BackgroundThe field and practice of equitable measurement and evaluation has advanced greatly through the work of organizations such as the Equitable Evaluation Initiative and We all Count: Project for Equity in Data Science. Organizations such as AIR have demonstrated that shared measurement can be a powerful tool for advancing equity at the systems level. Based on the case example of Rise to Health: A National Coalition for Equity in Health Care, we will share strategies and lessons learned to-date about developing a set of impact measures that are meaningful, sensitive to improvement, and usable for both improvement and evaluation.ObjectivesA measurement steering committee guided work of selection of measures that were intended to: Focus the field’s attention and effort on the most important indicators of progress towards vision; Help assess the association between short-term activities and 5–10 year impact; Support the production and sharing of knowledge about what improves health equity; Advance equity through the activity of meaningful, equitable measurement; Align with and reinforce key messages, narratives, and values of the Coalition.MethodsWe will describe approaches for measurement development including partnering with interested experts and people with lived experiences of inequity, multi-modal input and feedback processes including a modified Delphi process, and the development and application of measurement criteria and rubrics.ResultsOur work resulted in a proposed set of 20 measures across 4 impact areas (Access, Workforce, Quality & Safety, Social & Structural Drivers of Health), including at least four patient-reported items and six concepts for new measures to develop.ConclusionsChallenges that also presented as opportunities for innovation included navigating tension between selecting and spreading existing measures versus championing the development of new ones, and balancing measures relevant to specific audiences versus an initiative overall.

Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7). Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.

<div class="section abstract"><div class="htmlview paragraph">This paper outlines the history and background of the NLGI (formerly known as the National Lubricating Grease Institute) lubricating grease specifications, GC-LB classification of Automotive Service Greases as well as details on the development of new requirements for their High-Performance Multiuse (HPM) grease certification program.</div><div class="htmlview paragraph">The performance of commercial lubricating grease formulations through NLGI's Certification Mark using the GC-LB Classification system and the recently introduced HPM grease certification program will be discussed. These certification programs have provided an internationally recognized specification for lubricating grease and automotive manufacturers, users and consumers since 1989. Although originally conceived as a specification for greases for the re-lubrication of automotive chassis and wheel bearings, GC-LB is today recognized as a mark of quality for a variety of different applications. The main driving force to upgrade GC-LB was that six of the 12 property test methods utilized in ASTM D4950 had major issues, requiring either revised, alternative or new test methods. In addition to the issues associated with the test methods, NLGI recognized that advancements in materials, technologies and applications would be better served by newer specifications. The initiative that began as an update to the GC-LB specification then led to the introduction of the HPM specifications.</div><div class="htmlview paragraph">Analysis of GC-LB certified greases showed that most commercial greases also claimed other enhanced properties such as high load carrying, saltwater rust resistance, water resistance and long life in addition to meeting the GC-LB requirements. By 2019, NLGI’s Specification Working Group had developed a draft specification with proposed changes to upgrade the GC-LB classification. This draft was further modified through interviews, surveys and in-depth discussion with members of the lubricating grease industry. The initial focus was on updated specifications for a High-Performance Multiuse grease that could be used in a variety of bearings and applications which require similar lubricating properties. Additional specifications were defined as part of the HPM specification for all these properties except long life. Long life (+LL) and High Temperature (+HT) properties are currently being addressed in Phase 2 of the HPM Grease Certification Program. Additionally, the low temperature specification was added to the HPM specification after interest was shown during the interview and feedback process.</div></div>

This research aims to evaluate the properties of basic oxygen furnace slag (BOFS) as aggregates used in Superior Performing Asphalt Pavements (Superpave) mix design. A total of five different aggregates, including one limestone and four BOFS aggregates with different ages, were evaluated by the following aggregate properties: specific gravity, water absorption, Los Angles abrasion, aggregate crushing value, angularity, flakiness, soundness (sulfate chemical and freeze-thaw resistance), and expansion characteristics. Then, the volume stability of the hot mix asphalt (HMA) mixture was also discussed based on the aging effect of BOFS aggregate. Test results indicated that aged BOFS aggregate performs better than unaged BOFS aggregate: Aged BOFS aggregate has lower water absorption, lower aggregate crushing value, higher abrasion resistance, and less expansion. The flakiness and angularity of BOFS aggregates were satisfied with Superpave criteria. However, if free-lime (f-CaO) and free magnesium (f-MgO) in BOFS aggregate exist, it may cause the volume stability of asphalt mixtures with BOFS aggregate. In conclusion, if BOFS is appropriately aged and weathered, BOFS can be an alternative to conventional aggregate.

Chlorate is an effective herbicide, but also a by-product of chlorinating agents used to disinfect water, one of the reasons why it is regularly found in food. Perchlorate is a ubiquitous contaminant, which is naturally occurring in the environment but also released from anthropogenic sources such as the industrial use of certain natural fertilizers. Chlorate affects the hematological system, and perchlorate the thyroid. Implement and validate a simple and robust analytical method for the accurate determination of chlorate and perchlorate in baby food, infant and adult formulas, and ingredients thereof, which is suited for its application in routine environments where a broad variety of food commodities must be analyzed simultaneously. Typically, analytes are extracted with a mixture of water, acidified methanol and dichloromethane. Optionally, for dairy products and byproducts, extraction can be performed with water, acidified methanol and EDTA, followed by two steps clean-up (freezing-out and dispersive solid phase extraction with C18 in acetonitrile). Quantitative determination is carried out by isotopic dilution liquid chromatography tandem mass spectrometry (LC-MS/MS). The method was single laboratory validated in five Nestlé Quality Assurance Centers (NQACs) in a comprehensive range of representative matrices of different categories such as baby foods, infant/adult formulas and ingredients, with results generally in agreement with the acceptance criteria of the Standard Method Performance Requirements (SMPR) 2021.001 defined by AOAC INTERNATIONAL, in terms of representative matrices validated, LOQs, trueness and precision.

The purpose of this research is to develop a set of continuous glucose monitoring (CGM)-related measure concepts to be tested in a health care system. Existing measures assessing the quality of diabetes care do not include modern approaches to diabetes management, such as CGM. Continuous glucose monitors rival traditional methods of measuring diabetes management by providing real-time, longitudinal data and demonstrating glucose variability over time. The Improving Diabetes Quality Initiative seeks to address this gap in diabetes quality measurement. A Technical Expert Panel (TEP) was convened to curate a diabetes quality measures portfolio and conceptualize three new CGM-related quality measures within the portfolio. From the additional measure concepts identified in the portfolio, the TEP prioritized three for conceptualization. High-level measure concept specifications were made available during a public comment period. The measure concepts prioritized by the TEP included a shared decision-making measure to assess the value of initiating CGM for disease management, a utilization measure to address disparities in access and use of CGM, and a patient-provider review of CGM data to promote routine consideration of these assessments in treatment and ongoing management. Clinical literature, public comments, and TEP feedback informed full measure specifications. The evolution of diabetes technology reflects the need to shift diabetes quality of care. The measure concepts will be tested in a flexible pilot setting to understand the future of diabetes care and communicate the value of CGM to people with diabetes, providers, and payers.

Policy Points A decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support. A 2020 poll that probed both support for one public option approach (Medicare "buy-in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts. Although the COVID-19 pandemic viscerally highlighted the need for a more coherent health care system-including universal coverage-other recent evolutions in the broader US political context could undermine reform.

Antibiotics are essential medications for treating life-threatening infections. However, incorrect prescribing can lead to adverse events and contribute to antibiotic resistance. We sought to develop a utilization quality measure that could be used by health insurance plans to track overall prescribing for respiratory conditions. A consensus-based process that included evidence review, testing, and stakeholder input was used to develop a measure and assess its usefulness for the Healthcare Effectiveness Data and Information Set (HEDIS), a national quality measurement tool. Guidelines and literature were reviewed to establish the rationale for the measure. The measure was tested in claims data for commercial, Medicaid and Medicare Advantage enrollees to assess feasibility of collecting and reporting needed information. The measure was vetted with multistakeholder advisory panels and posted for public comment to solicit wide input on relevance and usability. Respiratory conditions are frequent reasons for outpatient care in the data assessed. On average, across all lines of business, the measure revealed that approximately one-third of outpatient visits for respiratory conditions are followed by antibiotics. Stakeholders supported the measure as a tool for monitoring antibiotic prescribing across health plans alongside existing measures that assess inappropriate prescribing for specific conditions. The final measure assesses the number of antibiotic prescriptions dispensed across all outpatient respiratory-related encounters at a health-plan level. The measure on antibiotic prescribing for respiratory conditions was relevant, feasible, and useful. Stakeholders strongly supported the newly developed measure and recommended its integration into HEDIS.