Medicare claims data as public use files: a new tool for public health surveillance.

Claims data are an important source of data for public health surveillance but have not been widely used in the United States because of concern with personally identifiable health information and other issues. We describe the development and availability of a new set of public use files created using de-identified health care claims for fee-for-service Medicare beneficiaries, including individuals 65 years and older and individuals with disabilities younger than 65 years, and their application as tools for public health surveillance. We provide an overview of these files and their attributes; a review of beneficiary de-identification procedures and implications for analysis; a summary of advantages and limitations for use of the public use files for surveillance, alone and in combination with other data sources; and discussion and examples of their application for public health surveillance using examples that address chronic conditions monitoring, hospital readmissions, and prevalence and expenditures in diabetes care.

Self-management program participation by older adults with diabetes: Chronic Disease Self-Management Program and Diabetes Self-Management Program.

The Chronic Disease Self-Management Program and the Diabetes Self-Management Program offer evidence-based self-management for persons with diabetes. We examined participation and completion rates for older adults in the Communities Putting Prevention to Work initiative and found that completion is more likely (1) in Diabetes Self-Management Program for individuals with diabetes; (2) for Chronic Disease Self-Management Program and Diabetes Self-Management Program with introductory class zero; and (3) in small classes. We also found that participants reporting depression were less likely to complete either workshop. Future research is needed to examine workshop availability and selection, health and behavioral outcomes, and participant/completer experience.

Bringing evidence-based interventions to the field: the fidelity challenge.

Fidelity of implementation in replicating evidence-based health promotion interventions, to ensure implementation as designed and proven through research, is crucial if evidence-based community and population health interventions are to achieve promised results but can be difficult to attain in practice. This article highlights major challenges, considerations, and strategies associated with fidelity as public health care practitioners implement evidence-based interventions and bring them to scale in the field. There is need for sharing information about "what works" in implementing these interventions with fidelity, as well sharing information about implementation challenges and improvements to intervention design. Fidelity is important if practitioners are to obtain results and outcomes planned by intervention developers and is an essential value proposition for evidence-based public health practice and population health improvement.

Harnessing social media for health promotion and behavior change.

Rapid and innovative advances in participative Internet communications, referred to as "social media," offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or identified. People of all demographics are adopting these technologies whether on their computers or through mobile devices, and they are increasingly using these social media for health-related issues. Although social media have considerable potential as tools for health promotion and education, these media, like traditional health promotion media, require careful application and may not always achieve their desired outcomes. This article summarizes current evidence and understanding of using social media for health promotion. More important, it discusses the need for evaluating the effectiveness of various forms of social media and incorporating outcomes research and theory in the design of health promotion programs for social media.

Racial and ethnic minority participants in chronic disease self-management programs: findings from the Communities Putting Prevention to Work initiative.

BACKGROUND: The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We examine whether there are differences in the enrollment and completion rates of members of racial and ethnic minority groups and what sites have done to enhance their delivery of the CDSMP to such groups. METHOD: This study used a multi-method approach including: site visits to 6 states, telephone interviews with the 47 program grantees and delivery sites, review of program reports, and analysis of administrative data on participants, completers, workshops and leaders. RESULTS: Grantees served 89,861 participants, including 56.3% who self-identified as White, 17.3% as Black, 5.0% as other/multi-racial, 3.2% as Asian/Asian Americans, 1.4% as American Indian/Alaskans, .8% as Native Hawaiian/Pacific Islanders, and 16.0% individuals of unknown race. Overall, completion rates averaged 74.5%, with Native Hawaiian/Pacific Islanders completing workshops at a higher rate (90.6%) than other groups. Completion rates for participants aged > or = 75 were higher than for younger participants. Senior centers, health care organizations, and residential facilities served 63.1% of the participants. CONCLUSIONS: Grantees have successfully delivered CDSMP to racially and ethnically diverse participants in a range of settings. As the Administration for Community Living/Administration on Aging (ACL/AoA) grantees have demonstrated, CDSMP can be brought to scale by community organizations, partnerships and networks to reach diverse populations in diverse settings. The program can be a significant tool for addressing health disparities and empowering racial/ethnic minorities to take charge, promote better health and self-management of chronic conditions.

Enhancing behavioral health treatment and crisis management through mobile ecological momentary assessment and SMS messaging.

Many veterans returning from service in Afghanistan or Iraq suffer from post-traumatic stress disorder or mild traumatic brain injury. Treating these conditions can be challenging because of high rates of relapse and associated memory impairments. We report on a pilot study that assessed the utility of mobile health (mHealth) technologies, including personal digital assistant-based ecological momentary assessment and two-way interactive text (SMS) messaging, for providing treatment feedback to clinicians, encouraging and motivating veterans throughout treatment, and monitoring participants for relapse after treatment discharge. The results of the pilot suggest that mHealth technologies are feasible adjuncts to traditional mental treatment in the veteran population. Additional work is needed to establish the degree of clinical and economic value.

ACOs, PCMHs, and health care reform: nursing's next frontier?

National health reform includes an emphasis on integrated service delivery models including Accountable Care Organizations and Patient-Centered Medical Homes. These value-based models of care delivery may offer opportunities for nursing to advance its patient care and profession. This paper presents four pillars of health care delivery reform-team-based care; cross-team communication, coordination and collaboration; infrastructure and technology; and aligned payment incentives -intended to improve quality of care while reducing cost increases. Opportunities and challenges for nursing are discussed in this context.

Value-based purchasing: the evidence.

OBJECTIVE: This report presents evidence about "what works" in value-based purchasing strategies emphasized in national healthcare reform legislation, with a focus on service delivery integration, payment, and value-based insurance design. We review key findings to address the question: What is the evidence that a value-based strategy will improve health outcomes or reduce healthcare costs? STUDY DESIGN: This report is a review of peer-reviewed and field-based research associated with several value-based strategies purchasers can use to increase value in their healthcare market decision making: Accountable Care Organizations, Patient Centered Medical Homes, bundled payment methods and incentives, and value-based insurance designs. METHODS: Environmental scans and evidence reviews of value-based purchasing were conducted to inform this report. RESULTS: Many value-based approaches are new to the healthcare arena, and evidence of performance in improving health outcomes or reducing healthcare costs is limited but increasing as experience with these approaches grows. CONCLUSIONS: Purchasers should be aware that evidence is contingent on market environment and study assumptions in considering specific strategies, and be cautious implementing them. The need for a new measurement paradigm for cost and quality that reaches across the care continuum is evident.

Payment incentives and integrated care delivery: levers for health system reform and cost containment.

The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality, and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.

Type 2 diabetes epidemic in First Nations people of Canada.

Diabetes is a chronic condition that results in the body's inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for homeostatic organ maintenance. Over 151 million people worldwide, including 7% of the US and 5% of Canadian populations have been diagnosed with diabetes, and the prevalence varies greatly by race and ethnicity. However, since the end of World War II, the people with the greatest risk include First Nations people, including Canada's aboriginal, Inuit and Native Indian populations with up to a 5-fold greater prevalence than the general population. Prevalence can vary from 8% to 48% among the sexes and tribes. Understanding the prevalence and causes of this epidemic is immediately needed as diabetes precedes various other endocrine and cardiovascular diseases. Here we review the current understanding of diabetes risk in Canada's First Nations people in the hope to bring greater awareness among healthcare professionals and implementation of measures to prevent spread of this disease.

African Americans' organ donor intentions: who has used which registration mode to express her or his intentions?

AIM: To describe the various means that African American adults had used to express their intention to become an organ donor, as well as to determine whether there were characteristics that distinguished those individuals who had expressed their intention from those individuals who had not. PARTICIPANTS: Participants were 1 567 African American adults who resided in four urban areas in New Jersey. METHODS: From July 2005 to April 2006, university survey center interviewers conducted 7-minute, random-digit-dial telephone interviews. RESULTS: Approximately 3.2 percent reported that they had donated an organ; 3.4 percent reported being an organ recipient; 11.4 percent reported that a family member had donated an organ or tissue; and 12 percent reported that a family member was a recipient. Forty-six percent reported that they had indicated their willingness to be an organ donor when they applied for a driver's license; 37 percent had done so by discussing their wishes with family members. Fewer had signed an organ donor card (21%) or had signed up with an organ donor registry (16%). A multiple logistic regression model revealed a negative association between the respondent's age and whether the respondent had expressed an intention to be a donor, and a positive association between having known a family member who had received or donated an organ and the respondent's intention. Neither gender nor marital status was associated with the intention to donate. CONCLUSIONS: As the driver's license was the means favored by African Americans for declaring their intentions to be organ donors, motor vehicle registries appear to hold the greatest promise for documenting and communicating this intention.

How African Americans express their intentions to be organ donors.

CONTEXT: As part of an organ sharing network's outreach, African American adults were interviewed to assess their awareness of the network's efforts and willingness to donate their organs after death. OBJECTIVE: To describe (1) the proportion who expressed their intentions to be an organ donor, (2) the means they had used, and (3) sociodemographic characteristics of the participants who used a particular means. DESIGN: A repeated, cross-sectional, random-digit dialing telephone interview was conducted from July 2005 (start of wave 1) to April 2006 (end of wave 3). Each interview averaged 7 minutes and consisted of 60 items. SETTING: Trained interviewers placed telephone calls to the residences of African Americans who resided in 1 of 4 New Jersey locales: East Orange/Orange, Irvington, Jersey City/Newark, and Trenton. PARTICIPANTS: One thousand five hundred sixty-seven African Americans, aged 18 to 95 years. MAIN OUTCOME MEASURES: Five Yes/No items were used to determine if participants had declared their intention to be an organ donor via driver's license application, donor card, donor registry, will/healthcare directive, or discussion with a family member. RESULTS: Twenty-seven percent of the participants had expressed their intentions to be an organ donor with an organ donor card, driver's license, donor registry, or will/healthcare directive. The participants who had used one or more of these formal means were 14.4 times more likely to have discussed their intention to be an organ donor with a family member than were the participants who had not.