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NEJM—Health Policy and Reform

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Mathuram Santosham, Duncan Steele
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 improvements in water, sanitation, and hygiene do not..
March 23, 2017: New England Journal of Medicine
Krisda H Chaiyachati, David A Asch, David T Grande
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..
March 23, 2017: New England Journal of Medicine
Kamalini Ramdas, Ara Darzi
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 routine care of chronic conditions, patient..
March 23, 2017: New England Journal of Medicine
Jonathan Oberlander
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. Can the GOP dismantle Obamacare? The bill..
March 22, 2017: New England Journal of Medicine
Kelly J Kelleher, William Gardner
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..
March 16, 2017: New England Journal of Medicine
George Q Daley
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 approval of treatments for serious illnesses or..
March 16, 2017: New England Journal of Medicine
Merle Ederhof, Paul B Ginsburg
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..
March 16, 2017: New England Journal of Medicine
Susan W Tolle, Joan M Teno
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 (Figure 1). These utilization patterns are..
March 16, 2017: New England Journal of Medicine
Sarah E Wakeman
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..
March 16, 2017: New England Journal of Medicine
Sarah Miller, Laura R Wherry
Background By September 2015, a total of 29 states and Washington, D.C., were participating in Medicaid expansions under the Affordable Care Act. We examined whether Medicaid expansions were associated with changes in insurance coverage, health care use, and health among low-income adults. Methods We compared changes in outcomes during the 2 years after implementation of the Medicaid expansion (2014 and 2015) relative to the 4 years before expansion (2010 through 2013) in states with and without expansions, using data from the National Health Interview Survey...
March 9, 2017: New England Journal of Medicine
Karen M Emmons, Graham A Colditz
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 that vaccination against the human..
March 9, 2017: New England Journal of Medicine
Ravi B Parikh, Arnold Milstein, Sachin H Jain
In recent years, a growing number of medical schools have begun to provide training in cost stewardship, as part of efforts to improve the value of health care. Yet everyday patient encounters provide sober reminders of the unintended consequences of myopic physician education about costs. Consider..
March 9, 2017: New England Journal of Medicine
Daniel G Bausch
Despite the slowing and eventual halting of the spread of Ebola virus disease (EVD) in West Africa, the battle for preventing and managing future outbreaks is still on. This is no time to be complacent. The scale of the outbreak, in which every few days during the early part of the outbreak about..
March 9, 2017: New England Journal of Medicine
Julie E Ledgerwood, Adam D DeZure, Daphne A Stanley, Emily E Coates, Laura Novik, Mary E Enama, Nina M Berkowitz, Zonghui Hu, Gyan Joshi, Aurélie Ploquin, Sandra Sitar, Ingelise J Gordon, Sarah A Plummer, LaSonji A Holman, Cynthia S Hendel, Galina Yamshchikov, Francois Roman, Alfredo Nicosia, Stefano Colloca, Riccardo Cortese, Robert T Bailer, Richard M Schwartz, Mario Roederer, John R Mascola, Richard A Koup, Nancy J Sullivan, Barney S Graham
Background The unprecedented 2014 epidemic of Ebola virus disease (EVD) prompted an international response to accelerate the availability of a preventive vaccine. A replication-defective recombinant chimpanzee adenovirus type 3-vectored ebolavirus vaccine (cAd3-EBO), encoding the glycoprotein from Zaire and Sudan species, that offers protection in the nonhuman primate model, was rapidly advanced into phase 1 clinical evaluation. Methods We conducted a phase 1, dose-escalation, open-label trial of cAd3-EBO. Twenty healthy adults, in sequentially enrolled groups of 10 each, received vaccination intramuscularly in doses of 2×10(10) particle units or 2×10(11) particle units...
March 9, 2017: New England Journal of Medicine
Peter D Friedmann, Christina M Andrews, Keith Humphreys
As the U.S. Surgeon General’s recent report on addiction highlights, the United States faces a serious opioid epidemic that shows no signs of abating. In 2015, more than 13 million Americans reported nonmedical use of opioids in the previous year, and about 2.5 million of those people have an..
March 9, 2017: New England Journal of Medicine
David S Mandell, Colleen L Barry
The false belief that vaccines cause autism has been forcefully countered by the scientific community, which recognizes that vaccines are among the most valuable medical innovations of our time. President Donald Trump’s apparent openness to a long-debunked link between vaccines and autism risks..
March 9, 2017: New England Journal of Medicine
Kathleen R Page, Sarah Polk
A pregnant woman from Central America was diagnosed with syphilis at the Baltimore City Health Department in 2007. The outreach team contacted her to discuss the need for, and availability of, treatment. She agreed to return to the clinic, but did not. When reached by phone, she reported that on..
March 23, 2017: New England Journal of Medicine
Catharine I Paules, Anthony S Fauci
Four arthropod-borne viruses (arboviruses) have recently emerged or reemerged in the Americas, spreading rapidly through populations that had not previously been exposed to them and causing substantial morbidity and mortality. The first was dengue, which reemerged to cause widespread disease..
March 8, 2017: New England Journal of Medicine
Christine Grady, Steven R Cummings, Michael C Rowbotham, Michael V McConnell, Euan A Ashley, Gagandeep Kang
This multipart review provides an overview of innovative approaches to improving and expanding the informed consent process for researchers and participants, along with short essays covering specific areas of innovation. The Changing Face of Informed Consent. Christine Grady, R.N. Ph.D. In the..
March 2, 2017: New England Journal of Medicine
Ranjana Srivastava
I groan internally at the sight of the laminated yellow reminder that the next patient needs an interpreter, who is waiting patiently outside my office. Non–English-speaking patients take at least twice the time of others. Everything one says has to be understood, and some of it jotted down, by the..
March 2, 2017: New England Journal of Medicine
2017-03-03 05:30:14
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