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Depression, Mental --- Meditation --- Alternative treatment. --- Therapeutic use.

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The Department of Defense (DoD) has been one of the leaders in actions to improve teamwork, which it has pursued with the goal of achieving safer care and reducing adverse events for patients served by its military hospitals. DoD and the Agency for Healthcare Research and Quality (AHRQ) have worked together to develop tools to improve teamwork in delivering care in order to achieve safer outcomes for patients. In 2004, AHRQ modified its Patient Safety Evaluation Center contract with RAND to add an analytic study to identify and test measures that have the potential to capture improvements in t

Inpatients. --- Military hospitals. --- Outcome Assessment (Health Care). --- Patient Care Team. --- Quality of Health Care. --- Health care teams --- Outcome assessment (Medical care) --- Medicine --- Medical errors --- Organization and Administration --- Outcome Assessment (Health Care) --- Quality of Health Care --- Hospitals, Military --- Patient Care Team --- Medical Errors --- Inpatients --- Biomedical Research --- Patients --- Outcome and Process Assessment (Health Care) --- Hospitals, Federal --- Patient Care Management --- Health Care Quality, Access, and Evaluation --- Health Services Administration --- Military Facilities --- Health Services --- Health Care Evaluation Mechanisms --- Hospitals, Public --- Health Care --- Health Care Facilities, Manpower, and Services --- Persons --- Facility Design and Construction --- Research --- Named Groups --- Architecture as Topic --- Science --- Hospitals --- Technology, Industry, and Agriculture --- Health Facilities --- Natural Science Disciplines --- Technology, Industry, Agriculture --- Disciplines and Occupations --- Medical Professional Practice --- Health & Biological Sciences --- Quality control --- Safety measures --- Prevention --- Health care teams. --- Quality control. --- Safety measures. --- Prevention. --- Clinical sciences --- Medical profession --- Assessment of outcome (Medical care) --- Outcome evaluation (Medical care) --- Outcome measures (Medical care) --- Outcomes assessment (Medical care) --- Outcomes measurement (Medical care) --- Outcomes research (Medical care) --- Patient outcome assessment --- Health teams --- Medical care teams --- Patient care teams --- Team work in medicine --- Teamwork in medicine --- Human biology --- Life sciences --- Medical sciences --- Pathology --- Physicians --- Medical care --- Medical cooperation --- Medical personnel --- Evaluation --- Health Workforce

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Frailty is a clinical syndrome that is characterized by a constellation of symptoms, including loss of strength, low energy, and weight loss. According to research, the syndrome is associated with negative health outcomes, such as falls, disability, fractures, and increased risk of mortality. Research has also shown that frailty is associated with increased utilization and spending, independent of other medical risk factors. Identifying and quantifying frailty might be an important component of risk-adjustment for value-based payments or might help target specific interventions. Despite its importance, measuring frailty is challenging because of the lack of consistent measurement of frailty-related concepts. The authors reviewed and refined claims-based algorithms. To identify individuals at greater risk of frailty and functional impairment, they developed new algorithms using Medicare fee-for-service (FFS) claims that were validated using patient assessment data from two types of post-acute care (PAC) providers: home health agencies (HHAs) and skilled nursing facilities (SNFs). Finally, they compared the relative performance of the new and existing algorithms at predicting three claims-based outcomes in a data set representative of all Medicare FFS beneficiaries. Overall, they found that using algorithms previously developed by Kim and colleagues and reported in a 2018 article performed best for most outcomes and subpopulations, although the new algorithms performed slightly better at predicting a nursing home stay in the following year by some metrics, particularly among PAC patients.

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"Complementary and alternative medicine (CAM) comprises a large number of therapies (e.g., acupuncture and chiropractic) that developed outside the conventional biomedical model of care. About one-third of the general population report using CAM either on their own (e.g., yoga) or through the services of a CAM provider (e.g., massage). While CAM is offered within the military health system, no systemwide data are available on its use. RAND conducted an environmental scan (CAM survey) of military treatment facilities (MTFs) to understand the availability of CAM, the conditions for which CAM is being used, and the types and process of credentialing and privileging of CAM providers. Most MTFs (83 percent) offer CAM services, usually up to eight different types, with relaxation therapy, acupuncture, progressive muscle relaxation, guided imagery, and chiropractic being the most common. Lack of provider availability was the primary reason reported for not offering CAM. These services are most often used for chronic pain, stress, anxiety, and sleep disturbance. There is variability across MTFs and types of CAM in the process and criteria used for credentialing and privileging providers. While most MTFs reported that CAM use is usually documented in a patient's electronic medical record, there was variation in the availability and use of procedure codes. Standardization of CAM coding would allow consistent tracking of CAM providers and use for better manpower management, and easier data collection for future comparison studies. Standardization of CAM provider credentialing and privileging would ensure that providers are properly trained and have clear practice requirements"--

Alternative medicine. --- Medicine, Military --- Complementary Therapies --- Health Services Needs and Demand. --- Military Medicine --- utilization. --- manpower. --- methods. --- United States.

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Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers' performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services (HHS) is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals. This report summarizes the current state of knowledge about VBP programs, focusing on pay-for-performance programs, accountable care organizations, and bundled payment programs. The authors discuss VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. The report concludes with a set of recommendations for the design, implementation, and monitoring and evaluation of VBP programs and a discussion of HHS's efforts in this regard.

Medical care --- Government purchasing --- Health services administration --- Health care reform --- Medicare. --- Purchasing --- Management.