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"One of the challenges in treating cancer is the disease's complexity and variation among patients. Cancer manifests differently in each patient, so treatments that are effective in one patient may not be effective in another. As cancer care becomes more personalized, subpopulations of individuals will be given preventive or therapeutic interventions based on their susceptibility to a particular disease or their predicted response to a specific treatment. However, before the use of personalized cancer care can reach its full potential, the health care system must resolve a number of technological, regulatory, and reimbursement issues. To explore these policy challenges, the National Cancer Policy Forum held the workshop Policy Issues in the Development of Personalized Medicine in Oncology in June 2009. Experts provided presentations on the current state of personalized medicine technology, as well as issues in the validation of, regulation of, and reimbursement for the predictive tests that underpin personalized medicine. Participants discussed the obstacles and possible solutions to further developing and using personalized medicine technologies. This document summarizes the workshop"--

FrontMatter -- Reviewers -- Preface -- Contents -- Abbreviations and Acronyms -- Summary -- 1 Introduction -- 2 Evaluating the Evidence -- 3 Exposure to the Herbicides Used in Vietnam -- 4 Information Related to Biologic Plausibility -- 5 Epidemiologic Studies-New Citations and Background on Repeatedly Studied Populations -- 6 Cancer -- 7 Reproductive Effects and Impacts on Future Generations -- 8 Neurologic Disorders -- 9 Other Health Effects -- 10 Conclusions and Recommendations -- Appendix A: Agendas of Public Meetings Held by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) -- Appendix B: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers -- Appendix C: Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) and Staff Biographies.

INTRODUCTION AND SUMMARY OF CONCLUSIONS -- HEALTH CARE OF MEMBERS OF RACIAL AND ETHNIC MINORITY GROUPS -- RACIAL DIFFERENCES IN USE OF NURSING HOMES -- APPENDIXES -- APPENDIX A: Racial Patterns Within Medicare and Medicaid -- APPENDIX B: Relevant Portions of the Title VI Regulations -- APPENDIX C: Guidelines for Compliance of Nursing Homes and Similar Facilities With Title VI of the Civil Rights Act of 1964 -- APPENDIX D: Hill-Burton Community Service Regulations -- APPENDIX E: Case Study: Cook v. Ochsner

CONTENTS -- INTRODUCTION AND OVERVIEW -- QUESTIONS RAISED BY THE SECRET SERVICE AND SUMMARIES OF CONFERENCE RESPONSES -- OPENING REMARKS -- OPENING REMARKS -- SECRET SERVICE EXPECTAT IONS FROM THE CONFERENCE -- SUMMARY OF WORKSHOP AND PLENARY DISCUSSIONS -- PROBLEMS IN ASSESSING AND MANAGING DANGEROUS BEHAVIOR -- NOTES ON THE SECRET SERVICE AND THE PROTECTION OF THE PRESIDENT -- LEARNING FROM EXPERIENCE, THE SECRET SERVICE, AND CONTROLLED EXPERIMENTATION -- PROBLEMS IN ASSESSING AND MANAGING DANGEROUS BEHAVIOR: SOME COMMENTS AND REFLECTIONS

Front Matter -- 1 Introduction -- 2 The Metrics Landscape -- 3 Using Metrics Locally -- 4 Measurement and Health Equity -- 5 World Café -- 6 Reflections on the Workshop -- Appendix A: References -- Appendix B: Workshop Agenda -- Appendix C: Speaker, Moderator, and Invited Guest Biographical Sketches

FrontMatter -- Foreword -- Contents -- Introduction--Harvey Fineberg -- Overview--Gail L. Warden -- Chronic Care--William L. Roper -- Primary Care--Arthur Garson, Jr. -- Information Technology--Edward H. Shortliffe -- Uninsured--Karen Davis -- Liability--William M. Sage -- Discussion -- Biosketches.

FrontMatter -- Contents -- Summary -- 1 Introduction and Literature Review -- 2 The Healthcare Environment and Its Relation to Disparities -- 3 Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient- and System-Level Factors -- 4 Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter -- 5 Interventions: Systemic Strategies -- 6 Interventions: Cross-Cultural Education in the Health Professions -- 7 Data Collection and Monitoring -- 8 Needed Research -- References -- Appendixes -- A Data Sources and Methods -- B Literature Review -- C Federal-Level and Other Initiatives to Address Racial and Ethnic Disparities in Healthcare -- D Racial Disparities in Healthcare: Highlights from Focus Group Findings -- E Committee and Staff Biographies -- Paper Contributions -- Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes-H. Jack Geiger -- Racial and Ethnic Disparities in Healthcare: A Background and History-W. Michael Byrd and Linda A. Clayton -- The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives-Jennie R. Joe -- Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare-Lisa A. Cooper and Debra L. Roter -- The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare-Mary-Jo DelVecchio Good, Cara James, Byron J. Good, and Anne E. Becker -- The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status-Thomas E. Perez -- Racial and Ethnic Disparities in Healthcare: Issues in the Design, Structure, and Administration of Federal Healthcare Financing Programs Supported Through Direct Public Funding-Sara Rosenbaum

REFORMING PHYSICIAN PAYMENT -- Copyright -- Contents -- PREFACE -- CONFERENCE SUMMARY -- Conference Agenda -- Major Conference Themes -- A Climate for Change -- A Need for Change -- Non-economic Influences on Physician Behavior -- Payment Objectives -- Paucity of Data and Research Findings -- Potential Contributions by the Institute of Medicine -- COMMISSIONED PAPERS -- POLITICS AS USUAL AND CUSTOMARY? PHYSICIAN PAYMENT IN TRANSITION -- THE PERPLEXING TARGET OF POLICY -- THE RISE AND DECLINE OF USUAL AND CUSTOMARY -- FORCES FOR CHANGE -- PROSPECTS FOR CHANGE -- CHALLENGES OF CHANGE -- References -- CHANGING PHYSICIAN BEHAVIOR: In Search of the Little Blue Button -- SUMMARY -- INTRODUCTION -- PRIMARY INFLUENCES -- ENVIRONMENTAL CHANGES -- NEW RESEARCH INITIATIVES -- References -- THE IMPACT OF CHANGES IN PAYMENT METHODS ON THE SUPPLY OF PHYSICIANS' SERVICES -- INTRODUCTION -- THE PAYMENT SYSTEM AND PHYSICIANS' SPECIALTY AND LOCATION DECISIONS -- Location Choices -- Specialty Choice -- PHYSICIANS' PRODUCTIVITY -- Defining Efficiency and Productivity -- Productivity in Solo, Fee-for-Service Practice -- Productivity in Group, Fee-for-Service Practices -- Productivity in Pre-Paid Group Practice -- PARTICIPATION IN HEALTH INSURANCE PROGRAMS -- CONCLUSIONS -- References -- THIRD PARTY CARRIER PERSPECTIVE ON PHYSICIAN PAYMENT -- PAYMENT IS A MEANS, NOT AN END -- The Patient -- The Physician -- The Payor -- The Public -- The Carrier -- THERE ARE FUNDAMENTAL DIFFERENCES BETWEEN INSTITUTION-CARRIERS AND PROFESSIONAL-CARRIER RELATIONSHIPS -- Specialization -- Location -- Target Income -- Controls -- Competition -- Dissatisfaction -- A PAYMENT SYSTEM SHOULD BE IN REASONABLE SYNCHRONIZATION WITH THE EVOLUTION OF THE SOCIAL AND DELIVERY SYSTEMS -- PAYMENT SYSTEMS ARE DESIGNED FOR SPECIFIC BENEFIT, ADMINISTRATIVE, AND LEGAL CIRCUMSTANCES.

TOWARD A NATIONAL STRATEGY FOR LONG-TERM CARE OF THE ELDERLY -- Copyright -- Contents -- PREFACE -- OVERVIEW -- SECTION I BACKGROUND AND STUDY RATIONALE -- FUTURE GROWTH IN LONG-TERM CARE NEEDS -- The Elderly -- The Population Under Age 65 -- The Composite Picture -- LONG-TERM CARE COSTS -- Annual Costs and Personal Income -- Misconceptions About Insurance Coverage of Costs -- NATIONAL LONG-TERM CARE EXPENDITURES7 -- Nursing Home Expenditures -- Noninstitutional Care Expenditures -- FINANCING LONG-TERM CARE -- AVAILABILITY, APPROPRIATENESS, AND QUALITY OF LONG-TERM CARE -- SECTION II STUDY CONCEPT -- STUDY FOCUS -- Components of an Optimal Long-Term Care System -- Achieving Desirable Outcomes -- STUDY SCOPE -- Study Population -- Time Frame -- SECTION III STUDY APPROACH -- (1) DEFINING THE PROBLEM -- (2) NARROWING THE GAP BETWEEN THE DESIRABLE AND THE ACTUAL -- (3) FINANCING LONG-TERM CARE -- (4) MAKING LONG-TERM CARE AFFORDABLE -- (5) CROSS-NATIONAL COMPARISONS: LESSONS FOR THE U.S. -- (6) IMPLICATIONS FOR THE NONELDERLY DISABLED -- GENERAL ISSUES -- ANTICIPATED STUDY OUTCOMES -- SECTION IV PROPOSED BUDGET - LONG-TERM CARE STUDY -- ASSUMPTIONS -- Duration -- Staff -- Committee Meetings -- Subcontracts, Commissioned Papers, and Consultants -- Dissemination -- Other Costs -- REFERENCES AND NOTES -- EXHIBIT A-1 THE CHALLENGE: AN ACCELERATING GROWTH IN LONG-TERM CARE NEEDS -- THE ELDERLY -- THE UNDER AGE 65 POPULATION -- The Developmentally Disabled -- The Chronically Mentally Ill -- Other Disabled Persons Under Age 65 -- Future Needs of Under Age 65 Functionally Dependent -- ESTIMATED OVERALL GROWTH - 1980 TO 2000 -- EXHIBIT A-2 HEALTH STATUS, LIFE EXPECTANCY AND LONG-TERM CARE UTILIZATION BY THE ELDERLY -- THE CHANGING DEMOGRAPHICS -- Mortality -- Health Status and Use of Medical Care Services -- Expenditures for Medical Care.

Changing the Health Care System -- Copyright -- Foreword -- Contents -- Overview -- Health Care Reform: The European Experience -- LEARNING FROM OTHERS -- EUROPEAN HEALTH REFORMS IN REVIEW -- THE TRANSFORMATION OF EUROPEAN HEALTH CARE -- THE LESSONS -- REFERENCES -- Development and Diffusion of Medical Technology in Europe -- REFERENCES -- DISCUSSION -- European Health Care Reform and Primary Care -- BACKGROUND -- WHAT IS PRIMARY CARE? -- HOW IMPORTANT IS PRIMARY CARE? -- WHAT'S SO DIFFERENT ABOUT PRIMARY CARE? -- PRIMARY CARE: THE U.S. EXPERIENCE -- REFLECTIONS FROM THE BRITISH EXPERIENCE -- CONCLUSION -- REFERENCES -- Response to Jo Ivey Boufford -- REFERENCES -- DISCUSSION -- Operating Under a Global Budget: Perspectives from the United States and Abroad -- EXPENDITURE- VERSUS BUDGET-DRIVEN HEALTH SYSTEMS -- PROSPECT FOR A BUDGET-DRIVEN AMERICAN HEALTH SYSTEM -- Managed Competition as an Alternative to Top-Down Budgeting -- Is There a Future for U.S. Health Care? -- Defining "Equitable Access" -- Additional Perspectives on Global Budgeting -- PHYSICIAN PERSPECTIVE -- Reference -- CANADIAN EXPERIENCE -- ROCHESTER, NEW YORK, EXPERIENCE -- Rochester's Health Care Infrastructure -- The Hospital Experimental Payment Program -- Strengths and Weaknesses of the Rochester Experiment -- Building on the Rochester Experiment -- HOSPITAL PERSPECTIVE -- PANEL DISCUSSION -- Contributors.

RELIABILITY OF MEDICARE HOSPITAL DISCHARGE RECORDS -- Copyright -- CONTENTS -- FOREWORD -- Chapter 1 INTRODUCTION -- SPECIFIC STUDY OBJECTIVES -- Chapter 2 STUDY METHODS -- SAMPLING PLAN -- Initial National Sample of Hospitals -- Subsample of Hospitals for Abstracting -- Sample of Medicare Records -- Retrieval of Medicare Claim Forms -- RESEARCH INSTRUMENTS -- Abstracting Form -- Information Checklist -- FIELD WORK -- CONFIDENTIALITY -- DATA PROCESSING -- Chapter 3 ANALYSIS -- TOTAL FREQUENCIES OF DISCREPANCIES -- ANALYSIS OF DIAGNOSTIC INFORMATION -- Reasons for Discrepancies -- Admitting vs. Principal Diagnosis -- Influence of Diagnostic Groupings -- Diagnostic Specific Discrepancies -- Influence of Multiple Diagnoses -- ANALYSIS OF PRINCIPAL PROCEDURES -- ANALYSIS OF CLAIMS INFORMATION -- Principal Diagnosis -- Principal Procedure -- INFLUENCE OF DIAGNOSTIC DATA RELIABILITY ON UTILIZATION STATISTICS -- Influence of Hospital Characteristics -- Chapter 4 SUMMARY AND RECOMMENDATIONS -- CONCLUSIONS -- RECOMMENDATIONS -- Appendix A BIBLIOGRAPHY -- Appendix B SAMPLE LETTER TO HOSPITAL ADMINISTRATOR -- Appendix C DIAGNOSTIC CODES INCLUDED AS COMPONENTS OF THE SAMPLE OF MEDICARE RECORDS -- Appendix D IOM RE-ABSTRACTING FORM -- Appendix D GENERAL INSTRUCTIONS FOR FIELD TEAM -- Appendix D SPECIFIC INSTRUCTIONS FOR IOM RE-ABSTRACTING FORM -- UHDDS DEFINITIONS -- MEDICARE DEFINITIONS -- MEDICARE CODING OF PROCEDURES -- Appendix E INFORMAL CHECKLIST -- APPENDIX F RELIABILITY OF FIELD WORK -- Methods -- Analysis -- Summary -- Appendix G PERCENT OF ABSTRACTS WITH NO DISCREPANCY FOR EACH DIAGNOSIS INCLUDED AS A COMPONENT OF MEDICARE RECORDS -- Appendix H NET AND GROSS DIFFERENCE RATES IN DESIGNATION OF PRINCIPAL DIAGNOSIS (BASED ON FOUR-DIGIT COMPARISONS OF SPECIFIC….

New Partnerships for a Changing Environment: Why Drug and Alcohol Treatment Providers and Researchers Need to Collaborate -- New Partnerships for a Changing Environment: Why Drug and Alcohol Treatment Providers and Researchers Need to Collaborate -- A Need for Research: The State of Substance Abuse Treatment in Communities -- BRIDGING THE GAP: A WIN-WIN SITUATION -- SUBSTANCE ABUSE AND WOMEN: A RESEARCH OPPORTUNITY -- Challenges for Community Treatment Providers -- Patient Population -- Changing Environment -- Policy Barriers -- Stigma about Substance Abuse -- Providers and Researchers: Working Together -- Putting Research Findings into Practice -- Using Provider Knowledge for New Research -- Getting on the Research Track -- What Is "Research"? -- HOW TO SCREEN RESEARCH REQUESTS -- Benefits for Treatment Providers as Research Partners -- Starting Up -- THE LEARNING ORGANIZATION -- Collaboration Models for Success -- Arapahoe House -- Iowa Consortium for Substance Abuse Research and Evaluation -- Community Clinical Oncology Program (CCOP) -- Taking Action: Next Steps for Treatment Programs -- Recommendations for Bridging the Gap Between Practice and Research -- Strategies for Linking Research and Practice -- Strategies for Linking Research Findings, Policy Development and Treatment Implementation -- Strategies for Knowledge Development -- Strategies for Dissemination and Knowledge Transfer -- Strategies for Consumer Participation -- Training Strategies for Community-Based Research Collaboration -- Copyright.