Policy Analysis (United States)

This Viewpoint discusses how real-world evidence studies could help the US Centers for Medicare & Medicaid Services align spending with value in their drug price negotiations.

Forcibly displaced people face significant biopsychosocial barriers to accessing health care. Digital health interventions have emerged as tools to bridge care gaps and have been successfully implemented in other disadvantaged populations to improve health care access and outcomes. However, the feasibility and practicality of digital health interventions among forcibly displaced individuals cannot be fully evaluated without characterizing recruitment and retention rates for these interventions in this unique population. To evaluate the recruitment rate and retention rate for digital health interventions in forcibly displaced people. A comprehensive search was conducted in PubMed, Web of Science, and SocINDEX in January 2023, with an updated search in February 2024. The search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in PROSPERO. Only randomized clinical trials evaluating digital health interventions in forcibly displaced populations were included. Non-peer reviewed studies, reviews, and studies lacking recruitment or retention data were excluded. Two independent reviewers screened and selected studies, and conflicts were resolved by a third reviewer. Data were extracted independently by 2 reviewers using Covidence, and a third reviewer resolved discrepancies. Meta-analysis was conducted using a random-effects model to estimate the pooled recruitment rate and retention rate. Study quality was assessed using the Downs and Black Checklist. Recruitment rate (percentage of prospective participants who were successfully randomized) and retention rate (percentage of randomized participants who completed the intervention). A total of 9 randomized clinical trials with 2858 participants were analyzed. The most frequently investigated technology was mobile applications (4 trials), followed by mobile phones (3 trials), with 1 study utilizing tablets and another using wearables. Recruitment rates varied widely across studies (16% to 100%), as did retention rates (28% to 91%). The pooled recruitment rate was 91% (95% CI, 57%-99%; I2 = 99%), and the pooled retention rate was 68% (95% CI, 48%-84%; I2 = 98%). In this systematic review and meta-analysis of 9 randomized clinical trials, forcibly displaced populations exhibited variable recruitment and retention rates, although pooled estimates were high. These findings suggest that digital technologies provide a unique opportunity for scalable health interventions in this population, which may mitigate the negative health consequences arising from the many biopsychosocial barriers to in-person care.

Purpose This study aims to provide international evidence on the effectiveness of mentoring programs in increasing new teachers’ expected career length, focusing on the mediating roles of job satisfaction and organizational commitment. Design/methodology/approach This study utilizes multilevel structural equation modeling to analyze international data from the Teaching and Learning International Survey 2018. Findings The results indicate a direct effect of mentoring program participation on novice teachers’ expected career length. The study reveals that this relationship is mediated by organizational commitment, while job satisfaction does not serve as a mediating factor. These findings deepen our understanding of the mechanisms through which mentoring programs relate to novice teachers’ expected career length. Practical implications School leaders and policymakers are encouraged to provide and tailor mentoring programs in a way to promote organizational commitment, thereby enhancing the effectiveness of mentoring on novice teachers’ retention. Originality/value The insights will be informative for school leaders and administrators in retaining novice teachers, supporting more efficient school administration, management and improvement.

ABSTRACT Research on educational leadership preparation remains limited despite its importance for the larger educational leadership scholarship. This paper aims to provide a helicopter view of the current research topics in leadership preparation and their evolution. Using structural topic modeling (STM), it analyzes 786 full-text articles in the field published between 1966 and 2023. The analysis estimates 19 topics grouped into three clusters: Leadership Learning & Development, Policy, Equity & System Change, and Research, Theory & Practice. Over time, the research focus on leadership preparation has shifted from administrative and compliance-oriented topics like leadership standards and accreditation toward more equity-centered, emotionally attuned and practice-based approaches. Several topics, including instructional leadership, partnerships, race and identity, and emotional and reflective practices, have continued to grow, while topics like standards and system reform have declined. Finally, the study discusses the findings by pointing out the importance of incorporating equity, emotional engagement, and global perspectives into leadership preparation. The use of topic modeling provides a data-driven map of research trends by offering insights for future scholarship, policy reform, and program (re)designing.

Abstract Farm delinquency is linked to many negative indicators of farm survival, including increased risk of bankruptcy and farm failure. Minority farmers and ranchers (MFR) have been found to exhibit higher rates of delinquency on U.S. Department of Agriculture (USDA) Farm Service Agency (FSA) loans compared to their non‐Hispanic White male counterparts. These findings persist even after accounting for economic/financial factors expected to predict loan repayment performance. In this study, to further explore the existing discrepancy between loan default rates for MFR and White, non‐Hispanic borrowers, we look more broadly than financial indicators and introduce MFR representation on the FSA County Office Committee (COC) as a proxy for the local cultural climate in an agricultural community. Using changes in COC membership demographics over time and across counties, this study suggests that MFR representation on the COC is associated with a lower probability of MFR delinquency by roughly 10 percentage points. With the probability of delinquency also being about 10 percentage points higher among MFR, the effect represents a significant improvement in loan repayment outcomes for the group. The FSA COCs represent an important linkage between the USDA and the local agricultural community. Moreover, elected minority representation on COCs can be considered as indicative of supportive cultural climates for minorities in agriculture. Given that COC membership composition may represent a proxy for local cultural climate in agriculture, this research raises interesting questions about the potential relationship of MFR representation and community engagement, to FSA program performance.

ABSTRACT This paper evaluates the impact of Sweden’s R&D payroll tax subsidy on the employment of highly skilled workers, focusing on PhDs and STEM professionals. Unlike traditional R&D tax incentives, which reduce taxable income, this subsidy directly lowers payroll taxes for R&D personnel, making it particularly relevant for SMEs and financially constrained firms. Using firm-level panel data from 2011 to 2019 and a difference-in-differences (DiD) approach, we find that the subsidy significantly increases the employment of high-skilled workers. The effects are consistent across firm characteristics, though some variation exists between smaller and larger firms. To ensure robustness, we conduct additional tests using alternative outcome measures, firms near the subsidy cap, and a linear estimation model. A parallel trends sensitivity analysis further supports the validity of our identification strategy. Our findings contribute to the literature on R&D tax incentives and innovation policy by providing new evidence on the labour market effects of payroll tax subsidies for R&D personnel. These insights are particularly relevant for policymakers designing tax-based R&D support schemes.