TY - BOOK AU - Institute of Medicine AU - National Research Council A2 - Maria Hewitt A2 - Joseph V. Simone TI - Enhancing Data Systems to Improve the Quality of Cancer Care SN - DO - 10.17226/9970 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9970/enhancing-data-systems-to-improve-the-quality-of-cancer-care PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - One of the barriers to improving the quality of cancer care in the United States is the inadequacy of data systems. Out-of-date or incomplete information about the performance of doctors, hospitals, health plans, and public agencies makes it hard to gauge the quality of care. Augmenting today's data systems could start to fill the gap. This report examines the strengths and weaknesses of current systems and makes recommendations for enhancing data systems to improve the quality of cancer care. The board's recommendations fall into three key areas: Enhance key elements of the data system infrastructure (i.e., quality-of-care measures, cancer registries and databases, data collection technologies, and analytic capacity). Expand support for analyses of quality of cancer care using existing data systems. Monitor the effectiveness of data systems to promote quality improvement within health systems. ER - TY - BOOK AU - Institute of Medicine A2 - Jonathan R. Davis TI - Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary SN - DO - 10.17226/9760 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9760/managed-care-systems-and-emerging-infections-challenges-and-opportunities-for PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - This workshop summary report examines how the managed care revolution has created both problems and opportunities in the fight against infectious diseases. It highlights ways in which managed care systems can aid research, develop clinical guidelines, manage the use of antibiotics, support public education efforts, and monitor the spread of emerging infections and microbial resistance. ER - TY - BOOK AU - Institute of Medicine TI - State Programs Can Reduce Tobacco Use DO - 10.17226/9762 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9762/state-programs-can-reduce-tobacco-use PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine ER - TY - BOOK AU - Institute of Medicine A2 - Henry J. Aaron A2 - Hellen Gelband TI - Extending Medicare Reimbursement in Clinical Trials SN - DO - 10.17226/9742 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9742/extending-medicare-reimbursement-in-clinical-trials PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Increasingly over the past five years, uncertainty about reimbursement for routine patient care has been suspected as contributing to problems enrolling people in clinical trials. Clinical trial investigators cannot guarantee that Medicare will pay for the care required, and they must disclose this uncertainty to potential participants during the informed consent process. Since Medicare does not routinely "preauthorize" care (as do many commercial insurers) the uncertainty cannot be dispelled in advance. Thus, patients considering whether to enter trials must assume that they may have to pay bills that Medicare rejects simply because they have enrolled in the trial. This report recommends an explicit policy for reimbursement of routine patient care costs in clinical trials. It further recommends that HCFA provide additional support for selected clinical trials, and that the government support the establishment of a national clinical trials registry. These policies (1) should assure that beneficiaries would not be denied coverage merely because they have volunteered to participate in a clinical trial; and (2) would not impose excessive administrative burdens on HCFA, its fiscal intermediaries and carriers, or investigators, providers, or participants in clinical trials. Explicit rules would have the added benefit of increasing the uniformity of reimbursement decisions made by Medicare fiscal intermediaries and carriers in different parts of the country. Greater uniformity would, in turn, decrease the uncertainty about reimbursement when providers and patients embark on a clinical trial. ER - TY - BOOK AU - National Research Council TI - Review of the U.S. Geological Survey's Volcano Hazards Program SN - DO - 10.17226/9884 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9884/review-of-the-us-geological-surveys-volcano-hazards-program PB - The National Academies Press CY - Washington, DC LA - English KW - Earth Sciences AB - The United States has more than 65 active or potentially active volcanoes, more than those of all other countries except Indonesia and Japan. During the twentieth century, volcanic eruptions in Alaska, California, Hawaii, and Washington devastated thousands of square kilometers of land, caused substantial economic and societal disruption and, in some instances, loss of life. More than 50 U.S. volcanoes have erupted one or more times in the past 200 years. Recently, there have been major advances in our understanding of how volcanoes work. This is partly because of detailed studies of eruptions and partly because of advances in global communications, remote sensing, and interdisciplinary cooperation. The mission of the Volcano Hazards Program (VHP) is to "lessen the harmful impacts of volcanic activity by monitoring active and potentially active volcanoes, assessing their hazards, responding to volcanic crises, and conducting research on how volcanoes work." To provide a fresh perspective and guidance to the VHP about the future of the program, the Geologic and Water Resources Divisions of the United States Geological Survey (USGS) requested that the National Research Council conduct an independent and comprehensive review. Review of the U. S. Geological Survey's Volcano Hazards Program is organized around the three components of hazards mitigation. Chapter 2 deals with research and hazard assessment. Chapter 3 covers monitoring and Chapter 4 discusses crisis response and other forms of outreach conducted by the VHP. Chapter 5 describes various cross-cutting programmatic issues such as staffing levels, data formats, and partnerships. Chapter 6 offers a vision for the future of the Volcano Hazards Program, and Chapter 7 summarizes the conclusions and recommendations of the preceding chapters. Throughout the report, major conclusions are printed in italics and recommendations in bold type. The committee has written this report for several different audiences. The main audience is upper management within the USGS and the VHP. However, the committee believes that scientists within the VHP will also find the report valuable. The report is written in such a manner as to be useful to congressional staff as well. ER - TY - BOOK AU - National Research Council TI - Clean Coastal Waters: Understanding and Reducing the Effects of Nutrient Pollution SN - DO - 10.17226/9812 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9812/clean-coastal-waters-understanding-and-reducing-the-effects-of-nutrient PB - The National Academies Press CY - Washington, DC LA - English KW - Earth Sciences KW - Environment and Environmental Studies AB - Environmental problems in coastal ecosystems can sometimes be attributed to excess nutrients flowing from upstream watersheds into estuarine settings. This nutrient over-enrichment can result in toxic algal blooms, shellfish poisoning, coral reef destruction, and other harmful outcomes. All U.S. coasts show signs of nutrient over-enrichment, and scientists predict worsening problems in the years ahead. Clean Coastal Waters explains technical aspects of nutrient over-enrichment and proposes both immediate local action by coastal managers and a longer-term national strategy incorporating policy design, classification of affected sites, law and regulation, coordination, and communication. Highlighting the Gulf of Mexico's "Dead Zone," the Pfiesteria outbreak in a tributary of Chesapeake Bay, and other cases, the book explains how nutrients work in the environment, why nitrogen is important, how enrichment turns into over-enrichment, and why some environments are especially susceptible. Economic as well as ecological impacts are examined. In addressing abatement strategies, the committee discusses the importance of monitoring sites, developing useful models of over-enrichment, and setting water quality goals. The book also reviews voluntary programs, mandatory controls, tax incentives, and other policy options for reducing the flow of nutrients from agricultural operations and other sources. ER - TY - BOOK AU - Institute of Medicine A2 - Maria Hewitt TI - Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary DO - 10.17226/10005 PY - 2000 UR - https://nap.nationalacademies.org/catalog/10005/interpreting-the-volume-outcome-relationship-in-the-context-of-health-care-quality PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine ER - TY - BOOK AU - Institute of Medicine A2 - Molla S. Donaldson A2 - Julie J. Mohr TI - Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis DO - 10.17226/10096 PY - 2000 UR - https://nap.nationalacademies.org/catalog/10096/exploring-innovation-and-quality-improvement-in-health-care-micro-systems PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Exploring Innovation and Quality Improvement in Health Care Micro-Systems defines and describes health care micro-systems and analyzes characteristics that enable specific micro-systems to improve the quality of care provided to their patient populations. This study reports on structured interviews used to collect primary data from 43 micro-systems providing primary and specialty care, hospice, emergency, and critical care. It summarizes responses to the interviews about how micro-systems function, what they know about their level of performance, how they improve care, the leadership needed, the barriers they have encountered, and how they have dealt with these barriers. ER - TY - BOOK AU - National Research Council TI - Networking Health: Prescriptions for the Internet SN - DO - 10.17226/9750 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9750/networking-health-prescriptions-for-the-internet PB - The National Academies Press CY - Washington, DC LA - English KW - Computers and Information Technology KW - Health and Medicine AB - Consumer health websites have garnered considerable media attention, but only begin to scratch the surface of the more pervasive transformations the Internet could bring to health and health care. Networking Health examines ways in which the Internet may become a routine part of health care delivery and payment, public health, health education, and biomedical research. Building upon a series of site visits, this book: Weighs the role of the Internet versus private networks in uses ranging from the transfer of medical images to providing video-based medical consultations at a distance. Reviews technical challenges in the areas of quality of service, security, reliability, and access, and looks at the potential utility of the next generation of online technologies. Discusses ways health care organizations can use the Internet to support their strategic interests and explores barriers to a broader deployment of the Internet. Recommends steps that private and public sector entities can take to enhance the capabilities of the Internet for health purposes and to prepare health care organizations to adopt new Internet-based applications. ER - TY - BOOK AU - National Research Council TI - Bridging Boundaries Through Regional Marine Research SN - DO - 10.17226/9772 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9772/bridging-boundaries-through-regional-marine-research PB - The National Academies Press CY - Washington, DC LA - English KW - Earth Sciences KW - Environment and Environmental Studies AB - As appreciation of the interdisciplinary and multidimensional character of environmental issues has increased, there have been attempts to address regional needs more directly. One of these, the Regional Marine Research Program (RMRP), was established by Congress in 1990 to provide a mechanism to fund coastal marine research based on regionally-defined priorities. The RMRP legislation established a system of nine regional marine research boards around the United States. Each board was responsible for planning marine research to address issues of water quality and ecosystem health on a regional scale. Although all nine regions received funding for planning activities and development of a research plan, only the Gulf of Maine RMRP received funding for program implementation. The completion of the Gulf of Maine program, in 1997, presents an opportunity to evaluate whether the process for planning and managing the Gulf of Maine research was adequate, whether the research fulfilled the goals of the program, and whether this experience should serve as a model for similar regional programs elsewhere. Bridging Boundaries through Regional Marine Research is a study of the RMRP, with a specific review of the Gulf of Maine program as well as an assessment of other modesl for regional marine research. This report assesses the need for regional marine research,reviews processes by which regional marine research needs can be defined, and discusses existing programs for regional marine research in the United States. It also identifies short- and long-term approaches that might be taken by NOAA. ER - TY - BOOK AU - Institute of Medicine TI - The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population SN - DO - 10.17226/9741 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9741/the-role-of-nutrition-in-maintaining-health-in-the-nations-elderly PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Malnutrition and obesity are both common among Americans over age 65. There are also a host of other medical conditions from which older people and other Medicare beneficiaries suffer that could be improved with appropriate nutritional intervention. Despite that, access to a nutrition professional is very limited. Do nutrition services benefit older people in terms of morbidity, mortality, or quality of life? Which health professionals are best qualified to provide such services? What would be the cost to Medicare of such services? Would the cost be offset by reduced illness in this population? This book addresses these questions, provides recommendations for nutrition services for the elderly, and considers how the coverage policy should be approached and practiced. The book discusses the role of nutrition therapy in the management of a number of diseases. It also examines what the elderly receive in the way of nutrition services along the continuum of care settings and addresses the areas of expertise needed by health professionals to provide appropriate nutrition services and therapy. ER - TY - BOOK AU - National Research Council TI - Opportunities for Environmental Applications of Marine Biotechnology: Proceedings of the October 5-6, 1999, Workshop SN - DO - 10.17226/9988 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9988/opportunities-for-environmental-applications-of-marine-biotechnology-proceedings-of-the PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies KW - Biology and Life Sciences AB - This 2-day workshop is the culmination of a study of the status and future of marine biotechnology. The overall goal of this workshop is to examine what was initially called "Opportunities for Marine Biotechnology in the United States," to consider where we are now in this field of "Environmental Marine Biotechnology," to envision the field in the future, and to discuss any impediments that might be encountered along the way. Opportunities for Environmental Applications of Marine Biotechnology: Proceedings of the October 5-6, 1999, Workshop addresses the question of where the federal government should invest its limited funds and what future initiatives should be planned. ER - TY - BOOK AU - National Research Council TI - Watershed Management for Potable Water Supply: Assessing the New York City Strategy SN - DO - 10.17226/9677 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9677/watershed-management-for-potable-water-supply-assessing-the-new-york PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies KW - Earth Sciences AB - In 1997, New York City adopted a mammoth watershed agreement to protect its drinking water and avoid filtration of its large upstate surface water supply. Shortly thereafter, the NRC began an analysis of the agreement's scientific validity. The resulting book finds New York City's watershed agreement to be a good template for proactive watershed management that, if properly implemented, will maintain high water quality. However, it cautions that the agreement is not a guarantee of permanent filtration avoidance because of changing regulations, uncertainties regarding pollution sources, advances in treatment technologies, and natural variations in watershed conditions. The book recommends that New York City place its highest priority on pathogenic microorganisms in the watershed and direct its resources toward improving methods for detecting pathogens, understanding pathogen transport and fate, and demonstrating that best management practices will remove pathogens. Other recommendations, which are broadly applicable to surface water supplies across the country, target buffer zones, stormwater management, water quality monitoring, and effluent trading. ER - TY - BOOK AU - Institute of Medicine TI - Calling the Shots: Immunization Finance Policies and Practices SN - DO - 10.17226/9836 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9836/calling-the-shots-immunization-finance-policies-and-practices PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores: The evolution of the system in light of changing U.S. demographics, development of new vaccines, and other factors. The effectiveness of public health and health insurance strategies, with special emphasis on the performance of the "Section 317" program. The condition of the infrastructure for control and prevention of infectious disease, surveillance of vaccines rates and safety, and efforts to sustain high coverage. Calling the Shots will be an indispensable resource to those responsible for maintaining our nation's vaccine vigilance. ER - TY - BOOK AU - Institute of Medicine A2 - Marilyn J. Field A2 - Robert L. Lawrence A2 - Lee Zwanziger TI - Extending Medicare Coverage for Preventive and Other Services SN - DO - 10.17226/9740 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9740/extending-medicare-coverage-for-preventive-and-other-services PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicare—or to society generally—is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions. ER -