Federal Initiative Has Helped U.S. Cities Better Prepare to Respond to Public Health Emergencies
The Cities Readiness Initiative (CRI) was instituted in 2004 by the U.S. Department of Health and Human Services to help the nation's largest metropolitan areas prepare to dispense antibiotics to 100 percent of their populations within 48 hours—a goal based on an outdoor anthrax bioterrorism attack scenario. CRI currently involves 72 metropolitan regions and covers approximately 57 percent of the U.S. population.
In 2007, the Centers for Disease Control and Prevention (which administers the program) asked RAND to provide an initial evaluation of CRI. The evaluation found that CRI has improved cities' readiness to dispense antibiotics and health-related supplies to large numbers of people under emergency conditions. Specifically, CRI has enabled communities to increase staffing, strengthen partnerships, expand plans, purchase equipment, and engage in key planning activities and exercises. The evaluation could not determine CRI's impact on communities' ability to implement plans, because data are not yet available. The evaluation concluded that there is merit in provisionally continuing the program, which would allow CDC and others to monitor progress and reassess program impact in two to three years.
Retail Medical Clinics: Who Uses Them and What Kinds of Services do They Provide?
Retail medical clinics are clinics located in drug stores, grocery stores, and large "box stores." Typically, the clinics provide preventive care or care for simple, acute problems. The first retail clinic opened in 2000, and the number has rapidly increased in the United States. There are now more than 1,000 across the country. The growth of retail clinics has generated significant controversy. In particular, professional medical groups have raised concerns about whether they disrupt existing relationships between patients and primary care doctors. Despite these concerns, there has been little empirical analysis of retail clinics. A recent RAND study was the first to examine the characteristics of patients who use retail clinics and the medical services these clinics deliver. Researchers analyzed details of more than 1.3 million visits to retail clinics from 2000 to 2007 and compared information from that analysis to national data on primary care physician office visits and emergency department visits. According to the study's findings,
- The largest group of clinic users is young adults, age 18-44, who accounted for 43 percent of patients. Nationally, this group comprises only 23 percent of patients who visit primary care physicians.
- Retail clinic patients were less likely to have a personal doctor; 39 percent said that they had a primary care physician, compared to 80 percent of patients nationally.
- About 90 percent of visits to retail clinics were for 10 simple acute conditions and preventive care.
The results suggest that retail clinics attract patients who are not routine users of the current health care system and who are seeking convenient care for easily treated conditions. The majority of retail clinic patients do not report having a primary care physician and therefore, for these patients, there is no patient-physician relationship to disrupt.
Scaling Up Delivery of HIV/AIDS Treatment in Sub-Saharan Africa
The only proven medical treatment for HIV/AIDS is antiretroviral therapy (ART). In recent years, governments and humanitarian organizations in sub-Saharan Africa have rapidly scaled up the distribution and delivery of ART to deliver treatment to over a million people, but millions more still need treatment. What lessons have emerged from this initial scale-up experience that can help make mass distribution of ART more efficient and cost-effective? A RAND study addressed this question. In collaboration with AIDS Healthcare Foundation (AHF), a team of RAND Health researchers evaluated ART scale-up operations at clinics in Uganda, Zambia, and South Africa. Among the key lessons identified by researchers were those focused on involving community leaders in ART outreach to reduce the stigma of seeking care, developing strategies to help patients support each other and reduce dropouts from therapy, and implementing effective organizational management and personnel policies to reduce ART clinic staff burnout.
The researchers concluded that the objective of most ART scale-up programs is to make treatment available to all who need it, and, thus, most scale-up efforts have concentrated on increasing the number of clinics and staff without much attention to efficiency. A more thorough understanding of how to make ART scale-up more cost-effective and efficient while still providing quality care is critical to making ART access widespread and sustainable in sub-Saharan Africa.
ON THE HILL
Terri Tanielian testified before the House Veterans' Affairs Committee,
Subcommittee on Disability Assistance and Memorial Affairs on March 24,
2009. Her written statement, "Assessing Combat Exposure and
Post-Traumatic Stress Disorder in Troops and Estimating the Costs to
Society: Implications from the RAND Invisible Wounds of War Study" can
be downloaded at www.rand.org/pubs/testimonies/CT321/.
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RESEARCHER PROFILE
Christopher Nelson
Christopher Nelson is a Senior Political Scientist at RAND. He holds an
M.A. and Ph.D. from the University of North Carolina at Chapel Hill and
a B.A. summa cum laude from the University of Minnesota, where he was
elected to Phi Beta Kappa. Nelson has an active research agenda on
public health emergency preparedness that focuses on performance
measurement, standards, evaluation, and system improvement. Nelson's
work on occupational safety and health has explored the links between
organizational processes and organizational safety outcomes. Nelson has
also studied education reform, producing a book and numerous papers and
technical reports on school choice.
Read more work by Mr. Nelson »
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'COMPARE' Provides Global Positioning System for Health
Care Policy
There is no shortage of proposals for improving the U.S. health care system. What has been in short supply is reliable information that decisionmakers can use to understand the effects of implementing different policy choices. COMPARE meets this need. Read more at www.randcompare.org.
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RAND Health's 40th Anniversary
To mark RAND Health’s 40th anniversary, we are highlighting 40 studies or streams of research conducted over the past four decades that reflect the breadth and scope of our work and have made the greatest contribution to shaping health care policy, advancing health research, and improving the health of individuals around the world. Our March features include RAND’s study of the psychological and cognitive effects of deployment to Iraq and Afghanistan, media influences on teen sexual behavior, mental health interventions for school children following Hurricanes Katrina and Rita, and our studies of SCHIP’s effect on health care access and quality for children. Read more at www.rand.org/health/.
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RAND CONGRESSIONAL RESOURCES STAFF
Lindsey Kozberg
Vice President, Office of External Affairs
Shirley Ruhe
Director, Office of Congressional Relations
Kristy Anderson
Health Legislative Analyst
RAND Office of Congressional Relations
(703) 413-1100 x5395
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