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Objective. To provide a conceptual framework and to assess the availability of empirical data for supply-side microsimulation modeling in the context of health care. Data Sources. Multiple secondary data sources, including the American Community Survey, Health Tracking Physician Survey, and SK&A physician database. Study Design. We apply our conceptual framework to one entity in the health care market--physicians--and identify, assess, and compare data available for physician-based simulation models. Principal Findings. Our conceptual framework describes three broad types of data required for supply-side microsimulation modeling. Our assessment of available data for modeling physician behavior suggests broad comparability across various sources on several dimensions and highlights the need for significant integration of data across multiple sources to provide a platform adequate for modeling. A growing literature provides potential estimates for use as behavioral parameters that could serve as the models' engines. Sources of data for simulation modeling that account for the complex organizational and financial relationships among physicians and other supply-side entities are limited. Conclusions. A key challenge for supply-side microsimulation modeling is optimally combining available data to harness their collective power. Several possibilities also exist for novel data collection. These have the potential to serve as catalysts for the next generation of supply-side-focused simulation models to inform health policy. Key Words. Microsimulation, supply, physicians, Microsimulation modeling is one tool in the arsenal available to policy makers for understanding the effects of potential policy changes. Such models have been used for decades in a variety [...]

Objective. To compare health insurance coverage estimates from the American Community Survey (ACS) to the Current Population Survey (CPS-ASEC). Data Sources/Study Setting. The 2008 ACS and CPS-ASEC, 2009. Study Design. We compare age-specific national rates for all coverage types and state-level rates of uninsurance and means-tested coverage. We assess differences using t-tests and p-values, which are reported at Principal Findings. Despite substantial design differences, we find only modest differences in coverage estimates between the surveys. National direct purchase and state-level means-tested coverage levels for children show the largest differences. Conclusions. We suggest that the ACS is well poised to become a useful tool to health services researchers and policy analysts, but that further study is needed to identify sources of error and to quantify its bias. Key Words. Health insurance coverage, state health policy, current population survey, American community survey, In 2008, the U.S. Census Bureau began fielding a health insurance coverage question in the American Community Survey (ACS), establishing a valuable new resource for health services researchers and policy [...]

* As this historic presidential election draws near, what do RNs think of our nation's priorities? Which candidates do they think will be most effective in shaping our health care system and addressing the most pressing issues of our time? * The results of this survey show that RNs do not identify overwhelmingly with one political ideology or party and, in fact, they closely resemble the public on these political dimensions. * The data also show that RNs identify health care issues as the most important problem facing the nation. RNs who believe that it is the * responsibility of the government to provide health insurance to those without it, have more confidence in the government to achieve this outcome, and are more likely to be Democrats than Republicans. * The presidential election is expected to be highly contested and could be determined by a relatively small margin of votes and, thus, nurses should recognize their chances of influencing the outcome of the election. * The data from this survey provide baseline information potentially useful to increasing the political influence of the nursing profession, informing other organizations about where they might align with nurses, and helping candidates and the political parties compete more effectively in seeking the support of roughly 3 million RN voters., THIS IS A COMPLEX TIME IN American politics. The economy is barely growing and may yet slip into recession, the war continues in Iraq, the President has historically low popularity [...]

Cardiopulmonary resuscitation (CPR) is a commonly practiced method of emergency lifesaving. Decisions regarding the application of CPR are made by competent patients or family members of incompetent patients. CPR policies in nursing homes can be used to assess whether the personal wishes of their residents are being respected. In a survey of 209 long-term nursing homes in North Carolina regarding CPR policies, 83 percent reported having a written policy on CPR. CPR was performed in nine out of 10 nursing homes. CPR could be restricted by physician's orders in 92 percent of the homes. Ten ethical, legal and procedural principles stated in the model policy were used for comparison. Ethical and legal principles of policies included the patients right to decide, informed consent (communication of 'do not resuscitate', or DNR, orders), patient competency, dignity and quality of care and the notification of treatment alternatives. Procedural provisions included authorization, documentation, patient identification, evaluation of DNR and review of patient's condition to see if DNR orders are applicable. The policies of long-term nursing homes varied widely. Procedural provisions were followed in more than half of the nursing homes. Fewer than half had criteria regarding patient's autonomy, treatment alternatives, dignity and quality of care and patient identification. To improve the decision-making of nursing home residents, all 10 CPR policy criteria should be included. (Consumer Summary produced by Reliance Medical Information, Inc.)

Improving America's health will take more than universal insurance MARCH brought frenzied attention to Barack Obama's health law. The Supreme Court heard arguments over its constitutionality. Outside the court, supporters [...]

Byline: Douglas Backstrom The Commonwealth Fund/Modern Healthcare Opinion Leaders Survey, conducted by Harris Interactive, is an online poll designed to highlight perspectives on the most timely health policy issues from [...]

Byline: Douglas Backstrom The Commonwealth Fund/Modern Healthcare Opinion Leaders Survey, conducted by Harris Interactive, is an online poll designed to highlight perspectives on the most timely health policy issues from [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2008.10.007 Byline: David J. Magid (a), Ashley F. Sullivan (b), Paul D. Cleary (f), Sowmya R. Rao (d)(e), James A. Gordon (b)(e), Rainu Kaushal (g), Edward Guadagnoli (h), Carlos A. Camargo (b)(e), David Blumenthal (c)(e) Abstract: Well-functioning systems are critical to safe patient care, but little is known about the status of such systems in US health care facilities, including high-risk settings such as the emergency department (ED). The purpose of this study is to assess the degree to which EDs are designed, managed, and supported in ways that ensure patient safety. Author Affiliation: (a) Institute for Health Research, Kaiser Permanente Colorado and the Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO (b) Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (c) Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (d) Biostatistics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA (e) Institute for Health Policy, Massachusetts General Hospital, Boston, MA (f) Yale School of Public Health, Yale School of Medicine, New Haven, CT (g) Weill Medical College of Cornell University and New York-Presbyterian Hospital, New York, NY (h) Department of Health Care Policy, Harvard Medical School, Boston, MA Article History: Received 24 June 2008; Revised 25 September 2008; Revised 30 September 2008; Accepted 6 October 2008 Article Note: (footnote) Provide feedback on this article at the journal's Web site, www.annemergmed.com., Supervising editor: Robert L. Wears, MD, MS, Author contributions: All authors take responsibility for the accuracy of the paper. DJM takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This project was supported by grant number 5 R01 HS013099 from the Agency for Healthcare Research and Quality. The Agency for Healthcare Research and Quality had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. All of the authors have participated sufficiently in the work to take public responsibility for the content and have no financial arrangement with a company that makes a product or makes a competing product discussed in the article., Reprints not available from the authors., Publication date: Available online December 3, 2008.

Byline: James Tehrani, Copy editor The Commonwealth Fund/Modern Healthcare Opinion Leaders Survey, conducted by Harris Interactive, is an online poll designed to highlight perspectives on the most timely health-policy issues [...]

Byline: Todd Sloane The Commonwealth Fund/Modern Healthcare Opinion Leaders Survey, conducted by Harris Interactive, is an online poll designed to highlight perspectives on the most timely health-policy issues from a [...]

Byline: Tony Fong The good news is that health plans reporting to the National Committee for Quality Assurance improved in most areas in 2004. The bad news is that fewer [...]

AHRQ: HCAHPS test. The Agency for Healthcare Research and Quality is looking for hospitals willing to test the latest draft of the Hospital Consumer Assessment of Health Plans. This 27-item [...]

Some pharmacists are worried that clinical governance might turn into a heavy-handed policing exercise. Adrienne de Mont investigates whether or not their fears are justified The Royal Pharmaceutical Society stresses [...]