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Think and act alobally: Health Affairs' September issue

Health Affairs

This issue was supported by the Qatar Foundation and World Innovation Summit for Health (WISH), Hamad Medical Corporation, Imperial College London, and The Commonwealth Fund.

How is accountable care taking shape internationally?

Mark McClellan of the Brookings Institution and coauthors seek to offer a global description of an accountable care system and a mechanism to assess related reforms. They suggest five components for a framework applicable internationally: population, outcomes, metrics and learning, payments and incentives, and coordinated delivery. They also define an accountable care system as "one in which a group of providers are held jointly accountable for achieving a set of outcomes for a prospectively defined population over a period of time and for an agreed cost." The authors highlight the fundamental nature of the shift from a supply-driven system to a demand-driven one, and the importance of data and collaboration during this transition. They suggest that policy-makers in all countries begin to take a more holistic view through a population health lens, reward outcomes, foster collaboration and support interoperability to help accountable care achieve its promise.

Fighting the global obesity epidemic--one instant message at a time.

Approximately six percent of all global health care budgets are linked to the obesity crisis, and in the United States alone, the cost of obesity is expected to rise to $957 billion by 2030.

Hutan Ashrafian from the Institute of Global Health Innovation at Imperial College London and colleagues conducted a review and meta-analysis of twelve studies involving 941 patients following The World Innovation Summit for Health (WISH) 2013. They found that body mass index (BMI) can indeed be reduced through the use of interventions using social networking, by a modest but significant .64 percent. They found an optimal duration of the interventions to be 6 to 12 months, with no significant effects before or after this timeframe. The authors suggest social networking techniques can be applied to other noncommunicable diseases associated with obesity, and highlight the importance of ease-of use and simplicity to maximize effect.

Hospital to home transition interventions can keep people out of the hospital longer, especially for older patients.

Kim J. Verhaegh of the Academic Medical Center Amsterdam and colleagues examined whether readmission rates for chronically ill patients from a variety of countries could be improved with interventions targeted at the discharged patients and their informal caregivers. They found a readmission rate reduction in both the intermediate (31-180 days) and long term (181-365 days), yet a reduction in the short term only after high-intensity interventions. With high-intensity approaches including a home visit within three days of discharge, care coordination by a nurse, and hospital-primary care coordination, the absolute risk reduction was 5 percent in the short term, 7 percent in the intermediate-term and 13 percent in long-term readmissions. The authors conclude that countries around the globe with aging, chronically ill patients should consider these interventions as a method of reducing preventable and costly readmissions, and study new ways to improve short-term readmissions in particular.

Jeremy Laurance of the Imperial College of London and coauthors offer four case studies on the promise of patient engagement in lowering costs and improving outcomes from regions including the United Arab Emirates and the United Kingdom.


Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears monthly in print, online, on mobile and on iPad. Additional and late-breaking is found at in Web First papers, Health Affairs Blog, Health Policy Briefs, Videos and Podcasts, and more.

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