Browsing by Author "McClellan, Mark"
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Item Open Access A National COVID-19 Surveillance System: Achieving Containment(2020-04-07) McClellan, Mark; Gottlieb, Scott; Mostashari, Farzad; Rivers, Caitlin; Silvis, LaurenItem Open Access A National Decision Point: Effective Testing and Screening for Covid-19(2020-09-09) McClellan, Mark; Silcox, Christina; Anderson, David; Zavodszky, Anna; Borre, Ethan; Dentzer, Susan; Aspinall, MaraThis Duke-Margolis report out provides a framework for public health officials and community leaders in schools, businesses and other institutions on how to use Covid-19 screening test strategies to operate safely and prevent further spread of the virus. A National Decision Point: Effective Testing and Screening for Covid-19, was developed with funding from the Rockefeller Foundation, and aims to be a useful tool to help officials customize screening strategies of asymptomatic people to local circumstances and risk – with a particular focus on higher-risk populations and suppressing community spread.Item Open Access Achieving Widespread Availability of Timely and Efficient COVID-19 Testing(2020-03-26) McClellan, Mark; Gottlieb, ScottItem Open Access Advancing the future of equitable access to health care: recommendations from international health care leaders.(Health affairs scholar, 2024-08) Boyer, Beth; Huber, Katie; Zimlichman, Eyal; Saunders, Robert; McClellan, Mark; Kahn, Charles; Noach, Ryan; Salzberg, ClaudiaDisparities in access to health care are persistent and contribute to poor health outcomes for many populations around the world. Barriers to access are often similar across countries, despite differences in how health systems are structured. Health care leaders can work to address these barriers through bold, evidence-based actions. The Future of Health (FOH), an international community of senior health leaders, collaborated with the Duke-Margolis Institute for Health Policy to identify priority organizational and policy actions needed to improve equitable access to health care through a consensus-building exercise, a targeted literature review, and an expert discussion group. This paper describes four key action areas for health care leaders that FOH members identified as critical to enabling the future of equitable access to health care: ensuring prioritization of and accountability for equitable access to care; establishing comprehensive, organization-wide strategies to address barriers to access; clearly defining and incentivizing improvement on key measures related to reducing disparities in access; and establishing cross-sector partnerships to improve equitable access.Item Open Access Advancing Treatments to Save Lives and Reduce the Risk of COVID-19(2020-03-19) McClellan, Mark; Gottlieb, ScottItem Open Access Betting on Better Drug Trials to Beat Covid-19(Wall Street journal (Eastern ed.), 2020-08-23) McClellan, Mark; Gottlieb, ScottItem Open Access Covid Shows the Need for a Diagnostic Stockpile(Wall Street journal (Eastern ed.), 2020-07-26) McClellan, Mark; Gottlieb, ScottItem Open Access COVID-19 Manufacturing for Monoclonal Antibodies(2020-08-01) McClellan, Mark; Sharma, Isha; Wosinska, Marta; Sullivan, Haley; Kroetsch, adamItem Open Access Data Interoperability and Exchange to Support COVID-19 Containment(2020-05-01) McClellan, Mark; Mostashari, FarzadItem Open Access From Development to Market: Understanding COVID-19 Testing and Its Challenges(2020-08-19) McClellan, Mark; Schneider, Monika; Dentzer, Susan; Sheehan, Sarah; Silcox, Christina; Hamilton Lopez, Marianne; Wosinska, MartaAmid the SARS-CoV-2 pandemic and a crisis over inadequate and delayed testing, this report describes COVID-19 testing methods and applications, the regulatory process for approving tests, how tests are paid for, and how access to testing is obtained. The report also highlights the challenges that stakeholders are facing and will face in the coming months around COVID-19 testing.Item Open Access Health Care Payment to Support COVID-19 Detection and Containment(2020-05-01) McClellan, Mark; Mostashari, Farzad; Barker, TomItem Open Access Health leaders: Let’s #OpenSafely(2020-05-20) McClellan, Mark; Slavitt, AndyItem Open Access Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.(Neurosurgery, 2020-12) Adil, Syed M; Charalambous, Lefko T; Spears, Charis A; Kiyani, Musa; Hodges, Sarah E; Yang, Zidanyue; Lee, Hui-Jie; Rahimpour, Shervin; Parente, Beth; Greene, Kathryn A; McClellan, Mark; Lad, Shivanand PBackground
Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs.Objective
To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction.Methods
The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME).Results
A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01).Conclusion
Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.Item Open Access Legislative and Regulatory Steps for a National COVID-19 Testing Strategy(2020-08-05) McClellan, Mark; Rivers, Caitlin; Silcox, ChristinaThe Duke-Margolis Center for Health Policy report, “Legislative and Regulatory Steps for a National COVID-19 Testing Strategy,” outlines legislative actions and federal appropriation targets that Duke-Margolis and its collaborating experts believe are needed to get a robust, diversified testing strategy in place for the nation by fall 2020.Item Open Access Legislative and Regulatory Steps for a National COVID-19 Testing Strategy(2020-08-05) McClellan, Mark; Caitlin Rivers, Caitlin; Silcox, ChristinaItem Open Access Lost (and Found) in Translation: Applying the Accountable Care Framework to Support the Diffusion of Health Innovations(2018-12) Kadakia, KushalRising health expenditures and growing disease burden have generated new impetus for value-based health reforms across the world. However, fragmented evidence for implementation science in health policy limits the design and diffusion of health innovations to fill common gaps in care delivery. This paper explores how the accountable care framework can be used as a model for adapting international health innovations to improve outcomes and reduce costs for high-need, high-cost populations in the United States. A national advisory board of health policy experts and leaders was convened to identify the primary challenges faced by systems today. These criteria were used to develop a standardized survey for reviewing the global landscape of health innovations that increase access, improve outcomes, and reduce cost, resulting in a curated database of 175 international delivery and payment innovations. Innovations were analyzed using the accountable care framework for trends in performance, methodology, and diffusion experience. These insights were then synthesized into a model for translating innovations across health systems. To validate the model, three partner institutions – CareSouth Carolina, the University of Arkansas for Medical Sciences, and the Henry Ford Health System – were selected as use cases in the United States. Value-based readiness assessments were administered to the senior leadership teams of each health system, who then participated in an iterative six-month process to co-design an integrated solution set using the adaptation model, with feedback from health systems confirming the model’s applicability to support the diffusion of innovations to the health policy context of the United States. The results of this work offer a new paradigm for health innovation and identify practical opportunities for policymakers and practitioners to support care transformation in America.Item Open Access National coronavirus response: A road map to reopening(2020-03-28) McClellan, Mark; Gottlieb, Scott; Rivers, Caitlin; Silvis, Lauren; Watson, CrystalItem Open Access Testing as an Alternative to Quarantining: Key Considerations and Best Practices for Implementing Test to Stay(Duke-Margolis Center for Health Policy, 2022-01-19) McClellan, Mark; Silcox, Christina; Roades, Thomas; Thoumi, AndreaItem Open Access The potential for artificial intelligence to transform healthcare: perspectives from international health leaders.(NPJ digital medicine, 2024-04) Silcox, Christina; Zimlichmann, Eyal; Huber, Katie; Rowen, Neil; Saunders, Robert; McClellan, Mark; Kahn, Charles N; Salzberg, Claudia A; Bates, David WArtificial intelligence (AI) has the potential to transform care delivery by improving health outcomes, patient safety, and the affordability and accessibility of high-quality care. AI will be critical to building an infrastructure capable of caring for an increasingly aging population, utilizing an ever-increasing knowledge of disease and options for precision treatments, and combatting workforce shortages and burnout of medical professionals. However, we are not currently on track to create this future. This is in part because the health data needed to train, test, use, and surveil these tools are generally neither standardized nor accessible. There is also universal concern about the ability to monitor health AI tools for changes in performance as they are implemented in new places, used with diverse populations, and over time as health data may change. The Future of Health (FOH), an international community of senior health care leaders, collaborated with the Duke-Margolis Institute for Health Policy to conduct a literature review, expert convening, and consensus-building exercise around this topic. This commentary summarizes the four priority action areas and recommendations for health care organizations and policymakers across the globe that FOH members identified as important for fully realizing AI's potential in health care: improving data quality to power AI, building infrastructure to encourage efficient and trustworthy development and evaluations, sharing data for better AI, and providing incentives to accelerate the progress and impact of AI.Item Open Access Value-Based Care in the COVID-19 Era: Enabling Health Care Response and Resilience(2020-06-01) McClellan, Mark; Roiland, Rachel; Japinga, Mark; Singletary, Elizabeth; Sharma, Isha; Gonzalez-Smith, Jonathan; Wang, Gary; Jacobs, Jeremy; Bleser, William; Saunders, Robert