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There are several ethical questions surrounding the American Medical Association's policy prohibiting physicians from giving substances they believe are placebos to their patients unless the patient is informed of and agrees to use of the substance, according to a 2012 report from the Hastings Center.
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Since Fallon Community Health Plan in Worcester, MA, began integrating medical case management and mental health case management, members in the health plan's Medicaid HMO with medical issues have experienced fewer inpatient days and emergency department visits and those in behavioral health have less need for unplanned medical care, says Dena Miller, RN, MSN, vice president of clinical innovation and implementation for the health plan.
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To keep a lid on costs, health care policy experts recognize that hospitals need to find more effective ways to manage transitions. The care coordination piece can be particularly problematic in the fast-paced ED setting, and yet it can make a big difference in determining whether a patient receives appropriate follow-up after an acute event and whether he or she is back in the ED within days or weeks with another acute exacerbation of the same issue.
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A collaborative approach in which primary care physicians and nurse case managers work with patients with depression has resulted in a 50% improvement of scores on a depression questionnaire among patients who were part of a pilot project at UC Davis Family Medicine in Sacramento.
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As the National Committee for Quality Assurance hopes that all-cause readmission rate reporting by health plans will assist in creating more consideration of patient care across the continuum, the National Quality Forum (NQF) hopes a new measurement framework for multiple chronic conditions will likewise help improve care in and out of the hospital.
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Recognizing that medical problems and behavioral health issues are often intertwined, payers and providers are coordinating behavioral health and medical health case management.
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In the past, if a member of Capital District Physicians' Health Plan (CDPHP) in Albany, NY, was hospitalized for a suicide attempt and ended up in the intensive care unit, or was hospitalized with a medical problem and diagnosed with a behavioral health issue as well, the medical case manager would give him or her a referral to a toll-free number for an out-of-state vendor that provided behavioral health management for the health plan.
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Human research protection programs (HRPPs) often must balance the need to handle research complaints with the goal of conducting fair and reasonable investigations into any potential problem. HRPPs also must use staff time efficiently and not get bogged down in disputes that clearly are not pertinent to protecting research subjects, an expert says.
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Whole genome sequencing research raises important informed consent issues for IRBs and investigators, and the recent report by the Presidential Commission for the Study of Bioethical Issues (PCSBI) addresses these in its recommendations.
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More subject diversity is needed in clinical trials to reduce the risk of adverse outcomes, according to the keynote speaker at the Clinical Trials in Georgia conference.
