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News Article | November 22, 2016
Site: www.eurekalert.org

The international community needs to stand up for medical neutrality in war zones, and mandate the UN Security Council to act in the face of persistent and blatant breaches of the Geneva Convention, urge global health experts in an editorial in the online journal BMJ Global Health. Some 196 countries ratified the International Humanitarian Law, which specifically promotes medical neutrality and protection of medical services for people in war zones, as set out in the four Geneva Conventions of 1949.Breaches of the law, which was modified in 1977 and 2005 to strengthen it further, are regarded as war crimes, because of their impact on civilians and medical staff who have a duty of care to those wounded in war-torn countries. "But over the years, war crimes have persisted with little or no definitive action by the international community to stem the tide," insist the authors, Drs Soumitra Bhuyan, School of Public Health, University of Memphis, Ikenna Ebuenyi, King's College London and London School of Hygiene and Tropical Medicine, and Jay Bhatt, The Health Research and Educational Trust, Chicago. The inaction dates back to the 1970s in Mozambigue, and is still evident today in Syria, Iraq, Afghanistan and South Sudan, they point out. And the destruction of healthcare facilities around the world shows no sign of abating. In 2015-16, 600 such attacks were recorded--228 of them in Syria alone--killing1000 people and injuring more than 1500 others. According to data from the World Health Organization, 113 healthcare facilities in 17 countries were attacked in the first 6 months of the 2016 alone. And as of the first week of October, every hospital in eastern Aleppo in Syria has been hit at least once, with one of the main trauma hospitals hit four times within a 5-day period. Since the war in Syria started, 654 doctors and nurses have lost their lives. The impact of these attacks is "enormous," say the authors, outlining the psychological trauma for the survivors and the erosion of preventive healthcare, such as vaccinations and infectious disease control. "The [International Humanitarian Law] is explicit and provides for the protection of patients, health facilities, health personnel and patients in times of war as long as they are not directly involved in hostilities," they write. "The international community needs to rise to the occasion and match action with words by mandating the United Nations Security Council to provide protection for health facilities in war zones and enter into dialogue with government and warring groups to respect the principles of medical neutrality in conflict areas," they urge. This means that the Council and governments of all nations need to develop some form of punishment that would deter aggressors from further breaches of the legislation and educate armed forces personnel to respect medical neutrality and the Geneva Convention, they say. Editorial: Persisting trend in the breach of medical neutrality: a wake-up call to the international community http://gh. BMJ Global Health is one of 60 specialist journals published by BMJ. http://gh.


Lemak C.H.,University of Alabama at Birmingham | Nahra T.A.,University of Michigan | Cohen G.R.,University of Michigan | Erb N.D.,Health Research and Educational Trust | And 3 more authors.
Health Affairs | Year: 2015

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.


DesRoches C.M.,Mathematica Policy Research | Charles D.,United Information Technology | Furukawa M.F.,United Information Technology | Joshi M.S.,Health Research and Educational Trust | And 4 more authors.
Health Affairs | Year: 2013

The US health care system is in the midst of an enormous change in the way health care providers and hospitals document, monitor, and share information about health and care delivery. Part of this transition involves a wholesale, but currently uneven, shift from paper-based records to electronic health record (EHR) systems. We used the most recent longitudinal survey of US hospitals to track how they are adopting and using EHR systems. Only 44 percent of hospitals report having and using what we define as at least a basic EHR system. And although 42.2 percent meet all of the federal stage 1 "meaningful-use" criteria, only 5.1 percent could meet the broader set of stage 2 criteria. Large urban hospitals continue to outpace rural and nonteaching hospitals in adopting EHR systems. The increase in adoption overall suggests that the positive and negative financial incentives currently in place across the US health care system are working as intended. However, achieving a nationwide health information technology infrastructure may require efforts targeted at smaller and rural hospitals. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.


Fakih M.G.,St John Hospital And Medical Center | George C.,Michigan Health and Hospital Association | Edson B.S.,Health Research and Educational Trust | Goeschel C.A.,Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality | Saint S.,University of Michigan
Infection Control and Hospital Epidemiology | Year: 2013

Catheter-associated urinary tract infection (CAUTI) represents a significant proportion of healthcare-associated infections (HAIs). The US Department of Health and Human Services issued a plan to reduce HAIs with a target 25% reduction of CAUTI by 2013. Michigan's successful collaborative to reduce unnecessary use of urinary catheters and CAUTI was based on a partnership between diverse hospitals, the state hospital association (SHA), and academic medical centers. Taking the lessons learned from Michigan, we are now spreading this work throughout the 50 states. This national spread leverages the expertise of different groups and organizations for the unified goal of reducing catheter-related harm. The key components of the project are (1) centralized coordination of the effort and dissemination of information to SHAs and hospitals, (2) data collection based on established definitions and approaches, (3) focused guidance on the technical practices that will prevent CAUTI, (4) emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges), and (5) partnering with specialty organizations and governmental agencies who have expertise in the relevant subject area. The work may serve in the future as a model for other large improvement efforts to address other hospital-acquired conditions, such as venous thromboembolism and falls. © 2013 by The Society for Healthcare Epidemiology of America.


Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Kaiser Family Foundation | Damico A.,University of Chicago | Kenward K.,Health Research and Educational Trust | Osei-Anto A.,Brandeis University
Health Affairs | Year: 2012

Health care premiums rose moderately for single and family employer-sponsored coverage this year, the 2012 annual Kaiser Family Foundation/Health Research and Educational Trust (HRET) Survey of Employer Health Benefits found. Even with the lingering effects of the recession, cost-sharing levels remained relatively stable in 2012. Also remaining stable was the rate at which employers offered coverage, according to the survey, which was based on telephone interviews with 2,121 public and private employers contacted from January through May 2012. The average annual premiums in 2012 were $5,615 for single coverage and $15,745 for family coverage, an increase of 3 and 4 percent, respectively, from 2011. The percentage of firms offering health benefits, 61 percent, was similar to last year's, as was the percentage of workers at offering firms who were covered by their firm's health benefits, 62 percent. One noteworthy change, because of a provision of the Affordable Care Act, is that 2.9 million young adults who would not otherwise have been enrolled in a parent's employer-sponsored health insurance were covered by that insurance in 2012. © 2012 Project HOPE- The People-to-People Health Foundation, Inc.


Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Kaiser Family Foundation | Panchal N.,Kaiser Family Foundation | Damico A.,Kaiser Family Foundation | And 3 more authors.
Health Affairs | Year: 2013

Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm's health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.


McHugh M.,Northwestern University | Van Dyke K.,Health Research and Educational Trust | Osei-Anto A.,Health Research and Educational Trust | Haque A.,National Quality Forum
Medical Care Research and Review | Year: 2011

In 2008, Medicare implemented a policy limiting reimbursement to hospitals for treating avoidable hospital-acquired conditions (HACs). Although the policy will expand nationally to Medicaid programs in 2011, little is known about the impact on safety net hospitals. The authors conducted interviews with 60 chief quality officers and 55 chief financial officers from safety net hospitals to explore the impact of Medicare's HACs policy during its first year. Despite the predicted small financial impact, the authors found that the policy gained the attention of hospital leaders and many governing boards. Although the policy reportedly provided additional motivation to reduce HACs, few hospitals implemented new care practices and instead focused on documenting conditions that are present for patients on admission. The findings also illustrate the need for Centers for Medicare & Medicaid Services to provide more guidance to the industry when this type of policy is introduced. © SAGE Publications 2011.


Jha A.K.,Harvard University | DesRoches C.M.,HealthCare Partners | Kralovec P.D.,Health Forum | Joshi M.S.,Health Research and Educational Trust
Health Affairs | Year: 2010

Given the substantial federal financial incentives soon to be available to providers who make "meaningful use" of electronic health records, tracking the progress of this health care technology conversion is a policy priority. Using a recent survey of U.S. hospitals, we found that the share of hospitals that had adopted either basic or comprehensive electronic records has risen modestly, from 8.7 percent in 2008 to 11.9 percent in 2009. Small, public, and rural hospitals were less likely to embrace electronic records than their larger, private, and urban counterparts. Only 2 percent of U.S. hospitals reported having electronic health records that would allow them to meet the federal government's "meaningful use" criteria. These findings underscore the fact that the transition to a digital health care system is likely to be a long one. © 2010 Project HOPE- The People-to-People Health Foundation, Inc.


Claxton G.,Henry J Kaiser Family Foundation | Rae M.,Henry J Kaiser Family Foundation | Panchal N.,Henry J Kaiser Family Foundation | Whitmore H.,University of Chicago | And 3 more authors.
Health Affairs | Year: 2015

The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. The percentage of firms offering health benefits and the percentage of workers covered by their employers' plans remained statistically unchanged from 2014. Eighty-one percent of covered workers were enrolled in a plan with a general annual deductible. Among those workers, the average deductible for single coverage was $1,318. Half of large employers either offered employees the opportunity or required them to complete biometric screening. Of firms that offer an incentive for completing the screening, 20 percent provide employees with incentives or penalties that are tied to meeting those biometric outcomes. The 2015 survey included new questions on financial incentives to complete wellness programs and meet specified biometric outcomes as well as questions about narrow networks and employers' strategies related to the high-cost plan tax and the employer shared-responsibility provisions of the Affordable Care Act. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.


Yu J.B.,Yale University | Soulos P.R.,Yale University | Herrin J.,Yale University | Herrin J.,Health Research and Educational Trust | And 5 more authors.
Journal of the National Cancer Institute | Year: 2013

BackgroundProton radiotherapy (PRT) is an emerging treatment for prostate cancer despite limited knowledge of clinical benefit or potential harms compared with other types of radiotherapy. We therefore compared patterns of PRT use, cost, and early toxicity among Medicare beneficiaries with prostate cancer with those of intensity-modulated radiotherapy (IMRT).MethodsWe performed a retrospective study of all Medicare beneficiaries aged greater than or equal to 66 years who received PRT or IMRT for prostate cancer during 2008 and/or 2009. We used multivariable logistic regression to identify factors associated with receipt of PRT. To assess toxicity, each PRT patient was matched with two IMRT patients with similar clinical and sociodemographic characteristics. The main outcome measures were receipt of PRT or IMRT, Medicare reimbursement for each treatment, and early genitourinary, gastrointestinal, and other toxicity. All statistical tests were two-sided.ResultsWe identified 27,647 men; 553 (2%) received PRT and 27,094 (98%) received IMRT. Patients receiving PRT were younger, healthier, and from more affluent areas than patients receiving IMRT. Median Medicare reimbursement was $32,428 for PRT and $18,575 for IMRT. Although PRT was associated with a statistically significant reduction in genitourinary toxicity at 6 months compared with IMRT (5.9% vs 9.5%; odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.96, P =. 03), at 12 months post-treatment there was no difference in genitourinary toxicity (18.8% vs 17.5%; OR = 1.08, 95% CI = 0.76 to 1.54, P =. 66). There was no statistically significant difference in gastrointestinal or other toxicity at 6 months or 12 months post-treatment.ConclusionsAlthough PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment. © 2012 The Author.

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