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Newsletter Article


Recent Commonwealth Fund reports and Fund-supported studies in the professional literature.

Toward a High Performance Health System: New Commonwealth Fund Commission. Karen Davis, Ph.D. Health Affairs, September/October 2005. Fund president Karen Davis discusses the rationale behind the Fund's new Commission on a High Performance Health System, the key issues to be addressed, and the range of activities the commission will pursue.

Functional Gaps in Attaining a National Health Information Network. Rainu Kaushal, M.D., M.P.H., David W. Bates, M.D., M.Sc., Eric G. Poon, M.D., M.P.H. et al. Health Affairs, September/October 2005. In this study, the authors estimate implementation of health information technologies will likely triple or quadruple in the next five years.

The Value of Electronic Health Records in Solo or Small Group Practices. Robert H. Miller, Ph.D., Christopher West, Tiffany Martin Brown, M.A., Ida Sim, M.D., Ph.D., and Chris Ganchoff, M.A. Health Affairs, September/October 2005. The authors conducted 14 case studies of solo or small primary care practices that had used electronic health records (EHRs) for one to three years, and determined that small physician practices recouped the cost of investing in EHRs in two-and-a-half years.

Health and Productivity Among U.S. Workers. Karen Davis, Ph.D., Sara R. Collins, Ph.D., Michelle M. Doty, Ph.D., Alice Ho, and Alyssa L. Holmgren. September 2005. Health problems among working-age Americans and their families carry an estimated price tag of $260 billion in lost productivity each year, according to this study.

Resident Physicians' Preparedness to Provide Cross-Cultural Care. Joel S. Weissman, Ph.D., Joseph R. Betancourt, M.D., M.P.H., Eric G. Campbell, Ph.D. et al., Journal of the American Medical Association, September 7, 2005. In this study, doctors-in-training say they don't feel prepared to provide all patients with culturally competent care.

Mixed Messages: Resident Physicians' Experiences Learning Cross-Cultural Care. Elyse R. Park, Ph.D., Joseph R. Betancourt, M.D., M.P.H., Minah K. Kim, Ph.D. et al., Academic Medicine, September 2005. Medical residents feel that cross-cultural care, although endorsed by their training institutions, is a low priority in their curricula due to lack of time and resources, according to this study.

Advising Patients About Patient Safety: Current Initiatives Risk Shifting Responsibility. Vikki A. Entwistle, M.Sc., Ph.D., Michelle M. Mello, J.D., Ph.D., M.Phil., and Troyen A. Brennan, M.D., J.D., M.P.H. Joint Commission Journal on Quality and Patient Safety, September 2005. According to this study's authors, federal agencies, health care quality organizations, consumer advocacy groups, and others have created brochures to educate patients about ways to avoid harm from medical errors, but the advice contained in these materials may not always be effective or appropriate.

The Costs of a National Health Information Network. Rainu Kaushal, M.D., M.P.H., David Blumenthal, M.D., M.P.P., Eric G. Poon, M.D., M.P.H. et al., Annals of Internal Medicine, August 2, 2005. The authors of this study determine that achieving an ideal national health information network will cost $156 billion over five years in capital investment and $48 billion in annual operating costs.

How Medical Claims Simplification Can Impede Delivery of Child Developmental Services. Anne Markus, J.D., Ph.D., M.H.S., Sara Rosenbaum, J.D., Alexandra Stewart, J.D. et al. August 2005. The authors argue that federal regulations originally designed to streamline the health care system may unintentionally limit coverage for vital child developmental services.

Best Practices in Specialty Provider Recruitment and Retention: Challenges and Solutions. Karen L. Brodsky, M.H.S. August 2005. According to the authors, recruiting and retaining high-quality health care providers is especially challenging for Medicaid managed care plans, which must contend with historically low reimbursement rates.

A Look at Working-Age Caregivers' Roles, Health Concerns, and Need for Support. Alice Ho, Sara R. Collins, Ph.D., Karen Davis, Ph.D., and Michelle M. Doty, Ph.D. August 2005. The authors report that caregivers ages 19 to 64 are more likely to not be working, to miss days of work if they are employed, and to lack health insurance coverage than non-caregivers.

Seeing Red: Americans Driven into Debt by Medical Bills. Michelle M. Doty, Ph.D., Jennifer N. Edwards, Dr.P.H., and Alyssa L. Holmgren. August 2005. The researchers report that while medical bill problems and debt are experienced most often by the uninsured, even many working-age adults who are continually insured have problems paying their medical bills and have medical debt.

Eliminating Disparities in Treatment and the Struggle to End Segregation. David Barton Smith, Ph.D. August 2005. By reviewing the history of civil rights era efforts to integrate health care and assessing its accomplishments, the author offers lessons to inform current efforts to eliminate treatment disparities.

Equity Measures and Systems Reform as Tools for Reducing Racial and Ethnic Disparities in Health Care. Sidney D. Watson, J.D. August 2005. Performance measurements that do not track data by race and ethnicity, the author says, miss inequities and likely overlook promising techniques for reaching particular groups of patients.

Reinsurance: How States Can Make Health Coverage More Affordable for Employers and Workers. Katherine Swartz, Ph.D. July 2005. The author reports that state-provided reinsurance—in essence, insurance for insurance companies—can allow insurers to lower premiums significantly by relieving them of the risk of enrolling large numbers of people with catastrophic medical costs, but that only two states, New York and Arizona, have reinsurance programs in place.

The Role of States in Improving Health and Health Care for Young Children. Vernon K. Smith, Ph.D. July 2005. The author of this issue brief argues that states are in a unique position to improve the quality of health and care for young children, but that quality improvement initiatives are often hampered by lack of coordination among programs, inadequate data and information technology, and a tendency to focus on short-term projects.

Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers Are Measured Matters. Glenn Flores, M.D., Milagros Abreu, M.D., and Sandra C. Tomany-Korman, M.S. Public Health Reports, July/August 2005. In this article, the authors' analysis shows that, even when factoring in multiple variables, parents with limited English proficiency are three times more likely than parents who report speaking English very well to have a child in fair or poor health.

Impact of Changes to Premiums, Cost-Sharing, and Benefits on Adult Medicaid Beneficiaries: Results from an Ongoing Study of the Oregon Health Plan. Bill J. Wright, Ph.D., Matthew J. Carlson, Ph.D., Jeanene Smith, M.D., M.P.H. et al. July 2005. In 2003, Oregon raised premiums, required copays for the first time, and imposed a six-month lockout for individuals missing premium payments. This study reports that nearly two-thirds of surveyed individuals lost their coverage after the initial premium and cost-sharing increases, many directly resulting from increased costs.

Care in U.S. Hospitals—The Hospital Quality Alliance Program. Ashish K. Jha, M.D., M.P.H., Zhonghe Li, M.A., E. John Orav, Ph.D. et al., New England Journal of Medicine, July 21, 2005. The researchers report wide variation in the quality of care provided in the nation's hospitals, and that quality appears to vary not only by geographic region and type of hospital, but also across conditions within individual hospitals.

The Quality of Antipsychotic Drug Prescribing in Nursing Homes. Becky A. Briesacher, Ph.D., M. Rhona Limcangco, Ph.D., Linda Simoni-Wastila, Ph.D. et al. Archives of Internal Medicine, June 13, 2005. The authors report that, after a period of marked decreases, antipsychotic drug prescribing in nursing homes has been rising.

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