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Can a decision aid intervention about goals of care improve communication, decision-making, and palliative care for patients with advanced dementia? ... In this randomized trial of 302 nursing home residents with advanced dementia, family decision makers reported better end-of-life communication with clinicians. Clinicians were more likely to address palliative care in treatment plans, use Medical Orders for Scope of Treatment, and less likely to send patients to the hospital. (Hanson et al., 11/28)

In this cohort study evaluating students with asthma, higher mouse allergen exposure at school was significantly associated with both increased asthma symptoms and lower lung function, independent of allergic sensitization and allergen exposure in the home. ... The school environment is an important contributor to childhood asthma morbidity, and future school-based environmental interventions may benefit all children with asthma. (Sheehan et al., 11/21)

The report covers the health care cost and utilization trends for Americans younger than age 65 and covered by employer-sponsored insurance (ESI) for the years 2012 through 2015. ... In 2015, spending per capita for the ESI population grew by 4.6% over the previous year, to $5,141 per person .... This growth was faster than previous years’ growth: 3.0% growth in 2013 and 2.6% growth in 2014. ... In every year studied, the biggest driver of per capita spending growth was increasing prices. However, in some years increases in the utilization of services also played a role in spending growth. (11/22)

Most people at some point in their lives need to take time away from work to deal with a serious personal or family illness or to care for a new child. In contrast to almost every other developed nation in the world, the United States has no federal law that guarantees paid family or medical leave, whether that leave is to care for a new child or a seriously ill family member, or to address one's own serious health condition. ... President-elect Donald Trump during the campaign surprised many in the Republican Party by proposing a modest paid maternity leave policy. Republicans in Congress might oppose guaranteed paid leave in any form or promote their own reform. (Findlay, 11/21)

Policymakers, health care providers, and policy analysts continue to call for “delivery system reform”—changes to the way health care is provided and paid for in the United States—to address concerns about rising costs, quality of care, and inefficient spending. The Affordable Care Act (ACA) established several initiatives to identify and test new health care payment models that focus on these issues. Many of these ACA programs apply specifically to Medicare, the social insurance program that provides coverage to 57 million Americans age 65 and older and younger adults with permanent disabilities. This Primer describes the framework and concepts of three payment models that CMS is currently testing and implementing within traditional Medicare—medical homes, ACOs, and bundled payments. (Baseman et al., 11/17)