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As the United States moves forward with health reform, the communication gap between researchers and policy makers will need to be narrowed to promote policies informed by evidence. Social media represent an expanding channel for communication. Academic journals, public health agencies, and health care organizations are increasingly using social media to communicate health information. For example, the Centers for Disease Control and Prevention now regularly tweets to 290,000 followers. We conducted a survey of health policy researchers about using social media and two traditional channels (traditional media and direct outreach) to disseminate research findings to policy makers. Researchers rated the efficacy of the three dissemination methods similarly but rated social media lower than the other two in three domains: researchers’ confidence in their ability to use the method, peers’ respect for its use, and how it is perceived in academic promotion. Just 14 percent of our participants reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year. Researchers described social media as being incompatible with research, of high risk professionally, of uncertain efficacy, and an unfamiliar technology that they did not know how to use. Researchers will need evidence-based strategies, training, and institutional resources to use social media to communicate evidence. [ABSTRACT FROM AUTHOR]

The study of adverse event disclosure has typically focused on the words that are said to the patient and family members after an event. But there is also growing interest in determining how patients and their families can be involved in the analysis of the adverse events that harmed them. We conducted a two-phase study to understand whether patients and families who have experienced an adverse event should be involved in the postevent analysis following the disclosure of a medical error. We first conducted twenty-eight interviews with patients, family members, clinicians, and administrators to determine the extent to which patients and family members are included in event analysis processes and to learn how their experiences might be improved. Then we reviewed our interview findings with patients and health care experts at a one-day national conference in October 2011. After evaluating the findings, conference participants concluded that increasing the involvement of patients and their families in the event analysis process was desirable but needed to be structured in a patient-centered way to be successful. We conclude by describing when and how information from patients might be incorporated into the event analysis process and by offering recommendations on how this might be accomplished. [ABSTRACT FROM AUTHOR]

In 2010 five New York City hospitals implemented a communication-and-resolution program (CRP) in general surgery. The program's goals were to improve reporting of serious adverse events to risk management, support clinical staff in discussing these events with patients, rapidly investigate why injuries occurred, communicate to patients what was discovered, and offer apologies and compensation when the standard of care was not met. We report the hospitals' experiences with implementing the CRP over a twenty-two-month period. We found that all five hospitals improved disclosure and surveillance of adverse events but were not able to fully implement the program's compensation component. These experiences suggest that strong support from top leadership at the hospital and insurer levels, and adequate staff resources, are critical for the success of CRPs. Hospitals considering adopting a CRP should ensure that their organizations can tolerate risk, their leaders are willing to reinforce CRP implementation, and resources are in place to educate clinical staff about how the program can benefit them. [ABSTRACT FROM AUTHOR]

Communication-and-resolution programs (CRPs) in health care organizations seek to identify medical injuries promptly; ensure that they are disclosed to patients compassionately; pursue timely resolution through patient engagement, explanation, and, where appropriate, apology and compensation; and use lessons learned to improve patient safety. CRPs have existed for years, but they are being tested in new settings and primed for broad implementation through grants from the Agency for Healthcare Research and Quality. These projects do not require changing laws. However, grantees' experiences suggest that the path to successful dissemination of CRPs would be smoother if the legal environment supported them. State and federal policy makers should try to allay potential defendants' fears of litigation (for example, by protecting apologies from use in court), facilitate patient participation (for example, by ensuring access to legal representation), and address the reputational and economic concerns of health care providers (for example, by clarifying practices governing National Practitioner Data Bank reporting and payers' financial recourse following medical error). [ABSTRACT FROM AUTHOR]

Hypothetical comparative effectiveness studies of two migraine drugs offer an opportunity to analyze the legal issues that manufacturers face in conveying to practicing physicians information from such research about prescription drugs. This information, derived from observational studies, supposedly cannot be communicated to clinicians because it does not constitute "substantial evidence" as required by law. In fact, however, the emerging effectiveness data can be included in manufacturers' communications to physicians about drugs' clinical utility through various existing channels defined by other law. This article argues that Congress should further clarify the circumstances under which such communications can occur to comply with First Amendment requirements that speech constraints be narrowly drawn, known in advance, and precise. Otherwise, the Food and Drug Administration risks losing First Amendment arguments in cases involving the agency's regulation of the communications-or "speech"-of drug manufacturers. [ABSTRACT FROM AUTHOR]

This article provides a perspective from the pharmaceutical industry on a hypothetical comparative effectiveness research case, highlighting tension between the reality of conducting comparative effectiveness research and the regulation of biopharmaceutical industry communication. Specifically, under current law and regulations, Aesculapion, the hypothetical maker of the fictional migraine headache drug Hemikrane, would have limited ability to communicate findings or to respond to inaccurate "what-if ' scenario communications. Principles for communicating drug information could increase decision makers' access to information while making it easier for them to assess the quality and potential biases of different information sources. The article proposes two complementary approaches: formal Food and Drug Administration guidance clarifying how industry can participate meaningfully and proactively in the comparative effectiveness research discourse, possibly based on 1997 legislation governing communication of "health care economic information"; and stakeholder collaboration on development and adoption of voluntary "good communication principles." [ABSTRACT FROM AUTHOR]

The hypothetical comparative effectiveness research case study on migraine treatments raises questions about how to disseminate the research findings. However, at least two important elements would be necessary to maximize the value and credibility of the findings. The study would need an independent evaluation to help decision makers understand the strength of the research, its place in the context of other existing evidence, and how the research could inform real-world decisions. Also, the patient community would have to be engaged throughout the research continuum to provide patients' perspective on living with chronic conditions and how various treatments affect them. [ABSTRACT FROM AUTHOR]

As policy makers seek to slow the growth in Medicare spending, they have appropriately focused attention on beneficiaries with multiple chronic conditions. Many care coordination and disease management programs designed to improve beneficiaries' care and reduce their need for hospitalizations have been tested, but few have been successful. This study, however, found that four of eleven programs that were part of the Medicare Coordinated Care Demonstration reduced hospitalizations by 8-33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches practiced by care coordinators in at least three of the four programs were as follows: supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations. When care management fees were included, the programs were essentially cost neutral, but none of these programs generated net savings to Medicare. Our results suggest that incorporating these approaches into medical homes, accountable care organizations, and other policy initiatives could reduce hospitalizations and improve patients' lives. However, the approaches would save money only if care coordination fees were modest and organizations found cost-effective ways to deliver the interventions. [ABSTRACT FROM AUTHOR]

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers--those who offer higher quality and lower prices--and thus contribute to the broader goal of controlling national health care spending. However, communicating this information effectively is more challenging than it might first appear. For example, consumers are more interested in the quality of health care than in its cost, and many perceive a low-cost provider to be substandard. In this study of 1,421 employees, we examined how different presentations of information affect the likelihood that consumers will make high-value choices. We found that a substantial minority of the respondents shied away from low-cost providers, and even consumers who pay a larger share of their health care costs themselves were likely to equate high cost with high quality. At the same time, we found that presenting cost data alongside easy-to-interpret quality information and highlighting high-value options improved the likelihood that consumers would choose those options. Reporting strategies that follow such a format will help consumers understand that a doctor who provides higher-quality care than other doctors does not necessarily cost more. [ABSTRACT FROM AUTHOR]

An uncomfortable truth about US health care is that medical harm and needless deaths continue to occur, even after a decade of concentrated efforts to eliminate them. However, some hospital systems are managing to improve patient safety. Legacy Health, a system with six hospitals in the Portland, Oregon, metropolitan area, engaged its entire workforce in an initiative to reduce rates of infection and mortality. Legacy staff used bundles of best practices to prevent four common health care-associated infections; reviewed deaths and revised procedures based on the findings; and included staff from different disciplines in daily medical rounds. The results were a 44.6 percent reduction in infections and a 13.5 percent reduction in mortality, as well as annual savings of more than $6.8 million for each of the first two years from the avoided costs of treating health care-associated infections. Fewer patients suffered, died, or incurred daunting copayments for hospital care. These results demonstrate that health care systems can greatly improve quality and safety and lower costs when leaders as well as front-line clinicians and staff are highly involved in improvement efforts. [ABSTRACT FROM AUTHOR]

America's health care systems have not achieved the desired level of quality and safety. This may be due, in part, to the lack of clear and robust approaches for institutions to follow. Denver Health, an integrated, public safety-net institution, developed a multifaceted, structured approach to quality and safety improvement that has produced positive outcomes. For example, in 2010 Denver Health ranked first of 112 US academic medical centers in terms of actual mortality observed relative to the national mortality rate. Given these results, we argue that regulatory bodies should refocus their oversight to consider an institution's overall structured approach to quality improvement and safety, instead of monitoring individual small outcomes, such as a patient's receipt of antibiotics for pneumonia within six hours of arriving in the emergency department. [ABSTRACT FROM AUTHOR]

The new national emphasis on comparative effectiveness research is likely to generate an unprecedented volume of new findings. It is essential to anticipate the obstacles that front-line health care professionals will face in translating these results into better clinical decision making. We review the current barriers to the dissemination of evidence-based clinical recommendations, including problems with continuing medical education, provider incentives, and quality assurance. We then propose solutions, including more effective educational outreach programs, requirements for practitioners to master important findings, and alignment of incentives to encourage evidence-based practice. Such strategies can lead to policies that could encourage the uptake of new comparative effectiveness data and encourage their translation into better clinical practice. [ABSTRACT FROM AUTHOR]

The article focuses on the training programs for critical event teams of medical practitioners in Fairview Northland Medical Center in Minnesota to prevent medical errors and malpractice lawsuits by providing a safe and better health care. It states that the project is part of the Medical Liability Reform Safety Demonstration Grants established by the administration of U.S. President Barack Obama in June 2010 with total grants of 25 million dollars. It mentions that the training program was expanded to cover additional delivery and labor issues at 16 hospitals in Minnesota with funding from the U.S. Agency for Healthcare Research and Quality (AHRQ). It says that the project aimed to improve communication among medical team members and patients to reduce error and litigations. INSET: Preventing Medical Errors.

When the novel strain of A/H1N1 influenza first appeared in spring 2009, closing schools was initially a common and often challenging strategy implemented in many communities. Arguments for and against closing schools are likely to arise anew if influenza spikes in the fall of 2009. Policymakers and community officials considering this and other non pharmaceutical responses can learn from the experiences of ninety-one years ago, during the 1918-19 influenza pandemic that killed thousands of Americans. Analysis of the school closure policies of forty-three U.S. cities during that pandemic shows that smooth implementation was associated with clear lines of authority among agencies and with transparent communication between health officials and the public. [ABSTRACT FROM AUTHOR]