Workshop
Implementation of the Affordable Care Act (ACA) of 2010 will result in significant changes to the U.S. health care system. Among its many provisions, the ACA will extend access to health care coverage to millions of Americans who have been previously uninsured. Many of the newly eligible health insurance consumers will be individuals of low health literacy, some speakers of English and others more comfortable using languages other than English. Health insurance terms such as "deductible," "co-insurance," and "out-of-pocket limit" are difficult to communicate even to those with moderate-to-high levels of health literacy and so health exchanges will face challenges as they attempt to communicate to the broader community. In addition to having to convey some of these basic, and yet complex, principles of insurance, state exchanges will be attempting to adapt to the many changes to enrollment and eligibility brought about by ACA.
The Institute of Medicine (IOM) convened the Roundtable on Health Literacy that brings together leaders from the federal government, foundations, health plans, associations, and private companies to discuss challenges facing health literacy practice and research and to identify approaches to promote health literacy in both the public and private sectors. The roundtable sponsored a workshop in Washington, DC, on July 19, 2011, that focused on ways in which health literacy can facilitate state health insurance exchange communication with potential enrollees. The roundtable's workshop focused on four topics: (1) lessons learned from existing state insurance exchanges; (2) the impact of state insurance exchanges on consumers; (3) the relevance of health literacy to health insurance exchanges; and (4) current best practices in developing materials and communicating with consumers.
Facilitating State Health Exchange Communication Through the Use of Health Literate Practices summarizes the presentations and discussion that occurred during the workshop. The report provides an overview of health insurance exchanges, presents evidence on the extent to which consumers understand underlying health insurance concepts, and describes the relevancy of health literacy to health insurance reform and how health literacy interventions can facilitate the implementation of health insurance reforms. The report also provides a review of best practices in developing materials and communicating with consumers, and concludes with reflections on the workshop presentations and discussions by members of the roundtable and its chair. Further information is provided in the appendixes, the workshop agenda (Appendix A), workshop speaker biosketches (Appendix B), and testimony provided by the organization America's Health Insurance Plans (AHIP) (Appendix C).
116 pages
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ISBN Paperback: 0-309-22029-7
ISBN Ebook: 0-309-22030-0
DOI:
https://doi.org/10.17226/13255
Institute of Medicine. 2012. Facilitating State Health Exchange Communication Through the Use of Health Literate Practices: Workshop Summary. Washington, DC: The National Academies Press.
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The number of women participating in clinical trials has increased during the last two decades, but women are still underrepresented in clinical trials in general. Some of the overall increase can be attributed to the greater number of women-only trials (of therapies for diseases that affect only women). Even when women are included in clinical trials, the results are often not analyzed separately by sex.
On August 30, 2011, the Institute of Medicine (IOM) Board on Population Health and Public Health Practice hosted the workshop Sex-Specific Reporting of Scientific Research. The workshop explored the need for sex-specific reporting of scientific results; potential barriers and unintended consequences of sex-specific reporting of scientific results; experiences of journals that have implemented sex-specific requirements, including the challenges and benefits of such editorial policies; and steps to facilitate the reporting of sex-specific results. Presenters and participants included current and former editors of scientific journals, researchers, and scientists and policymakers from government, industry, and nonprofit organizations. Presentations and discussions highlighted the importance to both women and men of having sex-specific data, the problems with sample size and financial constraints for conducting the research, the appropriateness of sex-specific analyses, and the limitations of journal policies to change experimental designs.
Sex-Specific Reporting of Scientific Research summarizes the presentations and discussions by the expert panelists during the IOM workshop. The workshop's first session focused on why sex-specific reporting is important. Panelists highlighted historical and current events that have hindered or helped to advance the study of women. In the next session, panelists in academe discussed the challenges of collecting, analyzing, and reporting sex-specific data from the researcher's perspective. That was followed by two panels of leading journal editors who shared their experiences in developing and implementing editorial policies and the implications of sex-specific reporting policies for journals.
72 pages
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ISBN Paperback: 0-309-22524-8
ISBN Ebook: 0-309-22525-6
DOI:
https://doi.org/10.17226/13307
Institute of Medicine. 2012. Sex-Specific Reporting of Scientific Research: A Workshop Summary. Washington, DC: The National Academies Press.
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Health literacy is the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. According to Health Literacy: A Prescription to End Confusion (IOM, 2004), nearly half of all American adults—90 million people—have inadequate health literacy to navigate the healthcare system.
To address issues raised in that report, the Institute of Medicine convened the Roundtable on Health Literacy, which brings together leaders from the federal government, foundations, health plans, associations, and private companies to discuss challenges facing health literacy practice and research and to identify approaches to promote health literacy in both the public and private sectors. On November 30, 2010, the roundtable cosponsored a workshop with the University of California, Los Angeles (UCLA), Anderson School of Management in Los Angeles.
Improving Health Literacy Within a State serves as a summary of what occurred at the workshop. The workshop focused on understanding what works to improve health literacy across a state, including how various stakeholders have a role in improving health literacy. The focus of the workshop was on presentations and discussions that address (1) the clinical impacts of health literacy improvement approaches; (2) economic outcomes of health literacy implementation; and (3) how various stakeholders can affect health literacy.
114 pages
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ISBN Paperback: 0-309-21572-2
ISBN Ebook: 0-309-21573-0
DOI:
https://doi.org/10.17226/13185
Institute of Medicine. 2011. Improving Health Literacy Within a State: Workshop Summary. Washington, DC: The National Academies Press.
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The Robert Wood Johnson Foundation asked the Institute of Medicine (IOM) to examine three topics in relation to public health: measurement, the law, and funding. IOM prepared a three book series-one book on each topic-that contain actionable recommendations for public health agencies and other stakeholders that have roles in the health of the U.S population.
For the Public's Health: Revitalizing Law and Policy to Meet New Challenges is the second in the For the Public Health's Series, and reflects on legal and public policy reform on three levels: first, laws that establish the structure, duties, and authorities of public health departments; second, the use of legal and policy tools to improve the public's health; and third, the health effects of laws and policies from other sectors in and outside government.
The book recommends that states enact legislation with appropriate funding to ensure that all public health departments have the mandate and the capacity to effectively deliver the Ten Essential Public Health Services. The book also recommends that states revise their laws to require public health accreditation for state and local health departments through the Public Health Accreditation Board accreditation process. The book urges government agencies to familiarize themselves with the public health and policy interventions at their disposal that can influence behavior and more importantly change conditions-social, economic, and environmental-to improve health. Lastly, the IOM encourages government and private-sector stakeholders to consider health in a wide range of policies (a health in all policies approach) and to evaluate the health effects and costs of major legislation.
This book, as well as the other two books in the series, is intended to inform and help federal, state, and local governments, public health agencies, clinical care organizations, the private sector, and community-based organizations.
140 pages
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ISBN Paperback: 0-309-18691-9
ISBN Ebook: 0-309-18692-7
DOI:
https://doi.org/10.17226/13093
Institute of Medicine. 2011. For the Public's Health: Revitalizing Law and Policy to Meet New Challenges. Washington, DC: The National Academies Press.
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Health literacy has been shown to affect health outcomes. The use of preventive services improves health and prevents costly health care expenditures. Several studies have found that health literacy makes a difference in the extent to which populations use preventive services. On September 15, 2009, the Institute of Medicine Roundtable on Health Literacy held a workshop to explore approaches to integrate health literacy into primary and secondary prevention.
Promoting Health Literacy to Encourage Prevention and Wellness serves as a factual account of the discussion that took place at the workshop. The report describes the inclusion of health literacy into public health prevention programs at the national, state, and local levels; reviews how insurance companies factor health literacy into their prevention programs; and discusses industry contributions to providing health literate primary and secondary prevention.
116 pages
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ISBN Paperback: 0-309-21577-3
ISBN Ebook: 0-309-21578-1
DOI:
https://doi.org/10.17226/13186
Institute of Medicine. 2011. Promoting Health Literacy to Encourage Prevention and Wellness: Workshop Summary. Washington, DC: The National Academies Press.
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Women suffer disproportionate rates of chronic disease and disability from some conditions, and often have high out-of-pocket health care costs. The passage of the Patient Protection and Affordable Care Act of 2010 (ACA) provides the United States with an opportunity to reduce existing health disparities by providing an unprecedented level of population health care coverage. The expansion of coverage to millions of uninsured Americans and the new standards for coverage of preventive services that are included in the ACA can potentially improve the health and well-being of individuals across the United States. Women in particular stand to benefit from these additional preventive health services.
Clinical Preventive Services for Women reviews the preventive services that are important to women's health and well-being. It recommends that eight preventive health services for women be added to the services that health plans will cover at no cost. The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The services include improved screening for cervical cancer, sexually transmitted infections, and gestational diabetes; a fuller range of contraceptive education, counseling, methods, and services; services for pregnant women; at least one well-woman preventive care visit annually; and screening and counseling for interpersonal and domestic violence, among others.
Clinical Preventive Services for Women identifies critical gaps in preventive services for women as well as measures that will further ensure optimal health and well-being. It can serve as a comprehensive guide for federal government agencies, including the Department of Health and Human Services and the Center for Disease Control and Prevention; state and local government agencies; policy makers; health care professionals; caregivers, and researchers.
249 pages
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ISBN Paperback: 0-309-21538-2
ISBN Ebook: 0-309-21539-0
DOI:
https://doi.org/10.17226/13181
Institute of Medicine. 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Academies Press.
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Medical devices that are deemed to have a moderate risk to patients generally cannot go on the market until they are cleared through the FDA 510(k) process. In recent years, individuals and organizations have expressed concern that the 510(k) process is neither making safe and effective devices available to patients nor promoting innovation in the medical-device industry. Several high-profile mass-media reports and consumer-protection groups have profiled recognized or potential problems with medical devices cleared through the 510(k) clearance process. The medical-device industry and some patients have asserted that the process has become too burdensome and is delaying or stalling the entry of important new medical devices to the market.
At the request of the FDA, the Institute of Medicine (IOM) examined the 510(k) process. Medical Devices and the Public's Health examines the current 510(k) clearance process and whether it optimally protects patients and promotes innovation in support of public health. It also identifies legislative, regulatory, or administrative changes that will achieve the goals of the 510(k) clearance process. Medical Devices and the Public's Health recommends that the U.S. Food and Drug Administration gather the information needed to develop a new regulatory framework to replace the 35-year-old 510(k) clearance process for medical devices. According to the report, the FDA's finite resources are best invested in developing an integrated premarket and postmarket regulatory framework.
318 pages
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ISBN Paperback: 0-309-21242-1
ISBN Ebook: 0-309-21243-X
DOI:
https://doi.org/10.17226/13150
Institute of Medicine. 2011. Medical Devices and the Public's Health: The FDA 510(k) Clearance Process at 35 Years. Washington, DC: The National Academies Press.
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Workshop
Although efforts to reduce health disparities receive attention at the national level, information on the successes of state and local efforts are often not heard. On May 11, 2009, the Institute of Medicine held a public workshop to discuss the role of state and local policy initiatives to reduce health disparities. The workshop brought together stakeholders to learn more about what works in reducing health disparities and ways to focus on localized efforts when working to reduce health disparities.
138 pages
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ISBN Paperback: 0-309-18745-1
ISBN Ebook: 0-309-18746-X
DOI:
https://doi.org/10.17226/13103
Institute of Medicine. 2011. State and Local Policy Initiatives to Reduce Health Disparities: Workshop Summary. Washington, DC: The National Academies Press.
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The indoor environment affects occupants' health and comfort. Poor environmental conditions and indoor contaminants are estimated to cost the U.S. economy tens of billions of dollars a year in exacerbation of illnesses like asthma, allergic symptoms, and subsequent lost productivity. Climate change has the potential to affect the indoor environment because conditions inside buildings are influenced by conditions outside them.
Climate Change, the Indoor Environment, and Health addresses the impacts that climate change may have on the indoor environment and the resulting health effects. It finds that steps taken to mitigate climate change may cause or exacerbate harmful indoor environmental conditions. The book discusses the role the Environmental Protection Agency (EPA) should take in informing the public, health professionals, and those in the building industry about potential risks and what can be done to address them. The study also recommends that building codes account for climate change projections; that federal agencies join to develop or refine protocols and testing standards for evaluating emissions from materials, furnishings, and appliances used in buildings; and that building weatherization efforts include consideration of health effects.
Climate Change, the Indoor Environment, and Health is written primarily for the EPA and other federal agencies, organizations, and researchers with interests in public health; the environment; building design, construction, and operation; and climate issues.
286 pages
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ISBN Paperback: 0-309-20941-2
ISBN Ebook: 0-309-20942-0
DOI:
https://doi.org/10.17226/13115
Institute of Medicine. 2011. Climate Change, the Indoor Environment, and Health. Washington, DC: The National Academies Press.
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Health literacy is the degree to which one can understand and make decisions based on health information. Nearly 90 million adults in the United States have limited health literacy. While poor health literacy spans all demographics, rates of low health literacy are disproportionately higher among those with lower socioeconomic status, limited education, or limited English proficiency, as well as among the elderly and individuals with mental or physical disabilities. Studies have shown that there is a correlation between low health literacy and poor health outcomes.
In 2010, President Obama signed the Affordable Care Act designed to extend access to health care coverage to millions of Americans who have been previously uninsured. Many of the newly eligible individuals who should benefit most from the ACA, however, are least prepared to realize those benefits as a result of low health literacy. They will face significant challenges understanding what coverage they are eligible for under the ACA, making informed choices about the best options for themselves and their families, and completing the enrollment process. Health Literacy Implications for Health Care Reform explores opportunities to advance health literacy in association with the implementation of health care reform. The report focuses on building partnerships to advance the field of health literacy by translating research findings into practical strategies for implementation, and on educating the public, press, and policymakers regarding issues of health literacy.
128 pages
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ISBN Paperback: 0-309-16416-8
ISBN Ebook: 0-309-16417-6
DOI:
https://doi.org/10.17226/13056
Institute of Medicine. 2011. Health Literacy Implications for Health Care Reform: Workshop Summary. Washington, DC: The National Academies Press.
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A single tick bite can have debilitating consequences. Lyme disease is the most common disease carried by ticks in the United States, and the number of those afflicted is growing steadily. If left untreated, the diseases carried by ticks—known as tick-borne diseases—can cause severe pain, fatigue, neurological problems, and other serious health problems. The Institute of Medicine held a workshop October 11-12, 2010, to examine the state of the science in Lyme disease and other tick-borne diseases.
560 pages
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ISBN Paperback: 0-309-21109-3
ISBN Ebook: 0-309-21110-7
DOI:
https://doi.org/10.17226/13134
Institute of Medicine. 2011. Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report. Washington, DC: The National Academies Press.
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In the United States, chronic diseases currently account for 70 percent of all deaths, and close to 48 million Americans report a disability related to a chronic condition. Today, about one in four Americans have multiple diseases and the prevalence and burden of chronic disease in the elderly and racial/ethnic minorities are notably disproportionate. Chronic disease has now emerged as a major public health problem and it threatens not only population health, but our social and economic welfare.
Living Well with Chronic Disease identifies the population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals who are at risk of developing a chronic disease and those with one or more diseases. The book recommends that all major federally funded programmatic and research initiatives in health include an evaluation on health-related quality of life and functional status. Also, the book recommends increasing support for implementation research on how to disseminate effective longterm lifestyle interventions in community-based settings that improve living well with chronic disease.
Living Well with Chronic Disease uses three frameworks and considers diseases such as heart disease and stroke, diabetes, depression, and respiratory problems. The book's recommendations will inform policy makers concerned with health reform in public- and private-sectors and also managers of communitybased and public-health intervention programs, private and public research funders, and patients living with one or more chronic conditions.
350 pages
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ISBN Paperback: 0-309-22127-7
ISBN Ebook: 0-309-22128-5
DOI:
https://doi.org/10.17226/13272
Institute of Medicine. 2012. Living Well with Chronic Illness: A Call for Public Health Action. Washington, DC: The National Academies Press.
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The Food and Drug Administration (FDA) is responsible for ensuring that medical devices are safe and effective before they go on the market. Section 510(k) of the Federal Food, Drug, and Cosmetic Act requires a manufacturer of medical devices to notify FDA of its intent to market a medical device at least 90 days in advance. That window of time allows FDA to evaluate whether the device is substantially equivalent to a product already legally on the market (called a predicate), in which case the device does not need to go through the premarket approval (PMA) process.
As part of its assessment of the FDA's premarket clearance process for medical devices, the Institute of Medicine (IOM) held a workshop on July 28, 2010 to discuss how medical devices are monitored for safety after they are available to consumers. Its primary focus was on monitoring the safety of marketed medical devices, including FDA's postmarket surveillance activities, analysis of safety concerns that resulted in medical device recalls, and non-FDA sources of adverse-event information.
Public Health Effectiveness of the FDA 501(K) Clearance Process summarizes the views of the workshop participants.
132 pages
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ISBN Paperback: 0-309-16206-8
ISBN Ebook: 0-309-16207-6
DOI:
https://doi.org/10.17226/13020
Institute of Medicine. 2011. Public Health Effectiveness of the FDA 510(k) Clearance Process: Measuring Postmarket Performance and Other Select Topics: Workshop Report. Washington, DC: The National Academies Press.
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For the past three decades, the Department of Health and Human Services (HHS) has issued a national agenda aimed at improving the health of all Americans over each 10-year span. Under each of these Healthy People initiatives, HHS established health targets and monitored how well people were reaching them over time.
In response to a request from the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) established the Committee on Leading Health Indicators for Healthy People 2020 to develop and recommend 12 indicators and 24 objectives for consideration by HHS for guiding a national health agenda and for consideration for inclusion in Healthy People 2020. The work of the committee built upon the 1999 IOM report, Leading Health Indicators for Healthy People 2010, and on the work of the Committee on the State of the USA Health Indicators. Leading Health Indicators for Healthy People 2020 lays out the proposed agenda for the current decade, which will end in 2020.
98 pages
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ISBN Paperback: 0-309-18637-4
ISBN Ebook: 0-309-18638-2
DOI:
https://doi.org/10.17226/13088
Institute of Medicine. 2011. Leading Health Indicators for Healthy People 2020: Letter Report. Washington, DC: The National Academies Press.
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Increased HIV screening may help identify more people with the disease, but there may not be enough resources to provide them with the care they need. The Institute of Medicine's Committee on HIV Screening and Access to Care concludes that more practitioners must be trained in HIV/AIDS care and treatment and their hospitals, clinics, and health departments must receive sufficient funding to meet a growing demand for care.
114 pages
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ISBN Paperback: 0-309-18507-6
ISBN Ebook: 0-309-18508-4
DOI:
https://doi.org/10.17226/13074
Institute of Medicine. 2011. HIV Screening and Access to Care: Health Care System Capacity for Increased HIV Testing and Provision of Care. Washington, DC: The National Academies Press.
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Despite having the costliest medical care delivery system in the world, Americans are not particularly healthy. Recent international comparisons show that life expectancy in the U.S. ranks 49th among all nations, and infant mortality rates are higher in the U.S. than in many far less affluent nations. While these statistics are alarming, the bigger problem is that we do not know how to reverse this trend. Our lack of knowledge is due in large part to significant inadequacies in the health system for gathering, analyzing, and communicating health information about the population.
To inform the public health community and all other sectors that contribute to population health, For the Public's Health: The Role of Measurement in Action and Accountability reviews current approaches for measuring the health of individuals and communities and creates a roadmap for future development. This book, the first of three in a series, focuses on data and measurement-not as ends in themselves, but rather tools to inform the myriad programs, policies, and processes developed or undertaken by governmental public health agencies and their many partners in the health system.
For the Public's Health seeks to reinstate the proper and evidence-based understanding of health as not merely the result of medical or clinical care but the result of the sum of what we do as a society to create the conditions in which people can be healthy. To achieve this goal, the book suggests changes in the processes, tools, and approaches used to gather information about health outcomes and their determinants. The book also recommends developing an integrated and coordinated system in which all parties-including governmental and private sector partners at all levels-have access to timely and meaningful data to help foster individual and community awareness and action.
204 pages
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ISBN Paperback: 0-309-16127-4
ISBN Ebook: 0-309-16128-2
DOI:
https://doi.org/10.17226/13005
Institute of Medicine. 2011. For the Public's Health: The Role of Measurement in Action and Accountability. Washington, DC: The National Academies Press.
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With the widespread use of highly active anti-retroviral treatment (HAART), HIV has become a chronic, rather than a fatal, disease. But for their treatment to succeed, patients require uninterrupted care from a health care provider and uninterrupted access to anti-HIV medications. The IOM identifies federal, state, and private health insurance policies that inhibit HIV-positive individuals from initiating or continuing their care.
114 pages
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paperback
ISBN Paperback: 0-309-16419-2
ISBN Ebook: 0-309-16420-6
DOI:
https://doi.org/10.17226/13057
Institute of Medicine. 2011. HIV Screening and Access to Care: Exploring the Impact of Policies on Access to and Provision of HIV Care. Washington, DC: The National Academies Press.
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Nearly nine out of 10 adults have difficulty using everyday health information to make good health decisions. The Institute of Medicine (IOM) Roundtable on Health Literacy held a meeting on May 27, 2010, to explore areas for research in health literacy, the relationship between health literacy and health disparities, and ways to apply information technology to improve health literacy.
110 pages
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ISBN Paperback: 0-309-16185-1
ISBN Ebook: 0-309-16186-X
DOI:
https://doi.org/10.17226/13016
Institute of Medicine. 2011. Innovations in Health Literacy Research: Workshop Summary. Washington, DC: The National Academies Press.
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