The Milbank quarterly
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The Milbank quarterly · Jan 2004
Translating evidence-based depression management services to community-based primary care practices.
Randomized controlled trials have demonstrated the efficacy and cost-effectiveness of using treatment models for major depression in primary care settings. Nonetheless, translating these models into enduring changes in routine primary care has proved difficult. ⋯ This article discusses barriers to introducing and sustaining evidence-based depression management services in community-based primary care practices and suggests organizational and financial solutions based on the Robert Wood Johnson Foundation Depression in Primary Care Program. It focuses on strategies to improve depression care in medical settings based on adaptations of the chronic care model and discusses the challenges of implementing evidence-based depression care given the structural, financial, and cultural separation between mental health and general medical care.
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The Milbank quarterly · Jan 2002
ReviewUsing administrative data to study persons with disabilities.
Administrative data result from administering health plans--tracking service utilization, paying claims, monitoring costs and quality--and have been used extensively for health services research. This article examines the strengths and limitations of administrative data for health services research studies of people with disabilities. ⋯ Potentially useful administrative data elements include eligibility for Medicare or Medicaid through Social Security disability determinations, diagnosis and procedure codes, pharmacy claims, and durable medical equipment claims. Linking administrative data to survey or other data sources enhances the utility of administrative data for disability studies.
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The Milbank quarterly · Jan 2002
Examining the role of health services research in public policymaking.
Conceptual, methodological, and practical issues await those who seek to understand how to make better use of health services research in developing public policy. Some policies and some policymaking processes may lend themselves particularly well to being informed by research. ⋯ Some conditions may favor the use of research in policymaking, like sustained interactions between researchers and policymakers. Results from an exploratory study on the use of health services research by Canadian provincial policymakers illustrate these issues.
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The Milbank quarterly · Jan 2001
Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.
This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. ⋯ Understanding what works within the constraints and complexities of the system on a small scale is critical in order to bring forth policy and processes that will be of value systemwide. Finally, we note that general medical care faces many of the same quality-related problems and challenges as occupational health care. Medical care for chronic diseases, such as diabetes, is often fragmented and uncoordinated. (ABSTRACT TRUNCATED)
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The Milbank quarterly · Jan 1998
ReviewSupply dynamics of the mental health workforce: implications for health policy.
The U. S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. ⋯ The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.