Negotiate or Litigate? Effects of WTO Judicial Delegation on U.S. Trade Politics

Goldstein and Steinberg argue that the World Trade Organization Appellate Body has been able to use its authority to engage in judicial lawmaking to reduce trade barriers in ways that would not otherwise have been possible through negotiation. This lawmaking authority was not the result of a purposeful delegation; rather, it was an unintended byproduct of the creation of an underspecified set of rules and procedures. There is nevertheless a high rate of compliance with Appellate Body decisions because decentralized enforcement can induce domestic importers to lobby for trade liberalization. In the US, this judicial lawmaking may also allow the President to achieve trade policies that are more liberal than those desired by Congress, if compliance can be achieved by a regulatory change or by sole Executive action

Advancing Behavioral Health Integration Within NCQA Recognized Patient-Centered Medical Homes

This report details the behavioral health elements required in achieving recognition as a patient-centered medical home (PCMH) by the National Committee for Quality Assurance (NCQA). Advancing Behavioral Health Integration Within NCQA Recognized Patient-Centered Medical Homes aims to support safety-net providers across the country by outlining the newest NCQA PCMH standards as they relate to integrating behavioral health into primary care

Relative abundance, temporal distribution, and functional feeding groups of aquatic insects in two first-order southwestern Pennsylvania streams

Two first to second order streams (Kent Run and Munnell Hollow) at Ryerson Station State Park, Greene County, Pennsylvania, were compared as to water parameters (dissolved oxygen, hardness, temperature, pH, and current velocity), species diversity, and abundance of both immature and adult insects. Samples were taken biweekly for one year from May, 1999 through April, 2000 for a total of 26 sampling periods. Data were analyzed using a repeated measures ANOVA. Kent Run had lower dissolved oxygen, higher pH and hardness, lower temperatures, and higher current velocity. A total of 137 taxa were collected at both streams. Of the total 3,299 individuals collected at Kent Run, 1,166 were adults and 2,133 were immatures. Munnell Hollow had 1,273 adults and 890 immatures for a total of 2,163 individuals. For the adult and immature community metrics, there was a higher number of shredder taxa and a greater percentage of shredders at Munnell Hollow, both a higher number of taxa and a higher percentage of both collector-filterers and collector-gatherers at Kent Run, a higher number of scraper taxa and a greater percentage of scrapers at Kent Run, an equal number of predator taxa at each stream, and a higher percentage of predators at Munnell Hollow. Overall, community metrics were significantly higher for May 12--14, 1999 and April 24--26, 2000, indicating an optimal time for sampling for assessment of community metrics. The combination of the water parameters at Kent Run and its wider area and higher number of leaf packs, snags, and debris dams contributed to the higher numbers of individuals collected

Organizational Structure and Professional Norms in an Alternative Health Care Setting: Physicians in Health Maintenance Organizations

The development of new organizational forms for the delivery of health and medical care in the U.S. includes health maintenance organizations (HMOs), designed to provide a set of comprehensive basic health services to a defined population for a fixed prepaid premium. As complex organizations, HMOs have the potential for limiting the autonomy of professionals working in them. This paper describes the legal requirements and organizational mechanisms under which physicians practice in HMOs and considers the potential for conflict between the organization and professional norms. On the basis of document and interview data from nine HMOs, it appears that mechanisms developed to implement the mode of physician reimbursement and legal requirements for quality assurance and member grievance procedures do not limit physician autonomy in these HMOs. Variation was observed among the three organizational models: staff, group, and independent practice association

Diabetes Care Trends in the MA Patient Centered Medical Home Initiative (MA PCMHI) at Mid-Point

Background: The MA PCMHI is a multi-payer demonstration involving 45 primary care practices. Thirty-one (31) practices receive additional financial support; all receive technical assistance. Objectives: To assess data trends in diabetes quality measures from participating adult practices. Study Design: Quality improvement study utilizing practices’ self-reported data on clinical quality measures. Diabetes measures included blood pressure, LDL cholesterol and hemoglobin A1C control and depression screening. Methods: Monthly quality data from 38 practices reported June 2011 (baseline) through November 2012 were evaluated. Using a general linear mixed model Analysis of Variance (ANOVA), an overall comparison across time and pair-wise comparisons between times were made to identify periods with significant changes. The analysis also identified the effect of each practice’s performance on aggregate performance and practice performance in change over time for each measure, to determine high and low performers. Results: On aggregate, the change over time performance was statistically significant for two measures: hemoglobin A1C \u3e9% and depression screening. Some practices were either high or low performers on most measures. Some practices were high performers on some but low performers on other measures. Practices with and without financial support were equally represented in high and low performer categories. Conclusions: In the first 18 months of the MA PCMHI, participating practices have significantly improved diabetes care by reducing the percentage of patients with poorly controlled diabetes and by more consistently screening patients for depression. Certain sites are excelling – consistently or only in certain measures. Financial support does not appear to be a factor but practice payer mix, size and leadership engagement may be important factors. Analysis of the impact of these factors and a qualitative analysis of best practices implemented by high performing sites, are planned. Policy Impact: Findings will inform the technical assistance provided to practices undergoing transformation to PCMHs

MA PCMH Eval Week: Ann Lawthers, Sai Cherala, and Judy Steinberg on How You Define Success Influences Your Findings

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness. This blog post was posted to AEA365 during a week of posts featuring the team at the University of Massachusetts Medical School that helped to evaluate the Massachusetts Patient-Centered Medical Home Initiative

How Can Care Management Improve Patient Outcomes? Focus on Risk Stratification

The poster helps practices recognized as PCMH identify and manage the care of the highest-risk, complex and costly patients. Clinical care management has helped patient-centered medical homes reduce costs and hospital admissions and stays, while increasing patient satisfaction. Presented at the Institute for Healthcare Improvement 2015 Conference

Innovations in Primary Care: Implementing Clinical Care Management in Primary Care Practices

The Massachusetts Patient Centered Medical Home Initiative (MA PCMHI) is a statewide, multi-payer demonstration that seeks to transform 46 primary care practices into PCMHs. Clinical care management of high-risk patients is a key element of the PCMH and a new service for most primary care practices. Training for practices in the MA PCMHI includes the clinical care manager (CCM) role, identification/tracking of highest-risk patients, care plan development/implementation, care coordination, and communications. Content is delivered through learning collaborative sessions, monthly webinars and practice-based transformation facilitation. Assessment of progress towards implementation is made through practice-based data on clinical care management measures and self-assessment of transformation. At year one of implementation, averages for measures such as percentage of patients who received timely follow-up after hospitalizations and ED visits range 37%-63% with 35-40 of 46 practices reporting. The challenges that have hampered implementation include lack of: (1) EMR/registry functionality, (2) hospital to practice notification systems, (3) clarity of the CCM role and workflow, (4) risk stratification criteria for high-risk patients, and (5) adequate resources to support this service. An important lesson learned is that engaged leadership is critical to successful clinical care management implementation. Next steps include refinement of the practice-based self-assessment that is used as a monitoring and QI tool, and a pilot to study the coordination of payer-based and practice-based clinical care management

Revisión de literatura: integración regional en América Latina y América del Sur

Si en la década del 90 se hablaba de integración regional liberal y de tipo comercial, en el decenio del 2000 se empezó a hablar de integración regional postliberal y de carácter política. En este trabajo se realiza una revisión de literatura que busca relevar el análisis académico actual sobre la integración regional en América Latina. Específicamente estudia si hay o no un nuevo proceso de integración regional y de qué tipo resulta ser este. En segundo lugar se evalúa la integración sub-regional en América del Sur