Impact of Suspended Particles on Bacterial Concentrations in Great Bay Estuary Oysters

Vibrio parahaemolyticus bacteria are naturally occurring in marine ecosystems globally. However, with recent environmental changes, such as increased water temperature, they have an increasing presence in northeast United States waters, including the Great Bay Estuary in New Hampshire. Due to the accumulation of bacteria in filter feeders that are often consumed, such as oysters, surveillance is necessary to monitor bacteria. I spent the summer of 2017 collecting plankton, water, suspended solids (floating material), sediment, and oysters from the Great Bay Estuary to characterize how suspended solids might impact V. parahaemolyticus concentrations in oysters. I hypothesized that when the mass of the suspended solids increased, the bacterial concentration in the oysters would also increase, due to the oysters filtering the water around them and collecting floating particles that might have bacteria clinging to them. My data supported my hypothesis and suggested that inorganic material, such as sand and clay, plays a bigger role in this bacterial accumulation than organic material, such as plant matter and plankton. This information could be used to develop new methods to ensure consumers have access to seafood that is safe to eat

Higher Readmissions at Safety-Net Hospitals and Potential Policy Solutions

The Hospital Readmissions Reduction Program (HRRP), established by the Affordable Care Act, ties a hospital's payments to its readmission rates -- with penalties for hospitals that exceed a national benchmark -- to encourage hospitals to reduce avoidable readmissions. This new Commonwealth Fund analysis uses publicly reported 30-day hospital readmission rate data to examine whether safety-net hospitals are more likely to have higher readmission rates, compared with other hospitals. Results of this analysis find that safety-net hospitals are 30 percent more likely to have 30-day hospital readmission rates above the national average, compared with non-safety-net hospitals, and will therefore be disproportionately impacted by the HRRP. Policy solutions to help safety-net hospitals reduce their readmission rates include targeting quality improvement initiatives for safety-net hospitals; ensuring that broader delivery system improvements include safety-net hospitals and care delivery systems; and enhancing bundled payment rates to account for socioeconomic risk factors

Driving Value in Medicaid Primary Care: The Role of Shared Support Networks for Physician Practices

Examines the challenges of transforming small primary care practices under healthcare reform and options for Medicaid to drive changes through practice supports to help implement and sustain new models of care or catalyze investments in new systems

Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?

Explores proposed models and configurations of accountable care organizations, which combine provider payment and delivery system reforms, and their potential to slow the rise of healthcare costs. Outlines key issues and program features under debate

How Will Comparative Effectiveness Research Affect the Quality of Health Care?

Outlines how the use of comparative effectiveness research on the relative merits of a healthcare intervention compared with others could improve quality of care and outcomes. Presents challenges in enhancing CE research and expanding its adoption

Doing Better by Doing Less: Approaches to Tackle Overuse of Services

Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $765 billion of health care dollars wasted in 2009, a quarter --$210 billion -- was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.This overuse of services has implications for both health care costs and outcomes. There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent

The Center for Medicare and Medicaid Innovation: Activity on Many Fronts

Provides an overview of the Innovation Center's organization, differences from CMS's traditional demonstration authority, payment and delivery reform initiatives, and first-year efforts to solicit and promote new ideas and collaborate with other payers

How Does the Quality of U.S. Health Care Compare Internationally?

Explores definitions of high-quality health care and evidence for comparing U.S. health care with care in other countries. Discusses measures of specific types of care; findings on over-utilization, patient safety, and uninsurance; and implications

How Will the Patient Protection and Affordable Care Act Affect Seniors?

Summarizes how healthcare reform provisions including changes to Medicare premiums and drug benefits, preventive services, Medicare Advantage plans; reduced provider payment rates; and efforts to improve quality and system performance will affect seniors