Journal Article
This study of menu content at the 400 top restaurant chains the United States found that ninety-six percent of entrees exceed a measure based on USDA recommendations for sodium, fat, saturated fat, and calories combined.
Journal Article
Projections of a nursing shortage led to a substantial expansion in the RN workforce between 2005 and 2010. Rather than indicating that the crisis has passed, analysis indicates the growth to be largely a temporary bubble that is likely to burst between 2010 and 2015 as the unemployment rate falls.
Journal Article
Parents of newborns and seriously ill children often know about family leave options, but are sometimes too overwhelmed to apply for them or experience difficulties in accessing and using benefits. New parents reported wanting expert guidance, and saw hospitals and clinics as promising information sources.
Journal Article
A culturally relevant web-based Motivational Interviewing in English and Spanish was developed for use in DUI educational settings. The web format was widely accepted by both staff and clients, indicating this tool is feasible and may help help deter recidivism among first time DUI offenders.
Journal Article
Quality evaluations of medical procedures generating written reports historically required expensive coding and analysis, but new natural language processing programs effectively “read” dictated reports and measure colonoscopy quality. This analysis highlights the need for more routine measurement.
Journal Article
Multiple patient safety events (MPSEs), in which multiple health problems occur during a single hospitalization, affect thousands of US patients yearly. This first-time national estimate suggests that MPSEs cluster in disadvantaged populations, are resource intensive, and may often be avoidable.
Journal Article
Probiotics are believed to improve health by maintaining a normal balance of microorganisms in the human intestines. Evidence shows that they can reduce the risk of developing diarrhea, which is a common side effect of taking antibiotics.
Journal Article
If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.
Journal Article
The United States spends much more on health care per capita than any European country, but critics argue that US patients gain little from this extra spending. However, comparing cancer survival times in US to the EU show important gains, suggesting costs are justified by the results.
Journal Article
Coverage of specialty drugs for cancer and other diseases may be valued by healthy people thinking of future need as well as the sick. Surveyed US adults were willing to pay more for premiums than they would pay out of pocket with a less generous insurance plan, implying resistance to cost sharing on expensive drugs.
Journal Article
HIV-related stigmas have been seen as a barrier to greater faith-based involvement in HIV prevention and care. A study of diverse religious congregations suggested that stigma doesn’t prevent HIV outreach activities, and may in fact contribute to the further reduction of stigma over time.
Journal Article
New combination vaccines reduce the number of injections needed for immunization, but with higher prices and increased minor adverse events. Surveys revealed people are willing to pay to avoid increased risk of minor adverse events as well as to increase community-level immunization coverage.
Journal Article
2011 rules limiting work hours for medical interns will increase costs for hospitals, but may also lower the amount of preventable adverse events. Costs will be be greatly affected by the specifics of the work transfer, and also the amount of change to adverse events rates.
Report
When enacting, implementing, and evaluating health care reform, policymakers should consider potential spillover effects on workers' compensation insurance. The experience of Massachusetts's heath care reform suggests that reform may reduce medical costs.
Announcement
Elliott, a senior statistician with RAND Health, was recognized for outstanding contributions to statistical methods and practice in measuring patient experience with health services, health disparities and survey methods research, and promoting high caliber statistical practice in research.
Journal Article
Public reporting of health care costs is intended to motivate consumers to choose lower cost providers, and motivate providers to lower costs to retain market share. However, research suggests that consumer beliefs may end up working against the intended outcomes.
Journal Article
Most local public health officials rely on their perceptions of the legal environment in which they operate, but those perceptions often do not match the actual laws enacted. While the scope and provisions of laws can be confusing, much more could be done to help practitioners navigate the system.
Journal Article
Electronic Medical Record (EMR) systems are perceived as reducing efficiency for office staff. However, research revealed very little difference in the percentage of time spent completing documentation with or without electronic charting options, compared with all other categories of care.
Research Brief
The use of dedicated anesthesia providers for routine gastroenterology (GI) procedures is seen as medically justifiable only for high-risk patients, who account for a small number of cases. Eliminating these services for low-risk patients could generate $1.1 billion in savings per year.
Journal Article
Under pressure to form accountable care organizations, medical groups may merge and support private health information exchanges, but the private exchanges won't affect the usefulness of community health information exchanges.
Journal Article
The rapid growth of health care costs has had far-reaching economic effects, including those with work-based insurance. Rising health costs reduce employment-based private insurance availability and enrollment, and the financial protection provided by it, especially for middle-class families.
Commentary
While some downplay the burden that growing health care costs place on the United States, RAND Health Director Art Kellermann responds in the
Los Angeles Times that the U.S. healthcare system fails too many, too often, and at too high of a price.
Journal Article
An evaluation of the care provided to patients with cognitive problems found that those treated by primary care physicians often do not receive the fundamental care processes that could identify reversible causes of impairment, and the work-up and treatment for new dementia is largely inadequate.
Journal Article
The nurse practitioner (NP) workforce has been growing rapidly in recent years, but future projections have been varied. A new study forecasts dramatic growth by 2025, easing concerns about a potential looming nursing shortage and suggesting that NPs will fill a substantial amount of future need for care.
Journal Article
Missed appointments compromise the ability to plan for and deliver quality care. By implementing Electronic Medical Records and same day patient tracing, researchers were able to reduce missed appointments and increase efficiency in an community-based care clinic.
Journal Article
When faced with a pandemic like H1N1, the thinking affecting the decision to be vaccinated can be complicated. The fear of getting sick is a major motive in vaccination, but research has found factors associated with changes in this perceived risk.
Journal Article
Public reports of provider performance can help or hinder consumers’ search for a good doctor — but better methods can tip the odds in consumers’ favor.
Journal Article
Many school-based programs to prevent adolescent alcohol and drug use exist, but most are mandatory and during class time. A voluntary after-school program focused specifically on alcohol and drug use may be effective in deterring alcohol use among early adolescents.
Journal Article
The Dutch policy of officially tolerating cannabis sales is seen as a model for legalization elsewhere in the world. An analysis of the data looked at consumption, markets and user harm since 1976, and found both good and bad implications for public health in the Dutch system.
Journal Article
Electronic prescribing is looked to as a cost-saving and error-preventing tool for health care. In offices where e-prescribing was implemented, prescribers used information about formularies and drug benefits, but missing information reduced confidence in these resources and led to paper-based workarounds.
Journal Article
An analysis of two rules that allow small businesses to avoid participating in health reform concludes they will have only a minor impact because relatively few businesses are likely to take advantage of the options.
Journal Article
As health care reform expands the use of "report cards" to grade health care providers, greater attention to reporting methods may be needed to assure the quality of such efforts.
Journal Article
It's widely assumed that living near fast-food restaurants and convenience stores encourages overconsumption, while supermarkets encourage healthier diets. However, an analysis found no robust link between food environment and consumption in youths, indicating a more complicated relationship than some theories suppose.
Journal Article
Although Medicare is a federal program, spending on prescription drugs varies from region to region. Are the sources of spending differences due to variations in regional health, or are the types of treatments offered causing the differences?
Project
The Agency for Healthcare Research and Quality (AHRQ) has released a free toolkit designed to guide hospitals in using the AHRQ Patient Safety Indicators and Inpatient Quality Indicators to improve hospital performance. A RAND Health team, in partnership with UHC, developed and field-tested the toolkit.
Research Brief
Overturning the individual mandate of the Affordable Care Act would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
Journal Article
Despite growing concern that junk food availability in schools has contributed to the childhood obesity epidemic, research shows that the availability does not significantly increase BMI or obesity among a group of fifth-graders — even though they are likely to buy junk food.
Journal Article
Away-from-home foods are less healthy, and many localities are adopting regulations to improve the quality of away-from-home foods. Is there a rationale for developing nutritional performance standards for away-from-home foods, and what are the barriers to implementing consumer standards?
Journal Article
Substance abuse treatment programs are widely used, but the efficacy of specific therapies used in programs is largely unstudied. MET/CBT-5 was evaluated in adolescents undergoing treatment for cannabis-related issues, and significant differences in outcomes were found compared to standard therapy.
Report
The ubiquity of the internet and digital media has also increased the amount of explicit material available to adolescents. The effects of new media on adolescent sexual health are being researched, but researchers will need to bridge gaps in theory and methods when studying this area.
Journal Article
The financial burden Americans face paying out-of-pocket costs for prescription drugs has declined, although prescription costs remain a significant challenge for people with lower incomes and those with public insurance.
Journal Article
Asthma in children holds many dangers for children, especially minorities. Many of these risks come from poor adherence to treatment, but a brief educational session with tailored, reinforcing text messages sent to adolescents' cell phones improved adherence and health outcomes.
Report
Emergency readmission to hospital is frequently used to measure avoidable adverse outcomes after initial admission - not only are readmissions costly and dangerous, but they highlight areas of care needing improvement. However, hospitals may mask the true statistics in their coding and reporting.
Journal Article
African Americans have high levels of medical mistrust, including conspiracy beliefs related to HIV, and black men have the highest rates of HIV and AIDS diagnoses in the US. Conspiracy beliefs were associated with high-risk sexual behavior, showing the impact of medical mistrust on outreach and education efforts.
Journal Article
Commmunities around the world are investing in outdoor exercise equipment in parks to increase physical activity, yet the impact of such improvements is unclear. Research shows that adding equipment to parks seems to attract more new park users and result in a higher expenditure of energy.
Journal Article
Ethnic minority groups in the UK consistently report less positive experiences with their primary care than do whites. Minority concentration in low-rated practices explains some of the difference, but some groups report less satisfaction than do whites at the same offices.
Journal Article
Abuse of prescription drugs represents a growing problem. This article discusses the challenge to federal and private efforts to combat the problem and outlines strategies for physicians to recognize and minimize the effects of the availability of these medications on the Internet.
Journal Article
Antipsychotic drugs are used to treat conditions unapproved by the FDA, but what is the evidence of their efficacy for these uses? Researchers analyzed years of medical literature to compile the findings of studies evaluating off-label treatments, as well as details of side effects.
Report
Vaccine-preventable disease takes a heavy toll on U.S. adults, despite the widespread availability of effective vaccines. This report lays out a blueprint for improving access to adult vaccinations and encouraging more adults to seek vaccination.
Journal Article
Cancer care has increasingly moved from hospital to outpatient settings, transferring significant aspects of patient care from medical professionals to family. A survey of African American and white caregivers found significant racial differences in preparedness, social support and time spent providing care.
Journal Article
According to a Mexican nutrition survey, childhood obesity and anemia rates are near 20%, but it is less clear how often the two conditions affect the same children. Significant age and gender associations were found for both conditions, highlighting the need for nutrition education.
Journal Article
In 2010, the US Centers for Disease Control (CDC) began universally recommending annual influenza vaccination to all people aged 6 months and older. Healthy young adults, in particular, are impacted by this new recommendation — but how widely has awareness spread since the policy change?
Report
Reliable measures to track quality and efficiency are foundational in evaluating the results of health care spending. This study tracks how the currently developed measures are being used while documenting opportunities for and obstacles to further improvement.
Journal Article
Cafeteria food in California children's hospitals gets an average rating on a nutritional scale. Cafeterias could improve by providing nutritional information, using signage to promote healthy choices, and eliminating impulse items at the register.
Journal Article
Electronic Health Records hold much promise for making health care better and less expensive - but they also can hold challenges and risks. This online resource helps healthcare organizations anticipate, avoid, and address problems that can occur when implementing and using an electronic health record (EHR).
Journal Article
Historically, less than 25% of opioid dependent individuals receive opioid agonist therapy (OAT) in treatment. Buprenorphine (Suboxone) provides a more flexible, office-based alternative to methadone for OAT, but how does it impact larger treatment trends?
Journal Article
This investigation explores the connections between two factors associated with health risks (pessimism and higher lead exposure) and low socioeconomic status (SES), which is linked with higher lead levels and greater pessimism. Research on an older population revealed an interrelated role of lead burden and SES.
Journal Article
Countries whose citizens trust each and their government also report significantly higher scores in self-rated health than countries whose social capital is lower, according to new statistical analysis of longitudinal, cross-national data. Given the close linkages between self-rated health and mortality, these findings indicate that the public health gains from increased trust may be large.
Report
Hypertensive patients who received a one-time $15 payment to see a doctor and were provided educational materials were more likely to schedule a visit, and pre-hypertensive patients saw a significant and sustained reduction in their blood pressure. However, the financial incentive had no effect on reducing racial or ethnic gaps in hypertension.
Journal Article
The number of people aged 23 to 26—primarily women—who became registered nurses increased by 62 percent from 2002 to 2009, approaching numbers not seen since the mid-1980s. This trend should ease some of the concern about a looming nursing shortage in the United States.
Commentary
Delivery of evidence-based care to all veterans with PTSD or depression would pay for itself—or even save money—within two years by improving productivity and reducing medical and mortality costs, writes Terri Tanielian.
Journal Article
Retail clinic use increased 10-fold in just two years; by 2009, roughly 7 percent of all visits by commercially insured patients for 11 common acute-care conditions were to a retail clinic. If these trends continue, health plans will see a dramatic increase in retail clinic utilization, especially among young, healthy, and higher-income individuals.
Report
To ensure that children and underserved communities would benefit from plans to improve a Pittsburgh park's nature center, RAND conducted focus groups and interviews with local residents. Recommendations focus on the design of the new building, how to improve access to the park and the center, and how to structure and market park programs.
Journal Article
Nearly 40% of a nationally representative cohort of children started kindergarten with a BMI in the top quartile of the growth charts. This proportion increased significantly between 1st and 3rd grades but there was no further increase during middle school.
Report
With the health care safety net in California under stress from the state's continuing financial crisis, jurisdictions across the state face unprecedented challenges caring for the health and social service needs of people released from state prisons.
Tool
The U.S. Department of Defense sponsors many programs for servicemembers and their families. RAND compiled a searchable online catalog of 211 programs that address psychological health and traumatic brain injury.
Announcement
Before, during, and after deployment, military families face significant challenges. RAND has developed resources for these families—and also for those who assist and advocate for them—including research on recovery from psychological and cognitive injuries.
Report
In the past decade, longer and more-frequent deployments have resulted in significant mental health problems among some servicemembers. More than 200 programs are available to help treat psychological health and traumatic brain injury issues, but better coordination of those efforts is needed.
News Release
While seen as potential cost-cutting tool, bundled payments to providers have been slow to put into practice; in the three years of the PROMETHEUS pilot project, no payments have been made. Still, while implementation has been difficult, progress is being made.
Journal Article
Hepatitis C treatment efficacy among HIV patients is limited by poor treatment adherence. Good mental health may be an indicator of readiness to adhere to treatment for this population, which leads to improved health outcomes.
Journal Article
Wars in Iraq and Afghanistan have increased the need for mental health services. The 15% of veterans with mental health illness accounted for about 33% of total VA costs, mostly for non-mental health conditions. Quality of care was generally better than that in private plans, but quality varied across VA regions.
Journal Article
The strong link in adolescents between having a best friend who smokes and starting or escalating smoking isn’t affected by individual factors such as self-esteem, depression, school and family bonds, and access to cigarettes.
Journal Article
A controlled study of HIV antiretroviral therapy (ART) in sub-Saharan Africa found that ART increases sexual activity and condom use, but depression undercuts the prevention benefits of ART, highlighting the need to integrate mental health services into HIV care.
Journal Article
Vulnerable older adults enrolled in plans that use nurse care managers receive, on average, 69% of recommended care for common geriatric conditions, compared with 53% for elders in plans without nurse care managers. The model addresses important deficits common in physician care.
Journal Article
Multiple dimensions of harm need to be displayed to inform human judgments of what drugs should be scheduled; recent efforts ignores drug interactions and mix aggregate and individual harms inappropriately
Journal Article
Data from reporting systems is used to evaluate hospitals and track patient safety in healthcare. Evidence from 2005 to 2009 shows that hospital reporting of adverse events has improved, but variations in reporting rates within hospitals need to be reduced.
Journal Article
Compared with white residents, black residents in California experienced roughly 2.5 times the exposure to air pollution in excess of federal standards. Pollution exposure may help to explain difference in hospital visits across races and ethnicities.
Journal Article
Medicare's National Pilot Program on Payment Bundling will pay providers once for acute care and rehabilitation, to control postacute care costs and prevent readmission. This study found an recommended episode length, as well as appropriate conditions, for use in the pilot.
Journal Article
Among homeless youth in Los Angeles County, a broad range of individual, relationship, and contexual factors play a role in condom use. Use is more likely if partners were concerned about pregnancy, had talked about condom use, or met by chance.
Journal Article
Health care reform might require more clerks, not more physicians and nurses, based on analysis of the Massachusetts Health Care Reform Plan .
Journal Article
Self-organized sub-regional cooperation in disease surveillance is increasingly recognized as an important new element in global disease prevention and control. The Mekong Basin Disease Surveillance countries improved their response to the 2009 H1N1 virus in areas previously considered problematic.
Journal Article
All literacy skills are significantly associated with patients' self advocacy when examined in isolation, but greater speaking and listening skills are significantly associated with better patient advocacy when all skills are examined together.
Project
Project CHOICE is a weekly confidential after-school program for Los Angeles teenagers to discuss alcohol, cigarette, and drug use, and to get information on teenage substance use, its consequences, and how to avoid it.
Journal Article
Interviews with young black men who have sex with men showed that perception of masculinity was the primary contextual factor influencing partner selection, risk assessment, and decision-making with regard to condom usage.
Journal Article
Approaching disparities through a public health framework can provide the foundation for developing more robust evidence to inform additional policies for improving access and reducing disparities.
Journal Article
Recommended age guidelines for cancer screening differ between the U.S. and Canada. An analysis found international differences in screening rates for breast, colorectal and prostate cancer both within and outside the age recommendations, which may help explain breast cancer outcome differences.
Report
Medicare's payment for physician work and malpractice liability expenses is the same regardless of where a service is provided, but payments differ for facility-related components of care.
Report
To contain growth in health care costs, DoD is exploring approaches to rewarding or penalizing military treatment facilities (MTF) based on performance. This volume examines the pros and cons of alternative approaches to measuring MTF performance.
Journal Article
Quality improvement (QI) studies are a growing body of work, but the diversity of the studies can make them hard to locate and to identify as QI within search tools. The authors developed search strategies to aid the search for QI studies in MEDLINE and PubMed, but QI-specific search terms are needed.
Journal Article
Tracheotomy, increasingly performed on children with complex chronic medical conditions, requires multiple medications, equipment and care from multiple providers. Care creates a large body of health information; how does its management affect the perception of care, and how can its exchange be improved?
Report
Countries with high rates of human immunodeficiency virus (HIV) rely on donors for programs, but funding is trending flat. Thus, getting the most results with the available funds is essential - yet expenditure and outcome data is unclear, making evaluation of projects difficult.
Journal Article
Comparative effectiveness research (CER) can imply impartial evaluation, bureaucratic meddling, or limiting benefits and curtailing care. In this paper, the author categorizes CER into 7 buckets to help identify participants and stakeholders of each class.
Report
New drugs and devices have improved outcomes and quality of life in patients while driving the increase in health care costs. Policymakers charged with controlling costs often treat innovative activities as single object, but they can be separated into those that are worth their social costs and those which are not.
Journal Article
An initiative to develop centers to provide multidisciplinary, innovative care while advancing education and training opportunities found that while the process takes time and resources, the resulting centers had an impact on key aspects of research.
Journal Article
Discrete choice experiments (DCEs) and best–worst scaling (BWS) are two methods to measure public preferences. To compare the two, researchers used both in a quality of life survey and compared results. Analysis showed similar patterns and insignificant differences between the techniques.
Journal Article
Geriatric patients are at risk for falls and urinary incontinence, which are associated with poor quality of life and largely under-treated. This study measured quality of life before and after care was provided. Better care was associated with improved outcomes, indicating the importance of improved care.
Journal Article
The historic RAND Health Insurance Experiment found that patients had little or no control over their health care spending once they began to receive a physician's care, but this has changed for those enrolled in consumer-directed health plans.
News Release
The use of antipsychotic drugs for non-FDA approved uses has doubled in the past 3 years. Research indicates their utility in treating conditions including obsessive-compulsive disorder and post-traumatic stress disorder - but with significant side effects.
Journal Article
5 practices identified as ideal e-prescribing implementors were studied to identify elements of their success which could be extrapolated to others. The investigation found factors which made the implementation possible, as well as some of the obstacles facing practices.
Journal Article
Information about costs of implementing a multisite school-based prevention program was captured using microcosting methods. Program costs varied widely based on a number of factors, but median costs were overall lower than general government estimates.
Journal Article
Not enough is known about a possible association between anaplastic large cell lymphoma and breast implants. A panel was formed to determine points of consensus and disagreement among experts of multiple medical disciplines.
Journal Article
Analysis of Oregon's state parity law suggests full parity for behavioral health care does not significantly increase costs for mental health and substance abuse treatment. Research holds positive implications for The Mental Health Parity and Addiction Equity Act of 2008.
Research Brief
RAND's evaluation of Safe Start Promising Approaches identified program successes and challenges in implementing programs for children exposed to violence. The evaluation results, though largely inconclusive, can inform similar efforts going forward.
Research Brief
Large variations exist across medical specialties in the frequency of malpractice claims and the amount paid on them. Over 75% of physicians face at least one claim during their careers, but most claims do not result in a payment.
Report
Consumer-controlled personal health management systems (HMSs) are a class of tools that promote healthy lifestyle choices and provide health data to individuals, as well as aid in decision support. How will they be used to reduce health care costs, and to what effect?
Report
Non-communicable diseases (NCDs) such as cancer, diabetes, and cardiovascular disease are the leading cause of global sickness and death. This analysis presents a first step towards developing a policy research agenda for improving access to NCD medicines, especially in developing countries.
Report
Description of fidelity rating tools for the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) and BRIGHT-2 interventions for depression and substance abuse, interrater reliability of measures, and a training plan for coders.
Report
Safe Start Promising Approaches (SSPA) is the second phase of a community-based initiative focused on developing and fielding interventions to prevent and reduce the impact of children's exposure to violence. This report shares the results of SSPA, which was intended to implement and evaluate promising and evidence-based programs in 15 program sites across the country.
Periodical
The RAND Health Quarterly is an online journal sharing the results of recent RAND research areas across a broad spectrum of health-related issues.
Research Brief
Between 1990 and 2009, the number of emergency rooms (ERs) in nonrural U.S. hospitals declined by 27 percent (from 2,446 to 1,779). Economic factors play a central role in an ER's ability to remain open.
Research Brief
A new RAND Health study shows that the doubling of health costs between 1999 and 2009 largely wiped out an average family's real income gains. In fact, in 2009 the family had a net gain of only $95 per month. If health care costs had tracked general inflation over the decade, the family would have had nearly $5,400 more in 2009.
Journal Article
Increased consolidation among health plans nationally may benefit consumers by lowering hospital prices, at least in those regions where health plans are the most consolidated.
Project
The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) project is a collaborative effort to understand how well cognitive behavioral therapy depression treatment works for people with substance use disorder.
Research Brief
Summarizes key RAND studies on the causes of obesity, its economic and health consequences, and potential strategies for prevention, including work on health care costs, junk food, food deserts, school meals, and proximity of parks
Journal Article
This book chapter gives an introduction on how to read and how to do a systematic review or a meta-analysis, and discusses advances and limitations of this method.
Journal Article
Clinical decision support (CDS) refers to electronic technology used to enhance clinical decision making. The basic challenge for policymakers interested in promoting adoption of CDS is to ensure that liability concerns do not derail the clinical value of new CDS technology.
Research Brief
If all veterans suffering from major depression and post-traumatic stress disorder (PTSD) were to receive evidence-based treatments, policy simulations suggest that cost savings generated would be $138 million (15 percent) over two years.
Journal Article
Depressed patients report poorer health care experiences and have less confidence that they can recognize their need for care.
Journal Article
A systematic review of the literature found that a form of anaplastic large cell lymphoma may be associated with breast implants. Future research on the epidemiology and biology of this rare disease is clearly needed to better understand its nature.
Journal Article
Menopause has a negative impact on some domains of health-related quality of life (HRQoL), regardless of menopausal symptoms. Clinicians should work to improve HRQoL, rather than expect it to improve spontaneously when menopausal symptoms resolve.
Report
Policy changes could increase the quality and efficiency of care delivered under the California workers compensation system.
Journal Article
HPV vaccine coverage among young adult women is low overall, and lower among the uninsured. Public financing and care provision programs are needed to expand vaccine coverage among uninsured women.
Journal Article
Adolescents tend to choose friends who do similar amounts of physical activity and emulate their behavior; such networks could help promote physical activity among adolescents.
Journal Article
Comparative effectiveness reviews need to be regularly updated as new evidence is produced. Lack of attention to updating may lead to outdated and sometimes misleading conclusions that compromise health care and policy decisions.
Report
Through laboratory research and pilot testing, the authors evaluated RxNorm's potential to improve how medications are represented in electronic prescribing (e-prescribing) transactions.
Report
BRIGHT and BRIGHT-2 are manualized group cognitive behavioral therapy programs designed so that non-mental health practitioners, and practitioners with less formal training than professional mental health counselors, can deliver the programs, thus providing evidence-based depression treatment to individuals who often do not receive it.
Journal Article
Patient education integrated with acupuncture had a sufficiently promising effect on cancel-related fatigue that a larger randomized controlled trial is warranted.
Journal Article
Weight-based similarities among friends stem from marginalization of overweight adolescents by their peers. These findings highlight the importance of modeling friendship selection processes when estimating social influence effects on adiposity.
Journal Article
Neighborhood socioeconomic status (NSES) is associated with cognitive functioning in older US women. Future research is needed on the longitudinal relationships between NSES, cognitive impairment, and cognitive decline.
Journal Article
Substance use among homeless men is associated with health problems and riskier personal networks. These findings underscore the importance of interventions that focus on improving mental health and mitigating the drug-using norms of personal networks.
Journal Article
Doctor-patient communication is strongly associated with use of patient assistance programs; this link has important implications for clinical care regardless of whether the programs are viewed as drivers of prescription costs or a remedy for them.
Journal Article
Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care.
Journal Article
Appropriate use of existing diagnostic tests for infections, and development of better ones, could reduce overuse and support correct selection of antibacterial drugs.
Journal Article
This study found that cable television ad placements on for beer, spirits, and alcopops increased as adolescent viewership rose from 0% to 30%, especially for adolescent female viewers.
Journal Article
This article provides detailed recommendations for organizing and conducting committee work, which is central to successful community-partnered research projects.
Journal Article
Sexual behavior among adolescents with HIV-positive mothers was less prevalent than among other adolescents, but was more likely to occur with adolescent alcohol use, lack of parental monitoring, and poorer physical functioning of HIV-positive mothers.
Journal Article
Decreased use of myeloid colony-stimulating factors in patients at lower or intermediate risk of febrile neutropenia from high-risk chemotherapy regimens could yield substantial cost savings without compromising patient outcomes.
Report
Many programs are available to increase psychological resilience among service members and families, but little is known about their effectiveness. This report reviews existing programs to identify evidence-informed factors for promoting resilience.
Journal Article
Online prescription drug sales require better oversight: For every 10 percent increase in high-speed Internet use at the state level, associated treatment facility admissions for prescription drug abuse rose by 1 percent.
Journal Article
Racial/ethnic differences influence the way that neighborhood socioeconomic status affects health behaviors
Journal Article
This project developed and designed Students for Nutrition and eXercise (SNaX), an intervention aimed at translating school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes.
Journal Article
Bob Brook's article, "What if Physicians Actually Had to Control Medical Costs," received the 2011 ABIM Foundation Professionalism Article Prize. A committee of experts in medical professionalism reviewed more than 100 articles published in 2010 and judged them based on clarity of writing, thoroughness, methodology, and contributions to the field and society. The commentary suggests that rationing health care is inevitable and urges physicians to lead the way in developing a plan to do it reasonably and equitably.
Journal Article
Bladder pain syndrome/interstitial cystitis symptoms are widespread among United States women and associated with considerable disability. Bladder pain syndrome/interstitial cystitis may be underdiagnosed.
Journal Article
This study used data from 3 sites to examine the invariance and psychometric characteristics of the Brief Symptom Inventory–18 across black, Hispanic, and white mothers of 5th graders. Results showed that the instrument may be used for mean comparisons between black and white women.
Journal Article
Evaluation of translational research should focus on identification of key operational and measurable markers along a generalized process pathway from research to practice.
Project
Policymakers at the Federal and state levels are facing new
challenges as they implement the Patient Protection and Affordable Care Act (ACA).
RAND COMPARE is a modeling tool that simulates the impact of implementation
decisions on insurance coverage, premiums, and health care spending.
The results of these simulations can be used by policy makers
to help them understand and anticipate likely choices made by
firms and consumers under a variety of options.
Research Brief
Two goals of the joint medical training and education campus at Ft. Sam Houston are to become a high-performing learning organization and an accredited, degree-granting institution. A research and evaluation capability would help it meet these goals.
Journal Article
This study examined whether specific parenting factors can be used to predict adolescent problem behaviors in intervention studies.
Announcement
Getting To Outcomes® (GTO) is a framework that sets out a model for planning, changing, and evaluating interventions delivered to children and families. It was recently featured in a news story in
Prevention Action, an online news publication reporting on innovation and effectiveness for improving children's health and development. On July 4, 2011, GTO started a new NICHD-funded study to evaluate how it helps community-based organizations conduct evidence based programming. That study is called Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS).
Commentary
Approaches for integrating Clinical Decision Support technology into clinical practice need to take complex issues into account, including "alert fatigue," medical liability concerns, and general patient welfare. Liability concerns, while important, should not override or derail the clinical value of CDS and patient safety.
Journal Article
Case management of community interventions is intended to narrow racial and ethnic disparities, but this study of homeless individuals with severe mental illness found that it reduced disparities for blacks, but not for Latinos.
Journal Article
Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes.
Journal Article
Homeless men on LA's Skid Row use visual and behavioral cues, social reputation, feelings of trust, perceived relationship seriousness, and medically inaccurate "folk" beliefs to judge whether partners were risky and/or condom use was warranted.
Journal Article
Combining the best elements of academic medical centers and community health centers could deliver high-quality, cost-effective care to low-income Americans while training the next generation of health care professionals.
Journal Article
The mix of fee-for-service and Medicare Advantage enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations in CAHPS scores between California and the nation.
Journal Article
This study of a Cherokee Indian population in North Carolina found, surprisingly, that sudden increases in income were associated with short-term increases in risk-taking behavior and higher rates of accidental death.
Journal Article
Training addiction counselors to deliver group therapy can bring effective mental treatment to depressed individuals who are also substance abusers.
Journal Article
This study concluded that little evidence exists about the influence of context on patient safety interventions, but found significant gaps in the research that should be addressed by future work.
Journal Article
Using a 12-year county-level panel, this study found that a 10 percent increase in births that occur in hospitals with electronic medical records reduces neonatal mortality by 16 deaths per 100,000 live births.
Journal Article
This study simulated the social costs and savings of providing universal access to care for depression and PTSD to troops returning from Operations Enduring Freedom and Iraqi Freedom.
Journal Article
This article describes a theoretical framework, derived from the literature, for classifying diverse patient safety practices.
Journal Article
The existing scientific literature does not adequately address questions about the safety of probiotics.
Journal Article
Communication between healthcare providers and adults about influenza vaccination was relatively uncommon during the 2009–2010 pandemic. Increased communication could significantly enhance influenza vaccination rates.
Journal Article
A reanalysis of data from earlier studies continues to show associations between sex in the media and adolescent sexual outcomes. The evidence does not prove causality but suggests cautions for parents.
Journal Article
This commentary argues that involving communities in the formation of accountable care organizations would be a dramatic step toward more patient-centered care.
Journal Article
Encryption is seen as a way to prevent malicious use of patient data, but there is no empirical evidence that it does.
Journal Article
This paper discusses a contemporary social cognitive framework that can be used to understand the role of the self-concept in smoking.
Journal Article
This article describes results of a systematic literature review focused on which interventions can be integrated into routine care to prevent pressure ulcers.
Report
Lessons learned from a review of practices at community colleges, corporate universities, the UK's Defence Medical Education and Training Agency, and other federal agencies can be useful to the medical education and training campus at Fort Sam Houston.
Journal Article
Communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.
Journal Article
Outlets that sell alcohol on the premises (e.g., bars or restaurants) do more to prevent alcohol sales to minors than outlets such as convenience or liquor stores.
Report
This report presents results of the first year of a multi-year evaluation of the Department of Health and Human Services’ national initiative to reduce healthcare-associated infections, a major public health problem in the United States.
Announcement
Paul Shekelle has received this year's Under Secretary's Award for Outstanding Achievement in Health Services Research, the highest honor for a Veterans Affairs health services researcher at the 2011 Health Services Research & Development Service National Meeting. Shekelle met the major criteria for the award, with more than 20 years invested in healthcare research in the greater Los Angeles VA system.
Journal Article
Longitudinal research has demonstrated a link between exposure to sexual content in media and subsequent changes in adolescent sexual behavior, including initiation of intercourse and various noncoital sexual activities.
Journal Article
This paper proposes a new model and new mechanisms for use in clinical research that address barriers to clinician participation in research studies.
Journal Article
Consumers in high deductible health plans use less health care, but they also cut use of preventive services, even though plans exempt preventive services from the deductible.
Journal Article
Involving community practitioners in biomedical research could improve the translation of research results into improvements in clinical practice.
Journal Article
An environmental scan of quality measures in use by state correctional systems and the Federal Bureau of Prisons found substantial variation in the number and type of measures being used and the underlying data systems used to construct measures.
Journal Article
This analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases.
Journal Article
This paper identifies several approaches that healthcare organizations can use to overcome barriers to clinician participation in research studies.
Journal Article
Prison health institutions, like all other large health institutions, need robust measurement systems. The indicators presented in this article provide a basic library for prison health managers developing such systems.
Journal Article
This study found that the number of emergency departments operating in the US from 1990 to 2009 declined by 27%. EDs with safety-net status, for-profit ownership, and low profit margin were at higher risk of closure.
Report
This study provides an overview of quality indicator systems and quality measurement approaches now being considered for integration into the national resource allocation framework currently under development for the German health insurance system.
Journal Article
The move toward comparative effectiveness research may be a positive one for complementary and alternative medicine, but a more critical evaluation of their relationship might be in order.
Announcement
Robert Brook, RAND Distinguished Chair in Health Care Services, and Director of the Robert Wood Johnson Clinical Scholars Program at UCLA, has been named one of the 50 most influential physician executives in 2011 by Modern Healthcare.
Journal Article
This study examines the effect of alcohol excise taxes on the demand for alcohol across different racial and ethnic groups.
Journal Article
Stressful events such as death of a family member, moving, or parental divorce significantly lower children’s health-related quality of life.
Journal Article
Cognitive behavior therapy and pharmacotherapy medication is more effective than is usual care for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.
Report
This report provides the content for a toolkit that will prepare
community and faith-based organizations to take advantage of
opportunities presented in the Patient Protection and Affordable Care
Act and engage faith and community leaders in promoting health in
their communities.
Journal Article
Health services research has made many important contributions, but it has not revolutionized the way that medicine is practiced to increase its value and moderate costs.
Journal Article
This study explores home-based medication triggers for taking antiretrovial therapy, including meals, pillboxes, time of day, and visual cues.
Journal Article
This meta-analysis suggests that children with diabetes are at slightly elevated risk for psychological difficulties such as depression, anxiety, and behavioral problems
News Release
Breast implants appear to be associated with a rare form of lymphoma, but there is not yet evidence to show that the cancer is caused by implants or to suggest an underlying mechanism for how the disease might develop. The disease takes a slow course and can be controlled by surgical removal of the implant and surrounding capsule.
Journal Article
A patient’s social environment is an important dimension of treatment for chronic illness; interventions intended to help individuals understand and change their social environments could benefit from incorporating visualizations of social networks.
Journal Article
The largest-ever assessment of high-deductible health plans find that such plans significantly cut health spending but families with such plans also cut preventive care such as cancer screening, childhood immunizations, and routine diabetes testing.
Journal Article
Failure to account for language differences in items from the Consumer Assessment of Healthcare Providers and Systems surveys may result in misleading conclusions about disparities in health care experiences between Spanish and English speakers.
Journal Article
Given the high stakes of performance evaluations, statistical benchmarks used in constructing physician profiles should be accompanied by estimates of the benchmarks’ precision.
Journal Article
The benefits of health information technology (HIT) are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters; however, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving HIT's potential.
Journal Article
Although most physicians qualify for federal incentives to promote adoption of electronic health records, eligibility varies substantially by specialty and practice size.
Project
How the Affordable Care Act Will Affect Coverage and Costs in Five States
— Apr 5, 2011
RAND Health, in partnership with The Council of State Governments (CSG), used the RAND COMPARE simulation model to assess the likely effects of the ACA on insurance coverage and state government health-care spending in five states (California, Connecticut, Illinois, Montana, and Texas). The percentage of residents with health care coverage is expected to rise significantly in all five states; health care spending will also increase in four of the five states (all except Connecticut).
Journal Article
Making influenza vaccination available to healthcare personnel at work could increase uptake and highlight the need to reach beyond hospitals in promoting vaccination among these workers.
News Release
The largest-ever assessment of high-deductible health plans finds that while such plans significantly cut health spending, they also prompt patients to cut back on preventive health care.
Journal Article
This study highlights the critical role that discrimination plays in adherence to antiretroviral therapy among African American men experiencing posttraumatic stress.
Journal Article
Having a usual source of care was associated with lower depression prevalence and higher realized access among community-dwelling Medicare beneficiaries.
Journal Article
Geographic variation in food prices across the US affects youth’s consumption of fruit, vegetables and milk; price variation does not seem to affect consumption of fast food or soft drinks, perhaps because consumption is less price sensitive.
Journal Article
Economics offers tools and topical expertise that complement other disciplines associated with the addiction sciences. Its value goes far beyond the ability to monetize nonmonetary outcomes or to calculate a cost-benefit ratio.
Journal Article
This systematic review distils lessons on successfully implementing congregation HIV efforts.
Journal Article
Failing to incorporate dependence on prior event history in subsequent relapse risk in Markov models can bias modeling results, overestimating the impact of prevention and treatment by up to 85% or underestimating the impact by up to 20%.
Research Brief
This brief summarizes findings from an extensive analysis of how adoption of electronic medical records can affect health care quality.
Journal Article
The use of patient navigators—individuals who perform outreach, coordination, and education across language and cultural barriers—improved breast cancer quality of care in a public hospital and may help reduce disparities in quality of cancer care.
Journal Article
The chemical compounds found in marijuana deserve more attention as efforts to regulate marijuana for medical and recreational use go forward.
Announcement
Chrissy Eibner has been named director of the COMPARE effort moving forward,
guiding the team's efforts to address the complex issues associated with
implementing health care reform. Chrissy is an economist and has been
involved in the COMPARE project since 2005. COMPARE is housed within the
Health Economics, Finance and Organization program in RAND Health.
Journal Article
Depression treatment improves mental health and reduces the effects of pain on work among individual with both chronic pain and depression.
Journal Article
A faith-based health research network could create a framework for evaluating such efforts.
Journal Article
Real-time data collected by palm-top computer confirms individual differences in situational smoking associations.
Journal Article
Quality improvement in Medicare managed care plans should target care for particular subgroups such as beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school.
Journal Article
Clinic violence reduces abortion services in targeted areas; however, once travel is taken into account, the overall effect of the violence is much smaller.
Journal Article
The
PROMIS Smoking Initiative has the goal of developing,
evaluating, and making widely available a set of
items for assessing smoking behavior and the biopsychosocial constructs
that can be used to predict smoking outcomes.
Report
Health care spending reforms should be met with new efforts to develop and refine quality-of-care and other performance measures in order to assure that any changes will improve medical care and not harm patients.
Report
Communities can build resilience to disasters through systematic
efforts such as joint planning of government and non-governmental
organizations and the development of community networks.
Journal Article
Hispanic seniors, especially if Spanish-preferring and in linguistically isolated areas, are immunized at lower rates than non-Hispanic whites. Physicians and policymakers may be able to help by addressing cultural and linguistic barriers to immunization.
Journal Article
Children admitted to the hospital seem more likely to have a prolonged stay in the emergency department if they are Hispanic, come to the ED in the winter, and arrive early in the morning.
Journal Article
This study compared the cost-effectiveness of different public interventions for promoting exercise and found that community-based campaigns and school-based interventions have the greatest potential to be scaled up at the lowest costs.
Journal Article
Nearly 90% of women with bladder pain syndrome/interstitial cystitis report sexual dysfunction and reduced quality of life
Journal Article
Depression affects self-efficacy, work status, and condom use among HIV+ men in sub-Saharan Africa.
Announcement
The Health Services Research (HSR) Impact Award recognizes research that improves access to behavioral health care for returning U.S. service members. The "Invisible Wounds of War" study analyzed the mental health and cognitive needs of veterans returning from the conflicts in Afghanistan and Iraq. Terri Tanielian, a senior social research analyst and co-director of the RAND Center for Military Health Policy Research, accepted the award.
Journal Article
A strong social network, informational support from sex partners, and other social factors affect whether homeless women receive substance abuse treatment.
Journal Article
This article describes a new approach to analyzing client outcomes when a rolling admissions policy is used in group therapy.
Journal Article
The Patient Protection and Affordable Care Act requires that the federal government define an essential benefit package for individuals who will obtain insurance through the new health insurance exchanges. Should ability to choose one’s own physician and hospital be considered essential?
Journal Article
This paper presents the methodology used to develop a comprehensive set of performance indicators in a national evaluation of the mental healthcare delivered by the Veterans Health Administration.
Journal Article
This study examined variations in treatment of ductal carcinoma in situ, a common form of breast cancer, and compared the effectiveness of different treatments.
Announcement
Richard Hillestad and co-authors have topped the list of "most-viewed" research papers of 2010 in
Health Affairs' archives. The archive spans a 29 year collection. The paper, "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs,” was published in a special
Health Affairs supplement in 2005.
Announcement
Richard Hillestad and co-authors have topped the list of "most-viewed" research papers of 2010 in
Health Affairs' archives. The archive spans a 29 year collection. The paper, "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs,” was published in a special
Health Affairs supplement in 2005.
Journal Article
People living in unaffordable housing are more likely to rate their health as poor.
Journal Article
Massachusetts physicians receive detailed reports of how patients view physician performance, but focus improvement efforts on office workflow and support staff.
Journal Article
Small primary care practices have limited staff and fewer resources than larger group practices, making it difficult to improve care for minority patients on their own. Other challenges include language barriers and lack of information systems.
Journal Article
A nationally representative sample of white, African American, and Latino respondents reported generally similar expectations about physicians' behaviors and provided similar average responses to questionnaires about interactions with physicians.
Journal Article
National performance standards for public health preparedness can be developed based on existing evidence, but would be helped immensely by a stronger evidence base.
Journal Article
Direct to consumer advertising was associated with increased overall use of a cervical cancer-screening test; clinical guidelines were associated with increased appropriate use.
Commentary
Immunization remains the best and first line of defense against serious
infectious illness. However, suspicion of vaccines is a serious problem
that could cost lives.
Project
The RAND Health project "Helping Families Raise Healthy Children" of Allegheny County, Pennsylvania, seeks to improve identification and services for families who have a risk of experiencing caregiver depression and early childhood developmental delays.
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