Health Care and the American Recovery and Reinvestment Act

Steinbrook, Robert

doi:10.1056/nejmp0900665

Cited by 209 publications

(130 citation statements)

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“…1,2 If physicians only use EHRs to do the same tasks that they previously did on paper, such as gathering and storing information, EHRs may not improve health care quality. 3 "Meaningful use" refers to the use of EHRs not only for gathering and storing information, but also for tracking and improving specific outcomes.…”

Section: Introductionmentioning

confidence: 99%

Electronic Health Records and Ambulatory Quality of Care

et al. 2012

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CONTEXT: The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect. OBJECTIVE: To determine the effect of EHRs on ambulatory quality in a community-based setting. DESIGN: Cross-sectional study, using data from 2008. SETTING: Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians. PARTICIPANTS:We included all general internists, pediatricians and family medicine physicians who: were members of the Taconic Independent Practice Association, had patients in a data set of claims aggregated across five health plans, and had at least 30 patients per measure for at least one of nine quality measures selected by the health plans. IINTERVENTION: Adoption of an EHR. MAIN OUTCOME MEASURES: We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests. We also created a composite quality score by standardizing performance against a national benchmark and averaging standardized performance across measures. We used generalized estimation equations, adjusting for nine physician characteristics. KEY RESULTS: We included 466 physicians and 74,618 unique patients. Of the physicians, 204 (44 %) had adopted EHRs and 262 (56 %) were using paper. Electronic health record use was associated with significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening. Effect sizes ranged from 3 to 13 percentage points per measure. When all nine measures were combined into a composite, EHR use was associated with higher quality of care (sd 0.4, p= 0.008). CONCLUSIONS: This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting.KEY WORDS: electronic health records; primary health care; quality of health care.

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Section: Introductionmentioning

confidence: 99%

Electronic Health Records and Ambulatory Quality of Care

et al. 2012

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“…45 The economic stimulus bill (the American Recovery and Reinvestment Act) abruptly increased NIH funding by adding $10 billion, to be spent over fiscal years 2009 and 2010. 46 …”

Section: Causes and Curesmentioning

confidence: 99%

Is Health Spending Excessive? If So, What Can We Do About It?

Aaron

Ginsburg

2009

Health Affairs

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The case that the United States spends more than is optimal on health care is overwhelming. But identifying reasons for excessive spending is not the same as showing how to wring it out in ways that increase welfare. To lower spending without lowering net welfare, it is necessary to identify what procedures are effective at reasonable cost, to develop protocols that enable providers to identify in advance patients in whom expected benefits of treatment are lower than costs, to design incentives that encourage providers to act on those protocols, and to provide research support to maintain the flow of beneficial innovations. [Health Aff (Millwood). 2009;28(5):1260-75; 10.1377/hlthaff.28.5.1260 A c h i l d t r a i n e d to s ay " c o s t, q ua l i t y, ac c e s s " might pass as a health policy analyst. Sustaining the deception would become more difficult if the innocent were asked to define those terms. "Access" would not pose much problem: being able to obtain care when you believe you need it. Defining "quality" would be more challenging. In concept, it means that patients are getting the outcomes expected from the application of current medical knowledge. Often, however, the practical difficulties in measuring outcomes and adjusting risk variation among patient populations means that "good" quality is instead defined in terms of whether certain processes have been followed.The problem of rising cost-or, more accurately, spending-once again, seems clear enough. But is it? To begin with, spending is simply price times quantity. Is the problem excessive price, excessive quantity, or both? Those troubled by rising spending seem to have a range of concepts in mind (see Exhibit 1). If spending is rising and if that seems problematic, the practical questions are as follows: what exactly is wrong with spending more on some good than one spent in the past? And what tools are available to control spending on something that is beneficial on average but not for each patient?Level Of Health Spending O v e r v i e w

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“…The number Concern about those growth projections, combined with the recent economic stimulus legislation, the change in administration, and a renewed interest in health care reform, has led to some potentially large short-term increases in HSR funding (Steinbrook 2009). This growth is a substantial departure from recent trends and underscores the difficulty in making longterm projections about HSR funding and the associated demand for researchers.…”

Section: What Factors Drive Employers' Demand For Researchers Who Canmentioning

confidence: 99%

Employer Demand for Health Services Researchers in the Year 2020

Thornton

Brown

2009

Health Services Research

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Objective. To describe factors that will shape future demand for doctoral-trained health services researchers. Study Design/Data Sources. Commentary based on recent trends in funding for health services research (HSR), the number of federally funded HSR projects listed in HSRProj, national expenditures for health, and interviews with a small number of employers. Principal Findings. Despite rapid growth in the overall health care sector, inflationadjusted funding for HSR has declined, implying little or no net growth in demand for people to lead HSR studies. Employers report being able to hire researchers to conduct HSR by drawing on people trained in many disciplines. Conclusion. Employers have considerable flexibility in hiring individuals to conduct HSR when demand is relatively stable. They may have much more difficulty hiring well-qualified researchers when faced with sharp increases in demand for HSR, such as could be generated by recent economic stimulus legislation.Key Words. Health services researchers, HSR job market As national health expenditures (NHE) increase and policy makers investigate ways to control costs, promote quality, and improve health, there is potential for growth in the demand for health services research (HSR) and health services researchers. However, the demand for HSR and the corresponding resources allocated to HSR compete with other federal and state government priorities as well as with health-related funding for clinical and basic science research. Thus, the future demand for health services researchers remains uncertain, along with the relative demand for researchers trained in the field of HSR and those trained in any of the numerous other fields that study health services delivery, financing, and performance.This uncertainty means that demand for health services researchers from universities, research organizations, government, or private industry in the year 2020 cannot be forecast with precision. Nevertheless, it is useful to describe the factors that may influence the underlying demand for HSR and r Health Research and Educational Trust

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Health Care and the American Recovery and Reinvestment Act

Cited by 209 publications

References 0 publications

Electronic Health Records and Ambulatory Quality of Care

Electronic Health Records and Ambulatory Quality of Care

Is Health Spending Excessive? If So, What Can We Do About It?

Employer Demand for Health Services Researchers in the Year 2020

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