Health affairs
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Improving the quality of care is a national priority in the United States; however, it is not clear how to accelerate progress for mental health care. We recommend advances in three capacities: (1) developing quality improvement resources applicable to a diverse set of mental health disorders, clients, and service settings; (2) improving the infrastructure for providing evidence-based psychotherapy and psychosocial interventions; and (3) promoting innovation in financial incentives for quality improvement in mental health care. We also discuss the need to develop leadership among health care stakeholders and community engagement to promote public commitment to high-quality care in mental health.
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Separate public financing and regulation of substance (SA) abuse treatment distinct from mental health (MH) treatment preserves a focus on the special needs of those with substance abuse but creates challenges to providing appropriate care for the large number of people with co-occurring conditions. This paper reviews recent efforts to overcome these challenges through clinical and systems approaches that better integrate care. Although much progress has been made for some subgroups of people with co-occurring disorders, further efforts to develop and sustain clinically integrated service delivery approaches within separate systems, particularly in SA treatment settings, are needed.
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This study examines hospice use among adult hospice patients based on the 1992-2000 National Home and Hospice Care Surveys, the 1997-1999 National Nursing Home Surveys, and the 1991-2000 annual Underlying and Multiple Cause-of-Death Files. The total number of adult hospice patients tripled between 1991-1992 and 1999-2000. ⋯ The increased hospice utilization rates and increased percentage of adult hospice patients with short stays in hospice indicate changes in hospice enrollment patterns over time. Hospice is still in the process of growing toward a steady state.
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This paper describes the Institute of Medicine's (IOM's) eight-year experiment in examining cancer policy issues through the National Cancer Policy Board and more recently through the early phases of the National Cancer Policy Forum. Both were primarily funded by the National Cancer Institute and Centers for Disease Control and Prevention. The forum identifies and explores issues but, unlike the board, does not author IOM advisory reports. We report on the events that led to the establishment of these activities and discuss the factors that could lead to success in influencing policy, using examples of actual reports and effects on public- and private-sector programs and policies.