RESUMO
The 2009 stimulus package released a burst of pent-up creativity in the applications submitted by US researchers, but there was a complicating factor with funding decisions: the need for quick results. Quinn Eastman provides a progress report.
Assuntos
American Recovery and Reinvestment Act , Pesquisa Biomédica/economia , Pesquisa Biomédica/legislação & jurisprudência , Financiamento Governamental , National Institutes of Health (U.S.) , Estados UnidosRESUMO
The US Government has embarked on the largest initiative to date to encourage widespread use of electronic health records (EHRs). Up to now, it is not yet clear that what the actual effectiveness of EHR promotion is like since the Health Information Technology for Economic and Clinical Health (HITECH) Act. As a response, this study analyzes the EHR conversion at the primary stage (sign-up EHRâgo-live EHR) and the advanced stage (go-live EHRâmeaningful use of EHR) for different types of healthcare providers in the United States. With the data from the Office of National Coordinator for Health Information Technology-Regional Extension Centers Program, this study finds that healthcare providers have achieved progress in the EHR conversion at both the primary and advanced stage. However, the levels of progress made at different stages of EHR conversion vary for different providers. For rural and underserved healthcare settings, the progress made at the advanced stage is smaller than that at the primary stage, contrary to the case for other kinds of providers. Moreover, although the greater progress has been made at the advanced stage for some kinds of providers, the overall level of EHR conversion for various healthcare providers is far greater at the primary stage than at the advanced stage.
Assuntos
Registros Eletrônicos de Saúde , Informática Médica , American Recovery and Reinvestment Act , Pessoal de Saúde , Humanos , Uso Significativo , Estados UnidosRESUMO
INTRODUCTION: Single-fraction stereotactic radiosurgery (SRS) is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). Implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS: The National Cancer Database from 2010-2016 identified brain metastases patients from non-small cell lung cancer throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010-2012), during (2013-2014) and after (2015-2016) ATRA implementation. RESULTS: In 2013, there was a substantial decrease of LINAC SRS in favor of GKRS in non-academic centers. Over the 3-year span immediately preceding ATRA implementation, 39% of all eligible SRS cases received LINAC. There was a modest decrease in LINAC utilization over the 2 years immediately following ATRA implementation (35%), followed by an increase over the next two years (40%). SRS modality showed differences over the three time periods (unadjusted, p = 0.043), primarily in non-academic centers (unadjusted, p = 0.003). CONCLUSIONS: ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a decline to rates similar to the years before implementation. These findings indicate that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US, serving as a reminder of the importance/impact of public policy on treatment modality utilization by physicians and hospitals.
Assuntos
Neoplasias Encefálicas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Política de Saúde/legislação & jurisprudência , Neoplasias Pulmonares/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Radiocirurgia/economia , Radiocirurgia/legislação & jurisprudência , Adenocarcinoma de Pulmão/economia , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Idoso , American Recovery and Reinvestment Act , Neoplasias Encefálicas/economia , Neoplasias Encefálicas/secundário , Carcinoma de Células Grandes/economia , Carcinoma de Células Grandes/patologia , Carcinoma de Células Grandes/cirurgia , Carcinoma Pulmonar de Células não Pequenas/economia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/economia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Financiamento Governamental , Seguimentos , Humanos , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estados UnidosRESUMO
OBJECTIVE: The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status. DESIGN: Pre/post analysis. SETTING: Boston, MA, USA. PARTICIPANTS: Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA. RESULTS: Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants. CONCLUSIONS: Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.
Assuntos
American Recovery and Reinvestment Act , Dieta/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores Socioeconômicos , Estados UnidosAssuntos
Acesso à Informação/legislação & jurisprudência , Segurança Computacional , Registros Eletrônicos de Saúde/legislação & jurisprudência , Troca de Informação em Saúde , Interoperabilidade da Informação em Saúde/legislação & jurisprudência , Sistemas Computadorizados de Registros Médicos/normas , American Recovery and Reinvestment Act , Troca de Informação em Saúde/legislação & jurisprudência , Sistemas de Informação em Saúde/legislação & jurisprudência , Health Insurance Portability and Accountability Act , Humanos , Estados UnidosRESUMO
In this editorial, we first summarize the 2nd International Workshop on Semantics-Powered Data Analytics (SEPDA 2017) held on November 13, 2017 in Kansas City, Missouri, U.S.A., and then briefly introduce 13 research articles included in this supplement issue, covering topics such as Semantic Integration, Deep Learning, Knowledge Base Construction, and Natural Language Processing.
Assuntos
Ciência de Dados , Semântica , American Recovery and Reinvestment Act , Mineração de Dados , Aprendizado Profundo , Humanos , Processamento de Linguagem Natural , Estados UnidosRESUMO
OBJECTIVE: To provide an update on the status of provider participation in the US Wound Registry (USWR) and its specialty registry the Hyperbaric Oxygen Therapy Registry (HBOTR), which provide much-needed national benchmarking and quality measurement services for hyperbaric medicine. METHODS: Providers can meet many requirements of the Merit-Based Incentive Payment System (MIPS) and simultaneously participate in the HBOTR by transmitting Continuity of Care Documents (CCDs) directly from their certified electronic health record (EHR) or by reporting hyperbaric quality measures, the specifications for which are available free of charge for download from the registry website as electronic clinical quality measures for installation into any certified EHR. Computerized systems parse the structured data transmitted to the USWR. Patients undergoing hyperbaric oxygen (HBO2) therapy are allocated to the HBOTR and stored in that specialty registry database. The data can be queried for benchmarking, quality reporting, public policy, or specialized data projects. RESULTS: Since January 2012, 917,758 clinic visits have captured the data of 199,158 patients in the USWR, 3,697 of whom underwent HBO2 therapy. Among 27,404 patients with 62,843 diabetic foot ulcers (DFUs) captured, 9,908 DFUs (15.7%) were treated with HBO2 therapy. Between January 2016 and September 2018, the benchmark rate for the 1,000 DFUs treated with HBO2 was 7.3%, with an average of 28 treatments per patient. There are 2,100 providers who report data to the USWR by transmitting CCDs from their EHR and 688 who submit quality measure data, 300 (43.6%) of whom transmit HBO2 quality data.
Assuntos
Benchmarking , Pé Diabético/terapia , Fidelidade a Diretrizes , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Oxigenoterapia Hiperbárica/normas , Sistema de Registros/estatística & dados numéricos , American Recovery and Reinvestment Act , Amputação Cirúrgica , Benchmarking/economia , Glicemia/análise , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Pé Diabético/sangue , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos , Avaliação Nutricional , Osteomielite/terapia , Osteorradionecrose/terapia , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Sistema de Registros/normas , Mecanismo de Reembolso , Resultado do Tratamento , Estados Unidos , Procedimentos Desnecessários/estatística & dados numéricos , CicatrizaçãoAssuntos
American Recovery and Reinvestment Act , Atenção à Saúde/organização & administração , Economia Hospitalar , Custos de Cuidados de Saúde , Uso Significativo , Atenção à Saúde/economia , Atenção à Saúde/legislação & jurisprudência , Eficiência Organizacional/legislação & jurisprudência , Registros Eletrônicos de Saúde , Reembolso de Incentivo , Escalas de Valor Relativo , Estados UnidosRESUMO
RATIONALE: The American Recovery and Reinvestment Act (ARRA) allowed National Heart, Lung, and Blood Institute to fund R01 grants that fared less well on peer review than those funded by meeting a payline threshold. It is not clear whether the sudden availability of additional funding enabled research of similar or lesser citation impact than already funded work. OBJECTIVE: To compare the citation impact of ARRA-funded de novo National Heart, Lung, and Blood Institute R01 grants with concurrent de novo National Heart, Lung, and Blood Institute R01 grants funded by standard payline mechanisms. METHODS AND RESULTS: We identified de novo (type 1) R01 grants funded by National Heart, Lung, and Blood Institute in fiscal year 2009: these included 458 funded by meeting Institute's published payline and 165 funded only because of ARRA funding. Compared with payline grants, ARRA grants received fewer total funds (median values, $1.03 versus $1.87 million; P<0.001) for a shorter duration (median values including no-cost extensions, 3.0 versus 4.9 years; P<0.001). Through May 2014, the payline R01 grants generated 3895 publications, whereas the ARRA R01 grants generated 996. Using the InCites database from Thomson-Reuters, we calculated a normalized citation impact for each grant by weighting each article for the number of citations it received normalizing for subject, article type, and year of publication. The ARRA R01 grants had a similar normalized citation impact per $1 million spent as the payline grants (median values [interquartile range], 2.15 [0.73-4.68] versus 2.03 [0.75-4.10]; P=0.61). The similar impact of the ARRA grants persisted even after accounting for potential confounders. CONCLUSIONS: Despite shorter durations and lower budgets, ARRA R01 grants had comparable citation outcomes per $million spent to that of contemporaneously funded payline R01 grants.
Assuntos
American Recovery and Reinvestment Act , Bibliometria , Financiamento Governamental/economia , National Heart, Lung, and Blood Institute (U.S.)/economia , Apoio à Pesquisa como Assunto/economia , Orçamentos , Análise Custo-Benefício , Bases de Dados Bibliográficas/estatística & dados numéricos , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/estatística & dados numéricos , Humanos , Pesquisadores/estatística & dados numéricos , Apoio à Pesquisa como Assunto/legislação & jurisprudência , Apoio à Pesquisa como Assunto/estatística & dados numéricos , Estados UnidosRESUMO
This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.
Assuntos
Registros Odontológicos/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Prática Odontológica de Grupo/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Adulto , Fatores Etários , American Recovery and Reinvestment Act , Análise Custo-Benefício , Odontólogos/estatística & dados numéricos , Registros Eletrônicos de Saúde/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Fatores Sexuais , Inquéritos e Questionários , Estados UnidosRESUMO
POLICY POINTS: The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain. The future of health information technology (health IT) support nationally is likely to depend on the ability of the technology to satisfy its users that its functionalities address the interests policymakers and other stakeholders have in using technology to promote better care, improved outcomes, and reduced costs. CONTEXT: The Health Information Technology for Economic and Clinical Health (HITECH) Act set ambitious goals for developing electronic health information as one tool to reform health care delivery and improve health outcomes. With HITECH's grant funding now mostly exhausted but statutory authority for standards remaining, this article looks back at HITECH's experience in the first 5 years to assess its implementation, remaining challenges, and lessons learned. METHODS: This review derives from a global assessment of the HITECH Act. Earlier, we examined the logic of HITECH and identified interdependencies critical to its ultimate success. In this article, we build on that framework to review what has and has not been accomplished in building the infrastructure authorized by HITECH since it was enacted. The review incorporates quantitative and qualitative evidence of progress from the global assessment and from the evaluations funded by the Office of the National Coordinator for Health Information Technology (ONC) of individual programs authorized by the HITECH Act. FINDINGS: Our review of the evidence provides a mixed picture. Despite HITECH's challenging demands, its complex programs were implemented, and important changes sought by the act are now in place. Electronic health records (EHRs) now exist in some form in most professional practices and hospitals eligible for HITECH incentive payments, more information is being shared electronically, and the focus of attention has shifted from adoption of EHRs toward more fundamental issues associated with using health information technology (health IT) to improve health care delivery and outcomes. In some areas, HITECH's achievements to date have fallen short of the hopes of its proponents as it has proven challenging to move meaningful use beyond the initial low bar set by Meaningful Use Stage 1. EHR products vary in their ability to support more advanced functionalities, such as patient engagement and population-based care management. Many barriers to interoperability persist, limiting electronic communication across a diverse set of largely private providers and care settings. CONCLUSIONS: Achieving the expansive goals of HITECH required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, some better positioned to move forward than others. To date, it has proven easier to get providers to adopt EHRs, perhaps in response to financial incentives to do so, than to develop a robust infrastructure that allows the information in EHRs to be used effectively and shared not only within clinical practices but also across providers. Effective exchange of data is necessary to drive the kinds of delivery and payment reforms sought nationwide.
Assuntos
American Recovery and Reinvestment Act , Difusão de Inovações , Registros Eletrônicos de Saúde/estatística & dados numéricos , Informática Médica/legislação & jurisprudência , Atenção à Saúde , Registros Eletrônicos de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde , Política de Saúde , Uso Significativo , Estados UnidosAssuntos
American Recovery and Reinvestment Act , Exclusão Digital , Registros Eletrônicos de Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Prioridades em Saúde , Humanos , Uso Significativo/legislação & jurisprudência , Reembolso de Incentivo/legislação & jurisprudência , Estados UnidosRESUMO
Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.
Assuntos
Documentação/normas , Registros de Saúde Pessoal , American Recovery and Reinvestment Act , Continuidade da Assistência ao Paciente , Registros Eletrônicos de Saúde/legislação & jurisprudência , Registros Eletrônicos de Saúde/normas , Humanos , Comunicação Interdisciplinar , Imperícia , Sumários de Alta do Paciente Hospitalar/normas , Estados UnidosRESUMO
Hospitals and clinics are adapting to new technologies and implementing electronic health records, but the efforts need to be aligned explicitly with goals for patient safety. EHRs bring the risks of both technical failures and inappropriate use, but they can also help to monitor and improve patient safety.
Assuntos
Registros Eletrônicos de Saúde , Segurança do Paciente , American Recovery and Reinvestment Act , Segurança Computacional , Objetivos , Humanos , Uso Significativo , Sistemas Computadorizados de Registros Médicos/instrumentação , Software , Estados UnidosAssuntos
American Recovery and Reinvestment Act , Regulamentação Governamental , Uso Significativo/legislação & jurisprudência , Informática Médica/legislação & jurisprudência , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Reembolso de Incentivo , Integração de Sistemas , Estados Unidos , Vocabulário ControladoAssuntos
Informática Médica/legislação & jurisprudência , Sistemas Computadorizados de Registros Médicos/normas , American Recovery and Reinvestment Act , Registros Eletrônicos de Saúde , Previsões , Regulamentação Governamental , Humanos , Uso Significativo/legislação & jurisprudência , Informática Médica/tendências , Sistemas Computadorizados de Registros Médicos/legislação & jurisprudência , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/tendências , Estados UnidosRESUMO
We identified and described strategies for promoting smoking cessation and smoke-free environments that were implemented in Oregon and Utah in treatment centers for mental illness and substance abuse. We reviewed final evaluation reports submitted by state tobacco control programs (TCPs) to the Centers for Disease Control and Prevention and transcripts from a call study evaluation. The TCPs described factors that assisted in implementing strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative. These strategies could be used by other programs serving high-need populations for whom evidence-based interventions are still being developed.
Assuntos
Promoção da Saúde/métodos , Serviços de Saúde Mental/normas , Política Antifumo , Abandono do Hábito de Fumar/legislação & jurisprudência , Centros de Tratamento de Abuso de Substâncias/normas , Poluição por Fumaça de Tabaco/prevenção & controle , American Recovery and Reinvestment Act , Centers for Disease Control and Prevention, U.S. , Relações Comunidade-Instituição , Comportamento Cooperativo , Coleta de Dados , Prática Clínica Baseada em Evidências , Implementação de Plano de Saúde , Humanos , Liderança , Serviços de Saúde Mental/economia , Modelos Organizacionais , Oregon , Avaliação de Programas e Projetos de Saúde , Abandono do Hábito de Fumar/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/economia , Estados Unidos , Utah , Populações VulneráveisRESUMO
This final rule with comment period specifies the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and Medicaid electronic health record (EHR) incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program. In addition, it changes the Medicare and Medicaid EHR Incentive Programs reporting period in 2015 to a 90-day period aligned with the calendar year. This final rule with comment period also removes reporting requirements on measures that have become redundant, duplicative, or topped out from the Medicare and Medicaid EHR Incentive Programs. In addition, this final rule with comment period establishes the requirements for Stage 3 of the program as optional in 2017 and required for all participants beginning in 2018. The final rule with comment period continues to encourage the electronic submission of clinical quality measure (CQM) data, establishes requirements to transition the program to a single stage, and aligns reporting for providers in the Medicare and Medicaid EHR Incentive Programs.