Assessment of the effectiveness of weight-adjusted antibiotic administration, for reduced duration, in surgical prophylaxis of primary hip and knee arthroplasty.

Background: Prophylactic antibiotics have significantly led to a reduction in the risk of post-operative surgical site infections (SSI) in orthopaedic surgery. The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed, for the duration of the operation, the minimum inhibitory concentration of the likely organisms that are encountered. Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4% and 8% to between 1% and 3%.

From the Office of the National Coordinator: the strategy for advancing the exchange of health information.

Electronic health information exchange addresses a critical need in the US health care system to have information follow patients to support patient care. Today little information is shared electronically, leaving doctors without the information they need to provide the best care. With payment reforms providing a strong business driver, the demand for health information exchange is poised to grow.

Research glut and information famine: making research evidence more useful for policymakers.

The gap between the two worlds of researchers and policymakers renders the use of research in the policy-making process problematic. Policymakers have three primary needs in their use of research evidence: clear translation, accessible and easy-to-use information, and relevance to the policy context. These needs are sometimes at odds with the priorities of the research community.

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives.

Pay-for-performance (P4P) initiatives have been discussed since the early 1990s, but support for the concept has grown recently, fueled by experience with quality of care measures, endorsements by key players and research that underlines the need for quality improvements and reform to the physician payment system. This synthesis examines the evidence on P4P. Key findings include: About one-third of U.

The built environment and physical activity.

Regular physical activity has many health benefits, but in spite of the benefits many Americans are not sufficiently active. There is increasing recognition of the importance of environmental factors-including the built environment-to help promote physical activity. The built environment describes physical or manmade features such as sidewalks, streetlights, traffic and parks that may promote or discourage activity.

Medical malpractice: impact of the crisis and effect of state tort reforms.

As a result of rapidly rising medical malpractice insurance premiums, reduced availability of coverage, and financially distressed liability insurers, many states have passed tort reforms. This synthesis examines the medical malpractice ""crisis"" and the effect of state tort reforms. Evidence shows that caps on non-economic damages reduce the average size of malpractice awards by 20 to 30 percent and have a modest impact on malpractice insurance premium growth There is also evidence that the most severely injured patients are disproportionately affected by caps, however.

How has hospital consolidation affected the price and quality of hospital care?

During the 1990s, the hospital industry was transformed by mergers and acquisitions. This synthesis looks at why this rapid consolidation occurred and what impact it had on the price and quality for patients, and the cost of care for hospitals. Key findings include: Managed care was not a main driver of consolidation, but fear of managed care may have played a part.

How will employers respond to coverage reforms.

Any change in the health insurance market could prompt a reaction by employers in what kind and at what cost they offer coverage. This policy brief examines the research on employer decision-making. Key findings include: Firms are most likely to offer plans that respond to the preferences of their most valuable, hard-to-retain workers.

Geographic variation in medicare per capita spending.

Persistent, widespread variations in Medicare spending across the country are largely and well-documented. In 1996, Medicare per capita spending across the country ranged from $3,000 to $8,500. This synthesis examines the Medicare spending variation, underlying causes, possible solutions, and whether people in higher-spending areas receive better care.

Public program crowd-out of private coverage.

Coverage expansions by Medicaid, SCHIP and other state programs significantly increased the number of people covered by public insurance. Crowd-out occurs when people drop private coverage for public coverage, when those enrolled in public insurance turn down private coverage when eligible, or when employers opt not to offer private insurance because of the existence of a public program. This synthesis examines the extent of crowd-out and whether it can be reduced.

An overview of recent state HCBS budget cuts.

This policy brief, covering the period FY 2002- FY 2004, examines state budget cuts and other state policy changes affecting long term care (LTC) services for the elderly, focusing on home and community based services (HCBS). In the second year of budget deficits, states made deeper Medicaid cuts and focused on LTC services because of their contribution to Medicaid budgets (fifteen states say LTC is one of the top three Medicaid spending drivers). In all, states made or planned an estimated 64 cuts to LTC services in the last three fiscal years.

Performance of an automatic external cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia.

An automatic external cardioverter-defibrillator (AECD) with a programmable supraventricular-ventricular tachycardia (VT) zone underwent evaluation of arrhythmia discrimination performance in the electrophysiologic laboratory during induced supraventricular tachycardia (SVT) and unipolar and bipolar atrial pacing. The AECD SVT zone was programmed so that the induced SVT rate would fall within this zone. Atrial pacing was also performed at a rate within this zone.

Tax subsidies for private health insurance.

The exclusion from income and payroll taxes for employer-paid health insurance premiums amounted to more than $240 billion in 2010. As policy-makers search for ways to pay for health care reform and contain health care costs, this exclusion is coming under scrutiny, despite the fact that employee-sponsored insurance (ESI) is an integral part of the health insurance system. This update of a 2003 synthesis looks at the tax subsidy for private health insurance.

From coverage to care.

An important determinant of access is whether people have a usual source of care. Health insurance coverage is one factor that makes people more likely to have a usual provider, but coverage alone does not guarantee access. This synthesis examines the relationship between health insurance and having a regular care provider.