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FEBRUARY 2008 HOT TOPICSLive Telephone Operators Are Crucial to Disease-Reporting Hotlines
Results showed that local health departments that relied on live operators at all times to receive urgent case reports by phone were more likely to meet federal guidelines designed to limit the spread of infectious diseases. Optimal performance in connecting callers with trained public health professionals within the time recommended by CDC guidelines—30 minutes or less—was achieved by 31 percent of participating health departments. (Since the study was completed, CDC has shortened the recommended time to 15 minutes.) However, among nearly 40 percent of health departments, one or more calls never reached a trained public health professional. The study also identified other factors that may be important to improving performance, including ensuring that telephone operators are well trained and have a system of formal protocols to respond to calls. This study provides an example of objective performance measurement in public health systems and suggests that improvements in telephone-based disease-reporting systems may be possible with regular assessment. Read More »Why People Overeat: Rethinking the Causes of Obesity
Psychologists have found that many human responses to environment factors, including eating, can be understood as automatic behaviors. Labeling eating as an automatic behavior does not mean that people cannot control their eating; automatic behaviors can be controlled temporarily. But control over these behaviors is limited and hard to sustain over the long term. As a society, we find it difficult to accept that eating could be an automatic behavior. We tend to blame lack of will power when the more likely culprit is an automatic response to cues to eat and the availability of cheap, convenient, high-calorie foods. Viewing eating as an automatic behavior implies a new response to the obesity epidemic. Instead of educating or motivating people to eat less, it may be necessary to decrease the accessibility, visibility, and quantity of foods to which people are exposed, which, in turn, reduces environmental cues that encourage eating. Read the Fact Sheet »Improving Quality of Care for the Vulnerable Elderly
Based on these findings and on progress in diagnosis and treatment, the ACOVE team has updated its quality indicators. These indicators are intended to evaluate whether the care being delivered at the system level meets minimal standards of quality. They are also intended to guide the design of future interventions aimed at improving the quality of care that the vulnerable elderly receive. Read the Research Brief »
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RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health/. The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. Learn More »Copyright © 2008 RAND Corporation. 1776 Main Street, Santa Monica, CA 90401-3208. RAND® is a registered trademark. The RAND Health Congressional Newsletter is distributed on an opt-in basis only by visiting us at www.rand.org. We respect your privacy. If you do not wish to receive this periodic newsletter, please email ocr@rand.org or call (703) 413-1100 x5395. This newsletter is also available on the RAND Congressional web site » |
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Local health departments are the nation's first line of defense against infectious disease outbreaks. Because no one can predict where or when an outbreak will occur, health departments must be prepared to receive information about urgent cases and act promptly. As part of an assessment of public health readiness in the United States, RAND Health tested local health department response times to reports of an urgent infectious disease. Researchers conducted a series of unannounced tests on the telephone-based disease-reporting systems of a nationally representative sample of 74 local health departments. Health directors agreed to participate but were asked not to alert their staff about the testing until it was complete. RAND researchers used trained callers posing as doctors or nurses at a local health care facility to place calls to local health departments to report an urgent case of infectious disease. 
Public campaigns to prevent obesity have focused on nutritional guidelines, diets, and food labels. These efforts assume that, armed with proper information and motivation, people will consume fewer calories. This assumption, in turn, assumes that eating is a conscious act. However, the acceleration of America's obesity epidemic despite these efforts has caused researchers to question these assumptions. In a recent article, RAND researcher Deborah Cohen explores an alternative assumption: Eating is influenced more by environmental factors than by conscious choice. Numerous studies provide evidence for this view. Research has shown, for example, that when people are served larger portions, they eat more food, regardless of other factors. In addition, the amount of food consumed increases as the effort to eat decreases, and people eat more when sharing meals with others. Further, once people begin eating, they usually continue to eat until the food is gone or until interrupted in some way. 
In 2000, RAND Health researchers released quality measures developed for the vulnerable elderly—those most likely to die or become severely disabled within two years. The Assessing Care of Vulnerable Elderly (ACOVE) indicators reflect the most comprehensive examination ever conducted of the quality of medical care provided to vulnerable older Americans. A second phase of the ACOVE study is now complete. Researchers used the results of the earlier assessments, and the quality measures themselves, to design interventions aimed at improving care quality for three conditions associated with aging: falls and mobility impairment, urinary incontinence, and cognitive impairment. They then tested the effects of these interventions on care practices in a controlled trial carried out in two large medical groups in Southern California. Elderly patients whose doctors' offices implemented the interventions received significantly better care for mobility impairment and incontinence (but not for cognitive impairment) than did patients whose doctors' offices did not participate. 
