Predictable Unpredictability: The Problem with Basing Medicare Policy on Long-Term Financial Forecasting

The authors assess how Medicare financing and projections of future costs have changed since 2000. They also assess the impact of legislative reforms on the sources and levels of financing and compare cost forecasts made at different times. Although the aging U.S. population and rising health care costs are expected to increase the share of gross domestic product devoted to Medicare, changes made in the program over the past decade have helped stabilize Medicare's financial outlook—even as benefits have been expanded. Long-term forecasting uncertainty should make policymakers and beneficiaries wary of dramatic changes to the program in the near term that are intended to alter its long-term forecast: the range of error associated with cost forecasts rises as the forecast window lengthens. Instead, policymakers should focus on the immediate policy window, taking steps to reduce the current burden of Medicare costs by containing spending today

A Comparison of Psychiatrist Evaluation and Patient Symptom Report in a Jail Telepsychiatry Clinic

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2004.10.S-54.The effectiveness of a jail telepsychiatry service was evaluated by comparing psychiatrist and inmate report of psychopathology. Sixty-two inmates completed a total of 107 consultations at a rural county jail via interactive televideo. The inmates completed the Symptom Rating Checklist-90-Revised (SCL-90-R), and the psychiatrist completed a Psychiatrist Evaluation Form including the Clinical Global Impression Scale—Severity Index (CGI) after each teleconsultation. Most inmates were rated mild to moderately ill on the CGI. There was a significant, high correlation between telepsychiatrist evaluation on the CGI and inmate report of overall symptoms on the SCL-90-R [r(101) = 0.35, p < 0.05]. The findings support the effectiveness of telepsychiatric evaluation for the jail population. The patterns of telepsychiatric use in the county jail as well as future directions in this setting are described

Expanding Sustainable Community Health Centers in New York City

The Community Health Care Association of New York State (CHCANYS) has authored an updated analysis identifying New York City neighborhoods with the greatest need for expanded access to primary care and the ability to support sustainable growth of federally qualified health centers (FQHC).Building on its Plan for Expanding Sustainable Community Health Centers, published in 2013 with support from the NYS Health Foundation, CHCANYS has partnered with the Office of the Mayor of New York City to release the updated report, which ranks the primary care need and sustainability of 42 United Hospital Fund (UHF) New York City neighborhoods using a quantitative analysis of communities' relative need for additional FQHC capacity and the feasibility of such expansions. Authored with financial support from the Office of the Mayor of New York City, Expanding Sustainable Community Health Centers in New York City informed development of the New York City Caring Neighborhoods initiative, a new program that will significantly increase primary care access in underserved areas across the City's five boroughs. New York City-based FQHCs served 972,000 patients in 2014, and it is anticipated that this number will rise to over 1 million patients in 2015. Current state and federal health reform efforts emphasize the critical role of primary care in achieving improved delivery system outcomes, and increasing the capacity of FQHCs to meet these demands is essential.

Reproducibility in modeling and simulation of the knee:Academic, industry, and regulatory perspectives

Stakeholders in the modeling and simulation (M&amp;S) community organized a workshop at the 2019 Annual Meeting of the Orthopaedic Research Society (ORS) entitled “Reproducibility in Modeling and Simulation of the Knee: Academic, Industry, and Regulatory Perspectives.” The goal was to discuss efforts among these stakeholders to address irreproducibility in M&amp;S focusing on the knee joint. An academic representative from a leading orthopedic hospital in the United States described a multi-institutional, open effort funded by the National Institutes of Health to assess model reproducibility in computational knee biomechanics. A regulatory representative from the United States Food and Drug Administration indicated the necessity of standards for reproducibility to increase utility of M&amp;S in the regulatory setting. An industry representative from a major orthopedic implant company emphasized improving reproducibility by addressing indeterminacy in personalized modeling through sensitivity analyses, thereby enhancing preclinical evaluation of joint replacement technology. Thought leaders in the M&amp;S community stressed the importance of data sharing to minimize duplication of efforts. A survey comprised 103 attendees revealed strong support for the workshop and for increasing emphasis on computational modeling at future ORS meetings. Nearly all survey respondents (97%) considered reproducibility to be an important issue. Almost half of respondents (45%) tried and failed to reproduce the work of others. Two-thirds of respondents (67%) declared that individual laboratories are most responsible for ensuring reproducible research whereas 44% thought that journals are most responsible. Thought leaders and survey respondents emphasized that computational models must be reproducible and credible to advance knee M&amp;S.</p

Use of Distraction Loading to Estimate Subject-specific Knee Ligament Slack Lengths

Knee ligaments guide and restrain joint motion, and their properties influence joint mechanics. Inverse modeling schemes have been used to estimate specimen-specific ligament properties, where external joint forces are assumed to balance with internal ligament and contact forces. This study simplifies this assumption by adjusting experimental loads to remove internal contact forces. The purpose of this study was to use novel experimental loading in an inverse modeling scheme to estimate ligament slack lengths, perform validation using additional loading scenarios, and evaluate sensitivity to the applied loading. Joint kinematics and kinetics were experimentally measured for a set of load cases. An optimization scheme used a specimen-specific forward kinematics model to estimate ligament slack lengths by minimizing the residual between model and experimentally measured kinetics. The calibrated model was used for a form of validation by evaluating non-optimized load cases. Additionally, uncertainty analysis related kinetic errors to previously reported kinematic errors. The six DOF tibial reactions realized RMS errors less than 23 N and 0.75 Nm for optimized load cases, and 33 N and 2.25 Nm for the non-optimized load cases. The uncertainty analysis, which was performed using the optimized load cases, showed average kinetic RMS errors less than 26 N and 0.45 Nm. The model’s recruitment patterns were similar to those found in clinical and cadaveric studies. This study demonstrated that experimental distraction loading can be used in an inverse modeling scheme to estimate ligament slack lengths with a forward kinematics model

Use of Distraction Loading to Estimate Subject-specific Knee Ligament Slack Lengths

Knee ligaments guide and restrain joint motion, and their properties influence joint mechanics. Inverse modeling schemes have been used to estimate specimen-specific ligament properties, where external joint forces are assumed to balance with internal ligament and contact forces. This study simplifies this assumption by adjusting experimental loads to remove internal contact forces. The purpose of this study was to use novel experimental loading in an inverse modeling scheme to estimate ligament slack lengths, perform validation using additional loading scenarios, and evaluate sensitivity to the applied loading. Joint kinematics and kinetics were experimentally measured for a set of load cases. An optimization scheme used a specimen-specific forward kinematics model to estimate ligament slack lengths by minimizing the residual between model and experimentally measured kinetics. The calibrated model was used for a form of validation by evaluating non-optimized load cases. Additionally, uncertainty analysis related kinetic errors to previously reported kinematic errors. The six DOF tibial reactions realized RMS errors less than 23 N and 0.75 Nm for optimized load cases, and 33 N and 2.25 Nm for the non-optimized load cases. The uncertainty analysis, which was performed using the optimized load cases, showed average kinetic RMS errors less than 26 N and 0.45 Nm. The model’s recruitment patterns were similar to those found in clinical and cadaveric studies. This study demonstrated that experimental distraction loading can be used in an inverse modeling scheme to estimate ligament slack lengths with a forward kinematics model

Evaluation of the Western Australian Department of Health telehealth project

In 1999, the Department of Health in Western Australia began a telehealth project, which finished in 2004. The 75 videoconferencing sites funded by the project were part of a total state-wide videoconference network of 104 sites. During the period from January 2002 to December 2003, a total of 3266 consultations, case reviews and patient education sessions took place. Clinical use grew to 30% of all telehealth activity. Educational use was approximately 40% (1416 sessions) and management use was about 30% (1031 sessions). The average overhead cost per telehealth session across all regions and usage types was $A192. Meaningful comparisons of the results of the present study with other public health providers were difficult, because many of the available Websites on telehealth were out of date. Despite the successful use of telehealth to deliver clinical services in Western Australia, sustaining the effort in the post-project phase will present significant challenges