At the close of the ACA's open enrollment period, no significant changes in opinion were observed in the RAND Health Reform Opinion Study. This may be because open enrollment has no bearing on the health insurance of many people.
A promising strategy for helping adults with serious mental illness gain access to appropriate primary and preventive medical services is to integrate those services into a setting in which the population already receives care.
A team of community leaders and researchers from UCLA and RAND was recognized for a decade-long effort to improve depression care in low-income areas. “With community leaders and scientists working together,” said RAND's Kenneth Wells, “we can improve mental and physical health and reduce homelessness, as well as provide relief for those suffering from depression.”
As more Americans become newly covered under the Affordable Care Act, the cost of providing automobile insurance, workers compensation, and homeowners insurance may decline. Meanwhile, an increase in the number of people using the health care system may trigger a corresponding increase in the number of medical malpractice claims.
Early survey evidence indicates that the Affordable Care Act has already led to a substantial increase in insurance coverage. Consistent with the ACA's design, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.
Some point to the healthcare spending slowdown as an early success of the Affordable Care Act. Others warn that it's merely a hangover from the recession, and that the inevitable spending rebound will be exacerbated by the ACA coverage expansions.
Right now there are 5.5 million wives, husbands, siblings, parents, children and friends devoted to the care of those injured fighting America's wars. Theirs is an all-consuming, emotionally draining task, one that has been driven for too long by loyalty and love, but little support.
A world without military caregivers would be a harsher one for all, particularly for those who have served. Caregivers' sacrifices improve the lives of wounded, ill, and injured service members and veterans, more of whom would suffer without them.
Caregiving can take a lot of time and impose a heavy burden on caregiver health and well-being. But finding and utilizing support resources can help. Support services for military caregivers may provide respite care, financial stipends, health care and mental health care services, and more.
This summary distills a longer report, Hidden Heroes: America's Military Caregivers. It describes the magnitude of military caregiving in the United States, identifies gaps in support services, and offers recommendations.
Health care providers can support military caregivers in many ways: acknowledge them as part of the health care team, routinely assess caregiving needs and the presence of caregiver support, integrate them into health providers' culture, and adopt appropriate caregiver documentation requirements to facilitate their engagement.
There are 5.5 million Americans caring for wounded, ill, and injured service members and veterans, providing indispensable services and saving the nation millions in health and long-term care costs. Researchers describe who these caregivers are, the burden they bear, available programs and resources, and areas where they need more support.
The business community can support military caregivers in many ways: raise awareness by promoting messages that support military caregivers, offer support services, work with employees to accomodate their caregiver duties, and hire caregivers.
Congress can support military caregivers in many ways: reconsider eligibility requirements for caregiver support programs, ensure health care coverage for military caregivers, promote the integration and coordination of programs and services, and fully fund the Lifespan Respite Care Act.
There are 5.5 million military caregivers across the United States, with nearly 20 percent caring for someone who served since the terrorist attacks of Sept. 11, 2001. Military caregivers experience more health problems, face greater strains in family relationships, and have more workplace issues than noncaregivers. Changes are needed to both provide assistance to caregivers and to help them make plans for the future.
A novel approach to curbing America's growing health care spending is to change the drugs, devices, and health information technology that get invented in the first place. Realigning incentives for inventors, investors, payers, providers, and patients could yield medical products that reduce spending and improve health.
Women make up a majority of the U.S. population. Yet research policies and practices often treat women's health and health care as special topics or minority issues. The resulting knowledge gaps hamstring efforts to improve women's health care and outcomes even for cardiovascular disease, the leading cause of death among women.
Given the high prevalence of obesity and chronic diseases and their enormous societal burden, every restaurant, including fast food outlets, should offer healthier meal options and discourage over-consumption.
In a nationally representative sample of more than 6,000 Americans, researchers found an acute lack of understanding among low-income people regarding finances in general, and health reform and health insurance in particular.
Despite military caregivers' vital contributions, little is known about their numbers, the burden of caregiving that they shoulder, or the resources that exist to support them. To shed light on these "hidden heroes," a RAND team conducted the largest, most comprehensive study to date of military caregivers.
Ideally, restaurant food should be tailored and sold the way clothing is, so people can get the exact amount that is appropriate for their bodies. Such sizing options should be required in all dining establishments to give people the option of consuming meals that fit.
With the end of the ACA's open enrollment period looming on March 31, it is perhaps unsurprising that opinions are again changing in a significant way. The final push to encourage or discourage enrollment may be renewing public attention to the ACA.
Despite pervasive challenges associated with the rollout of the Affordable Care Act (ACA), the administration remains optimistic about its fate. Critics, however, have seized upon the recent mishaps as evidence of the ACA's inevitable demise.
Among a large group of Medicare patients, even modest improvements in the continuity of care for those with diabetes, congestive heart failure, or emphysema were associated with sizable reductions in use of hospital emergency departments and hospitalizations.
Despite the frequency with which people are convicted of multiple DUI offenses, California continues to require that all individuals with a DUI attend a 30- or 60-hour education program. However, these programs aren't that effective.
For many individuals, opinion is not stable. New information—whether gleaned from the media; interactions with health care providers, insurers, or peers; or some other channel—could lead to further changes in opinion.
If practicing physicians are correct, the current state of EHR technology has introduced several impediments to providing patient care, undermining physician professional satisfaction. Many of these problems also should be of great concern to patients.
Due to budget concerns the federal government just shut down a critical data source that provides insights into abuse, dependence on, and spending on heroin and other hard drugs like crack and methamphetamine.
Although one of the primary objectives of the ACA is to achieve near-universal health insurance coverage, the Congressional Budget Office projects that 30 million residents, more than 10 percent of the nonelderly population, will remain uninsured after the major provisions of the ACA take full effect.
Each year, drug users in the United States spend on the order of $100 billion on cocaine, heroin, marijuana, and methamphetamine. This has been stable over the decade, but there have been important shifts. In 2000, users spent much more on cocaine than marijuana; in 2010, the opposite was true.
Currently, evidence for the safety, harmfulness, utility, and addictiveness of e-cigarettes is lacking. The questions that research needs to answer, however, are clear as day—particularly since business is booming.
After a decade of experimentation with reforms that give health providers financial incentives to improve performance, relatively little is known about how to best execute such strategies or judge their success.
Amid mounting political pressure and angst in the business community, the Obama administration announced an additional delay in enforcing the employer mandate component of the Affordable Care Act for some firms until 2016. The additional delay will have little impact.
High-quality routine care for both cardiovascular disease and diabetes is at least as relevant to women's health and survival as it is to men's. Yet evidence suggests that women continue to face gaps in even low-cost, routine aspects of care.
A study suggests that medical home interventions may require further refinements before their full potential can be realized. Evaluations like this can help guide the improvement of the medical home model.
The press and trade publications strongly endorse workplace wellness programs as a good investment for employers. Soeren Mattke, a physician and RAND senior scientist, explains why his work tells a different story.
Everyone should take the time to ask themselves what they can do to improve their health, and to support the health of friends, families, and communities. When it comes to good health, it takes a community.
Two-thirds of U.S. adults report that they regularly sleep with a partner. Yet, through 60 years or so of sleep research, scientists have tended to view sleep as an individual behavior, largely ignoring the potential impact of bedmates.
Compared to their peers, children with autism spectrum disorders have higher annual costs for health care appointments and prescriptions ($3,000 on average) and non-health care costs ($17,000 on average), such as special education at school. Previous analyses underestimated this economic burden, particularly for school systems.
CVS Caremark will stop selling cigarettes and other tobacco products at its CVS/pharmacy stores beginning Oct. 1. Though it stands to lose $2 billion dollars in annual revenue, CVS CEO Larry J. Merlo said that selling tobacco products is at odds with the company's mission of improving health outcomes.
Infections that strike patients are one of the most preventable leading causes of death in the United States. A federally sponsored plan to lower health care-acquired infections was successful in addressing the challenges of prioritizing and coordinating strategies.
Friday is National Wear Red Day, when people are asked to wear red to raise awareness about the health risks women face from heart disease. Too little attention is devoted to preventing heart disease in women and improving the quality and outcomes of their care.
People who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help — including prescriptions — by talking to a doctor over the telephone.
The care that women receive for cardiovascular disease (CVD) lag behind those of men, despite the fact that more women have died from CVD each year for decades. Experts explain CVD within the context of women's health, outlining possible solutions for improving quality of care.
For the past four weeks, the percentage of individuals with a favorable opinion of the Affordable Care Act (ACA) has remained stable. However, we are seeing in this week's numbers a decline in unfavorable opinion.
A focused review of recent RAND research identified small ideas that could save the U.S. health care system a total of up to $22 billion per year. These small ideas do not require systemic change, which may make them more feasible to implement and less likely to encounter stiff political and organizational resistance.
Obama called for “a year of action” to achieve his 2014 agenda — from helping people sign up for health insurance, to immigration reform, to completing the mission in Afghanistan. RAND is committed to raising the level of public policy debates and offering evidence-based, actionable solutions.
As familiar as Americans are with the problems of youth drug and alcohol abuse, we are not identifying all the potential solutions. While observers criticize overemphasis in U.S. policy on enforcement and scant resources devoted to treatment, the focus on these approaches often ignores a key piece of the puzzle: prevention.
Overall opinion of the ACA continues to be stable with no discernible changes in the rate of favorable opinion since last week. Unfavorable opinion was in line with findings from the last few weeks of December and the first week of January.
Although three options put forward to help people keep their old health insurance plans all would cause some disruption of the risk pools that are important to the insurance exchanges, none of the changes would be severe enough to threaten their viability.
The cardiovascular and diabetes-related care that women receive—and their relevant health outcomes—both lag behind those of men. This is true even for routine care, such as cholesterol monitoring and control. Awareness of this disparity is limited, in part, because quality of care is not routinely measured and reported by gender.
To identify the policies that will make a big fat dent in obesity rates, we first need an accurate diagnosis: Americans are overweight and obese because they are inundated with too much food. The use of impulse marketing strategies has skyrocketed, with invitations to indulge at every turn.
As seductive as a warm bed may be on a cold morning, staying in bed too long can lead to disrupted sleep and a sleep-sapping case of the winter blues. These are the times when we need to resist the urge to hibernate and force ourselves to get going.
Since Colorado and Washington allow profit-maximizing firms to grow and sell marijuana, there is concern they will use advertising to promote consumption by heavy users. With help from the federal government, the states will be better positioned to head off the negative consequences associated with commercialization.
The significant decline in public opinion 'churn' regarding the Affordable Care Act continues. Those reporting a change in their opinion dropped from 25 percent from September to November, to 15 percent from November to December, and to less than 10 percent from the first week of December to the first week of January.
Employers and policymakers should not assume that workplace wellness programs will reduce health care costs. Researchers found that while the disease management component of a large program was associated with lower costs, its lifestyle management component was not.
Perhaps the most common New Year's resolution is improving our eating habits. According to Dr. Deborah Cohen, who hosted an “Ask Me Anything” session on Reddit yesterday, that's much easier said than done.
One groundbreaking provision of the Affordable Care Act is its funding for home visiting programs that match the parents of young children with trained specialists who provide information, social support, parental skill instruction, and more.
Just as we needed policies to protect people from having alcohol thrust in their faces everywhere they went, we need to develop and implement policies that protect people from food cues and triggers designed to make them eat when they're not hungry and over-consume.
In a large employee wellness program offered by PepsiCo, efforts to help employees manage chronic illnesses saved $3.78 in health care costs for every $1 invested in the effort. However, the program's lifestyle management components that encourage healthy living did not deliver returns that were higher than the costs.
The latest data from the RAND Health Reform Opinion Study indicates that positive opinion of the ACA continues to increase. The overall favorable rating is now as high as it was in late September, prior to the opening of the health insurance exchanges.
The obesity epidemic is among the most critical health issues facing the United States. Although it has generated a lot of attention and calls for solutions, it also has served up a super-sized portion of myths and misunderstandings.
Last week we introduced the RAND Health Reform Opinion Study, a new way to measure public opinion of the Affordable Care Act. Negative opinion about the ACA seems to be stabilizing, while positive opinion is increasing. Those undecided about the ACA are decreasing.
During the holiday season, a time when overindulgence is a tradition for many, food marketing creates especially serious challenges for people trying to limit their intake and make careful decisions about healthier eating.
U.S. workplace wellness programs are prevalent, and most observers expect uptake to grow, especially as the Affordable Care Act will increase employment-based coverage and promotes workplace wellness programs through numerous provisions. But there is currently insufficient evidence to definitively assess their impact on health outcomes and cost.
Whether the public will begin to settle on an overall positive or negative perception of the Affordable Care Act (ACA) is very much an open question. But understanding how opinion of the law evolves over time could offer valuable insight into Americans' appetite both for the ACA and for health reform more broadly.
In Washington state, marijuana consumption likely will range from 135 to 225 metric tons during 2013. Understanding the current market should help state policymakers with decisions about the number of marijuana sales licenses to issue, to project tax revenues, and provide a foundation for assessments of legalization.
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
For most lower-income people who obtain coverage as a result of the Affordable Care Act, health care spending will fall. But spending by some newly insured higher-income people will increase because they will be now paying insurance premiums.
Though “microsleep,” commonly referred to as “highway hypnosis,” may enter the public discourse most often when it's cited as the possible cause of a disaster like the Metro-North train wreck, it is responsible for fatal accidents on American highways every day.
Market forces are stacking the deck against development of drugs for common central nervous system disorders, such as Alzheimer's, schizophrenia, and depression. But policy changes could steer investment into drugs for these neglected diseases by reducing development cost and uncertainty and increasing expected revenue.
Large coverage expansions under the ACA have reignited concerns about physician shortages. These estimates result from models that forecast future supply and demand for physicians based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment.
The holiday season is a time when people try to do too much. And that often leads to stress and worry, which can be the enemies of a good night's sleep. Here are a few tricks to help manage the episodic bouts of insomnia that are common during the holidays.
2014 will be an important year for the Patient Protection and Affordable Care Act. Health insurance exchanges will offer people new ways to buy insurance. Medicaid will expand in many states. And people without “minimum essential coverage” may have to pay a fee.
Most people lack the information they need to judge or track the quantity and quality of the nutrients they consume. The FDA should take a disease prevention approach — as it is currently doing with trans fat — in promoting standards that address how all foods are prepared and served away from home.
Convenient options for treating minor health problems are an important new feature of the health care landscape. Ateev Mehrotra discusses these options and their implications for the medical marketplace.
As the ACA is implemented, policy makers should be attuned to potential inefficiencies and inequities created by a system with different regulatory and tax rules for small employers, large employers, and individual health plans. Attempts to equalize the playing field may be difficult.
Atop the new mayor's agenda should be improving the health and well-being of Pittsburgh residents. With an unassailable electoral mandate in hand, Mr. Peduto is positioned to take bold steps. And the best way to do that is by applying scientific and medical evidence to shape an integrated, citywide, health-policy framework.
ACA reforms can potentially address barriers that get in the way of individuals with asthma getting the care they need. At the population level, the law has the potential to improve outcomes and efficiency and equity of services for chronic conditions such as asthma for which cost-effective preventive treatments exist.
If it doesn't seem that state laws as currently written can help increase the number of health care workers vaccinated against influenza, then what can? There is evidence that imposing consequences for vaccination refusal, including the requirement to wear a surgical mask, can help.
If Congress wants to save Medicare, it can start by driving waste and excess out of the system. This can be done without impoverishing patients or driving doctors out of business, if physicians are willing to practice smarter, more efficient medicine. Spending on prescription drugs is a case in point.
Military families play a critical role in supporting U.S. servicemembers during deployment and afterwards. Equally vital but often less visible is the role played by those who care for the servicemembers who return with disabling injuries or illnesses and require long-term support beyond what the formal health care system provides.
College students documented their exposure to pro-smoking media messages during their normal routine over a three-week period. After exposure to just one, their smoking intentions immediately increased by an average of 22 percent. Smoking intentions decreased with each passing day but remained elevated for seven days.
With more than 150 million Americans overweight or obese and an estimated 1.5 billion affected globally, obesity is the world's most pressing public health crisis. In A Big Fat Crisis, RAND's Deborah Cohen unpacks the hidden causes of the obesity epidemic and outlines concrete strategies for defeating it once and for all.
The recovery from Sandy shows once again that how well communities bounce back from disasters depends not just on how they react after a crisis, but on how resilient they have made themselves beforehand. Building community resilience should be part and parcel of disaster preparedness.
In “Redesigning the Health Care Workforce,” a new special issue of the journal Health Affairs, RAND researchers contribute to several timely examinations of challenges, opportunities, and potential solutions relating to the future of health care staffing in the U.S. and abroad.
The Affordable Care Act (ACA) expands coverage to millions of Americans. But the newly eligible may face challenges enrolling if they lack understanding of how the health care system itself works. Laurie Martin explains the role of health literacy in determining how successful the ACA will be in providing coverage for America's uninsured.
Foreign-educated and foreign-born health professionals fill important gaps in the U.S. health care workforce, but strategic shifts such as changes in immigration laws may be needed to stabilize the nation's health workforce.
Much of the shortage of primary care physicians expected over the next decade could be eliminated if the nation increases use of new models of medical care that expand the role of nurse practitioners and physician assistants.
Group motivational interviewing is a guided therapeutic approach that helps people think about their motivations for behavior and their commitment to change. It is an excellent fit for adolescents, because it engages them about their personal experiences while eliciting ideas about how they can change and make healthy choices.
Dr. Mark Schuster has been elected to the Institute of Medicine. He is an adjunct researcher at RAND and the William Berenberg Professor of Pediatrics at Harvard Medical School and Chief of General Pediatrics and Vice Chair for Health Policy in the Department of Medicine at Boston Children's Hospital.
Most medical research focuses on fighting individual disease. But delayed aging could boost life expectancy by more than two years and yield more than $7 trillion over 50 years. Greater investment in research to delay aging could be a very efficient way to prevent disease, improve public health, and extend healthy life.
Restaurants make changes to their menus regularly, but they may make both healthy and unhealthy changes simultaneously. Overall, there were no meaningful changes in average energy or sodium content in main entrées from top U.S. restaurant chains between 2010 and 2011.
The RAND Corporation is launching a new research initiative to provide objective and nonpartisan analysis about the impact and future of the 340B program, a major federal program that gives safety net hospitals and other health care providers access to discounted outpatient medications.
Expanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.
Colorado and Washington will remove the prohibition on commercial marijuana production and distribution for nonmedical purposes and start regulating and taxing it. Not even the Netherlands goes that far, writes Beau Kilmer.
The American Medical Association officially designated obesity as a disease, hoping to help change the way doctors approach the issue with their patients, increase funding for research on effective treatments, spur insurers to cover prescription weight loss medications, and maybe even help de-stigmatize the condition.
Adolescents' perceptions of peer substance use grow significantly during their middle school years. These can affect current and future use. Early interventions that limit this influential factor may be appropriate during this developmental period.
Being able to provide high-quality health care is a primary driver of job satisfaction among physicians, and obstacles to quality patient care are a source of stress for them. For example, the systems for electronic health records in use today are cumbersome to operate and contribute to their dissatisfaction.
Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations, medical practice structures intended to improve medical care and cut costs.
America's prison population tends to be sicker than the general population. While Medicaid eligibility under the ACA offers an historic opportunity, enrolling the formerly incarcerated into the health exchanges or Medicaid will be neither simple nor straightforward.
Despite increasing interest and investments in climate adaptation science, the implementation of adaptation plans through institutional policies or other actions designed to reduce health vulnerabilities has been slow. Institutionalized assumptions are an important roadblock.
One of the chief aims of the Affordable Care Act (ACA) is the expansion of insurance coverage to individuals who at present either cannot afford it or choose not to purchase it. Unfortunately, many Americans lack the financial literacy needed to navigate the numerous and complex options thrust upon them by the ACA.
Out-of-pocket spending on health care will decrease for both the newly insured as well as for those changing their source of insurance. These decreases will be largest for those who would otherwise be uninsured.
As of October 1, many Americans can now shop for health insurance through state exchanges created as part of the Affordable Care Act (ACA)—the sweeping health care reform often referred to as “Obamacare.” To provide some insight into the ACA, RAND's Carter Price hosted an “Ask Me Anything” session on Reddit today.
The Affordable Care Act will have a varied impact on health spending by individuals and families, depending primarily on their income and whether they would have been uninsured in 2016 without the program.
The growing number of Americans newly-insured under the ACA will undoubtedly lead to a surge in demand for care, whether through Medicaid or insurance exchanges. But, if predictions hold, the increase won't be as dramatic as some may fear, writes David I. Auerbach.
If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.
There are times when no amount of care, however cutting-edge it is, will save a patient. In these instances, further critical care is said to be “futile.” This type of treatment is not uncommon in intensive care units, and that raises some uncomfortable questions.
California's influenza immunization requirement for health care personnel was too weak to encourage hospitals with low vaccination rates to improve. Hospitals with high vaccination rates were able to comply by simply maintaining current practices.
The philosophy and motivation surrounding community resilience has strongly resonated with community leaders but there remains a divide between how experts articulate resilience policy and how that policy translates to on-the-ground implementation. Building Community Resilience: An Online Training addresses that tension.
American youth enjoy increasing access to television, movies, music, games, websites, and advertising—often on pocket-size devices. Given the prominent and growing role that media plays in the lives of U.S. children and adolescents, what effects do these conditions have on their health and well-being?
Measuring community preparedness and resilience is a challenge. A study of measures of partnership, self-sufficiency, and social connectedness, as well as gaps and opportunities in the measurement of community preparedness and resilience, found major limitations in existing data.
The bottom line is that the employer mandate does not provide a large inducement for firms to change their health insurance offerings, but it does raise a substantial amount of money to pay for the ACA's coverage provisions over time.
The Affordable Care Act requires insurers in the nongroup and small group markets to issue and renew policies to everyone seeking coverage, regardless of health status. Researchers examine the likely effects this will have on insurance enrollment and premiums.
The response to the 2009 H1N1 influenza pandemic provides an opportunity to learn about the public health system's emergency response capabilities and to identify ways to improve preparedness for future events.
Under-resourced communities of color have limited access to programs that could improve recognition and treatment of depression. RAND and UCLA investigators applied an engagement model to determine how to better serve these communities.
Potential policy changes, such as raising the eligibility age of Medicare from 65 to 67, would save Medicare from $400 billion to $4 trillion between 2012 and 2036 but would also reduce the number of seniors enrolled.
Anti-tobacco policies that have clear scientific support will strengthen the FDA's regulatory position. While the evidence base is solid in this area, it needs to be much stronger and broader if the TCA is going to have any lasting success against the industry.
Many physician-patient encounters do not require face-to-face contact, and “eVisits” have gained acceptance among many health systems and health plans. But what do we know about the types of patients who opt for online visits over conventional office appointments?
Colleges should acknowledge their responsibility not to put their students at risk for weight gain, obesity and the host of chronic diseases related to poor diets, writes Deborah Cohen. Students have to make their own food choices, but it's colleges who're setting the table.
The Centers for Medicare & Medicaid Services (CMS) has funded 108 Health Care Innovation Awards through the Affordable Care Act. Award recipients are those who propose compelling new models of service delivery or payment improvements that promise to deliver better health, better health care, and lower costs through improved quality of care for Medicare, Medicaid, and Children's Health Insurance Program enrollees.
Inadequate care coordination is a major problem in health care delivery, but information technology is emerging as an important tool for enhancing coordination and, ultimately, improving the delivery of care, writes Robert Rudin.
Since women are almost twice as likely as men to experience depression and most women age 15 to 50 have children, maternal depression is an important issue. This report informs policymakers and practitioners of evidence connecting maternal depression and negative outcomes for both mother and child.
Compared to other Medicare beneficiaries, whites have better access to care, assuming no major health conditions. Disparities in receiving timely care and immunizations are smaller among those with greater disease burden. Outreach to minorities with low utilization and few or no major health conditions could help.
Transparency varies across websites that provide information on the performance of medical providers. This is especially true of how providers can review or correct results, how case mix adjustments are made, and how the reliability of measures is assessed.
Resilient communities withstand and recover from disasters. They also learn from past disasters to strengthen future recovery efforts. The Resilience in Action website offers toolkits, training, multimedia, newsletters, and other resources to help communities build and strengthen their resilience.
Resolving the question of whether or not the U.S. has finally gotten a handle on health care spending is vitally important, because the choices we make going forward will have profound implications for our economy, the financial wellbeing of millions of American families, and ultimately America's standing in the world.
Awareness of sexual violence within the U.S. military has grown over the past decade, but barriers still exist for servicemembers who report the crimes and seek psychological health care. A research agenda needs to take full account of the types of damage being done.
We cannot assume, based on Boston's response to the marathon bombings, that other U.S. cities are as prepared. Emergency managers and public safety agencies remain focused on disaster preparedness, but some hospitals have lapsed into thinking that it is a costly distraction from daily business.
New interventional cardiac catheterization services offered by U.S. hospitals generally duplicate existing programs and do not help patients gain access to timely emergency cardiac care. Instead, the focus has been on competing with other hospitals.
To improve health care spending and efficiency, the Department of Veterans Affairs should reduce dual use of both Veterans Health Administration (VHA) and non-VHA care, coordinate care between both systems, integrate electronic information, and consider a pilot program through which to test these recommendations.
The Veterans Health Administration (VHA) can better use its scarce resources through improved coordination with the private sector to reduce potential redundancies. The VHA can also provide access to high-quality care and meet rapidly changing needs.
Using the example of the Los Angeles County Community Disaster Resilience Project, this paper discusses the experience and perspective of a large urban county to better understand how to implement a community resilience framework in public health practice.
Wellness programs do in fact reduce health risks, like smoking and obesity, write Soeren Mattke and Kristin Van Busum. But resulting cost savings could not be detected, especially when compared to the costs of the programs.
Listen in on this panel discussion featuring sociologist Chloe E. Bird on women's health, heart health, gender-based disparities in health care, and the need for gender-specific approaches to diagnosis and treatment.
The Affordable Care Act (ACA) contains many Medicaid-related provisions. RAND is working closely with decisionmakers at the federal and state levels to help resolve challenges associated with implementing the ACA's sweeping reforms.
RAND congratulates physician researcher Ateev Mehrotra on receiving AcademyHealth's 2013 Alice S. Hersh New Investigator Award. The award recognizes early-career health services researchers who “show exceptional promise for future contributions.”
Better integration of health and social services in Washington, D.C., may help facilitate the use of preventive health services such as for asthma, obesity, and sexual and mental health, according to a community health needs assessment.
Understanding how patients experience care can encourage delivery of high-quality services. It also helps payers, including the Centers for Medicare & Medicaid Services, ensure that they pay for effective and efficient care.
Improving care for depression in low-income communities — places where such help is frequently unavailable or hard to find — provides greater benefits to those in need when community groups such as churches and even barber shops help lead the planning process.
Alignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.
While the expansion of Medicaid under the Affordable Care Act will require additional spending by the Commonwealth of Pennsylvania, these costs will be more than offset by additional revenue or reductions in other spending in the 2014-2020 timeframe.
Because of the ACA's regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.
Incorporating community programs such as churches, social service providers, and beauty salons into efforts to improve depression care in low-income neighborhoods can help improve quality of life and lower the risk of a life crisis.
It was widely assumed that Atlanta's Grady Memorial Hospital would be the next storied public hospital close its doors, but at its darkest hour, it received help from an unexpected quarter, says Art Kellermann.
The findings of a baseline survey on community resilience in Los Angeles highlighted opportunities for engaging communities in disaster preparedness and informed the development of a community action plan and toolkit.
RAND researchers have analyzed how opting out of Medicaid expansion would affect insurance coverage and spending and whether alternative policy options—such as partial Medicaid expansion—could cover as many people at lower costs to states.
The dependent coverage provision of the Affordable Care Act is working as intended, say Andrew Mulcahy and Katherine Harris. In 2011, it spared individuals and hospitals from $147 million in emergency room costs.
Physician payment policy is shifting from one that incentivizes the delivery of more services without regard to quality or outcomes to one that incentivizes the delivery of high quality, resource conscious health care. Thoughtful incentive design can ease the transition process for both physicians and the Medicare program.
Bariatric surgery for diabetic people who are not severely obese has shown promising results in controlling glucose, but more information is needed about the long-term benefits and risks before recommending bariatric surgery over non-surgical weight-loss treatment for these individuals.
States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.
While there has been interest in using utilization measures to profile physicians, examinations of these measures are rare. This study found only a small number of commonly used utilization measures reliably capture real differences in utilization among physicians.
A framework derived from information economics for assessing the value of diagnostics demonstrates that the social value of such diagnostics can be very large, both by avoiding unnecessary treatment and by identifying patients who otherwise would not get treated.
An examination of the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors found that eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths.
Ensuring the availability of needed mental health resources was critical in the immediate aftermath and recovery phase of the 2011 Joplin, Missouri tornado. Authorities in Oklahoma must ensure that such services are in place early so that Moore's residents can begin the long journey to recovery.
Workplace wellness programs are becoming quite common, and employers are optimistic about their benefits. However, such programs must be well-executed to have a meaningful effect on employee health, and significant reductions in health care cost may take time to materialize.
A new federal law allowing young adults to remain on their parents' medical insurance through age 25 has shielded them, their families, and hospitals from the full financial consequences of serious medical emergencies.
The toll of the tornado on school students in Moore, Oklahoma, cannot be overstated. To assist with recovery, RAND's CBITS program offers resources on psychological first aid for schools, as well as additional materials for educators and parents.
A combination of factors could slow the U.S. obesity epidemic while also improving overall nutritional well-being: lowering prices on healthier food, initiatives to control portion sizes, and a long-term campaign to support better food quality.
While our research has taught us many things about suicide prevention, we think additional research is critically needed in two areas, writes Rajeev Ramchand. The first is gun control. The second area is the quality of behavioral health care available to those who need it.
The rising cost of Medicare can be slowed by increasing premiums, switching to a premium support program, and raising the eligibility age, but those moves might drive many elderly Americans from the program.
It is likely that communities with low rates of non-urgent ED use not only have better access to primary care, but patients who are educated about appropriate care seeking and convenient alternatives for acute care, writes Lori Uscher-Pines.
Driving Mexican marijuana out of the U.S. would probably reduce the traffickers' export revenue by a few billion dollars a year, writes Beau Kilmer. But would reducing that revenue lead to a corresponding decrease in trafficker violence?
Three mass-casualty events occurring in three very different settings show that disaster preparedness should not be limited to large cities or “target” areas in the United States. One trait that is common to all such events is the need for coordinated, responsive trauma care for victims.
Emergency departments account for a rising proportion of hospital admissions and serve increasingly as an advanced diagnostic center for primary care physicians. While often targeted as the most expensive place to get medical care, emergency rooms remain an important safety net for Americans who cannot get care elsewhere.
A large number of youth enrolled in Medicaid with depressive symptoms do not receive adequate acute treatment. Due to workforce constraints in the child mental health sector, quality improvement and system redesign efforts are likely required to address this issue.
To celebrate our first 60 years, we created 60 Ways RAND Has Made a Difference, an online book. On our 65th birthday, we share five more recent ways that RAND has made a difference. This includes our efforts to develop, implement, and evaluate a school-based program to help children traumatized by violence.
The U.S. prison population grew nearly fivefold between 1980 and 2009, at least partially due to the “War on Drugs.” Racial disparities in criminal justice referrals to drug treatment potentially affect access to treatment for hundreds of thousands of individuals arrested for drug offenses each year.
Having dealt with outbreaks of H5N1 bird flu and other communicable diseases like Severe Acute Respiratory Syndrome (SARS) in 2003 and H1N1 swine flu in 2009, health officials are now far better prepared to detect new diseases early and react quickly to monitor and contain their spread.
An investigation of the impacts of Medicare payment reform on post-acute providers found that payment reforms reducing average and marginal payments reduced entries and increased exits from the market, which may affect market structure, access to care, quality and cost of care, and patient outcomes.
The Guidelines for Foodborne Outbreak Response and the companion Toolkit developed by the Council to Improve Foodborne Outbreak Response (CIFOR) are valuable resources, according to their target audience. However, lack of resources may be a challenge when it comes to implementing the CIFOR's recommendations.
Oral health is important to children’s overall health and well-being. However, access to care can be a challenge for parents seeking oral health services for children who are Medicaid beneficiaries. Also, providers have noted a general unawareness among parents about the importance of preventive oral health care.
California's Mental Health Services Act emphasizes stigma and discrimination reduction. Researchers examined whether this effort changed the public perception of mental illness and the individual experience of stigma.
Community-based practitioners can improve their programs using Getting To Outcomes®, a toolkit, training, and onsite-support package which enhances their ability to prevent drug and alcohol use among youth.
At the rate that the U.S. population is aging, the total cost of dementia could reach half a trillion dollars a year by 2040. Those who care for impaired relatives and friends are acutely aware of the effects of dementia, and unfortunately they are all too familiar with its costs, writes Kathleen J. Mullen.
While a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states' economies seem misguided given the full range of projected economic impacts on the states, writes Carter C. Price.
A RAND project surveys Head Start health managers to determine how services are prioritized, sustained, and implemented. Researchers will also identify program features and policy levers that support Head Start health services.
Beau Kilmer, co-director of the RAND Drug Policy Research Center and coauthor of Marijuana Legalization: What Everyone Needs to Know, hosted an “Ask Me Anything” (AMA) session on Reddit this week. He fielded questions from participants on a variety of drug policy issues.
Policymakers in Washington and Colorado are confronting some new and tricky issues that have never been addressed. For them, and for anyone else thinking about changing their pot laws, there are seven key decision areas that will shape the costs and benefits of marijuana legalization.
Boston's health care providers reacted the way they did because they knew what they were supposed to do. Those who did not were smart enough to follow the lead of those who did. That's how a “ritualized” disaster plan works.
Viewing tobacco ads in retail locations may be associated with higher smoking risk. The tobacco industry has begun using these promotions more than traditional channels, such as billboards and magazines.
If this issue were to be decided on the basis of public health benefits, the outcome would be clear: Condoms indisputably prevent both unintended pregnancies and the spread of sexually transmitted infections, writes Chloe Bird.
Based on insurance claims for nine common outpatient services in consumer-directed health plans (CDHPs), researchers found no evidence that those with lower expected medical expenses engaged in more price shopping. Consumers did not engage in more price shopping before reaching the CDHP deductible, either.
To prevent and respond to falls, many hospitals employ numerous techniques, including patient education, bed-exit alarms, post-fall evaluations, and more. However, better reporting of outcomes, implementation, adherence, and interventions is necessary to establish evidence on how hospitals can best prevent falls.
Merchants who engage in state-approved “responsible beverage service” training are more likely to believe they'll be cited for selling alcohol to minors. Therefore, targeting merchant attitudes could be a successful way to encourage them to check IDs.
Improvements in provider-patient communication can enhance efficiency and lead to higher-quality care. However, the success of communication interventions depends largely on the motivation and skill of the participating providers.
Multistate plans are most likely to appeal to out-of-state students, interstate migrants, out-of-state workers, seasonal movers (e.g., “snowbirds”), and similar groups that require improved access to health care across state lines.
If Pennsylvania opts into Medicaid expansion under the Affordable Care Act, more residents would have health coverage and the state would enjoy a positive economic effect. However, benefits would have a long-term cost, with uneven regional results.
Men experiencing homelessness valued committed relationships but were frustrated by their lack of access to female partners—accentuated by the stigma attached to homelessness—and also by logistical barriers to relationships.
Sexual health problems affect adolescents disproportionately more than adults, and efforts to improve their sexual health and decision making have not been fully successful. However, research integrating insights from neuroscience and other areas could increase our understanding of sexual risk behaviors among youth.
When it comes to women's health, cancer gets a good deal of the attention; somehow, it hasn't fully registered that so many of our mothers, sisters, friends and daughters are being affected by another, often silent killer, writes Chloe E. Bird.
Secure parent-child relationships can affect children's self-regulation, including the ability to “self-soothe” at bedtime. Sleep, in turn, may serve as a pathway linking attachment security with future emotional and behavioral problems in children.
The ACA requires the government to work with insurance issuers to establish at least two multistate plans (MSPs) in each state's health insurance exchange. MSPs may be especially attractive to those interested in issuers that operate in multiple states, such as out-of-state students or temporary workers.
Simultaneous developmental delays among young children and depression among parents can create serious challenges for many families. However, results from the Helping Families Raise Healthy Children initiative suggest that aligning early intervention and behavioral health systems can help.
Lowering the costs of healthy foods in supermarkets increases the amount of fruits, vegetables, and whole grain foods that people eat, while also appearing to reduce consumption of nutritionally less-desirable foods.
Nearly 15 percent of women develop depressive episodes during pregnancy. A similar percentage develop depression in the first three months following birth. Physiologic and psychological challenges unique to pregnancy can complicate the identification and management of perinatal depression.
The way adolescents react to stress has been shown to be a significant factor in our understanding of sex differences in depression. Adolescent girls experienced greater total stress than boys, particularly interpersonal stress, which may explain their higher rates of depression.
If a medical treatment worked only a fraction of the time and resulted in bad outcomes more often than not, practitioners would not make this treatment the default approach. Yet that is exactly what has happened when it comes to CPR for individuals 85 years and older who suffer cardiac arrest in a community setting.
New York should see the judge's ruling as an opportunity to revise the law to close the loopholes, including the Big Gulp exemption, and develop regulations in line with the scientific consensus that even 16 ounces is way too much, writes Deborah Cohen.
The TB outbreak in Los Angeles shows that bioterrorism isn't the only threat our country faces in the health security realm. Routine public health practices such as outbreak detection, laboratory diagnosis, epidemiological investigation, and disease control must continue to be a priority.
Substance use disorders are a serious issue, but treatment is often sporadic, despite ongoing need. Low rates of follow-up care among adults who received detoxification without subsequent residential treatment and among those with serious mental illness suggest that targeting these individuals could help.
A small percentage of patients die during hospitalization or shortly thereafter. More or better nursing care may be able to prevent some of these deaths. However, stronger conclusions are impossible until research evaluates an intentional change in nurse staffing to improve patient outcomes.
Considerable differences across U.S. regions in workforce age structure could result in gaps in the supply of registered nurses (RN) over the next fifteen years. Projections indicate substantial growth in RN supply in the Midwest and South and declines in the Northeast and West.
Several barriers may prevent children of parents with substance use disorders from obtaining mental health services, including children's ambivalence about treatment and parental disagreement and lack of involvement. However, peer support, afterschool activities, and family counseling may help.
Patients' use of emergency departments (ED) for nonurgent conditions may lead to excessive health care spending, unnecessary testing and treatment, and weaker primary care relationships. These patients tend to be younger and may visit the ED due to a physician referral or for convenience.
M-TEENS, the Military Teenagers' Environments, Exercise, and Nutrition Study, will examine how military adolescents' schools and neighborhoods influence their physical activity, eating behaviors, and more.
Globally, the health IT industry should not wait to be forced by government regulators into doing a better job. Developers can boost the pace of adoption by creating more standardized systems that are easier to use, truly interoperable, and afford patients greater access to and control over their personal health data.
Most of the millions of cataract cases worldwide can be cured by quick, inexpensive procedures. But a shortage of trained surgeons remains a challenge. The HelpMeSee approach, a high-volume training and development system, could help close this gap.
Getting along with peers and fear of being viewed negatively by them may influence the difference between how adolescents view their body size and what they think the ideal size should be. Those with warm, nurturing parents are more likely to have positive views about their body size.
A new field called implementation science examines how to best support providers in taking up new, research-proven treatments and implementing them well. A RAND study will test how Boys & Girls Clubs carry out a program proven to prevent teen pregnancy and sexually transmitted infections, with and without an intervention called Getting To Outcomes®.
Public and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.
Creating an effective Performance-Based Accountability System (PBAS) requires careful attention to selecting an appropriate design for the PBAS, given the context in which it is to operate, and to monitor, evaluate, and adjust the system, as appropriate.
While the current state of the evidence does not provide clear guidance to policymakers seeking to address the twin pillars of health care quality and cost, it is apparent that researchers must produce more detailed data on how to reduce health care spending while improving quality, writes Peter Hussey.
Relationships between specific features of individuals and particular features of specific objects over time in specific contexts could be what creates the conditions necessary for stopping problematic substance use.
The health insurance subsidy in the U.S. tax code enables individuals to pay premiums in pre-tax dollars and encourages the purchase of more generous health insurance plans. This paper explores how the income tax subsidy distorts optimal cost-sharing in health insurance and influences cost-sharing in private plans.
California health regulators should begin collecting physician identifiers as part of their routine data collection efforts about the services provided at the state's hospitals. Such a move would help providers improve quality by aiding efforts to benchmark performance and reduce variations in the delivery of care.
To be wise purchasers of health care services, consumers need access to accurate and understandable information about health plans and providers. They wrongly assume that more expensive providers are better than less expensive ones, despite inconsistent evidence that there is any link between health care cost and quality.
Health care providers are encouraged to implement “shared decision making” in which patients and doctors together choose the treatment that is best for each patient. However, doctors need more instruction on how to engage patients and better information systems to make sure patients know their options and receive individualized care.
Research based primarily on reports from an individual's surviving relatives often suggests that end-of-life care experiences are particularly poor. However, this examination of reports from patients found that those who died within a year of being surveyed reported slightly better experiences than other enrollees.
Sleep disturbances and interpersonal problems are common in military veterans with PTSD and are associated with increased health care costs. Findings suggest that attachment anxiety and avoidance are linked with specific disruptions in sleep among these veterans.
People who consume just one or two sugar-sweetened drinks a day have a 26 percent greater risk of developing type 2 diabetes than people who rarely drink these beverages, write Kristin Van Busum and Lauren Hunter.
Bullying is a serious medical and public health issue. While adults can help in a number of ways, they may also make things worse by serving as negative role models, ignoring bullying, or even bullying children themselves. Clinicians can help, but they must first be able to recognize the signs of bullying.
The potential for treatment costs can discourage screening in developing countries. A field experiment in Nigeria offered cervical cancer screening to women at randomly chosen prices, as well as a chance for treatment subsidies. Findings indicate that preventive efforts in developing countries should subsidize both testing and treatment costs.
Given the size of the annual “health care spend”—$2.7 trillion—summing up the savings associated with very minor cost-saving policy changes is likely to achieve significant aggregate savings, writes Jeffrey Wasserman.
The U.S. malpractice system is widely regarded as inefficient, in part because of how long cases take to resolve. Malpractice reforms should be assessed by how well they reduce litigation time without undermining patients' needs.
By 2030, California's entire elderly population is projected to double what it was in 2000. This profile provides a factual framework to help consumer advocates, health care providers, and policymakers better understand California's Medicare population and inform their efforts to design programs and policies.
Religious organizations in the U.S. may have a unique opportunity to address HIV due to their wide social reach and access to institutional and community resources. However, relatively few formally engage with people with HIV, and many have reported barriers to introducing HIV prevention activities.
A review of more than 60 studies reveals extremely mixed findings on the association between health care quality and cost. Future work should determine what types of spending effectively improve quality and what types are wasteful.
Use of and spending on complementary and alternative medicine have flattened out. Including providers of these services in new delivery systems such as accountable care organizations could help slow growth in national health care spending.
Programming is often based on the assumption that young women only care about risk reduction when making decisions about sexual encounters. However, their most important goals are communicating clearly and avoiding unwanted sex.
President Obama's task force on gun violence has raised the stakes in the policy debate on gun control and policy in the wake of the recent shootings in Colorado and Connecticut. Some of RAND's top researchers share what is, and what isn't, known about firearms and gun control.
If policymakers and the public expect the mental health community to play a significant role in preventing future incidents like Newtown, the mental health research agenda must become a higher national priority in future federal funding decisions, writes Terry Schell.
More than a dozen hospital staffers in four states have been terminated for refusing flu shots in the midst of a fierce flu season. Yet only one-tenth of health care employers require their staff to be vaccinated.
Medicare and private plans encourage individuals to use hospitals that are designated as centers of excellence. Evidence shows that the costs of knee and hip replacements in centers of excellence do not differ from other hospitals, but patients who had hip replacements in such centers had lower complication rates.
In examining the socioeconomic benefits of HIV antiretroviral therapy (ART) in Uganda, researchers find that ART helps alleviate the food insecurity of adults with HIV, which in turn may improve ART outcomes.
Injury prevention research has dramatically reduced deaths in the U.S. from motor vehicle crashes, drowning and fire. But since 1996, funds for similar public health science on firearms violence has effectively been muffled.
The Medicaid expansion under the ACA will result in about 400,000 people newly insured in Arkansas by 2016. The state is likely to save about $67 million for reduced uncompensated care costs for the uninsured, and receive $430 million in federal funds. Wealthier states, however, will have a different experience.
Despite wide investments nationally in electronic medical records and related tools, the cost-saving promise of health information technology has not been reached because the systems deployed are neither interconnected nor easy to use.
As a Southerner who learned to shoot at an early age, I've never had a problem with guns. But emergency-room doctors like me also know how much damage they can cause if misused or allowed to fall into the wrong hands, writes Arthur Kellermann.
An examination of whether retirees and near-retirees understand what their likely out-of-pocket health care expenditures might be in retirement found many do not understand the magnitude and variability of their future out-of-pocket health care costs, and may be unprepared to finance higher-than-typical expenditures.
For Arkansas, the Affordable Care Act will result in an increase in GDP of around $550 million and the creation of about 6,200 jobs. The new law will also increase health insurance coverage by 400,000 newly insured individuals.
Unfortunately, nearly every actor in our health care delivery system—hospitals, physicians, other health care providers, insurance companies, and the manufacturers of drugs and devices—is currently focused on maximizing revenue growth, write Arthur Kellermann and David Auerbach.
Family environments present opportunities for interventions that promote physical activity. Family members share genetic risk factors associated with chronic health conditions, and physical inactivity tends to cluster within families and households.
Programs that offer 30 days' worth of selected generic drugs for $4 have become important options for seniors to obtain affordable medications, but little is known about access to these programs and the characteristics of those who use them.
A look at the Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS) study, which tests how well a community-based setting (Boys & Girls Clubs) conducts a program to prevent teen pregnancy and sexually transmitted infections.
The development of an assets framework which identifies relevant nongovernmental resources for disaster preparedness and response and assesses their availability at state and local levels found that the capacity of each sector to capture data needs strengthening.
This analysis used peer-reviewed literature, relevant policy, and federal guidance to characterize the capabilities of nongovernmental organizations, factors that determine their involvement, and key services they provide during disaster response and recovery.
Experts find that identifying whether a suicide prevention program is effective is challenging, because suicide is such a rare event. While these programs may show immediate reductions in suicide attempts, long-term effects are uncertain.
Student mental health programs can improve staff, faculty, and student knowledge of mental health problems, provide skills for identifying and referring students in need, and change attitudes toward mental health problems.
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are designed to capture patients' experiences in a systematic way that facilitates reporting the results publicly to help other consumers make more savvy care decisions. Consumer choices may influence providers to improve the care they offer so that they can effectively compete in the market.
In our national conversation on mental health, we should remember the role of families when thinking about treatment and ensure that our policies open up opportunities to support parents, siblings and relatives, and enhance their capacity for care, writes Ramya Chari.
Art Kellermann reviews what is known from broad outlines of the Newtown attack and past research on gun violence to offer some preliminary thoughts to the Obama Administration's task force and the public.
The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence, writes Arthur Kellermann.
With an event like this, “recovery” doesn't mean a return to normal, because lives have been permanently altered. Recovery can only mean finding a new normal, a new path forward. And schools, those places of safety and healthy development, can help with that process, by providing a structure and community to support healing, writes Lisa Jaycox.
Many families experience the challenges of caregiver depression and early childhood developmental delays. Although services and supports across systems could help caregivers to deal with such issues at the family level, numerous obstacles prevent adequate screening and identification, referral, and service delivery.
RAND congratulates Art Kellermann, M.D., Paul O'Neill–Alcoa Chair in Policy Analysis, on being named by his peers to serve on the Institute of Medicine's (IOM) Council of Governors. The Council is responsible for approving IOM studies, overseeing budget and investments, and guiding policy.
As Newtown, Connecticut and the rest of the nation tries to recover from the tragic shooting that took the lives of 28 people, the CBITS program offers helpful materials including “psychological first aid” for schools and tips for talking to children about the shooting.
The Affordable Care Act focuses primarily on extending coverage to uninsured Americans, but it is also intended to help curb cost growth. M. Susan Ridgely explains one of the key tools for doing that—the “accountable care organization,” an alternative delivery model intended to lower costs while also improving quality of care.
For all teens, and especially those who have already experienced problems related to alcohol and drug use, it is essential to monitor the quality of work experiences and keep in mind that some work environments might increase risk for substance use.
In this December 2012 Congressional Briefing, Amelia Haviland presents the results of several RAND studies on cost and quality in consumer-directed health plans, and explores how switching plans affects the quality of care.
Incentives to participate in wellness programs or reach health-related targets are popular, but could expose employers and insurers to litigation risk because incentives might violate state and federal insurance, anti-discrimination, or privacy laws.
Researchers present one of the first investigations into the impact of small and moderate disasters on morbidity, physical growth, and immunizations by combining household data on over 80,000 children from rural India.
During a panel discussion at RAND's Politics Aside event, Bill Frist, a medical doctor and former Senate majority leader, says the healthcare industry faces serious obstacles but he believes it ultimately will find its way. Meanwhile, RAND's Arthur Kellermann notes that the recent decade of health care cost growth has wiped out real income gains for average U.S. families.
Using a template for molecular genetic test reports, developed to reduce communication errors between the laboratory and ordering clinician, was found to improve physician ratings compared to standard laboratory templates—especially with doctors who were least familiar with the reports.
The Cognitive-Behavioral Intervention for Trauma in Schools Program (CBITS) is a targeted intervention for school children who have experienced a traumatic or violent event and have symptoms of posttraumatic stress disorder.
The longer that Mexican immigrants stay in the U.S., the greater their odds of becoming obese, according to a new study examining three generations of immigrants. First-generation immigrants are more likely to be obese than their peers still in Mexico. Succeeding generations are even more likely to carry extra weight.
For vaccination to become a public health priority in the U.S., stakeholders must strengthen guidance for providers, which would make it easier for physicians to both assess vaccination needs and aid communication with patients about the efficacy and safety of vaccines.
Immigrants who come to the U.S. from Mexico arrive with a significant amount of undiagnosed disease. About half who have diabetes are unaware they have it, and about one-third of those with high blood pressure are unaware of the illness.
Given the broad range of threats facing the United States, including those related to extreme weather, it is imperative that monies invested in enhancing health security be well spent, writes Shoshana Shelton.
As policymakers worldwide debate ways to reform health care to reduce expenditures, estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Here, data from Chile was used to estimate elasticity of expenditures across a variety of health care services.
Cost-sharing leads consumers to reduce both highly beneficial and less beneficial care, so they must be empowered with useful information to make informed decisions. Public cost and quality reports must be accurate, accessible, and understandable.
Neighborhood socioeconomic status is significantly associated with coronary heart disease risk, according to a nationally-representative sample. The association is larger in men than women and in whites than minorities.
Researchers determine that retail clinics may disrupt whether patients see a primary care physician first for new conditions, as well as continuity of care. However, retail clinics do not negatively impact preventive care or diabetes management.
Research evidence has many gaps, but treatment guidelines for children with autism spectrum disorders represent a significant step forward. Future research should focus on assessment and monitoring of outcomes, the needs of pre- or non-verbal children, and the most effective treatment strategies and duration.
Ninety-two percent of U.S. employers with 200 or more employees reported offering workplace wellness programs in 2009. However, participation remains limited; a 2010 survey suggests that typically less than 20 percent of eligible employees participate in wellness interventions.
Calculating statins' social value reveals that consumers captured 76 percent of the total social value of the survival gains, with even greater consumer benefits expected in the future as prescribing rates rise and statin costs decrease.
Excessive alcohol consumption costs society nearly a quarter of a trillion dollars each year. An innovative program that combines frequent alcohol testing for offenders with swift and certain sanctions for failed tests can help reduce problem drinking and improve public health.
The problem is that on any given day, disaster preparedness takes a back seat to ongoing operations. The tyranny of the urgent prevents hospital administrators from making investments in preparedness, writes Art Kellermann.
Providers can dramatically improve American health care by focusing on “value” instead of “volume,” eliminating wasteful and inappropriate care, applying the best available evidence to their practices, and enhancing patient safety.
Health information technology has not achieved its full potential, but its benefits should grow over time. Because health care is largely regulated at the state level, the states can play a valuable role as “laboratories” for innovative policies.
Despite widespread enthusiasm about the potential impact of new investments in comparative effectiveness research, recent history suggests that scientific evidence may be slow to change clinical practice.
Evidence suggests that subsidizing healthier foods tends to be effective in modifying dietary behavior. However, future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.
Researchers discuss deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations.
Efforts to maintain and increase veteran participation in the mental health and substance-use services offered by Veterans Affairs should be informed by individuals' characteristics, such as younger age and better physical health relative to other veterans.
Commercial health plans and Medicare are using cost profiles to identify which physicians account for more health care spending than others, while devising strategies to reward those who provide quality care at a lower cost. Doctors with less than 10 years of experience had 13.2 percent higher overall costs than those with 40 or more years of experience.
Hospitals with higher cultural competency ratings have better scores on multiple dimensions of care. Findings also indicate that greater cultural competency may particularly benefit minorities in interactions with hospital staff, while also contributing to general quality improvement.
The Medical Insurance Program for the Poor in the republic of Georgia provides a free and extensive benefit package and operates through a publicly funded voucher program, enabling beneficiaries to choose their own private insurance company. This research looks at costs, usage and health behaviors under this system.
Racial/ethnic minorities report more difficulties in getting drugs and needed information through Medicare's Part D program. However, quality improvement efforts may reduce these disparities in beneficiary experience with prescription drug coverage.
Do patients in the last stages of a terminal illness have an unqualified right to costly treatments of marginal or uncertain value for as long as they want? Because if the answer is “yes,” the rest of us must be prepared to pay the price, writes Art Kellermann.
About $500 million a year is being spent in the United States. on comparative effectiveness studies that will conclude that therapy A can, or cannot, be distinguished from therapy B. But will physicians be able to use such information to arrive at better decisions for their patients?
Fourteen quality indicators for the management of heart failure were selected in 1999 as part of the Assessing the Care of Vulnerable Elders (ACOVE) project. Since that publication, several new therapies have been shown to prolong life for patients with heart failure.
Findings suggest that while depression is related to work and income, its influence may only be indirect through its relationship to other factors such as work self-efficacy and physical health functioning.
The burden of cancer is not experienced equally across the population: Nationwide, black Americans have higher rates of death from cancer than white Americans, and nowhere has this disparity been more apparent than in the nation's capital, writes Rebecca Anhang Price.
Research indicates that individuals of lower socioeconomic status engage in less leisure time physical activity than their higher socioeconomic counterparts. This difference is believed to be due in part to varying access to parks and other resources that support physical activity.
Regardless of which candidate wins in November, and regardless of whether “Obamacare” is repealed, amended, or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year, writes Arthur Kellermann.
Despite remarkable progress in medical science, the global death rate is still 100 percent. So the question is not whether we will live, or die. The question is where and how we'll die, and who will be with us when we do.
Although placement is a factor that is right in front of our noses, we should consider treating it as a hidden risk factor, like carcinogens in water, because placement influences our food choices in a way that is largely automatic and out of our conscious control, write Deborah A. Cohen and Susan H. Babey.
As we look for ways to provide efficient, high-quality and cost-effective healthcare to more Americans, states may study California as a potential model for how to do more to deliver on what the Affordable Care Act has to offer women, while saving money at the same time, writes Chloe Bird.
Absent from the discussion about health care during the first debate between President Barack Obama and Governor Mitt Romney was any mention of one of the main providers of care for America's uninsured: emergency rooms. What does research tell us about the use of ERs and the relevant implications on health care access and cost?
In 2004, California voters passed a proposition intended to transform their community mental health system from a crisis-driven system to one including a focus on prevention and wellness. RAND researchers have developed a framework for evaluating the impact of California's prevention and early intervention services.
For the past four decades, children have been the most vulnerable group in America. With this in mind, this commentary poses a series of policy questions for the 2012 presidential candidates to spur a dialogue about the vital issues of child poverty, health, development, and education.
Physician organizations (POs) in lower socioeconomic status areas may score poorly in pay-for-performance programs. Programs that do not account for this are likely to pay higher bonuses to POs in areas of higher socioeconomic status, thus increasing the resource gap, which may also increase disparities in care.
Morbid obesity entails far more serious health consequences for patients than moderate obesity and creates additional challenges for providers. The prevalence of morbid obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.
Cross-coordination of health systems could help fight depression among parents. A new cross-system quality improvement initiative is focused on improving identification and treatment of families faced with the dual challenge of caregiver depression and early childhood developmental delays.
Both a hospital's protocol and a state's legal environment are significantly correlated with physicians' propensity to take action when they suspect Prenatal Substance Exposure. However, physicians prefer a patient-centered approach in these situations over more punitive measures.
Researchers examine whether residential neighborhood characteristics influence the initiation of marijuana use and binge drinking, and if these factors—including the proportion of households below the poverty line and female-headed, unemployment rate, residential stability, and perceived cohesion and safety—heighten or dampen peer influences on substance use.
Whether the Affordable Care Act is repealed, defended, or weakened will hinge on who holds the balance of power next January. Regardless of what happens with the ACA, the spiraling cost of health care in the United States will remain a huge challenge.
The Affordable Care Act requires changes in payment policies for Medicare postacute care services intended to contain spending and help ensure the program's financial sustainability. Policymakers will need to monitor the reforms' impact and amend policies as necessary to ensure that spending is controlled without compromising the service delivery.
Much of the talk has focused on how New York City's ban on sugary drinks, intended to curb obesity by improving dietary choices for consumers, will restrict individuals’ options. Of course, even after the ban, consumers can still buy a second soda. But they might want to take a moment to think about the consequences before doing so, writes Chloe Bird.
Alarming disparities in life expectancy persist in the U.S. among racial groups and between the well-educated and those with less education. To reduce this gap in health and longevity, policymakers should improve education at young, middle, and older ages for people of all races.
It is time we treated food with the same respect we hold for the power of alcohol. It's time to develop and implement regulations that will help us moderate our diets and stem the obesity epidemic, write Deborah Cohen and Lila Rabinovich.
This November, Washington state, Oregon, and Colorado voters will consider ballot measures to legalize the production, distribution, and possession of marijuana for nonmedical purposes. Even if voters pass these measures at the state level, marijuana will still be prohibited by the federal government, writes Beau Kilmer.
Researchers find that patient perceptions of discrimination based on race/ethnicity and Medicaid insurance are widespread and are associated with lower patient assessments of care. Practices must develop and implement strategies to reduce perceived discrimination among their patients.
By 8th grade, Hispanic and black children are 50 percent more likely to be obese than non-Hispanic white children. Obesity is equally prevalent among Hispanic and black children, but it emerges and is sustained earlier in Hispanics. This should have implications for diagnosis and prevention strategies going forward.
Established in December 2005 to support hurricane recovery and long-term economic development, the RAND Gulf States Policy Institute is dedicated to developing informed public policy in Louisiana, Mississippi, and Alabama and a better future for the people who live there.
High school girls reported consuming an average of 3.5 servings per week of snacks high in solid oils, fats, and added sugars at someone else's house and 3.0 weekly servings at retail food outlets. These findings demonstrate the widespread availability of low-nutrient foods across multiple settings.
Discussions about reducing harms associated with drug use and antidrug policies are often politicized, infused with questionable data, and unproductive. This nonpartisan primer should be of interest to those who are new to the field of drug policy, as well as those working in the trenches.
As we look for ways to provide efficient, high-quality, and cost-effective health care to more Americans, we can't afford to ignore women's health issues, including reproductive health care and the cost savings that contraceptive access provides, writes Chloe Bird.
Treating stroke patients is time-sensitive; risk of death or disability by hemorrhage may increase with stroke size and time. An innovative but risky stroke therapy, recombinant tissue plasminogen activator, may decrease time between symptom onset and drug administration. But is it suitable for late-arriving patients?
This article describes a conceptual framework and protocol that combines evidence review with expert opinion, using a modified Delphi expert panel process, to elicit clinically meaningful objectives for clinical decision support directly from specialists.
Don't forget—an American's odds of living a long and healthy life still depend more on his zip code than his genetic code. That won't change until we make healthcare more affordable, writes Dr. Arthur Kellermann.
Workplaces across the world that rely on a teenage workforce, like supermarkets and fast food restaurants, need to do a better job protecting young people from starting to smoke, writes Rajeev Ramchand.
Greater use of geriatricians in hospital settings could reduce health care costs while maintaining quality of care, but there are fewer than four certified geriatricians in the U.S. per 10,000 individuals 75 years of age or older.
Patient nonadherence to prescriptions affects up to 40 percent of older adults in the U.S. and is associated with poor health outcomes, more hospitalizations, and higher mortality. While physicians uniformly feel responsible for promoting adherence, only a minority ask their patients detailed questions on the topic.
Researchers find that hospitals serving large minority populations are more likely to divert ambulances. This suggests that establishing more uniform policies to regulate diversion may help reduce disparities in access to emergency care.
Policies that regulate how alcohol is displayed, packaged, and sold long have been used to help curb alcohol abuse and its associated health risks. Could some of those same policies help control obesity if applied to food?
This study engaged staff members from VA homeless programs using Getting-To-Outcomes (GTO), which builds practitioner capacity to plan, implement, and self-evaluate evidence-based practices. Staff found GTO to be helpful and felt that communication, staff commitment to the program, and technical assistance were crucial.
Higher parental respect was protective against adolescent alcohol use for Whites and Asians, but not for Blacks or Hispanics. Interventions focused on maintaining strong cultural values and building strong bonds between adolescents and their families may help reduce the risk of alcohol initiation.
The not-for-profit Wounded Warrior Project gives injured veterans access to programs to improve their health and economic outcomes. Participants are achieving the goal of not missing work due to physical health problems and have obesity rates proportionate to that of the U.S. population.
A decade of unprecedented efforts in Arkansas has cut cigarette use by nearly one-third and reduced incidence of tobacco-related illnesses such as heart attacks and stroke. To maintain these gains, Arkansas should continue its financial commitment of devoting tobacco settlement funds to public health programs.
This DVD set contains demonstrations of techniques, strategies, and exercises used in the BRIGHT group therapy for depression in individuals with alcohol and drug use problems. BRIGHT counselors address common concerns about using a treatment manual, and guide viewers through steps in preparing to lead a BRIGHT group.
Physicians who incorporate acupuncture into their practice do so mainly to treat pain. These physicians are more likely to work in private practices, to be nonspecialists, and to use or endorse other complementary and alternative practices.
Homeless youth are at high risk for HIV and other sexually transmitted infections (STI), yet those at greatest risk may never have been tested. Drop-in centers can play an important role in facilitating testing, including among injection drug users, but more outreach is needed to encourage testing in other at-risk subgroups.
Reducing inappropriate and wasteful tests, treatments, and procedures has the potential to save billions annually and simultaneously improve the quality and safety of American medicine, writes Art Kellermann.
As the nation struggles to confront the twin challenges of rising health care costs and uncertain quality, we should embrace innovative practices wherever they exist—whether they are developed in private, for-profit health care systems or so-called "socialized" ones, like Britain's NHS or America's VA, writes Art Kellermann.
According to new evidence, perceptions of the seriousness of HIV/AIDS in one's community may predict HIV testing behavior. Those with high perceived seriousness had significantly greater rates of testing than those who perceived HIV as less serious.
National organizations and major nongovernmental organizations that regularly participate in global disaster relief should regularly meet to share experiences, offer insights, and critique response in a nonjudgmental way. This should inform policy decisions around personnel, supplies, transportation, and communication.
Drug use studies typically focus on young people or problematic users (arrestees or those in treatment), however, neither approach captures the full scope of the issue over time. However, a new model can synthesize both sorts of data and may help evaluate policies aimed at reducing marijuana use over the life course.
Researchers examine the relationship between depression, productivity, and work loss among working-age U.S. veterans, finding that improved depression status is associated with a greater chance of gaining employment.
Legislation requiring improved coverage for Autism Spectrum Disorder services by private insurers may decrease the number of families seeking eligibility to obtain Medicaid-funded services, with an associated substantial decrease in Medicaid expenditures.
Inpatient rehabilitation facilities (IRFs) decreased in quality from 2004 to 2009. However, this was a result of increasing severity in case mix. After adjusting for this, IRFs actually improved on every quality metric. Risk-adjustment methods should be used as the basis for revealing overall quality trends.
A problem with using surveys to predict behavior is that they measure employer sentiment toward the ACA today, rather than the economic decisions employers typically make when the time comes, writes Art Kellermann.
We will be more successful at stemming the growing tide of obesity and improving our own health if everyone accepts their share of responsibility for the obesity epidemic, write Chloe E. Bird and RAND Health's Tamara Dubowitz.
When people talk about legalization they're talking about removing the prohibitions on production, distribution, and possession, and sometimes they also talk about having regulations and taxation. This is very different from decriminalization, which generally focuses on reducing the penalties associated just with possession.
Simulating a convenience store environment, researchers find that young adolescents' snack purchasing choices are affected by taxes on unhealthy snacks, subsidies for healthy options, and the presence of peers.
Researchers from the RAND Drug Policy Research Center (DPRC) discuss marijuana legalization, how it differs from decriminalization, its possible consequences, and federal response to state initiatives.
College students encounter some form of pro-smoking media—movies, paid advertising, point-of-sale displays—nearly three times per week. Results of this study indicate that exposure to such media increases smoking risk among college students.
Researchers examine the impact of TV sex on teenagers’ sexual beliefs and activities, finding that teens who watch a lot of TV with sexual content are more likely to initiate intercourse. Moreover, shows in which characters talk about sex affect teens just as much as those that actually depict sexual activity.
Ian Coulter, who holds the Samueli Institute Chair in Policy for Integrative Medicine at RAND, joins fellow experts in complementary and alternative medicine (CAM) to discuss patient use of CAM and how hospitals, universities, and the military are integrating CAM into traditional medical practices throughout the U.S.
Retail clinics—which provide health care within supermarkets, pharmacies, and stores—are a promising and popular venue for the promotion and administration of vaccinations. However, they could become more viable by reviewing patient histories and providing counsel about vaccination benefits.
Efforts to measure patients' health care experiences must expand to include non-English speakers. However, drastic differences in “subjective” ratings on medical surveys provided in multiple languages suggest that some questions may not be compatible across cultures.
Errors are most likely to occur during the pre- and postanalytic phases of the genetic testing process, which can contribute to underuse, overuse, and misuse of genetic tests. A template that utilizes the combined features of synoptic reporting and narrative interpretation was created to mitigate such errors.
Lessons learned from implementing evidence-based practices, such as cognitive-behavior therapy, in the wake of Hurricane Katrina could help identify barriers to disseminating evidence-based interventions in other low-resource communities affected by disaster.
Someone who uses cocaine every other day or more often is probably cocaine dependent; someone who uses marijuana every other day or more often is probably not cannabis dependent. In this regard, marijuana resembles alcohol more than it does the “hard” drugs.
A study of middle school students' alcohol consumption habits finds that adolescents with a larger number of school-based friendship ties are more inclined to drink. Popular students may have more direct exposure to drinking role models, access to alcohol, opportunities to use, or social stress.
Computerized clinical decision support (CDS) systems have been developed to enhance physician decisionmaking and reduce the incidence of avoidable medical errors. Drug-drug interaction warnings are a mainstay of CDS systems, but they give rise to a fundamental problem that limits the utility of the systems to date.
The importance of cultural competency in health care is growing with the increasing diversity of the U.S. This study examines the relationship between organizational and market factors and cultural competency, finding that linking the latter to performance may be essential to attract more profit-driven hospitals.
U.S. government programs regarding the importance of citizen preparedness are based on several untested assumptions. Despite extensive communications efforts and surveys related to preparedness activities, the role individual Americans are being asked to play is largely based on conventional wisdom.
The Affordable Care Act will likely increase the probability that small businesses will offer health coverage to their employees, especially for firms with 50 or fewer workers. This will be a result of increased individual demand for insurance, since there is a penalty associated with being uninsured under the new law.
Antiretroviral (ARV) treatment allows patients with HIV to live longer, healthier lives, but significant access and affordability barriers persist. High prices pressure government insurers to contain costs by rationing care or restricting eligibility. This study examines options for negotiating lower ARV costs.
A shortage of nurse practitioners (NPs), combined with increased demand for sexual and reproductive health (SRH) services under new health care laws that increase coverage, could undermine SRH care delivery in the U.S. This study examines policy options that may help close this future gap between supply and demand.
In this June 2012 Congressional Briefing, Lois Davis discusses the health care needs of prisoners who reenter the general population; the roles that health care providers, other social services, and family members play in successful reentry; and recommendations for improving access to care for this population in the current fiscal environment.
The U.S. Supreme Court's ruling on the Affordable Care Act is unquestionably historic, but there is a critical aspect of health care reform that still needs to be fixed. The nation needs to take decisive action to address the rising costs of health care, writes Arthur Kellermann.
Switching to a consumer-directed health plan (CDHP) could save families 20 percent or more on their health care costs. Families with CDHPs initiate less episodes of care and spend less per episode, however, they also tend to scale back on high-value preventive care, such as child vaccinations.
This study examined more than 5,000 elderly patients diagnosed with stage III colon cancer. Use of adjuvant chemotherapy decreased with age and comorbidity among these patients, however, findings suggest that older patients may receive a survival benefit from this form of treatment.
People living with HIV report increased levels of post-traumatic stress disorder symptoms (PTSS). This six-month study finds that prolonged exposure therapy could be effective in reducing PTSS—namely, negative cognitions—among people living with HIV.
The $15 co-pay a mother is expected to cover represents half of a full week's food costs under the U.S. Department of Agriculture's “thrifty” food plan for her six-year-old, write Art Kellermann and Robin Weinick.
Former RAND researcher Elizabeth McGlynn has been honored with AcademyHealth's 2012 Distinguished Investigator Award. Her extensive research on health care quality has had an enormous impact on how experts evaluate health care reform.
This study of nearly 300 residential addiction treatment clients with depressive symptoms suggests that group cognitive-behavioral therapy for depression (GCBT-D) could promote recovery efforts and reduce depressive symptoms.
Hysterectomies recommended for nonemergency and nononcologic reasons are often unnecessary. Seventy percent of cases examined did not meet the recommended level of care and were deemed inappropriate. Physicians must complete proper diagnostic evaluation and consider appropriate treatments before recommending hysterectomy.
The pharmaceutical industry can and should reconfigure its considerable resources to develop innovative and meaningful business models that are based on services that improve access and adherence to prescription drugs for common chronic conditions.
Homeless youth are particularly vulnerable to HIV and other STIs; they are more likely to engage in multiple partnerships, unprotected sex, and sex trading. This study examines levels of social influence and concludes that interventions aimed at the partner/relationship level could be effective in reducing risk behavior.
More than three out of four cancer patients surveyed preferred “hopeful gambles” (treatments that potentially offer longer periods of survival) to “safe bets”. Either hope should be incorporated into the value of therapies, or a higher threshold should be set for cost-effectiveness ratios during end-of-life scenarios.
Cuts and restrictions in care are the common health care cost reduction methods, but cutting waste (including overtreatment, poor clinical and administrative coordination, and fraud) would save at least 20% of health care expenditures. Doing so will require significant cooperation across the health care professions.
This study examines how movie characters' motives for smoking affect self-reported risk for future smoking among early adolescents, finding that those who viewed characters smoking to relax or for social reasons were at greater risk for future smoking.
Reports on the costs of individual providers designed to steer consumers toward lower-cost options may actually accomplish the opposite. Consumers have fixed co-payments and caps on their out-of-pocket spending that make most cost information impractical. Many also equate higher costs with higher quality of care.
If the pharmaceutical industry develops innovative and meaningful business models to offer services that improve access and adherence to prescription drugs for common chronic conditions, it can profit far more than by developing more "blockbuster" drugs.
The results of physicians' management style in planning, making treatment decisions and delivering care on patient outcomes is unstudied. Using results from a survey about a hypothetical patient and real patient outcomes, research showed that physicians who co-managed tasks had better patient ratings of care.
Private health facilities provide much of the care in developing countries, but are often poorly integrated into the health system. Barriers, especially financial ones, increase costs and impact patient care. Research indicates that improving facilities' business needs would improve growth and overall success.
Quality of care in hospitals is a significant problem. However, researchers have developed a toolkit that outlines steps designed to help hospitals calculate desired rates for quality indicators, set priorities for improvement, develop specific strategies and goals, implement these strategies, and sustain improvements.
Most electronic health records (EHRs) automatically alert users to drug-drug interactions (DDIs), but this can result in providers being overloaded by minor alerts and missing severe ones. This project identified a set of critical DDIs for use in EHRs, and built a process to better communicate the alerts to users.
Helen Wu discusses a RAND study that looked at over 300,000 menu items in 245 restaurants. The largest survey of chain restaurant nutrition, the study found that 96 percent of restaurant items exceeded USDA recommendations.
Every year, vaccine-preventable diseases cost the economy billions, sicken millions and kill thousands, yet adult vaccination rates are consistently low. An analysis shows that providers are under-promoting vaccinations to adults, possibly due to cost barriers which discourage office-based vaccinations.
This study of menu content at the 400 top restaurant chains in the United States found that 96 percent of entrées exceed a measure based on USDA recommendations for sodium, fat, saturated fat, and calories combined.
Childhood obesity holds wide physical, psychological and social consequences. Unhealthy eating and physical inactivity have been shown to be influenced by peers. A literature study indicates that peer networks may be crucial to prevention and intervention efforts, but the exact mechanisms are as of yet unclear.
As commerce and travel continues to expose the U.S. to international health risks, the lines between 'local' and 'global' public health increasingly blur. U.S. agencies can aid preparedness by promoting awareness to clinicians, learning from other countries, measuring effectiveness, and keeping a global perspective.
A description of the development of 22 clinical decision support (CDS) artifacts as part of the Advancing Clinical Decision Support effort to accelerate the effective use of CDS interventions and facilitate evidence-based clinical practice.
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.
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.
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.
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.
If the individual mandate requiring all Americans to have health insurance were eliminated, it would sharply reduce the number of people gaining coverage and slightly increase the cost for those who do buy policies through the new insurance exchanges.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Data on the treatment choices of terminally ill patients used to estimate the value they associate with care revealed that patients place high valuations on metastatic cancer therapy – on average, twenty-three times higher than its cost.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Estimation of six-month prognosis is essential in hospice referral decisions, but accurate, evidence-based tools to assist in this task are lacking. PROMPT, a new prognostic model incorporating health-related quality of life, demonstrates promising performance and potential value for hospice referral decisions.
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.
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?
Detection is key in improving cancer outcomes, but colonoscopy quality is often inadequate and varies widely among physicians. Quality is measured by expensive manual review of free-text patient charts. Researchers built a natural language processing (NLP) application to evaluate quality measurements.
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.
New RAND research finds that eliminating the requirement that all Americans have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges. RAND Economist Christine Eibner discusses the ramifications.
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.
Eliminating a key part of the Affordable Care Act that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
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.
Pharmaceutical advertising and rising drug costs have focused attention on physician prescribing behavior. Researchers examined how doctors were prescribing drugs, what drove their choices, and the impact of their prescribing behavior on patient outcomes.
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?
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.
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.
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.
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.
The rates of emergency readmission to hospitals are 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.
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.
Communities 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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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).
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?
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.
A new online tool, called the "Unintended Consequences Guide," is available from the U.S. Agency for Healthcare Research and Quality to help hospitals and other health care organizations anticipate, avoid, and address problems that can occur when adopting and using electronic health records.
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.
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.
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.
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.
In this December 2011 Congressional Briefing, Katherine Watkins discusses the VA's capacity to deliver care to veterans with mental health and substance use disorders and the quality of the care that is delivered. This congressionally mandated study is the first comprehensive look at the full spectrum of clinical services provided to veterans with mental health issues.
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.
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.
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.
RAND Health Director Art Kellermann was the guest speaker at the inaugural lecture of the Cambridge Centre for Health Services Research (CCHSR), a joint effort of RAND Europe and the University of Cambridge. His talk focused on the challenges of acute care in the U.S. health system.
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.
Labor issues, healthcare, education, social programs, and other factors affecting economic development in Latin America were the focus of a two-day conference in Santiago, Chile. RAND researchers joined university colleagues, industry experts, government leaders, and policymakers in discussing a range of critical topics.
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.
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.
Under bundled payments, doctors, hospitals, and other providers share one fee for treating all aspects of a procedure such as a hip replacement or a chronic disease like diabetes. The approach should eliminate unnecessary care and improve quality, but putting it into practice is proving to be more difficult than anticipated.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
Mexican citizens are living longer and overall have experienced an improvement in their quality of life compared to that of prior generations. However, older Mexicans are especially vulnerable to poverty and the health challenges posed by the growing prevalence of chronic disease.
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.
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.
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.
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?
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.
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.
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.
Policymakers should carefully distinguish between innovative activities that are worth their social costs and activities that are not worth their social costs and try to encourage the former and discourage the latter.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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
Within complementary and alternative medicine (CAM), systematic reviews are of major relevance in order to summarize the state of current knowledge. This introduction covers how to read and how to do a systematic review or a meta-analysis, and discusses advances and limitations of this method.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Appropriate use of existing diagnostic tests, and developing better ones, could avoid selective pressure from unnecessary antibacterial use. Advances in genomics, nanoscience, microfluidics and bioengineering can help to overcome research and development barriers for such diagnostics.
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.
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.
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.
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.
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.
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.
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.
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.
This RAND Health survey captures key differences between managed and "unmanaged" care as well as differences among managed care arrangements, and it includes six domains predicted to have an impact on access, service utilization, costs, and quality.
Policymakers 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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
A study of how the UK and German health care systems responded to a major cost-saving innovation: the availability of generic simvastatin, a cholesterol-lowering drug found institutional differences rooted in the two health care systems and to the structure of patient cost-sharing in particular.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
RAND Health recognizes Children's Mental Health Awareness Day by highlighting a tool designed to help children who have been traumatized by violence. The Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) is an evidence-based intervention that has been used widely and effectively in the United States and other countries to help children cope with the effects of experiencing or witnessing some form of violence, trauma, or maltreatment.
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.
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.
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.
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.
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.
High-deductible plans significantly reduce health care spending but also lead consumers to cut back on their use of preventive health care—even though high-deductible plans waive the deductible for such care.
Researchers simulate how the coverage-related provisions of the Affordable Care Act will affect health insurance coverage, and state spending on health care in California, Connecticut, Illinois, Montana, and Texas.
Posttraumatic stress disorder (PTSD) is relatively common among people living with HIV/AIDS, as these individuals are more likely to have experienced hate crimes. Research shows that discrimination plays a critical role in adherence to antiretroviral therapy among African American men experiencing PTSD.
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.
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.
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%.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
The Helping Families Raise Healthy Children project seeks to improve identification and services for families who have a risk of experiencing caregiver depression and early childhood developmental delays.
Lack of definition and clarity about the term integrative medicine (also known as integrative health care) and the absence of taxonomy for models of IM make it difficult to efficiently conduct systematic reviews of the literature in this field.
One in 5 pediatricians reported that inadequate reimbursement prevented their using 1 or more combination vaccines. Vaccination was less likely in smaller practices, and those with a lower proportion of publicly insured patients.
Despite the promise of technologies that would support home health care, a global study of needs, priorities, and stakeholder expectations reveals that such technologies face substantial adoption barriers.
Researchers analyzed data on child and maternal health care use from 34 African countries and found that private sector participation in the health care system is associated with increased access to health care facilities and reduced disparities in care.
Examining the impact of Proposition K (a bonding initiative in Los Angeles authorizing the expenditure of $30 million annually to develop and renovate parks) on physical activity and other health outcomes, using community-based participatory research.
High-level priorities in DC’s public behavioral health care system include reducing unmet need for mental health care, tracking/coordinating care, improving substance use treatment, and improving data infrastructure.
There is little evidence of an association between short- or long-term exposure to particulate matter air pollution and venous thromboembolism; and no evidence that hormone therapy is modifing such a link.
Findings of this study suggest that measurement of health related quality of life after prostate cancer treatment should incorporate the distress that patients experience from urinary, sexual, and bowel problems resulting from prostate cancer treatment.
Emergency department physicians are devising an ever-expanding list of workarounds to deal with ED overcrowding, but the author argues that their success in doing so perhaps enables abuse of patients rather than their protection.
Depressed Latino patients receiving care in public-sector clinics preferred counseling or counseling/medication over medication alone. Compared to usual care, those receiving collaborative care were 21 times as likely to receive preferred treatment.
Results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey shows modest but meaningful gains on most dimensions of patients experience in hospitals, but doctors still get low marks for communication.
Youth who think they are likely to get HIV are at greater risk for later substance abuse problems and risky sexual behaviors, but this perception doesn't cause them to reduce their substance use and change their behavior.
This study assessed hospice use by men dying of prostate cancer and compared the use of high-intensity care between those who did or did not enroll in hospice. Those who enroll in hospice are less likely to receive high-intensity end-of-life care.
A systematic literature review highlighted challenges in synthesizing knowledge about healing, including lack of widely accepted definitions of "healing," and the absence of standards for conducting rigorous program evaluations in hospitals.
This paper describes the conceptual framework and research design of a national evaluation of the quality of mental healthcare provided to veterans by the Veterans Health Administration, and present results on the reported availability of evidence-based practices.
Legalizing marijuana in California could significantly reduce revenues of Mexican drug traffickers and related violence only if California-produced marijuana is smuggled to other states at prices that are lower than current Mexican prices.
Review of published reports, interviews with major donor organizations, and case studies of laboratory systems in 3 countries shed light on how countries and donors have worked together to improve laboratory services in resource-limited settings.
When looking for a new physician, patients are often encouraged to select those who are board certified or who have not made payments on malpractice claims—characteristics that are not always a good predictor of which physicians will provide the highest quality medical care.
About 17 percent of all visits to hospital emergency departments across the United States could be treated at retail medical clinics or urgent care centers, potentially saving $4.4 billion annually in health care costs.
A survey of students conducted by RAND Health researchers at 16 California middle schools shows Hispanic kids are more likely to smoke, drink, or use marijuana than their peers in other ethnic or racial groups.
The ACA builds on the employer-based health insurance system by developing exchanges through which small employers can offer coverage and by penalizing large employers that do not offer coverage. The exchanges could alleviate some of the difficulties faced by small firms that want to offer insurance.
Cross-country differences exist in the use of medicines for diseases such as osteoporosis, dementia, and rheumatoid arthritis due to reimbursement schemes, access to specialists, and clinical practices. The "On-Call Facility" for International Healthcare Comparisons examined these variations via a literature review.
This web-based mapping tool can help health care decisionmakers in Missouri identify community-level hotspots where suboptimal health care exists, in particular when it is related to low health literacy.
Retail clinics are becoming increasingly widespread. This research brief explores who uses them, the types of services they provide, and whether the common claims about retail clinics are supported by evidence.
Legalizing the production and distribution of marijuana in California could cut the price of the drug by as much as 80 percent and increase consumption. While the state has estimated taxing legal marijuana could raise more than $1 billion in revenue, this could be dramatically higher or lower based on a number of factors.
Documents the implementation of 15 programs across the country that provide interventions for families in which children have been exposed to violence, with the goal of building knowledge about the effectiveness of specific intervention strategies.
The ACA provides health insurance coverage to the largest number of Americans while keeping federal costs as low as reasonably possible. The only alternatives that would have covered more Americans at a lower cost to the federal government were all politically untenable.
To avoid changes in current health coverage, the ACA exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
Faith-based organizations such as churches and religious relief and development groups can play an important role in the response to HIV and AIDS in Central America, despite the fact that many do not support certain prevention measures such as condoms.
Profiles created for physicians based on the cost of the care they provide can vary widely depending upon the methods used by insurance companies to create the profiles in order to encourage patients to visit low-cost physicians.
Food allergies are a frequently diagnosed condition, yet variation in the measures used to make the diagnosis is limiting advancements in how to best treat patients with the condition and raises the potential for over diagnosis of the problem.
Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and by minorities. Increasing the number of primary care physicians is also not enough to boost U.S. health care quality and lower costs.
Small sales taxes on soft drinks in the range currently in force in some states are insufficient to reduce consumption of soda or curb obesity among children. Such small taxes may reduce consumption in among children at greater risk for obesity, but reducing consumption for all children would require larger taxes.
The newly approved health care legislation is confusing enough without relying on myths and misinformation. To clear up some of the confusion, Elizabeth McGlynn debunks some common misconceptions about the bill . . .
Increasingly common insurance plans that encourage patients to receive care from physicians who keep medical costs lower are based on unreliable estimates of doctor performance and may not achieve the intended savings.
New results from a major initiative on the quality of cancer care in the U.S. have found that patients with a common type of colon cancer—especially older patients—often are not treated as aggressively with chemotherapy as research shows is necessary to improve survival.
California's dirty air caused more than $193 million in hospital-based medical care from 2005 to 2007 as people sought help for problems such as asthma and pneumonia that are triggered by elevated pollution levels.
California's dirty air caused more than $193 million in hospital-based medical care from 2005 to 2007 as people sought help for problems such as asthma and pneumonia that are triggered by elevated pollution levels.
An independent evaluation of the health reform proposal made this week by President Obama shows that the plan would reduce the number of uninsured Americans by 30 million by 2019—very similar to the results expected under separate legislation passed by the House and Senate.
As federal lawmakers prepare for a summit on health care, a new analysis shows that health reform legislation passed by the U.S. Senate would cut the number of uninsured Americans by about half and cost the federal government about $899 billion by 2019.
Using the COMPARE microsimulation model, researchers estimate the Affordable Care Act's effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers' health care spending.
Measures were fielded as part of "Partners in Care," a trial conducted to determine whether primary care clinics could implement practical programs for improving depression care for adults and to assess whether such programs could reduce disparities in care for minorities in comparison to usual care.