)‐assigned patients.
Data ...Sources
Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA patients assigned to an MD primary care provider (PCP) who left VA practice between 2010 and 2012.
Study Design
We applied a difference‐in‐difference approach comparing outcomes between patients reassigned to MD and NP PCPs, respectively. We examined measures of outpatient (primary care, specialty care, and mental health) and inpatient (total and ambulatory care sensitive hospitalizations) utilization, costs (outpatient, inpatient and total), and clinical outcomes (control of hemoglobin A1c, LDL, and blood pressure) in the year following reassignment.
Principal Findings
Compared to MD‐assigned patients, NP‐assigned patients were less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations. Differences in costs, clinical outcomes, and receipt of diagnostic tests between groups were not statistically significant.
Conclusions
Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost‐effective approach to addressing anticipated shortages of primary care physicians.
Being intelligible to a listener means getting your message across and improving speech intelligibility is one of the most common goals for clients working with a speech-language pathologist (SLP). ...Improving Speech Intelligibility in Adults: Clinical Application of Evidence-Based Strategies is a professional resource for practicing SLPs working with adults with communication disorders, such as dysarthria, acquired apraxia of speech, and voice disorders.
There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the ...impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.
In The Battle for Veterans' Healthcare, award-winning author Suzanne Gordon takes us to the front lines of federal policymaking and healthcare delivery, as it affects eight million Americans whose ...military service makes them eligible for Veterans Health Administration (VHA) coverage.Gordon's collected dispatches provide insight and information too often missing from mainstream media reporting on the VHA and from Capitol Hill debates about its future. Drawing on interviews with veterans and their families, VHA staff and administrators, health care policy experts and Congressional decision makers, Gordon describes a federal agency under siege that nevertheless accomplishes its difficult mission of serving men and women injured, in myriad ways, while on active duty.The Battle for Veterans' Healthcare is an essential primer on VHA care and a call to action by veterans, their advocacy organizations, and political allies. Without lobbying efforts and broader public understanding of what's at stake, a system now functioning far better than most private hospital systems may end up looking more like them, to the detriment of patients and providers alike.
Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these ...new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context.
The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence.
One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users.
Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand.
Prospero registration number: 42016037725 .
Context: There is a widespread belief that the US health care system needs to move "from volume to value." This transformation to value (eg, quality divided by cost) is conceptualized as a two-fold ...movement: (1) from fee-for-service to alternative payment models; and (2) from solo practice and freestanding hospitals to medical homes, accountable care organizations, large hospital systems, and organized clinics like Kaiser Permanente. Methods: We evaluate whether this transformation is happening quickly, shifting risk to providers, lowering costs, and improving quality. We draw on recent evidence on provider payment and organization and their effects on cost and quality. Findings: Data suggest a low prevalence of provider risk payment models and slow movement toward new payment and organizational models. Evidence suggests the impact of both on cost and quality is weak. Conclusions: We need to be patient in expecting system improvements from ongoing changes in provider payment and organization. We also may need to look for improvements in other areas of the economy or to accept and accommodate prospects of modest improvements over time.
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