Data on the US Economy-A Model for Health Data?

This JAMA Forum discusses 3 key steps for restructuring the acquisition of health data to enable more timely access to the data and more timely public health action, similar to the successes seen with the COVID-19 pandemic response in the US.

Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment.

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.

The Role for Policy in AI-Assisted Medical Diagnosis.

This JAMA Forum discusses the promise and pitfalls of using large language models and artificial intelligence (AI) in the diagnosis of patients.

US Community Pharmacies and Public Health-Building on the COVID-19 Response.

This JAMA Forum discusses the ways that US community pharmacies can build on the flexibility during the COVID-19 response to care for patients with HIV, hypertension, and opioid use disorder and improve access to reproductive health care.

Public Health Emergency Preparedness After COVID-19.

Policy Points The critical task of preparedness is inseparable from the regular work of advancing population health and health equity.

Planning For The Next Pandemic: Lab Systems Need Policy Shift To Speed Emerging Infectious Disease Warning And Tracking.

Early detection and ongoing monitoring of infectious diseases depends on diagnostic testing. The US has a large, diverse system of public, academic, and private laboratories that develop new diagnostic tests; perform routine testing; and conduct specialized reference testing, such as genomic sequencing. These laboratories operate under a complex mix of laws and regulations at the federal, state, and local levels. The COVID-19 pandemic exposed major weaknesses in the nation's laboratory system, some of which were seen again during the global mpox outbreak in 2022. In this article we review how the US laboratory system has been designed to detect and monitor emerging infections, describe what gaps were revealed during COVID-19, and propose specific steps that policy makers can take both to strengthen the current system and to prepare the US for the next pandemic.

The Public Health Fixes That Missed the Omnibus.

This JAMA Forum discusses the $1.7 trillion omnibus bill passed in December 2022 and the areas of pandemic preparedness and the public health system it addresses and misses.

A cross-sectional analysis of trends in dermatology practice size in the United States from 2012 to 2020.

Physicians are trending towards practice consolidation nationally; however, changes in dermatology practice size remain to be assessed. The objective of this study was to analyze trends in dermatology practice size from 2012 to 2020 using a large-scale Medicare physician database. We performed a retrospective cross-sectional analysis using 2012 and 2020 data obtained from the Physician Compare Database. Responses from dermatologists were analyzed for trends in practice size, with a sub-analysis to examine differences among different regions, gender, and years of experience. The proportion of dermatologists in solo practice decreased from 26.1% in 2012 to 15.6% in 2020 (p < 0.001). Dermatologists were 40% less likely to be practicing in solo practice and 36% more likely to be in a practice with 10 or more members in 2020 (p < 0.001). These findings were consistent among all regions and genders examined. Additionally, in 2020, dermatologists with 30 or more years in practice were 7.5 times more likely to be in solo practice compared to dermatologists with 0-9 years in practice (p < 0.001). There is a trend of dermatologists working for larger practices, which is consistent with a larger nationwide trend of expanding physician practices. This shift in practice settings should be closely monitored to analyze the effect on healthcare efficiency, cost, and delivery.

The New US National Biodefense Strategy-Necessary but Not Sufficient.

This JAMA Forum discusses the Biden administration's recently released National Biodefense Strategy and recommends that the implementation of this national strategy be accompanied by recommendations from the Commonwealth Fund Commission.

Transparency practices at the FDA: A barrier to global health.

Data sharing among regulators must be "business as usual".

The development and implementation of a new hospital performance measure to assess hospital contributions to community health and equity.

OBJECTIVE: To develop and implement a measure of how US hospitals contribute to community health with a focus on equity. DATA SOURCES: Primary data from public comments and hospital surveys and secondary data from the IBM Watson Top 100 Hospitals program collected in the United States in 2020 and 2021. STUDY DESIGN: A thematic analysis of public comments on the proposed measure was conducted using an iterative grounded approach for theme identification. A cross-sectional survey of 207 hospitals was conducted to assess self-attestation to 28 community health best practice standards in the revised measure. An analysis of hospital rankings before and after inclusion of the new measure was performed. DATA COLLECTION/EXTRACTION METHODS: Public comment on the proposed measure was collected via an online survey, email, and virtual meetings in 2020. The survey of hospitals was conducted online by IBM in 2021. The analysis of hospital ranking compared the 2020 and 2021 IBM Watson Top 100 Hospitals program results. PRINCIPAL FINDINGS: More than 650 discrete comments from 83 stakeholders were received and analyzed during measure development. Key themes identified in thematic analysis included equity, fairness, and community priorities. Hospitals that responded to a cross-sectional survey reported meeting on average 76% of applicable best practice standards. Least met standards included providing emergent buprenorphine treatment for opioid use disorder (53%), supporting an evidence-based home visiting program (53%), and establishing a returning citizens employment program (27%). Thirty-seven hospitals shifted position in the 100 Top Hospital rankings after the inclusion of the new measure. CONCLUSIONS: There is broad interest in measuring hospital contributions to community health with a focus on equity. Many highly ranked hospitals report meeting best practice standards, but significant gaps remain. Improving measurement to incentivize greater hospital contributions to community health and equity is an important priority.