Clinical effectiveness research (CER) serves as the bridge between the development of innovative treatments and therapies and their productive application to improve human health. Building on efficacy and safety determinations necessary for regulatory approval, the results of these investigations guide the delivery of appropriate care to individual patients. As the complexity, number, and diver…
Because of their potential to enable the development of new knowledge and to guide the development of best practices from the growing sum of individual clinical experiences, clinical data represent the resource most central to healthcare progress (Arrow et al., 2009; Detmer, 2003). Whether captured during product development activities such as clinical research trials and studies, or as a part …
The fundamental notion of the learning healthcare system—continuous improvement in effectiveness, efficiency, safety, and quality—is rooted in principles that medicine shares with engineering. In particular, the fields of systems engineering, industrial engineering, and operations research have long experience in the systematic design, analysis, and improvement of complex systems, notably i…
Though often hidden in the past,lesbians,gay men,and bisexual women area substantial and increasingly visible minority of the population.With the growing cultural openness about lesbian and gay identities in recent years,issues relating to sexual orientation have become more and more prominent in public discourse.In the 1980s and 1990s,psychological research and theory on gay,lesbian,and bi-s…
Accounting knowledge is a core business skill that both complements and enhances your other talents. Individuals promoted to management or supervisory roles from either line or staff jobs find that many of their new responsibilities involve knowing something about accounting. Congratulations on your promotion! You’ve come to the right place to start developing those accounting skills. If you …
The Institute of Medicine’s Committee on Optimizing Graduate Medi- cal Trainee (Resident) Hours and Work Schedules to Improve Patient Safety evaluated the literature concerning (1) the impact of current residents’ duty hours on patient safety and (2) the relationship of hours of work and sleep to performance. The principal aim of residency training in the United States is to prepare young d…
The United States has the highest per capita spending on health care of any industrialized nation—50 percent greater than the second highest and twice as high as the average for Europe (Peterson and Burton, 2009). Current U.S. healthcare costs are projected at nearly $2.5 trillion, about 17 percent of the entire economy (Sisko et al., 2009). The Congressional Budget Office estimated that Medi…
In 2001, the United States experienced the effects of bioterrorism when envelopes containing anthrax spores were sent through the postal service to several different recipients, including two U.S. senators. It is likely that several thousand people were exposed to anthrax, with antibiotic prophylaxis widely prescribed for those whose exposure was known or suspected. The consequences of this eve…
Lack of adequate documentation is one of the largest pitfalls facing any accounting system. One of four excuses is usually given: (1) nobody reads it, (2) the hands-on approach in which each person teaches another is a better method, (3) written policies and procedures are too confining, and (4) nobody has the time to write documentation. In a constantly changing accounting world, none of t…
There is currently a crisis in cancer care that experts predict will worsen in the near future due to a rapidly growing population of Americans requiring cancer care combined with an aging/retiring oncology workforce, and inadequate numbers of replacement workers. By 2020, the American Society of Clinical Oncology (ASCO) predicts a 48 percent increase in cancer incidence and an 81 percent incre…
The first several chapters of this text present the accounting and re- porting for investment activities of businesses. The focus is on investments when one firm possesses either significant influence or control over another through ownership of voting shares. When one firm owns enough voting shares to be able to affect the decisions of another, ac- counting for the investment can become challe…
The most compelling reason for finding ways of successfully treating people who commit sexual offences against children is one of child protection. Programmes to change the behaviour of offenders may have a beneficial effect on the individuals involved and enable them to rejoin society or to be reunited with their families. But for the majority of workers engaged in managing programmes, in…
Oncology is similar to the other areas in health care in that it is under pressure to control expenditures while maintaining or improving quality of care and patient outcomes such that the value of oncology care is enhanced. Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially com- plex. First, patients an…
The goal of eliminating disparities in health care in the United States remains elusive. The findings of the National Healthcare Disparities Report reveal that even as quality improves on specific measures, disparities often persist (AHRQ, 2008a, 2008b). Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those d…
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effec- tiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect t…
The United States faces the real possibility of a catastrophic public health event that involves tens of thousands or hundreds of thousands of victims. Public health emergencies—such as the 2009 H1N1 pandemic, an intentional anthrax release, infectious disease threats such as severe acute respiratory syndrome (SARS), fires, floods, earthquakes, and hurri- canes—highlight the ever-changing t…
OF ALL CREATURES ON THIS EARTH, humans are the most emotional. Our speech, actions (gestures, body movements, and postures), and our faces, too, are frequently contorted with emotion. We express anger, anxiety, fright, shame, joy, love, and sadness, as well as other perhaps socially more subtle emotions, such as guilt, envy, jealousy, pride, relief, hope, gratitude, and compassion. Everything i…
In June 2009 the Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop with the goal of convening many of the best minds in health preparedness for a wide-ranging update on preparations for a major public health threat. For the health community, a primary issue at hand before and during a catastrophic incident is how to prov…
As the United States continues to devote extensive resources toward achieving a high-value, high-quality health care system, the capacity to evaluate the state of care is increasingly important. Since 2003, the annual publication of the National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) by the Agency for Healthcare Research and Quality (AHRQ) has played …