Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

In response to widespread concerns regarding Veterans\u27 access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research and Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination

Replicating viral vector platform exploits alarmin signals for potent CD8⁺ T cell-mediated tumour immunotherapy.

Viral infections lead to alarmin release and elicit potent cytotoxic effector T lymphocyte (CTL <sup>eff</sup> ) responses. Conversely, the induction of protective tumour-specific CTL <sup>eff</sup> and their recruitment into the tumour remain challenging tasks. Here we show that lymphocytic choriomeningitis virus (LCMV) can be engineered to serve as a replication competent, stably-attenuated immunotherapy vector (artLCMV). artLCMV delivers tumour-associated antigens to dendritic cells for efficient CTL priming. Unlike replication-deficient vectors, artLCMV targets also lymphoid tissue stroma cells expressing the alarmin interleukin-33. By triggering interleukin-33 signals, artLCMV elicits CTL <sup>eff</sup> responses of higher magnitude and functionality than those induced by replication-deficient vectors. Superior anti-tumour efficacy of artLCMV immunotherapy depends on interleukin-33 signalling, and a massive CTL <sup>eff</sup> influx triggers an inflammatory conversion of the tumour microenvironment. Our observations suggest that replicating viral delivery systems can release alarmins for improved anti-tumour efficacy. These mechanistic insights may outweigh safety concerns around replicating viral vectors in cancer immunotherapy

No Excuses Charter Schools: A Meta-Analysis of the Experimental Evidence on Student Achievement

While charter schools differ widely in philosophy and pedagogical views, the United States’s most famous urban charter schools typically use the No Excuses approach. Enrolling mainly poor and minority students, these schools feature high academic standards, strict disciplinary codes, extended instructional time, and targeted supports for low-performing students. The strenuous and regimented style is controversial amongst some scholars, but others contend that the No Excuses approach is needed to rapidly close the achievement gap. We conduct the first meta-analysis of the achievement impacts of No Excuses charter schools. Focusing on experimental studies, we find that No Excuses charter schools significantly improve math scores and reading scores. We estimate gains of 0.25 and 0.16 standard deviations on math and literacy achievement, respectively, as the effect of attending a No Excuses charter school for one year. Though the effect is large and meaningful, we offer some caveats to this finding and discuss policy implications for the United States as well as other countries

Integrating precision cancer medicine into healthcare—policy, practice, and research challenges

Abstract Precision medicine (PM) can be defined as a predictive, preventive, personalized, and participatory healthcare service delivery model. Recent developments in molecular biology and information technology make PM a reality today through the use of massive amounts of genetic, ‘omics’, clinical, environmental, and lifestyle data. With cancer being one of the most prominent public health threats in developed countries, both the research community and governments have been investing significant time, money, and efforts in precision cancer medicine (PCM). Although PCM research is extremely promising, a number of hurdles still remain on the road to an optimal integration of standardized and evidence-based use of PCM in healthcare systems. Indeed, PCM raises a number of technical, organizational, ethical, legal, social, and economic challenges that have to be taken into account in the development of an appropriate health policy framework. Here, we highlight some of the more salient issues regarding the standards needed for integration of PCM into healthcare systems, and we identify fields where more research is needed before policy can be implemented. Key challenges include, but are not limited to, the creation of new standards for the collection, analysis, and sharing of samples and data from cancer patients, and the creation of new clinical trial designs with renewed endpoints. We believe that these issues need to be addressed as a matter of priority by public health policymakers in the coming years for a better integration of PCM into healthcare

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care

In response to concerns about Veterans’ access to Veterans Affairs (VA) health care services, Congress passed the Veterans Access, Choice and Accountability Act of 2014 (Choice), which broadened Veterans’ eligibility to receive health care delivered by non-VA community providers paid for by VA (ie, Community Care).1 Specifically, the Veterans Choice Program (VCP) allowed Veterans waiting longer than 30 days for specific services in VA, who lived \u3e40 miles from a VA clinic, or who experienced specific hardships in accessing VA care, the option of receiving Community Care. To help implement VCP successfully, the VA established the Office of Community Care (OCC) in fiscal year (FY) 2015 to lead the coordination of Community Care expansion. This included reorganizing local departments at each VA facility to ensure that VA/Community Care referrals across systems occurred seamlessly