Category Archive: NEJM

Adopting Innovations in Care Delivery — The Case of Shared Medical Appointments

Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for rou…

Patient Inducements — High Graft or High Value?

In May 2016, Uber announced a partnership with the Southeastern Pennsylvania Transportation Authority (SEPTA) to provide discounted ride-sharing services to “bridge the first and last mile gap” and encourage people to ride the regional rail system. It was a potential win for all — increased…

Rotavirus Vaccines — A New Hope

Rotavirus gastroenteritis is the leading cause of diarrhea-associated hospitalization and death in children younger than 5 years of age, with more than 85% of the approximately 200,000 annual rotavirus deaths occurring in Africa and Asia. Since improve…

The Mirage of Reform — Republicans’ Struggle to Dismantle Obamacare

Republicans have vowed to repeal and replace the Affordable Care Act (ACA) ever since its enactment. But President Donald Trump and congressional Republicans are discovering what Democrats learned long ago: health care reform is politically treacherous…

Out of Sight, Out of Mind — Behavioral and Developmental Care for Rural Children

The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and…

Another Senseless Death — The Case for Supervised Injection Facilities

Frankie liked to tell people “we made our bones together.” He must have said that a hundred times, to every new medical student I introduced to him, to every nurse, and during every one of our many visits. I had a general sense of what he meant, but on the morning I heard that he’d died from an…

Improving Hospital Incentives with Better Cost Data

Under the current Medicare payment system, hospitals are reimbursed for inpatient stays on the basis of each patient’s assigned Medicare severity diagnosis-related group (MS-DRG). The Centers for Medicare and Medicaid Services (CMS) attempts to set reimbursement rates so that the average hospital…

Lessons from Oregon in Embracing Complexity in End-of-Life Care

Under the incentives of fee-for-service Medicare, the utilization trends among persons with chronic progressive medical illness include more care in the intensive care unit (ICU), more hospitalizations, and often late or no referrals to hospice care (F…

Polar Extremes in the Clinical Use of Stem Cells

The U.S. biotechnology and pharmaceutical industries arguably lead the world in innovation while operating under stringent regulations set by the Food and Drug Administration (FDA). Although flexible pathways exist to accelerate the development or appr…

Realizing the Potential of Cancer Prevention — The Role of Implementation Science

In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have. Tobacco use, inactivity, and obesity are modifiable causes of cancer, and evidence now suggests t…

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