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Publication A Comprehensive Measure of the Costs of Caring For a Parent: Differences According to Functional Status(2018-10-10) Coe, Norma B.; Skira, Meghan M; Larson, Eric B.Providing unpaid care for an older parent has costs that go well beyond a caregiver’s lost wages. A new estimate suggests that the median direct and indirect costs of caregiving are $180,000 over two years, about the same as full-time institutional care. This estimate accounts for lost earnings as well as non-tangible factors, such as lost leisure time and changes to the caregiver’s well-being. It suggests that informal care cost caregivers at least $277 billion in 2011, which is 20 percent higher than estimates that only consider lost wages.Publication A Decade of Charter Schools: From Theory to Practice(2002-04-01) Bulkley, Katrina; Fisher, JenniferThe number of schools operating under charter school laws has soared over the last decade, from a small number operating in just a few states to more than 2,300 schools serving over 575,000 students in 34 states and the District of Columbia. More than half of these schools are concentrated in a few states — Arizona has over 400 charter schools, and California, Florida, Michigan, and Texas each has more than 150. Charter schools are relatively autonomous schools of choice that operate under a charter or contract issued by a public entity such as a local school board, public university, or state board of education. In theory, these contracts, usually lasting three-to-five years, provide school operators more autonomy than afforded a district-run public school in exchange for enhanced accountability by requiring schools to prove they are worthy of succeeding contracts. The Consortium for Policy Research in Education (CPRE) was commissioned by the U.S. Department of Education to conduct a review of the research on charter schools. This CPRE Policy Brief summarizes some key findings of our review. It is important to note that charter schools are an institutional innovation, meaning the laws allow schools to operate under a different structure. Charter school laws are not an attempt to endorse any particular learning approach or curriculum in the schools. Ted Kolderie, one of the creators of the charter school concept, explains that, “…the chartered school is not a kind of school; not a A Decade of Charter Schools: From Theory to Practice By Katrina Bulkley and Jennifer Fisler learning program or method. The opportunity the law provides is an empty institutional structure, as a building is an empty physical structure. Students learn from what the organizers put into it” (personal communication, October 25, 2001). Thus, in comparing schools operating under charter school laws with those directly operated by public school districts, it is necessary to consider the substantial variation under the charter school umbrella.Publication A Different Approach to Solving the Teacher Shortage Problem(2001-01-01) Ingersoll, Richard; Ingersoll, RichardFew educational problems have received more attention in recent times than the failure to ensure that elementary and secondary classrooms are all staffed with qualified teachers. Over the past two decades, dozens of studies, commissions, and national reports have warned of a coming crisis resulting from widespread teacher shortages. This article briefly summarizes a recent study I undertook that used national data to examine the sources of school staffing problems and teacher short- ages. This research shows that although these issues are among the most important facing schools, they are also among the least understood. The data also reveal that many currently popular reforms will not solve the staffing problems of schools because they do not address some of their key causes.Publication A Financial Assessment of Municipal Fiber in the U.S.(2017-05-01) Yoo, Christopher S.; Pfenninger, TimothyIn the interest of bringing high-speed broadband access to communities underserved by current Internet service providers, many U.S. cities have initiated municipal broadband projects. Such efforts have received favorable attention from those eager to help close the digital divide. This brief presents a first look at a new, comprehensive empirical analysis of 20 U.S. municipal fiber builds for which financial data is available. The findings show that half of the projects in this study are cash-flow negative, and based on their performance from 2010-2014, 90 percent are unable to generate sufficient cash to recover their project costs within the 30-40 year life expectancy of a municipal fiber build. City leaders considering such projects, as well as state and federal officials interested in supporting them, need to understand the documented costs and risks before encouraging new municipal fiber programs to form.Publication A National Comparison of Operative Outcomes of New and Experienced Surgeons(2019-10-25) Kelz, Rachel R.; Sellers, Morgan M.; Niknam, Mijan A.; Sharpe, James E.; Rosenbaum, Paul R.; Hill, Alexander S.; Zhou, Hong; Hochman, Lauren L.; Bilimoria, Karl Y.; Itani, Kamal; Romano, Patrick S.; Silber, Jeffrey H.In this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient’s emergency status – rather than physician inexperience – explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.Publication A National Comparison of Operative Outcomes of New and Experienced Surgeons(2019-10-25) Kelz, Rachel R.; Sellers, Morgan M.; Niknam, Bijan A.; Sharpe, James E.; Rosenbaum, Paul R.; Hill, Alexander S.; Zhou, Hong; Hochman, Lauren L.; Bilimoria, Karl Y.; Itani, Kamal; Romano, Patrick S.; Silber, Jeffrey S.Publication A New Coalescence in the Housing Finance Reform Debate?(2016-06-01) Wachter, Susan M; Wachter, Susan M; McCoy, Patricia AIn the wake of the stalled Johnson-Crapo bill, the overarching goal of housing finance reform continues to be the efficient provision of long-term fixed-rate mortgages to credit-worthy borrowers in all markets throughout the business cycle.This Issue Brief analyzes three newly-proposed plans for reforming the U.S. housing finance system: (1) a proposal from Jim Parrot et al. to merge Fannie Mae and Freddie Mac into a new government corporation; (2) Andrew Davidson’s proposal for mutual ownership of the GSEs by mortgage originators; and (3) an opposing plan from Mark Calabria, arguing against securitization altogether and for a return to the regime of originate-and-hold.Publication A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation(2018-05-25) Halpern, Scott D.; Harhay, Michael O.; Saulsgiver, Kathryn; Brophy, Christine; Troxel, Andrea B.; Volpp, Kevin G.In a trial examining five approaches to smoking cessation among over 6,000 U.S. employees, financial incentives combined with free cessation aids were more effective at getting employees to stop smoking than free cessation aids alone. Specifically, the most effective intervention (free cessation aids plus $600 in redeemable funds) helped 2.9% of participants stop smoking through six months after their target quit date; this rate jumped to 12.7% among participants who actively engaged in the trial and were more motivated to quit. For employees with access to usual care (information and a free motivational text messaging service), offering free cessation aids or electronic cigarettes (e-cigarettes) did not help them quit smoking.Publication A Wake-Up Call: Quality of Care After Resident Duty Hour Reform(2007-10-01) Volpp, Kevin G; Silber, Jeffrey H; Volpp, Kevin G; Silber, Jeffrey HOn first glance, it seems self-evident: sleep-deprived physicians-intraining (residents) are more likely to make mistakes that could harm patients. Like pilots and truck drivers, these new physicians might need restrictions on how much they work. Such restrictions were created in 2003, but the impact of these new rules is unclear. Are patients any safer? Is hospital care more fragmented? Who’s doing the work that residents performed prior to duty hour reform? This Issue Brief summarizes several studies that offer evidence about the impact of these regulations on patient mortality, as well as on residents’ perceptions of the effects on quality of care, medical education, and residents’ quality of life.Publication ACA-Mandated Elimination of Cost Sharing for Preventive Screening has had Limited Early Impact(2015-12-21) Polsky, Daniel; Zhu, Jingsan; Mehta, Shivan; Polsky, Daniel; Zhu, Jingsan; Volpp, Kevin G; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin GDid the Affordable Care Act’s elimination of cost sharing for preventive services increase rates of colonoscopy and mammography screening? Early results say no.Publication Accommodating Medical School Faculty with Disabilities(2003-01-06) Steinberg, Annie G; Iezzoni, Lisa I; Conill, Alicia; Stineman, MargaretMore than ten years have passed since the Americans with Disabilities Act (ADA) mandated that all employers provide “reasonable accommodations” for employees with disabilities. This mandate applies to medical schools, but no systematic information is available to assess the accommodations provided to medical school faculty with disabilities. This Issue Brief summarizes anecdotal evidence from several medical schools about the experiences of faculty with disabilities, and the barriers they face in establishing and maintaining their careers. It also recommends practical steps medical schools can take to provide a welcoming and accessible academic medical environment.Publication Accountability during school closures: moving from external to internal(2020-11-10) Francois, Chantal; Weiner, Jennie; Leading in CrisisThis inquiry found that the lack of external accountability pressures neither appeared to negatively impact teachers’ efforts, commitment to relevancy and rigor in their classrooms, or their responsiveness to families. This is one of a series of briefs that focused on a ‘critical incident’ surrounding school closure and offers pragmatic suggestions to educational leaders as they continue to grapple with the disruptions of the pandemic.Publication Accountable Care Organizations: Back to the Future?(2012-12-04) Burns, Lawton R; Pauly, Mark V; Burns, Lawton R; Pauly, Mark VAccountable Care Organizations (ACOs) are networks of providers that assume risk for the quality and total cost of the care they deliver. Public policymakers and private insurers hope that ACOs will achieve the elusive “triple aim” of improving quality of care, improving population health, and reducing costs. The model is still evolving, but the premise is that ACOs will accomplish these aims by coordinating care, managing chronic disease, and aligning financial incentives for hospitals and physicians. If this sounds familiar, it may be because the integrated care networks of the 1990s tried some of the same things, and mostly failed in their attempts. This Issue Brief summarizes the similarities and differences between the new ACOs and the integrated delivery networks of the 1990s, and presents the authors’ analysis of the likely success of these new organizations in affecting the costs and quality of health care.Publication Addressing Personal-Income-Tax Manipulation with Tools from Psychology(2017-10-01) Rees-jones, Alex; Rees-jones, AlexIn order to better understand the tax manipulation decision-making process—both legal uses of tax deductions and illegal tax evasion—this brief looks at the impact of gain/loss framing. Analysis of tax data confirms that tax decisions are influenced by “loss aversion.” For instance, taxpayers are more likely to pursue tax reduction activities when they make a loss smaller, as compared to when they make a gain larger. The brief looks at tools that policymakers have at their disposal for both deterring tax evasion and making exiting tax incentives maximally effective. The brief discusses instances when such gain/loss framing interventions might be deployed, and provides estimates around the size of the revenue responses they may generate. The author estimates that if tax filers who face losses experienced the lower motivation to manipulate shown by those facing gains, annual tax revenue would increase by $1.4 billion. Even attempts at marginal interventions, though smaller in predicted effects, might be financially worthwhile.Publication Adherence to HIV Drug Therapy(2012-11-13) Gross, RobertAntiretroviral therapy has dramatically improved the prognosis for many patients with HIV infection. For many patients who can navigate combinations of drugs and time their doses precisely, these drug regimens typically slow the progression of the disease and lengthen survival. But because these drug regimens are very complex, adherence—the degree to which patients follow medical advice in taking the prescribed drugs—is now a major determinant of HIV treatment success. This Issue Brief summarizes recent work on the effect of adherence on short-term outcomes, and the ability of providers to predict and estimate their patients’ adherence to therapy.Publication Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer(2016-02-03) Epstein, Andrew J; Epstein, Andrew J; Wong, Yu-Ning; Mitra, Nandita; Vachani, Anil; Hin, Sakhena; Armstrong, Katrina; Smith-McLallen, Aaron; Armstrong, Katrina; Groeneveld, Peter WGenomic testing in patients with early-stage breast cancer is associated with decreased use of chemotherapy and lower costs in younger patients, and slightly increased use of chemotherapy and higher costs in older patients. Genomic testing in actual practice may “rule out” chemotherapy in younger women, and “rule in” chemotherapy in older women.Publication Advances in Digital Health Research(2018-02-01) Palmarella, Graceann; McGrath, Colleen; Solomon, Sara; Dupuis, Roxanne; Cannuscio, CarolynSocial media and emerging mobile technologies have sparked radical shifts in human behavior, with people worldwide spending an average of 2 hours and 15 minutes daily on social networks. Facebook, Instagram, and Twitter have more than 2 billion users globally. Social networking site use has risen dramatically by all age groups, with the highest use among 18-29 year olds (see Figure below). Every second, Twitter users send 6,000 tweets, amounting to 500 million tweets per day. Instagram users post approximately 95 million photos, generating 4.2 billion likes, each day. A newer platform, Snapchat, has 178 million daily users, 60% of whom are under 25 years of age. They share an average of 3 billion snaps, or rapidly vanishing photos, every day. Researchers at Penn are turning these Tweets, posts, and snaps into innovative data sources that hold vital clues about behaviors, emotions, preferences, opinions, and social networks—all with potential implications for population health. Through the analysis of keywords, images, phrases, emoticons, likes, and hashtags, Penn teams are turning troves of digital information into human-centered health interventions and educational initiatives.Publication Affirmative Action Bans and Health Risk Behaviors(2019-07-19) Venkataramani, Atheendar S.; Cook, Erin; O'Brien, Rourke L.; Kawachi, Ichiro; Jena, Anupam B.; Tsai, Alexander C.College affirmative action bans were associated with higher rates of smoking and drinking in underrepresented minority 11th and 12th graders, and these students continued to smoke at higher rates into young adulthood. Policymakers should consider unintended public health consequences of proposals, such as affirmative action bans, that may limit socioeconomic opportunities.Publication After Debt: A Path Forward for Puerto Rico(2016-04-01) Skeel, David A; Skeel, David AThis Issue Brief summarizes events surrounding the current debt crisis in Puerto Rico and presents a two-step plan for restructuring Puerto Rico’s debt and encouraging more effective governance. This plan draws extensively on the previous experiences of debt crises in municipalities on the U.S. mainland. Step one entails the creation of a financial control board (FCB) for Puerto Rico, monitored by the U.S. federal government but involving significant Puerto Rican representation. Step two would be for Congress either to craft a restructuring framework applicable to all of America’s territories, or to extend the existing bankruptcy laws in Chapter 9 of the Bankruptcy Code (with modifications) to Puerto Rico and its municipalities.Publication An examination of challenges educators and families faced in the Aftermath of COVID-19(2020-11-09) Banwo, Bodunrin O; Anderson, Erin; Childs, Joshua; Stone-Johnson, Corrie; Leading in CrisisAs schools begin to fully or phase into re-opening, they should ensure that the 3 “I”s that have emerged during Covid-19 in education; infrastructure, interaction, and instruction (both in-person and online) are adequately addressed. This is one of a series of briefs that focused on a ‘critical incident’ surrounding school closure and offers pragmatic suggestions to educational leaders as they continue to grapple with the disruptions of the pandemic.