How to make pediatric assent guidelines specific for IRBs to apply uniformly?” Now that you have an issue, what about the issue requires a governmental solution (as opposed to an individual or non-governmental organization solution)?
Topic: issue analysis
please see attached guidelines .They must be followed . I thought a good topic might be womens health birth control issues currently being debated . I am a conservative republican so I would prefer you take this approach on the topic you feel is appropriate
For this assignment, you will adopt the role of a staff member for an elected official in either the state or federal government. This policy maker is a lawyer by education and has a typical layman’s knowledge of health care. One day he works on trade issues, the next energy issues, the next may be focused on the criminal justice system…health care is simply one of many issues he deals with. You will write the analysis to, and for, this elected official. Therefore, this will be different from any paper that you’ve ever written: it is not a typical academic paper. This is not an opinion piece. It is not an advocacy piece: you must approach the topic as an unbiased analyst. Based upon your analysis of the political issue, you will make 2-3 action recommendations for the elected official, your boss. You should assume that your boss trusts you and may take your recommendations and march onto the floor on the governing body and give a speech based upon your analysis. See an example of an issue analysis paper at the end of this syllabus AND an important comment about citing URLs.
• Select a health or health care issue that is amenable to legislation or government regulation for a solution or improvement. Not every issue/problem should be legislated! The topic should be manageable… “Oral Health” as a topic is too large but “Fluoridation of water supplies” is manageable. State the title or role of your imaginary boss.
• Clarity is the goal. Accuracy is essential: statements, facts and figures must be supported with citations. The best analyses are not solid text…they have data compiled for the reader into a figure or a table.
• References should be annotated with a brief description of any political bias within each reference or source. Use common sense here. Step outside your comfort zone and use references that politicians use, email associations, calls government offices to get unpublished information that will make your analysis shine.
• Create tables or charts of information rather than writing out lengthy statistics or facts. If you provide a table of facts, you can simply label the table in a 10 font with the citation and not repeat it in the reference list. Label/cite all graphics that are not your originals.
“Dew knot trussed yore spell chequer two fined awl yore mistakes.” – Brendan Hills
Formatting the Issue Analysis Paper:
1. No more than 10 pages, double-spaced, including references. No appendices allowed.
2. Times New Roman 12 font, 1 inch side margins, 1 inch top/bottom margins. Number all pages.
3. Use either APA or JAMA format for your citations and references.
4. Title page. We need your name! (Recommend that you include your name in the FILE name)
5. Introduction: Introduce an issue (rather than a problem) using these rules- In terms of policy making, a problem rises to the level of an issue only if there is a dispute or more than one option for a solution (e.g., Everyone agrees pediatric assent guidelines for research are not specific enough. That is the problem. But the issue is “How to make pediatric assent guidelines specific for IRBs to apply uniformly?” Now that you have an issue, what about the issue requires a governmental solution (as opposed to an individual or non-governmental organization solution)?
6. Economic and non-economic costs of the present situation. Stakeholders. Identify all stakeholders and their importance. What are their positions on the issue? Are there any champions on either side of the dispute? You must identify both supporters and opponents for your “boss” even if you are able to say that no one opposes it. If there are numerous stakeholders, creating a table is wise.
7. Policy options.
8. Recommendations stated briefly and clearly. These should be realistic recommendations for action. These recommendations must be feasible. No more than three well-supported recommendations.
9. Economic and non-economic savings/losses of your recommendations.
10. Evidence that you’re proposed solution/recommendations will make a difference
11. Implementation: ease or difficulty or implementation and a timeline for implementation
12. Enforceability of the recommendations. Include who will monitor and regulate compliance with the recommended recommendations as well as an educated guesstimate of the costs of monitoring.
Peer Evaluation Rubric
0 = absent, 1 = poor, 2 = fair, 3 = average, 4 = good, 5 = excellent
Support these ratings using track changes and comments within the body of your peer’s paper.
Item of evaluation Points 0-5
1. Selected topic is appropriate for action at the level of government indicated. The title or role of the imaginary boss is stated.
2. Uses facts and figures effectively and provides supporting citations
3. References are annotated appropriately
4. Formatting – complies with all instructions
5. Rate the clarity of writing for these sub-headings in the analysis:
a. Introduction
b. Economic and non-economics costs of present situation
c. Stakeholders
d. Policy options
e. Recommendations
f. Economic and non-economic savings/losses of recommendations
g. Evidence solution will make a difference
h. Implementation: difficulty and timeline
i. Enforceability
6. Poor grammar (subject-verb disagreements, incomplete sentences, its versus it’s, ‘data are’ versus ‘data is’, run-on sentences, paragraphs with less than two sentence, and improper use of capital letters are common errors)
7. Spelling errors
TOTAL 0-80
Faculty Grading Rubric
Presents and defines a focused policy issue 10
Presents critical analysis of current state of situation, including:
Economic and non-economic costs 10
Stakeholders and their importance 5
Presents 2-3 policy options that are feasible given current state of the issue 20
Presents critical analysis of proposed solutions/options, including:
Economic and non-economic savings/losses 10
Specific descriptions of how proposed options will a difference on the issue 5
Enforceability (who will monitor, costs) 5
Ease and timeline of implementation 5
Cites relevant references with annotations and bias 10
Is clearly and well written (no typos, grammar mistakes, coherent sentences and paragraph) 20
100
EXAMPLE OF ISSUE ANALYSIS
Tax Credit for Employee Wellness Programs
STUDENT NAME
Duke University School of Nursing
Introduction
Poor diet, physical inactivity, and tobacco use are the major preventable causes of death in the United States. These problems are linked to approximately 33 percent of all deaths-about 700,000 each year, making them nearly as lethal as HIV/AIDs, alcohol, drug abuse, motor vehicle accidents, murders, suicides and fires combined (Mensah, 2004). According to the Centers for Disease and Prevention, in 2001, 21 percent of adults in the US were obese, 26 percent of adults were classified as physically inactive, and more than 22 percent of adults smoke regularly (as cited in NGA center for Best Practices, 2001).
Per the Healthy Workforce Act (2009), the United States has more than 12 million employers and approximately 135 million working adults. Workers spend more than one third of their day on the job. Rising health care costs and alarming statistics on unhealthy lifestyles have driven some employers and states to adopt employee wellness programs. Furthermore, Healthy People 2010 identified 2 major worksite objectives:
1. Most employers (75%) regardless of size will offer a comprehensive employee health promotion program 2. Most employees (75%) will participate in employee sponsored health promotion activities (US Department of Health and Human Services, 2000).
Employee Wellness Programs generally promote healthy habits, health education and screenings, disease management, and regular physical activity. These programs can be offered in a variety of formats such as mandatory training sessions or voluntary seminars. A third party administrator is often advised to avoid potential confidentiality issues. The employer covers the bill for the programs because an investment in employee health is a business. Voluntary wellness programs are the most popular and in most cases are made available to employers but participation is not linked to any type of consequence. Incentive based company wellness programs are based on incentives or rewards employees receive for participation in the wellness program such as reduced medical care premiums or fitness center membership. Employers are often confused as to what incentives they can lawfully implement. Incentives conditioned on program participation rather than health factors are compliant withthe Health Insurance Portability and Accountability Act of 1996 (HIPAA). Mandatory wellness programs may require participation and ban certain health related actions and can take the form of mandatory high risk health assessments and bans on smoking or alcohol use. The Employee Retirement Income Security Act (ERISA), HIPAA, and the Americans with Disabilities Act (ADA) are potential legal hurdles to any mandatory wellness program (Ghandakly, 2008). Mandated employee wellness programs can lead to increase in turnover as staff members either chose to leave or are fired for non-compliance.
Many employers of the nation’s 135 million workers have been reluctant to or unable to institute wellness programs mainly for financial reasons. As reflected in the findings of the 2004 National Worksite Health Promotion Survey, only 6.9% of surveyed organizations met the criteria for a comprehensive health promotion program (Linnan, Bowling, Childress, et al, 2008). This is far short of the target goal of 75% included in the Healthy People 2010. Lack of employee interest, lack of participation, and lack of resources were also cited as barriers to offering health promotion programs in this survey. The Wellness and Prevention Act (2007) proposed a wellness program employer tax credit and an employee participant wellness tax credit. Wellness programs needed to meet acceptable standards. This bill was introduced in the House and deferred to committee. The Healthy Workforce Act (2009) reintroduced an employer tax credit in the Senate and was deferred to the finance committee.
Policy Option Description
• Would offer a tax credit to businesses that have comprehensive employee wellness program.
• Would credit businesses up to $200 per employee for the first 200 employees and up to $100 per employee, thereafter.
• Companies would be eligible for the tax credit by establishing programs that raise health awareness among employees by health education and screenings, encourage employee behavioral changes in areas of tobacco use, obesity, stress management, physical fitness, nutrition, prompt employee participation through an incentive, and offer a supportive environment component. Qualified wellness programs shall offer at least 2 of the preventative services strongly recommended by the US Preventative Task Force.
• Qualified wellness programs shall be certified by the office of the Secretary of Health and Human Services in coordination with the Director of the Center for Disease Control and Prevention.
• Would offer a participant tax credit of 200 dollars per taxable year for those who participate in at least 2 of the preventative services.
Costs to government and stakeholders
Nationally US healthcare costs are steadily rising. The Agency for Healthcare Research and Quality (AHRQ) states that in 1996 the average health care expense per person in the US was $2,398 versus $3, 879 in 2004. Aggregate expenses in 1996 totaled $554 billion versus $964 billion in 2004 (as cited Ghandakly, 2008). A report issued by the US Department of Health and Human Services estimated that 75% of US health care dollars are spend on chronic conditions, most of which are preventable (as cited in Ghandakly, 2008). Tobacco use and obesity have an annual total financial impact of $157 billion and $117 billion respectively and are major risks factors for chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disease, cancer, and diabetes (as cited in Partnership for Prevention & US Chamber of Commerce, 2000). Studies related to obesity, physical inactivity, and tobacco use have shown that these risks cost employers billions of dollars in excess health care costs. A 2008 study found that moderate to extremely obese employees experience a 4.2 percent loss in productivity due to weight related health problems which equated to $506 dollars in lost productivity per worker per year (Burton et al. as cited in Partnership for Prevention & US Chamber of Commerce, 2001).
Employer sponsored health benefits cover over 156 million Americans. Private health insurance premiums grew 5.0 percent from 1997 to 2000 and nearly doubled from 2000 to 2005. By 2015, annual health care spending is estimated to reach 4 trillion (Henry J. Kaiser Family Foundation as cited in Partnership for Prevention &US Chamber of Commerce, 2000). Due to rising costs, there is a decline in small firms offering health coverage. In 2007, 60 percent of employers offered health benefits, lower that the 69 percent reported in 2000 (Henry J. Kaiser Family Foundation as cited in Partnership for Prevention & US Chamber of Commerce, 2000). Among companies that offer health benefits, many are likely to increase the amount workers contribute to premiums, increase deductible amounts, increase office visit copays, and increase drug prescription coverage.
The Center for Disease Control and Prevention provides cost calculators to estimate the cost of employee wellness programs including administration costs and as well as costs to the company for various conditions and behaviors that employees may have. Calculators are available for depression, tobacco, alcohol, and physical inactivity, (cdc.gov). LEAN works is a free web based program offered by the CDC that helps employers calculate how much obesity costs their company and how much the company could save by implementing an obesity prevention program (www.cdc.gov/leanworks). The costs of wellness programs vary from 100 to 400 per employee a year. The actual costs depends on many factors such as whether it is run by a contractual vendor, how extensive the follow up interventions are, whether health coaching is involved, what health screening are being conducted, and what kind of incentives are provided. Return on investment will be also dependent on these factors. Dr. Ron Goetzel, director of Cornell University Institute for Health and Productive studies recommends investing about $150 per employee per year for an expected $450 annual ROI per employee (WELCOA, 2007).
Evidence
Successful employee wellness programs have generated noteworthy return on employer investments by achieving: reduction in health care costs, reduction in employee’s blood pressure, cholesterol, and weight, decreased absenteeism due to illness, depression, and stress, declines in on the job injuries, and increased satisfaction, morale, and productivity (Partnership for Prevention & US Chamber of Commerce, 2001). An 18 month wellness pilot program in one North Carolina county resulted in 20 percent newer cases of diabetes, 10 percent fewer new cases of heart disease, and 12 percent fewer cases of stroke. The state expects to save 22.5 million annually by implementing wellness initiative statewide (Easly as cited NGA Center for Best Practices, 2005). Ohio adopted their own public employee wellness program and put together a 10 million “Take Charge, Live Well” program to incentivize health assessments and screenings as well as exercise and stress reduction programs. The state estimates that 44% of its healthcare bill is made up of preventable conditions and expects at 35 million annual return on health care after the program has been in place for a few years (NGA Center for Best Practices, 2005). Tax credit for employee wellness will allow more organizations to have employee wellness programs and will motivate employees to participate.
Potential costs and savings
Studies indicate that the annual savings produced by wellness programs are around $613 per participant (as cited in Ghandakly, 2008). The University of Michigan Health Management Resource Center estimates that an organization saves $350 annually when a low risk employee remains low risk, compared to a savings of $153 when a high risk employees health risks are reduced (as cited in Partnership for Prevention & US Chamber of Commerce, 2001). Findings from 56 studies of worksite health promotion programs showed an average 27 percent reduction in sick leave absenteeism 26 percent reduction in health care costs, 32 percent reduction in worker’s compensation and disability management cost claims, and $5.81 to $1 return on investment (ROI) ratio. (Chapman, 2005).Intangible benefits may be even more important to an organization’s overall health: Studies show a correlation between employees who seek out corporate wellness programs and the most productive workers. Morale is another benefit of a wellness program. These programs are ways to show employees the organization is interested in them as total persons (Sims, 1997). Beyond this, wellness programs may save lives by early detection and treatment.
Partnership for Prevention (2005) convened the National Commission on Prevention Priorities to analyze the relative health impact and cost effectiveness of 25 preventive series recommended by the US Preventative Services task force. The health benefits of preventive services were defined as clinically preventable burden (CBP) or the disease, injury, and premature death that would be prevented if the service were delivered as recommended to all people in the target population. CBP was measured in quality adjusted life years or QALYS. The economic values of services were measured as cost effectiveness (CE) which compares the net cost of a service to its health benefits measured in QUALYS. Services that produce the most health benefits received the highest CBS score of 5 and services that were the most cost effective received the highest CE score of 5 (Partnership for Prevention, 2005). The table below cites some key relevant findings in relation to potential employee wellness offerings. Tobacco screening revealed the most health benefit and cost effectiveness.
Services:
Screening and intervention CBP CE Total
Tobacco 5 5 10
Hypertension 5 3 8
Cholesterol 5 2 7
Obesity 3 2 5
Diet 1 1 2
Implementation
Several governors and federal agencies have implemented wellness programs for state and federal employees. Some cities have passed resolutions requiring a focus on employee wellness. Healthy Workforce 2010 and Beyond (2000) is a guidebook to help employers plan, implement, and evaluation work place wellness programs. The Partnership for Prevention’s Priorities for America’s Health: Capitalizing on Life Saving Cost-Effective Preventive Services-Employers Guide (2005) gives employers fundamental principles on which to build their medical plans and employee wellness plan (2009 HRP). Wellness Councils of America (WELCOA) offers a step by step guide to help employers design and implement wellness programs. Other organizations such as insurance companies and the CDC also offer tools for developing wellness programs. Companies may need to contract with outside providers to provide wellness services..
Timeline
The effective date of this tax credit would apply to taxable years beginning after December 31, 2010. This would allow time to plan wellness programs and hire contractors if necessary to begin implementation in 2011.
Comprehensiveness
As defined by Healthy People 2010, a comprehensive worksite health promotion program includes 5 program elements. 1. Health education which focuses on skill development and lifestyle behavior change 2. Supportive social and physical environments 3.Integration of Worksite Program into organization’s structure 4.Linkage to related services like Employee Assistance Programs 5. Worksite screening programs (US Department of Health and Human Services, 2000). Qualified wellness programs shall offer at least 2 preventative services strongly recommended by the US Preventative Task Force. Programs will need to be signed off by the office of the Secretary of Health and Human Services in order to receive the tax credit.
Enforceability
The best wellness plan in the world is ineffective if the company is unwilling or unable to encourage participation by employees. This is where the tax credit could be favorable in enforceability. Certification of employee wellness programs will ensure that wellness programs meet comprehensive components. The Health Workforce Act (2009) requires the Secretary of the Treasury to institute an outreach program to inform businesses about the availability of the wellness program tax credit. This is essential as employers and employees need to be aware that the tax credit is available.
References
Chapman, L.S. (2005). The Art of Health Promotion-Meta-evaluation of Worksite Health Promotion Economic Return Studies: 2005 Update. American Journal of Health Promotion, 6.
Ghandakly, E. (2008). Employee Wellness Programs: A Cure for Employer Health Plans? Entrepreneurial Business Law Journal. 3.1
Healthy Workforce Act of 2009, S. 803, 111th Congress. (2009).
Linnan, L., Bowling, M., Childress, J., Lindsay, G., Blaky, C., Pronk, S., Wieker, S., & Royal, P.(2008). Results of the 2004 National Worksite Health Promotion Survey.American Journal of Public Health, 98, 1503-1509.
Mensah, G. A. (2004, December). Center for Disease Control and Prevention: Chronic Illness and Disease Prevention. Paper presented at the meeting of the National Conference of States Legislature Annual Conference.
NGA Center for Best Practices.(2005, May).State Employee Wellness Initiatives (Issue Brief No. 202/624-5332). Washington, DC: Bayard, Madeleine.
Partnership for Prevention & U.S. Chamber of Commerce.(2001). Healthy Workforce 2010 and Beyond. Washington, DC.
Partnership for Prevention (2005).Priorities for America’s Health: Capitalizing on Life Saving, Cost Effective Preventative Services. Washington, DC.
Sims, M. (1997). Wellness Programs are Worth Every Dollar You Spend. St. Louis Business Journal.
US Department of Health and Human Services.(2000). Healthy People 2010. Washington, DC. U.S Government Printing Office.
WELCOA. (2007). The Cost of Wellness: an interview with Ron Goetzel, Cornell University Institute for Health & Productivity Studies.
Wellness and Prevention Act of 2007, H.R. 853, 110th Congress. (2007).
Analysis of the References for Political Bias
• Partnership for Prevention is a national membership organization dedicated to disease prevention and health promotion policies and practices. Their landmark study was sponsored by the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ). The Partnership for Prevention is a national, nonprofit organization. Its members include several state health departments, health organizations (including the American Heart Association, American Cancer Society, American Diabetes Association, and March of Dimes), and several drug and insurance companies. This organization works closely with the Congressional Prevention Caucus, a bipartisan caucus formed in 1998 to raise the level of knowledge in Congress about prevention and strategies that can lead to a healthier nation.
• The US Preventative Task Force is sponsored by the AHRQ
• Kaiser Family Foundation serves as a non-partisan source of facts, information, and analysis for policy makers, the media, the health care community, and the public.
• NGA center for Best Practice states it is a bipartisan public policy and lobbying organization made up of chief executives of 50 states.
• St. Louis Business Journal has no stated political affiliation.
Citing URLs in the Issues Paper
In 2011 several students began using truncated URLs within the body of the issues paper. In the example below, the reader is directed to the home page of the CDC. It is pretty obvious that this is not the specific web page that was sourced…it is the home page of an organization. This is an incorrect way to cite web pages.
Recall that the purpose of all citations is to provide the reader with enough information to find the actual reference as desired. Clearly, citing the main page of a large organization’s webpage doesn’t provide enough information to accomplish this goal. In the example provided below, you can see that there are two references for the CDC. As the reader, one is left to wonder which one belongs to which citation in the paper.
I am not a nitpicker about format as long as I can easily find the information I want. I am seeing incomplete URLs, URLs cited in the body of the paper with no corresponding reference and URLs that are complete dead ends….I have to conclude that they are made up. Since at least 3 out of 9 students have used this “strange” style, I am wondering if you have been taught this method at some point.
If a policy maker gets frustrated with something like this, he/she will simply stop reading and will ask you (as his employee) to rewrite the paper OR he will never ask you to write anything else…ever.
EXAMPLE FROM THE BODY OF A PAPER:
“The flu season in the United States is typically considered November through April. It is during this time that flu viruses are circulating and people are in close contact indoors: the best way to reduce the chances of individuals contracting this virus is through vaccination. The hardest hit population during the flu season are those 65 years and older, with 90 percent of deaths occurring within that age group (cdc.gov).”
EXAMPLE OF THE CORRESPONDING REFERENCES:
Centers for Disease Control & Prevention.(2010, February). CDC’s Advisory Committee on
Immunization Practices (ACIP) Recommends Universal Influenza Vaccination. Press
Release. https://www.cdc.gov/media/pressrel/2010/r100224.htm
Centers for Disease Control & Prevention.Seasonal Influenza. Influenza Vaccination
Information for Health Care Workers.
http://www.cdc.gov/flu/HealthcareWorkers.htm
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