Policy & Practice


Breast-Feeding Support Still Lacking

Many hospitals continue to fall short in their support of breast-feeding by new mothers, according to a study published in Morbidity and Mortality Weekly Report. The findings are based on a national survey of maternity practices that scored (on a scale of 0–100) how hospitals and birth centers across the country support breast-feeding. The mean national score was 63, with hospitals and birthing centers scoring best on direct breast-feeding assistance (mean score, 80) and worst on providing support after discharge (mean score, 40). In addition, the researchers found that many hospitals and birthing centers engaged in practices that have been shown to interfere with breast-feeding. For example, 70% of facilities reported providing breast-feeding mothers with infant formula samples. More than 2,600 hospitals and birthing centers responded last year to the study, the Center for Disease Control and Prevention's first national Maternity Practices in Infant Nutrition and Care survey.

SG Releases Preterm Birth Agenda

The Surgeon General, along with a panel of experts in obstetrics, pediatrics, and public health, has released a national agenda aimed at combating the rising rate of preterm birth. Among their priorities: a national education program to engage women in preventing premature labor, and studies to identify biomarkers that would signal the beginning of preterm labor. The broad-based agenda covers biomedical research; epidemiologic research; psychosocial and behavioral considerations; professional education and training; public outreach; and quality of health care and health services. The agenda was crafted during a 2-day, Congressionally mandated conference last month.

DTC Drug Ads and Women

The Society for Women's Health Research is asking Food and Drug Administration officials to expand their study of demographic differences in the effects of direct-to-consumer drug advertising to include gender. Congress has tasked the FDA with analyzing the effect of DTC ads by age, race, and ethnicity. “It is very likely that DTC ads are and will be specifically targeted to communicate to women. Biological sex should be a vital component to any research in this area and collection of such data will be the only way to efficiently and effectively examine the impact of DTC ads on women,” Phyllis Greenberger, president and CEO of the Society for Women's Health Research, wrote in a letter to the FDA. Ms. Greenberger also noted that DTC ads should educate consumers that men and women may experience different biological responses, even when they take the same drug.

Contraceptive Research

Officials at the Contraception and Reproductive Health (CRH) Branch, part of the National Institute of Child Health and Human Development, are considering a consortium program to help develop new, nonhormonal contraceptives. The program would likely emphasize research on male contraceptives, according to a draft report from the CRH that outlines future research directions. In addition, branch officials plan to continue work on developing hormonal contraceptives for women that have better safety and side-effect profiles. For example, researchers plan to consider testing products that could be safer for obese women. The research directions are based in part on advice from a panel of 12 experts in contraception, reproductive endocrinology, drug development, clinical trials, epidemiology, and pelvic-floor disorders.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans (AHIP) has endorsed the concept of a medical home, and has sketched out what it sees as principles to guide the transformation of health care delivery into a coordinated, comprehensive approach. The board voted to approve the principles in June at the organization's Institute 2008 meeting. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all of those settings should follow the eight broad principles it outlined, including the following: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be employed; clinicians should commit to being accountable for quality and to measuring and reporting on outcomes and cost-effectiveness; and payments should reflect the level of management involved and should help support the cost of developing a medical home infrastructure.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health-insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments (from a low of less than 0.5% to a high of more than 9%). Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.


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