Human Services Administration Research Articles

Concomitant Filled Prescriptions of Oxymorphone or Oxycodone with CYP3A Inhibitors and Inducers.

Oxymorphone's metabolism does not involve the hepatic cytochrome P450 (CYP) system. The effect of this pharmacokinetic feature of oxymorphone on opioid prescribing is unknown. To assess the relative frequency with which oxymorphone and oxycodone (a CYP3A-metabolized opioid analgesic) were each prescribed to patients concomitantly receiving CYP3A-modifying drugs (i.e., inducers and inhibitors) to characterize opioid-prescribing patterns in patients at risk for CYP3A-related drug interactions. We analyzed the Sentinel Distributed Database from January 1, 2013, to December 31, 2016, to identify the proportion of patients with concomitant dispensing of selected CYP3A modifiers among initiators of oxymorphone. We then repeated the analysis using oxycodone instead of oxymorphone. We conducted sensitivity analyses that varied the washout periods for each opioid to account for potential opioid switching. In the primary analysis, the proportion of patients with concomitant incident dispensings of oxymorphone and selected CYP3A modifiers was 3.26% (95% CI = 3.09%-3.43%), and the proportion of patients with incident dispensings of oxycodone and selected CYP3A modifiers was 2.82% (95% CI = 2.79%-2.85%). The difference between proportions was 0.43% (95% CI = 0.26%-0.60%). Sensitivity analyses that varied the washout periods for each opioid with respect to the other opioid to account for switching yielded similar results. We observed similar proportions of patients using selected CYP3A modifiers concomitantly with both oxymorphone and oxycodone. While the CIs of the point estimates did not overlap, the absolute differences between the proportions were small. This project was supported by Task Order HHSF22301001T under Master Agreement HHSF223201400030I from the U.S. Food and Drug Administration (FDA). The FDA approved the study protocol, including the statistical analysis plan, and reviewed and approved the manuscript. Coauthors from the FDA participated in the results interpretation and in the preparation and decision to submit the manuscript for publication. Coyle, Money, Staffa, Meyer, and Woods are employed by the FDA. The other authors have no financial conflicts of interest to report. The views expressed are those of the authors and not necessarily those of the U.S. Department of Health and Human Services, U.S. Food and Drug Administration.

Rethinking Distribution and Design: A New Look for the Journal of Health and Human Services Administration

Rethinking Distribution and Design: A New Look for the <i>Journal of Health and Human Services Administration</i>

Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study

Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study

Multidisciplinary Teams Knock Down Barriers to Medication Treatment for OUD

Multidisciplinary Teams Knock Down Barriers to Medication Treatment for OUD

Characterizing the Use of Direct Oral Anticoagulants in Children Using the American Thrombosis and Hemostasis Network Dataset (ATHNdataset)

Background: The incidence of venous thromboembolism (VTE) in children has risen significantly. (Raffini, Huang et al. 2009) There are currently four direct oral anticoagulants (DOACs) - apixaban, dabigatran, edoxaban, and rivaroxaban - approved for the acute treatment and prevention of VTE in adults. Advantages of these medications over the traditionally used anticoagulants, enoxaparin and warfarin, include fixed dosing, no need for routine laboratory monitoring, few drug interactions and no dietary restrictions. Despite lack of information on the safety and efficacy of these agents in children, pediatric hematologists across the United States are using DOACs in their patients based on extrapolated data from adult studies. The American Thrombosis and Hemostasis Network (ATHN) is a nonprofit network of over 140 federally funded Hemophilia Treatment Centers (HTCs) which provides the infrastructure for clinical and surveillance-based research. ATHN maintains the ATHNdataset (ADS), a "limited dataset" free of protected health information, with data collected on patients with bleeding and clotting disorders at participating HTCs within the Human Resources and Services Administration (HRSA)-supported regional hemophilia networks across the US. The authors acknowledge ATHN, the ATHN-affiliated U. S. Hemophilia Treatment Centers and their 39,000+ patients who have contributed their demographic, clinical, and genetic information to the ATHNdataset. Methods: The objective of this study was to describe the characteristics of pediatric patients diagnosed with VTE in the ADS, focusing on those patients who received a DOAC. Data were abstracted for patients in the ADS who had acute VTE at age &lt;21 years from January 2010 to March 2019. Data extraction included basic demographics and information about VTE and treatment. Results : A total of 1,094 pediatric VTE cases were captured in the ADS. 577 (52.7%) were male. Caucasians were the most prevalent racial group (n = 809; 74%), followed by African-Americans (n = 203; 18.6%).14.9% (n = 163) were Hispanic. Deep venous thrombosis (DVT) was the most prevalent pediatric VTE reported in the ADS (n=889, 81.3%), followed by pulmonary embolism and cerebral venous thrombosis (n=130, 11.9% and n=40, 3.7% respectively). VTE location by age group is listed in Table 1. The most common DVT location was the lower extremities or pelvis, comprising 37.5% (n = 333) of all reported DVTs. Upper extremities or upper thorax DVT occurred less often (n = 211; 23.8 %). 345 (38.8 %) cases were reported only as "DVT" without a specific thrombus location. We reviewed 1,051 anticoagulant prescriptions for 650 VTE patients (mean 1.6 prescriptions per person). Enoxaparin was the most commonly prescribed anticoagulant (n = 676 prescriptions; 64.3%) followed by warfarin (n = 178 prescriptions, 16.9%). Interestingly, 116 (11%) patients, from 21 HTCs, had a DOAC prescribed as their anticoagulant regimen. Anticoagulant prescription by anticoagulant starting age is shown in Table 2. Further analysis of the DOAC subgroup showed that rivaroxaban was the most prescribed DOAC with 77.6% (n = 90/116) of the patients using this agent. Apixaban and dabigatran use was also reported (n= 23, 19.8% and n= 3, 2.6% respectively). The majority of DOACs were prescribed for patients older than 13 years of (111/116, 95.7 %). In children between 3 to 6 years of age (n = 3), rivaroxaban was the only DOAC prescribed. DOACs were primarily used to treat DVT of the extremities (84/116 patients). Other scenarios in which DOACs were also prescribed were PE and abdominal venous thrombosis patients (26, and 4 patients, respectively). Anticoagulant prescription by anticoagulant starting age is shown in Table 2. Conclusion: DVT of the lower extremities and pelvis is the most prevalent pediatric VTE in the ADS. Enoxaparin and warfarin remain the main anticoagulant agents used for pediatric VTE treatment. Despite lack of an FDA-approved pediatric indication, hematologists in US-based HTCs are already using DOACs in pediatric patients with VTE. As further characterization of DOAC use in children is needed, the authors, in collaboration with ATHN, are currently building a multi-institutional retrospective and prospective registry, ATHN 15. This registry will serve as a resource for pediatric hematologists to collect real-world use of DOACs in children, as we await the results of prospective clinical trials. Disclosures Davila: Octapharma: Other: Grant to attend VWD meeting ; Genentech: Other: Advisory board; Spire Learning: Speakers Bureau. Raffini:Bayer: Other: Advisory Board; CSL Behring: Other: Advisory Board; Roche: Other: Advisory Board. Thornburg:Sanofi Genzyme: Research Funding; Bluebird bio: Other: Data Safety Monitoring Board; Genentech: Speakers Bureau; NovoNordisk: Research Funding; Ironwood: Other: Data Safety Monitoring Board; Sanofi Genzyme: Other: Data Safety Monitoring Board. Corrales-Medina:Octapharma: Membership on an entity's Board of Directors or advisory committees; Kedrion: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda-Shire: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Study Protocol for ‘Informing American Muslims about Organ Donation (I AM a LD)’

Background: American Muslims tend to hold more negative attitudes towards organ donation than other American populations, and these attitudes are contributed to by gaps in biomedical and religious knowledge. As a result, there is significant need for religiously-tailored health education on organ donation within this community. Thus our study sought to test the effectiveness of a mosque-based, religiously-tailored health education program that addressed biomedical and religious knowledge gaps regarding living organ donation amongst Muslim Americans.&#x0D; Methods: A randomized, controlled, cross-over trial of religiously-tailored educational workshops held at four mosques in Washington D.C. and Chicagoland. Mosques are randomized into early and late intervention arms and participants are recruited at worship services and other mosque events. The primary study outcomes are changes in biomedical and religious knowledge regarding living organ donation. Secondary outcomes include change in procedural knowledge about the process and types of living organ donation, beliefs regarding organ donation, and religious knowledge regarding end-of-life care.&#x0D; Funding and Ethics: This study is supported by a grant from the U.S. Human Services Health Resources and Services Administration and received ethics approval from the University of Chicago’s Biological Sciences Division Institutional Review Board.

Liver transplantation and waitlist mortality for HCC and non-HCC candidates following the 2015 HCC exception policy change.

Historically, exception points for hepatocellular carcinoma (HCC) led to higher transplant rates and lower waitlist mortality for HCC candidates compared to non-HCC candidates. As of October 2015, HCC candidates must wait 6months after initial application to obtain exception points; the impact of this policy remains unstudied. Using 2013-2017 SRTR data, we identified 39 350 adult, first-time, active waitlist candidates and compared deceased donor liver transplant (DDLT) rates and waitlist mortality/dropout for HCC versus non-HCC candidates before (October 8, 2013-October 7, 2015, prepolicy) and after (October 8, 2015-October 7, 2017, postpolicy) the policy change using Cox and competing risks regression, respectively. Compared to non-HCC candidates with the same calculated MELD, HCC candidates had a 3.6-fold higher rate of DDLT prepolicy (aHR=3.49 3.69 3.89 ) and a 2.2-fold higher rate of DDLT postpolicy (aHR=2.09 2.21 2.34 ). Compared to non-HCC candidates with the same allocation priority, HCC candidates had a 37% lower risk of waitlist mortality/dropout prepolicy (asHR=0.54 0.63 0.73 ) and a comparable risk of mortality/dropout postpolicy (asHR=0.81 0.95 1.11 ). Following the policy change, the DDLT advantage for HCC candidates remained, albeit dramatically attenuated, without any substantial increase in waitlist mortality/dropout. In the context of sickest-first liver allocation, the revised policy seems to have established allocation equity for HCC and non-HCC candidates.

Insights from outside BJOG

Insights from outside BJOG

Non-viral pathogens: Identification, relevance, and prevention for xenotransplantation.

For xenotransplantation, strategies to prevent transmission of microorganisms from the source animal to the human recipient must be closely coordinated since tissues and organs are classified as non-sterile. Strategies for international cooperation and coordination of xenogeneic infection / disease surveillance and response are available. The regulatory frameworks and criteria on microbial safety as published by World Health Organization (WHO), European Pharmacopoeia (Ph. Eur.), European Medicines Agency (EMA) as well as U.S. Department of Health and Human Services (DHHS), Food and Drug Administration (FDA) and Center for Biologics Evaluation and Research (CBER), are outlined. Different sources of microbial germs are considered including potential infectious agents. Monitoring of livestock and testing of xenografts is accompanied by positive and negative controls to detect and to exclude tissue specific microorganisms such as bacteria. The criteria of microbial status to be considered for xenotransplants are summarized.

Privacy preservation in data intensive environment

Healthcare data frameworks have enormously expanded accessibility of medicinal reports and profited human services administration and research work. In many cases, there are developing worries about protection in sharing restorative files. Protection procedures for unstructured restorative content spotlight on recognition and expulsion of patient identifiers from the content, which might be lacking for safeguarding privacy and information utility. For medicinal services, maybe related exploration thinks about the therapeutic records of patients ought to be recovered from various destinations with various regulations on the divulgence of healthcare data.

Abstract WP240: Regional Disparities in Stroke Transfers for Endovascular Treatment- Outcomes from the Early Years of Neurointervention

Introduction: Acute stroke care has been revolutionized with the advent of intravenous alteplase and endovascular therapy. The number of centers in the United States equipped to offer endovascular therapy are limited, often necessitating inter-hospital transfer. We studied the outcomes of such patients in terms of mortality and disability, and attempted to determine the possible contributory factors in the early years of neurointervention for acute stroke management. Methods: We used the Nationwide Inpatient Sample data to identify the acute stroke patients requiring transfer for endovascular treatment, the National Center for Health Statistics data to determine their location, the United States Census Bureau website for determining the population demographics, the Joint Commission data on the distribution of Primary Advanced and Comprehensive Stroke Centers, and the Human Resources and Services Administration data on delivery of medical care. We compared the outcomes in the four major regions of the country in terms of mortality and disability at discharge. Results: Age above 80 years (p&lt;0.05) and a high Charlson’s co-morbidity index (p&lt;0.01) were consistent predictors for increased disability in transferred patients receiving endovascular therapy. Age greater than 80 years was also a predictor for higher mortality (p&lt;0.001) in all regions. The prevalence of significant disability was higher in the Midwest compared to the national average (p=0.0147). Conclusion: Distribution of healthcare facilities capable of offering endovascular treatments affects time to treatment and consequently, outcomes. Strategic triage system and distribution of Primary Advanced and Comprehensive Stroke Centers could help reduce disparities of outcomes.

NewSTEPs: The Establishment of a National Newborn Screening Technical Assistance Resource Center.

As newborn screening (NBS) programs in the US implement expanded screening panels, utilize emerging technologies and identify areas for improvement, the need to establish and maintain a community engagement based national technical assistance center becomes apparent. The Newborn Screening Technical assistance and Evaluation Program (NewSTEPs)—a program of the Association of Public Health Laboratories (APHL) in partnership with the Colorado School of Public Health (ColoradoSPH), offers expertise in newborn screening program development, member connection, data analysis, and program evaluation. NewSTEPs provides a secure online data repository designed to collect comprehensive data on newborn screening programs in three strata: state profiles (description of each state program including program hours, fees, and disorders screened), quality indicators (metrics of program performance encompassing screening accuracy and timeliness) and NBS public health surveillance case definitions. NewSTEPs was created in 2012 under a cooperative agreement with the United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Successful activities of NewSTEPs have resulted in the establishment of a technical assistance resource center and the organization of a network of newborn screening experts. In addition, NewSTEPs coordinates efforts with other federally funded programs in order to maximize resources and to ensure a unified approach to data collection and information sharing.

Commentary

Commentary

(Invited) From Discovery through to Commercialization: Federal Support

As a Program Director at the National Science Foundation (NSF) working in the Mathematical and Physical Sciences Directorate, most efforts deal with supporting the discovery aspects of science – creating/revealing new materials or phenomena, improving the understanding of scientific underpinnings, and/or establishing new techniques and approaches. However, many NSF programmatic funding opportunities have an option to link to industrial partners through a mechanism called Grant Opportunities for Academic Liaison with Industry (GOALI). Also, there are centers across NSF that foster partnerships with industry; some include mandates to do so. The locus on going beyond discovery to applications at NSF lies within the Engineering Directorate, particularly in the Division of Industrial Innovation and Partnerships (IIP). NSF is not alone in these undertakings; many Federal agencies have such efforts. The recently released 2016 National Academies report, Triennial Review of the National Nanotechnology Initiative (https://doi.org/10.17226/23603) summarizes many of these efforts to address technology transition. The Nanotechnology Innovation and Commercialization Ecosystem (NICE) Working Group chartered by the Nanoscale Science, Engineering, and Technology (NSET) Subcommittee (https://www.nano.gov/about-nni/working-groups) is interested in further identification of activities to improve technology exchange across the 20 Federal departments and independent agencies engaged in the National Nanotechnology Initiative (NNI). This region between discovery and commercialization is often described in some circles as the Valley of Death – however, the National Institutes of Health discusses stages from basic science research through four translational phases: humans, patients, practice, and community where each occurs in conjunction with clinical trials. The assortment of programs available reflects the different agency missions, their attention to pinpointing specific hurdles in the process, and the importance of realizing economic benefits from the research. One example, the Small Business Technology Transfer (STTR) program, fosters technology transfer through cooperative R&D between research institutions and small businesses. Participating organizations include the Department of Defense (DOD), Department of Energy (DOE), Department of Health and Human Services (HHS), National Aeronautics and Space Administration (NASA) and NSF. Another example, Innovation Corps (I-Corps), teaches grantees to identify valuable product opportunities that can emerge from academic research, and offers entrepreneurship training facilitated by domain experts. Both NSF and NIH participate. These and other model programs will be discussed.

Allele-level HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis

The standard for selecting unrelated umbilical cord blood units for transplantation for non-malignant diseases relies on antigen-level (lower resolution) HLA typing for HLA-A and HLA-B, and allele-level for HLA-DRB1. We aimed to study the effects of allele-level matching at a higher resolution-HLA-A, HLA-B, HLA-C, and HLA-DRB1, which is the standard used for adult unrelated volunteer donor transplantation for non-malignant diseases-for umbilical cord blood transplantation. We retrospectively studied 1199 paediatric donor-recipient pairs with allele-level HLA matching who received a single unit umbilical cord blood transplantation for non-malignant diseases reported to the Center for International Blood and Marrow Transplant Research or Eurocord and European Group for Blood and Marrow Transplant. Transplantations occurred between Jan 1, 2000, and Dec 31, 2012. The primary outcome was overall survival. The effect of HLA matching on survival was studied using a Cox regression model. Compared with HLA-matched transplantations, mortality was higher with transplantations mismatched at two (hazard ratio [HR] 1·55, 95% CI 1·08-2·21, p=0·018), three (2·04, 1·44-2·89, p=0·0001), and four or more alleles (3·15, 2·16-4·58, p<0·0001). There were no significant differences in mortality between transplantations that were matched and mismatched at one allele (HR 1·18, 95% CI 0·80-1·72, p=0·39). Other factors associated with higher mortality included recipient cytomegalovirus seropositivity (HR 1·40, 95% CI 1·13-1·74, p=0·0020), reduced intensity compared with myeloablative conditioning regimens (HR 1·36, 1·10-1·68, p=0·0041), transplantation of units with total nucleated cell dose of more than 21 × 107 cells per kg compared with 21 × 107 cells per kg or less (HR 1·47, 1·11-1·95, p=0·0076), and transplantations done in 2000-05 compared with those done in 2006-12 (HR 1·64, 1·31-2·04, p<0·0001). The 5-year overall survival adjusted for recipient cytomegalovirus serostatus, conditioning regimen intensity, total nucleated cell dose, and transplantation period was 79% (95% CI 74-85) after HLA matched, 76% (71-81) after one allele mismatched, 70% (65-75) after two alleles mismatched, 62% (57-68) after three alleles mismatched, and 49% (41-57) after four or more alleles mismatched transplantations. Graft failure was the predominant cause of mortality. These data support a change from current practice in that selection of unrelated umbilical cord blood units for transplantation for non-malignant diseases should consider allele-level HLA matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1. National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute for Allergy and Infectious Diseases; US Department of Health and Human Services-Health Resources and Services Administration; and US Department of Navy.

Healthcare reform in the Middle East and the USA.

Mustafa Z Younis speaks to Laura Dormer, Commissioning Editor: Dr Mustafa Z Younis is an internationally recognized scholar and was a member of the Executive Committee of the International Society for Research of Healthcare Financial Management. Dr Younis has authored and published over 200 articles, abstracts and presentations in refereed journals and meetings, and has presented at national and international conferences. Dr Younis has administrative experience as Senior Adviser for the President at Zirve University, Turkey and as Chair of the Department of Health Policy and Management at Florida International University (FL, USA) where he led the accreditation efforts for the Healthcare Management Program. Dr Younis has a history of playing visible roles on the editorial boards of journals as Chief Editor, Guest Editor and Editorial board member of leading journals such as Journal of International Medical Research, Journal of Health Care Finance, Inquiry, Journal of Health and Human Services Administration, Journal of Public Budgeting, Accounting and Financial Management. Dr Younis is a frequent speaker for both academic and professional audiences. His talks often feature his latest research and work in progress as well as cross-industry trends and strategy implications. He has provided workshops and presentation for wide organizations. His research and findings applied to for-profit, non-profit settings, and government. Dr Younis has consulted with several organizations on healthcare finance, and economics. Dr Younis is often invited to speak about the challenges in the healthcare industry and other related topics to health economics, finance, and research. He has presented topics such as, healthcare reform, ownership structure, profitability, unit cost, payment system and efficiency in management, at a variety of forums and conferences in Europe, Asia and Middle East.

A Comparison of Telemental Health Terminology Used Across Mental Health State Licensure Boards

Mental health care professional shortage areas fall across the United States (Rural Assistance Center, 2015). According to the Health Resources and Services Administration, there is an immediate need for approximately 4,000 mental health providers nationwide (Kaiser Family Foundation, 2014). According to the Bureau for Labor Statistics (2014), the mental health counselor workforce is not distributed in proportion to the need. The National Institute of Mental Health (2014) estimated 43.6 million adults aged 18 or older in the United States suffered from some form of mental illness in the past year. Many individuals' mental health needs go untreated due to gaps in resources or delivery of services (Brown, 1998; Gibson, Morley, & Romeo-Wolff, 2002; Modai et al., 2006).The U.S. government has demonstrated a strong commitment to the development, promotion and integration of technology-assisted care into the U.S. health care system through ongoing work in telemental health (Godleski, Nieves, Darkins, & Lehmann, 2008; National Center for Telehealth & Technology, 2011, 2015; Pruitt & Woodside, 2015). In addition, the government has issued numerous grants for telemental health and other health services for license reciprocity (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2015), established the Office for the Advancement of Telehealth, and published the 2015 Treatment Improvement Protocol (Substance Abuse and Mental Health Services Administration, 2015).Pruitt, Luxton, and Shore (2014) stated that home-based telemental health has several important benefits for both patients and clinical practitioners including improved access to services, convenience, flexibility, and potential cost savings (p. 340). Policymakers and advocates view telehealth technology as particularly promising given the continuing shortage of mental health clinicians and long travel distances to obtain care (Lambert, Gale, Hansen, Croll, & Hartley, 2013).With advancements in technology and the availability of the Internet, mental health care providers have sought new ways to integrate technology into practice (Maheu, Pulier, Wilhelm, McMenamin, & Brown-Connolly, 2005), including implementing technology in scheduling appointments, distributing assessments and providing treatment services. Using Internet-based videoconferencing, mental health care providers can easily connect with clients without requiring in-office meetings (Baker & Bufka, 2011). Some individuals will not or cannot seek mental health services when inperson services are needed; therefore, the in-person treatment process becomes a treatment barrier (Bensink, Hailey, & Wootton, 2006). According to Brown (1998), some individuals fail to seek mental health services due to geographical restrictions. Other individuals may struggle with physical health restrictions, preventing them from seeking traditional, in-office services. Mental health conditions such as panic disorder (Klein, Richards, & Austin, 2006), agoraphobia and eating disorders (Zabinski, Celio, Wilfley, & Taylor, 2003) may restrict individuals from receiving traditional services. Using Internet-based services, mental health practitioners can reach clients who are in rural locations, who are seriously ill or who do not seek traditional counseling.While the use of technology increases access to care, the technology itself creates new, unique challenges and potential risks for mental health providers (Baker & Bufka, 2011). Fifteen years ago, Riemer-Reiss (2000) discussed utilizing distance technology in mental health practice, listing foreseeable concerns for practitioners. More recent publications (Barnett & Kolmes, 2016a, 2016b) present similar concerns and questions for mental health providers. Counselors must attain competency in working with special populations or in specific practice areas, including the use of telemental health services (Baker & Bufka, 2011; Barnett & Kolmes, 2016a, 2016b). …

Leprosy and Lack of Awareness in U.S. Clinicians

ABSTRACT Hansen’s disease, synonymously and commonly referred to as leprosy, is an important consideration when treating any chronic skin disorder and rheumatologic disorder. Personal clinical experience and a review of the literature highlight a lack of awareness for this disease by U.S. clinicians. In this country, accurate diagnosis is delayed. One cannot ensure swift and proper treatment without timely, accurate diagnosis. Unfortunately, severe debilitating nerve and tissue damage can occur within months. The authors draw upon recent personal and clinical experiences diagnosing and treating cases of the disease during a current resurgence in Florida. The authors aim to encourage readers to increase awareness for this ancient disease. In doing so, its relevance today and essential points in diagnosis and treatment are emphasized. This article is a compilation of our recent clinical experiences, in consultation with one of the world’s leading authorities in the diagnosis and treatment of the disease and its complications: The National Hansen’s Disease Program within the U.S. Department of Health and Human Services, Health Resources and Services Administration, Baton Rouge, Louisiana.

Learn More About Value-Based Payment

In January 2015, the US Department of Health and Human Services administration set goals for value-based payments within the Medicare fee-for-service system and invited private sector payers to match or exceed them…

What’s the Latest on Acrylamide?

What’s the Latest on Acrylamide?