The U.S. Department of Health and Human Services (HHS) profoundly affects the lives of all Americans. Its agencies and programs protect against domestic and global health threats, assure the safety of food and drugs, advance the science of preventing and conquering disease, provide safeguards for America's vulnerable populations, and improve health for everyone. However, the department faces serious and complex obstacles, chief among them rising health care costs and a broadening range of health challenges. Over time, additional responsibilities have been layered onto the department, and other responsibilities removed, often without corresponding shifts in positions, procedures, structures, and resources. At the request of the U.S. House of Representatives Committee on Oversight and Government Reform, HHS in the 21st Century assesses whether HHS is ideally organized to meet the enduring and emerging health challenges facing our nation. The committee identifies many factors that affect the department's ability to address its range of responsibilities, including divergence in the missions and goals of the department's agencies, limited flexibility in spending, impending workforce shortages, difficulty in retaining skilled professionals, and challenges in effectively partnering with the private sector.
This handbook is intended to provide the reader with a basic understanding of the Medicaid program. There is a specific emphasis on the interplay between Medicaid principles and behavioral health services. The goal is for the reader to navigate his or her state Medicaid program so that he or she can contribute meaningfully to policy conversations related to provision of behavioral health services to individuals who are eligible for Medicaid. Throughout this document, the term behavioral health encompasses both mental and substance use disorders. When a mental or substance use disorder is addressed singularly, the reference will be only to that disorder. Because each state's Medicaid program is different from all others and because Medicaid laws and policies are ever changing, this handbook cannot contemplate every permutation of program construction.
This guide was created to promote the early identification of children and adolescents with mental health and substance use problems as well as to provide guidance, tools, and resources for early identification-including a compendium of the most developmentally, culturally, and environmentally appropriate screening instruments. SAMHSA developed the guide using the input of the members of the Federal/National Partnership* (FNP) Early Identification Workgroup, chaired by representatives from the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).
Implementing these practical and largely achievable suggestions will improve access to timely and targeted mental health services in primary care settings. Program and clinical experts agree that the early prevention and treatment of mental disorders will result in decreases in individual suffering, family burden, and medical costs. This project provided an important opportunity to review policy and service-delivery change mechanisms aimed at improving the reimbursement of mental health services in primary care settings. By using knowledge from a variety of individuals and settings and combining empirical research with qualitative interviews and the Expert Forum proceedings, this project identified areas where Federal agencies, states, provider organizations, and commissioner associations can clarify, collaborate, educate, and provide support to improve the reimbursement of and access to mental health services in primary care settings.
The Agency for Healthcare Research and Quality (AHRQ) is pleased to release the fourth annual National Healthcare Quality Report (NHQR) on behalf of the U.S. Department of Health and Human Services (HHS) and in collaboration with an HHS-wide Interagency Work Group. Like previous reports, the 2006 NHQR also received significant guidance from AHRQ leadership and AHRQ's National Advisory Committee. The NHQR examines and tracks the quality of health care in the United States, using the most scientifically credible measures and data sources available. Measures of health care quality address the extent to which providers and hospitals deliver evidence-based care for specific services as well as the outcomes of the care provided. The measures are organized around four dimensions of quality—effectiveness, patient safety, timeliness, and patient centeredness—and cover four stages of care—staying healthy, getting better, living with illness or disability, and coping with the end of life. The NHQR is complemented by its companion report, the National Healthcare Disparities Report (NHDR), a comprehensive national overview of disparities in access to and quality of health care among racial, ethnic, and socioeconomic groups, as well as among subpopulations such as children and the elderly. Both reports measure health care quality and track changes over time but with different orientations. The NHQR addresses the current state of health care quality and the opportunities for improvement for all Americans as a whole. This perspective is useful for identifying where the Nation is doing well and where more work is needed. The NHDR addresses the distribution of improvements in health care quality and access across the different populations that make up America. This perspective is useful for ensuring that all Americans benefit from improvements in care. Both reports' perspectives are needed for a complete understanding of quality of healthcare, and both reports support HHS Secretary Mike Leavitt's 500-Day Plan to fulfill the President's vision of a healthier America, specifically in the areas of better transparency of health care quality information and eliminating inequities in health care. The NHQR comprises 211 measures. This large measure set is distilled to 42 core measures which are the major focus of the 2006 report; of these, 40 have data for 2 or more years. The measures are balanced across the four dimensions of quality and provide a more readily understandable summary and explanation of the key results derived from the data. Major additions to the core measures have been made this year. Among them are three new measures on prevention, including advice from health care professionals on eating, exercise, and vision care, and two new composite measures for patient safety, including measures on postoperative complications and adverse events. Also, new measures were added to the overall measure set in the areas of asthma, hospice care, and patient centeredness in hospitals. The Highlights section offers a concise overview of findings from the 2006 NHQR. Four themes emerge from the 2006 NHQR: Most measures of quality are improving, but the pace of change remains modest; Quality improvement varies by setting and phase of care; The rate of improvement accelerated for some measures while a few continued to show Deterioration; Variation in health care quality remains high.
The audience for these documents includes those interested in familiarizing themselves with the child welfare, alcohol and other drug services, and court systems. These documents are also intended for jurisdictions interested in or in the process of developing cross-systems relationships. The primer and guide are targeted to management and administrative personnel in State, county, and tribal jurisdictions' alcohol and drug services, child welfare, and court systems. The primer is not an exhaustive review of each system's mandates, practices, and policies. However, this document does provide an overview of the framework, target population, key legislation and funding sources, and structure and organization of services for each system.
Treatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and HumanServices (HHS). Each TIP involves the development of topic-specific best practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment andprevention. TIPs are distributed to facilities and individuals across the country. Published TIPs can be accessed via the Internet at http: //store.samhsa.gov. Although each consensus-based TIP strives to include an evidence base for the practices it recommends, SAMHSA recognizes that behavioral health is continually evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. If research supports a particular approach, citations are provided.
The National Agenda for Public Health Action represents a monumental step in addressing a priority health issue for women. It has been a work in progress and a true collaboration among the Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA), the Association of State and Territorial Health Officials (ASTHO), and the American Public Health Association (APHA) – and numerous additional partnering organizations. The National Agenda for Public Health Action challenges us as a nation to reach beyond our traditional boundaries of public and private health care, federal and state politics, community programs and academic research, and media and training. It poses a vision of a nation in which diabetes among women is prevented or at least delayed whenever possible, and it outlines a rational and feasible plan for making that vision a reality. We hope that the National Agenda will become a beacon for mobilizing the collective energies and resources of multiple entities to truly make a difference in the lives of women and their families who face the daily challenges of diabetes. Diabetes is a tremendous financial burden on patients, their families and society. It's a burden that grows in conjunction with America's obesity epidemic. Diabetes costs our country $132 billion a year in direct medical costs and in indirect costs such as disability, missed work and premature death. More importantly, it costs Americans their lives, their health and their well-being. But amidst all the bad news, there is also good news: Diabetes is often preventable. Of the more than 17 million Americans with diabetes, more than half are women. An additional 16 million more Americans have pre-diabetes. We must all work to fight this disease that affects so many of our friends, neighbors and loved ones. Fighting diabetes through research and public education is one of our top priorities at the Department of Health and Human Services. That's why HHS' Centers for Disease Control and Prevention, in cooperation with partners such as the American Diabetes Association, the American Public Health Association, and the Association of State and Territorial Health Officials, developed the National Agenda for Public Health Action. We hope this agenda will guide the nation in addressing diabetes and women's health. We want an America in which: Diabetes among women is prevented or at least delayed whenever possible; Women at risk for diabetes are provided the family and community support they need to prevent or delay diabetes and its complications; Appropriate care and management of diabetes among women is promoted across the life stages; And the occurrence of complications from diabetes among women is prevented, delayed, or minimized.~
Community-based behavioral health providers and systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community, and as for all community members with behavioral health needs, individualized, integrated, comprehensive, coordinated, and continuous service is the standard of care. Individuals with behavioral health issues are overrepresented in jails and prisons across the United States.1 Most of these individuals return to their communities, families, and social networks and subsequently require community-based behavioral and physical health care services. Research has shown that mental and substance use disorders affect people from all walks of life, with or without justice involvement, and, with the services and supports of behavioral health providers, many people recover.
The Ryan White HIV/AIDS Program was borne of a movement that began with the onset of the AIDS epidemic in America. First by the tens, then by the hundreds, then by the thousands, brave and commit¬ted people from all walks of life made a decision to get involved. Some were public health officials; others were activists. Some were community leaders, and others—at least until that time—were citizens quietly living their lives. In this sixth edition of the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) Progress Report, we celebrate the legacy of those first responders. We also celebrate the incredible journey we have taken since 1990, when the first Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was passed into law. Who could have imagined in those early years that we would one day have treatments powerful enough to forestall the progression of HIV/AIDS? Who could have known that we would touch so many lives? This year alone, through scores of grantees and providers* in cities and towns across America, the Ryan White HIV/ AIDS Program will serve well over half a million people. We continue to face hurdles in our fight against the epidemic, but we have made enormous progress. Highlights from this year include the following: At $2.29 billion, FY 2010 appropriations for the Program were the largest in Program history; Our AIDS Education and Training Centers (AETCs) conducted more than 18,000 trainings; Under the AIDS Drug Assistance Program (ADAP), we distributed medications to more than 175,000 clients; We treated the people most disproportionately affected by HIV: 73 percent of our clients were racial and ethnic minorities, and 88 percent of our clients had no private health insurance; We conducted research on innovative, replicable models of HIV care to reduce health disparities in women of color, improve access to oral health care, establish linkages between jail settings and HIV primary care, and expand health information technology and electronic medical systems; We have been involved in the Healthy People 2010 broad-based national collaborative to meet the Nation's most pressing health needs; We continue to set the standard for HIV/AIDS care using well-respected performance measures. This response to HIV/AIDS constitutes nothing less than a modern public health miracle. . . and within it lie other miracles, too—like that of an HIV-positive person living into old age, or the promising future that unfolds before the eyes of an HIV-positive adolescent. In this publication, you will read about many of the milestones we have encountered in our 20-year journey and the many qualities that make our team successful. We embarked on a quest that many would not. We stepped up to the plate when others stepped away. And today we constitute a powerful and cohesive force seldom seen in combating a single disease. Our rewards lie in victory after victory over isolation and disease and in the improved lives of our clients. It has been an amazing and empowering journey, and it is not over. We are trained. We are committed. We are full of resolve. And we will not stop. In this Progress Report, we remember and we honor the determination of those first responders and of Ryan White himself. It was the determination to go the distance for people living with HIV/AIDS, what¬ever it took and whatever the cost. That determination has never been more alive than it is today.
reatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). Each TIP involves the development of topic-specific best-practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment and prevention. TIPs are distributed to facilities and individuals across the country.
No single organization or person can address the multitude of services needed to help people affected by mental health or substance use conditions. The Government is no exception. While the Government can provide financial support and technical assistance to communities to deal with these challenges, it recognizes that the best sources are the people who live, serve, and work in the community and the best results are often seen when they undertake such action together. Today, in the United States, community partnerships are being established around many local challenges, including efforts to promote wellness and overcome issues associated with mental health and substance use conditions. In addressing these matters, unlikely alliances are being formed among community service organizations, the Government, the private sector, health and education systems and, in recent years, with grassroots faith-based organizations.
Health care seeks to prevent, diagnose, and treat disease and to improve the physical and mental well-being of all Americans. Across the lifespan, health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with death and dying. Quality health care delivers these services in ways that are safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need, or they receive care that causes harm. Care can be delivered too late or without full consideration of a patient's preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations. Some Americans receive worse care than other Americans. These disparities may be due to differences in access to care, provider biases, poor provider-patient communication, and poor health literacy. Since 2003, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for improving health care quality and reducing health care disparities. Guided by a subcommittee of AHRQ's National Advisory Council and a Department of Health and Human Services (HHS) Interagency Work Group, past reports were built on more than 250 measures categorized across six dimensions: effectiveness, patient safety, timeliness, patient centeredness, efficiency, and access to care. The Institute of Medicine (IOM) first provided guidance to AHRQ on the NHQR and NHDR in 2002. In 2008, AHRQ asked the IOM to offer suggestions for enhancing future reports and associated products to ensure that these reports raise awareness of the performance of the U.S. health care system. Findings from the 2010 NHQR and 2010 NHDR have been integrated into a single summary document. This is intended to reinforce the need to consider simultaneously the quality of health care and disparities across populations when assessing our health care system. The National Healthcare Reports Highlights seeks to address three questions critical to guiding Americans toward the optimal health care they need and deserve: What is the status of health care quality and disparities in the United States? How have health care quality and disparities changed over time? Where is the need to improve health care quality and reduce disparities greatest? The 2010 reports emphasize one of AHRQ's priority populations as a theme. This year, we present expanded analyses of care across the urban-rural continuum, and the National Healthcare Reports Highlights includes a summary of care received by residents of different types of geographic areas. Finally, this document summarizes information on eight national priorities identified by the IOM Committee and presents novel strategies for improving quality and reducing disparities from AHRQ's Health Care Innovations Exchange (HCIE). Four themes from the 2010 NHQR and 2010 NHDR emphasize the need to accelerate progress if the Nation is to achieve higher quality and more equitable health care in the near future. Health care quality and access are suboptimal, especially for minority and low-income groups; Quality is improving; access and disparities are not improving; Urgent attention is warranted to ensure improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations, including: Cancer screening and management of diabetes; States in the central part of the country; Residents of inner-city and rural areas; Disparities in preventive services and access to care. Progress is uneven with respect to eight national priorities: Two are improving in quality: Palliative and End-of-Life Care and Patient and Family Engagement; Three are lagging: Population Health, Safety, and Access; Three require more data to assess: Care Coordination, Overuse, and Health System Infrastructure; All eight priority areas showed disparities related to race, ethnicity, and socioeconomic status.
Health care seeks to diagnose, treat, and improve the physical and mental well-being of all Americans. Across the lifespan, health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with death and dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable.1 Unfortunately, Americans too often do not receive care that they need, or they receive care that causes harm. Care can also be delivered too late or without full consideration of a patient's preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations. Each year since 2003, the Agency for Healthcare Research and Quality (AHRQ), together with its partners in the Department of Health and Human Services (HHS), has reported on progress and opportunities for improving health care quality, as mandated by the U.S. Congress. The information amassed for the National Healthcare Quality Report (NHQR) since its inception is a growing knowledge base that can be used to address three critically important questions: What is the status of health care quality in the United States? Where is health care quality improvement most needed? How is the quality of the health care delivered to Americans changing over time? The significance of tracking this sector's performance is evident from many vantage points. More than $2 trillion is spent each year on health care in the United States.2 Spending on health care is escalating relentlessly, threatening the financial security of families and businesses. Quality and value are increasingly considered in the decisions patients and payers make. To help patients choose doctors and hospitals prudently, tools have been produced that gather information about hospitals and rate health care providers. To motivate providers to deliver high-quality care, some purchasers reward superior performance. In addition, some refuse to pay for additional care needed to correct hospital-acquired conditions that could reasonably have been prevented through the application of evidence-based medicine. Monitoring the success of these efforts is crucial to help stakeholders refine quality improvement activities and to lead Americans toward the optimal health care they need and deserve. The NHQR is built on more than 200 measures categorized across four dimensions of quality: effectiveness, patient safety, timeliness, and patient centeredness. Guided by a subcommittee of AHRQ's National Advisory Council and an HHS Interagency Work Group, the NHQR focuses on a group of core report measures that represent the most important and scientifically credible measures of quality for the Nation. By focusing on core measures, the NHQR provides a readily understandable summary and explanation of the key results derived from available data. Three themes from the 2009 NHQR emphasize the need to accelerate progress if the Nation is to achieve higher quality health care in the near future: Health care quality needs to be improved, particularly for uninsured individuals, who are less likely to get recommended care; Some areas merit urgent attention, including patient safety and health care-associated infections (HAIs); Quality is improving, but the pace is slow, especially for preventive care and chronic disease management. We also summarize AHRQ and HHS efforts to accelerate the pace of improvement by: Improving measurement; Removing barriers to quality care; Empowering providers with health information technology (HIT) and training; Establishing and sustaining partnerships to lead change.
The Centers for Disease Control and Prevention (CDC) define a healthcare-associated infection (HAI) as: “[A] localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s). There must be no evidence that the infection was present or incubating at the time of admission to the acute care setting.” The CDC estimates that in 2002 there were 1.7 million HAI and 99,000 HAI-associated deaths in hospitals. The four largest categories of HAI, responsible for more than 80 percent of all reported HAI, are central line–associated bloodstream infections (CLABSI, 14%), ventilator associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). In a CDC report, national costs of HAI were estimated, based on 2002 infection rates and adjusted to 2007 dollars using the Consumer Price Index for inpatient hospital services. Estimates of the total annual direct medical costs of HAI for U.S. hospitals ranged from $35.7 billion to $45 billion. The prevention and reduction of HAI is a top priority for the U.S. Department of Health and Human Services. A call to action for the elimination of HAI has been issued jointly by the Association for Professionals in Infection Control and Epidemiology, Inc., the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the Association of State and Territorial Health Officials, the Council of State and Territorial Epidemiologists, the Pediatric Infectious Diseases Society, and the CDC. In a consensus statement issued by these groups, a plan for the elimination of HAI includes the promotion of adherence to evidence-based practices through partnering, educating, implementing, and investing. In 2003, the Institute of Medicine (IOM) published a report, Priority Areas for National Action: Transforming Health Care Quality. The report identified 20 clinical topics for which there are quality concerns because of the gap between knowledge of the topic and integration of that knowledge into the clinical setting. In response to the IOM report, the Agency for Healthcare Research and Quality (AHRQ) initiated a series of technical reviews on quality improvement strategies focused on improving the quality of care for the IOM's 20 priority areas. This systematic review updates the AHRQ Evidence Report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 6—Prevention of Healthcare Associated Infections. From here on, this report is referred to as the 2007 report. The objective of that evidence review was to identify QI strategies that successfully increase adherence to effective preventive interventions and reduce infection rates for CLABSI, VAP, SSI, and CAUTI. The current review expands the settings to be considered from primarily hospitals to include ambulatory surgery centers, freestanding dialysis centers, and long-term care facilities, where the prevention of HAI needs to be addressed as well. Where applicable, the current report also applies the recommendation of a report prepared for AHRQ by RAND Health in which the impact of context on the effectiveness of patient safety practices is assessed. The context of an intervention can have an important impact on whether preventive interventions are adopted. Key Questions for this report follow. Key Question 1. Which quality improvement strategies are effective in reducing the following healthcare-associated infections - Central line–associated bloodstream infections (CLABSI), Ventilator-associated pneumonia (VAP), Surgical site infections (SSI), Catheter-associated urinary tract infections (CAUTI)? Key Question 2. What is the impact of the health care context on the effectiveness of quality improvement strategies, including reducing infections and increasing adherence to preventive interventions?
In September 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS) and the Administration on Children, Youth and Families (ACYF) held a technical expert panel to identify what the research tells us about services for children in therapeutic/treatment foster care (TFC)1 with behavioral health issues (see Appendix A for meeting agenda). A non-Department of Health and Human Services2 16-member panel of researchers representing the fields of mental health, child welfare, measurement and evaluation, social work and psychology came together to provide policymakers with a responsible assessment of currently available information on services for children in therapeutic/treatment foster care with behavioral health issues (see Appendix B for participant list).
Case management has been variously classified as a skill group, a core function, service coordination, or a network of "friendly neighbors." Although it defies precise definition, case management generally can be described as a coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. The Consensus Panel that developed this TIP believes that case management lends itself to the treatment of substance abuse, particularly for clients with other disorders and conditions who require multiple services over extended periods of time and who face difficulty in gaining access to those services. This document details the factors that programs should consider as they decide to implement case management or modify their current case management activities. This summary is excerpted from the main text, in which references to the research appear.
Crisis Services are a continuum of services that are provided to individuals experiencing a psychiatric emergency. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. Core crisis services include: 23-hour crisis stabilization/observation beds, short term crisis residential services and crisis stabilization, mobile crisis services, 24/7 crisis hotlines, warm lines, psychiatric advance directive statements, and peer crisis services. The research base on the effectiveness of crisis services is growing. There is evidence that crisis stabilization, community-based residential crisis care, and mobile crisis services can divert individuals from unnecessary hospitalizations and ensure the least restrictive treatment option is available to people experiencing behavioral health crises.
The Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) are pleased to release this report, Women With Diabetes: Quality of Health Care, on behalf of the U.S. Department of Health and Human Services (DHHS). This report uses national data sets to show gaps in knowledge about quality of care among women with diagnosed diabetes. The report examines the quality of health care in the United States for women with and without diagnosed diabetes, using the most scientifically based measures and national data sources available. It presents 15 measures of health care quality showing the use of services in several areas: access to care, general well-being, evidence-based diabetes-specific preventive care, cardiovascular disease-specific preventive care, cancer-specific care, immunizations, and dental care. An estimated 24 million people in the United States, or 8% of adults 20 years or older, have diabetes; of these, almost half are women. Projections indicate that women will account for the majority of cases between 2010 and 2050.2 According to the Public Health Service Task Force on Women's Health Issues, diabetes is a women's health issue because of the unique health concerns that can arise from diabetes in pregnancy. In addition, women with diabetes face an increased risk of cardiovascular disease. Yet, many reports do not stratify by sex, so it is difficult to determine the quality of care that women with, or are at risk of, diabetes receive. Chronic illnesses and complications from diseases such as diabetes can affect overall quality of life. These conditions may place people at risk of disability, comorbid conditions such as depression and cardiovascular disease, and premature death. Diabetes treatment strategies to reduce morbidity and mortality include specific interventions such as strict blood glucose control, eye and foot examinations, and cholesterol and blood pressure control. Recent national data suggest that implementation of these recommendations for diabetes care for the total diabetic population has improved since 1995. However, the quality of care remains suboptimal. The projected increase in the number of women with diagnosed diabetes suggests the need for analyses of data that examine the level of use of recommended preventive care services for these women. The Centers for Disease Control and Prevention (CDC) collaborated with the Agency for Healthcare Research and Quality (AHRQ) to develop this report, which assesses and describes the quality of care that women with diagnosed diabetes receive in the United States. The information in this report can be used to identify gaps in public health programs, policies, research, and services related to women with diagnosed diabetes across the lifespan. Programs specifically designed to ameliorate barriers to optimal care are needed to reduce the sex disparities in quality of health care currently delivered to women with diagnosed diabetes.
The Treatment Improvement Protocol (TIP) series fulfills the Substance Abuse and Mental Health Services Administration's (SAMHSA's) mission to improve prevention and treatment of substance use and mental disorders by providing best practices guidance to clinicians, program administrators, and payers. TIPs are the result of careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates debates and discusses their particular area of expertise until they reach a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers.
Misuse of alcohol, tobacco, and other drugs is a problem throughout the United States. Communities vary greatly in the specific problems they face, the groups affected by those problems, and the events that rouse people to take action. In addition to having different problems and priorities, some communities have more resources and experience with locally based prevention activities than others. Yet, with a "can do" approach and a bit of guidance, any community can have success in implementing strategies and programs to prevent substance use. This is where Focus on Prevention can help. The U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), has developed this guide as a starting point to help a wide range of groups and communities move from concerns about substance use to proven and practical solutions.
Fiscal year 2009 (FY09) was an exciting year for the American health care system. An infusion of funding from the American Recovery and Reinvestment Act (Recovery Act) and the debate over health reform brought new attention to the opportunities and the challenges the system faces in improving the safety and quality of health care, ensuring access to care, increasing the value of health care, reducing disparities, and increasing the use of health information technology. The Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care (EHC) Program has successfully grown into a program that is collaborative, transparent, stakeholder-driven, relevant, and timely. Our goal is to develop evidence-based information that is both rigorous and relevant to clinical decisions and is available when decisions are made. We have learned that to achieve that goal, ongoing dialogue with public and private sector stakeholders is essential. In order to gain and maintain the trust of all stakeholders, comparative effectiveness research (CER) must be fully transparent to all. Transparency has been a hallmark of the EHC Program. The transparency begins with an open process for setting research priorities, which the secretary of the Department of Health and Human Services (HHS) sets through discussion with and extensive input from stakeholders. Within the boundaries of those priorities, the public and other interested stakeholders have the opportunity to comment on the framing of specific research questions and to critique draft reports. In addition to the open invitation to comment, manufacturers are notified when a comparative effectiveness review begins on one of their products and are invited to submit relevant studies and data. Efforts to encourage outside input ensure that all stakeholders have equal and fair access to the process. Comparative effectiveness research aims to improve health outcomes by developing and disseminating evidence-based information to patients, providers, and health care decision-makers about the effectiveness of treatments relative to other options. AHRQ's comparative effectiveness research considers the effectiveness of treatments in specific subpopulations and the clinical utility and validity of genetic tests. Additionally, AHRQ supports research on the way patients and physicians receive and access the latest health care information. This research, along with information about each individual patient, can be used to optimize care for the individual and can help us achieve the vision of personalized medicine. The Agency fulfills this mission by developing and working with the health care system to implement information that: Reduces the risk of harm from health care services by using evidence-based research and technology to promote the delivery of the best possible care; Transforms the practice of health care to achieve wider access to effective services and reduce unnecessary health care costs; Improves health care outcomes by encouraging providers, consumers, and patients to use evidence-based information to make informed treatment decisions. Ultimately, the Agency achieves its goals by translating research into improved health care practice and policy. Health care providers, patients, policymakers, payers, administrators, and others use AHRQ research findings to improve health care quality, accessibility, and outcomes of care. This report presents key accomplishments, initiatives, and research findings from AHRQ's research Portfolios during FY09. The Agency's mission helps HHS achieve its strategic goals to improve the safety, quality, affordability, and accessibility of health care; promote public health, disease prevention, and emergency preparedness; contribute to the economic and social well-being of individuals, families, and communities; and advance scientific and biomedical research and development related to health and human services.
American Indians and Alaska Natives have consistently experienced disparities in access to healthcare services, funding, and resources; quality and quantity of services; treatment outcomes; and health education and prevention services. Availability, accessibility, and acceptability of behavioral health services are major barriers to recovery for American Indians and Alaska Natives. Common factors that infuence engagement and participation in services include availability of transportation and child care, treatment infrastructure, level of social support, perceived provider effectiveness, cultural responsiveness of services, treatment settings, geographic locations, and tribal affliations.
The United States has experienced remarkable improvements in public health and medical progress throughout much of the twentieth century, including major advances in pharmaceutical and medical device innovation and gains in life expectancy. These improvements, however, have not been accessible to all parts of U.S. society. Substantial disparities in life expectancy, health, and health care persist. Although many actors—including health care systems, insurers, health care providers, and patients—contribute to these disparities, bias, discrimination, and stereotyping during the clinical encounter also explain health care disparities. Experts recommend reducing fragmentation in health care systems, improving awareness on the part of health care providers of these problems, strengthening culturally competent approaches to the delivery of health care, and increasing the diversity of the health care workforce, as strategies to reduce health care disparities. A core component in recommendations to address healthcare disparities is the involvement of the community: specifically, the involvement of community health workers (CHWs). The RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) conducted a systematic review on outcomes of CHW interventions. The review addressed four key questions (KQs): KQ 1. How do CHWs interact with participants? Specifically, what is the place of service, type of service, type of educational materials used, duration of interaction with participants, and length of followup? KQ 2. What is the impact of CHWs on outcomes, particularly knowledge, behavior, satisfaction, health outcomes, and health care utilization? KQ 3. What is known about the cost-effectiveness of CHWs for improving health outcomes? KQ 4a. What are characteristics of training for CHWs in the outpatient setting? KQ 4b. Are particular training characteristics associated with improved outcomes for patients?
Unemployment and substance abuse may be intertwined long before an individual seeks treatment. Although the average educational level of individuals with substance abuse disorders is comparable to that of the general U.S. population, people who use substances are far more likely to be unemployed or underemployed than people who do not use substances. According to the U.S. Census Bureau, employment rates for the non- substance-using population ranged from 72.3 percent in 1980 to 76.8 percent in 1991. However, employment rates of the population with substance abuse problems before admission or at admission to treatment have remained at relatively stable, low levels since 1970, ranging from 15 to 30 percent. Most of the research on the employment rates of persons with substance abuse disorders has focused on opiate-dependent persons (usually heroin), and employment rates for other substance users may vary. The data clearly indicate the need for interventions to improve employment rates...
This Treatment Improvement Protocol (TIP)is a companion to TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women. These two volumes look at how gender-specific treatment strategies can improve outcomes for men and women, respectively.The physical, psychological, social, and spiritual effects of substance use and abuse on men can be quite different from the effects on women, and those differences have implications for treatment in behavioral health settings. Men are also affected by social and cultural forces in different ways than women, and physical differences between the genders influence substance use and recovery as well.This TIP, Addressing the Specific Behavioral Health Needs of Men, addresses these distinctions. It provides practical information based on available evidence and clinical experience that can help counselors more effectively treatment with substance use disorders
The goal of this technical review is to examine critical issues of care coordination for children with special health care needs. It is intended to supplement the more comprehensive Evidence-based Practice Center (EPC) report on care coordination currently under preparation. Experts in the field such as Perrin and colleagues and Stein have described in detail the requirements for providing coordinated care for children with complex medical needs. In addition, professional organizations such as the American Academy of Pediatrics and a variety of advocacy groups and service programs for families with children with special health care needs have developed care coordination strategies and developed very useful guidance materials regarding this issue. These sources, while embracing general principles of care coordination that are relevant for all populations and age groups, emphasize those elements of care that are of particular importance for children with special health care needs. Although quite varied, they tend to be due to (1) the dependence of children on parents or other adult caretakers; (2) the distinct epidemiology of childhood and its implications for the organization of health services; (3) the developmental nature of child health problems and the need to link care with educational institutions; and (4) the special financial basis for child health and related services. The inherent dependence of children on adults acting on their behalf adds a level of complexity to care coordination efforts in that the facilitation, monitoring, and at times the enforcement of this proxy function must always be incorporated into coordinative programs for children. The most important distinctive characteristic of the epidemiology of childhood is that unlike in the elderly, serious chronic illness is relatively rare. This requires that specialized services for children with such disorders are heavily dependent on regional referral centers, programs that maintain the expertise, volume of patients, and resource commitment to address these serious but relatively rare disorders. The developmental nature of childhood implies that the problems and service needs of children will be highly dynamic over time and involve developmental support services, such as early intervention programs, as well as school-based interactions. Because children are the poorest segment of our population, poverty and means-tested public programs, such as Medicaid, are of particular concern in developing and evaluating care coordination efforts for children. In general, these efforts for improving the coordination of care for children with special health care needs have taken two forms: Specialized care coordination interventions for selected clinical populations. These include the use of case managers, the establishment of a medical home, or home care strategies. The structural organization of health care services. The dominant current approach is managed care. What has generally been lacking is an assessment of the evidence regarding the actual impact of care coordination efforts on outcomes for children with special health care needs. In response, this technical review is directed at the evaluative literature, those published reports that attempt to assess the experience of children with special health care needs and their families in response to purposeful care coordination efforts. Specifically, the technical review addresses the following objectives: 1. To identify and critically examine studies that empirically evaluate models of care coordination interventions for children with special health care needs. 2. To identify and critically examine studies that empirically evaluate the impact of managed care on children with special health care needs, particularly those enrolled in Medicaid. 3. To develop recommendations for future research and the evidence related to potential ameliorative action.
Major research advances have substantially improved our understanding of the biology of HIV and the pathogenesis (i.e., origin and development) of AIDS. The pathogenesis of AIDS is now known to result from the ability of HIV to replicate at the rate of a billion new virions (viral particles) per day and nearly 10 trillion new virions over the course of HIV infection. This, countered by the ability of the body to produce CD4+ T cell lymphocytes (a primary target cell for HIV), sets the stage for the struggle between HIV and the immune system-a struggle that lasts from the first day of HIV infection to end-stage disease and death.
The Federal Guidelines for Opioid Treatment Programs (Guidelines) describe the Substance Abuse and Mental Health Services Administration's (SAMHSA) expectation of how the federal opioid treatment standards found in Title 42 of the Code of Federal Regulations Part 8 (42 CFR � 8) are to be satisfied by opioid treatment programs (OTPs). Under these federal regulations, OTPs are required to have current valid accreditation status, SAMHSA certification, and Drug Enforcement Administration (DEA) registration before they are able to administer or dispense opioid drugs for the treatment of opioid addiction.
Thank you for visiting our website. Would you like to provide feedback on how we could improve your experience?
This site does not use any third party cookies with one exception — it uses cookies from Google to deliver its services and to analyze traffic.Learn More.