The document discusses the "Triple Aim" of improving the U.S. healthcare system by simultaneously pursuing three goals: improving individual care experiences, improving population health outcomes, and reducing per capita healthcare costs. It argues that achieving the Triple Aim requires identifying a specific population, establishing constraints like universal coverage, and designating an "integrator" organization responsible for coordinating care across settings to achieve all three goals. The integrator's key functions include engaging patients, redesigning primary care, managing population health, and integrating different parts of the healthcare system.
Reinventing How Health Systems Manage Revenue and Can Improve the Economics o...revenuecyclem
Learn how healthcare organizations need to go beyond simply improving current revenue cycle management processes to create a brighter financial future.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Reinventing How Health Systems Manage Revenue and Can Improve the Economics o...revenuecyclem
Learn how healthcare organizations need to go beyond simply improving current revenue cycle management processes to create a brighter financial future.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
An Investigation of the Factors Affecting Capitation Programme in Provision ...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
The Economics Of Language Services In Healthcare FinalDouglas Green
The initial presentation of the Economics of Language Access. For an updated version with new research please do not hesitate to contact Douglas Green through the website. Thank you.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Our biggest problem in healthcare is efficiency (quality of care per dollar spent) and Obamacare doesn't solve it. Our spending is off the charts by any measure (growth over time, % of GDP, per capita) Consumerism as a force of change in Healthcare is just getting started, but there are many barriers in place that serve to protect existing stakeholders in the industry. Knocking down these barriers to competition is what the GOP should be focusing on, but it's not. "Repeal and replace" seems to be a slogan, not a plan. Do Republican lawmakers have the will to make changes that might upset entrenched players?
MRC/info4africa KZN Community Forum | July 2013info4africa
This special forum took place after the 2013 SA AIDS Conference and reflected upon the important goal of "Getting to Zero with HIV Prevention and Treatment Interventions". This vibrant and enlightening panel discussion included Prof Quarraisha Abdool Karim – Associate Scientific Director – Centre for the AIDS Programme of Research in South Africa (CAPRISA); Prof Hoosen Coovadia – Director – Maternal, Adolescent and Child Health (MATCH) and Dr Heidi Van Rooyen – Research Director – Social, Behavioural and Biomedical Interventions Unit – Human Sciences Research Council (HSRC).
An Investigation of the Factors Affecting Capitation Programme in Provision ...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
The Economics Of Language Services In Healthcare FinalDouglas Green
The initial presentation of the Economics of Language Access. For an updated version with new research please do not hesitate to contact Douglas Green through the website. Thank you.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Our biggest problem in healthcare is efficiency (quality of care per dollar spent) and Obamacare doesn't solve it. Our spending is off the charts by any measure (growth over time, % of GDP, per capita) Consumerism as a force of change in Healthcare is just getting started, but there are many barriers in place that serve to protect existing stakeholders in the industry. Knocking down these barriers to competition is what the GOP should be focusing on, but it's not. "Repeal and replace" seems to be a slogan, not a plan. Do Republican lawmakers have the will to make changes that might upset entrenched players?
MRC/info4africa KZN Community Forum | July 2013info4africa
This special forum took place after the 2013 SA AIDS Conference and reflected upon the important goal of "Getting to Zero with HIV Prevention and Treatment Interventions". This vibrant and enlightening panel discussion included Prof Quarraisha Abdool Karim – Associate Scientific Director – Centre for the AIDS Programme of Research in South Africa (CAPRISA); Prof Hoosen Coovadia – Director – Maternal, Adolescent and Child Health (MATCH) and Dr Heidi Van Rooyen – Research Director – Social, Behavioural and Biomedical Interventions Unit – Human Sciences Research Council (HSRC).
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
Lean Healthcare: 6 Methodologies for Improvement from Dr. Brent JamesHealth Catalyst
The survival of healthcare organizations depends on applying lean principles. Organizations that adopt lean principles can reduce waste while improving the quality of care. By applying stringent clinical data measurement approaches to routine care delivery, healthcare systems identify best practice protocols and incorporate those into the clinical workflow. Data from these best practices are applied through continuous-learning loop that enables teams across the organization to update and improve protocols–ultimately reducing waste, lowering costs, and improving access to care.
This executive report based on a presentation by Dr. Brent James at a regional medical center, covers the following:
1. How lean healthcare principles can help improve the quality of care.
2. The steps healthcare organizations need to take to create a continuous-learning loop.
3. How a lean approach creates financial leverage by eliminating waste and improving net operating margins and ROI.
Read Logica’s paper on the need for convergence of healthcare and pharmaCGI
As the biggest industry sector in most European economies, healthcare is already given a big chunk of the gross domestic product (GDP). This portion is expected to become even bigger and have a huge impact on employment, the opportunities to grow businesses and economies in general.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
Essay On Health Care Reform
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CHAPter3ConneCting tHe strAtegiC Dots Does Hit mAt.docxtiffanyd4
CHAPter
3
ConneCting tHe strAtegiC Dots:
Does Hit mAtter?
learning objectives
1. List and define five major challenges facing healthcare delivery systems
today.
2. Describe the complexity of these interrelated challenges for healthcare
and healthcare information technology.
3. Illustrate the history, development, and current state of healthcare
information systems.
4. Name and describe the four categories of healthcare information
systems.
5. Analyze the key priorities of healthcare information systems today that
will affect their future.
Healthcare information technology: the future is now
Healthcare delivery continues to be an information-intensive set of processes.
A series of Institute of Medicine (IOM 1999, 2001) studies suggests that
high-quality patient care relies on careful documentation of each patient’s
medical history, health status, current medical conditions, and treatment
plans. Financial information is essential for strategic planning and efficient
operational support of the patient care process. Management of healthcare
organizations requires reliable, accurate, current, secure, and relevant clini-
cal and administrative information. A strong argument can be made that the
healthcare field is one of the most information-intensive sectors of the US
economy.
Information technology has advanced to a high level of sophistication.
However, technology can only provide tools to aid in the accomplishment
of a wider set of organizational goals. Analysis of information requirements
in the broader organizational context should always take precedence over a
rush to computerize. Information technology by itself is not the answer to
management problems; technology must be part of a broader restructuring
of the organization, including reengineering of business processes. Alignment
1
Glandon-Proof.indb 3 6/10/13 11:40 AM
I n f o r m a t i o n S y s t e m s f o r H e a l t h c a r e M a n a g e m e n t4
of information technology strategy with management goals of the healthcare
organization is essential. Despite these cautions, effective design, implemen-
tation, and management of healthcare information technology (HIT) show
great promise (De Angelo 2000; Glaser and Garets 2005; Kaushal, Barker,
and Bates 2001; Smaltz et al. 2005a).
An essential element in a successful information systems implementa-
tion is carefully planned teamwork by clinicians, managers, and technical
systems specialists. Information systems developed in isolation by technicians
may be technically pure and elegant in design, but rarely will they pass the
test of reality in meeting organizational requirements. On the other hand,
very few managers and clinicians possess the equally important technical
knowledge and skills of systems analysis and design, and the amateur analyst
cannot hope to avoid the havoc that can result from a poorly designed sys-
tem. A balanced effort is required: Operational personnel contribut.
CHAPter3ConneCting tHe strAtegiC Dots Does Hit mAt.docxmccormicknadine86
CHAPter
3
ConneCting tHe strAtegiC Dots:
Does Hit mAtter?
learning objectives
1. List and define five major challenges facing healthcare delivery systems
today.
2. Describe the complexity of these interrelated challenges for healthcare
and healthcare information technology.
3. Illustrate the history, development, and current state of healthcare
information systems.
4. Name and describe the four categories of healthcare information
systems.
5. Analyze the key priorities of healthcare information systems today that
will affect their future.
Healthcare information technology: the future is now
Healthcare delivery continues to be an information-intensive set of processes.
A series of Institute of Medicine (IOM 1999, 2001) studies suggests that
high-quality patient care relies on careful documentation of each patient’s
medical history, health status, current medical conditions, and treatment
plans. Financial information is essential for strategic planning and efficient
operational support of the patient care process. Management of healthcare
organizations requires reliable, accurate, current, secure, and relevant clini-
cal and administrative information. A strong argument can be made that the
healthcare field is one of the most information-intensive sectors of the US
economy.
Information technology has advanced to a high level of sophistication.
However, technology can only provide tools to aid in the accomplishment
of a wider set of organizational goals. Analysis of information requirements
in the broader organizational context should always take precedence over a
rush to computerize. Information technology by itself is not the answer to
management problems; technology must be part of a broader restructuring
of the organization, including reengineering of business processes. Alignment
1
Glandon-Proof.indb 3 6/10/13 11:40 AM
I n f o r m a t i o n S y s t e m s f o r H e a l t h c a r e M a n a g e m e n t4
of information technology strategy with management goals of the healthcare
organization is essential. Despite these cautions, effective design, implemen-
tation, and management of healthcare information technology (HIT) show
great promise (De Angelo 2000; Glaser and Garets 2005; Kaushal, Barker,
and Bates 2001; Smaltz et al. 2005a).
An essential element in a successful information systems implementa-
tion is carefully planned teamwork by clinicians, managers, and technical
systems specialists. Information systems developed in isolation by technicians
may be technically pure and elegant in design, but rarely will they pass the
test of reality in meeting organizational requirements. On the other hand,
very few managers and clinicians possess the equally important technical
knowledge and skills of systems analysis and design, and the amateur analyst
cannot hope to avoid the havoc that can result from a poorly designed sys-
tem. A balanced effort is required: Operational personnel contribut ...
Chapter 9 Comprehensive BenefitsAnother important measure of heJinElias52
Chapter 9
"Comprehensive BenefitsAnother important measure of health care systems is whether they offer all of theessential services individuals need. The difficulty lies in defining what is essential.Although all observers would agree that comprehensive health care must includecoverage forprimary care, agreement breaks down quickly when we begindiscussing specialty care. Some individuals, for example, consider coronary bypasssurgery an essential service, but others consider it an overpriced and overhypedluxury. Similarly, some favor offering only procedures necessary to keep patientsalive, but others support offering procedures or technologies such as hip replace-ment surgery, home health care, hearing aids, or dental care, which improvequality of life but don’t extend life.Any system that does not provide comprehensive benefits runs the risk ofdevolving into a two-class system in which some individuals can buy more carethan others can. To those who believe health care is a human right, such a sys-tem seems unethical. Others object to such systems on economic grounds, argu-ing that it costs less in the long run to plan on providing care for everyone thanto haphazardly shift costs to the general public when individuals who can’t affordcare eventually seek care anyway.AffordabilityGuaranteeingaccessto health care does not help those who can’t afford topur-chaseit. Consequently, we also must evaluate health care systems according towhether they make health care coverage affordable, restraining the costs notonly of insurance premiums but also ofco-payments, deductibles, and othercrucial services such as prescription drugs and long-term care. Although the ACAoffers some subsidies and tax credits to help people pay their premiums, it stillleaves millions with many bills for these latter costs.For health care to be affordable, individual costs must reflect individualincomes. As noted earlier, most insured Americans receive their insurancethrough employers. Typically, employers pay part of the cost for that insuranceand deduct the rest from each employee’s wages. Because low- and high-wageworkers have their salaries reduced by the same dollar amount, low-wage work-ers are effectively hit harder: Paying $3,000 per year for health insurance might,for example, force a wealthier worker to scale back his vacation plans but force apoorer worker to put off fixing his roof. For this reason, the US system is con-sideredfinancially regressivein that poorer people must pay a higher percent-age of their income than do wealthier people. In contrast, in countries such asGreat Britain and Canada, health coverage is paid for through graduated in-come taxes. Poorer persons pay alowerpercentage of their income for taxesand therefore for health care than do wealthier persons, creating afinanciallyprogressivesystem. Either way—whether through taxes or lowered wages—the nation’s citizens pay all the costs of health care" "Financial EfficiencyAnother critical measure of ...
Due Tomorrow At 100 PMDiscussion Board #6HCA 340Discu.docxsleeperharwell
Due Tomorrow At 1:00 PM
Discussion Board #6
HCA 340
Discussion Board Assignment #6
Chapter 7--The Health Care Workforce and Chapter 8—Financing Health
Answer the following questions on Health Care Workforce/Personnel:
The majority of schools of medicine, dentistry, nursing, and other professions and their teaching hospitals are heavily subsidized by federal and state funds. Many of those graduates, when they become health practitioners, feel no obligation to society for their publicly supported education. Do health care providers who reap the benefits of high compensation and social position have an ethical responsibility to repay taxpayers by meeting the needs of the medically underserved?
Technical advances in health care have spawned an ever-increasing number of specialty- trained personnel. More recently, however, hospitals and other institutions are promoting the cross-training of personnel so that they can perform multiple tasks and work more flexibly, based on institution needs. What are the implications of cross training, in terms of quality of care, costs, and efficiency?
Men comprise a small segment of the nurse population, although their numbers are increasing. Given the good income potential of the nursing profession and continuing demand, what is your opinion about why nursing does not attract more males?
Answer the following questions on Health Care Financing:
Name one (1) way each of the following has affected the costs of health care in the US?
The health insurance industry
Advances in medical care technology
Changes in U.S. demographics
Government support for health care
Consumer expectations
If we accept the premises that resources available to meet the costs of health care are finite, and that continuing to increase dollars allocated for health care expenses carries “opportunity costs“ for the nation and society, discuss your position on the following: As a national policy should we allocate a set level of resources and apply them to achieving “the greatest good for the greatest number” (necessarily leaving some out) OR should we adopt the individualist approach of “those who can pay get, those who can’t pay, don’t?”
From the patient perspective, what might be some of the positive and negative aspects of “disease management programs?”
.
The value of health to an economy is hard to quantify, but its importance is undeniable. A population’s health plays a key role in economic progress, and in coming years healthcare will be a key area of focus for policymakers, payers,providers and the public alike. Financing the future: Choices and challenges in global health studies the role of healthcare against a backdrop of changing demographic patterns, rising healthcare costs and technological innovation.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Q uali ty & Acco untabi li ty
cost burden, the United States is the only industrialized nation that does not guar-
antee universal health insurance to its citizens. We claim we cannot afford it.
n Care improvement efforts. Most recent efforts to improve the quality of
health care have aimed to reduce defects in the care of patients at a single site of care
in all six dimensions identified by the Institute of Medicine (IOM): safety, effective-
ness, patient-centeredness, timeliness, efficiency, and equity.5 Slow progress in each
of these is occurring, as measurements, incentives, knowledge, will, and experi-
ments come increasingly into alignment. However, the task of improving individu-
als’ care is hardly completed. In the wave of projects on “pay-for-performance” (P4P)
and public reporting, policymakers, payers, and health care leaders are still strug-
gling to make highly reliable and safe health care a norm rather than an exception.6
Moreover, too few improvement efforts address defects in care across the contin-
uum, such as those that plague patients with CHF.
Defining The “Triple Aim”
Work to improve site-specific care for individuals should expand and thrive. In
our view, however, the United States will not achieve high-value health care un-
less improvement initiatives pursue a broader system of linked goals. In the aggre-
gate, we call those goals the “Triple Aim”: improving the individual experience of
care; improving the health of populations; and reducing the per capita costs of care
for populations.
n Interdependent goals. The components of the Triple Aim are not independ-
ent of each other. Changes pursuing any one goal can affect the other two, sometimes
negatively and sometimes positively. For example, improving care for individuals
can raise costs if the improvements are associated with new, effective, but costly
technologies or drugs. Conversely, eliminating overuse or misuse of therapies or di-
agnostic tests can lead to both reduced costs and improved outcomes. The situation
is made more complex by time delays among the effects of changes. Good preventive
care may take years to yield returns in cost or population health.
n An exercise in balance. Pursuit of the Triple Aim is an exercise in balance
and will be subject to specified policy constraints, such as decisions about how
much to spend on health care or what coverage to provide and to whom. The most
important of all such constraints, we believe, should be the promise of equity; the
gain in health in one subpopulation ought not to be achieved at the expense of an-
other subpopulation. But that decision lies in the realms of ethics and policy; it is not
technically inherent in the Triple Aim.
A health system capable of continual improvement on all three aims, under
whatever constraints policy creates, looks quite different from one designed for
the first aim only. The balanced pursuit of the Triple Aim is not congruent with
the current business models of any but a tiny number of U.S. health care organiza-
tions. For most, only one, or possibly two, of the dimensions is strategic, but not
all three. Thus, we face a paradox with respect to pursuit of the Triple Aim. From
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3. Tr i p l e Ai m
“The Holy Grail of universal coverage may remain out of reach
unless we can reduce per capita costs.”
the viewpoint of the United States as a whole, it is essential; yet from the view-
point of individual actors responding to current market forces, pursuing the three
aims at once is not in their immediate self-interest.
Take hospitals as an example. Under current market dynamics and payment in-
centives, it is entirely rational for hospitals to try to fill beds and to expand ser-
vices even though the work of Elliott Fisher and John Wennberg strongly predicts
the net effect to be much higher cost and no higher quality.7 Most hospitals seem
to believe that they can protect profits best by protecting and increasing revenues.
Higher efficiency in local production can help, too, but systemic efficiencies that
reduce revenues or admission rates are threats to profit. The same payment dy-
namics often lead hospitals to focus only on care within their walls, viewing CHF
readmissions, for example, as indicating defects outside the hospital, not as their
responsibility to avert.
n A “tragedy of the commons.” Rational common interests and rational indi-
vidual interests are in conflict. Our failure as a nation to pursue the Triple Aim
meets the criteria for what Garrett Harden called a “tragedy of the commons.”8 As in
all tragedies of the commons, the great task in policy is not to claim that stake-
holders are acting irrationally, but rather to change what is rational for them to do.
The stakes are high. Indeed, the Holy Grail of universal coverage in the United States
may remain out of reach unless, through rational collective action overriding some
individual self-interest, we can reduce per capita costs.
n Obstacles to pursuit of the Triple Aim. The changes we would need to mobi-
lize pursuit of the Triple Aim are large, and the obstacles are daunting. Among the
biggest barriers are supply-driven demand; new technologies including many with
limited impact on outcomes; physician-centric care; little or no foreign competition
to spur domestic change, as it does in manufacturing; and too little appreciation of
system knowledge among clinicians and organizations, leading them to subopti-
mize the components of the system with which they are most familiar, at the ex-
pense of the whole.
n Promising innovations. Despite these obstacles, a handful of innovators are
starting to challenge the U.S. health care market. These disruptive innovations are
by no means yet mainstream, but the examples align surprisingly well with the
objectives of the Triple Aim. For example, innovations in primary care such as the
medical home, as well as “Minute Clinics” and other retail health care providers are
challenging the prevailing approach to primary care.9 Experiments in telecommuni-
cations are offering care that is no longer location-specific.10 One form of foreign
competition—“medical tourism”—is beginning to catch on. Also, a few hospitals,
such as Virginia Mason Medical Center, Denver Health, and ThedaCare, are learning
H E A L T H A F F A I R S ~ Vo l u m e 2 7 , N u m b e r 3 761
4. Q uali ty & Acco untabi li ty
to use systems knowledge to reduce costs and improve profit, such as by adapting
“lean production” to health care.11
n Measuring health care quality. In general, opacity of performance is not a
major obstacle to the Triple Aim. Many tools are in hand to construct part of a bal-
anced portfolio of measures to track the experience of a population on all three com-
ponents. At the Institute for Healthcare Improvement (IHI), for example, we have
developed and are using a balanced set of systemwide measures closely related to the
Triple Aim.12 A more complete set of system metrics would include ways to track the
experience of care in ambulatory settings, including patient engagement, continuity,
and clinical preventive practices.
n Measuring costs and health status. Measuring per capita costs is still a big
challenge; it requires that we capture all relevant expenditures, index them appro-
priately to local market circumstances, and be able to measure actual costs in a care
system whose current methods of pricing and discounting obscure them. Popula-
tion health measures would require some form of registration or sampling for de-
fined populations and would be speeded by widespread implementation of elec-
tronic health record systems. Citing one serious gap, the IOM recently concluded
that measures of both cost and care across the continuum, impeded by the fragmen-
tation of delivery itself, still need much more developmental work.
Preconditions For Pursuit Of The Triple Aim
Despite the social need and the feasibility of measurement, actual pursuit of the
Triple Aim remains the exception. What would be the preconditions for changing
that?
We suggest that three inescapable design constraints underlie effective accom-
plishment of the Triple Aim: (1) recognition of a population as the unit of concern,
(2) externally supplied policy constraints (such as a total budget limit or the re-
quirement that all subgroups be treated equitably), and (3) existence of an “inte-
grator” able to focus and coordinate services to help the population on all three
dimensions at once.
n Specifying a population of concern. A “population” need not be geographic.
What best defines a population, as we use the term, is probably the concept of enroll-
ment. (This is different from the prevailing meaning of the word enrollment in U.S.
health care today, which denotes a financial transaction, not a commitment to a
healing relationship.) A registry that tracks a defined group of people over time
would create a “population” for the purposes of the Triple Aim. Other examples of
populations are “all of the diabetics in Massachusetts,” “people in Maryland below
300 percent of poverty,” “members of Group Health Cooperative of Puget Sound,”
“the citizens of a county,” or even “all of the people who say that Dr. Jones is their
doctor.” Only when the population is specified does it become, in principle, possible
to know about its experiences of care, its health status, and the per capita costs of
caring for it. Under current conditions, such registries are rare in the United States,
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5. Tr i p l e Ai m
especially for geographically defined populations. Creating them will require re-
search, development, and investment.
n Policy constraints. The policy constraints that shape the balance sought
among the three aims are not automatic or inherent in the idea. Rather, they derive
from the processes of decision making, politics, and social contracting relevant to
the population involved. For example, a nation or state might or might not decide
that “universal coverage” is mandatory; a community in a town meeting or an em-
ployer in negotiation with a labor union might or might not decide to spend no more
than x dollars per capita or y dollars per year on health care. Logically—that is,
mathematically—optimizing on three aims at once requires constraints on at least
two of them.
n Integrator. An “integrator” is an entity that accepts responsibility for all three
components of the Triple Aim for a specified population. Importantly, by definition,
an integrator cannot exclude members or subgroups of the population for which it is
responsible. The simplest such form, such as Kaiser Permanente, has fully integrated
financing and either full ownership of or exclusive relationships with delivery struc-
tures, and it is able to use those structures to good advantage. We believe, however,
that other models can also take on a strong integrator role, even without unified fi-
nancing or a single delivery system. That role might be within the reach of a power-
ful, visionary insurer; a large primary care group in partnership with payers; or even
a hospital, with some affiliated physician group, that seeks to be especially attractive
to payers.
In crafting care, an effective integrator, in one way or another, will link health
care organizations (as well as public health and social service organizations)
whose missions overlap across the spectrum of delivery. It will be able to recog-
nize and respond to patients’ individual care needs and preferences, to the health
needs and opportunities of the population (whether or not people seek care), and
to the total costs of care. The important function of linking organizations across
the continuum requires that the integrator be a single organization (not just a
market dynamic) that can induce coordinative behavior among health service
suppliers to work as a system for the defined population.
Functions Of An Integrator
n Involving individuals and families. Pursuit of the Triple Aim requires that the
population served become continually better informed about both the determinants
of their own health status and the benefits and limitations of individual health care
practices and procedures. An effective integrator would work persistently to change
the “more-is-better” culture through transparency, systematic education, communi-
cation, and shared decision making with patients and communities, rather than by
restricting access, shifting costs, or erecting administrative hurdles to care. Many
members of the population, especially those with chronic illnesses, will need some-
one who can work with them to establish a plan for their ongoing care, guide them
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6. Q uali ty & Acco untabi li ty
through the technological jungle of acute care, advocate for them, and interpret.
n Redesign of primary care services and structures. We believe that any ef-
fective integrator will strengthen primary care for the population. To accomplish
this, physicians might not be the sole, or even the principal, providers. Recently, phy-
sicians and other clinicians have proposed principles for expanding the role of pri-
mary care under the title of the medical home. This expanded role includes estab-
lishing long-term relations between patients and their primary care team;
developing shared plans of care; coordinating care, including subspecialists and hos-
pitals; and providing innovative access to services through improved scheduling,
connection to community resources, and new means of communication among indi-
viduals, families, and the primary care team facilitated by a patient-controlled per-
sonalized health record. The integrator would assume responsibility for building
the capability and infrastructure to enable primary care practices to function in this
expanded role.
n Population health management. The integrator would be responsible for
deploying resources to the population, or for specifying to others how resources
should be deployed. Segmentation of the population, perhaps according to health
status, level of support from family or others, and socioeconomic status, will facili-
tate efficient and equitable resource allocation.13 The growing availability of high-
quality health information on the Internet will help all segments manage their own
care and understand options for treatment.
Today’s individual health care processes are designed to respond to the acute
needs of individual patients, rather than to anticipate and shape patterns of care
for important subgroups. An integrator would act differently, assigning much
more value and many more resources, for example, to the monitoring and intercep-
tion of early signs of deterioration among the 100 CHF patients in a doctor’s panel
or the 1,000 CHF patients who used the hospital last year.
Famously, the “actual” causes of mortality in the United States lie in behavior
that the individual health care system addresses unreliably or not at all, such as
smoking, violence, physical inactivity, poor nutrition, and unsafe choices.14 An in-
tegrator would increase preventive efforts. An integrator would also encourage
and cooperate with governmental policies, agencies, and programs to discourage
smoking, combat obesity, provide alternatives to violence and substance abuse,
and address community determinants of mental health problems.
n Financial management system. The broken financing system of the present
mirrors the fragmented care system. An effective integrator would assure that pay-
ment and resource allocation support the Triple Aim. An important first step for a
systems approach to cost control would be defining, measuring, and making trans-
parent the per capita cost of care for a defined population. For example, companies
could begin to show on employees’ paychecks the amount of money spent per em-
ployee by the company to provide health insurance. The Centers for Medicare and
Medicaid Services (CMS) could provide regions with cost information per benefi-
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7. Tr i p l e Ai m
ciary to allow comparisons of costs and inflation across the country.
A mainstay of reduction and control of per capita costs would be yearly initia-
tives to reduce waste in all of its forms, especially procedures, tests, and visits that
represent rework, errors, unscientific care, or otherwise valueless services. George
Isham, medical director of HealthPartners in Minneapolis, has called for a project
to identify the ten most common forms of waste in each medical specialty.15 Any
integrator collaborating on improvement of value with its suppliers of specialty
care would be very interested in Isham’s list. An indication of progress on the Tri-
ple Aim would be doctors’ leading and energetically participating in such efforts.
Perhaps the most powerful needed change is to disrupt the dynamics of supply-
driven care and instead to match supply better to underlying needs. An integrator
would approach new technologies and capital investments with skepticism and
require that a strong burden of proof of value lie with the proponent. Operating
budgets would encourage thinking across boundaries. An integrator would ask,
“Might two additional home outreach nurses be better for the Triple Aim than an-
other cardiologist?” Capital budgets would be informed by the insights of Fisher
and Wennberg, and good integrators would encourage through incentives—and,
if needed, regulations—strict limits on the growth of facilities.
The hallmarks of proper financial management in a system pursuing the Triple
Aim, we suspect, are government policies, purchasing contracts, or market mech-
anisms that lead to a cap on total spending, with strictly limited year-on-year
growth targets.
n System integration at the macro level. A conscientious integrator would as-
pire to produce or contract for individual care and population-based interventions
that are evidence-based and highly reliable. To achieve that, all in the system of care
would need access to up-to-date medical knowledge, standardized definitions of
quality and cost, and evidence and measurement collected and distributed by a thor-
oughly trustworthy body. In effect, patients, caregivers, organizations, and manag-
ers would know the “state of the system” with respect to its reliability, adherence to
evidence, cost, and progress in improvement.
In most cases, the integrator would not be a direct provider of all necessary ser-
vices. Instead, it would need to commission some services from suppliers through
business relationships consciously designed to facilitate pursuit of the Triple Aim.
Michael Porter and Elizabeth Teisberg have called for a redefinition of competi-
tion in health care.16 They assert that value is added by care that produces the best
outcomes at the lowest cost over time. An integrator, following their logic, might
contract with a multifunctional group of providers to serve a specific subpopula-
tion.
Precedents And Possibilities
The Triple Aim is far from a totally new idea. As one would expect, organiza-
tions and other stakeholders in a variety of countries that begin with a population
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8. Q uali ty & Acco untabi li ty
in mind tend to want to achieve all three goals at once. Among these stakeholders
are (1) government-sponsored or -owned health care systems that have legally
chartered duties to defined populations and that own facilities, employ clinicians,
and provide and manage clinical services (in the United States, these include the
Veterans Health Administration, the Indian Health Service, and the Military
Health Command); (2) classical staff- and group-model health maintenance orga-
nizations (HMOs), such as Kaiser Permanente, HealthPartners, and Group Health
Cooperative of Puget Sound, which combine insurance and care delivery func-
tions (although usually not public health systems) for enrolled populations; and
(3) national and other governmental health care systems that aggregate tax reve-
nues into global budgets and, through employment, ownership, and contracting,
ensure care for populations. Examples include the National Health Service (NHS)
in the United Kingdom and health care in Sweden, where counties act as integra-
tors, using general tax revenues to fund the comprehensive care systems that
county-level executives organize and improve for their entire population.17
In the United States, a few additional cases of Triple Aim–oriented organiza-
tions have emerged. Some employers, fed up with out-of-control costs but unwill-
ing to give up trying to ensure proper care for their employees, have started their
own care systems, reminiscent of the roots of Kaiser Permanente. For example,
QuadGraphics, a large U.S. publishing company, started QuadMed, a wholly
owned subsidiary that provides care to QuadGraphics employees using a highly
innovative model of strong primary care as the mainstay.18
Occasional entrepreneurial hospital-based systems, often with very high mar-
ket share and strong community roots, such as Intermountain Health Care,
Geisinger Health System, Bellin Health System, and (for care of the underserved)
Denver Health, try to knit together components of the care system in virtual ag-
gregates through technical support and innovative contracts. The numerous re-
cent state-level initiatives for universal health insurance coverage inevitably face
the Triple Aim as the only route to affordability; Massachusetts, as one example,
has established a Quality and Cost Council to try to determine how to keep all
three aims in a single field of vision.19
n HMOs as integrators. So what happened to HMOs? As conceived by their
greatest champion, Paul Ellwood, HMOs were, or were intended to be, integrators
exactly as we propose, in pursuit of the Triple Aim.20 On closer inspection, the HMO
movement was eventually defined by its organizational structure rather than its
aims and performance. The experience of people enrolled in HMOs was not suffi-
ciently improved to overcome the restriction of choice of providers or the perceived
barriers to access to specialists that became part of the HMO model. Because they
restricted care, HMOs were vulnerable to competitive retaliation by indemnity in-
surers and others, which began offering products called “HMO” or “managed care”
that merely managed money, not care. Furthermore, proponents of HMOs might
have overestimated the cost-saving potential of proper preventive care, instead of
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9. Tr i p l e Ai m
“Innovations in payment design encourage integrated behavior
without the managerial superstructure of an HMO.”
viewing population health status and per capita cost control as separate aims.21 Fi-
nally, HMOs were competing for doctors and acute care suppliers in an environment
in which these providers were in control of demand and thus revenue. The HMO
was not an attractive business alternative for them.
n Encouraging signs for integrated care. Even with the similarity between an
HMO and our view of the integrator, we are encouraged in large measure because
the possibilities of integrated care have so thoroughly changed with the advent of
electronic support systems and the possibilities for virtual integration and instant
communication that were unimaginable when HMOs were first described. Fisher’s
recent proposals for virtual integration of care through extended medical staffs, for
example, represent innovations that draw on some of the principles of classical
HMOs, but with entirely new processes and relationships at their core.22 Innova-
tions in payment design, such as bundled payment experiments by the CMS for
chronic disease management and Harold Luft’s conceptualization of case rates for
local microsystems, offer interesting approaches to encouraging integrated behavior
without the managerial superstructure of an HMO.23
n What it takes to progress toward integrated care. From the (we hope tem-
porary) failure of the best features of the HMO concept we take the lesson not that
all integrated care is destined to fail, but rather that pursuit of the Triple Aim threat-
ens the U.S. status quo health care system. The current behavior, destructive of the
Triple Aim and inimical to the best aspects of sound, managed care, is a predictable,
indeed inevitable, consequence of the current rules. If we want different behavior,
we will need new financing and competitive dynamics. What new financing or dy-
namics, different from today’s, would lead rational hospitals to try to reduce re-
admissions dramatically for CHF?
If we could ever find the political nerve, we strongly suspect that financing and
competitive dynamics such as the following, purveyed by governments and pay-
ers, would accelerate interest in the Triple Aim and progress toward it: (1) global
budget caps on total health care spending for designated populations, (2) mea-
surement of and fixed accountability for the health status and health needs of des-
ignated populations, (3) improved standardized measures of care and per capita
costs across sites and through time that are transparent, (4) changes in payment
such that the financial gains from reduction of per capita costs are shared among
those who pay for care and those who can and should invest in further improve-
ments, and (5) changes in professional education accreditation to ensure that cli-
nicians are capable of changing and improving their processes of care. With some
risk, we note that the simplest way to establish many of these environmental con-
ditions is a single-payer system, hiring integrators with prospective, global bud-
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10. Q uali ty & Acco untabi li ty
gets to take care of the health needs of a defined population, without permission
to exclude any member of the population.
Indicators Of Progress
In our lighter moments, we have tried to imagine the most elegant possible “Tri-
ple Aim Test,” asking, “How would we know at first glance that the care for a pop-
ulation is actually making progress on the Triple Aim?” Our proposed test has only
three items. First, hospitals involved in the Triple Aim would be trying to be emp-
tier, not fuller. They would celebrate as success that the hospital is less and less of-
ten needed by the population. Second, Fisher and Wennberg would be happier.
They would observe that the dynamics of supply-driven care are no longer strong
and that patients pull resources, rather than vice versa. And third, patients would
say of those who try to maintain and restore their health: “They remember me.”
They would recognize that the health care system is mindful of their needs, wants,
and opportunities for health even when they themselves forget. Health care would
also be mindful that people have excellent uses for their wealth other than paying
for care they do not need or for illnesses they could have avoided.
W
h e t h e r o r n o t t h e t r i p l e a i m is within reach for the United
States has become less and less a question of technical barriers. From
experiments in the United States and from examples of other coun-
tries, it is now possible to describe feasible, evidence-based care system designs
that achieve gains on all three aims at once: care, health, and cost. The remaining
barriers are not technical; they are political. The superiority of the possible end
state is no longer scientifically debatable. The pain of the transition state—the
disruption of institutions, forms, habits, beliefs, and income streams in the status
quo—is what denies us, so far, the enormous gains on components of the Triple
Aim that integrated care could offer.
The authors are grateful for the contributions of Jane Roessner, Frank Davidoff, Val Weber, Samantha Henderson,
and Maureen Bisognano.
NOTES
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York: Commonwealth Fund, June 2007); and Commission on a High Performance Health System, “Why
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National Academies Press, 2001).
768 May/ June 2008
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safety/tools-services/p4p/hqi/index.jsp (accessed 28 June 2007).
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Quality, and Accessibility of Care,” Annals of Internal Medicine 138, no. 4 (2003): 273–287; and E.S. Fisher et al.,
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