National Academy Of Medicine Research Articles

Nothing About Patients Without Patients: More Than Just a Catchphrase!

Health care is sometimes called a "team sport," yet patients were traditionally not considered to be "on the team" in medicine. In 2001, the Institute of Medicine (now National Academy of Medicine) published its seminal book Crossing the Quality Chasm, in which patient-centered care was identified as 1 of 6 quality aims. Many organizations have since included patient-centered care as an important aspect of quality, including The Joint Commission, Centers for Medicare and Medicaid, and many large employers. In the past 10 years, the focus on patient-centered care has expanded in the Kaiser Permanente, Southern California region to include innovative ways for patients to collaborate with health care teams to codesign improvement efforts that are truly patient-centered. We will describe 3 important approaches that have greatly increased the patient-centeredness of our organization: individual patient approaches; adding patients onto health care teams; and effectively utilizing patient and family advisory councils. We will provide examples of how all health care organizations can better partner with their patients to improve their ability to provide higher quality, safer, more equitable, and affordable health care. The slogan "Nothing About Patients Without Patients" was an early rallying cry of the patient engagement movement. It conveyed the idea that as with everything else in our society, patients now expect to have a say in the design and implementation of their care. We show that this is not only possible, but also highly effective and even necessary to improving care.

The Relationship between Gestational Weight Gain and Cesarean Delivery among Patients undergoing Induction of Labor.

This study aimed to determine the impact of pregnancy weight gain above National Academy of Medicine (NAM) guidelines on cesarean delivery rates following induction. This is a secondary analysis of a prospective cohort study of patients who underwent induction at a single tertiary care center between July 2017 and July 2019. Included in the primary study were patients undergoing term (≥37 weeks) labor induction with a singleton gestation, intact membranes, and unfavorable cervical examination (Bishop score of ≤6 and cervical dilation ≤ 2 cm). Eligibility for this analysis was limited to patients with a documented prenatal body mass index (BMI) < 20 weeks' gestation. The primary exposure was gestational weight gain greater than NAM guidelines (WGGG) for a patient's initial BMI category. The primary outcome was cesarean delivery for any indication. Of 1,610 patients included in the original cohort, 1,174 (72.9%) met inclusion criteria for this analysis and 517 (44.0%) of these had weight gain above NAM guidelines. Of the entire cohort, 60.0% were Black and 52.7% had private insurance. In total, 160 patients (31%) with WGGG underwent cesarean compared with 127 patients (19.3%) without WGGG (p < 0.001), which equates to a 59% increased odds of cesarean when controlling for initial BMI category, parity, gestational diabetes, and indication for induction (Adjusted Odds Ratio [aOR] 1.58, 95% confidence interval [CI] 1.17-2.12). Among only nulliparous patients, WGGG was associated with an increased odds of cesarean (26.4 vs. 38.2%, aOR 1.50, 95% CI 1.07-2.10). In multiparous patients, however, there was no difference in cesarean between those with and without WGGG (8.8 vs. 14.1%, aOR 1.85, 95% CI 0.96-3.58). This study demonstrates that weight gain above NAM guidelines is associated with more than a 50% increased odds of cesarean. Patients should be informed of this association as gestational weight gain may be a modifiable risk factor for cesarean delivery. · Weight gain above NAM guidelines was associated with a 59% increased odds of cesarean delivery.. · Nulliparous patients with weight gain above NAM guidelines are at higher risk of cesarean delivery.. · No difference in cesarean delivery among multiparous patients regardless of gestational weight gain..

Drug use and spending under a formulary informed by cost-effectiveness.

BACKGROUND: The National Academy of Medicine has called for value-based drug formularies to address health plan prescription drug spending while maintaining access to high-value medicines. Thirty employer-sponsored plans implemented a "Value-Based Formulary-essentials" (VBF-e) program that uses cost-effectiveness evidence to inform cost-sharing and coverage exclusion. OBJECTIVE: To evaluate if the VBF-e was associated with changes in medication use and patient out-of-pocket spending and health plan spending on prescription drugs and other health care. METHODS: This was a cohort study using a difference-in-differences design from 2015 through 2019 with 1 year of follow-up after VBF-e implementation at Premera Blue Cross, the largest nonprofit health plan in the Pacific Northwest. The VBF-e exposure group was composed of all individuals aged younger than 65 years and enrolled at least 12 months prior to their employer group's VBF-e implementation date. The contemporaneous control group was composed of propensity score-matched individuals with the same inclusion criteria but their employer group that did not implement VBF-e. We prespecified the following outcomes: days of medication on hand overall and by VBF-e tier (high-value generic, brand, and specialty drugs were in tiers 1 to 3, respectively, and low-value drugs were in tier 4 or excluded from coverage); prescription drug spending; and other health care use (emergency department visits, hospital days, and outpatient visits). RESULTS: Comparing 12,111 exposed (mean age = 36.0; 49.8% female sex) participants with 24,222 control participants (mean age = 34.7; 49.6% female sex), VBF-e reduced use of low-value drugs by 0.3 days per member per month (PMPM) (95% CI = -0.5 to -0.1; 17% decrease) for tier 4 drugs and 0.4 days PMPM (95% CI = -0.5 to -0.4; 83% decrease) for excluded drugs. High-value specialty drug use increased by 0.1 days PMPM (95% CI = 0.0-0.1; 123% increase). Health plan spending decreased by $14 PMPM (95% CI = -26 to -4) and member out-of-pocket spending increased by $1 PMPM (95% CI = 1-2). Other health care use did not change significantly. CONCLUSIONS: An exclusion formulary informed by cost-effectiveness evidence reduced low-value drug use, increased high-value specialty drug use, reduced health plan spending, and increased member out-of-pocket spending without increasing acute care use. DISCLOSURES: This research was supported by a grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation's Greater Value Portfolio Program. Study Registration Number: NCT04904055.

Parathyroid hormone-vitamin D dynamics vary according to the definition of vitamin D deficiency in newborn infants.

Parathyroid hormone (PTH) is an indirect functional indicator of vitamin D status. Risk of vitamin D deficiency, assessed using circulating 25-hydroxyvitamin D (25(OH)D), is defined as <30nmol/L by the National Academy of Medicine and alternatively <25nmol/L in the global consensus recommendation on prevention and management of nutritional rickets. To test PTH concentrations and the odds for elevated values according to vitamin D deficiency cut-points (<30nmol/L, or <25nmol/L) in newborn infants. Healthy term-born infants (n=858) were recruited from Montreal, Canada (2016-2019). Obstetric data were obtained from medical records, and demographic factors surveyed. Immunoassays were used to measure newborn (24-36h) serum PTH and 25(OH)D; 25(OH)D was standardized to National Institute of Standards and Technology (NIST) standard reference materials. Serum PTH was log-transformed before comparing serum 25(OH)D groups (<30 vs. ≥30; or <25 vs. ≥25nmol/L) using ANCOVA adjusted for infant sex, type of delivery, parity, race, and family income. The odds of elevated PTH (>71.48pg/mL) were tested using logistic regression, adjusted for the same covariates. Infants (50.2% female) were 39.6±1.0weeks gestational age (mean±SD), and 3.41±0.38kg. Median serum 25(OH)D was 45.4 (IQR 23.2) nmol/L; 20.5% had serum 25(OH)D<30nmol/L, and 12.4% <25nmol/L. Median serum PTH was 30.72 (IQR 33.90) pg/mL, elevated in 12.7% overall, and higher in infants born with serum 25(OH)D<25 vs. ≥25nmol/L (35.96 (IQR 39.20) vs. 30.36 (IQR 32.93) pg/mL, p=0.0158). The odds of elevated PTH were higher when serum 25(OH)D was <25nmol/L (ORadj 2.13, 95% CI: 1.23, 3.69). PTH concentration and the odds of being elevated did not differ according to the 30nmol/L cut-point. Based on this study, the definition of vitamin D deficiency relative to bone health as set by the National Academy of Medicine (<30nmol/L) exceeds the threshold at which PTH is elevated in newborn infants.

Practice Guidelines Development: The APSARD United States Guidelines for the Diagnosis and Treatment of ADHD in Adults

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder arising in children that persists in many people for the remainder of their lives. While several diagnostic and treatment guidelines in the United States (US) have been developed for childhood ADHD, no guidelines have been published in the US for adults with ADHD. With the increase of care seeking by adults with ADHD accompanied by increasing ADHD medication prescriptions in the past few years, the American Professional Society for ADHD and Related Disorders Association (APSARD) has recognized the need for diagnostic and treatment guidelines for the US. The development of clinical practice guidelines follows a rigorous scientific process of literature review, conflict of interest management, levels of participation of the working group members, clinical recommendations based on published research, a ranking of the quality of data, and a Delphi process to evaluate the rank order of clinical recommendations with little published research available. The Institute of Medicine (now The National Academy of Medicine) and the American Psychiatric Association have established protocols for each of the aforementioned phases of the manuscript development. This article reviews this process in detail and conveys the complexity of the endeavor. [ Psychiatr Ann . 2023;53(10):449–454.]

Sociotechnical Factors Contributing to Burnout among Radiation Oncology Medical Physicists: Survey and Focus Group Results from a Systems-Analysis Approach

While burnout and contributing factors have been studied among physicians and surgeons, there is limited understanding of the factors contributing to radiation oncology medical physicists' (MPs) burnout. Therefore, this study aims to i) explore factors associated with burnout among MPs using a systems-analysis approach, and ii) identify and prioritize key improvement efforts. We administered a survey to MPs at a US academic medical center between May 19-June 2, 2022. The survey included a 2-item Connor-Davidson Resilience Scale, a 2- item abbreviated Maslach Burnout Inventory (MBI) measuring emotional exhaustion (EE) and depersonalization (DP), and 21 general workplace stressors based on the National Academy of Medicine's systems approach to clinicians' burnout. Participants rated workplace stressor severity on a 5-item Likert scale and priorities for improvement on a 4-item Likert scale. Burnout was categorized using a 2-Question Summative Score totaling >3 for EE and DP. Focus groups were held with ∼3 participants per group via a video conferencing platform on June 8-9, 2022. Survey results from top-rated workplace stressors and priorities were summarized and presented to focus groups. Participants were asked open-ended questions to promote discussion and elicit more contextual information about workplace stressors and to rank their highest priority stressors at the end of the focus group. Of the 12 MPs the survey was sent to, 8 responses (67%) were received. Table 1 summarizes the results. The mean resilience score was 6.88, with a standard deviation (SD) of 0.63. 87.5% (n = 7) of MPs identified themselves as burned out. The key workplace stressors contributing most to MPs' burnout were inadequate staffing (mean [SD] 3.1 [1.2]), work-life integration (3.1 [1.2]), excessive workload (2.8 [1.1]), and time pressure (2.6 [1.2]). Specifically, MPs suggested following improvements: i) hire additional physicists to cover clinic responsibilities, ii) limit or compensate for work done post-work hours, iii) improve scheduling workflow, and iv) retain hybrid work model. Survey data demonstrated moderate resilience but high levels of burnout among MPs. Results indicate inadequate staffing as the most severe workplace stressor and highest priority for improvement efforts and remained the top priority even after focus groups. These results warrant further studies with larger sample sizes, assessing factors contributing to burnout among MPs and systems-focused interventions.

Screening for Financial Hardship: Comparing Patient Survey Responses Using Two Different Screening Tools.

Healthcare delivery organizations are increasingly screening patients for social risks using tools that vary in content and length. To compare two screening tools both containing questions related to financial hardship. Cross-sectional survey. Convenience sample of adult patients (n = 471) in three primary care clinics. Participants randomly assigned to self-complete either: (1) a screening tool developed by the Centers for Medicare & Medicaid Services (CMS) consisting of six questions on financial hardship (housing stability, housing quality, food security, transportation security, utilities security); or (2) social and behavioral risk measures recommended by the National Academy of Medicine (NAM), including one question on financial hardship (financial strain). We compared patient acceptability of screening, positive screening rates for financial hardship, patient interest in assistance, and self-rated health. Ninety-one percent of eligible/interested patients completed the relevant survey questions to be included in the study (N = 471/516). Patient acceptability was high for both tools, though more participants reported screening was appropriate when answering the CMS versus NAM questions (87% vs. 79%, p = 0.02). Of respondents completing the CMS tool, 57% (132/232) reported at least one type of financial hardship; on the NAM survey, 52% (125/239) reported financial hardship (p = 0.36). Nearly twice as many respondents indicated interest in assistance related to financial hardship after completing items on the CMS tool than on the NAM question (39% vs. 21%, p < 0.01). Patients reported high acceptability of both social risk assessment tools. While rates of positive screens for financial hardship were similar across the two measures, more patients indicated interest in assistance after answering questions about financial hardship on the CMS tool. This might be because the screening questions on the CMS tool help patients to appreciate the types of assistance related to financial hardship that may be available after screening. Future research should assess the validity and comparative validity of individual measures and measure sets. Tool selection should be based on setting and population served, screening goals, and resources available.

Systematic review of the association between talc and female reproductive tract cancers.

Talc is a hydrous magnesium sheet silicate used in cosmetic powders, ceramics, paints, rubber, and many other products. We conducted a systematic review of the potential carcinogenicity of genitally applied talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM, now the National Academy of Medicine) and several US EPA frameworks for systematic reviews, evaluating and integrating the epidemiological, animal, and mechanistic literature on talc and cancer. We conducted a comprehensive literature search. Detailed data abstraction and study quality evaluation, adapting the Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 40 primary studies that assessed exposure to talc and female reproductive cancer risks in humans (n = 36) and animals (n = 4). The results of our evaluation emphasize the importance of considering biological plausibility and study quality in systematic review. Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between perineal application of talcum powders and risk of ovarian cancer at human-relevant exposure levels. We also concluded that there is suggestive evidence of no association between genital talc application and endometrial cancer, and insufficient evidence to determine whether a causal association exists between genital talc application and cervical cancer based on a smaller but largely null body of literature.

Surmounting Barriers to Healthcare Data and Information: International Case Studies

Objective: In this article, the authors review the progress in healthcare interoperability from 2010 to 2023 from an international perspective. Countries covered here include the Republic of China (Taiwan), the Republic of Croatia, the Republic of Estonia, and the Commonwealth of Australia. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations,” as defined by the Institute of Electrical and Electronic Engineers (IEEE). This is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting. Methodology: A literature review was conducted on established interoperability standards and systems in healthcare based on information obtained from journal publications, government, academy reports, published materials, and publicly available websites. Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: 1) inter-facility (macro-tier) interoperability, 2) intra-facility (meso-tier) interoperability, and 3) Point-of-Care (micro-tier) interoperability. The authors assessed the adoption levels of each standard by looking at factors that support or limit its systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made in instances where verifiable data are available. Results: Presented here is an evaluation of four interoperability parameters: 1) device/equipment interoperability, 2) compatibility issues, 3) involved organizations, and 4) migration and conversion issues. Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information in the mobile devices, Internet of Things (IoT), and electronic health records (HER) sectors, there remains space for improvement. The recent development of the Trusted Exchange Framework and Common Agreement (TEFCA) framework has significantly reduced the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, may also be an effective strategy for consolidating healthcare data and improving information exchange.

Surmounting Barriers to Healthcare Data and Information: Cases in Point, the U.S. Experience

Objective: The authors review the progress in healthcare interoperability from 2010 to 2023 in the United States. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations”, as defined by the IEEE (Institute of Electrical and Electronic Engineers). This is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting. Methodology: A literature review was conducted on established interoperability standards and systems in healthcare based on information obtained from journal publications, government, academy reports, published materials, as well as publicly available websites. Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: 1) inter-facility (macro-tier) interoperability, 2) intra-facility (meso-tier) interoperability, and 3) Point-of-Care (micro-tier) interoperability. An evaluation of four interoperability parameters: 1) device/equipment interoperability, 2) compatibility issues, 3) involved organizations, and 4) migration and conversion issues are presented. The evaluation assessed the adoption levels of each standard by looking at factors that support or limit its systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made in instances where verifiable data were available. Results: This review reveals that… Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information, in the mobile devices, Internet of Things (IoT), and electronic health record (HER) sectors, there remains space for improvement. The recent development of the Trusted Exchange Framework and Common Agreement (TEFCA) greatly reduces the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, might also be an effective strategy for consolidating healthcare data and improving information exchange.

Pragmatic Approaches to Interoperability – Surmounting Barriers to Healthcare Data and Information Across Organizations and Political Boundaries

Objective This paper provides a review of the landscape of interoperability efforts in healthcare from 2010 to 2023, in the US and abroad. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations”, as defined by the IEEE (Institute of Electrical and Electronic Engineers). This review is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting. Methodology and Results A literature review was conducted on established interoperability standards and systems in healthcare, based on information obtained from journal publications, government, academy reports, published materials, and publicly available websites. The review emphasizes four interoperability parameters: device/equipment interoperability, compatibility issues, involved organizations, and migration and conversion issues. It evaluates adoption levels for each standard, evaluating factors supporting and/or limiting systemic adoption. Estimations on the number of users – both medical professionals and patients – for each system were made in instances where verifiable data were available. Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: Inter-facility (macro-tier) interoperability, Intra-facility (meso-tier) interoperability, and Point-of-care (micro-tier) interoperability. Conclusions Despite many parallel ongoing efforts to improve the standardization of healthcare information, in the mobile devices, IoT, and EHR sectors, there is still more space for improvement. The recent development of the TEFCA framework has greatly reduced the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, may also be an effective strategy for consolidating healthcare data and improving information exchange.

The decision aid is the easy part: workflow challenges of shared decision making in cancer care.

Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision making to improve patient-centered care, but widespread adoption of shared decision making into clinical care has been limited. Shared decision making is a process in which a patient and the patient's health-care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient on the basis of their values, preferences, and goals for care. Patients who engage in shared decision making report higher quality of care, whereas patients who are less involved in these decisions have statistically significantly higher decisional regret and are less satisfied. Decision aids can improve shared decision making-for example, by eliciting patient values and preferences that can then be shared with clinicians and by providing patients with information that may influence their decisions. However, integrating decision aids into the workflows of routine care is challenging. In this commentary, we explore 3 workflow-related barriers to shared decision making: the who, when, and how of decision aid implementation in clinical practice. We introduce readers to human factors engineering and demonstrate its potential value to decision aid design through a case study of breast cancer surgical treatment decision making. By better employing the methods and principles of human factors engineering, we can improve decision aid integration, shared decision making, and ultimately patient-centered cancer outcomes.

Effects of putative metformin targets on phenotypic age and leukocyte telomere length: a mendelian randomisation study using data from the UK Biobank

Metformin, a first-line medication for type 2 diabetes, might also have a protective effect against ageing-related diseases, but so far little experimental evidence is available. We sought to assess the target-specific effect of metformin on biomarkers of ageing in the UK Biobank. In this drug target mendelian randomisation study, we assessed the target-specific effect of four putative targets of metformin (AMPK, ETFDH, GPD1, and PEN2), involving ten genes. Genetic variants with evidence of causation of gene expression, glycated haemoglobin A1c (HbA1c), and colocalisation were used as instruments mimicking the target-specific effect of metformin via HbA1c lowering. The biomarkers of ageing considered were phenotypic age (PhenoAge) and leukocyte telomere length. To triangulate the evidence, we also assessed the effect of HbA1c on the outcomes using a polygenic mendelian randomisation design and assessed the effect of metformin use on these outcomes using a cross-sectional observational design. GPD1-induced HbA1c lowering was associated with younger PhenoAge (β -5·26, 95% CI -6·69 to -3·83) and longer leukocyte telomere length (β 0·28, 0·03 to 0·53), and AMPKγ2 (PRKAG2)-induced HbA1c lowering was associated with younger PhenoAge (β -4·88, -7·14 to -2·62) but not with longer leukocyte telomere length. Genetically predicted HbA1c lowering was associated with younger PhenoAge (β -0·96 per SD lowering of HbA1c, 95% CI -1·19 to -0·74) but not associated with leukocyte telomere length. In the propensity score matched analysis, metformin use was associated with younger PhenoAge (β -0·36, 95% CI -0·59 to -0·13) but not with leukocyte telomere length. This study provides genetic validation evidence that metformin might promote healthy ageing via targets GPD1 and AMPKγ2 (PRKAG2), and the effect could be in part due to its glycaemic property. Our findings support further clinical research into metformin and longevity. Healthy Longevity Catalyst Award, National Academy of Medicine, and Seed Fund for Basic Research, The University of Hong Kong.

The Concept of Light Food Ration for Military Personnel of the Russian Federation or LFR. Minimization of Weight and Size Indicators

Introduction. The conditions for the use of individual food rations (IFR) by military personnel during hostilities impose specific requirements on IFR development and the products chosen for the rations. The complex effect of various stress factors which lead to metabolic disorders in the body and protein-energy deficiency characterizes the conditions of nutrition and functioning of the human body as extreme. The difficulty or impossibility of timely food provision jeopardizes the fulfillment of military personnel's tasks and requires the achievement of minimum weight and size parameters of the diet to increase personnels' autonomy while simultaneously providing the necessary nutrients and energy.Purpose. The study substantiates the possibility of using alternative traditional products to form the diet food matrix. In the context of the article, these are the products of deep technical conversion or structural modification (derivative products), primarily proteins, carbohydrates and fats from various sources of raw materials.Materials and Methods. Analysis of information published in domestic and foreign literature concerning the basic scientific foundations of the theories of balanced and adequate nutrition, functional human nutrition under extreme conditions, research papers of US National Academies divisions including Committee on Optimization of Nutrient Composition of Military Rations for Short-Term, High-Stress Situations, Committee on Military Nutrition Research, Food and Nutrition Board, National Academy of Medicine, requirements for the diet of military personnel of the Armed Forces of the Russian Federation and NATO countries, concept of a nutritious food, emergency nutrient norms and standards was used to determine the required adequate amount of macronutrients and micronutrients in the formation of the LFR food matrix.Results. A comparative analysis of the nutrient content, energy value, and bulk density of the IFR products and powdered forms of derivative products reveals the advantages of the latter, which provide minimization of weight and size indicators, adequate satisfaction of the need for basic macro and micronutrients, metabolizable energy, improvement of the functional parameters of military personnel. The expected economic effect from non-traditional products is estimated as savings from reduced logistics costs and purchase price. The presented conceptual groundwork shows the prospects and expediency of further practical development and creation of a light diet based on non-traditional products in light food rations. In addition, this approach contributes to the solution of one of the main tasks in Military Doctrine of the Russian Federation which is improvement of the military-economic support of the military organization based on the rational use of financial, material and other resources.

Editorial introductions.

Editorial introductions.

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

Sunrise Over Baltimore.

This address calls for eliminating health care disparities and was delivered for the inaugural David G. Nichols Health Equity award at the 2022 Pediatric Academic Societies meeting. As I contemplate the meaning of this award, I am the first to recognize that it is much larger than the current and future recipients and carries far more significance than the person after whom it is being named. This award represents our shared commitment to advancing the health of all children, which cannot be done unless it is done equitably, as called for by the National Academy of Medicine over 2 decades ago.1 I share my journey toward equity and eliminating health care disparities for children with the hope that it will encourage others.

Combining Frameworks to Improve Military Health System Quality and Cybersecurity

Existing conceptual frameworks and commercially available technology could be considered to rapidly operationalize the use of Quality Measures (QM) within military health systems (Costantino et al. 2020). Purchased healthcare as well as digital healthcare services have paved the way for data collection from multiple information systems thus offering stakeholders actionable intelligence to both guide and measure healthcare outcomes. However, the collection of data secondary to Smart Devices, disparate information systems, cloud services, and the Internet of Medical Things (IOMT) is a complication for security experts that also affect clients, stakeholders, organizations, and businesses delivering patient care. We have combined three conceptual frameworks: (1) Donabedian’s Quality Attributes Framework (DQA), (2) The National Academy of Medicine (NAM) framework, and the (3) Healthcare and Public Health (HPH) Cybersecurity Framework (HCF). Each of these frameworks is well-tested, widely accepted, and referenced as the gold standard in delivering quality care (DQA and NAM) and cybersecurity (HCF) for healthcare. Separately, each framework provides long-used analysis, guidance, and application of quality reliable measures of healthcare services. The combined frameworksmay enhance data integrity (collection and standardized safety of data in regard to regulatory compliance). The combined frameworks also support identifying gaps in quality of care, support the prioritization of cost-effective methodologies that predictably improve patient outcomes, and support DHA’s quality measures. Finally, we offer the importance of understanding the components of quality measures in a more precise manner while maintaining information technology (IT) governance compliance.

The National Academy of Medicine at 50: Celebrating the Past and Envisioning the Future.

The National Academy of Medicine at 50: Celebrating the Past and Envisioning the Future.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.