scholarly journals Learning by Doing: Lessons From the Care and Prevention in the United States Demonstration Project

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 18S-27S ◽  
Author(s):  
Kim M. Williams ◽  
Raekiela D. Taylor ◽  
Thomas Painter ◽  
William L. Jeffries ◽  
Cynthia Prather ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Learning By Doing ◽  
Demonstration Project

The More Med-Mals, the Shorter the Litigation: Evidence from Florida

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Kowsar Yousefi
Keyword(s):  
United States ◽  
Average Duration ◽  
The United States ◽  
Learning By Doing ◽  
Career Concerns ◽  
Malpractice Litigation ◽  
Tort System ◽  
Alternative Hypotheses ◽  
Reputation Concern ◽  
Realistic Perception

Abstract Medical malpractices (med-mals) are among the most long-lasting litigations in the United States with an average duration of more than 4 years. Using the Florida database of med-mals, this study examines each physician in multiple sequential cases and documents a significantly negative correlation between the length of litigation and defendants’ numbers of past med-mals: a case closes nearly 1 year sooner if its defendant has previously experienced another claim. To explain this stylized fact, a dynamic model with the feature of “firmness of beliefs” is developed. The model assumes that the more prior litigations, the more realistic perception of the tort system and therefore a faster closure of the final dispute. I call this mechanism “learning-by-doing.” Alternative hypotheses include the following: (1) plaintiffs’ endogenous choice of filing against physicians with worse histories and (2) physicians’ reputation (career) concerns. I find no evidence in support of the first one, but the reputation concern cannot be rejected. The learning-by-doing mechanism is consistent in many robustness tests, including controlling for the reputation concerns. An earlier version of this paper was circulated under the title: Learning How to Handle Malpractice Litigation from Experience: Evidence from Florida

Results from a PrEP Demonstration Project for At-Risk Cisgender Women in the United States

2021 ◽  
Author(s):  
Jill Blumenthal ◽  
Sonia Jain ◽  
Feng He ◽  
K Rivet Amico ◽  
Ryan Kofron ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
Text Messaging ◽  
Hiv Infections ◽  
The United States ◽  
Dried Blood Spots ◽  
Demonstration Project ◽  
Open Label ◽  
Drug Concentrations ◽  
Hiv Acquisition

Abstract Background Daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is effective for reducing HIV acquisition among cisgender women. We report results from the first United States observational open-label demonstration project of PrEP among at-risk cisgender women. Methods Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label demonstration study of daily oral TDF/FTC in cisgender women ≥18 years old at-risk for HIV. Adherence was supported using two-way text messaging and titrated adherence counseling based on rapid-turnaround tenofovir diphosphate concentrations from dried blood spots. Study visits occurred at baseline, and at weeks 4, 12, and quarterly through week 48. Outcomes included TDF/FTC adherence, retention and persistence. Results From June 2016 to October 2018, 136 cisgender women enrolled [mean age 40 (SD 11); 38% non-Hispanic (NH) Black and 19% Latina]. At 48 weeks, 84 (62%) participants were retained and 62 (46%) remained on PrEP. Over one-third (12/31) of those on study but off PrEP throughout study discontinued TDF/FTC due to side effects, and one adverse event led to study discontinuation. Of 120 participants with drug concentrations measured, 67 (56%) had at least one concentration consistent with ≥6 doses/week (d/w); 22 (18%) had consistent ≥6 d/w across all study visits attended. There were no incident HIV infections and 4 incident bacterial STIs. Conclusion Adequate PrEP adherence for protective drug concentrations was not achieved for most study participants. More work needs to be done to fully explicate the reasons for non-adherence and low retention in cisgender women.

The Unintended Sentence of Criminal Justice Debt

2011 ◽  
Vol 24 (1) ◽  
pp. 62-65
Author(s):  
Alexandra Shookhoff ◽  
Robert Constantino ◽  
Evan Elkin
Keyword(s):  
United States ◽  
Criminal Justice ◽  
The United States ◽  
Demonstration Project ◽  
Negative Consequences ◽  
Standard Practice ◽  
Ability To Pay ◽  
Criminal Justice Systems ◽  
Justice Systems

Increases in both the number and amount of court fees, fines, and surcharges—regardless of offenders' ability to pay—have become standard practice in courthouses throughout the United States. A recent report from the Brennan Center for Justice, as well as several others, have shown that imposing criminal justice debt can interfere with reentry and rehabilitation. In response to this identified problem, the Vera Institute of Justice is exploring a potential demonstration project that would help jurisdictions generate revenue and hold offenders accountable for their crimes without the unintended negative justice outcomes. The Fines and Fees Initiative seeks to ameliorate the negative consequences that criminal justice debt may have on individuals, communities, and criminal justice systems.

Hospice Care: A New Opportunity for Pharmacists

1990 ◽  
Vol 3 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Stephen G. Arter ◽  
Arthur G. Lipman
Keyword(s):  
United States ◽  
National Cancer Institute ◽  
Hospice Care ◽  
Drug Information ◽  
Clinical Skills ◽  
The United States ◽  
Demonstration Project

Hospices are programs of care for patients who have advanced, irreversible diseases and life expectancies that are measurable in weeks and months as opposed to years. The first hospice in the United States was started in 1974 as a National Cancer Institute demonstration project. Since that time, approximately 1,700 programs have been started in this country. Most hospice care is provided in the patients' homes. The focus of care is the relief of pain and other symptoms. Hospice is interdisciplinary and medically directed. Pharmacists are important members of hospice teams. This article will describe the development of hospice programs in this country, how pharmacists might become involved in hospice care, and the roles that pharmacists play in hospice programs. A variety of pharmacist expertise, including clinical skills, drug information capabilities, management, and compounding, are needed by hospice programs. Hospice presents a challenging and professionally rewarding practice for many pharmacists today. Many more pharmacists are needed.

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