Publications on Health Care Quality
Quality of care is the extent to which all individuals receive the right care, at the right time, every time. RAND has been conducting research on measuring and assessing quality of health care for 40 years, and RAND teams developed many of the quality measures being used around the world today. In 2005, RAND analysts produced the first national report card on quality of care in the United States.
Selected Publications, 2007 to Present
Hospital Executives' Perspectives on Pay-for-Performance and Racial/Ethnic Disparities in Care — October 1, 2010
The findings suggest that payers should be hesitant to use pay-for-performance as a mechanism for reducing disparities until a wide variety of concerns about the design of such programs can be addressed.
A "Quiet Revolution" in Nephrology: Challenges and Opportunities for Advancing the Treatment of Chronic Kidney Disease — July 30, 2010
Shares results of a study examining changes in nephrology as it evolves from a focus on end-stage renal disease to the treatment of all stages of chronic kidney disease (CKD). Earlier stages of CKD progression can be slowed, halted, or even reversed.
Using the Lessons of Behavioral Economics to Design More Effective Pay-for-Performance Programs — July 1, 2010
Although pay for performance incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in these programs can enhance their effectiveness.
From Community-Based Pilot Testing to Region-Wide Systems Change: Lessons from a Local Quality Improvement Collaborative — July 1, 2010
This community-based collaborative project tested evidence-based approaches for improving the quality of care for mothers and their children in Allegheny County, Pennsylvania.
Examines changes in nephrology as it evolves from a focus on end-stage renal disease (ESRD) to treating earlier stages of chronic kidney disease (CKD). Once patients reach ESRD, treatments are limited to kidney transplantation and dialysis. However, the progression of earlier stages of CKD can be slowed, halted, or reversed when treated. Clinics are still establishing best-practice models, and reimbursement remains a challenge.
Patient Protection and Affordable Care Act: Laying the Infrastructure for National Health Reform — June 1, 2010
This article discusses the range of health information technology initiatives included in the 2009 economic stimulus legislation that collectively are known as the Health Information Technology for Economic and Clinical Health (HITECH) initiative; these include proposed regulations on "meaningful use" of information technology and standards; funding of regional extension centers; and support for the development and use of clinical registries and linked health outcomes research networks.
The choice of attribution rule affects how costs are assigned to a physician and can substantially affect the cost category to which a physician is assigned.
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.
International benchmarking of healthcare quality: A review of the literature — February 15, 2010
The report describes existing indicators to compare healthcare quality in different countries and their challenges. Case studies of avoidable mortality and cancer survival illustrate the potential of cross-national comparisons and their difficulties.
Racial/ethnic Differences in Patients' Perceptions of Inpatient Care Using the HCAHPS Survey — February 1, 2010
Using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the CAHPS Hospital Survey) data from 2,684 hospitals, the authors compare the experiences of Hispanic, African American, Asian/Pacific Islander, American Indian/Alaska Native, and multiracial inpatients with those of non-Hispanic White inpatients to understand the roles of between- and within-hospital differences in patients' perspectives of hospital care.
Assessing Care of Vulnerable Elders--Alzheimer's Disease: A Pilot Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care — February 1, 2010
This pilot study suggests that a practice-based intervention can increase referral to Alzheimer's Association chapters and improve quality of dementia care.
Effectiveness of Shared Pharmaceutical Care for Older Patients: RESPECT Trial Findings — January 1, 2010
Evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards.
Children's Health in Washington, D.C.: Access and Health Challenges Despite High Insurance Coverage Rates — October 28, 2009
Assesses children's health issues in Washington, D.C., including the health care delivery system and neighborhood health environments.
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.
Increase the Use of Comparative Effectiveness — October 12, 2009
The RAND Corporation's COMPARE initiative provides information and tools to help policymakers, the media, and others understand, design, and evaluate health care policies.
Change Medical Liability Laws to Reduce the Frequency and Severity of Claims — October 12, 2009
This document explores how changing medical liability laws to reduce the frequency and severity of claims would affect health system performance along nine dimensions.
Physician Pay for Performance — October 12, 2009
This document explores how physician pay for performance (P4P) programs would affect health system performance along nine dimensions.
Hospital Pay for Performance — October 12, 2009
This document explores how hospital pay for performance (P4P) programs would affect health system performance along nine dimensions.
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.
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.
Episode-based Performance Measurement and Payment: Making It a Reality — September 1, 2009
Proposals to use episodes of care as a basis for payment and performance measurement are largely conceptual at this stage, with little empirical work or experience in applied settings to guide their design.
Presents the results of a two-year study that analyzes how patient safety practices are being adopted by U.S. health care providers, examines hospital experiences with a patient safety culture survey, and assesses patient safety outcomes trends. In case studies of four U.S. communities, researchers collected information on the dynamics of local patient safety activities and on adoption of safe practices by hospitals.
Radiation or surgery can lead to significant dysfunction or distress in the urinary, sexual, or bowel domains. Hence, the simultaneous consideration of both quality and quantity of life improves medical decision making for these men.
Defining High Quality Health Care — July 1, 2009
It is crucial that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.
When Drug Cost-Sharing Increases, Patients Newly Diagnosed with a Chronic Illness Delay Starting Medication — June 29, 2009
Describes a study showing that increasing copayments for prescription drugs causes patients newly diagnosed with hypertension, high cholesterol, and diabetes to delay starting treatment, which in turn increases their risk for heart attack and stroke.
A Systematic Review of Health Care Efficiency Measures — June 1, 2009
Review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods.
Experiences of Agency for Healthcare Research and Quality-Funded Projects That Implemented Practices for Safer Patient Care — April 1, 2009
Synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices.
Adopting Information Technology to Drive Improvements in Patient Safety: Lessons from the Agency for Healthcare Research and Quality Health Information Technology Grantees — April 1, 2009
Document and assess the experiences of 104 Agency for Healthcare Research and Quality (AHRQ)-funded health information technology (health IT) grantees in planning and implementing health IT systems.
The authors document the numbers and types of interorganizational partnerships within the national patient safety domain, changes over time in these networks, and their potential for disseminating patient safety knowledge and practices.
Describe the evaluation performed of the patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ).
Setting the Stage for the Second Decade of the Era of Patient Safety: Contributions By the Agency for Healthcare Research and Quality and Grantees — April 1, 2009
This year marks the 10th anniversary of the Institute of Medicine's (IOM) To Err Is Human report that focused the health care community and the public on the inherent risks that patients face when they seek care. Importantly, the message made it clear that many adverse consequences were preventable if only we thoughtfully implemented systems that would prevent good people from making serious mistakes. To that end, the IOM challenged us to reduce the number of health care errors by 50 percent over 5 years.
To prepare Agency for Healthcare Research and Quality (AHRQ) for monitoring the impact of its own patient safety initiative, by exploring available outcomes data, assessing usability of measures, and estimating national trends in patient outcomes.
Assessment of Contributions to Patient Safety Knowledge By the Agency for Healthcare Research and Quality-Funded Patient Safety Projects — April 1, 2009
Characterizes the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)'s patient safety portfolio and assess their aggregate potential to contribute to knowledge development.
Comparing process- and outcome-oriented approaches to voluntary incident reporting in two hospitals — March 1, 2009
The debate over whether patient safety efforts should focus on adverse events or errors logically extends to voluntary incident reporting in hospitals. Reports emphasizing adverse events take an outcome-oriented approach to improving quality, whereas those emphasizing errors take a process-oriented approach. These approaches were compared in an analysis of 2,228 paper incident reports for 16,575 randomly selected inpatients at an academic hospital and a community hospital in the United States in 2001.
Improving Patient Safety in the EU: Assessing the expected effects of three policy areas for future action — December 15, 2008
Presents findings of a study in which we assess the expected effects of three policy areas for future action towards improving patient safety in the EU-27. Our study was informed by a mixture of methods, including the existing European and international studies and evaluations on patient safety and related initiatives, as well as primary qualitative data based on 32 key informant interviews with identified experts.
Impact of Date Stamping on Patient Safety Measurement in Patients Undergoing CABG: Experience with the AHRQ Patient Safety Indicators — August 13, 2008
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) provide information on hospital risk-adjusted rates for potentially preventable adverse events. Use of the present-on-admission indicator increases PSI accuracy.
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.
Assessment of the AHRQ Patient Safety Initiative: Final Report -- Evaluation Report IV — June 16, 2008
Updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the current priorities and activities undertaken; and assesses contributions of funded projects and dissemination actions to support adoption of evidence-based safe practices. Discusses implications for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities.
When Should Measures Be Updated? Development of a Conceptual Framework for Maintenance of Quality-of-Care Measures — June 1, 2008
Documents current practices on long-term maintenance of quality measures and develops a consensus framework to guide the design of maintenance systems. Three key maintenance functions are ad hoc review, annual maintenance, and regular re-evaluation.
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.
High-deductible Health Plans and Better Benefit Design — May 1, 2008
Advocates of high-deductible health plans, which shift more of the cost of care to individuals, believe that consumers will more carefully assess the balance of health care benefits versus costs, ultimately improving efficiency and quality of care.
Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices — April 1, 2008
Describes practice characteristics associated with implementation and use of e-prescribing in ambulatory settings. Successful practices exhibited greater familiarity with capabilities and had more modest expectations about benefits of e-prescribing.
Organizing for Quality: Inside the ''Black Box'' of Health Care Improvement in Europe and the United States — March 10, 2008
This research brief summarizes a book on health care quality improvement efforts, suggesting a focus on the organizational and human dimensions of change and the processes by which these dimensions are set in motion and unfold over time.
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.
Improving the Quality of Health Care for Older Adults — February 6, 2008
This research brief summarizes the results of Assessing Care of Vulnerable Elderly (ACOVE)-2, which measured the quality of care delivered to a group of older adults, and describes a recent revision of the quality measures, known as ACOVE-3.
Trends in Socioeconomic Disparities in Health Care Quality in Four Countries — February 1, 2008
Found socioeconomic disparities in health care quality and status for most of the indicators studied in four countries. These disparities in varied indicators underscore the importance of factors common to the systems or factors outside the system.
How Costly Is Hospital Quality? A Revealed-Preference Approach — January 1, 2008
The authors inferred quality at hospitals in greater Los Angeles from the revealed preference of pneumonia patients. The authors then decompose the joint contribution of quality and unobserved productivity to hospital costs, relying on heterogeneous tastes among patients for plausibly exogenous quality variation. They found that more productive hospitals provide higher quality, demonstrating that the cost of quality improvement is substantially understated by methods that do not take into account productivity differences.
Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events — January 1, 2008
Patients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.
Evidence for the Effect of Disease Management: is $1 billion a year a good investment? — December 1, 2007
To assess the evidence for the effect of disease management on quality of care, disease control, and cost, with a focus on populationbased programs.
The Cumulative Effects of Quality Improvement for Depression on Outcome Disparities Over 9 Years: Results from a Randomized, Controlled Group-Level Trial — November 1, 2007
Quality improvement (QI) programs for depression can improve outcomes of care and reduce outcome disparities; but cumulative effects on mental health outcome disparities have seldom been evaluated.
The Quality of Ambulatory Care Delivered to Children in the United States — October 11, 2007
Little is known about the magnitude of deficits in the quality of care delivered to children, since comprehensive studies have been lacking.
Assessing the Diffusion of Safe Practices in the U.S. Health Care System: Interim Report to the Agency for Healthcare Research and Quality — October 9, 2007
Reports on RAND's FY 2007 work concerning the practice diffusion assessment component of the Agency for Healthcare Research and Quality's patient safety activities.
Assessment of the AHRQ Patient Safety Initiative: Focus on Implementation and Dissemination Evaluation Report III (2004-2005) — October 7, 2007
Updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the current priorities and activities undertaken; and assesses contributions of health information technology projects and dissemination actions to support adoption of evidence-based safe practices. Discusses implications for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities.
Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder — October 1, 2007
Explores the cost-effectiveness of quality-improvement interventions for depression in primary care, relative to usual care, among patients with subthreshold depression or depressive disorder.
Quality By Any Other Name? A Comparison of Three Profiling Systems for Assessing Health Care Quality — October 1, 2007
Adjusting for measurement error substantially enhanced our ability to identify this underlying construct.
The influence staffing levels, turnover, worker stability, and agency staff had on quality of care in nursing homes was examined.
Problem-Oriented Reporting of CAHPS Consumer Evaluations of Health Care — October 1, 2007
Consumer Assessment of Health Care Providers and Systems (CAHPS) is an organized effort to provide consumers with standardized, comprehensible, and usable data regarding consumers' experiences with health care.
A Systematic Review of the Adverse Effects of Prescription Drug Cost Sharing — September 11, 2007
This fact sheet summarizes a systematic review of published studies to analyze how the cost-sharing features of prescription drug benefits may affect access to prescription drugs and, consequently, health outcomes.
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.
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.
The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.
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.
Rates and Types of Events Reported to Established Incident Reporting Systems in Two US Hospitals — June 1, 2007
Hospital reporting systems receive many reports, but capture a spectrum of incidents that differs from the adverse events known to occur in hospitals, thereby substantially underdetecting physician incidents, particularly those involving operations, high-risk procedures and prescribing errors.
Effect of Content and Format of Prescription Drug Labels on Readability, Understanding, and Medication Use: A Systematic Review — May 1, 2007
Evaluates the evidence regarding the optimal content and format of prescription labels that might improve readability, understanding, and medication use.
The Response of Physician Groups to P4P Incentives — May 1, 2007
Although the scope and magnitude of incentives are still modest for many groups, the authors found an association between P4P incentives and the use of quality improvement initiatives.
Effect of Disease Management on Prescription Drug Treatment: What Is the Right Quality Measure? — April 1, 2007
Measures of medication adherence have become common parameters with which disease management (DM) programs are being evaluated, leading to the question of how this concept should be measured in the particular context of a DM intervention.
Assessment of the AHRQ Patient Safety Initiative: Moving from Research to Practice Evaluation Report II (2003-2004) — March 28, 2007
Updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the priorities and activities being undertaken; lays out an evaluation framework and possible measures of the effects on patient outcomes and on stakeholders other than patients. Discusses implications of the findings for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities.
Reducing Medical Malpractice By Targeting Physicians Making Medical Malpractice Payments — March 1, 2007
Some states use physicians' histories of medical malpractice payments to try to reduce the incidence of medical malpractice (and for other reasons). At least two types of policies fall into this category: using payments to decide which physicians will be investigated, and possibly sanctioned, by the state medical board; and making information about individual physicians' payment histories available to the public.
Consumer-Directed Health Care: Early Evidence Shows Lower Costs, Mixed Effects on Quality of Care — February 8, 2007
This research brief summarizes research on the effect of enrollment in consumer-directed health care (involving plans with high deductibles -- $1,000 or more annually) on the use, cost, and quality of medical care.
Does Ambulatory Process of Care Predict Health-Related Quality of Life Outcomes for Patients with Chronic Disease? — February 1, 2007
The use of instrumental variables allowed us to demonstrate a significant relationship between better ambulatory process of care and better health-related quality of life. This finding underscores the importance of efforts to improve the process of care.
Nursing Home Administrators' Opinions of the Resident Safety Culture in Nursing Homes — January 15, 2007
Nursing homes in the near future would benefit by addressing the resident safety culture. This may also have the beneficial effect of improving the image of the industry.
Measuring the benefits from research — January 12, 2007
This brief provides insight into the issues involved in research measurement and evaluation, and offers ways to approach the objective of assessing benefit. It also provides a 'toolkit' for use in the evaluation process.