For the first time, a single reference identifies medical technology assessment programs. A valuable guide to the field, this directory contains more than 60 profiles of programs that conduct and report on medical technology assessments. Each profile includes a listing of report citations for that program, and all the reports are indexed under major subject headings. Also included is a cross-listing of technology assessment report citations arranged by type of technology headings, brief descriptions of approximately 70 information sources of potential interest to technology assessors, and addresses and descriptions of 70 organizations with memberships, activities, publications, and other functions relevant to the medical technology assessment community.
A wave of new health care innovation and growing demand for health care, coupled with uncertain productivity improvements, could severely challenge efforts to control future health care costs. A committee of the National Research Council and the Institute of Medicine organized a conference to examine key health care trends and their impact on medical innovation. The conference addressed the following question: In an environment of renewed concern about rising health care costs, where can public policy stimulate or remove disincentives to the development, adoption and diffusion of high-value innovation in diagnostics, therapeutics, and devices?
The goal of the Institute of Medicine's Council on Health Care Technology is to promote the development and application of technology assessment in health and medicine. Among the activities cited in the congressional charge that provided for its formation, the council is to "identify needs in the assessment of health care technology." Early in its deliberations, the council decided to expand its charge to identify priority clinical conditions as well as medical technologies and practices. The process for setting assessment priorities demonstrated in this pilot study and the initial set of 20 priority assessment areas selected are in response to this expanded charge. The priority-setting group decided to undertake a pilot effort that would set a framework for national priority-setting, outline national priority-setting criteria, and use a consensus process to identify a preliminary list of priority clinical conditions and medical technologies. The priority-setting approach demonstrated here relies upon explicit criteria that are applicable at the national level and reflect the diverse needs of patients, clinicians, researchers payers, health facility managers, and policymakers.
The field of health care technology assessment focuses on the use of medical technologiesâ€"their impacts on safety, efficacy, and effectiveness; cost-effectiveness and cost benefit; quality; and their social, legal, and ethical implications. This wide-ranging monograph addresses some of the gaps in understanding health status and quality of life, such as the use of quality-of-life measures in technology assessment, organ transplantation, and pharmaceutical trials. One chapter provides basic references for the technical attributes of many established measures and some lesser known ones. The final chapter offers recommendations concerning the appropriate applications of these measures and highlights areas for cooperative research.
This volume consists of four "white papers," prepared for the Clinton administration as it took office, on important national policy issues in which science and technology play a central role. Topics covered are science and technology leadership, climate change policy, technology policy and industrial innovation, and health care reform. Also included are brief summaries of ten potentially high impact reports issued by various committees of the National Research Council.
Technology assessment can lead to the rapid application of essential diagnostic technologies and prevent the wide diffusion of marginally useful methods. In both of these ways, it can increase quality of care and decrease the cost of health care. This comprehensive monograph carefully explores methods of and barriers to diagnostic technology assessment and describes both the rationale and the guidelines for meaningful evaluation. While proposing a multi-institutional approach, it emphasizes some of the problems involved and defines a mechanism for improving the evaluation and use of medical technology and essential resources needed to enhance patient care.
The National Institute of Standards and Technology (NIST) Measurements and Standards Laboratories (MSL) provide technical leadership for the nation's measurement and standards infrastructure and assure the availability of essential reference data and measurement capabilities. At NIST's request the National Research Council (NRC) carries out a biennial assessment of the seven MSL. The assessment focuses on each laboratory's technical quality and merit; and effectiveness. It also examines the relevance of the NIST programs and how well laboratory facilities, equipment, and personnel are able to fulfill the MSL mission. This report presents an overall assessment of the MSL followed by detailed assessments of each of the seven laboratories.
In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost. Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives. Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.
Despite a strong commitment to delivering quality health care, persistent problems involving medical errors and ineffective treatment continue to plague the industry. Many of these problems are the consequence of poor information and technology (IT) capabilities, and most importantly, the lack cognitive IT support. Clinicians spend a great deal of time sifting through large amounts of raw data, when, ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models that depict the health status of the patient. Computational Technology for Effective Health Care advocates re-balancing the portfolio of investments in health care IT to place a greater emphasis on providing cognitive support for health care providers, patients, and family caregivers; observing proven principles for success in designing and implementing IT; and accelerating research related to health care in the computer and social sciences and in health/biomedical informatics. Health care professionals, patient safety advocates, as well as IT specialists and engineers, will find this book a useful tool in preparation for crossing the health care IT chasm.
Increasingly, the core mission of the Centers for Medicare and Medicaid Services (CMS), an agency of the Department of Health and Human Services, is expanding from one of focusing on prompt claims payment to one of becoming more broadly involved in improving health care quality and efficiency. The requirements for the information technology (IT) systems of CMS are changing as its mission changes, and the efforts to evolve its systems from those designed to support the agency's historical mission come in the midst of a push to modernize the nation's health care IT more broadly. These new challenges arise even as CMS must meet challenging day-to-day operational requirements and make frequent adjustments to its business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements. In light of these and other emerging challenges, CMS asked the National Research Council to conduct a study that would lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and information technology requirements. The study is being conducted in two phases. The first, resulting in the present volume, draws on a series of teleconferences, briefings, and an information-gathering workshop held in Washington, D.C., on September 27-28, 2010. The second phase, drawing on that workshop and on additional briefings, site visits, and committee deliberations, will result in a final report with recommendations, to be issued at the end of the project in 2011.
The Centers for Medicare and Medicaid Services (CMS) is the agency in the Department of Health and Human Services responsible for providing health coverage for seniors and people with disabilities, for limited-income individuals and families, and for children-totaling almost 100 million beneficiaries. The agency's core mission was established more than four decades ago with a mandate to focus on the prompt payment of claims, which now total more than 1.2 billion annually. With CMS's mission expanding from its original focus on prompt claims payment come new requirements for the agency's information technology (IT) systems. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services reviews CMS plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands. The report's recommendations and conclusions offered cluster around the following themes: (1) the need for a comprehensive strategic technology plan; (2) the application of an appropriate metamethodology to guide an iterative, incremental, and phased transition of business and information systems; (3) the criticality of IT to high-level strategic planning and its implications for CMS's internal organization and culture; and (4) the increasing importance of data and analytical efforts to stakeholders inside and outside CMS. Given the complexity of CMS's IT systems, there will be no simple solution. Although external contractors and advisory organizations will play important roles, CMS needs to assert well-informed technical and strategic leadership. The report argues that the only way for CMS to succeed in these efforts is for the agency, with its stakeholders and Congress, to recognize resolutely that action must be taken, to begin the needed cultural and organizational transformations, and to develop the appropriate internal expertise to lead the initiative with a comprehensive, incremental, iterative, and integrated approach that effectively and strategically integrates business requirements and IT capabilities.
America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
America's health care system is being reshaped by a variety of market-driven changes, and states are emerging as the major governmental influence on health care policy. Amid these changes, the health and well-being of children can slip from view. Although most children are fundamentally healthy, they require health care that emphasizes preventive services, such as immunizations and regular monitoring of physical and psychosocial growth and development. This volume takes a broad look at access and quality of care for pregnant women, children, and mothers. Among the issues addressed are the scope of benefits available under various health care reform efforts and services for special-needs children under managed care.
Increasing public investments in health care services for low-income and special needs children and adolescents in the United States have raised questions about whether these efforts improve their health outcomes. Yet it is difficult to assess the general health status and health care quality for younger populations, especially those at risk of poor health outcomes, because the United States has no national information system that can provide timely, comprehensive, and reliable indicators in these areas for children and adolescents. Without such a system in place, it is difficult to know whether and how selected health care initiatives and programs contribute to children's health status. Child and Adolescent Health and Health Care Quality identifies key advances in the development of pediatric health and health care quality measures, examines the capacity of existing federal data sets to support these measures, and considers related research activities focused on the development of new measures to address current gaps. This book posits the need for a comprehensive strategy to make better use of existing data, to integrate different data sources, and to develop new data sources and collection methods for unique populations. Child and Adolescent Health and Health Care Quality looks closely at three areas: the nature, scope, and quality of existing data sources; gaps in measurement areas; and methodological areas that deserve attention. Child and Adolescent Health and Health Care Quality makes recommendations for improving and strengthening the timeliness, quality, public transparency, and accessibility of information on child health and health care quality. This book will be a vital resource for health officials at the local, state, and national levels, as well as private and public health care organizations and researchers.
Several positive and negative lifelong behaviors are established during adolescence including diet and exercise, sexual conduct, practices related to oral health, smoking, drinking, and the use if legal and illegal substances. The complex issues that adolescents deal with on a daily basis can turn into health problems that persist throughout adulthood. Unfortunately the adolescents who are frequently the most disconnected from routine health care services - those who lack insurance and family support - are often those at greatest risk for multiple and chronic health problems. Therefore, those that are responsible for delivering health care services to adolescents must address the health conditions that require immediate attention while preparing young people to adopt practices that can help improve their future health status and prevent unhealthy behaviors. Challenges in Adolescent Health Care studies adolescent health care in the United States, highlights critical health care needs, and identifies service models and components of care that may strengthen and improve health care services, settings, and systems for adolescents. The book explores the nature of adolescent challenges and how they reflect larger societal issues such as poverty, crime and the prevalence of violence. These issues, in addition to lack of comprehensive health coverage, dysfunctional families and the lack of support systems, make providing adequate health care incredibly challenging. Challenges in Adolescent Health Care defines high-quality health care, identifies the strengths and weaknesses of various service models and explores various training programs. The book recommends that health care providers must be sensitive to socioeconomic factors and incorporate health care in a broad array of settings including schools, neighborhoods and community centers.
The report assesses the current state of chemistry and chemical engineering within the context of drug discovery, disease diagnosis, and disease prevention. Also addressed are chemical and chemical engineering challenges in pharmaceutical synthesis, delivery, and manufacture.
The nation's health care system has changed dramatically and the country is debating further significant changes. Comprehensive information is needed to guide policymakers in understanding and evaluating the current problems and in formulating federal health care policy. This book contains an evaluation of the plan developed by the National Center for Health Statistics for restructuring its existing provider surveys. It identifies current and future data needed by researchers and policymakers to assess the effect of changes in financing, organization, and delivery of health care on access, quality, costs, and outcomes of care and determines the extent to which the design and content of the proposed survey can meet these data needs. The book goes beyond a simple review and recommends a design framework to develop a coordinated and integrated data system to gather information about people and their illness over time and to link this information to costs and health care outcomes.
NASA's current missions to the International Space Station (ISS) and potential future exploration missions involving extended stays by astronauts on the lunar surface, as well as the possibility of near- Earth object (NEO) or Mars missions, present challenges in protecting astronauts from radiation risks. These risks arise from a number of sources, including solar particle events (SPEs), galactic cosmic rays (GCRs), secondary radiation from surface impacts, and even the nuclear isotope power sources transported with the astronauts. The serious early and late radiation health effects potentially posed by these exposures are equally varied, ranging from early signs of radiation sickness to cancer induction. Other possible effects include central nervous system damage, cataracts, cardiovascular damage, heritable effects, impaired wound healing, and infertility. Recent research, much of which has been sponsored by NASA, has focused on understanding and quantifying the radiation health risks posed by space radiation environments. Although many aspects of the space radiation environments are now relatively well characterized, important uncertainties still exist regarding biological effects and thus regarding the level and types of risks faced by astronauts. This report presents an evaluation of NASA's proposed space radiation cancer risk assessment model, which is described in the 2011 NASA report, Space Radiation Cancer Risk Projections and Uncertainties-2010. The evaluation in Technical Evaluation of the NASA Model for Cancer Risk to Astronauts Due to Space Radiation considers the model components, input data (for the radiation types, estimated doses, and epidemiology), and the associated uncertainties. This report also identifies gaps in NASA's current research strategy for reducing the uncertainties in cancer induction risks.
An NRC ad hoc committee analyzed the current status and future development potential of Armenia's science and technology base, including human and infrastructural resources and research and educational capabilities. The committee identified those fields and institutions offering promising opportunities for contributing to economic and social development, and particularly institutions having unique and important capabilities, worthy of support from international financial institutions, private investment sources, and the Armenian and U.S. governments. The scope of the study included both pure and applied research as well as education in science-related fields. The committee's report addresses the existing capacity of state and private research institutions, higher education capabilities and trends, scientific funding sources, innovative investment models, relevant success stories, factors hindering development of the science sector, potential domestic Armenian customers for scientific results and products, and opportunities for regional scientific collaboration. An Armenian language version of the report is also available.
This report is the proceedings of a 2003 symposium on "Electronic Scientific, Technical, and Medical Journal Publishing and Its Implications," which brought together experts in STM publishing, both producers and users of these publications, to: (1) identify the recent technical changes in publishing, and other factors, that influence the decisions of journal publishers to produce journals electronically; (2) identify the needs of the scientific, engineering, and medical community as users of journals, whether electronic or printed; (3) discuss the responses of not-for-profit and commercial STM publishers and of other stakeholders in the STM community to the opportunities and challenges posed by the shift to electronic publishing; and (4) examine the spectrum of proposals that has been put forth to respond to the needs of users as the publishing industry shifts to electronic information production and dissemination.
As the general public has become more aware of advances in nutrition, consumer demands for advice on matters of diet and disease have grown. This book offers recommendations to upgrade what were found to be largely inadequate nutrition programs in U.S. medical schools in order that health professionals be better qualified to advise and treat their patients. A comprehensive study of one-third of American 4-year undergraduate medical schools provided information on the current status of nutrition programs at each school. Conclusions were drawn and recommendations made from analysis of this gathered information. Questions examined in this volume include: Has medical education kept pace with advances in nutrition science? Are medical students equipped to convey sound nutritional advice to their patients? What strategies are needed to initiate and sustain adequate teaching of nutrition in medical schools?
Matching DNA samples from crime scenes and suspects is rapidly becoming a key source of evidence for use in our justice system. DNA Technology in Forensic Science offers recommendations for resolving crucial questions that are emerging as DNA typing becomes more widespread. The volume addreses key issues: Quality and reliability in DNA typing, including the introduction of new technologies, problems of standardization, and approaches to certification. DNA typing in the courtroom, including issues of population genetics, levels of understanding among judges and juries, and admissibility. Societal issues, such as privacy of DNA data, storage of samples and data, and the rights of defendants to quality testing technology. Combining this original volume with the new update--The Evaluation of Forensic DNA Evidence--provides the complete, up-to-date picture of this highly important and visible topic. This volume offers important guidance to anyone working with this emerging law enforcement tool: policymakers, specialists in criminal law, forensic scientists, geneticists, researchers, faculty, and students.
The global economy is characterized by increasing locational competition to attract the resources necessary to develop leading-edge technologies as drivers of regional and national growth. One means of facilitating such growth and improving national competitiveness is to improve the operation of the national innovation system. This involves national technology development and innovation programs designed to support research on new technologies, enhance the commercial return on national research, and facilitate the production of globally competitive products. Understanding the policies that other nations are pursuing to become more innovative and to what effect is essential to understanding how the nature and terms of economic competition are shifting. Building the 21st Century U.S.-China Cooperation on Science, Technology, and Innovation studies selected foreign innovation programs and comparing them with major U.S. programs. This analysis of Comparative Innovation Policy includes a review of the goals, concept, structure, operation, funding levels, and evaluation of foreign programs designed to advance the innovation capacity of national economies and enhance their international competitiveness. This analysis focuses on key areas of future growth, such as renewable energy, among others, to generate case-specific recommendations where appropriate.
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