Risk-adjustment methods for all-payer comparative performance reporting in Vermont.

Background: As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer, "whole-population" approach to facilitate the reporting of utilization, cost, and quality measures has grown.

Improving quality of care for patients with chronic obstructive pulmonary disease.

A chronic obstructive pulmonary disease (COPD) project was initiated at 18 primary care clinical practices located in rural areas of northeastern Maine to improve the diagnosis and treatment of patients with COPD through the adoption of evidence-based and best practice clinical guidelines for care management. Clinical guidelines based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) were implemented by the practices using the Institute for Healthcare Improvement Breakthrough Series learning session model. Practice barriers and patient barriers were identified through focus groups and were then addressed at the learning sessions and through direct contact with the practices.

Diesel exhaust and asthma: hypotheses and molecular mechanisms of action.

Several components of air pollution have been linked to asthma. In addition to the well-studied critera air pollutants, such as nitrogen dioxide, sulfur dioxide, and ozone, diesel exhaust and diesel exhaust particles (DEPs) also appear to play a role in respiratory and allergic diseases. Diesel exhaust is composed of vapors, gases, and fine particles emitted by diesel-fueled compression-ignition engines.