Commission Says Time for Health Reform Is Now
"With a large majority of Americans seeking profound change, the moment has come for the United States to take the necessary steps to ensure the health security of all Americans and put the nation's health care system on a path to high performance," said the Commonwealth Fund Commission on a High Performance Health System in a statement released November 21. "Bold actions that simultaneously improve the quality and efficiency of health care delivery" are necessary, said the Commission, which calls for changing how health care is paid for so providers are rewarded for providing quality care; organizing the health system to ensure access and coordination; investing in electronic information systems; and expanding the government's leadership role.
Is the Boom in Store-Based Health Clinics Ending?
Providing basic preventive services and treating simple health ailments, health clinics based in pharmacies and large retail stores have proliferated in recent years, appealing mostly to younger families, the uninsured, and minorities. But according to Checking Up on Retail-Based Health Clinics: Is the Boom Ending?, only a tiny fraction of U.S. families in 2007 used these in-store clinics. The study, prepared by Commonwealth Fund-supported researchers at the Center for Studying Health System Change (HSC), found that while the number of retail clinics grew from about 60 in 18 states at the beginning of 2006 to more than 900 in 30 states by the end of 2007, only 1.2 percent of families reported they had visited a retail clinic during the past 12 months. However, families who reported recent problems accessing medical care were almost 2.5 times as likely to have used a retail clinic as families without access problems.
Helping Pediatricians Help Parents
Although parents of young children often request information about healthy development and child-rearing techniques, studies indicate they do not always receive this guidance. An innovative quality improvement collaborative in Vermont and North Carolina shows that if provided help, physician practices can successfully implement systems to supply detailed guidance to young families. As Peter A. Margolis, M.D., Ph.D., and colleagues reported in Assisting Primary Care Practices in Using Office Systems to Promote Early Childhood Development (Ambulatory Pediatrics), the 18 primary care practices participating in the 12-month intervention increased their number of preventive and developmental care systems by 50 percent, and saw gains in developmental screening and psychosocial screening as well. Moreover, parents reported increased satisfaction with their child's care.
Racial Disparity Found in Prescribing Drugs for Dementia
In a study of 1,120 Medicare beneficiaries diagnosed with dementia, a Commonwealth Fund-supported research team led by the University of Maryland School of Pharmacy's Ilene H. Zuckerman, Pharm.D., Ph.D., found that use of anti-dementia medications among non-Hispanic whites during the period 2001 to 2003 was approximately 30 percent higher than among members of other racial and ethnic groups. The findings were reported in Racial and Ethnic Disparities in the Treatment of Dementia Among Medicare Beneficiaries. (Journal of Gerontology). Previous studies have found that dementia is often undiagnosed or misdiagnosed among African Americans, Latinos, and other ethnic groups, despite evidence that the condition is more prevalent in minorities.
Quality and Cost Not Necessarily Related, Study Finds
How resource use, or cost, relates to health care outcomes is crucial for quality improvement efforts, but the connection is not well understood. In a Commonwealth Fund-supported study of diabetes patients enrolled in 31 commercial health plans, researchers led by Joachim Roski, Ph.D., at the Brookings Institution found that quality and cost appear to be largely unrelated. In fact, resource use by health care organizations varied considerably more—as much as three to five times more—than did quality-of-care results. The authors of the study, which was published in the American Journal of Medical Quality, believe that resource use that does not lead to better health outcomes represents an opportunity to improve health system efficiency.
The Commonwealth Fund at 90
The 90th anniversary of The Commonwealth Fund serves as an occasion to reflect on the foundation's remarkable history and its role in supporting research and innovative practices that have driven improvements in the U.S. health care system for nearly a century. In her Web column, Commonwealth Fund president Karen Davis looks back at many of the foundation's accomplishments since 1918—from the first fellowships in child psychiatry to funding for the research that led to the Pap test for cervical cancer. Today, Davis says, the foundation is a leading voice for reforming the U.S. health care system. Watch a slide show celebrating the Fund's anniversary, as well as a tribute to the 100th anniversary of Harkness House, The Commonwealth Fund's home.