TY - BOOK AU - Institute of Medicine TI - Integrating Employee Health: A Model Program for NASA SN - DO - 10.17226/11290 PY - 2005 UR - https://nap.nationalacademies.org/catalog/11290/integrating-employee-health-a-model-program-for-nasa PB - The National Academies Press CY - Washington, DC LA - English KW - Industry and Labor KW - Health and Medicine AB - The American workforce is changing, creating new challenges for employers to provide occupational health services to meet the needs of employees. The National Aeronautics and Space Administration (NASA) workforce is highly skilled and competitive and employees frequently work under intense pressure to ensure mission success. The Office of the Chief Health and Medical Officer at NASA requested that the Institute of Medicine review its occupational health programs, assess employee awareness of and attitude toward those programs, recommend options for future worksite preventive health programs, and ways to evaluate their effectiveness. The committee’s findings show that although NASA has a history of being forward-looking in designing and improving health and wellness programs, there is a need to move from a traditional occupational health model to an integrated, employee-centered program that could serve as a national model for both public and private employers to emulate and improve the health and performance of their workforces. ER - TY - BOOK AU - Institute of Medicine A2 - Sean Tunis A2 - Allan Korn A2 - Alex Ommaya TI - The Role of Purchasers and Payers in the Clinical Research Enterprise: Workshop Summary SN - DO - 10.17226/10400 PY - 2002 UR - https://nap.nationalacademies.org/catalog/10400/the-role-of-purchasers-and-payers-in-the-clinical-research-enterprise PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - In a workshop organized by the Clinical Research roundtable, representatives from purchaser organizations (employers), payer organizations (health plans and insurance companies), and other stakeholder organizations (voluntary health associations, clinical researchers, research organizations, and the technology community) came together to explore: What do purchasers and payers need from the Clinical Research Enterprise? How have current efforts in clinical research met their needs? What are purchasers, payers, and other stakeholders willing to contribute to the enterprise? This book documents these discussions and summarizes what employers and insurers need from and are willing to contribute to clinical research from both a business and a national health care perspective. ER - TY - BOOK AU - Institute of Medicine A2 - Lawrence Geiter TI - Ending Neglect: The Elimination of Tuberculosis in the United States SN - DO - 10.17226/9837 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9837/ending-neglect-the-elimination-of-tuberculosis-in-the-united-states PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the world—ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB. ER - TY - BOOK AU - Institute of Medicine AU - National Research Council A2 - Sharyl J. Nass A2 - I. Craig Henderson A2 - Joyce C. Lashof TI - Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer SN - DO - 10.17226/10030 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10030/mammography-and-beyond-developing-technologies-for-the-early-detection-of PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Each year more than 180,000 new cases of breast cancer are diagnosed in women in the U.S. If cancer is detected when small and local, treatment options are less dangerous, intrusive, and costly-and more likely to lead to a cure. Yet those simple facts belie the complexity of developing and disseminating acceptable techniques for breast cancer diagnosis. Even the most exciting new technologies remain clouded with uncertainty. Mammography and Beyond provides a comprehensive and up-to-date perspective on the state of breast cancer screening and diagnosis and recommends steps for developing the most reliable breast cancer detection methods possible. This book reviews the dramatic expansion of breast cancer awareness and screening, examining the capabilities and limitations of current and emerging technologies for breast cancer detection and their effectiveness at actually reducing deaths. The committee discusses issues including national policy toward breast cancer detection, roles of public and private agencies, problems in determining the success of a technique, availability of detection methods to specific populations of women, women's experience during the detection process, cost-benefit analyses, and more. Examining current practices and specifying research and other needs, Mammography and Beyond will be an indispensable resource to policy makers, public health officials, medical practitioners, researchers, women's health advocates, and concerned women and their families. ER - TY - BOOK AU - Institute of Medicine A2 - Marilyn J. Field TI - Tuberculosis in the Workplace SN - DO - 10.17226/10045 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10045/tuberculosis-in-the-workplace PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Before effective treatments were introduced in the 1950s, tuberculosis was a leading cause of death and disability in the United States. Health care workers were at particular risk. Although the occupational risk of tuberculosis has been declining in recent years, this new book from the Institute of Medicine concludes that vigilance in tuberculosis control is still needed in workplaces and communities. Tuberculosis in the Workplace reviews evidence about the effectiveness of control measures—such as those recommended by the Centers for Disease Control and Prevention—intended to prevent transmission of tuberculosis in health care and other workplaces. It discusses whether proposed regulations from the Occupational Safety and Health Administration would likely increase or sustain compliance with effective control measures and would allow adequate flexibility to adapt measures to the degree of risk facing workers. ER - TY - BOOK AU - Institute of Medicine A2 - Marion Ein Lewin A2 - Stuart Altman TI - America's Health Care Safety Net: Intact but Endangered SN - DO - 10.17226/9612 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9612/americas-health-care-safety-net-intact-but-endangered PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety net—with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety net—public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the system—rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environment—detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populations—children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless. ER - TY - BOOK AU - Institute of Medicine A2 - Marilyn J. Field TI - Setting Priorities for Clinical Practice Guidelines SN - DO - 10.17226/4959 PY - 1995 UR - https://nap.nationalacademies.org/catalog/4959/setting-priorities-for-clinical-practice-guidelines PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - This book examines methods for selecting topics and setting priorities for clinical practice guideline development and implementation. Clinical practice guidelines are "systematically defined statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." In its assessment of processes for setting priorities, the committee considers the principles of consistency with the organization's mission, implementation feasibility, efficiency, utility of the results to the organization, and openness and defensibility—a principle that is especially important to public agencies. The volume also examines the implications of health care restructuring for priority setting and topic selection, including the link between national and local approaches to guidelines development. ER - TY - BOOK AU - Institute of Medicine TI - Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us SN - DO - 10.17226/18574 PY - 2014 UR - https://nap.nationalacademies.org/catalog/18574/advancing-workforce-health-at-the-department-of-homeland-security-protecting PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The more than 200,000 men and women that make up the Department of Homeland Security (DHS) workforce have been entrusted with the ultimate responsibility - ensuring that the homeland is safe, secure, and resilient against terrorism and other hazards. Every day, these dedicated individuals take on the critical and often dangerous challenges of the DHS mission: countering terrorism and enhancing national security, securing and managing the nation's borders, enforcing and administering U.S. immigration laws, protecting cyber networks and critical infrastructure, and ensuring resilience in the face of disasters. In return, DHS is responsible for protecting the health, safety, and resilience of those on whom it relies to achieve this mission, as well as ensuring effective management of the medical needs of persons who, in the course of mission execution, come into DHS care or custody. Since its creation in 2002, DHS has been aggressively addressing the management challenges of integrating seven core operating component agencies and 18 supporting offices and directorates. One of those challenges is creating and sustaining a coordinated health protection infrastructure. Advancing Workforce Health at the Department of Homeland Security examines how to strengthen mission readiness while better meeting the health needs of the DHS workforce. This report reviews and assesses the agency's current occupational health and operational medicine infrastructure and, based on models and best practices from within and outside DHS, provides recommendations for achieving an integrated, DHS-wide health protection infrastructure with the necessary centralized oversight authority. Protecting the homeland is physically and mentally demanding and entails many inherent risks, necessitating a DHS workforce that is mission ready. Among other things, mission readiness depends on (1) a workforce that is medically ready (free of health-related conditions that impede the ability to participate fully in operations and achieve mission goals), and (2) the capability, through an operational medicine program, to provide medical support for the workforce and others who come under the protection or control of DHS during routine, planned, and contingency operations. The recommendations of this report will assist DHS in meeting these two requirements through implementation an overarching workforce health protection strategy encompassing occupational health and operational medicine functions that serve to promote, protect, and restore the physical and mental well-being of the workforce. ER - TY - BOOK AU - Institute of Medicine TI - Review of NASA's Space Flight Health Standards: Letter Report DO - 10.17226/11862 PY - 2007 UR - https://nap.nationalacademies.org/catalog/11862/review-of-nasas-space-flight-health-standards-letter-report PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK AU - Institute of Medicine A2 - Joe Alper A2 - Claudia Grossmann TI - Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary SN - DO - 10.17226/18945 PY - 2015 UR - https://nap.nationalacademies.org/catalog/18945/integrating-research-and-practice-health-system-leaders-working-toward-high PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Health care has been called one of the most complex sectors of the U.S. economy. Driven largely by robust innovation in treatments and interventions, this complexity has created an increased need for evidence about what works best for whom in order to inform decisions that lead to safe, efficient, effective, and affordable care. As health care becomes more digital, clinical datasets are becoming larger and more numerous. By realizing the potential of knowledge generation that is more closely integrated with the practice of care, it should be possible not only to produce more usable evidence to inform decisions, but also to increase the efficiency and decrease the costs of doing clinical research. Patient-Centered Clinical Research Network, or PCORnet, is a nation-wide patient-centered clinical research network intended to form a resource of clinical, administrative, and patient data that can be used to carry out observational and interventional research studies and enhance the use of clinical data to advance the learning health care system. The primary goal of the first phase of PCORnet will be to establish the data infrastructure necessary to do such research. In April and June 2014 the Institute of Medicine's Roundtable on Value and Science-Driven Health Care convened two workshops aimed at accelerating progress toward real-time knowledge generation through the seamless integration of clinical practice and research, one of the fundamental concepts of a continuously learning health system, centered on the development of the PCORnet. The first workshop brought together health care system leaders, both administrative and clinical, and researchers to consider issues and strategic priorities for building a successful and durable clinical research network and facilitate progress toward a continuously learning health care system more broadly, including issues related to science, technology, ethics, business, regulatory oversight, sustainability, and governance. The second workshop focused on implementation approaches. Health system CEOs convened to consider strategic priorities and explore approaches to implementation. These workshops will inform the decisions of field leaders moving forward, including PCORI, the PCORnet steering committee, and PCORnet grantees. Integrating Research and Practice is the summary of the presentations and discussions of the workshops. ER - TY - BOOK AU - National Academy of Medicine A2 - James E. Tcheng A2 - Suzanne Bakken A2 - David W. Bates A2 - Hugh Bonner III A2 - Tejal K. Gandhi A2 - Meredith Josephs A2 - Kensaku Kawamoto A2 - Edwin A. Lomotan A2 - Erin Mackay A2 - Blackford Middleton A2 - Jonathan M. Teich A2 - Scott Weingarten A2 - Marianne Hamilton Lopez TI - Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series SN - DO - 10.17226/27122 PY - 2017 UR - https://nap.nationalacademies.org/catalog/27122/optimizing-strategies-for-clinical-decision-support-summary-of-a-meeting PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS. ER - TY - BOOK AU - Institute of Medicine AU - National Research Council TI - Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System: Interim Report DO - 10.17226/12599 PY - 2009 UR - https://nap.nationalacademies.org/catalog/12599/effectiveness-of-national-biosurveillance-systems-biowatch-and-the-public-health PB - The National Academies Press CY - Washington, DC LA - English KW - AB - For many years, concerns about bioterrorism and emerging infectious diseases have drawn attention to the need for strong surveillance systems. Experts are working to develop new and better ways to detect these biological threats as quickly as possible. One effort in this area is the Department of Homeland Security's BioWatch program. To evaluate the effectiveness of the BioWatch program, the Institute of Medicine (IOM) and National Research Council (NRC) convened the Committee on Effectiveness of National Biosurveillance Systems: BioWatch and the Public Health System. This interim report contains no findings and recommendations, but outlines the committee's initial progress. ER - TY - BOOK AU - Institute of Medicine A2 - Sarah H. Beachy A2 - Steve Olson A2 - Adam C. Berger TI - Genomics-Enabled Learning Health Care Systems: Gathering and Using Genomic Information to Improve Patient Care and Research: Workshop Summary SN - DO - 10.17226/21707 PY - 2015 UR - https://nap.nationalacademies.org/catalog/21707/genomics-enabled-learning-health-care-systems-gathering-and-using-genomic PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The inclusion of genomic data in a knowledge-generating health care system infrastructure is one promising way to harness the full potential of that information to provide better patient care. In such a system, clinical practice and research influence each other with the goal of improving the efficiency and effectiveness of disease prevention, diagnosis, and treatment. To examine pragmatic approaches to incorporating genomics in learning health care systems, the Institute of Medicine Roundtable on Translating Genomic-Based Research for Health hosted a workshop which convened a variety of stakeholder groups, including commercial developers, health information technology professionals, clinical providers, academic researchers, patient groups, and government and health system representatives, to present their perspectives and participate in discussions on maximizing the value that can be obtained from genomic information. The workshop examined how a variety of systems are capturing and making use of genomic data to generate knowledge for advancing health care in the 21st century. It also sought to evaluate the challenges, opportunities, and best practices for capturing or using genomic information in knowledge-generating health care systems. Genomics-Enabled Learning Health Care Systems summarizes the presentations and discussion of the workshop. ER - TY - BOOK AU - Institute of Medicine A2 - Claudia Grossmann A2 - Julia Sanders A2 - Rebecca A. English TI - Large Simple Trials and Knowledge Generation in a Learning Health System: Workshop Summary SN - DO - 10.17226/18400 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18400/large-simple-trials-and-knowledge-generation-in-a-learning-health-system PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Randomized clinical trials (RCTs) are often referred to as the "gold standard" of clinical research. However, in its current state, the U.S. clinical trials enterprise faces substantial challenges to the efficient and effective conduct of research. Streamlined approaches to RCTs, such as large simple trials (LSTs), may provide opportunities for progress on these challenges. Clinical trials support the development of new medical products and the evaluation of existing products by generating knowledge about safety and efficacy in pre- and post-marketing settings and serve to inform medical decision making and medical product development. Although well-designed and -implemented clinical trials can provide robust evidence, a gap exists between the evidence needs of a continuously learning health system, in which all medical decisions are based on the best available evidence, and the reality, in which the generation of timely and practical evidence faces significant barriers. Large Simple Trials and Knowledge Generation in a Learning Health System is the summary of a workshop convened by the Institute of Medicine's Roundtable on Value & Science-Driven Health Care and the Forum on Drug Discovery, Development, and Translation. Experts from a wide range of disciplines--including health information technology, research funding, clinical research methods, statistics, patients, product development, medical product regulation, and clinical outcomes research--met to marshal a better understanding of the issues, options, and approaches to accelerating the use of LSTs. This publication summarizes discussions on the potential of LSTs to improve the speed and practicality of knowledge generation for medical decision making and medical product development, including efficacy and effectiveness assessments, in a continuously learning health system. Large Simple Trials and Knowledge Generation in a Learning Health System explores acceleration of the use of LSTs to improve the speed and practicality of knowledge generation for medical decision making and medical product development; considers the concepts of LST design, examples of successful LSTs, the relative advantages of LSTs, and the infrastructure needed to build LST capacity as a routine function of care; identifies structural, cultural, and regulatory barriers hindering the development of an enhanced LST capacity; discusses needs and strategies in building public demand for and participation in LSTs; and considers near-term strategies for accelerating progress in the uptake of LSTs in the United States. ER - TY - BOOK AU - Institute of Medicine TI - Vaccine Safety Forum: Summaries of Two Workshops SN - DO - 10.17226/5881 PY - 1997 UR - https://nap.nationalacademies.org/catalog/5881/vaccine-safety-forum-summaries-of-two-workshops PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - On November 6, 1995, the Institute of Medicine's Vaccine Safety Forum convened a workshop on detecting and responding to adverse events following vaccination. Workshop speakers and participants discussed the difficulties in detecting adverse events, current adverse events detection and response methods and procedures, suggestions for improving the means of detecting and responding to adverse events following vaccination, and future areas of research. This document represents a summary of that workshop. ER - TY - BOOK AU - Institute of Medicine A2 - Denise Caruso A2 - Rebecca A. English A2 - Anne B. Claiborne TI - Characterizing and Communicating Uncertainty in the Assessment of Benefits and Risks of Pharmaceutical Products: Workshop Summary SN - DO - 10.17226/18870 PY - 2014 UR - https://nap.nationalacademies.org/catalog/18870/characterizing-and-communicating-uncertainty-in-the-assessment-of-benefits-and-risks-of-pharmaceutical-products PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Despite the extensive body of evidence that informs regulatory decisions on pharmaceutical products, significant uncertainties persist, including the underlying variability in human biology, factors associated with the chemistry of a drug, and limitations in the research and clinical trial process itself that might limit the generalizability of results. As a result, regulatory reviewers are consistently required to draw conclusions about a drug's safety and efficacy from imperfect data. Efforts are underway within the drug development community to enhance the evaluation and communication of the benefits and risks associated with pharmaceutical products, aimed at increasing the predictability, transparency, and efficiency of pharmaceutical regulatory decision making. Effectively communicating regulatory decisions necessarily includes explanation of the impact of uncertainty on decision making. On February 12 and May 12, 2014, the Institute of Medicine's Forum on Drug Discovery, Development, and Translation held public workshops to advance the development of more systematic and structured approaches to characterize and communicate the sources of uncertainty in the assessment of benefits and risks, and to consider their implications for pharmaceutical regulatory decisions. Workshop presentations and discussions on February 12 were convened to explore the science of identifying and characterizing uncertainty in scientific evidence and approaches to translate uncertainties into decisions that reflect the values of stakeholders. The May 12 workshop presentations and discussions explored tools and approaches to communicating about scientific uncertainties to a range of stakeholders in the drug development process. Characterizing and Communicating Uncertainty in the Assessment of Benefits and Risks of Pharmaceutical Products summarizes the presentation and discussion of both events. This report explores potential analytical and communication approaches and identifies key considerations on their development, evaluation, and incorporation into pharmaceutical benefit- risk assessment throughout the entire drug development lifecycle. ER - TY - BOOK AU - Institute of Medicine A2 - David E. Longnecker A2 - Frederick J. Manning A2 - Melvin H. Worth, Jr. TI - Review of NASA's Longitudinal Study of Astronaut Health SN - DO - 10.17226/10903 PY - 2004 UR - https://nap.nationalacademies.org/catalog/10903/review-of-nasas-longitudinal-study-of-astronaut-health PB - The National Academies Press CY - Washington, DC LA - English KW - Space and Aeronautics AB - As part of its ongoing commitment to the nation's space program, NASA's medical leadership asked the Institute of Medicine (IOM) to review specific aspects of the scientific basis, policies, and procedures associated with the Longitudinal Study of Astronaut Health (LSAH). NASA created the LSAH in 1992 to address a variety of issues, including both the health of astronauts during space flight and the longer-term health issues that might be associated with space flight and flight training. ER - TY - BOOK AU - Institute of Medicine A2 - Joe Alper A2 - Julia Sanders A2 - Robert Saunders TI - Core Measurement Needs for Better Care, Better Health, and Lower Costs: Counting What Counts: Workshop Summary SN - DO - 10.17226/18333 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18333/core-measurement-needs-for-better-care-better-health-and-lower-costs PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Health care quality and its affordability have become very pressing issues in the United States. All sectors of the country are attempting to push forward initiatives that will improve the health care system as well as the health of the American population in general. Despite the economical dedication to health care, about 1/5, the system remains uneven and fragmented, patient harm is quite common, care is often uncoordinated, and many more mishaps occur. There exists many obstacles to improve the nation's health care system; these include the capacity to reliably and consistently measure progress. In 2006 the Institute of Medicine (IOM) established the Roundtable on Value & Science-Driven Health Care which has since accelerated the development of a learning health system- one in which science, informatics, incentives, and culture are aligned to create a continuous learning loop. This learning loop would thus help make the health care system better. In response, the IOM organized a 2-day workshop to explore in depth the core measurement needs for population health, health care quality, and health care costs. The workshop hoped to gain a full understanding of how to improve the nation's measurement capacity to track progress in the health care system. Having this knowledge would help the nation get one step closer to the creation of an efficient learning loop. The workshop was divided into a series of sessions that focused on different aspects of measurement. Core Measurement Needs for Better Care, Better Health, and Lower Costs: Counting What Counts: Workshop Summary includes explanations and key details for these sessions: Vision, Current Measurement Capabilities, Specifying the Shape of a Core Metric Set, and Implementation. The report also features common themes within these areas, the workshop agenda, and information about those involved. ER - TY - BOOK AU - Institute of Medicine A2 - Ben Wheatley TI - Regionalizing Emergency Care: Workshop Summary SN - DO - 10.17226/12872 PY - 2010 UR - https://nap.nationalacademies.org/catalog/12872/regionalizing-emergency-care-workshop-summary PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - During medical emergencies, hospital staff and emergency medical services (EMS) providers, can face barriers in delivering the fastest and best possible care. Overcrowded emergency rooms cannot care for patients as quickly as necessary, and some may divert ambulances and turn away new patients outright. In many states, ambulance staff lacks the means to determine which hospitals can provide the best care to a patient. Given this absence of knowledge, they bring patients to the closest hospital. In addition, because emergency service providers from different companies compete with each other for patients, and emergency care legislation varies from state to state, it is difficult to establish the necessary local, interstate, and national communication and collaboration to create a more efficient system. In 2006, the IOM recommended that the federal government implement a regionalized emergency care system to improve cooperation and overcome these challenges. In a regionalized system, local hospitals and EMS providers would coordinate their efforts so that patients would be brought to hospitals based on the hospitals' capacity and expertise to best meet patients' needs. In September 2009, three years after making these recommendations, the IOM held a workshop sponsored by the federal Emergency Care Coordination Center to assess the nation's progress toward regionalizing emergency care. The workshop brought together policymakers and stakeholders, including nurses, EMS personnel, hospital administrators, and others involved in emergency care. Participants identified successes and shortcomings in previous regionalization efforts; examined the many factors involved in successfully implementing regionalization; and discussed future challenges to regionalizing emergency care. This document summarizes the workshop. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Erin Balogh A2 - Emily Zevon A2 - Margie Patlak A2 - Sharyl J. Nass TI - Developing and Sustaining an Effective and Resilient Oncology Careforce: Proceedings of a Workshop SN - DO - 10.17226/25533 PY - 2019 UR - https://nap.nationalacademies.org/catalog/25533/developing-and-sustaining-an-effective-and-resilient-oncology-careforce-proceedings PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The oncology careforce faces challenges as population growth in the U.S. contributes to increases in the number of patients diagnosed with cancer. Significant advances in cancer research, screening and diagnostic practices, and treatment have led to the age-adjusted declining mortality rate from cancer. However, as the field continues to develop and advance, cancer care has become more complex than ever before. There is a growing concern regarding the U.S. health care system's capacity to deliver high-quality cancer care to the increasing number of patients. The National Academies convened a workshop on February 11-12, 2019 to explore trends in cancer care and identify opportunities for improvement in the rapidly developing oncology careforce. Discussions at the workshop primarily focused on trends in demographics, the careforce, and oncology practice, as well as implications for the future of cancer care and strategies to improve the organization and delivery of cancer care. Opportunities to change policy and leverage technologies in oncology were also identified. This publication summarizes the presentations and discussions from the workshop. ER -