sábado, 25 de octubre de 2014

CMS Launches Transforming Clinical Practice Initiative

SAMHSA
HHS Announces $840 Million Initiative To Improve Patient Care and Lower Costs
Dear Colleague:
The Centers for Medicare & Medicaid Services (CMS) launched a new innovative model to support clinicians in achieving large-scale health care transformation. TheTransforming Clinical Practice Initiative will provide up to $840 million over the next 4 years to support 150,000 clinicians in sharing, adapting, and further developing comprehensive quality improvement strategies, which are expected to lead to greater improvements in patient health and reduction in health care costs.
This effort is especially significant to our behavioral health community. With implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, more than 60 million Americans will gain access to new or expanded coverage for mental health and substance abuse services. As our health system broadens, the behavioral health field has a responsibility to lead in setting comprehensive goals to develop the workforce, improve quality, and provide effective services to individuals with behavioral health conditions.
An opportunity such as this is an incentive for the behavioral health community to integrate with and leverage funding that will transform health care delivery. Below are some key descriptions and features of the initiative.
Transforming Clinical Practice Initiative
CMS will award cooperative agreement funding for two network systems under this initiative: the Practice Transformation Networks and the Support and Alignment Network.
  • Practice Transformation Networks ($670 million in grant funding available)
The Practice Transformation Networks are peer-based learning networks designed to coach, mentor, and assist clinicians in developing core competencies specific to practice transformation. This approach allows clinician practices to become actively engaged in the transformation. It also ensures collaboration among a broad community of practices that create, promote, and sustain learning and improvement across the health care system.
  • Support and Alignment Network ($30 million in grant funding available)
The Support and Alignment Network will provide a system for workforce development using national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development), this network will help ensure sustainability of these efforts. These tools will especially support the recruitment of clinician practices serving small, rural, and medically underserved communities and play an active role in the alignment of new learning.
How To Apply
Beginning October 23, 2014, CMS will begin accepting applications for the following funding opportunity announcements:
Potential applicants are highly encouraged to submit nonbinding Letters of Intent to apply by November 20, 2014.
The application period for both funding opportunity announcements is October 23, 2014, through January 6, 2015. The funding opportunity announcements and detailed application instructions are located on Grants.gov.
A series of informational session webinars for potential applicants will be held on November 6, 2014, and November 20, 2014. Attendees may submit questions during these informational webinars, and responses will be posted on this website after the respective webinars conclude.
Practice Transformation Networks Webinars
November 6, 2014 | 1 p.m.–2 p.m. Eastern Time
Register Here
November 20, 2014 | 1 p.m.–2 p.m. Eastern Time
Register Here
Support and Alignment Network Webinars
November 6, 2014 | 3 p.m.–4 p.m. Eastern Time
Register Here
November 20, 2014 | 3 p.m.–4 p.m. Eastern Time
Register Here
SAMHSA is committed to supporting your efforts to achieve large-scale behavioral health transformation. Please contact Christopher Carroll, Director of Health Care Financing and Integration, at christopher.carroll@samhsa.hhs.gov or 240-276-1765 if SAMHSA can be of assistance to you.
Sincerely,
Pamela S. Hyde, J.D.
Administrator
SAMHSA

viernes, 24 de octubre de 2014

MMWR Vol. 63 / No. 42

MMWR Vol. 63 / No. 42

MMWR Logo
 
MMWR Weekly
Vol. 63, No. 42
October 24, 2014
 
PDF of this issue
World Polio Day — October 24, 2014 
MMWR 2014;63:941
Polio-Free Certification and Lessons Learned — South-East Asia Region, March 2014 
Sunil Bahl, MD, Rakesh Kumar, MD, Nata Menabde, PhD, et al.
MMWR 2014;63:941-6
 

India, a member of the World Health Organization South-East Asia Region, had its last wild poliovirus case in January 2011. This was also the last case in the region. 
India, a member of the World Health Organization South-East Asia Region, had its last wild poliovirus case in January 2011. This was also the last case in the region.

Influenza Outbreak in a Vaccinated Population — USS Ardent, February 2014
Theodore L. Aquino, DO, Gary T. Brice, PhD, Sherry Hayes, MPH, et al.
MMWR 2014;63:947-9

Nonfatal Injuries 1 Week After Hurricane Sandy — New York City Metropolitan Area, October 2012
Robert M. Brackbill, PhD, Kimberly Caramanica, MPH, Maret Maliniak, et al.
MMWR 2014;63:950-4

History and Evolution of the Advisory Committee on Immunization Practices — United States, 1964–2014
Jean Clare Smith, MD, Alan R Hinman, MD, Larry K. Pickering, MD.
MMWR 2014;63:955-8

Control of Ebola Virus Disease — Firestone District, Liberia, 2014
Erik J. Reaves, DO, Lyndon G. Mabande, MD, Douglas A. Thoroughman, PhD, et al.
MMWR 2014;63:959-65

Announcement: World Stroke Day — October 29, 2014
MMWR 2014;63:966

QuickStats: Percentage of Adults Aged 18–59 Years Who Were Ever Tested for Human Immunodeficiency Virus (HIV), by Race and Hispanic Ethnicity — United States, National Health and Nutrition Examination Survey, 2003–2006 to 2007–2010
Joseph V. Woodring, DO, Deanna Kruszon-Moran, MS, Geraldine M. McQuillan, PhD, et al.
MMWR 2014;63:967

Notifiable Diseases and Mortality Tables 
Link to PDF for Notifiable Diseases and Mortality Tables 
Link to additional formats for Notifiable Diseases and Mortality Tables

MMWR – Morbidity and Mortality Weekly Report

MMWR – Morbidity and Mortality Weekly Report

MMWR Logo
 
MMWR Weekly
Vol. 63, No. 42
October 24, 2014
 
PDF of this issue

Polio-Free Certification and Lessons Learned — South-East Asia Region, March 2014

 

CDC Media Relations

404-639-3286

Stopping indigenous wild poliovirus (WPV) transmission in India was a tremendous effort that required commitment at every level of government, provision of adequate fiscal and human resources, development of innovations, and engagement with the private sector. Specific lessons learned have been successfully applied to improve childhood immunization services in India and to help overcome the challenges to polio eradication in other countries.



Influenza Outbreak in a Vaccinated Population — USS Ardent, February 2014

 

Theodore L. Aquino DO MBA 

United States Navy Reserve Medical Officer

(850) 284-1046

taquino@health.usf.edu

This influenza outbreak highlights the risk for an H3N2 influenza outbreak in a cohort of vaccinated and otherwise healthy young persons. In February 2014, 25 of the 102 crew members of a US Navy minesweeper sought medical care because of influenza-like illness attributed to an influenza A(H3N2) virus antigenically similar to the H3N2 component of the 2013-14 vaccine. Among the crew members, 99 percent had received influenza vaccination, including 24 of the 25 ill persons.




Nonfatal Injuries 1 Week After Hurricane Sandy — New York City Metropolitan Area, October, 2012

 

Jacquelynn Osoro

WTC Health Registry

347-396-2919

josoro@health.nyc.gov

Although many injuries occur when people have to evacuate through water and debris, most injuries are associated with clean-up or repairs of damaged residences. Hurricane (Superstorm) Sandy on October 29, 2012, caused extensive flooding and damage to homes and businesses in the New York City metro area. Many enrollees in the World Trade Center Health Registry lived in flooded areas of New York, New Jersey and Connecticut.



History and Evolution of the Advisory Committee on Immunization Practices — United States, 1964–2014

 

CDC Media Relations

404-639-3286

The ACIP has been in existence for 50 years. It provides expert, external advice to the CDC and the Department of Health and Human Services on the safe and effective use of vaccines in the civilian population of the U.S., using an explicit evidence-based system to develop vaccine recommendations. This year marks the 50th anniversary of the establishment of the Advisory Committee on Immunization Practices (ACIP).

Farmacéuticas europeas usaron en ensayos a 14.000 alemanes del Este | Ciencia | EL PAÍS

Farmacéuticas europeas usaron en ensayos a 14.000 alemanes del Este | Ciencia | EL PAÍS



MEDICINA

Farmacéuticas europeas usaron en ensayos a 14.000 alemanes del Este

Las compañías realizaron 220 test clínicos

Los autores del estudio analizaron los archivos de la Stasi, la policía secreta del régimen





Parte de los ensayos se realizaron en el Hospital Universitario Charité. / BUNDESARCHIV/ THURN, JOACHIM F.

EN ESTA NOTICIA



Unas 70 farmacéuticas occidentales, entre las que están las actuales principales compañías del sector, realizaron ensayos clínicos de nuevos fármacos en la antigua Alemania comunista. Investigadores que han revisado incluso los archivos de la Stasi, la policía secreta del régimen, cifran en al menos 14.000 los alemanes que participaron en los test. No han encontrado pruebas de que fueran informados pero tampoco de que no se siguieran los protocolos de investigación.
Desde la reunificación alemana, en 1990, varios medios publicaron informaciones sobre estos experimentos. Pero no fue hasta 2012 que el asunto tuvo alcance internacional. Entonces, el semanario Der Spiegel inició una serie de artículos sobre lo que parecía un pacto contra natura: farmacéuticas de países capitalistas usando a ciudadanos de la Alemania comunista como cobayas bajo la supervisión de las autoridades del régimen. Y todo por unos cuantos marcos.


Así contado, la noticia provocó una gran alarma y escándalo. Ahora, para separar el trigo de la paja, tres investigadores independientes liderados por el doctor Rainer Erices, del Instituto para la Historia y la Ética de la Medicina de laUniversidad Friedrich-Alexander de Erlangen-Núremberg,(Alemania) han buceado en los archivos oficiales del Sistema de Salud de la República Democrática Alemana (RDA) y en los de la Stasi.
Lo que encontraron fue un sofisticado y muy reglado sistema de autorizaciones y contratos ideado a comienzos de los años 80. Entonces, el Sistema de Salud, emblema de los logros del socialismo, estaba al borde de la bancarrota, una situación que, por otro lado, vivía toda la economía del Estado. Para generar divisas, la Oficina de Consultas para la Importación de Medicamentos y la compañía Berlinesa de Importación/Exportación firmaron una serie de contratos con compañías occidentales.
La mayoría de las 68 farmacéuticas que aparecen en los archivos son de la entonces Alemania Federal y Suiza, aunque también las hay estadounidenses, francesas, belgas, danesas o de Finlandia. La legislación de la RDA exigía que los ensayos clínicos en sus distintas fases de I a III sólo se podían hacer con el consentimiento informado de los participantes sobre el procedimiento, los efectos esperados y sus posibles riesgos.
Ensayaron antidepresivos, anticoagulantes, quimioterapia y hasta pasta de dientes



"Entre 1983 y 1990, se realizaron al menos 220 ensayos clínicos usando fármacos fabricados por compañías occidentales", escriben los autores en los resultados de su investigación, publicados por el Journal of Medical Ethics. Aunque el número exacto de participantes se desconoce, en los archivos aparecen algo más de 14.000. Lo que no han encontrado los investigadores son pruebas de que fueran informados pero tampoco de lo contrario.
"Las regulaciones legales sobre los ensayos farmacéuticos eran comparables entre las dos Alemanias", dice el doctor Erices. "Todos los ensayos en la RDA tenían que ser autorizados por el Ministerio de Sanidad. El personal responsable en el Ministerio pidió repetidamente que los ensayos cumplieran con las regulaciones legales, como que sólo se podían hacer con el consentimiento informado de los pacientes. Los doctores que particparon en las pruebas sostienen que ellos, de hecho, obtuvieron el consentimiento", añade el investigador alemán. Pero, reconoce: "no hemos encontrado pruebas escritas de ello".
En cuanto al número real de germano orientales que participaron en los ensayos, Erices insiste en que su investigación arranca en 1983. "Hemos tenido acceso a los archivos de la Stasi de épocas anteriores, pero todavía no están sistematizados. Por lo tanto, sólo podemos especular sobre el número de pacientes. Sabemos con seguridad que años antes de 1983 ya se hacían ensayos clínicos pero el número era menor que en los años posteriores. Si lo que me pregunta es una cifra fiable obtenida en una investigación rigurosa, simplemente no la hay", explica Erices.
Este documento de la Stasi recoge detalles de los test con la RU-486, la píldora abortiva, ensayada por una firma francesa. R. Erices
Aunque Der Spiegel hablaba de experimentos con sustancias dopantes suministradas a niños prematuros o uso de placebo en pacientes con enfermedades graves, los investigadores rebajan el tono. Entre los fármacos ensayados, algunos aún disponibles en las farmacias, había un poco de todo: agentes para la quimioterapia, antidepresivos, antialérgicos, anticoagulantes como la heparina, insulina y hasta pasta de dientes.
Por parte alemana, participaron casi un centenar de instituciones, pero la mayoría de los ensayos se realizaron en nueve facultades de medicina, encabezadas por la de la Universidad Humboldt de Berlín, la Academia de Ciencias de Dresde o el berlinés Hospital Universitario Charité.
Varias decenas de los participantes murieron durante los test pero los investigadores no han encontrado pruebas que indiquen que lo fueron por la administración de los fármacos. De hecho, para participar en un estudio de fase III, los sujetos han de tener la enfermedad para la que se ha diseñado el fármaco. Y, muchos, escriben los autores del estudio, "estaban seriamente enfermos".

Por unos millones de marcos

Los contratos analizados revelan que las compañías occidentales pagaron por los ensayos un total de 16,5 millones de marcos alemanes, unos 1.150 millones de pesetas de la época. Dada la perentoria necesidad de la economía de la Alemania del este, los pagos se hacían en divisas y sólo la mitad iban para el Sistema de Salud y, el resto, para los Ministerios de Sanidad y de Educación Superior. Los pacientes no recibieron nada.
Pero, ¿por qué?. Erices señala a una combinación de factores que explican estos ensayos. Por un lado, como demuestran algunos archivos de la Stasi, "los test eran más baratos, aunque las compañías occidentales lo niegan hoy", dice. Tampoco iba a haber protestas en un régimen tan controlado. Compartir idioma también ayudó. Además, recuerda el investigador alemán, esto podría abrir "nuevos mercados en el bloque del Este".
Para los autores lo peor de estos ensayos fue el oscurantismo. "La población de Alemania Oriental nunca fue informada de estas prácticas. La libertad de expresión no existía, así que no hubo debate público", comenta el doctor Erices. También crítica los intereses de las partes implicadas: "La RDA necesitaba las divisas y las firmas occidentales lo sabían. Además, el departmento secreto de Comercio Exterior, con fuertes lazos con la Stasi, tenía especial interés en esta serie de ensayos. Ellos contaban con gran influencia en el redactado de los contratos y recibieron la mitad de la remuneración, pagada en divisas".

Lista de las compañías que realizaron los ensayos

M.Á.C
Los investigadores encontraron en los archivos del Sistema de Salud de la RDA y de la Stasi decenas de contratos entre las autoridades germano orientales y las farmacéuticas occidentales. La gran mayoría especificaban la cantidad a pagar por las segundas.
Esta es la lista de las 10 princiaples empresas por número de ensayos. Algunas ya no existen y otras cambiaron de nombre durante la oleada de fusiones en el sector en los años 90:
  1. Boehringer Manheim, 32 ensayos y 1,4 millones de marcos.
  2. Sandoz, 18 test y 1,9 millones.
  3. Schering, 18 ensayos y 0,8 millones.
  4. Hoechst, 16 ensayos y 2,9 millones.
  5. Bayer, 12 pruebas y 0,8 millones.
  6. Ciba Geigy, 10 test y 0,4 millones.
  7. Gödecke, 6 ensayos y 0,2 millones.
  8. Braun Melsungen, 5 ensayos y 250.000 marcos.
  9. Behringwerke, 5 ensayos y 0,2 millones.
  10. Thiemann, 4 test y 0,7 millones.
Entre la cincuentena restante, la gran mayoría son de la entonces Alemania Federal. Con menos de cinco ensayos también aparecen compañías como Pfizer, DuPont, Merck, Roche o SmithKline.

The Next Generation of Clinical Practice Transformation | HHS Blog

The Next Generation of Clinical Practice Transformation | HHS Blog



Dept. of Health & Human Services

Oct 23, 2014
By: Darren DeWalt, MD, MPH, Director of the Learning and Diffusion Group, CMS Innovation Center and Paul McGann, MD, Co-Director of the Transforming Clinical Practice Initiative
Imagine a health care system that is seamless – one in which patients and health care professionals work together to develop plans that meet all of the patient’s health needs. In this system, patients and families engage as partners in care through regular and reliable contact with their health care professional team. The team knows them as individuals and knows the health conditions that led them to seek care. The team is available by telephone, email, as well as in-person. In this system, patients can rely on health professionals functioning at the top of their game and following a plan that the patient and family helped create.  Information flows smoothly and everyone gets the right care, at the right time, and at a cost that is reasonable and easy to understand.  A system of care like this will produce fewer unnecessary hospital admissions and readmissions, will cause fewer healthcare-associated infections, will harm fewer patients, and will show continuous improvement in quality outcomes and cost efficiency.

Secretary Burwell today announced the Transforming Clinical Practice Initiative that the Centers for Medicare & Medicaid Services (CMS) will administer over the next 4 years.We are proud to be part of this effort to engage with clinicians and their practices as we work together to advance health care in America. Through the Transforming Clinical Practice Initiative, clinicians and their practices will have the tools to improve the quality of care they provide, while keeping down costs.

Read More: Supporting the Next Generation of Clinical Practice Transformation 
Secretary Burwell Speaks at the AAFP

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Public Comment on Draft Research Plan: Screening for Obesity and Interventions for Weight Management in Children and Adolescents

Opportunity for Public Comment - US Preventive Services Task Force
U.S. Preventive Services Task Force banner
The U.S. Preventive Services Task Force posted today a draft Research Plan on screening for obesity and interventions for weight management in children and adolescents. The draft Research Plan is available for review and public comment from October 23 to November 19, 2014. To review the draft Research Plan and submit comments, go to http://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment.

CMS NEWS: Transforming Clinical Practice Initiative

Centers for Medicare & Medicaid Services

CMS FACT SHEET

FOR IMMEDIATE RELEASE                                     Contact: CMS Media Relations
October 23, 2014                                                              (202) 690-6145 or press@cms.hhs.gov


Transforming Clinical Practice Initiative  

OVERVIEW
The Centers for Medicare & Medicaid Services today launched a new innovative model to support clinicians in achieving large-scale health care transformation. The Transforming Clinical Practice Initiative will provide up to $840 million over the next four years to support 150,000 clinicians in sharing, adapting and further developing comprehensive quality improvement strategies, which are expected to lead to greater improvements in patient health and reduction in health care costs.
                                                                                                            
BACKGROUND
Since the launch of the Affordable Care Act, CMS has launched numerous programs and models to help health providers achieve large-scale transformation. Programs and models, such as the Hospital Value-Based Purchasing Program, Accountable Care Organizations, and the Partnership for Patients initiative with Hospital Engagement Networks, are helping clinicians and hospitals move from volume-based practices towards value-based and patient-centered quality health care services. This has resulted in fewer unnecessary hospital readmissions, reductions in healthcare-associated infections and hospital-acquired conditions, and improvements in quality outcomes and cost efficiency.

The Affordable Care Act has helped reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and 2013 – translating into 150,000 fewer readmissions – and quality improvements have resulted in saving 15,000 lives and $4 billion in health spending during 2011 and 2012. Additionally, national reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have avoided 518,000 patient injuries.

To date, there have only been small-scale investments in a collaborative peer-based learning initiative.CMS estimates that about 185,000 clinicians currently participate in existing programs, models, and initiatives that facilitate practice transformation. This represents only 16 percent of the nation’s one million Medicare and Medicaid providers. While this is an increase over previous years, there is much more work to be done.

The Transforming Clinical Practice Initiative is one of the largest federal investments uniquely designed to support clinician practices through nationwide, collaborative, and peer-based learning networks that facilitate practice transformation.
SUMMARY
Through this initiative, CMS will invest in the creation of evidence-based, peer-led collaboratives and practice transformation networks to support clinicians and their practices as they move towards and navigate a value-based health care system that rewards value and high quality care.

The initiative aligns with the criteria for innovative models set forth in the Affordable Care Act:

  • Promoting broad payment and practice reform in primary care and specialty care,
  • Promoting care coordination between providers of services and suppliers,
  • Establishing community-based health teams to support chronic care management, and
  • Promoting improved quality and reduced cost by developing a collaborative of institutions that support practice transformation.

The initiative leverages the preliminary success of existing programs and models that have proven effective in achieving transformation, specifically in quality improvement, health care collaborative networks, and financial and program alignment. It identifies existing successful healthcare delivery models and works to rapidly spread these models to other health care providers and clinicians.

CMS will award cooperative agreement funding for two network systems under this initiative: Practice Transformation Networks, as well as Support and Alignment Networks.

PRACTICE TRANSFORMATION NETWORKS
The Practice Transformation Networks are peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation. This approach allows clinician practices to become actively engaged in the transformation and ensures collaboration among a broad community of practices that creates, promotes, and sustains learning and improvement across the health care system.

CMS will award cooperative agreement funding to successful applicants who have pre-existing relationships with multiple clinician practices (primary care and/or specialists) that include data sharing capabilities. Successful applicants will collaboratively lead clinicians and their practices through the transformation process, achieve the initiative’s goals, and ensure that clinicians and their practices can maintain and sustain these activities in a dynamic care delivery system.

SUPPORT AND ALIGNMENT NETWORKS
The Support and Alignment Networks will provide a system for workforce development utilizing national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development) these networks will help ensure sustainability of these efforts. These will especially support the recruitment of clinician practices serving small, rural and medically underserved communities and play an active role in the alignment of new learning.

CMS will award cooperative agreement funding to successful applicants that may include eligible medical professional associations, specialty societies, and other organizations that are involved in aligning their programs with the aims of the initiative; generating evidence-based guidelines for clinical practice; promoting measurement for improvement; supporting members and practices in work to reduce unnecessary testing and procedures; and, effectively incorporating safety and patient and family engagement.

APPLICATION PROCESS
Applications will be accepted from eligible applicants for both cooperative agreement funding opportunities starting October 23, 2014. Applicants are encouraged, but not required, to submit a letter of intent by November 20, 2014. Applications are due to CMS no later than January 6, 2015. Applications received after this date will not receive consideration for the cooperative agreement funding opportunities.

CMS anticipates announcing awards in Spring/Summer 2015.

FOR MORE INFORMATION
For more information, please refer to the Transforming Clinical Practice Initiative funding opportunity announcement found at: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/   

For specific questions not answered in this fact sheet or funding opportunity announcement, please send an email to transformation@cms.hhs.gov

Also, the HHS press release can be found here: http://www.hhs.gov/news/press/2014pres/10/20141023a.html