Newsletter
Highlights
News about Publications from the Milbank Memorial Fund
September 2011
- Welcome
- New from The Milbank Quarterly
Table of Contents and Abstracts
"In This Issue"
by Bradford H. Gray, Editor - Recent Milbank Memorial Fund Report
Evolving Models of Behavioral Health Integration in Primary Care
by Chris Collins, Denise Levis Hewson, Richard Munger, and Torlen Wade
May 2010 - New Books
Inside National Health Reform
by John E. McDonough
September 2011House on Fire: The Fight to Eradicate Smallpox
by William H. Foege
June 2011 - Electronic Access to The Milbank Quarterly
1. WELCOME
Welcome to the September 2011 edition of Highlights, the Milbank Memorial Fund's update service. The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication on significant issues in health policy since its inception in 1905. Its staff organizes and participates in meetings with decision makers and publishes reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy.
Periodically, we will send you information about publications of the Fund. These messages will include links to the Milbank Memorial Fund web pages so that you can access, with no charge, electronic editions of selected Fund publications and request copies of available print editions of Fund reports. For a complete list of Fund reports or to request copies of print editions (available on a limited basis without charge for individual or educational use), please visit our home page, http://www.milbank.org, or contact us by telephone at (212) 355-8400.
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2. NEW FROM THE MILBANK QUARTERLY
VOLUME 89, NUMBER 3 (September 2011)
TABLE OF CONTENTS AND ABSTRACTS
"Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care"
by Diane E. Meier
ABSTRACT
FULL TEXT
"Enriching Patient-Centered Care in Serious Illness: A Focus on Patients' Experiences of Agency"
by Kathleen Montgomery and Miles Little
ABSTRACT
"Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices"
by Christopher G. Wise, Jeffrey A. Alexander, Lee A. Green, Genna R. Cohen, and Christina R. Koster
ABSTRACT
"Systematic Reviews and Health Policy: The Influence of a Project on Perinatal Care since 1988"
by Daniel M. Fox
ABSTRACT
"An Empirical Review of Major Legislation Affecting Drug Development: Past Experiences, Effects, and Unintended Consequences"
by Aaron S. Kesselheim
ABSTRACT
"Defining Health Diplomacy: Changing Demands in the Era of Globalization"
by Rebecca Katz, Sarah Kornblet, Grace Arnold, Eric Lief, and Julie E. Fischer
ABSTRACT
IN THIS ISSUE
End-of-life care presents both quality and cost challenges in many countries, including the United States. While it may not be surprising that a disproportionate share of medical expenditures occur near the end of life, the care patients receive in the United States is often of inadequate quality, as Diane Meier shows in the first article in this issue, "Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care." The article, which grew out of a paper initially prepared for the National Priorities Partnership of the National Quality Forum, provides an overview of a topic that will be increasingly important as the elderly population grows over the coming decades. Meier summarizes available research and gaps in research about clinical care and costs at the end of life in the United States, as well as outcome studies of palliative care and hospice services. She also explains the need to separate ideas about the appropriateness of palliative care from only the hospice context. Finally, she discusses recent policy initiatives and options for improving patients' access to high-quality palliative care.
The next article in this issue is "Enriching Patient-Centered Care in Serious Illness: A Focus on Patients' Experiences of Agency" by Kathleen Montgomery and Miles Little, an American sociologist and an Australian physician. The authors use the concept of agency to refer to factors that affect what happens to patients. Using data collected in multiple interviews at three- and six-month intervals with ten patients (and their caregivers) who were undergoing aggressive inpatient treatment for cancer in an Australian teaching hospital, Montgomery and Little describe how patients' experiences of care were affected by three types of factors: actors including not only humans but also technologies and the disease itself, actions initiated and received by patients, and domainsof action, including not only the health care system but also patients' bodies and their everyday worlds. The authors suggest that considering care from these perspectives can be useful to both professionals and policymakers in understanding the experiences of patients who are being treated for serious disease and in thinking about the meaning of patient-centered care.
The next article in this issue is "Journey Toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices" by Christopher Wise, Jeffrey Alexander, Lee Green, Genna Cohen, and Christina Koster. The patient-centered medical home (PCMH) involves ideas that have been around in various forms for many years, but the concept has been given new impetus by funding provisions of the Patient Protection and Affordable Care Act of 2010. The PCMH combines the core elements of primary care with such ideas as the use of electronic medical records to facilitate care coordination and the redesign of care processes to improve quality, lower cost, and improve patients' experiences.
Wise and colleagues illuminate the challenges of transforming ordinary primary care practices into PCMHs by reporting on a study of sixteen primary care practices in Michigan that participated in both the Blue Cross and Blue Shield of Michigan's Physician Group Incentive Program and the Robert Wood Johnson Foundation's quality improvement initiative called "Aligning Forces for Quality." Using qualitative interviews and other data sources to make comparisons of practices that scored high and low on a self-assessment regarding the principles of a primary care medical home, Wise and colleagues focused on factors that were associated with practices' success in moving toward the PCMH model. Factors related to both motivations and capabilities within practices were involved. Wise and colleagues discuss how the implementation of the PCMH concept was enhanced by strategies used within practices (e.g., taking an incremental approach, making use of data, team building). The results of their study should be of interest to both policymakers and practices seeking to advance the PCMH concept.
Systematic reviews of research evidence have become increasingly important to both clinical practice and health policy in recent decades and can easily be taken for granted. But how and why they gained influence is important to understand and is the topic of the next article in this issue, "Systematic Reviews and Health Policy: The Influence of a Project on Perinatal Care since 1988" by Daniel M. Fox. The project on which Fox focuses resulted in a series of highly influential, research-based publications on "effective care" by Iain Chalmers and other organizers of the Cochrane Collaboration (Chalmers 1988–1992; Chalmers, Enkin, and Keirse 1989; Enkin, Keirse, and Chalmers 1989; Sinclair and Bracken 1992). Fox's focus is on the largely favorable reception of these publications by policymakers in several countries. He contends that the influence of these publications was due to their blend of scientific and polemical discourse, the contemporary growth of a constituency for systematic reviews, and the recognition by some policymakers that systematic reviews could help make health care more cost-effective. The article, which extends Fox's other work on the use of research to inform policy (Fox 2010), is being co-published with the James Lind Library, which has also posted excerpts from the Chalmers, Enkin, and Keirse 1989 publication at the following link: http://www.jameslindlibrary.org/illustrating/records/effective-care-in-pregnancy-and-childbirth/key_passages?page=1.
The next article embodies the application of research to policy. It is "An Empirical Review of Major Legislation Affecting Drug Development: Past Experiences, Effects, and Unintended Consequences" by Aaron Kesselheim. Kesselheim summarizes the evidence about the effects of four legislative actions to foster public health goals in the pharmaceutical sciences: the Bayh-Dole Act of 1980, which encouraged development of commercial products growing out of federally funded research; the Orphan Drug Act of 1983, which provided several types of incentives to encourage research targeted at diseases that were too uncommon to create market rewards for new products; the Hatch-Waxman Act of 1984, which extended the patent life of pharmaceuticals under certain conditions; and the provisions of the FDA Modernization Act of 1997 that gave incentives to pharmaceutical companies to study the effects of already approved drugs on pediatric populations. All of these legislative actions sought to meet policy goals by using provisions of the drug regulatory process or patent law to provide incentives (patents forestall competition from generic products).
Kesselheim's review covers research assessing whether each piece of legislation had its intended effects and whether there were unintended effects. He concludes that some positive outcomes have resulted from these policies, but waste and other undesirable effects have also occurred. His conclusions point to the need for more rigorous evaluations of the effects of such policies and for closer ties of such incentive programs to measurable public health outcomes.
The final article in this issue is "Defining Health Diplomacy: Changing Demands in the Era of Globalization" by Rebecca Katz, Sarah Kornblet, Grace Arnold, Eric Lief, and Julie Fischer of George Washington University and the Stimson Global Health Security Program. The authors provide a broad overview of "global health diplomacy"—the integration of health concerns into countries' foreign policy strategies. The rationale is partly practical, since one of the consequences of globalization is that one country's health risks can affect another's, but support of health programs can also serve diplomatic goals. The article explains, and provides examples of, the different bilateral and multilateral forms that global health diplomacy can take. The authors distinguish among core diplomacy, which involves negotiations for dispute resolution and formal agreements between countries; multistakeholder global health diplomacy, in which multiple countries cooperate to address common issues; and informal global health diplomacy, which involves nongovernmental organizations, private enterprise, and the public.
Katz and her colleagues conclude that the rise of global health diplomacy calls for combinations of technical expertise, legal knowledge, and diplomatic skills that have not heretofore been cultivated among either foreign service or global health professionals. They point to the need for both the health and foreign policy communities to consider more deeply the combination of skills and resources needed to accomplish their mutual objectives.
Bradford H. Gray
Editor, The Milbank Quarterly
References
Chalmers, I, ed. 1988–1992. Oxford Database of Perinatal Trials. Oxford: Oxford University Press.
Chalmers, I., M. Enkin, and M.J. Keirse, eds. 1989. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press.
Enkin, M., M.J. Keirse, and I. Chalmers. 1989. A Guide to Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press.
Fox, D.M. 2010. The Convergence of Science and Governance: Research, Health Policy and American States. Berkeley: University of California Press.
Sinclair, C., and M.B. Bracken, eds. 1992. Effective Care of the Newborn Infant. Oxford: Oxford University Press.
3. RECENT MILBANK MEMORIAL FUND REPORT
Evolving Models of Behavioral Health Integration in Primary Care
by Chris Collins, Denise Levis Hewson, Richard Munger, and Torlen Wade
May 2010
Evolving Models of Behavioral Health Integration in Primary Care offers an approach to meeting the unmet needs of the millions of Americans suffering from mental illness and substance abuse: the integration of primary care and behavioral health care. The report summarizes the available evidence and states' experiences around integration as a means for delivering quality, effective physical and mental health care. For those interested in integrating care, it provides eight models that represent qualitatively different ways of integrating/coordinating care across a continuum—from minimal collaboration to partial integration to full integration—according to stakeholder needs, resources, and practice patterns.
4. NEW BOOKS
Inside National Health Reform
by John E. McDonough
September 2011
360 pages
co-published with and distributed by the University of California Press
cloth: $34.95, Ebook: $34.95, ISBN: 978-0-520-27019-0
Description from the Press:
"This indispensable guide to the Affordable Care Act, our new national health care law, lends an insider's deep understanding of policy to a lively and absorbing account of the extraordinary—and extraordinarily ambitious—legislative effort to reform the nation's health care system. Dr. John E. McDonough, DPH, a health policy expert who served as an advisor to the late Senator Edward Kennedy, provides a vivid picture of the intense effort required to bring this legislation into law. McDonough clearly explains the ACA's inner workings, revealing the rich landscape of the issues, policies, and controversies embedded in the law yet unknown to most Americans. In his account of these historic events, McDonough takes us through the process from the 2008 presidential campaign to the moment in 2010 when President Obama signed the bill into law. At a time when the nation is taking a second look at the ACA, Inside National Health Reformprovides the essential information for Americans to make informed judgments about this landmark law."
From the Foreword by Carmen Hooker Odom, President, and Samuel L. Milbank, Chairman:
"On March 23, 2010, President Obama signed the Affordable Care Act (ACA), following seventy-five years of efforts by U.S. Presidents and Congresses to establish a national health insurance framework. Experienced as a state legislator, legislative advisor, professor of public health and social policy, and consumer health advocate, McDonough writes about the twenty-two-month process that led to the passage of the ACA and provides readers with a comprehensive analysis of the law itself in Inside National Health Reform, his second book in the California/Milbank series."
For further information and to order, visit http://www.ucpress.edu/book.php?isbn=9780520270190.
House on Fire: The Fight to Eradicate Smallpox
by William H. Foege
June 2011
240 pages
co-published with and distributed by the University of California Press
cloth: $29.95, Ebook: $24.00, ISBN: 978-0-520-26836-4
Description from the Press:
"A story of courage and risk-taking, House on Fire tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India. In House on Fire, William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective—eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, House on Firegives an intimate sense of what it is like to work on the ground in some of the world's most impoverished countries—and tells what it is like to contribute to programs that really do change the world."
From the Foreword by Carmen Hooker Odom, President, and Samuel L. Milbank, Chairman:
"With an insider's knowledge of the worldwide smallpox eradication program in the 1960s and 1970s, Foege, a physician, relates the strategies used to eradicate smallpox in Africa and India and the challenges encountered along the way. He reveals the reasons behind the success of this program: a shared global objective; conception, implementation, and management of a clear plan tailored to a specific disease in terms of its context, range, and vulnerabilities; evaluation of the tools and techniques used and their subsequent modification; a willingness at all levels, from the local citizenry and government to country officials and global institutions, to communicate and work together to achieve the end goal; tenacity; and optimism."
For further information and to order, visit http://www.ucpress.edu/book.php?isbn=9780520268364.
The University of California Press and the Milbank Memorial Fund jointly sponsor the California/Milbank Books on Health and the Public. The series addresses the politics and policy of maintaining and improving the health of Americans. Other books in the series include Lawrence O. Gostin's Public Health Law and Ethics: A Reader (2010); Mark L. Rosenberg, Elisabeth S. Hayes, Margaret H. McIntyre, and Nancy Neill's Real Collaboration: What It Takes for Global Health to Succeed (2010); Lawrence O. Gostin's Public Health Law: Power, Duty, Restraint—Revised and Expanded Second Edition (2008); Carl F. Ameringer's The Health Care Revolution: From Medical Monopoly to Market Competition (2008); Amy L. Fairchild, Ronald Bayer, and James Colgrove's Searching Eyes: Privacy, the State, and Disease Surveillance in America (2007); and James C. Riley's Low Income, Social Growth, and Good Health: A History of Twelve Countries(2007).
To learn about all the books in this series and to order, visit http://www.ucpress.edu/books/series/cmhp.php or call the University of California Press at 1-800-777-4726.
5. ELECTRONIC ACCESS TO THE MILBANK QUARTERLY
SEARCHABLE ELECTRONIC SUBSCRIBER ACCESS
Beginning with the 1997 volume (number 75), The Milbank Quarterly is available via Wiley-Blackwell (http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-0009).Subscribing institutions and individuals can now search across all available full-text articles for words or phrases to find information; in addition, they can link directly from references, authors, and keywords to databases such as MEDLINE, ISI, and CrossRef and to cited articles in other journals. Those registered on Wiley Online Library can also sign up for electronic tables of contents to the Quarterly and other related journals and access online sample issues for all Wiley-Blackwell journals (http://onlinelibrary.wiley.com/browse/publications?type=journal&activeLetter=). Subscribers to the Quarterly will receive an access token and instructions on how to register on Wiley Online Library and activate their online subscription from Wiley-Blackwell. AcademyHealth members will receive information from the Academy about how to access the journal directly from the Academy website (http://www.academyhealth.org/Membership/?navItemNumber=504). The journal is also available to libraries via http://www.ovid.com on Journals@Ovid, a fully searchable, cross-referenced database. (Call 1-800-950-2035 for full details, including rates.) Individual subscribers also have free access via The Milbank Quarterly page on the Wiley-Blackwell website (http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-0009); single article purchases are also available to nonsubscribers. All articles from The Milbank Quarterly published between 1923 and the most recent one-year period are available for no charge through libraries and institutions that subscribe to JSTOR's Arts & Sciences IV Collection (http://www.jstor.org); single article purchases are also available to nonsubscribers. In case of difficulty, or if you have any questions about The Milbank Quarterly online, contact Journal Customer Services (http://olabout.wiley.com/WileyCDA/Section/id-397203.html).
An increasing number of recipients of Highlights are not affiliated with academic institutions, nor are they individual subscribers. If you would like to have access to the electronic version of the Quarterly, note that many university libraries are happy to offer privileges to persons in their communities, especially those in government positions.