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Outterson K.,Boston University | Outterson K.,Royal Institute of International Affairs | Outterson K.,Preventions Antimicrobial Resistance Working Group | Powers J.H.,George Washington University | And 2 more authors.
Health Affairs | Year: 2015

Multidrug-resistant bacterial diseases pose serious and growing threats to human health. While innovation is important to all areas of health research, it is uniquely important in antibiotics. Resistance destroys the fruit of prior research, making it necessary to constantly innovate to avoid falling back into a pre-antibiotic era. But investment is declining in antibiotics, driven by competition from older antibiotics, the cost and uncertainty of the development process, and limited reimbursement incentives. Good public health practices curb inappropriate antibiotic use, making return on investment challenging in payment systems based on sales volume. We assess the impact of recent initiatives to improve antibiotic innovation, reflecting experience with all sixty-seven new molecular entity antibiotics approved by the Food and Drug Administration since 1980. Our analysis incorporates data and insights derived from several multistakeholder initiatives under way involving governments and the private sector on both sides of the Atlantic. We propose three specific reforms that could revitalize innovations that protect public health, while promoting long-term sustainability: increased incentives for antibiotic research and development, surveillance, and stewardship; greater targeting of incentives to high-priority public health needs, including reimbursement that is delinked from volume of drug use; and enhanced global collaboration, including a global treaty. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.

Curley M.,National University of Ireland, Maynooth | Kenneally J.,Value Innovation
Proceedings - IEEE International Enterprise Distributed Object Computing Workshop, EDOC | Year: 2011

This paper gives a short overview of the IT Capability Maturity Framework (IT-CMF) and describes how it was used between 2007-2009 to help Intel IT navigate and track progress on IT capability improvement and value contribution from IT, whilst negotiating a strategic transition for the IT organization which involved significant downsizing and budget reduction. The case study illustrates how the ITCMF was used to measure capability improvements, provide business intelligence information and prioritized improvement recommendations. The paper also discusses how practices contained within the IT-CMF helped articulate a business value improvement whilst more traditional metrics of IT performance indicated a degradation in performance. © 2011 IEEE.

The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ≥4 points for men and ≥3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to "gold standard" measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening--positive or negative based on AUDIT-C scores--can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results--positive or negative screens based on the AUDIT-C score--that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C.

Fukunishi Y.,Japan National Institute of Advanced Industrial Science and Technology | Fukunishi Y.,Value Innovation | Nakamura H.,Japan National Institute of Advanced Industrial Science and Technology | Nakamura H.,Osaka University
Protein Science | Year: 2011

A new approach to predicting the ligand-binding sites of proteins was developed, using protein-ligand docking computation. In this method, many compounds in a random library are docked onto the whole protein surface. We assumed that the true ligand-binding site would exhibit stronger affinity to the compounds in the random library than the other sites, even if the random library did not include the ligand corresponding to the true binding site. We also assumed that the affinity of the true ligand-binding site would be correlated to the docking scores of the compounds in the random library, if the ligand-binding site was correctly predicted. We call this method the molecular-docking binding-site finding (MolSite) method. The MolSite method was applied to 89 known protein-ligand complex structures extracted from the Protein Data Bank, and it predicted the correct binding sites with about 80-99% accuracy, when only the single top-ranked site was adopted. In addition, the average docking score was weakly correlated to the experimental protein-ligand binding free energy, with a correlation coefficient of 0.44. © 2010 The Protein Society.

Melzer A.C.,University of Washington | Uman J.,Value Innovation | Au D.H.,Value Innovation
Annals of the American Thoracic Society | Year: 2015

Rationale: Diabetes and hypertension are common among patients with airflow limitation and contribute to cardiovascular (CV) mortality, one of the leading causes of death among patients with airflow limitation. Objectives: Our goal was to examine the association of severity of airflow limitation with adherence to medications for hypertension and diabetes. Methods: We identified 7,359 veterans with hypertension and/or diabetes in the Veterans Integrated Service Network-20. Entry date into the cohort was defined as the date of a patient's first pulmonary function testing (PFT). Diagnostic codes (ICD-9), PFT, and pharmacy data were available via the electronic medical record or via direct interrogation of PFT equipment. Our primary exposure was airflow limitation defined as FEV1 ≥80% predicted (normal), 80 > FEV1 ≥50% predicted (mild/moderate), 50 > FEV1 ≥30% predicted (severe), and FEV1 < 30% predicted (very severe). We assessed adherence using a validated method based on electronic pharmacy refill data and defined adherence as ≥80% medication possession for the period 6-12 months after enrollment. Medications of interest included b-blockers, calcium channel blockers, thiazides, and angiotensin-converting-enzyme inhibitors for patients with hypertension, and metformin and sulfonylureas for patients with diabetes. We used logistic regression models to assess the association between severity of airflow limitation and adherence, adjusted for demographics, health behaviors, and comorbidities. Measurements and Main Results: Overall adherence was poor (44.6-55.1%).Among patients with hypertension,when compared with subjects with normal FEV1, subjects with each category lower of FEV1 were less adherent to b-blockers, with an odds ratio (OR) of 0.87 (95% confidence interval [CI], 0.80-0.95); calcium channel blockers, with an OR of 0.83 (95% CI, 0.74-0.93); and angiotensinconverting-enzyme inhibitors with an OR of 0.91 (95% CI, 0.84-0.99). Airflow limitation was not associated with adherence to thiazides. Among patients with diabetes, we found no significant association of FEV1 with adherence, although a similar lower trend with increasing airflow limitation. In a sensitivity analysis limited to patients with chronic obstructive pulmonary disease, we found a nonstatistically significant trend for decreased adherence to b-blockers, calcium channel blockers, and angiotensin-converting-enzyme inhibitors in subjects with higher GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage. Conclusions: Severity of airflow limitation is associated with decreased adherence to b-blockers, calcium channel blockers, and angiotensin-converting-enzyme inhibitors. The decreased adherence to these medications may be related to adverse effects on symptoms in patients with lung disease, and may partially explain excess CV mortality in these patients. Copyright © 2015 by the American Thoracic Society.

Glass J.E.,University of Wisconsin - Madison | Williams E.C.,Value Innovation | Williams E.C.,University of Washington | Bucholz K.K.,University of Washington
Alcoholism: Clinical and Experimental Research | Year: 2014

Background: Alcohol use disorder (AUD) is among the most stigmatized health conditions and is frequently comorbid with mood, anxiety, and drug use disorders. Theoretical frameworks have conceptualized stigma-related stress as a predictor of psychiatric disorders. We described profiles of psychiatric comorbidity among people with AUD and compared levels of perceived alcohol stigma across profiles. Methods: Cross-sectional data were analyzed from a general population sample of U.S. adults with past-year DSM-5 AUD (n = 3,368) from the National Epidemiologic Survey on Alcohol and Related Conditions, which was collected from 2001 to 2005. Empirically derived psychiatric comorbidity profiles were established with latent class analysis, and mean levels of perceived alcohol stigma were compared across the latent classes while adjusting for sociodemographic characteristics and AUD severity. Results: Four classes of psychiatric comorbidity emerged within this AUD sample, including those with: (i) high comorbidity, reflecting internalizing (i.e., mood and anxiety disorders) and externalizing (i.e., antisocial personality and drug use disorders) disorders; (ii) externalizing comorbidity; (iii) internalizing comorbidity; and (iv) no comorbidity. Perceived alcohol stigma was significantly higher in those with internalizing comorbidity (but not those with high comorbidity) as compared to those with no comorbidity or externalizing comorbidity. Conclusions: Perceived stigma, as manifested by anticipations of social rejection and discrimination, may increase risk of internalizing psychiatric comorbidity. Alternatively, internalizing psychiatric comorbidity could sensitize affected individuals to perceive more negative attitudes toward them. Future research is needed to understand causal and bidirectional associations between alcohol stigma and psychiatric comorbidity. © 2014 by the Research Society on Alcoholism.

Daniel G.W.,Engelberg Center for Health Care Reform at Brookings | Caze A.,Deerfield Institute | Romine M.H.,Engelberg Center for Health Care Reform at Brookings | Audibert C.,Deerfield Institute | And 2 more authors.
Health Affairs | Year: 2015

New drugs and biologics have had a tremendous impact on the treatment of many diseases. However, available measures suggest that pharmaceutical innovation has remained relatively flat, despite substantial growth in research and development spending. We review recent literature on pharmaceutical innovation to identify limitations in measuring and assessing innovation, and we describe the framework and collaborative approach we are using to develop more comprehensive, publicly available metrics for innovation. Our research teams at the Brookings Institution and Deerfield Institute are collaborating with experts from multiple areas of drug development and regulatory review to identify and collect comprehensive data elements related to key development and regulatory characteristics for each new molecular entity approved over the past several decades in the United States and the European Union. Subsequent phases of our effort will add data on downstream product use and patient outcomes and will also include drugs that have failed or been abandoned in development. Such a database will enable researchers to better analyze the drivers of drug innovation, trends in the output of new medicines, and the effect of policy efforts designed to improve innovation. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.

Turner J.P.,Value Innovation | Rodriguez H.E.,Northwestern University | Daskin M.S.,University of Michigan | Mehrotra S.,Northwestern University | And 2 more authors.
Annals of Surgery | Year: 2012

Objective: Because continuity of care (CC) is a necessary component of resident education, this analysis was done to understand what keeps CC between residents and patients low and how it can be most effectively improved. Background: Many authors lament low CC between residents and patients, especially in the era of duty hour regulations. Some have tried lengthening rotations, some have tried increasing clinic attendance, and some have argued for various training models. Little detailed analysis has been done to identify root causes of low CC or ways to improve it. METHODS:: Two months of charts were reviewed to estimate baseline CC on a vascular surgery rotation. Probability theory and engineering simulations were used to determine whether CC can be enhanced by (a) lengthening rotations, (b) altering observed logistical patterns, (c) using a "resident return" model where residents are able to see patients postoperatively even if moved to a different rotation, or (d) employing an apprenticeship model. Results: Baseline analysis showed residents had 0% CC given 131 opportunities to do so. Probability analysis and the simulation outcomes suggest that rotation length plays a minor role in achieving CC. Logistical changes showed some improvement in CC, but not as much as using an apprenticeship rotation model. Conclusions: The limitations placed on CC by rotation duration are real, but lengthening the rotation does not meaningfully resolve the gap between acceptable CC levels and actual levels. Although CC can be enhanced with longer rotations if coupled with the use of the resident return model, the greater barrier to CC is the logistical patterns such as where residents spend time, how cases are assigned, and the lack of an alert system to inform residents about returning postoperative patients. The apprenticeship model enables residents to achieve CC closer to that of the faculty. © 2012 Lippincott Williams & Wilkins.

McClellan M.,Value Innovation | Kent J.,Boston Consulting Groups London office | Beales S.J.,Imperial College London | Cohen S.I.,University of Cambridge | And 4 more authors.
Health Affairs | Year: 2014

Accountable care-a way to align health care payments with patient-focused reform goals-is currently being pursued in the United States, but its principles are also being applied in many other countries. In this article we review experiences with such reforms to offer a globally applicable definition of an accountable care system and propose a conceptual framework for characterizing and assessing accountable care reforms. The framework consists of five components: population, outcomes, metrics and learning, payments and incentives, and coordinated delivery. We describe how the framework applies to accountable care reforms that are already being implemented in Spain and Singapore. We also describe how it can be used to map progress through increasingly sophisticated levels of reforms. We recommend that policy makers pursuing accountable care reforms emphasize the following steps: highlight population health and wellness instead of just treating illness; pay for outcomes instead of activities; create a more favorable environment for collaboration and coordinated care; and promote interoperable data systems. © 2014 by Project HOPE - The People-to-People Health Foundation, Inc.

Agency: National Science Foundation | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 150.00K | Year: 2010

This Small Business Innovation Research (SBIR) research project will develop a software-as-a-service toolkit for innovation processes and service oriented educational simulation for the value innovation process, applicable to both business educational needs and to the crucial college and K-12 demographic, where the core of STEM education takes place and where the principals of innovation should be directed if they are to properly influence future business innovators. Innovation, even more than entrepreneurship, is crucial to US competitiveness in the current global business environment. However, the current education and business environment lacks both a formal set of deployable tools that can facilitate the innovation process and a means of providing outcome testable training and education on innovation. Both are crucial to not only implementing processes of innovation, but to facilitating an innovation culture in an organization. The education will leverage the suite of service oriented, web-based tools that can be used to support an organization's innovation efforts with minimal impact on the organizations existing innovation or information technology structure. Innovation is one of the hottest topics in business today, with CEO's understanding that it's the engine driving their company's organic growth. However, most organizations do not have the knowledge or skill base to apply the concepts of innovation to their business' practices. This lack can be attributed to two problems: first, the company's employees often lack a basic understanding of innovation owing to a deficiency during their formal education and, second, the company lacks a usable set of tools that make an innovation process easily adaptable to the organization's situation and needs. The Value Innovation Teaching Toolkit addresses both unmet needs. By providing an educational simulation applicable to both business training needs and the educational needs of students in formal STEM programs at the university and K-12 level, the toolkit will provide the learner with an innovation learning environment that is outcome tested. Additionally, our toolkit will provide a suite of web-based tools that will facilitate the innovation process with minimal impact on an organization's current IT infrastructure.

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