Publications on Health Care Organization and Capacity
RAND Health research on the organization and capacity of the health care system takes a broad perspective. Our work has examined how organization affects the system’s ability to provide high-quality care and to use resources efficiently and effectively. Many studies have focused on the link between health system organization and the ability of the public health system to respond to public health emergencies, whether natural or the result of hostile action.
Selected Publications, 2007 to Present
Does Improved Patient Safety Reduce Malpractice Litigation? — April 7, 2010
Investigates the relationship between safety outcomes in hospitals and malpractice claiming against providers, using data for California hospitals and insurers from 2001 through 2005.
Presents information on the growing phenomenon of retail medical clinics, the types of patients they serve and the types of care they provide, and whether some common claims about retail clinics are supported by evidence.
Analysis of labor market trends suggests that the United States is experiencing a shortage of anesthesiology providers.
Post-Katrina Project Demonstrates a Rapid, Participatory Assessment of Health Care and Develops a Partnership for Post-Disaster Recovery in New Orleans — March 10, 2010
Stakeholders in communities in which health care access was disrupted by Hurricane Katrina were engaged in an assessment of health priorities, as well as in data interpretation and plan design, to produce a sustainable community-academic partnership.
California Ambulatory Surgery Centers: A Comparative Statistical and Regulatory Description — September 28, 2009
Ambulatory surgery centers (ASCs) are rapidly growing as a setting for the delivery of health care services, both in California and in the United States. This report describes the California ASC landscape, compares California ASCs to hospital outpatient surgery departments, and compares California's regulation of Ambulatory Surgery Centers to the regulations of other states.
Controlling Health Care Spending in Massachusetts — September 10, 2009
In 2006, Massachusetts passed landmark legislation ensuring near-universal health insurance coverage to its residents, but rising costs threaten the initiative; this policy brief assesses 21 options for controlling health care spending in the state.
Massachusetts passed legislation in 2006 ensuring health insurance to most residents, but rising costs and a weak economy threaten the sustainability of the reform. We analyzed 21 options for reducing health care spending in the state and identify those options that might produce savings over the next decade. Long-term solutions will require significant investments in information infrastructure and primary care capacity and fundamental change in health care delivery.
Electronic Health Records are Associated with Higher Quality in Primary Care Practices — October 27, 2009
Demonstrating a link between use of electronic health records in community-based primary care practices and higher-quality care, this study encourages prioritization of such technologies and their advanced functionalities.
Hospital Market Consolidation: Trends and Consequences — January 1, 2009
Examines the effects of hospital consolidation on hospital costs and prices to consumers.
A Policy-Relevant Picture of California's Ambulatory Surgery Centers — October 1, 2009
Examines how California's ambulatory surgical centers (ASCs) compare with hospital outpatient surgery departments and how the state compares with other states in regulating ASCs.
Delivery of Genomic Medicine for Common Chronic Adult Diseases — April 2, 2008
This fact sheet summarizes recommendations for health care workers, consumers, and the scientific community to prepare the health care system for genomic medicine for common chronic diseases.
Language and Regional Differences in Evaluations of Medicare Managed Care By Hispanics — April 1, 2008
Uses the Consumer Assessments of Healthcare Providers and Systems survey to examine the experiences of Hispanics enrolled in Medicare managed care. Hispanics face barriers to care; however, their experiences with care vary by language and region.
Medicare HMO Impact on Utilization at the End of Life — January 1, 2008
Medicare beneficiaries who died while enrolled in independent practice association model HMOs, including the Kaiser model, had many fewer hospital days during the two years before death than beneficiaries who died with fee-for-service coverage.
Finds a negative association between nonprice competition and quality of care in managed care plans in the New York SCHIP market. Pricing policy is likely a constraint on quality production, though it may not be interpreted as a causal relationship.
Addresses one step in the process of moving from teamwork training to teamwork practices that improve outcomes of care: identifying outcomes that are most likely to be affected as teamwork practices improve in an implementing organization. Discusses a literature search, methods for selecting and testing candidate measures, measures highly rated by clinical experts, and results of measure testing on administrative data of the DoD health system.
Scope of Rapid HIV Testing in Private Nonprofit Urban Community Health Settings in the United States — January 1, 2008
The authors examined patterns of rapid HIV testing in a multistage national random sample of private, nonprofit, urban community clinics and community-based organizations to determine the extent of rapid HIV test availability outside the public health system.
Spreading Nursing Unit Innovation in Large Hospital Systems — January 1, 2008
Evaluates efforts of three major hospital systems to internally disseminate nursing unit change among medical-surgical units. All organizations carefully planned, coordinated, and implemented a spread process; none left dissemination to chance.
Validating the Link Between Good Physician Process of Care and Better Health-Related Quality of Life for Patients — July 6, 2008
This fact sheet describes a study that confirms, for the first time, that better physician process of care leads to better health-related quality of life for patients receiving ambulatory care.
Accelerating the Adoption of Clinical IT Among the Healthcare Providers in US: Strategies & Policies — June 18, 2007
Analyzes the process of adopting clinical health information technology in hospitals and healthcare systems and derives policy strategies that could promote nationwide adoption.
Do Policies That Target Physicians Who Make Medical Malpractice Payments Reduce Negligent Injuries? — August 23, 2007
This fact sheet describes a study that found that policies targeting physicians' medical malpractice payment histories as a way to deter medical malpractice are ineffective, mainly because paying physicians are not the negligent ones.
Estimating the Potential Impact of Regionalizing Health Care Delivery Based on Volume Standards Versus Risk-Adjusted Mortality Rate — January 1, 2007
To examine whether basing regionalization on risk-adjusted mortality would lead to better population outcomes than basing regionalization on procedure volume.
The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration's Quality Transformation — January 1, 2007
Although VA's quality transformation had many underlying causes, investment in primary care development may have served as an essential substrate for many VA quality gains.
Forecasting the Supply of and Demand for Physicians in the Inland Southern California Area — September 12, 2007
Beckett and Morrison summarize their analysis of the projected supply of and demand for physicians who provide patient care in a region that includes Inland Southern California. As a means of comparison, they also analyzed the projected demand for and supply of physicians in the San Joaquin Valley and in California as a whole under a number of possible scenarios, including the creation of a new medical school in Inland Southern California.
Nurse Working Conditions and Patient Safety Outcomes — June 1, 2007
Nurse working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.
Organizational Culture and Physician Satisfaction with Dimensions of Group Practice — January 1, 2007
Some dimensions of physician organizational culture are significantly associated with various aspects of individual physician satisfaction with group practice.
Partially Capitated Managed Care Versus FFS for Special Needs Children — January 1, 2007
Little research has examined whether Medicaid managed care plans (MCPs) that incorporate case management are effective in coordinating services for children with special health care needs (CSHCN).
Redesign of the National Hospital Discharge Survey: Conceptual Framework and Feasibility Study: Final Report — April 24, 2007
The National Hospital Discharge Survey (NHDS), now over 40 years old, must reflect the types of care and services now offered in American hospitals. This report describes the first phase of an effort to develop an approach to redesigning the NHDS and to recommend, through a feasibility study, specific data elements to be included and field procedures to be used in that survey.
Teaching Systems-Based Practice to Primary Care Physicians to Foster Routine Implementation of Evidence-Based Depression Care — January 1, 2007
Although health care organizations seeking to improve quality often must change the system for delivering care, there is little available evidence on how to educate staff and providers about this change. As part of a 2002-2003 Veterans Health Administration multisite project using collaborative care to improve the management of depression, the authors implemented the Translating Initiatives for Depression into Effective Solutions (TIDES) program
Documents time allocated to care management activities and care manager workload capacity using data collected for studies of telephone care management of depression.