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The article, published in the June 2023 issue of the Quarterly, covers various topics related to population health. Topics include the need for improvements in monitoring child and adolescent mental health indicators, the impact of hospital system mergers on healthcare outcomes, the financing and ownership trends in the American healthcare system, and the strategic messaging to promote policies that advance racial equity.

Pneumonia causes a significant burden of disease worldwide. Although all populations are at risk of pneumonia, those at extremes of age and those with immunosuppressive disorders, underlying respiratory disease, and critical illness are particularly vulnerable. Although clinical practice guidelines addressing the management and treatment of pneumonia exist, few of the supporting studies focus on the crucial contributions of the host in pneumonia pathogenesis and recovery. Such essential considerations include the host risk factors that lead to susceptibility to lung infections; biomarkers reflecting the host response and the means to pursue host-directed pneumonia therapy; systemic effects of pneumonia on the host; and long-term health outcomes after pneumonia. To address these gaps, the Pneumonia Working Group of the Assembly on Pulmonary Infection and Tuberculosis led a workshop held at the American Thoracic Society meeting in May 2018 with overarching objectives to foster attention, stimulate research, and promote funding for short-term and long-term investigations into the host contributions to pneumonia. The workshop involved participants from various disciplines with expertise in lung infection, pneumonia, sepsis, immunocompromised patients, translational biology, data science, genomics, systems biology, and clinical trials. This workshop report summarizes the presentations and discussions and important recommendations for future clinical pneumonia studies. These recommendations include establishing consensus disease and outcome definitions, improved phenotyping, development of clinical study networks, standardized data and biospecimen collection and protocols, and development of innovative trial designs. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented on topics including the important characteristics of primary care, the implications of the U.S. underinvestment in its public health infrastructure and how it made the country susceptible to the spread of the coronavirus disease-2019 (COVID-19), and another on the trends in public health funding in the U.S.

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. The subjects were women aged 40 to 64 years, covered by private health insurance, undergoing screening mammography from 2007 to 2014. Except for Hawaii, Maryland, and New York, DBN legislation significantly increased the probability of ultrasound follow-up in all states that implemented DBN legislation before December 2014. It also increased the probability of MRI follow-up in California, North Carolina, Pennsylvania, and Texas. The financial and access consequences merit further study. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented, including one by Laurie Jinkins describing Washington State's 2019 legislation creating a public long-term care insurance program, another by James Capretta on the state's effort to test a public option in the individual insurance market, and one by David Kindig which analyzes infant mortality in the U.S. by using an unconventional approach.

Recently suggested novel implementation of the statistical distance measure (DM) for evaluating "physiological dysregulation" (PD) in aging individuals (based on measuring deviations of multiple biomarkers from baseline or normal physiological states) allows reducing high-dimensional biomarker space into a single PD estimate. Here we constructed DM using biomarker profiles from FRAMCOHORT (Framingham Heart Study) and CHS (Cardiovascular Health Study) Research Materials obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center, and estimated effect of PD on total survival, onset of unhealthy life (proxy for "robustness") and survival following the onset of unhealthy life (proxy for "resilience"). We investigated relationships between PD and declines in stress resistance and adaptive capacity not directly observed in data. PD was more strongly associated with the onset of unhealthy life than with survival after disease suggesting that declines in robustness and resilience with age may have overlapping as well as distinct mechanisms. We conclude that multiple deviations of physiological markers from their normal states (reflected in higher PD) may contribute to increased vulnerability to many diseases and precede their clinical manifestation. This supports potential use of PD in health care as a preclinical indicator of transition from healthy to unhealthy state. [ABSTRACT FROM AUTHOR]

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools—such as disease-specific quality improvement projects and clinical pathways—are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy. [ABSTRACT FROM AUTHOR]

This special issue of the Journal is devoted to understanding the many roads that lead toward achieving health equity. The eleven articles in the issue portray an America that is struggling with the clash between its historical ideal of pursuing equality for all and its ambivalence toward achieving equity in all social domains, especially health. Organized in five sections, the issue contains articles that examine and analyze: the role of civil rights law and the courts in shaping health equity; the political discourse that has framed our understanding of health equity; health policies that affect health equity, such as the Medicaid program, as well as related strategies that might help to improve equity, such as the use of mobile technologies to empower individuals; immigration policies and practices that impact health equity in marginalized populations; and commentaries in the final section that explore how the Affordable Care Act has addressed health equity, how repeal of the law would jeopardize equity gains, and how the political discourse and culture of the Trump administration could adversely affect health equity. [ABSTRACT FROM AUTHOR]

The article looks at the framework for change by the United Jewish Appeal (UJA)-Federation of New York and its influence in American Jewish communities. The innovation framework of UJA consists of essential elements in implementing change including vision, a cross-fertilization environment, and outside knowledge. The UJA-Federation applies these elements that led to the success of innovation projects including Six Points Fellowship, the Jewish Health, Healing and Hospice Alliance, and Camp Eden Village.

The article discusses the initiative of the United Jewish Appeal (UJA)-Federation of New York to create a Jewish hospice system in the city. From 2007-2009, a task force conducted a thorough literature review and consulted with UJA-Federation affiliated agency, and health institution professionals. Based on their research, the task force revealed the health care challenges facing American society. The task force proposed the need to enhance the service landscape and to create a cultural shift about Jews' perception of end-of-life care.

Five years after the Institute of Medicine (IOM) called for a redesigned U.S. health care system, relatively little was known about the extent to which hospitals had undertaken quality improvement (QI) efforts to address deficiencies in patient care. To examine the state of hospital QI activities in 2006, the authors designed and conducted a survey of short-term, general hospitals with 25 or more beds. In a sample of 470 hospitals, they found that many were actively engaged in improvement efforts but that these activities varied in method and impact. Hospitals with high levels of perceived quality, as reflected in assessments by their quality managers, were more likely to have embraced QI as a strategic priority, employed quality practices and processes consistent with IOM aims, fostered staff training and involvement in QI methods, engaged in an array of QI activities and clinical QI strategies, and maintained staffing levels favoring fewer patients per nurse. [ABSTRACT FROM AUTHOR]

Opinion. Comments on the article `Targets and Systems of Health Care Cost Control,' by Joseph White. Strategies for controlling health care cost in the United States; Relationship between price and service volume in health care cost control; Role of managed care in health care cost control.

This article distributes the Health Care Financing Administration's (HCFA) estimates of 1995 personal health care expenditures (PHCE) according to sex, age, and diagnosis for each type of health care service. Aggregate and per capita expenditures are reported for 18 broad categories of disease classified according to the International Classification of Diseases (ICD-9-CM). Special emphasis is given to expenditures for persons age 65 or over, the segment of the population with the highest expenditures. These results show how the relative importance of medical conditions and type of health services differs between the sexes and changes with increasing age. [ABSTRACT FROM AUTHOR]

Analyzes data from a 1989 survey of 1369 respondents from all U.S. schools of allopathic medicine to determine whether medical educators perceive a need for change in medical student education. Need for fundamental changes according to sciences faculty; Reforms advocated by educators; Condition of medical education in the U.S. as of February 1991.

Reports the experience of several primary care trainees in internal medicine compared with traditional-pathway trainees at the Boston City Hospital in Massachusetts. Description of the program; Methodology; Results.

The author reflects on the Medical Home model formed by several organizations, such as the American Academy of Pediatrics (AAP), which explores the primary care in the U.S. and proposes changes in the health care reform. The author notes that some of the concepts in the model are already present in European countries such as the General Practitioner (GP) training offered in Great Britain. The author mentions that the model has ideas on health promotion, disease prevention, and affordable care.

The article offers information on the Initiative on Subspecialty Clinical Training and Certification (SCTC). Topics include the concept of competency-based medical education (CBME), the Milestones Project of the Accreditation Council for Graduate Medical Education (ACGME), and the subspecialty training requirements. Also discussed is the creation of a Task Force to address the issue of clinical training requirements in relation to the current model of pediatrics subspecialty certification.