Scholars@Duke
Mark B McClellan

Mark B McClellan

Professor of the Practice of Business Administration
Fuqua School of Business
mark.mcclellan@duke.edu
Margolis Center for Health Policy, JB Duke Buildkng, 230 Science Drive, Durham, NC 27708
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Selected Publications

Overcoming the barriers to better evidence generation from clinical trials.

Journal Article Trials · September 16, 2024 Clinical evidence generation from and for representative populations can be improved through increased research access and ease of trial participation. To improve access and participation, a modern trial infrastructure is needed that broadens research into ... Full text Link to item Cite

Perspectives on Improving Value Assessment With the ISPOR SUITABILITY Checklist.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · June 2024 Full text Cite

The potential for artificial intelligence to transform healthcare: perspectives from international health leaders.

Journal Article NPJ digital medicine · April 2024 Artificial 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 ... Full text Open Access Cite

Food Is Medicine: A Presidential Advisory From the American Heart Association.

Journal Article Circulation · October 2023 Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the ... Full text Cite

Vital directions for health & health care: An initiative of the national academy of medicine

Book · September 9, 2023 What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United ... Full text Cite

Preface

Book · September 9, 2023 Cite

Advancing the Future of "Care Without an Address": Recommendations from International Health Care Leaders

Journal Article NEJM Catalyst Innovations in Care Delivery · July 26, 2023 Summary The demand for home- and community-based care will intensify across the world as populations age and technological advancements support innovative delivery approaches. The Future of Health, an international community of senior health leaders, colla ... Full text Cite

Health Policy Priorities for the Biden Administration.

Journal Article Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · March 2022 Full text Cite

Understanding Use of Real-World Data and Real-World Evidence to Support Regulatory Decisions on Medical Product Effectiveness.

Journal Article Clinical pharmacology and therapeutics · January 2022 RWE has potential to provide efficient and relevant information on the effectiveness of medical products, complementing the data generated in clinical trials; however, how RWE can support regulatory decision-making is unclear, potentially limiting its use. ... Full text Cite

Overcoming the barriers to better evidence generation from clinical trials.

Journal Article Trials · September 16, 2024 Clinical evidence generation from and for representative populations can be improved through increased research access and ease of trial participation. To improve access and participation, a modern trial infrastructure is needed that broadens research into ... Full text Link to item Cite

Perspectives on Improving Value Assessment With the ISPOR SUITABILITY Checklist.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · June 2024 Full text Cite

The potential for artificial intelligence to transform healthcare: perspectives from international health leaders.

Journal Article NPJ digital medicine · April 2024 Artificial 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 ... Full text Open Access Cite

Food Is Medicine: A Presidential Advisory From the American Heart Association.

Journal Article Circulation · October 2023 Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the ... Full text Cite

Vital directions for health & health care: An initiative of the national academy of medicine

Book · September 9, 2023 What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United ... Full text Cite

Preface

Book · September 9, 2023 Cite

Advancing the Future of "Care Without an Address": Recommendations from International Health Care Leaders

Journal Article NEJM Catalyst Innovations in Care Delivery · July 26, 2023 Summary The demand for home- and community-based care will intensify across the world as populations age and technological advancements support innovative delivery approaches. The Future of Health, an international community of senior health leaders, colla ... Full text Cite

Health Policy Priorities for the Biden Administration.

Journal Article Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · March 2022 Full text Cite

Understanding Use of Real-World Data and Real-World Evidence to Support Regulatory Decisions on Medical Product Effectiveness.

Journal Article Clinical pharmacology and therapeutics · January 2022 RWE has potential to provide efficient and relevant information on the effectiveness of medical products, complementing the data generated in clinical trials; however, how RWE can support regulatory decision-making is unclear, potentially limiting its use. ... Full text Cite

State variation in effects of state social distancing policies on COVID-19 cases.

Journal Article BMC Public Health · June 28, 2021 BACKGROUND: The novel coronavirus disease 2019 (COVID-19) sickened over 20 million residents in the United States (US) by January 2021. Our objective was to describe state variation in the effect of initial social distancing policies and non-essential busi ... Full text Link to item Cite

How Telehealth Expansion Can Support Comprehensive Virtual Care

Journal Article NEJM Catalyst Innovations in Care Delivery · June 16, 2021 Telehealth utilization grew rapidly in response to the Covid-19 pandemic, enabled by significant changes to regulations, benefits, and payments by the U.S. Centers for Medicare & Medicaid Services and commercial payers. These flexibilities are now extremel ... Full text Cite

Hospital-level compliance with the commission on cancer's quality of care measures and the association with patient survival.

Journal Article Cancer Med · June 2021 BACKGROUND: Quality measurement has become a priority for national healthcare reform, and valid measures are necessary to discriminate hospital performance and support value-based healthcare delivery. The Commission on Cancer (CoC) is the largest cancer-sp ... Full text Link to item Cite

Association of ACO Shared Savings Success and Serious Illness Spending.

Journal Article J Healthc Manag · May 2021 Accountable care organizations (ACOs) need confidence in their return on investment to implement changes in care delivery that prioritize seriously ill and high-cost Medicare beneficiaries. The objective of this study was to characterize spending on seriou ... Full text Link to item Cite

Vital Directions For Health And Health Care: Priorities For 2021.

Journal Article Health Aff (Millwood) · February 2021 In 2016, in anticipation of the US presidential election and forthcoming new administration, the National Academy of Medicine launched a strategic initiative to marshal expert guidance on pressing health and health care priorities. Published as Vital Direc ... Full text Open Access Link to item Cite

A Light Regulatory Touch to Keep Covid Drugs Current

Other Wall Street journal (Eastern ed.) · January 10, 2021 Link to item Cite

Improving patient-reported measures in oncology: a payer call to action.

Journal Article Journal of managed care & specialty pharmacy · January 2021 Despite rising interest in integrating the patient voice in value-based payment (VBP) models for oncology, barriers persist to implementing patient-reported measures (PRMs), including patient-reported performance measures (PR-PMs). This article describes t ... Full text Cite

Why Are Covid Antibody Drugs Sitting on Shelves?

Other Wall Street journal (Eastern ed.) · December 20, 2020 Link to item Cite

Comparing Associations of State Reopening Strategies with COVID-19 Burden.

Journal Article J Gen Intern Med · December 2020 BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopenin ... Full text Link to item Cite

Prospective or retrospective ACO attribution matters for seriously ill patients.

Journal Article Am J Manag Care · December 2020 OBJECTIVES: Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects ... Full text Link to item Cite

Pediatric accountable health communities: Insights on needed capabilities and potential solutions.

Journal Article Healthcare (Amsterdam, Netherlands) · December 2020 BackgroundPediatric accountable health communities (AHCs) are emerging collaborative models that integrate care across health and social service sectors. We aimed to identify needed capabilities and potential solutions for implementing pediatric A ... Full text Cite

Correction to: Comparing Associations of State Reopening Strategies with COVID-19 Burden.

Journal Article J Gen Intern Med · November 9, 2020 In the original version of this paper, an author was misidentified. The corrected author listing appears here, and has been updated in the online version. ... Full text Link to item Cite

You Can Trust the FDA’s Vaccine Process

Other Wall Street journal (Eastern ed.) · September 20, 2020 Open Access Link to item Cite

A National Decision Point: Effective Testing and Screening for Covid-19

Report · September 9, 2020 This 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 ... Open Access Link to item Cite

Betting on Better Drug Trials to Beat Covid-19

Other Wall Street journal (Eastern ed.) · August 23, 2020 Open Access Link to item Cite

From Development to Market: Understanding COVID-19 Testing and Its Challenges

Report · August 19, 2020 Amid 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 r ... Open Access Link to item Cite

Legislative and Regulatory Steps for a National COVID-19 Testing Strategy

Report · August 5, 2020 The 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 need ... Open Access Link to item Cite

Covid Shows the Need for a Diagnostic Stockpile

Other Wall Street journal (Eastern ed.) · July 26, 2020 Open Access Link to item Cite

Preclinical Alzheimer Disease Drug Development: Early Considerations Based on Phase 3 Clinical Trials.

Journal Article J Manag Care Spec Pharm · July 2020 The number of people in the United States living with Alzheimer disease (AD) is growing, resulting in significant clinical and economic impact. Substantial research investment has led to drug development in stages of AD before symptomatic dementia, such as ... Full text Link to item Cite

Improving Cardiovascular Drug and Device Development and Evidence Through Patient-Centered Research and Clinical Trials: A Call to Action From the Value in Healthcare Initiative's Partnering With Regulators Learning Collaborative.

Journal Article Circ Cardiovasc Qual Outcomes · July 2020 The pipeline of new cardiovascular drugs is relatively limited compared with many other clinical areas. Challenges causing lagging drug innovation include the duration and expense of cardiovascular clinical trials needed for regulatory evaluation and appro ... Full text Link to item Cite

Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative.

Journal Article Circ Cardiovasc Qual Outcomes · July 2020 Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population heal ... Full text Link to item Cite

Streamlining and Reimagining Prior Authorization Under Value-Based Contracts: A Call to Action From the Value in Healthcare Initiative's Prior Authorization Learning Collaborative.

Journal Article Circulation. Cardiovascular quality and outcomes · July 2020 Utilization management strategies, including prior authorization, are commonly used to facilitate safe and guideline-adherent provision of new, individualized, and potentially costly cardiovascular therapies. However, as currently deployed, these approache ... Full text Cite

Paying For Value From Costly Medical Technologies: A Framework For Applying Value-Based Payment Reforms.

Journal Article Health affairs (Project Hope) · June 2020 Innovative medical products offer significant and potentially transformative impacts on health, but they create concerns about rising spending and whether this rise is translating into higher value. The result is increasing pressure to pay for therapies in ... Full text Cite

North Carolina's Health Care Transformation to Value: Progress to Date and Further Steps Needed.

Journal Article North Carolina medical journal · May 2020 North Carolina has received national attention for its approach to health care payment and delivery reform. Importantly, payment reform alone is not enough to drive systematic changes in care delivery. We highlight the importance of progress in four comple ... Full text Cite

Advancing Value-Based Cardiovascular Care: The American Heart Association Value in Healthcare Initiative.

Journal Article Circulation. Cardiovascular quality and outcomes · May 2020 Full text Cite

Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.

Journal Article Circulation. Cardiovascular quality and outcomes · May 2020 Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in impr ... Full text Cite

The Past Decade of Paying for Value: From the Affordable Care Act to COVID-19

Journal Article North Carolina Medical Journal · January 1, 2020 The Affordable Care Act played a major role in transitioning American health care away from fee-for-service payment. We explore the spread of payment reforms since the implementation of the ACA, both nationally and in North Carolina; the corresponding effe ... Full text Cite

Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights.

Journal Article Pediatrics · August 2019 OBJECTIVES: To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on incentive program rationale, child and family engagement, and program evalu ... Full text Link to item Cite

ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.

Journal Article Health Aff (Millwood) · June 2019 Care for people living with serious illness is suboptimal for many reasons, including underpayment for key services (such as care coordination and social supports) in fee-for-service reimbursement. Accountable care organizations (ACOs) have potential to im ... Full text Link to item Cite

Current Policy and Practice for Value-Based Pricing.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · June 2019 Full text Cite

Why Do Accountable Care Organizations Leave The Medicare Shared Savings Program?

Journal Article Health affairs (Project Hope) · May 2019 The ability of accountable care organizations (ACOs) to continue reducing costs and improving quality depends on understanding what affects their survival. We examined such factors for survival in the Medicare Shared Savings Program (MSSP) of 624 ACOs betw ... Full text Cite

Can Innovation in Regulatory Science Address Health Care Cost Burdens?

Journal Article Clinical pharmacology and therapeutics · April 2019 Full text Cite

A Roadmap for Value-Based Payment Models Among Patients With Cirrhosis.

Journal Article Hepatology · March 2019 Healthcare reimbursement is shifting from fee-for-service to fee-for-value. Cirrhosis, which costs the U.S. healthcare system as much as heart failure, is a prime target for value-based care. This article describes models in which physician groups or healt ... Full text Link to item Cite

Payment Reform, Medication Use, and Costs: Can We Afford to Leave Out Drugs?

Journal Article Journal of general internal medicine · March 2019 Medications are one of the fastest growing sources of costs in the health system and the cornerstone of disease management. Despite extensive attention around drug pricing, medications have largely been excluded from CMS-derived, value-based payment models ... Full text Cite

Engaging Beneficiaries In Medicaid Programs That Incentivize Health-Promoting Behaviors.

Journal Article Health Aff (Millwood) · March 2019 Medicaid programs are increasingly adopting incentive programs to improve health behaviors among beneficiaries. There is limited evidence on what incentives are being offered to Medicaid beneficiaries, how programs are engaging beneficiaries, and how progr ... Full text Link to item Cite

Value-based arrangements may be more prevalent than assumed.

Journal Article Am J Manag Care · February 2019 OBJECTIVES: To better understand the prevalence of US value-based payment arrangements (VBAs), their characteristics, and the factors that facilitate their success or act as barriers to their implementation. STUDY DESIGN: Surveys were administered to a con ... Link to item Cite

Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

Journal Article Circulation · February 2019 Although advances in care have spurred improvements in cardiovascular outcomes, cardiovascular disease remains the leading cause of death in the United States and around the world. Previous declines in cardiovascular disease mortality have slowed and even ... Full text Cite

Seven Former FDA Commissioners: The FDA Should Be An Independent Federal Agency.

Journal Article Health affairs (Project Hope) · January 2019 Seven former commissioners of the Food and Drug Administration (FDA) from both sides of the political aisle recommend that the FDA be moved out of the Department of Health and Human Services and reconfigured as an independent federal agency. We believe tha ... Full text Cite

The FDA Sentinel Initiative - An Evolving National Resource.

Journal Article The New England journal of medicine · November 2018 Full text Cite

Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care.

Journal Article J Am Coll Cardiol · June 12, 2018 As we enter the information age of health care, digital health technologies offer significant opportunities to optimize both clinical care delivery and clinical research. Despite their potential, the use of such information technologies in clinical care an ... Full text Link to item Cite

Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop.

Journal Article Global heart · June 2018 Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a he ... Full text Cite

Implementation of a Market Entry Reward within the United States.

Journal Article The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · June 2018 As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards (MERs) are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Va ... Full text Cite

Payment Reform to Enhance Collaboration of Primary Care and Cardiology: A Review.

Journal Article JAMA cardiology · January 2018 Importance:The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health r ... Full text Cite

The Affordable Care Act: What's Next?

Journal Article Annual review of medicine · January 2018 The postelection efforts to repeal, replace, or modify the Affordable Care Act (ACA) suggest that the debate over healthcare coverage will remain contentious, particularly because of the high and rising cost of health care. Feasible, potentially bipartisan ... Full text Cite

Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients.

Journal Article Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation · January 2018 Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare deli ... Full text Cite

Accountable Care Reforms Improve Women's And Children's Health In Nepal.

Journal Article Health affairs (Project Hope) · November 2017 Over the past decade the Ministry of Health of Nepal and the nonprofit Possible have partnered to deliver primary and secondary health care via a public-private partnership. We applied an accountable care framework that we previously developed to describe ... Full text Cite

Improving Care And Lowering Costs: Evidence And Lessons From A Global Analysis Of Accountable Care Reforms.

Journal Article Health affairs (Project Hope) · November 2017 Policy makers and providers are under increasing pressure to find innovative approaches to achieving better health outcomes as efficiently as possible. Accountable care, which holds providers accountable for results rather than specific services, is emergi ... Full text Cite

Vital Directions for Health and Health Care: Priorities From a National Academy of Medicine Initiative.

Journal Article JAMA · April 11, 2017 IMPORTANCE: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions rec ... Full text Link to item Cite

Moving Beyond the Walls of the Clinic: Opportunities and Challenges to the Future of Telehealth in Heart Failure.

Journal Article JACC Heart Fail · April 2017 Telehealth offers an innovative approach to improve heart failure care that expands beyond traditional management strategies. Yet the use of telehealth in heart failure is infrequent because of several obstacles. Fundamentally, the evidence is inconsistent ... Full text Link to item Cite

Strategies For Assessing Delivery System Innovations.

Journal Article Health affairs (Project Hope) · March 2017 Driven by evidence of continuing gaps in health care quality and efficiency and inspired by the emergence of new value-based payment models, both large and small health care organizations are developing and deploying a wide range of care delivery innovatio ... Full text Cite

Advancing Value Assessment in the United States: A Multistakeholder Perspective.

Journal Article Value Health · February 2017 Rising costs without perceived proportional improvements in quality and outcomes have motivated fundamental shifts in health care delivery and payment to achieve better value. Aligned with these efforts, several value assessment frameworks have been introd ... Full text Link to item Cite

Existing and Emerging Payment and Delivery Reforms in Cardiology.

Journal Article JAMA cardiology · February 2017 ImportanceRecent health care reforms aim to increase patient access, reduce costs, and improve health care quality as payers turn to payment reform for greater value. Cardiologists need to understand emerging payment models to succeed in the evolv ... Full text Cite

Improving Oncology Quality Measurement in Accountable Care: Filling Gaps with Cross-Cutting Measures.

Journal Article Journal of managed care & specialty pharmacy · February 2017 Payment for health care services, including oncology services, is shifting from volume-based fee-for-service to value-based accountable care. The objective of accountable care is to support providers with flexibility and resources to reform care delivery, ... Full text Cite

Improving the tools of clinical pharmacology: Goals for 2017 and beyond.

Journal Article Clinical pharmacology and therapeutics · January 2017 Current trends in pronounced late-stage attrition rates of promising drug candidates are a pressing concern for patients, providers, and other stakeholders across the health care system. Here, we describe six areas in which clinical pharmacology methods an ... Full text Cite

Building a drug development database: challenges in reliable data availability.

Journal Article Drug development and industrial pharmacy · January 2017 ContextPolicy and legislative efforts to improve the biomedical innovation process must rely on a detailed and thorough analysis of drug development and industry output.ObjectiveAs part of our efforts to build a publicly-available databas ... Full text Cite

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

Journal Article Pediatrics · August 2016 Background and objectivesPayers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several di ... Full text Cite

Aligning payment reform and delivery innovation in emergency care.

Journal Article The American journal of managed care · August 2016 Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illu ... Cite

Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology.

Journal Article Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · April 2016 Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care m ... Full text Cite

The 21st Century Cures Act.

Journal Article The New England journal of medicine · October 2015 Full text Cite

Solutions for filling gaps in accountable care measure sets.

Journal Article The American journal of managed care · October 2015 ObjectivesA primary objective of accountable care is to support providers in reforming care to improve outcomes and lower costs. Gaps in accountable care measure sets may cause missed opportunities for improvement and missed signals of problems in ... Cite

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

Journal Article Health affairs (Project Hope) · September 2015 The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease preve ... Full text Cite

Case study: Transforming cancer care at a community oncology practice.

Journal Article Healthcare (Amsterdam, Netherlands) · September 2015 To assist practices and institutions throughout the country in implementing clinical redesign supported by - and aligned with - payment reform, we present a case study of the New Mexico Cancer Center (NMCC) based on numerous stakeholder interviews, literat ... Full text Cite

Improving evidence developed from population-level experience with targeted agents.

Journal Article Clinical pharmacology and therapeutics · May 2015 Off-label drug use is common in oncology, due in part to significant unmet medical need, the rarity of many cancers, and the difficulty of conducting randomized controlled trials (RCTs) to support labeling of every drug in every disease setting. As new dru ... Full text Cite

Transforming oncology care: payment and delivery reform for person-centered care.

Journal Article The American journal of managed care · May 2015 Cite

Oncology payment reform to achieve real health care reform.

Journal Article Journal of oncology practice · May 2015 Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high- ... Full text Cite

Repairing the broken market for antibiotic innovation.

Journal Article Health affairs (Project Hope) · February 2015 Multidrug-resistant bacterial diseases pose serious and growing threats to human health. While innovation is important to all areas of health research, it is uniquely important in antibiotics. Resistance destroys the fruit of prior research, making it nece ... Full text Cite

Improving pharmaceutical innovation by building a more comprehensive database on drug development and use.

Journal Article Health affairs (Project Hope) · February 2015 New drugs and biologics have had a tremendous impact on the treatment of many diseases. However, available measures suggest that pharmaceutical innovation has remained relatively flat, despite substantial growth in research and development spending. We rev ... Full text Cite

Accountable care around the world: a framework to guide reform strategies.

Journal Article Health affairs (Project Hope) · September 2014 Accountable care--a way to align health care payments with patient-focused reform goals--is currently being pursued in the United States, but its principles are also being applied in many other countries. In this article we review experiences with such ref ... Full text Cite

Wachter, McClellan offer takes on measuring quality.

Journal Article Modern healthcare · July 2014 Cite

New FDA breakthrough-drug category--implications for patients.

Journal Article The New England journal of medicine · July 2014 Full text Cite

Early experiences with accountable care in Medicaid: special challenges, big opportunities.

Journal Article Population health management · January 2013 Accountable care organizations (ACOs) and the more general movement toward accountable care, in which payments are aligned directly with improvements in quality and cost, are intended to increase the incentives and support for higher value in health care. ... Full text Cite

Meaningful physician payment reform in oncology

Journal Article Journal of Oncology Practice · January 1, 2013 Cancer care suffers from many of the well-known flaws in the American health care delivery system. Most of the care delivery shortfalls and inefficiencies can be tied, in part, back to payment systems that support high-cost procedures rather than focusing ... Full text Cite

Mark McClellan. Interview by Asher Mullard.

Journal Article Nature reviews. Drug discovery · September 2012 Full text Cite

Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.

Journal Article Health affairs (Project Hope) · July 2012 The US health care system is characterized by fragmentation and misaligned incentives, which creates challenges for both providers and recipients. These challenges are magnified for older adults who receive long-term services and supports. The Affordable C ... Full text Cite

Implementation through collaboration: The Brookings-Dartmouth ACO Learning Network.

Journal Article Maryland medicine : MM : a publication of MEDCHI, the Maryland State Medical Society · January 2012 Cite

Building the path to accountable care.

Journal Article The New England journal of medicine · December 2011 Full text Cite

Achieving the goals of effective, safe, and individualized cancer care.

Journal Article Clinical cancer research : an official journal of the American Association for Cancer Research · November 2011 Full text Cite

Measuring health care performance now, not tomorrow: essential steps to support effective health reform.

Journal Article Health affairs (Project Hope) · April 2011 Better data on the quality of health care being delivered in the United States are urgently needed if efforts to reform the nation's health care system are to succeed. This paper describes a "distributed data approach" to computing performance results whil ... Full text Cite

Developing the sentinel system - A national resource for evidence development

Journal Article New England Journal of Medicine · February 10, 2011 Full text Cite

An accelerated pathway for targeted cancer therapies.

Journal Article Nature reviews. Drug discovery · February 2011 A well-defined pathway for the accelerated development and approval of targeted cancer therapies and companion diagnostics would reduce uncertainty, improve efficiency in development and provide an effective incentive for developers. ... Full text Cite

Reforming payments to healthcare providers: the key to slowing healthcare cost growth while improving quality?

Conference The journal of economic perspectives : a journal of the American Economic Association · January 2011 This paper focuses on a broad movement toward a fundamentally different way of paying healthcare providers. The approach reaches beyond the old dichotomies about whether healthcare providers are reimbursed on a fee-for-service or a "capitated" or per-perso ... Full text Cite

Bending the curve through health reform implementation.

Journal Article The American journal of managed care · November 2010 In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Pa ... Cite

An evaluation of recent federal spending on comparative effectiveness research: priorities, gaps, and next steps.

Journal Article Health affairs (Project Hope) · October 2010 The American Recovery and Reinvestment Act of 2009 included new funding for developing better evidence about health interventions, with a down payment of $1.1 billion for comparative effectiveness research. Our analysis of funds allocated in the legislatio ... Full text Cite

Comparative effectiveness research: Policy context, methods development and research infrastructure.

Journal Article Statistics in medicine · August 2010 Comparative effectiveness research (CER) has received substantial attention as a potential approach for improving health outcomes while lowering costs of care, and for improving the relevance and quality of clinical and health services research. The Instit ... Full text Cite

Beyond the Affordable Care Act: achieving real improvements in Americans' health.

Journal Article Health affairs (Project Hope) · August 2010 Improved access to health care is essential if we are to fill the striking gaps between how healthy Americans are and how healthy they could be. But access alone is not enough. Health and longevity are also profoundly influenced by where and how Americans ... Full text Cite

A national strategy to put accountable care into practice.

Journal Article Health affairs (Project Hope) · May 2010 The concept of accountable care organizations (ACOs) has been set forth in recently enacted national health reform legislation as a strategy to address current shortcomings in the U.S. health care system. This paper focuses on implementation issues related ... Full text Cite

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

Journal Article Health economics · October 2009 The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for ... Full text Cite

Bending the curve: effective steps to address long-term healthcare spending growth.

Journal Article The American journal of managed care · October 2009 Cite

The new Sentinel Network--improving the evidence of medical-product safety.

Journal Article The New England journal of medicine · August 2009 Full text Cite

Fostering accountable health care: moving forward in medicare.

Journal Article Health affairs (Project Hope) · March 2009 To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measur ... Full text Cite

Mark McClellan, MD, PhD addressing the quality challenge.

Journal Article Healthcare financial management : journal of the Healthcare Financial Management Association · February 2008 Cite

I. impact of the age wave and chronic disease in the next generation

Conference Disease Management · December 1, 2007 Cite

Satisfaction guaranteed--"payment by results" for biologic agents.

Journal Article The New England journal of medicine · October 2007 Full text Cite

Money no excuse for hampering progress. Interview by Rebecca Allmark.

Journal Article The Health service journal · July 2007 Cite

Achieving value-driven health care.

Journal Article AHIP Coverage · July 2007 Cite

Drug safety reform at the FDA--pendulum swing or systematic improvement?

Journal Article The New England journal of medicine · April 2007 Full text Cite

The first months of the prescription-drug benefit--a CMS update.

Journal Article The New England journal of medicine · June 2006 Full text Cite

International differences in patient and physician perceptions of "high quality" healthcare: a model from pediatric cardiology.

Journal Article The American journal of cardiology · April 2006 Although the quality of health care would logically seem to be a universal concept, this study hypothesized that physicians and their patients could differ in their perceptions of "high-quality care" and that those beliefs might vary by country. Such a mis ... Full text Cite

The incidence of Medicare

Journal Article Journal of Public Economics · January 1, 2006 The Medicare program transfers nearly $300 billion annually from taxpayers to beneficiaries. This paper considers the incidence of such transfers in the context of a life cycle model with uncertainty about future health care expenditures. We find the distr ... Full text Cite

A prescription for a modern Medicare program.

Journal Article The New England journal of medicine · December 2005 Full text Cite

Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients.

Journal Article Circulation · October 2005 BackgroundAfrican Americans are more likely to be seen by physicians with less clinical training or to be treated at hospitals with longer average times to acute reperfusion therapies. Less is known about differences in health outcomes. This repor ... Full text Cite

The challenge of implementing the new Medicare drug benefit while updating physicians' pay.

Journal Article Bulletin of the American College of Surgeons · September 2005 Cite

Implantable cardioverter-defibrillators.

Journal Article N Engl J Med · May 12, 2005 Link to item Cite

Medicare Part D: opportunities and challenges for pharmacy.

Journal Article Journal of the American Pharmacists Association : JAPhA · May 2005 Full text Cite

Medicare coverage of ICDs.

Journal Article The New England journal of medicine · January 2005 Full text Cite

Detecting Medicare abuse.

Journal Article Journal of health economics · January 2005 This paper identifies which types of patients and hospitals have abusive Medicare billings that are responsive to law enforcement. For a 20% random sample of elderly Medicare beneficiaries hospitalized from 1994 to 1998 with one or more of six illnesses th ... Full text Cite

Use of outcomes research in assuring patient safety and quality care, second plenary session, ISPOR 8th annual international meeting, Arlington, VA, USA.

Journal Article Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · September 2004 Full text Cite

Think globally, protect locally: a conversation with Mark McClellan.

Journal Article Health affairs (Project Hope) · May 2004 Departing Food and Drug Administration (FDA) Commissioner Mark McClellan outlines the major initiatives of his sixteen-month tenure at the agency, including an expanded role for economic analysis in FDA policy, steps to promote "e-prescribing" and other in ... Full text Cite

Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life.

Journal Article Health services research · April 2004 ObjectiveAlthough an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportiona ... Full text Cite

The costs of decedents in the Medicare program: implications for payments to Medicare + Choice plans.

Journal Article Health services research · February 2004 ObjectiveTo discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life- ... Full text Cite

FDA: protecting and advancing America's health.

Journal Article Health matrix (Cleveland, Ohio : 1991) · January 2004 Cite

Advance directives and medical treatment at the end of life.

Journal Article Journal of health economics · January 2004 To assess the consequences of advance medical directives--which explicitly specify a patient's preferences for one or more specific types of medical treatment in the event of a loss of competence--we analyze the medical care of elderly Medicare beneficiari ... Full text Cite

Fifth Annual David A. Winston Lecture.

Journal Article The Journal of health administration education · January 1, 2004 Cite

Medicare's new drug discount card.

Journal Article Hospital outlook · January 1, 2004 Cite

Interview with Mark McClellan, MD, PhD

Journal Article Virtual Mentor · January 1, 2004 Full text Cite

Reducing uninsurance through the nongroup market: Health insurance credits and purchasing groups

Journal Article Health Affairs · December 1, 2003 The president's proposal to introduce tax credits for the purchase of health insurance will enable millions of Americans to purchase private health insurance, improving the functioning of private markets, empowering patients to make informed decisions, and ... Cite

Cardiac procedure use and outcomes in elderly patients with acute myocardial infarction in the United States and Quebec, Canada, 1988 to 1994.

Journal Article Medical care · July 2003 BackgroundStudies from the early 1990s have documented greater intensity of treatment for patients with acute myocardial infarction (AMI) in the United States compared with Canada, with little difference in health outcomes. Little is known about w ... Full text Cite

Is more information better? The effects of "Report Cards" on health care providers

Journal Article Journal of Political Economy · June 1, 2003 Health care report cards-public disclosure of patient health outcomes at the level of the individual physician or hospital or both-may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals ince ... Full text Cite

Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules.

Journal Article Ann Intern Med · May 6, 2003 BACKGROUND: Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is a potentially useful but expensive test to diagnose solitary pulmonary nodules. OBJECTIVE: To evaluate the cost-effectiveness of strategies for pulmonary nodule diagnosis an ... Full text Link to item Cite

Remarks of the Commissioner of Food and Drugs.

Conference Food and drug law journal · January 2003 Cite

Ensuring safe and effective medical devices.

Journal Article The New England journal of medicine · January 2003 Full text Cite

How liability law affects medical productivity.

Journal Article Journal of health economics · November 2002 Previous research suggests that "direct" reforms to the liability system-reforms designed to reduce the level of compensation to potential claimants-reduce medical expenditures without important consequences for patient health outcomes. We extend this rese ... Full text Cite

From the Food and Drug Administration.

Journal Article JAMA · November 2002 Full text Cite

Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients.

Journal Article Annals of internal medicine · October 2002 BackgroundPatients with end-stage renal disease are known to have decreased survival after myocardial infarction, but the association of less severe renal dysfunction with survival after myocardial infarction is unknown.ObjectivesTo deter ... Full text Cite

Managed care, hospice use, site of death, and medical expenditures in the last year of life.

Journal Article Archives of internal medicine · August 2002 BackgroundWe examined deaths of Medicare beneficiaries in Massachusetts and California to evaluate the effect of managed care on the use of hospice and site of death and to determine how hospice affects the expenditures for the last year of life.< ... Full text Cite

Racial and sex differences in refusal of coronary angiography.

Journal Article The American journal of medicine · August 2002 PurposeTo determine the effect of patient refusal on racial and sex differences in the use of coronary angiography and in outcomes among elderly patients with acute myocardial infarction.Subjects and methodsWe included Medicare beneficiar ... Full text Cite

Reducing uninsurance through the nongroup market: health insurance credits and purchasing groups.

Journal Article Health affairs (Project Hope) · July 2002 The president's proposal to introduce tax credits for the purchase of health insurance will enable millions of Americans to purchase private health insurance, improving the functioning of private markets, empowering patients to make informed decisions, and ... Full text Cite

Malpractice law and health care reform: Optimal liability policy in an era of managed care

Journal Article Journal of Public Economics · May 14, 2002 Because fee-for-service health insurance insulates providers from the costs of treatment decisions, it may lead to "defensive medicine" - precautionary treatment with minimal expected medical benefit administered out of fear of legal liability. By giving p ... Full text Cite

Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among medicare beneficiaries.

Journal Article The American journal of medicine · May 2002 PurposeThe implantable cardioverter defibrillator has been assessed in randomized trials, but the generalizability of trial results to broader clinical settings is unclear. Our purpose was to evaluate the outcomes and costs of defibrillator use in ... Full text Cite

The relation between managed care market share and the treatment of elderly fee-for-service patients with myocardial infarction.

Journal Article The American journal of medicine · February 2002 PurposeTo determine if greater managed care market share is associated with greater use of recommended therapies for fee-for-service patients with acute myocardial infarction.Subjects and methodsWe examined the care of 112,900 fee-for-ser ... Full text Cite

Trends in hospital treatment of ventricular arrhythmias among Medicare beneficiaries, 1985 to 1995

Journal Article American Heart Journal · January 1, 2002 Background. Treatment options for patients with ventricular arrhythmias have undergone major changes in the last 2 decades. Trends in use of invasive procedures, clinical outcomes, and expenditures have not been well documented. Methods. We used administra ... Full text Cite

The effects of hospital ownership on medical productivity.

Conference The Rand journal of economics · January 2002 To develop new evidence on how hospital ownership and other aspects of hospital market composition affect health care productivity, we analyze longitudinal data on the medical expenditures and health outcomes of the vast majority of nonrural elderly Medica ... Full text Cite

Utilization and outcomes of the implantable cardioverter defibrillator, 1987 to 1995

Journal Article American Heart Journal · January 1, 2002 Background. The patterns of adoption of the implantable cardioverter defibrillator (ICD) and the outcomes of its use have not been well documented in general, unselected populations. The purpose of this study was to document the impact of the ICD in widesp ... Full text Cite

Is technological change in medicine worth it?

Journal Article Health affairs (Project Hope) · September 2001 Medical technology is valuable if the benefits of medical advances exceed the costs. We analyze technological change in five conditions to determine if this is so. In four of the conditions--heart attacks, low-birthweight infants, depression, and cataracts ... Full text Cite

Technological change around the world: evidence from heart attack care.

Journal Article Health affairs (Project Hope) · May 2001 Although technological change is a hallmark of health care worldwide, relatively little evidence exists on whether changes in health care differ across the very different health care systems of developed countries. We present new comparative evidence on he ... Full text Cite

Comparison of the effects of angiotensin converting-enzyme inhibitors and beta blockers on survival in elderly patients with reduced left ventricular function after myocardial infarction.

Journal Article The American journal of medicine · April 2001 PurposeAngiotensin converting-enzyme (ACE) inhibitors decrease mortality after myocardial infarction among patients with depressed left ventricular function. Beta blockers may also improve survival in these patients. We compared the relative effec ... Full text Cite

Trends in treatment and outcomes for acute myocardial infarction: 1975-1995.

Journal Article The American journal of medicine · February 2001 PurposeTo review the trends in treatment and survival for patients with acute myocardial infarction over the last 20 years.Material and methodsStudies were identified through MEDLINE searches and review of study bibliographies. Additional ... Full text Cite

Productivity change in health care

Journal Article American Economic Review · January 1, 2001 Full text Cite

Managed care, health care quality, and regulation

Journal Article Journal of Legal Studies · January 1, 2001 The growth of managed care has prompted numerous questions about its effect on the quality of health care. This paper reviews evidence on the effects of managed care on quality. Most comparisons of care for patients in different plans within similar market ... Full text Cite

Does physician specialty affect the survival of elderly patients with myocardial infarction?

Journal Article Health services research · December 2000 ObjectiveTo determine the effect of treatment by a cardiologist on mortality of elderly patients with acute myocardial infarction (AMI, heart attack), accounting for both measured confounding using risk-adjustment techniques and residual unmeasure ... Cite

Overview of the special supplement issue.

Journal Article Health services research · December 2000 Cite

Are we inhibited? Renal insufficiency should not preclude the use of ACE inhibitors for patients with myocardial infarction and depressed left ventricular function.

Journal Article Archives of internal medicine · September 2000 ContextAngiotensin-converting enzyme (ACE) inhibitors have been shown to decrease mortality in patients with myocardial infarction and depressed left ventricular function, but physicians may be reluctant to prescribe ACE inhibitors to patients wit ... Full text Cite

Designing a Medicare prescription drug benefit: issues, obstacles, and opportunities.

Journal Article Health affairs (Project Hope) · March 2000 We review the policy concerns underlying some of the most contentious issues that must be resolved prior to the enactment of a Medicare drug benefit. We consider critical issues both in benefit design-targeted versus universal eligibility, benefit subsidie ... Full text Cite

Is hospital competition socially wasteful?

Journal Article Quarterly Journal of Economics · January 1, 2000 We study the consequences of hospital competition for Medicare beneficiaries' heart attack care from 1985 to 1994. We examine how relatively exogenous determinants of hospital choice such as travel distances influence the competitiveness of hospital market ... Full text Cite

Medicare reform: fundamental problems, incremental steps.

Journal Article The journal of economic perspectives : a journal of the American Economic Association · January 2000 This paper presents an overview of the Medicare reform debate. I begin by reviewing some of the features of Medicare and then turn to a discussion of reforms, both on the benefits side and on the financing side of the program. The reform proposals raise di ... Full text Cite

The marginal benefits of invasive treatments for acute myocardial infarction: does insurance coverage matter?

Journal Article Inquiry : a journal of medical care organization, provision and financing · January 2000 This paper applies instrumental variable (IV) techniques and estimates the average benefits of invasive surgical treatments for marginal acute myocardial infarction (AMI) patients by insurance coverage. The study uses data from the Agency for Healthcare Re ... Cite

How does managed care do it?

Journal Article The Rand journal of economics · January 2000 Integrating the health services and insurance industries, as health maintenance organizations (HMOs) do, could lower expenditure by reducing either the quantity of services or unit price or both. We compare the treatment of heart disease in HMOs and tradit ... Full text Cite

Spending growth rates: are the differences real?

Journal Article Health affairs (Project Hope) · November 1999 Full text Cite

Medicare reform: who pays and who benefits?

Journal Article Health affairs (Project Hope) · January 1999 As Medicare's share of federal spending and gross domestic product (GDP) rises, the program may have increasingly important consequences not only for the health of Americans but also for their net income and financial well-being. We use incidence analysis ... Full text Cite

Risks and costs of end-stage renal disease after heart transplantation.

Journal Article Transplantation · December 1998 ObjectivesTo estimate the risks and costs of end-stage renal disease (ESRD) after heart transplantation.BackgroundPrevious studies have shown high rates of ESRD among solid-organ transplant patients, but the relevance of these studies for ... Full text Cite

Technological Change in Heart-Disease Treatment: Does High Tech Mean Low Value?

Journal Article American Economic Review · May 1, 1998 Cite

What Has Increased Medical-Care Spending Bought?

Journal Article American Economic Review · May 1, 1998 Cite

Econometrics in outcomes research: the use of instrumental variables.

Journal Article Annual review of public health · January 1998 We describe an econometric technique, instrumental variables, that can be useful in estimating the effectiveness of clinical treatments in situations when a controlled trial has not or cannot be done. This technique relies upon the existence of one or more ... Full text Cite

Are medical prices declining? Evidence from heart attack treatments

Journal Article Quarterly Journal of Economics · January 1, 1998 We address long-standing problems in measuring medical inflation by estimating two types of price indices. The first, a Service Price Index, prices specific medical services, as does the current CPI. The second, a Cost of Living Index, measures a quality-a ... Full text Cite

The marginal cost-effectiveness of medical technology: A panel instrumental-variables approach

Journal Article Journal of Econometrics · January 1, 1997 We use panel instrumental variables techniques to estimate incremental mortality and cost effects of intensive procedures for treating heart attacks among the elderly. We identify incremental effects by comparing trends in procedure use, hospital costs, an ... Full text Cite

Hospital reimbursement incentives: An empirical analysis

Journal Article Journal of Economics and Management Strategy · January 1, 1997 Reimbursement systems for health-care providers are very complex, like the production systems that they regulate. This complexity has led to some important misperceptions about the incentive consequences of major reimbursement reforms. One example is the p ... Full text Cite

Are the returns to technological change in health care declining?

Journal Article Proceedings of the National Academy of Sciences of the United States of America · November 1996 Whether the U.S. health care system supports too much technological change-so that new technologies of low value are adopted, or worthwhile technologies become overused-is a controversial question. This paper analyzes the marginal value of technological ch ... Full text Cite

Do doctors practice defensive medicine?

Journal Article Quarterly Journal of Economics · January 1, 1996 "Defensive medicine" is a potentially serious social problem: if fear of liability drives health care providers to administer treatments that do not have worthwhile medical benefits, then the current liability system may generate inefficiencies much larger ... Full text Cite

Uncertainty, health-care technologies, and health-care choices.

Journal Article The American economic review · May 1995 Cite

Catheterization and Mortality in Elderly Patients With Acute Myocardial Infarction-Reply

Journal Article JAMA: The Journal of the American Medical Association · January 1, 1995 We used empirical data on treatments and outcomes of elderly AMI patients to estimate the mortality consequences of the additional catheterization and revascularization procedures performed by the most intensive hospitals relative to other hospitals. In co ... Full text Cite

The uncertain demand for medical care a comment on Emmett Keeler

Journal Article Journal of Health Economics · January 1, 1995 Full text Cite

Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables.

Journal Article JAMA · September 1994 ObjectiveTo determine the effect of more intensive treatments on mortality in elderly patients with acute myocardial infarction (AMI).DesignAnalysis of incremental treatment effects using differential distances as instrumental variables t ... Full text Cite

Appropriateness of care. A comparison of global and outcome methods to set standards.

Journal Article Medical care · July 1992 The RAND-UCLA Health Services Utilization Study previously analyzed the appropriateness of use of carotid endarterectomy based on a literature review and global expert judgments. In this study, for 45 of the same clinical indications used in the RAND-UCLA ... Cite