Robert H. Brook

It's Going to Be the Vaccination, Stupid!

The increasingly positive news on COVID-19 vaccine development is also bringing growing alarm over whether Americans will trust these vaccines when they become available. While we were clearly not prepared for this virus, we now need to understand how we are going to roll out any proven vaccine.

Should the Definition of Health Include a Measure of Tolerance?

Involving the medical community in helping to measure and increase tolerance could help make individuals and communities healthier. Since hate is both deadly and contagious, now is the time to engage the medical profession in eradicating it.

We Need to Know What Physicians Are Thinking

Before we allow others to implement policies attempting to optimize the use of physician time or reduce the amount of equivocal or inappropriate care, we need to understand what physicians think about these issues and what they are prepared to do about them, writes Robert H. Brook.

Do Physicians Need a 'Shopping Cart' for Health Care Services?

Providing physicians with cost data in real time automatically as a part of the electronic medical record could make them better purchasers for their patients and provide better value, writes Robert H. Brook.

Two Years and Counting: How Will the Effects of the Affordable Care Act Be Monitored?

Most will agree with the undeniable fact that a new era in US medicine and US health care begins in less than 2 years. The key question is what potential measures should be monitored to determine both anticipated and unanticipated effects of the new law on the health of the US population, writes Robert H. Brook.

Can the Patient-Centered Outcomes Research Institute Become Relevant to Controlling Medical Costs and Improving Value?

A scientific and political case could be made to amend health care legislation to require that cost be included in the studies that the PCORI funds, writes Robert H. Brook.

The Role of Physicians in Controlling Medical Care Costs and Reducing Waste

Because the budget crisis is really a crisis, it behooves physicians to answer the waste question as rapidly as possible. Without an answer, there is no hope that an appropriate policy process for reining in health care costs will be identified, writes Robert H. Brook.

Is Choice of Physician and Hospital an Essential Benefit?

The movement toward reporting results of surgeons and hospitals will probably lead to a society in which the wealthy receive care from the better hospitals and physicians, writes Robert H. Brook.

Physician Compensation, Cost, and Quality

Pay for performance, transparency, and other innovative ways of compensating physicians will work only if, at the same time, the system for providing care is changed to one that has clear objectives and provides specific tools to help physicians achieve those objectives, writes Robert H. Brook.

Medical Leadership in an Increasingly Complex World

It is time for physicians to think beyond making their institution, practice, or professional society better. The population needs, and deserves, such leadership, writes Robert H. Brook.

Rights and Responsibilities in Health Care: Striking a Balance

If patients do not take prescribed medications, are not appropriately vaccinated, or do not obtain preventive screening tests, they may incur costs that others will need to subsidize, writes Robert Brook.

The Primary Care Physician and Health Care Reform

Increased health care coverage raises issues in addition to cost containment. Increased coverage will mean increased demand for primary care physicians, writes Robert Brook.

Continuing Medical Education: Let the Guessing Begin

It is time for a change before innovative medical researchers develop a new array of tests and measurements, making it even less likely that physicians will have the right answer, writes Robert Brook.

Disruption and Innovation in Health Care

Successful health care reform may provide virtually all individuals in the United States an adequate health insurance package. However, the need to increase value for health care dollars will extend far beyond the current policy window, writes Robert Brook.

Assessing the Appropriateness of Care—Its Time Has Come

The appropriateness assessment system is a concrete way the medical profession could respond to the need to produce more efficient and effective care, writes Robert Brook.

Possible Outcomes of Comparative Effectiveness Research

Since the government is using taxpayer dollars to fund the comparative effectiveness initiative, it would be appropriate to have an organizing principle to guide the selection of which aspects of medical care to examine, writes Robert Brook.

The Science of Health Care Reform

It is time for physicians to commit as a profession to helping the President and Congress achieve the vision of a new health care system by improving the way medicine is practiced, writes Robert Brook.

Quality, Transparency, and the US Government

If the government is demanding transparency of physicians and hospitals, the very least the physicians and hospitals should do is demand transparency of the government, writes Robert Brook.

Health Policy and Public Trust

As a new political window for health care reform is approached, building trust and motivating collaboration between community members and the individuals who produce information about the system is critical, writes Robert Brook.

Journal Article

Linking Statistics with Testing Policy to Manage COVID-19 in the Community

Monitoring the evolution of the pandemic in our society is crucial. This discussion highlights some very important principles of statistical sampling that are relevant to formulating policy.

Journal Article

How Community and Unity Can Help Americans Survive

This article defines specific tasks that providers, government, business, and individuals could take now to help us address the COVID epidemic.

Journal Article

Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing

Taiwan learned from the SARS outbreak in 2003. Its response to COVID-19 holds lessons for other countries battling the new virus.

Journal Article

What Is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.

Single-payer systems are heterogeneous. Acknowledgment of what is considered single-payer and the characteristics that are variable is important for nuanced policy discussions on specific reform proposals.

Journal Article

Surgeon Perception of Risk and Benefit in the Decision to Operate

When presented with four common clinical scenarios, surgeons' perceptions of treatment risks and benefits vary widely.

Journal Article

Impact of a Risk Calculator on Risk Perception and Surgical Decision Making: A Randomized Trial

A surgical risk calculator could help surgeons make more accurate judgments of operative risks.

Journal Article

Variation in Hospital Use of Postacute Care After Surgery and the Association with Care Quality

Hospitals vary widely in their use of postacute care. To reduce variations, better criteria are needed to identify which patients benefit most from these services.

Journal Article

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

High levels of physician professional satisfaction were found across multiple specialties and primary care in the closed, integrated practice setting of Southern California Permanente Medical Group.

Journal Article

The Lack of Documentation of Preferences in a Cohort of Adults Who Died After Ischemic Stroke

Stroke patients' wishes to limit life-sustaining interventions were documented in less than 40 percent of cases in which patients died 30 days after hospital admission.

Journal Article

Fostering a Commitment to Quality: Best Practices in Safety-Net Hospitals

To support efforts at the recently opened Martin Luther King, Jr. Community Hospital in Los Angeles to develop a culture of quality, a team of scholars identified best practices based on interviews with high-performing hospital systems.

Journal Article

Identifying Best Practices for "Safe Harbor" Legislation to Protect Child Sex Trafficking Victims: Decriminalization Alone Is Not Sufficient

This study examines the effectiveness of Safe Harbor laws in protecting child sex trafficking victims.

Journal Article

A Quasi-Experimental Evaluation of Performance Improvement Teams in the Safety-Net: A Labor-Management Partnership Model for Engaging Frontline Staff

We evaluated the UBT model implemented by the Los Angeles County Department of Health Services in partnership with its union to engage frontline staff in improving patient care.

Brochure

Redefining Health Care Systems

This book provides a scientific and personal perspective on health services research over the last half-century. Its essays and commentaries suggest how that science base can stimulate innovative thinking about ways to improve health care systems.

Report

Improving Care for Chronic Conditions: Current Practices and Future Trends in Health Plan Programs

Documents the current range of health plans' chronic care management services, identifies best practices and industry trends, and examines factors in the plans' operating environment that limit their ability to optimize chronic care programs.

Journal Article

Using the Knowledge Base of Health Services Research to Redefine Health Care Systems

This Perspective discusses 12 key facts derived from 50 years of health services research.

Journal Article

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

A substantial proportion of advanced imaging studies ordered by emergency physicians may be medically unnecessary.

Journal Article

Emergency Physician Perceptions of Shared Decision-Making

A substantial proportion of advanced imaging studies ordered by emergency physicians may be medically unnecessary.

Journal Article

Comparison Between Clinical Registry and Medicare Claims Data on the Classification of Hospital Quality of Surgical Care

This paper aimed to estimate the effect of tobacco taxes on total mortality and cause-specific mortality in the 50 States plus the District of Columbia, USA, over the period 1970–2005 as well as the net effect on deaths averted in 2010.

Journal Article

Hospital Costs by Cost Center of Inpatient Hospitalization for Medicare Patients Undergoing Major Abdominal Surgery

This study aims to describe the magnitude of hospital costs among patients undergoing abdominal surgery, and determine whether hospital costs estimates are consistent with clinical expectations of hospital resource use.

Journal Article

Results from a National Survey on Chronic Care Management by Health Plans

We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market.

Journal Article

Disproportionate-share Hospital Payment Reductions May Threaten the Financial Stability of Safety-Net Hospitals

We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions.

Journal Article

Why Not Big Ideas and Big Interventions?

What would society and physicians propose and accept if they were allowed to be creative and contravening regulations were set aside? This essay explores some possibilities.

Research Brief

Factors Affecting Physician Professional Satisfaction

This fact sheet describes the results of research into the factors influencing physician professional satisfaction and their implications for health care.

Report

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

This report presents the results of a series of surveys and semistructured interviews intended to identify and characterize determinants of physician professional satisfaction.

Journal Article

Health Systems, Heuristics, and Comparative Effectiveness Research

Comparative effectiveness research will be hard to use appropriately because context and emotion often dominate a patient's rational decisionmaking and because therapies are provided in different health care environments, making small differences between therapies basically meaningless.

Journal Article

Changing Eating Habits for the Medical Profession

Although some members of the health professional community have called for changes to the food environment in the community in which they live, they have paid less attention to the quality of food served at hospitals, physician offices, and at conferences.

Journal Article

Do Physicians Need a "Shopping Cart" for Health Care Services?

The technology of the ubiquitous electronic shopping cart could be adapted to help physicians understand the cost of the services they order for patients, and possibly change the mix and total costs of the products in the cart.

Journal Article

Two Years and Counting: How Will the Effects of the Affordable Care Act Be Monitored?

The Affordable Care Act marks a new era in US health care and US medicine. This commentary suggests ways to monitor the act's effect on the health of the US population.

Journal Article

Vision and Persistence: Changing the Education of Physicians Is Possible

In the 1960s, a new paradigm for training physicians emerged: one that combined clinical training and its focus on individual patients with a research training focused on studying the health of populations.

Journal Article

Can the Patient-Centered Outcomes Research Institute Become Relevant to Controlling Medical Costs and Improving Value?

Research sponsored by the Patient Centered Outcomes Research Institute can help patients make better decisions by comparing the effectiveness of alternative therapies, but it is constrained from considering the costs of therapies it compares.

Journal Article

The Role of Physicians in Controlling Medical Care Costs and Reducing Waste

This commentary argues that physicians must take the lead in identifying and eliminating waste in US health care.

Journal Article

Accountable Care Organizations and Community Empowerment

This commentary argues that involving communities in the formation of accountable care organizations would be a dramatic step toward more patient-centered care.

Journal Article

Health Services Research and Clinical Practice

Health services research has made many important contributions, but it has not revolutionized the way that medicine is practiced to increase its value and moderate costs.

Journal Article

Is Choice of Physician and Hospital an Essential Benefit

This research brief summaries results of a longitudinal study of military families, which found that spouses and children faced major challenges when one parent was deployed overseas.

Journal Article

Assessment of Food Offerings and Marketing Strategies in the Food-Service Venues at California Children's Hospitals

Cafeteria food in California children's hospitals gets an average rating on a nutritional scale. Cafeterias could improve by providing nutritional information, using signage to promote healthy choices, and eliminating impulse items at the register.

Journal Article

Facts, Facts, Facts: What Is a Physician to Do

This commentary argues that it is timely to reengage physicians in the discussion of international comparative data about health care and to ask why the United States is so provincial in designing the systems by which care is delivered.

Journal Article

Response: Comments on "The Condition of the Literature on Differences in Hospital Mortality" by Mary E. W. Goss

The authors respond to Mary E. W. Goss's comments on their article: The Condition of the Literature on Differences in Hospital Mortality.

Journal Article

Rights and Responsibilities in Health Care: Striking a Balance

This commentary argues that people must become full participants and assume much greater responsibility for their actions if health benefits are to be maintained at an affordable cost.

Journal Article

The End of the Quality Improvement Movement: Long Live Improving Value

This commentary argues that 40 years after the birth of the quality improvement movement, we still don't know much about what's been accomplished. Going forward, academic and industry leaders should focus on the nexus of quality and cost.

Journal Article

Medical Leadership in an Increasingly Complex World

The author argues that it is time to expand the notion of medical leadership and demand that leaders be accountable for explaining how their leadership is focused on improving health, reducing its variation, and doing so in an affordable way.

Journal Article

Physician Compensation, Cost, and Quality

Pay-for-performance, transparency, and other innovative ways of compensating physicians will only work if, at the same time, the system for providing care has clear objectives and specific tools to help physicians achieve those objectives.

Journal Article

What If Physicians Actually Had to Control Medical Costs?

This commentary suggests that rationing health care is inevitable and urges physicians to lead the way in developing a plan to do it reasonably and equitably.

Journal Article

Possible Outcomes of Comparative Effectiveness Research

With substantial support across the political spectrum, the Obama administration has included in the American Recovery and Reinvestment Act more than $1 billion to support comparative effectiveness research.

Journal Article

The Science of Health Care Reform

Another health policy window has opened; through it will stream proposals to reform the US health care system. President Obama has demanded that reform proposals improve both coverage and quality of care and make health care more affordable for all Americans. Extending coverage without worrying about costs would be relatively easy. Improving quality of care without worrying about costs might also be achievable. But extending coverage and improving quality while also making coverage more affordable will be difficult.

Journal Article

Assessing the Appropriateness of Care — Its Time Has Come

The authors draw on more than 2 decades of empirical research based on the RAND/University of California Los Angeles (UCLA) Appropriateness Method (RUAM) to develop explicit criteria for determining the appropriateness of care.

Journal Article

Condom Use and High-Risk Sexual Acts in Adult Films: A Comparison of Heterosexual and Homosexual Films

The authors compared the prevalence of condom use during a variety of sexual acts portrayed in adult films produced for heterosexual and homosexual audiences to assess compliance with state Occupational Health and Safety Administration regulations.

Journal Article

Disruption and Innovation in Health Care

"Disruption" -- that is, fundamental, non-linear change -- may be required to achieve successful health care reform in the United States.

Journal Article

Off-label Prescribing to Children in the United States Outpatient Setting

The aim of this study was to determine the frequency of off-label prescribing to children at United States outpatient visits and to determine how drug class, patient age, and physician specialty relate to off-label prescribing.

Journal Article

Quality, Transparency, and the US Government

Some solutions for producing a better health care system in the United States and abroad call for paying clinicians more for better performance.

Research Brief

Out of the Ivory Tower, Into the Real World: Examples of Street-Smart Community Health Research

Discusses the potential of community-based participatory research (CBPR) to reduce the burden of chronic health problems on poor and minority neighborhoods and describes three successful CBPR programs.

Journal Article

High-deductible Health Plans and Better Benefit Design

Advocates of high-deductible health plans, which shift more of the cost of care to individuals, believe that consumers will more carefully assess the balance of health care benefits versus costs, ultimately improving efficiency and quality of care.

Research Brief

Modeling the Health and Medical Care Spending of the Future Elderly

This research brief summarizes studies showing that medical innovations will improve health and extend life but will likely increase Medicare spending; eliminating obesity and better prevention could save Medicare money and improve health.

Journal Article

Access to Care for Youth with Special Health Care Needs in the Transition to Adulthood

Insurance gaps and delayed care are prevalent for low-income young adults who aged out of a public program for children with special health care needs, despite ongoing health problems. Greater transition support might improve access.

Journal Article

Attrition in the RAND Health Insurance Experiment: A Response to Nyman

The authors obtained follow-up health-status data on the great majority of those who left prematurely. The authors found the health-status findings were insensitive to the inclusion of the attrition cases.

Journal Article

Health Policy and Public Trust

Health care news often focuses on business or professional entities and trust, but journalists rarely ask if research that examines the function and structure of the health care system with the goal of changing health policy should be believed.

Journal Article

Population-based Assessments of Ophthalmologic and Audiologic Follow-Up in Children with Very Low Birth Weight Enrolled in Medicaid: A Quality-of-Care Study

Finds a shortfall in provision of critical services for children with very low birth weight (<1500 g) at high risk for vision and hearing problems and enrolled in Medicaid. Findings support the importance of enrollment in Early Intervention Program.

Journal Article

Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events

Patients in intensive care units frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.

Journal Article

Rigorous Development Does Not Ensure That Guidelines Are Acceptable to a Panel of Knowledgeable Providers

Guideline acceptability should be independently and formally evaluated before dissemination.

Journal Article

Seven Ideas to Improve Quality

Despite the enormous and ongoing increase in health care expenditures, patients receive only half of recommended care, and many receive care that is equivocal or harmful. Ideas to improve quality are examined.

Periodical

RAND Review: Vol. 31, No. 2, Summer 2007

Feature stories discuss the precarious posture taken by the world toward Afghanistan, lessons for the U.S. National Guard from Hurricane Katrina, and competing claims stoked by the RAND Health Insurance Experiment.

Journal Article

Elderly Patients' Preferences and Experiences with Providers in Managing Their Drug Costs

Federal employee plans were more likely to augment managed care through contracts with managed behavioral health carve-out firms after parity.

Journal Article

High-deductible Health Plans and Emergency Department Use

The health care system needs to be reengineered so that unnecessary and harmful care is eliminated and effective care is provided more efficiently.

Journal Article

Identifying Widely Covered Drugs and Drug Coverage Variation Among Medicare Part D Formularies

Clinicians find it difficult to know which drugs are covered for their Medicare patients because formularies vary widely among Medicare Part D plans

Journal Article

Suboptimal Control of Atherosclerotic Disease Risk Factors After Cardiac and Cerebrovascular Procedures

More effective risk factor control programs are needed among most vascular procedure patients.

Research Brief

The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate

This research brief summarizes the main findings of the RAND Health Insurance Experiment and clarifies its relevance for today's health care debate.

Research Brief

Effects of Medicare's Prospective Payment System on the Quality of Hospital Care

This research brief summarizes a study of how Medicare's prospective payment system (PPS) affected the quality of care for hospitalized Medicare patients.

Journal Article

Quality-of-care Indicators for the Neurodevelopmental Follow-Up of Very Low Birth Weight Children: Results of an Expert Panel Process

To develop a set of quality indicators for the neurodevelopmental follow-up care of very low birth weight (VLBW; <1500 g) children

Research Brief

Electronic Prescribing Systems: Making It Safer to Take Your Medicine?

RAND Health researchers convened an expert panel that created a set of 60 recommendations for electronic prescribing systems.

Journal Article

How Good Is the Quality of Health Care in the United States?

The authors provide examples to illustrate quality in diverse settings, for diverse conditions, and for diverse demographic groups.

Journal Article

Identifying Potential Health Care Innovations for the Future Elderly

The authors used a method that combined literature review and expert judgment to assess potential medical innovations for older adults.

Report

Changing Practice Patterns in the Management of Primary Breast Cancer: Concensus Development Program

Changing Practice Patterns in the Management of Primary Breast Cancer: Concensus Development Program

Journal Article

Cost-lowering Strategies Used By Medicare Beneficiaries Who Exceed Drug Benefit Caps and Have a Gap in Drug Coverage

Health professionals need to explore how they can lessen the impact of caps on patients' health and financial burden.

Report

Cross-Validation Performance of Mortality Prediction Models

Cross-Validation Performance of Mortality Prediction Models

Report

Differences in Quality of Care for Hospitalized Elderly Men and Women

Differences in Quality of Care for Hospitalized Elderly Men and Women

Report

Does Inappropriate Use Explain Geographic Variations in the Use of Health Care Services?

In this study, the authors looked at the appropriateness of use of coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy, and its relationship to geographic variations in the rates of use of these procedures.

Report

Hospital Characteristics and Quality of Care

This study compares quality of care measured by explicit criteria, implicit review, and sickness-adjusted outcomes at different types of hospitals.

Report

How Coronary Angiography is Used: Clinical Determinants of Appropriateness

How Coronary Angiography is Used: Clinical Determinants of Appropriateness

Report

Preventable Deaths: Who, How Often, and Why?

Preventable Deaths: Who, How Often, and Why?

Journal Article

Recommendations for Comparing Electronic Prescribing Systems: Results of an Expert Consensus Process : Guidance to Help Early Adopters and Policymakers Select the Systems Most Likely to Benefit Patients

Electronic prescribing systems may differ in their effects on patients' health outcomes and on patients' ability to manage costs.

Journal Article

Surgical Quality: Review of Californian Measures

California consumers will not be able to choose surgical providers based on quality. A competitive market cannot exist under these conditions.

Report

Watching the Doctor-Watchers: How Well do Peer Review Organization Methods Detect Hospital Care Quality Problems?

Watching the Doctor-Watchers: How Well do Peer Review Organization Methods Detect Hospital Care Quality Problems?

Report

Measuring General Practice: A Demonstration Project to Develop and Test a Set of Primary Care Clinical Quality Indicators

The authors present the most comprehensive set of clinical indicators that have ever been developed for use in UK general practice.

Journal Article

Can Health Care Quality Indicators Be Transferred Between Countries?

There are considerable benefits in using work from other settings in developing measures of quality of care.

Journal Article

Children's Use of Emergency Departments for Asthma: Persistent Barriers or Acute Need

Explore, in a predominantly Latino inner-city population, why caregivers bring their children with asthma to the ED (emergency department).

Journal Article

Impact of an Annual Dollar Limit or Cap on Prescription Drug Benefits for Medicare Patients

At lower caps, a substantial proportion of Medicare patients exceeded their annual drug benefit.

Journal Article

Usage Patterns of Over-The-Counter Phenazopyridine (Pyridium)

Little is known about how the public uses formerly prescription medications that are available over-the-counter (OTC).

Journal Article

Utilization of Papanicolaou Smears by South Asian Women Living in the United States

Papanicolaou (Pap) smears are an underutilized screening modality among racial and ethnic minorities.

Journal Article

Visual Acuity Following Cataract Surgeries in Relation to Preoperative Appropriateness Ratings

These results provide evidence supporting the validity of the RAND-UCLA method to assess the appropriateness of surgery.

Journal Article

Waiting Times in California's Emergency Departments

Physician and nurse staffing should be investigated as a means of reducing waiting times.

Report

Evaluating the Quality of Care

Evaluating the Quality of Care

Report

How Good is the Quality of Health Care in the United States?

In September 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry released its final report on how to define, measure, and promote quality of health care.

Journal Article

Next-day Care for Emergency Department Users with Nonacute Conditions: A Randomized, Controlled Trial

Determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.

Journal Article

Quality of Breast Cancer Care: What Do We Know?

Review studies that describe patterns of care for breast cancer patients and to examine the data sources used for case identification.

Journal Article

Quality of Life of Patients with Chronic Stable Angina Before and Four Years After Coronary Revascularisation Compared with a Normal Population

3/5 of patients with chronic stable angina were free of angina and their HRQOL was the same as or better than that of the general Swedish population.

Research Brief

Report Cards for Health Care: Is Anyone Checking Them?

This research brief summarizes RAND research into health care reports cards and suggests how they may be made more user friendly.

Journal Article

Use of Preventive Services in a Population of Very Low-Income Women

Very low-income women continue to have unmet needs for Pap smears and mammograms, even though a large proportion have seen a physician within the year

Journal Article

Assessing Use of Primary Health Care Services by Very Low-Income Adults in a Managed Care Program

Assess the effect of providing free health care services to low-income adults.

Research Brief

Changing Views of Chiropractic: ... and a National Reappraisal of Nontraditional Health Care

AMA policy now states that it is ethical for physicians not only to associate professionally with chiropractors but also to refer patients to them for diagnostic or therapeutic services.

Report

Keeping Quality on the Policy Agenda

Keeping Quality on the Policy Agenda

Report

Managed Care is Not the Problem, Quality Is

Its major point is that quality of care is the problem, not managed care, and that prior to the adoption of managed care, there were substantial and major problems in quality of care.

Report

Measuring Underuse of Necessary Care Among Eledery Medicare Beneficiaries Using Inpatient and Outpatient Claims

Journal Article

Quality of Life of Chronic Stable Angina Patients 4 Years After Coronary Angioplasty or Coronary Artery Bypass Surgery

Bypass surgery and angioplasty lead to improved quality of life for patients with chronic stable angina and one- or two-vessel coronary artery disease

Periodical

RAND Review: Vol. 25, No. 2, Summer 2001

Recommends ambitious global reorganizations of the U.S. and allied armed forces; proposes a national tracking system to measure the quality of U.S. health care; and suggests that municipal power generation would be a good energy investment.

Report

Uterine Artery Embolization: A Systematic Review of the Literature and Proposal for Research

Uterine Artery Embolization: A Systematic Review of the Literature and Proposal for Research

Report

Prostate Cancer Patient Outcomes and Choice of Providers: Development of an Infrastructure for Quality Assessment

Report

Dying to Know: Public Release of Information about Quality of Health Care

This report assesses the U.S. experience with publicly releasing health care performance data and offers guidelines for establishing public disclosure policy in the United Kingdom.

Journal Article

An Agenda for Research Into Uterine Artery Embolization: Results of an Expert Panel Conference

To develop a research agenda for uterine artery embolization (UAE) for the treatment of symptomatic leiomyomata.

Journal Article

Associations Between Primary Care Physician Satisfaction and Self-Reported Aspects of Utilization Management

Indirect control mechanisms such as guidelines and education were positively associated with satisfaction.

Report

Defining and Measuring Quality of Care: A Perspective from U.S. Researchers

Defining and Measuring Quality of Care: A Perspective from U.S. Researchers

Report

Effect of Variability in the Interpretation of Coronary Angiograms on the Appropriateness of Use of Coronary Revascularization Procedures

These findings indicate the need for increased attention to the technical quality of studies and an independent second reading for angiograms before recommending revascularization.

Journal Article

An English and Spanish Pediatric Asthma Symptom Scale

Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations.

Journal Article

Family Planning Clinic Patients: Their Usual Health Care Providers, Insurance Status, and Implications for Managed Care

Publicly funded mental health systems are increasingly implementing managed care systems, such as capitation, to control costs.

Journal Article

Is the Diagnostic Yield of Upper GI Endoscopy Improved by the Use of Explicit Panel-Based Appropriateness Criteria?

Upper GI endoscopies performed for appropriate indications resulted in detecting significantly more clinically relevant lesions.

Research Brief

Measuring Quality of Care for Prostate Cancer

We need valid measures for assessing quality of care for prostate cancer, and we need to understand how variations in quality of care affect treatment outcomes. RAND researchers have built the framework necessary to begin this evaluation.

Journal Article

Overuse and Underuse of Colonoscopy in a European Primary Care Setting

To improve quality of care, both overuse and underuse of important procedures must be addressed.

Journal Article

Public Disclosure of Performance Data: Learning from the US Experience

U.S. experience of public disclosure and the evidence of its influence on the clinical and managerial practices of professionals and organizations.

Report

The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence

Journal Article

Public Reporting of Performance: Lessons from the USA

Public disclosure should be seen as an evolutionary process and health professionals and their representative bodies should play a part in the process

Journal Article

Quality of Care for Patients with Rheumatoid Arthritis

Patients with rheumatoid arthritis are at risk for substantial morbidity because of their arthritis and premature mortality due to comorbid diseases.

Journal Article

Safely Directing Patients to Appropriate Levels of Care: Guideline-Driven Triage in the Emergency Service

Standardized clinical criteria to identify patients presenting to the ED whose care may be safely deferred to a later date in a nonemergency setting.

Journal Article

Use of Performance Data to Change Physician Behavior

Physicians skepticism regarding performance data arises from concerns related to intent, accuracy, physician attribution, and relevance.

Journal Article

Appropriateness of Referral of Coronary Angiography Patients in Sweden

To evaluate the appropriateness of referral following coronary angiography in Sweden.

Journal Article

Elevated Asthma Morbidity in Puerto Rican Children: A Review of Possible Risk and Prognostic Factors

Latino children represent a significant proportion of all U.S. children, and asthma is the most common chronic illness affecting them.

Testimony

Ensuring Delivery of Necessary Care in the United States: Testimony Presented to the Senate Committee on Health, Education, Labor, and Pensions

Written statement delivered to the Senate Committee on Health, Education, Labor, and Pensions, March 2, 1999.

Journal Article

Measuring the Quality of Health Care

This policy paper extends efforts by the Institute of Medicine to inform policymakers, provider organizations and clinicians, purchasers, and consumers about the measurement of health care quality--its uses, methods, promise and current challenges.

Journal Article

The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior

Despite growing concern over the escalating antimicrobial resistance problem, physicians continue to prescribe inappropriately.

Research Brief

Taking the Pulse of Health Care in America

Their review of nearly 50 studies published over the past decade suggests that quality varies substantially across physicians, hospitals, geographical locations, types of care, and age groups.

Journal Article

Underuse and Overuse of Diagnostic Testing for Coronary Artery Disease in Patients Presenting with New-Onset Chest Pain

Concludes that among patients with new-onset crest pain, underuse of diagnostic testing for coronary artery disease was more common than overuse.

Report

Underuse of cardiac procedures : do women, ethnic minorities, and the uninsured fail to receive needed revascularization?

Underuse of cardiac procedures : do women, ethnic minorities, and the uninsured fail to receive needed revascularization?

Journal Article

Changes in the Healthcare System: Goals, Forces, Solutions

The goals of a health system should be to provide necessary care to everybody, improve quality of care, reduce variations, and eliminate waste.

Journal Article

Congruence Between Decisions to Initiate Chiropractic Spinal Manipulation for Low Back Pain and Appropriateness Criteria in North America

This study set out to determine the appropriateness of chiropractors' decisions to use spinal manipulation for patients with low back pain.

Journal Article

Costs Attributable to Osteoarthritis

The objective of this study was to estimate charges attributable to osteoarthritis (OA) in a managed care organization.

Journal Article

Differences Between Child and Parent Reports of Symptoms Among Latino Children with Asthma

The objectives of this study were to determine, in a population of predominantly Latino children with asthma 6 to 18 years old

Journal Article

Measuring the Quality of Outpatient Treatment for Schizophrenia

One approach to improving care begins by developing systems that monitor quality.

Journal Article

Member Ratings of Health Care Provided by 48 Physician Groups

Satisfaction with health plan performance has been assessed frequently, but assessment of physician group performance is rare

Journal Article

Performance of Panel-Based Criteria to Evaluate the Appropriateness of Colonoscopy: A Prospective Study

Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available.

Journal Article

Reliability of Panel-Based Guidelines for Colonoscopy: An International Comparison

This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method.

Journal Article

The Smoking Gun: Do Clinicians Follow Guidelines on Firearm Safety Counseling?

In L.A. gaps exist between clinicians' views of the benefits of counseling families with young children on firearm safety and their actual behavior.

Journal Article

Toward Assessing Outcomes of Emergency Care

Establishing the efficacy of emergency care for patients--what should or should not be done in the emergency department.

Journal Article

The UCLA Prostate Cancer Index: Development, Reliability, and Validity of a Health-Related Quality of Life Measure

The need for accurate measures of HRQOL in men treated for prostate cancer is important because they may survive for many years after their diagnosis

Journal Article

Visual Function Impairments in Relation to Gender, Age, and Visual Acuity in Patients Who Undergo Cataract Surgery

Relationship between visual function impairment in patients had extracapsular cataract extraction with posterior chamber intraocular lens implantation

Report

Health Information Systems: Design Issues and Analytic Applications

Provides practical guidance on using information systems effectively to answer questions posed by a variety of stakeholders in the U.S. health care system, including consumers, purchasers, providers, and health system administrators.

Journal Article

Effect of Panel Composition on Physician Ratings of Appropriateness of Abdominal Aortic Aneurysm Surgery: Elucidating Differences Between Multispecialty Panel Results and Specialty Society Recommendations

We examined the final ratings assigned by a nine-member multispecialty RAND Corporation physician panel regarding indications for abdominal aortic aneurysm surgery and the recommendations of a specialty society representing vascular surgeons who perform the same surgery.

Journal Article

Having a Foot in Both Camps: The Impact of Kerr White's Vision

The interface between clinical care and public health, and the differences in the quality of care provided at sophisticated referral centers and community-based clinics lie at the very heart of both the problems and the prospects confronting managed care.

Journal Article

Appropriateness of Indications for Surgery of Lumbar Disc Hernia and Spinal Stenosis

Evaluates prospectively the appropriateness of surgical intervention indications for herniated lumbar intervertebral disc or spinal stenosis in 328 consecutive patients undergoing the operation in two university neurosurgery departments in Switzerland.

Journal Article

The Appropriateness of Intention to Treat Decisions for Invasive Therapy in Coronary Artery Disease in the Netherlands

Examines the appropriateness of intention-to-treat decisions concerning coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for patients with coronary artery disease in the Netherlands.

Journal Article

Appropriateness of Upper Gastrointestinal Endoscopy: Comparison of American and Swiss Criteria

Compares the development of appropriateness criteria for upper gastrointestinal endoscopy in the United States and in Switzerland.

Journal Article

Influence of Projected Complication Rates on Estimated Appropriate Use Rates for Carotid Endarterectomy

Examine specifically the influence of estimated perioperative mortality and stroke rate on the assessment of appropriateness of carotid endarterectomy.

Journal Article

Overuse of Upper Gastrointestinal Endoscopy in a Country with Open-Access Endoscopy: A Prospective Study in Primary Care

Homeless adults living in congested innercity areas are at high risk of both latent and active TB.

Report

Phase II of the AHCPR-Sponsored Heart Failure Guideline: Translating Practice Recommendations into Review Criteria

In 1992, RAND assembled an expert panel to develop the Heart Failure Clinical Practice Guideline. Phase II of the effort was intended to identify which of the recommendations were suitable for use in retrospective utilization review and quality assessment programs.

Journal Article

Primary Care Physicians' Satisfaction with Quality of Care in California Capitated Medical Groups

Examines primary care physicians' satisfaction with quality of care in California capitated medical groups.

Journal Article

Understanding Changes in Health Status: Is the Floor Phenomenon Merely the Last Step of the Staircase?

This methodologic article provides new insight into changes in health status.

Journal Article

Under Use of Coronary Angiography: Application of a Clinical Method

It is important to develop standards of quality to address and safeguard against underuse of necessary medical care.

Journal Article

Underuse of Coronary Revascularization Procedures: Application of a Clinical Method

Examines underuse of coronary revascularization. The major finding of this study was that 75% of patients underwent a revascularization procedure, although it was expected that almost all such patients would undergo such a procedure. African Americans were less likely than whites to undergo a necessary operation, and patients in public hospitals were less likely than those in private hospitals to undergo angioplasty.

Journal Article

Underutilization of Upper Gastrointestinal Endoscopy

This article is a companion piece to the preceding article and looks at underuse of upper gastrointestinal endoscopy in the same 8,000 visits and over 600 patients who complained of upper digestive symptoms.

Journal Article

Variations in Cataract Extraction Rates in Medicare Prepaid and Fee-for-Service Settings

Examines variation in the use of procedures e.g. cataract extraction in Medicare prepaid and fee-for-service (FFS) settings.

Journal Article

Why the Quality of U.S. Health Care Must Be Improved

Journal Article

The Effect of Race and Ethnicity on the Use of Selected Health Care Procedures: A Comparison of South Central Los Angeles and the Remainder of Los Angeles County

The purpose of this study was to compare the use of eight hospital-based procedures in South Central Los Angeles to the remainder of Los Angeles County.

Report

Adapting practice patterns to a managed care environment, carotid endarterectomy--a case example

Adapting practice patterns to a managed care environment, carotid endarterectomy--a case example

Report

Adjusted hospital death rates : a potential screen for quality of medical care

Adjusted hospital death rates : a potential screen for quality of medical care

Journal Article

Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy Unit

Examines the appropriateness in diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy unit.

Report

The Appropriateness of Chiropractic Spinal Manipulation for Low-Back Pain, a Pilot Study

The Appropriateness of Chiropractic Spinal Manipulation for Low-Back Pain, a Pilot Study

Journal Article

The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

Compares the appropriateness of use of coronary artery bypass graft [CABG] surgery in Academic Medical Center Consortium hospitals as judged 1) according to criteria developed by an expert panel, 2) according to revisions of those criteria made by cardiac surgeons from the Academic Medical Center Consortium, and 3) by review of cases by the surgeons responsible for those cases.

Report

The appropriateness of coronary artery bypass graft surgery in academic medical centers

The appropriateness of coronary artery bypass graft surgery in academic medical centers

Journal Article

Assessment of Appropriateness of Cataract Surgery at Ten Academic Medical Centers in 1990

Develops criteria for the appropriateness of cataract surgery (extra-capsular cataract extraction or phacoemulsification with planned implantation of a posterior chamber intraocular lens) using a multidisciplinary expert panel and applied them to patients with cataract surgery from ten academic medical centers retrospectively.

Journal Article

Critical Issues in Radiotherapy, SBU/The Swedish Council on Technology Assessment

Journal Article

Determinants of Emergency Department Use: Are Race and Ethnicity Important?

Review of book on fertility change in Malaysia: Richard Leete. Malaysia's Demographic Transition: Rapid Development, Culture, and Politics.

Journal Article

Documentation Patterns Before Cataract Surgery at Ten Academic Centers

The purpose of this study was to determine the adequacy of documenting the preoperative evaluation for cataract surgery using criteria derived from published practice guidelines.

Report

Effects of Medicare's Prospective Payment System on Service Use by Depressed Elderly Inpatients

The authors try to determine the effects of Medicare's prospective payment system (PPS) on hospital care, changes in length of stay and intensity of clinical services received by 2,746 depressed elderly patients in 297 acute care general medical hospitals were studied.

Report

Health system reform and quality

Health system reform and quality

Testimony

Maintaining Quality of Care in a Cost-Conscious Environment: A National Imperative

Discusses ways to maintain and improve quality of care so that the best health care organizations survive in a competitive marketplace.

Report

Managed care and capitation in California, how do physicians at financial risk control their own utilization?

Managed care and capitation in California, how do physicians at financial risk control their own utilization?

Report

Measuring health and economic status of older adults in developing countries

Measuring health and economic status of older adults in developing countries

Report

Measuring Quality of Care: Part 2: Measuring Quality of care

Until recently, the monitoring of and improvement in medical care quality were generally left to individual clinicians.

Report

Medicare quality and getting older : a personal essay

Medicare quality and getting older : a personal essay

Report

Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery

Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery

Report

Practice guidelines : to be or not to be

Practice guidelines : to be or not to be

Journal Article

Quality Assurance in Capitated Physician Groups: Where Is the Emphasis?

Describes quality assurance programs implemented by capitated physician groups.

Report

Spinal Manipulation for Low-Back Pain

This article examines the use of lumbar spine manipulation of all types to treat low-back pain.

Journal Article

Variations by Specialty in Physician Ratings of the Appropriateness and Necessity of Indications for Procedures

The authors compare the appropriateness ratings and mutual influence of panelists from different specialties who rated a comprehensive set of indications for six surgical procedures.

Journal Article

Determinants of Emergency Department Use by Ambulatory Patients at an Urban Public Hospital

In addition to their lack of access to other providers, patients' perceived need for immediate care and referrals by health professionals contribute to ED use for non-emergency conditions.

Report

Benefits and costs of screening and treatment for early breast cancer : development of a basic benefit package

Benefits and costs of screening and treatment for early breast cancer : development of a basic benefit package

Journal Article

The Cost Effectiveness of Preoperative Autologous Blood Donations

A decision-analysis model assessed the cost-effectiveness of donating autologous blood for four surgical interventions. Results indicated that substituting autologous for community blood resulted in little expected health benefits at considerable additional cost. The additional cost was primarily a function of discarding the units that were donated but not transfused and of a more labor-intensive donation process (autologous donors are typically less healthy than regular donors, and so take longer to give blood).

Journal Article

Designing a National Report on Effectiveness and Appropriateness of Care: Measurement, Data Collection, and Reporting Strategies : Appendix B

A paper that was commissioned by the Institute of Medicine (IOM) Committee on the National Quality Report on Health Care Delivery to identify potential measures of effectiveness to include in a National Health Care Quality Report for Congress and the American public

Journal Article

Effect of Physician Specialty on Use of Necessary Coronary Angiography

Examines the effect of physician specialty on the receipt of necessary coronary angiography.

Journal Article

Geographic Variation in Rates of Selected Surgical Procedures Within Los Angeles County

Uses data from the California Discharge Dataset to examine geographic variation in the use of eight procedures among Los Angeles County residents.

Journal Article

The Institute of Medicine, Quality of Care, and the Future of Health Care

Draft

The Medical Quality Commission (TMQC) 1994-1995 Consumer Satisfaction Study

This report presents the results of the Medical Quality Commission 1994–1995 Consumer Satisfaction Study.

Journal Article

Outcome Assessment for Epilepsy Surgery: The Impact of Measuring Health-Related Quality of Life

The Epilepsy Surgery Inventory (ESI-55), developed at RAND, was used as an external standard to evaluate seven previously published seizure-based (physiologic) outcome classification systems.

Journal Article

Outcomes of Patients with Do-Not-Resuscitate Orders: Toward an Understanding of What Do-Not-Resuscitate Orders Mean and How They Affect Patients

The subjects of this study were part of the DRG Quality of Care Study, which included a national sample of hospitalized Medicare patients.

Journal Article

Quality of Care for Depressed Elderly Patients Hospitalized in the Specialty Psychiatric Units or General Medical Wards

Evaluates quality of care for depression before and after the implementation of Medicare's prospective payment system (PPS).

Journal Article

Quality-of-life Outcomes in Men Treated for Localized Prostate Cancer

Reports on a cross-sectional analysis of HRQOL outcome measures among men treated for localized prostate cancer with either radical prostatectomy, pelvic radiation, or observation alone.

Report

The RAND/UCLA Appropriateness Method

This article discusses the RAND/UCLA method for developing guidelines to measure the appropriateness of medical care.

Journal Article

Regionalization of Cardiac Surgery in the United States and Canada: Geographic Access, Choice, and Outcomes

Regionalization of facilities performing cardiac surgery is one of the most contentious regulatory policies currently restricting the supply of specialized health services and technology. This article compares the regionalization policies of the United States (New York and California) and Canada (Ontario, Manitoba, and British Columbia) in terms of geographic access to coronary artery bypass surgery (CABS) and surgical outcomes.

Journal Article

Validity of Criteria Used for Detecting Underuse of Coronary Revascularization

Reports on the validity of criteria used for detecting the underuse of coronary artery bypass surgery (CABS) and percutaneous transluminal coronary angioplasty (PTCA) in terms of patient outcomes.

Journal Article

Effect of Panel Composition on Appropriateness Ratings

Cholecystectomy is performed frequently and for relatively few indications.

Journal Article

Appropriateness: The Next Frontier

This article presents a potential solution to the problem of explicit measurement of appropriateness of care and describes a method by which appropriateness of care could be measured.

Report

The Appropriateness of the Use of Cardiovascular Procedures: British Versus U.S. Perspectives

To determine whether patients are less likely to receive an inappropriate procedure in countries that devote fewer resources to health care, the authors studied how coronary angiography and coronary artery bypass surgery were performed in the Trent region of the United Kingdom.

Journal Article

The Appropriateness of Use of Cardiovascular Procedures in Women and Men

This article examines whether there are differences between men and women in the appropriateness of cardiovascular procedures (coronary angiography, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft surgery). The study was based on data obtained from a random sample of over 4,000 patients in 30 hospitals in New York State. Analyses were conducted using both the RAND appropriateness method and the Duke Prognostic Exercise Treadmill Score.

Journal Article

Beyond Health Care Reform: Key Issues in Policy and Management

Report

Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery Between Canada and New York State

Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery Between Canada and New York State

Journal Article

Coronary Angiography and Revascularization: Defining Procedural Indications Through Formal Group Processes

Presents the results of a Canadian panel that assessed the appropriateness and necessity of coronary angiography and coronary revascularization using the RAND appropriateness method.

Journal Article

The Effect of Alternative Case-Mix Adjustments on Mortality Differences Between Municipal and Voluntary Hospitals in New York City

This study investigated how mortality differences between groups of municipal versus voluntary hospitals are affected by case-mix adjustment methods.

Journal Article

Functional Disability Screening of Ambulatory Patients: A Randomized Controlled Trial in a Hospital-Based Group Practice

The authors conducted a randomized controlled trial of functional disability screening in a hospital-based internal medicine group practice.

Report

Health care for black and poor hospitalized Medicare patients

Health care for black and poor hospitalized Medicare patients

Report

Health care reform is on the way, do we want to compete on quality?

Health care reform is on the way, do we want to compete on quality?

Journal Article

Measuring the Necessity of Medical Procedures

The RAND method distinguishes between appropriateness of a procedure and its necessity: Necessity means that withholding a procedure would be deleterious to a patient's health.

Journal Article

The Medical Appropriateness of Tympanostomy Tubes Proposed for Children Younger Than 16 Years in the United States

Describes the clinical reasons tympanostomy tubes are proposed for children and assesses their appropriateness.

Report

Quality Measures for Prenatal Care: A Comparison of Care in Six Health Care Plans

The authors performed a retrospective cohort study to develop a method for comparing the quality of prenatal care provided in different health care plans and making the results publicly available.

Journal Article

Quality of Antidepressant Medications Prescribed at Discharge to Depressed Elderly Patients in General Medical Hospitals Before and After Prospective Payment System

Journal Article

Quality of Care for Depressed Elderly Pre-Post Prospective Payment System: Differences in Response Across Treatment Settings

Using data from the RAND Prospective Payment/Quality of Care Study, examines whether quality of care changed for depressed, elderly hospitalized patients before and after implementation of the PPS.

Journal Article

Regular Source of Ambulatory Care and Medical Care Utilization by Patients Presenting to a Public Hospital Emergency Department

Using emergency departments as regular sources of care has been considered to be a marker of poor quality because it is difficult to provide continuity of care in that setting.

Journal Article

Indications for Cholecystectomy: The Results of a Consensus Panel Approach

A consensus panel approach was used in Israel to develop a list of clinical indications for which there was agreement that cholecystectomy should be performed.

Report

Assessing the Performance of Mortality Prediction Models: Final Report for HCFA Severity Project

Concerns about the cost and quality of health care have resulted in a national effort to determine the health outcomes of medical and surgical services.

Report

Medical Record Abstraction Form and Guidelines for Assessing the Appropriateness of Hysterectomy

This report documents the medical record abstraction form and guidelines for appropriateness of hysterectomy used in the HMO Quality of Care Consortium study of this procedure.

Report

Medical Record Abstraction Form and Guidelines for Assessing the Quality of Pre-Natal Care

Medical Record Abstraction Form and Guidelines for Assessing the Quality of Pre-Natal Care

Report

Coronary Angiography: Ratings of Appropriateness and Necessity by a Canadian Panel

This publication provides the results of a two-stage Delphi process by which a panel of Canadian physicians rated the appropriateness and necessity of indications for the use of coronary angiography.

Report

Coronary Artery Bypass Graft Surgery and Percutaneous Transluminal Coronary Angioplasty : Ratings of Appropriateness and Necessity by a Canadian Panel

This publication provides the definitions used by a nine-member panel of Canadian physicians who rated the appropriateness and necessity of indications for the use of coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty.

Journal Article

The Agreed Indications and Contra-Indications for Cholecystectomy

Indications as to which patients should undergo cholecystectomy remain, at least in part, a matter of controversy.

Report

Analysis of Quality of Care for Patients Who are Black and Poor in Rural and Urban Settings

This study finds racial and financial characteristics influence the quality of care received by acutely ill, insured patients after hospital admission.

Report

The appropriateness of hysterectomy : a comparison of care in seven health plans

The appropriateness of hysterectomy : a comparison of care in seven health plans

Journal Article

Appropriateness of the Use of Cardiovascular Procedures: A Method and Results of This Application

This article presents a method that combines what is known in the literature with expert physician judgment to generate clinically valid appropriateness guidelines.

Journal Article

The Appropriateness of Use of Coronary Angiography in New York State

Determine the appropriateness of use of coronary angiography in New York State.

Report

The Appropriateness of Use of Coronary Artery Bypass Graft Surgery, Percutaneous Transluminal Coronary Angioplasty, and Coronary Angiography in New York State

The authors used a retrospective randomized medical record review to determine the appropriateness of use of coronary artery bypass graft surgery in New York State.

Journal Article

The Appropriateness of Use of Percutaneous Transluminal Coronary Angioplasty in New York State

Determine the appropriateness of use of percutaneous transluminal coronary angioplasty (PTCA) in New York State.

Report

Cataract Surgery: A Literature Review and Ratings of Appropriateness and Cruciality

Reports the results of a literature review concerning the effectiveness and risks of cataract surgery.

Journal Article

Maintaining Hospital Quality: The Need for International Cooperation

The purpose of this article is to examine the assertion that improving a nation's health care will require measuring hospital quality and using that information to improve decisionmaking both at the physician and patient level and at the policy level.

Journal Article

Mortality Differences Between New York City Municipal and Voluntary Hospitals, for Selected Conditions

Determine if mortality differences between municipal and voluntary hospitals in New York City persist after adjustment for computerized administrative data (age, sex, principal diagnosis, and secondary diagnosis), six conditions in those hospitals from 1984 through 1987 were studied.

Journal Article

Quality of Care for Hospitalized Depressed Elderly Patients Before and After Implementation of the Medicare Prospective Payment System

The authors evaluated the impact of Medicare's Prospective Payment System on aspects of quality of care and outcomes for depressed elderly inpatients in acute-care general medical hospitals.

Draft

Quality of life of epilepsy surgery patients compared to outpatients with hypertension, diabetes, heart disease, and

Quality of life of epilepsy surgery patients compared to outpatients with hypertension, diabetes, heart disease, and

Journal Article

Use of Coronary Artery Bypass Surgery in the United States and Canada: Influence of Age and Income

Compare overall rates of coronary artery bypass surgery (CABS) in several Canadian and US jurisdictions and to compare use by age and income groups in the two countries.

Journal Article

Using Scientific Information to Improve Quality of Health Care

Discusses types of clinical evidence; quality of evidence and judgments of quality; types and designs of clinical trials; synoptic information (reviews, overviews, meta-analyses); journals and the press in disseminating information; evidence in medical education and practice; and financing evidence-producing research.

Journal Article

Assigning Appropriateness Ratings for Diagnostic Upper Gastrointestinal Endoscopy Using Two Different Approaches

Methods that combine information in the medical literature with expert clinical judgment are needed to determine the appropriateness of a procedure. The purpose of this study is to better understand the reliability and construct validity of this process.

Journal Article

Appropriateness of Care: A Comparison of Global and Outcome Methods to Set Standards

The authors compare the appropriateness judgments based on the global judgment method to appropriateness ratings based on probability estimates of specific outcomes that were provided by the same panel of experts.

Report

Abdominal Aortic Aneurysm Surgery: A Literature Review and Ratings of Appropriateness and Necessity

Reviews the literature on the benefits and risks of (AAA) surgery, provides a comprehensive list of potential indications for AAA surgery, and presents the ratings of appropriateness and necessity of those indications by a panel of experts.

Report

The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by an All-Chiropractic Expert Panel

This report presents results from the third stage of the RAND Appropriateness of Spinal Manipulation for Low-Back Pain Study.

Journal Article

Assessing Clinical Instability at Discharge: The Clinician's Responsibility

Based on the work done in RAND's effect of Diagnostic Related Groups (DRGs) study, urges physicians to adopt policies to prevent hospital discharge for people who are clinically unstable.

Report

Choosing Quality-of-Care Measures Based on the Expected Impact of Improved Quality of Care for the Major Causes of Mortality and Morbidity

This report presents an approach for selecting medical conditions for measuring technical quality of care, based on the expected impact of improved quality of care.

Journal Article

Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke

Report

Coronary Angiography: A Literature Review and Ratings of Appropriateness and Necessity

This report contains a literature review of coronary angiography, a comprehensive set of indications for performing this procedure, and ratings of the appropriateness and necessity for each indication. It primarily concentrates on coronary angiograph...

Journal Article

Defining Our Terms

Report

The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: Final Report

Assesses the quality of inhospital care for Medicare patients age 65 and over, before and after the implementation of PPS, and estimates the effects of the PPS intervention on quality of care, ...

Journal Article

Group Judgments of Appropriateness: The Effect of Panel Composition

Examines how appropriateness scores vary by panel composition and concludes that a panel made up of all doers, e.g., all surgeons for carotid endarterectomy, is more likely to favor operative treatment for carotid disease than is a multispecialty panel, such as the model RAND uses.

Journal Article

HMO Vs Fee-for-Service Care of Older Persons with Acute Myocardial Infarction

Compares care for older patients with acute myocardial infarction in HMOs with their care under the fee-for-service system.

Journal Article

Improving Practice: The Clinician's Role

Based on RAND's research in the appropriateness area as well as on the Health Insurance Experiment, this article concludes that making health care reform meaningful will require changes at a clinical level.

Report

Prenatal care : a literature review and quality assessment criteria

This report reviews the literature on the process and outcomes of prenatal care for the purpose of developing criteria by which such care could be assessed. The report includes the final set of criteria agreed upon by a Working Group of the HMO Quali...

Journal Article

Regional Differences in Appropriateness of Cholecystectomy in a Prepaid Health Insurance System

This study describes the quality of antidepressant medication use at hospital discharge for depressed elderly inpatients and compares quality of care before and after implementation of Medicare's Prospective Payment System (PPS).

Journal Article

Relation Between Hospital Experience and In-Hospital Mortality for Patient with AIDS-related Pneumocystis Carinii Pneumonia: Experience from 3,126 Cases in New York City in 1987

Shows that, for people admitted to a hospital with AIDS, mortality varies with hospital experience.

Journal Article

Reliability and Validity of the Katz Adjustment Scales in an Epilepsy Sample

Development of quality of life measures de novo is time-consuming and expensive, and a number of instruments are already available for general use.

Report

Appropriateness of Acute Medical Care for the Elderly: An Analysis of the Literature

Analyzes the literature regarding appropriateness of acute care provided to the elderly.

Report

The Appropriateness of Carotid Endarterectomy

Carotid endarterectomy is a commonly performed but controversial procedure. The authors conclude that carotid endarterectomy was substantially overused in the three geographic areas they studied.

Report

The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel

This report contains the indications and ratings for appropriateness for spinal manipulation that reflect the findings of a nine-member panel of back-pain experts.

Report

The Appropriateness of Spinal Manipulation for Low-Back Pain: Project Overview and Literature Review

Contains a literature review on spinal manipulation treatment for low-back pain, covering the literature from 1955 to 1991, and gathering data from 76 sources, including 22 controlled trials of the use of spinal manipulation for low-back pain.

Report

The Appropriateness of Using a Medical Procedure: Is Information in the Medical Record Valid?

Understanding the clinical appropriateness of a procedure's use may be critical in explaining geographic variations in its use. Little is known, however, about whether data on appropriateness can be obtained from a medical record.

Report

Assessing Clinical Decision Making: Is the Ideal System Feasible?

While caring for patients, physicians make a variety of decisions. Can current methods adequately determine whether these decisions are correct? If not, what improvements are needed?

Journal Article

Board Certification and Practice Style: An Analysis of Office-Based Care

Certified and noncertified family physicians treat similar patients. Certification in family practice is not associated with major differences in total service charges, but is associated with differences in the use of laboratory diagnostic services.

Report

Clinical Practice: Audit of Coronary Angiography and Bypass Surgery

The appropriateness of coronary angiography and coronary artery bypass surgery in the Trent regional health authority was assessed by comparison with predetermined consensus criteria.

Journal Article

A Community-Based Study of the Use of Chiropractic Services

The authors analyzed data from the RAND Health Insurance Experiment (HIE), a community-based study of the use of health services.

Journal Article

A Comparison of Cost-Sharing Versus Free Care in Children: Effects on the Demand for Office-Based Medical Care

Using data from the community based RAND Health Insurance Experiment, the effect of cost-sharing versus free care on the use of office-based medical care in children was examined.

Report

Consensus Methods: Characteristics and Guidelines for Use

This Note surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and by Glaser) and provides guidelines for those who want to use the techniques.

Report

Coronary Artery Bypass Graft: A Literature Review and Ratings of Appropriateness and Necessity

This report summarizes the evidence for efficacy and risk according to generally accepted indications for coronary artery bypass graft surgery.

Report

Derivation of Clinical Indications for Carotid Endarterectomy by an Expert Panel

The authors used a two-round consensus panel method to derive and rate the appropriateness of comprehensive sets of detailed clinical indications for performing carotid endarterectomy.

Report

Do Patient, Physician, and Hospital Characteristics Affect Appropriateness and Outcome of Selected Procedures?

Contains two separate but related reports. Both use data from the RAND/UCLA Health Services Utilization Study (HSUS) supplemented by additional data on patient, physician, and hospital characteristics.

Report

The Effect of Comorbidity on Appropriateness Ratings for Two Gastrointestinal Procedures

The authors evaluated the effect of patients' comorbidity on the appropriateness of performing esophagogastroduodenoscopy or cholecystectomy.

Journal Article

Effects of Cost Sharing in Health Insurance on Disability Days

The authors assess how cost sharing for medical services affects restricted activity days (RADs) and work loss disability days (WLDs), using data from a controlled experiment.

Report

The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: Executive Summary

This report constitutes the executive summary of an evaluation of the impact of the DRG-based PPS system.

Report

Efficacy, Effectiveness, Variations, and Quality: Boundary-crossing Research

Considers future directions for health care quality assessment research and the uses to which its products should be put. Health services research can profitably be focused on issues of efficacy, effectiveness, variations in use, or quality of care.

Report

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

Hospital death rates vary markedly, even for the same disease.

Journal Article

Failure of Physicians to Recognize Functional Disability in Ambulatory Patients

Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients.

Journal Article

A Fair Approach to Comparing Quality of Care

While individual plans may possess information on various aspects of quality, it is difficult to compare information from one plan to that of another.

Report

Geographic Variations in the Use of Services: Do They Have Any Clinical Significance?

Presents speculation on how the medical community might determine whether more medical care is better medical care by collecting information about the indications and outcomes of medical procedures and services.

Journal Article

The Health Care Resource Allocation Debate: Defining Our Terms

The problem of health care distribution in the United States demands immediate action.

Journal Article

Health, Health Insurance, and the Uninsured: A Short Essay

Report

Health Services Research: Is It Good for You and Me?

Two principles shape an applied research field such as health services research.

Report

Hospital Inpatient Mortality: Is It a Predictor of Quality?

Various potential measures of quality of care are being used to differentiate hospitals. In 1986, on the basis of diagnostic and demographic data, the Health Care Financing Administration identified hospitals in which the actual death rate differed ...

Report

Measuring the Clinical Appropriateness of the Use of a Procedure: Can We Do It?

Increasing attention is being paid to data on geographic differences in population-based rates of use of medical and surgical procedures. To understand these differences and to determine what level of use is appropriate, a method is needed to judge t...

Report

A Method for the Detailed Assessment of the Appropriateness of Medical Technologies

... discusses its application to rate the appropriateness of six medical and surgical procedures - coronary angiography, coronary artery bypass surgery, cholecystectomy, upper gastrointestinal endoscopy, colonoscopy, and carotid endarterectomy.

Journal Article

Outcomes of Carotid Endarterectomy-Response

Journal Article

Patients Who Leave a Public Hospital Emergency Department Without Being Seen by a Physician: Causes and Consequences

Determine whether patients who sought care at a public hospital emergency department and left without being seen by a physician needed immediate medical attention and whether they obtained care after leaving.

Report

Percutaneous Transluminal Coronary Angioplasty: A Literature Review and Ratings of Appropriateness and Necessity

This report summarizes information on percutaneous transluminal coronary angioplasty (PTCA) contained in research published between 1982 and October 1990.

Report

Physician Ratings of Appropriate Indications for Six Medical and Surgical Procedures

The authors convened three panels of physicians to rate the appropriateness of a large number of indications for performing a total of six medical and surgical procedures.

Journal Article

Quality of Care: Do We Care?

The quality of U.S. health care must improve. Practicing physicians need to become involved in generating new knowledge about what does and does not work in medical practice. Physicians might, for example, participate in building national databases on chronic and acute conditions using data from their patients or might help to enroll patients in cohort studies or experimental trials.

Report

Structured Implicit Review of the Medical Record: A Method for Measuring the Quality of Inhospital Medical Care and a Summary of Quality Changes Following Implementation of the Medicare Prospective Payment System

To measure the quality of medical care before and after implementation of the Prospective Payment System (PPS) by Medicare, the authors developed methods for both implicit and explicit review of the medical record.

Report

Sufficiency of Clinical Literature on the Appropriate Uses of Six Medical and Surgical Procedures

The authors reviewed the English-language clinical literature on carotid endarterectomy, cholecystectomy, upper gastrointestinal endoscopy, colonoscopy, coronary angiography, and coronary artery bypass graft procedure to identify the appropriateness ...

Report

Use of Carotid Endarterectomy in Five California Veterans Administration Medical Centers

Although carotid endarterectomy is a controversial and frequently performed surgical procedure, little is known about the clinical appropriateness of its use in actual practice.

Report

Will We Need to Ration Effective Health Care?

The authors conclude that development of an equitable and responsive health system need not entail rationing effective services.

Journal Article

Format and Conduct of Consensus Development Conferences, Multination Comparison

The consensus development conference method developed by the National Institutes of Health in the United States has been adopted and modified by a number of countries.

Journal Article

Carotid Endarterectomy for Elderly Patients: Predicting Complications

To determine whether the complication or death rate from carotid endarterectomy can be predicted from hospital and physician structural variables

Journal Article

Changes in Quality of Care for Five Diseases Measured By Implicit Review, 1981 to 1986

In this study, the authors measured quality of care before and after implementation of the prospective payment system

Journal Article

Changes in Sickness at Admission Following the Introduction of the Prospective Payment System

The authors developed disease-specific measures of sickness at admission based on medical record data to study mortality of Medicare patients.

Journal Article

Comparing Outcomes of Care Before and After Implementation of the DRG-based Prospective Payment System

The authors compared patient outcomes before and after the introduction of the diagnosis related groups (DRG)-based prospective payment system (PPS) in a nationally representative sample of 14,012 Medicare patients hospitalized in 1981 through 1982 and 1985 through 1986 with one of five diseases.

Journal Article

Effectiveness, Variations, and Quality: Boundary-Crossing Research

A discussion of hospital-wise quality assurance and approaches to quality appraisal, including staging, criteria mapping, health accounting and medical auditing.

Journal Article

The Effects of the DRG-based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: An Introduction to the Series

Review of the medical record supplemented by data on postdischarge outcomes drawn from the files of the HCFA and fiscal intermediaries

Journal Article

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

Identifying hospitals that provide poor-quality care based on administrative data and single-year death rates is unlikely

Report

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care

The authors used administrative (Part A Medicare) data to identify a representative sample of 1,126 patients with congestive heart failure and 1,150 with acute myocardial infarction in hospitals with significant unexpectedly high inpatient, ...

Journal Article

Measuring Quality of Care with Explicit Process Criteria Before and After Implementation of the DRG-based Prospective Payment System

Overall, process improvements across all four medical conditions were associated with a 1 percentage point reduction in 30-day mortality rates

Journal Article

Predicting the Appropriate Use of Carotid Endarterectomy, Upper Gastrointestinal Endoscopy, and Coronary Angiography

Appropriateness of care cannot be closely predicted from many easily determined characteristics of patients, physicians, or hospitals.

Report

Prepaid Group Practice Effects on the Utilization of Medical Services and Health Outcomes for Children: Results From a Controlled Trial

The results of this experiment neither strongly support nor indict fee-for-service or prepaid care for children.

Journal Article

Prospective Payment System and Impairment at Discharge: The 'Quicker-And-Sicker' Story Revisited

Since the introduction of the PPS anecdotal evidence has accumulated that patients are leaving the hospital quicker and sicker.

Journal Article

Quality of Ambulatory Care: Epidemiology and Comparison By Insurance Status and Income

This study assessed levels of depressive symptomatology in a household probability sample of Mexico-born and U.S.-born Mexican Americans.

Journal Article

Quality of Care Before and After Implementation of the DRG-based Prospective Payment System: A Summary of Effects

In this article the authors report on a mortality analysis, patient and hospital subgroup comparisons, and time series studies they have conducted.

Journal Article

The Relationship Between Appropriateness and Outcome

Report

A Summary of the Effects of DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients

The series of articles reports on the findings of a four-year evaluation, begun in 1985, of the effects on quality of care of the diagnosis-related-groups-based prospective payment system.

Journal Article

Surgery for Epilepsy

Increasing numbers of patients, including many children, are being referred for surgery. Improved technology has made it possible to identify more accurately where seizures originate in the brain, and advances in surgical techniques have made operations safer. It is recommended that data from major epilepsy centres be combined to clarify many unanswered questions about the use of these and other diagnostic methods.

Journal Article

The Condition of the Literature on Differences in Hospital Mortality

The quiescent interest in understanding the variations in the quality of hospital care has been revitalized recently with the government's release of hospital-specific mortality data.

Report

Appropriateness of Acute Medical Care for the Elderly: An Analysis of the Literature

The increase in the over-65 population and the rapid rise in health care costs have combined to create pressures on the health care system, giving rise to suggestions that health care services be rationed to offset increased expenditures.

Journal Article

Appropriateness of Care

Journal Article

The Appropriateness of Use of Selected Medical and Surgical Procedures and Its Relationship to Geographic Variations in Their Use

Study design, methods, procedures, analysis, and validation in the Rand studies of coronary angiography, carotid edarterectomy, and diagnostic upper gastrointestinal endoscopy.

Report

Changing Medical Practice Through Technology Assessment: An Evaluation of the NIH Consensus Development Program

Presents the major findings from RAND's evaluation of the National Institutes of Health (NIH) Consensus Development Program.

Report

Differences among Hospitals in Medicare Patient Mortality

Using hospital discharge abstract data for fiscal year 1984 for all acute-care hospitals treating Medicare patients, the authors measured four mortality rates: inpatient deaths, deaths within 30 days of discharge, and deaths within two fixed periods...

Journal Article

How Free Care Improved Vision in the Health Insurance Experiment

The authors studied reasons for the improvement in the functional vision of enrollees receiving free care in the Rand Health Insurance Experiment.

Journal Article

Improving Patient Function: A Randomized Trial of Functional Disability Screening

Whether a functional status questionnaire measuring physical, psychological, and social function can be used to help improve their patients' outcomes.

Journal Article

Practice Guidelines and Practicing Medicine: Are They Compatible?

In this time of ever-increasing financial pressure on medical facilities and physicians, the economic value and appropriateness of nearly every aspect of clinical practice is under scrutiny.

Journal Article

Relation Between Surgeons' Practice Volumes and Geographic Variation in the Rate of Carotid Endarterectomy

We examined the relation between the number of operative procedures carried out by individual surgeons and the variation in the rate of carotid endarterectomy among Medicare beneficiaries in areas of high, average, and low use of the procedure in 1981.

Report

Structured Implicit Review for Physician Implicit Measurement of Quality of Care: Development of the Form and Guidelines for Its Use

This Note documents the structured implicit review form used for the implicit measurement of quality of care for Medicare patients.

Journal Article

Management of Patients on Psychotropic Drugs in Primary Care Clinics

While nonpsychiatrist physicians account for the majority of prescriptions written for psychotropic drugs, little is known about the quality of their drug management strategy.

Journal Article

The Appropriateness of Performing Coronary Artery Bypass Surgery

Information about how appropriately procedures are performed is vital to the understanding of the impact of technology and to the success of efforts to channel its use appropriately.

Journal Article

Competition and Quality

Increasingly, physicians work as employees, patients have become consumers, and business school graduates are assuming control. As independent-practice-model health maintenance organizations (HMOs) grow rapidly, staff- and group-model HMOs are scared: will they go the way of the fee-for-service system? Competition, for the time being, seems to be king.

Journal Article

Diagnosis and Treatment of Coronary Disease: Comparison of Doctors' Attitudes in the USA and the UK

Panels of doctors from the USA and the UK were asked to indicate how appropriate they judged a series of possible indications for coronary angiography and coronary artery bypass graft operations.

Journal Article

The Early Effect of Medicare's Prospective Payment System on the Use of Medical Intensive Care Services in Three Community Hospitals

The authors reviewed the medical records of 400 MICU patients from three community hospitals: 200 patients were admitted before the prospective payment system (PPS) and 200 were admitted after the PPS.

Journal Article

Historical Trends in Quality Assurance for Mental Health

Journal Article

Interpreting Hospital Mortality Data: How Can We Proceed?

Uses for data about whether patients live or die following short-term-care hospitalization

Journal Article

Measuring Differences Between Teaching and Nonteaching Hospitals

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Acute Myocardial Infarction

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with acute myocardial infarction.

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Cerebrovascular Accident

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with cerebrovascular accident.

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Congestive Heart Failure

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with congestive heart failure.

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Depression

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with depression.

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Hip Fracture

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with hip fracture.

Report

Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Pneumonia

Documents the medical record abstraction form and guidelines used to collect data from the medical records of patients hospitalized with pneumonia.

Journal Article

Quality Assessment and Technology Assessment: Critical Linkages

Journal Article

The Quality of Care Received by Older Patients in 15 University-Based Ambulatory Practices

The authors evaluated how the medical problems of older patients are managed in university-based internal medicine practices by reviewing the medical records of 1,527 outpatients treated at 15 university teaching hospitals.

Journal Article

The Use and Misuse of Upper Gastrointestinal Endoscopy

Study how appropriately physicians in 1981 did upper gastrointestinal endoscopy in a randomly selected, community-based sample of Medicare patients.

Journal Article

Allocating Health Care Resources: How Can We Ensure Access to Essential Care?

Public debate over the cost and quality of, and access to health care in the United States has increased in volume and intensity over the last several years as society grapples with the question of how to allocate limited health resources.

Journal Article

The Association Between Hypertension Treatment, Control, and Functional Status

The authors examined the relationship between hypertension treatment, control, and functional status among 356 uncomplicated hypertensive patients receiving care in 16 teaching hospital group practices.

Journal Article

Assuring the Quality of Health Care for Older Persons: An Expert Panel's Priorities

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance.

Journal Article

Case-mix Measurement and Assessing Quality of Hospital Care

Patients, insurers, and health care systems are increasingly counseled to consider both quality and cost in purchasing health care services, particularly hospital care, to "buy right."

Report

Does Inappropriate Use Explain Geographic Variations in the Use of Health Care Services? : A Study of Three Procedures

Reports on studies of the appropriateness of use of coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy and its relationship to geographic variations in the rates of use of these procedures.

Report

Does More Generous Dental Insurance Coverage Improve Oral Health?

Considers the relationship between dental insurance and oral health by examining the effects of different levels and types of cost sharing (coinsurance, deductibles) on oral health.

Journal Article

Educating Physicians and Treating Patients in the Ambulatory Setting: Where Are We Going and How Will We Know When We Arrive?

The authors evaluated 15 group practices in general internal medicine in university hospitals.

Journal Article

Effect of a Health Maintenance Organization on Physiologic Health: Results from a Randomized Trial

Authors conclude that the cost savings achieved by this HMO through lower hospitalization rates were not reflected in lower levels of health status.

Report

Effect of a Health Maintenance Organization on Physiologic Health: Results from a Randomized Trial

This report, which originally appeared in Annals of Internal Medicine, v. 106, no. 1, January 1987, presents results from analysis of data collected as part of the RAND Health Insurance Experiment.

Report

The Effect of Cost Sharing on the Use of Antibiotics in Ambulatory Care: Results from a Population-Based Randomized Controlled Trial

Little is known about how generosity of insurance and population characteristics affect quantity or appropriateness of antibiotic use.

Report

Effects of Cost Sharing on Physiological Health, Health Practices, and Worry

In a randomized trial of the effects of medical insurance on spending and the health status of the nonaged, the authors previously reported that patients with limited cost sharing had approximately one-third less use of medical services;...

Journal Article

General Health Status Measures and Outcome Measurement: A Commentary on Measuring Functional Status

Report

Health Outcomes for Adults in Prepaid and Fee-for-Service Systems of Care: Results from the Health Insurance Experiment

... it has not been clear whether the cost reductions in HMOs, achieved largely by reductions in hospital admissions, have adverse effects on health.

Report

How Coronary Angiography Is Used: Clinical Determinants of Appropriateness

Uses ratings of appropriateness derived from an expert physician panel to measure how appropriately physicians in 1981 performed coronary angiography in a randomly selected, community-based sample of cases in the Medicare population.

Report

Measuring Case Mix and Quality of Care: Validity Studies for the Graduate Medical Education Study

Describes a series of studies designed to evaluate the validity of the quality-of-care and seriousness-of-illness measures in the Graduate Medical Education dataset.

Report

Measuring Case Mix and Quality of Care: Rater Training and Reliability in the Graduate Medical Education Study

Reviews the training of raters and the instructions associated with each instrument and assess the reliability of the quality-of-care and seriousness-of-illness measures in the Graduate Medical Education dataset.

Report

Medical Record Abstraction Forms for Assessing Compliance with NIH Consensus Conference Recommendations

Reprints the medical record abstraction forms and an illustrative set of guidelines for collecting data for the hospital-based portion of RAND's evaluation of the National Institutes of Health Consensus Development Program.

Journal Article

Monitoring Quality of Care in the Medicare Program: Two Proposed Systems

Report

Obtaining Clinical Data on the Appropriateness of Medical Care in Community Practice

They conclude that, with effort, cooperative research among disparate segments of the medical community can become a reality even if the topic studied is relatively sensitive.

Report

Physician Survey for Evaluating the NIH Consensus Development Program

Reprints the survey instrument used to collect data from physicians in RAND's evaluation of the National Institutes of Health (NIH) Consensus Development Program, a technology assessment and dissemination program aimed at facilitating the ...

Journal Article

Providing Primary General Medical Care in University Hospitals: Efficiency and Cost

It is financially feasible for university hospitals to provide primary care to disadvantaged populations.

Journal Article

Quality of Care for Psychotropic Drug Use in Internal Medicine Group Practices

To evaluate the care given by internists in group practices at 16 academic medical centers to patients who used minor tranquilizers or antidepressants, data were abstracted from medical records and compared with specific criteria for quality care.

Journal Article

Termination of Medi-Cal Benefits: A Follow-Up Study One Year Later

In 1982 California terminated Medi-Cal benefits for the state's 270,000 medically indigent adults and transferred responsibility for their care to the county system.

Journal Article

Changing Physician Payment for Medicare Patients: Projected Effects on the Quality of Care

Congress and the Reagan Administration, in an effort to contain costs, are considering changes in the way physicians are paid when they care for Medicare patients.

Journal Article

Comparison of Health Outcomes at Health Maintenance Organization with Those of Fee-for-Service Care

This research sought to determine whether health outcomes in a health maintenance organisation (HMO) differed from those in the fee-for-service (FFS) system.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 1, Overview of Chronic Disease in a General Adult Population

Combines information from the Health Insurance Experiment (HIE) on the prevalence, associated effects, and use of medical care for several important chronic conditions or impairments.

Report

Consumer Acceptance of Prepaid and Fee-for-Service Medical Care: Results from a Randomized Controlled Trial

To determine whether consumers find the care provided by health maintenance organizations (HMOs) and that provided in the fee-for-service (FFS) system equally acceptable, the authors randomly assigned 1,537 people ages 17 to 61 either to ...

Journal Article

Dental Insurance and the Oral Health of Preschool Children

Using data from the Rand Health Insurance Experiment, the effects of cost-sharing plans on the health of the primary teeth in 264 children aged 3 to 5 years were investigated.

Journal Article

Evaluation of Ambulatory Care Training by Graduates of Internal Medicine Residencies

In 1984, 154 physicians who had completed residencies in internal medicine at 15 major teaching hospitals in 1982 evaluated their residency training in ambulatory care.

Journal Article

Evaluation of the Effects on the Quality of Care of Selected Alternatives for Paying Physicians Under the Medicare Program

Journal Article

The Functional Status Questionnaire: Reliability and Validity When Used in Primary Care

This paper examines the reliability and validity of the FSQ.

Journal Article

Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans

Examines geographic variation in the rate of inappropriate hospitalization and the effect of cost sharing on that rate. The medical records of 1132 adults hospitalized in a randomized trial of health insurance plans were reviewed by two physicians who were blinded to the patients' insurance plan.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Cholecystectomy

This report is part of a larger study to determine the extent to which the appropriate use of medical procedures is related to overall rates of use among geographic areas.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Diagnostic Upper Gastrointestinal Endoscopy

This report contains a review of the published literature on the diagnostic use of upper gastrointestinal endoscopy from the procedure's introduction in the 1960s through 1981.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Coronary Angiography

This report is part of a larger study to determine the extent to which the appropriate use of medical procedures is related to overall rates of use among geographic areas.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Coronary Artery Bypass Graft Surgery

This report is part of a larger study to determine the extent to which the appropriate use of medical procedures is related to overall rates of use among geographic areas.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Colonoscopy

This report is part of a larger study to determine the extent to which the appropriate use of medical procedures is related to overall rates of use among geographic areas.

Report

Indications for Selected Medical and Surgical Procedures - A Literature Review and Ratings of Appropriateness: Carotid Endarterectomy

This report is part of a larger study to determine the extent to which the appropriate use of medical procedures is related to overall rates of use among geographic areas.

Report

Measurement of Physiologic Health for Children: Volume 6, Urinary Tract Infection

The RAND Health Insurance Experiment (HIE) will use data on the prevalence and adverse impact of urinary tract infection (UTI) to investigate the effects of differing levels of health insurance on the health status of and quality of care for children.

Journal Article

Medicare Capitation and Quality of Care for the Frail Elderly

The quality of care received by the frail elderly will be an important test of the success of Medicare capitation.

Report

Physician Ratings of Appropriate Indications for Six Medical and Surgical Procedures

The authors convened three panels of physicians to rate the appropriateness of a large number of indications for performing a total of six medical and surgical procedures.

Journal Article

Popular Press Coverage of Eight National Institutes of Health Consensus Development Topics

The quality of medical journalism has been widely criticized.

Journal Article

The Practices of General and Subspecialty Internists in Counseling About Smoking and Exercise

The authors compared the practices of subspecialists and general internists in counseling about smoking and exercise.

Journal Article

Setting Standards of Performance for Program Evaluations: The Case of the Teaching Hospital General Medicine Group Practice Program

Program evaluation is like research in its use of the scientific method.

Report

Use of Medical Care in the RAND Health Insurance Experiment: Diagnosis- and Service-specific Analyses in a Randomized Controlled Trial

Looks at reasons for seeking medical care and how care was utilized in the RAND Health Insurance Experiment (HIE), including how cost-sharing reduced the probability of using medical care across a wide spectrum of individual conditions.

Journal Article

Variations in the Use of Medical and Surgical Services By the Medicare Population

Authors measured geographic differences in the use of medical and surgical services during 1981 by Medicare beneficiaries in 13 large areas of the US.

Report

Variations in the Use of Medical and Surgical Services by the Medicare Population

The authors measured geographic differences in the use of medical and surgical services during 1981 by Medicare beneficiaries (age 65 or over) in 13 large areas of the United States.

Journal Article

Work Satisfaction and Career Aspirations of Internists Working in Teaching Hospital Group Practices

This paper presents data on the characteristics, work activities, job-related stress, work satisfaction, and career aspirations of 150 faculty and 595 housestaff physicians who regularly provide continuous primary care in 15 teaching hospital-based group practices.

Journal Article

Career Orientations of Medical and Pediatric Residents

This study identifies characteristics of postgraduate physicians that are associated with intentions to pursue an academic career or a full-time private practice.

Journal Article

Final Evaluation Report: Provider Survey Data

Journal Article

Final Evaluation Report: The Structure of Care

Journal Article

Final Evaluation Report: Medical Record Abstraction Data

Journal Article

Final Evaluation Report: Patient Survey Data

Journal Article

General Medical Care and the Education of Internists in University Hospitals: An Evaluation of the Teaching Hospital General Medicine Group Practice Program

Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education.

Journal Article

Geographic Variations in the Use of Medical Services and Surgical Procedures: A Chartbook

Journal Article

Health Status, Sociodemographic Factors, and Use of Prescribed Psychotropic Drugs

The relations among sociodemographic factors, health status, and use of prescribed sleeping pills and tranquilizers are examined.

Journal Article

How Free Care Reduced Hypertension in the Health Insurance Experiment

Free care also led to higher compliance by hypertensives with diet and smoking recommendations and higher use of medication by those who needed it.

Report

How Free Care Reduced Hypertension of Participants in the RAND Health Insurance Experiment

The cause of the difference was the additional contact with physicians under the free-care plan; this led to better detection and treatment of hypertensives not under care at the start of the study.

Journal Article

How to Help Your Patients Function Better

The traditional history and physical examination provide only limited information about problems of physical, psychological and social function.

Report

The Impact of Cost Sharing on Emergency Department Use

The authors of this Note studied the effect of insurance coverage on the use of emergency department services, using data from a national trial of cost sharing in health insurance.

Report

Impact of Medicare Prospective Payment on the Quality of Medical Care: A Research Agenda

This report identifies major issues relating to quality of care, sketches conceptual and practical aspects of carrying out appropriate studies of these issues, and outlines a quality-of-care research agenda.

Journal Article

Innovations in Medical Curricula: Templates for Change

In this article, the authors present a survey of the literature concerning medical school curricula innovations for the past ten years.

Report

Measurement of Physiologic Health for Children : Volume 4, Vision Impairments

This report is part of a large-scale social study, the Health Insurance Experiment (HIE), to assess how varying a patient's cost of health services affects his or her use of services, quality of care, patient satisfaction, and health status.

Journal Article

Persuasive Communication and Medical Technology Assessment

The authors outlined implications for educational interventions and promising research directions.

Journal Article

Physician and Patient Satisfaction as Factors Related to the Organization of Internal Medicine Group Practices

The present study compares patient satisfaction scores with job satisfaction scores of the physicians providing their care in 16 general internal medicine teaching hospital group practices.

Journal Article

Some Interim Results from a Controlled Trial in Health Insurance

A total of 7706 persons are participating in a controlled trial of alternative health-insurance policies. Interim results indicate that persons fully covered for medical services spend about 50 per cent more than do similar persons with income-related catastrophe insurance.

Report

Consequences of variations in definitions of the primary care physician

Several studies have concluded that specialists form a hidden system for primary care delivery. These studies, however, assume that a specialist who provides the majority of care is the primary care physician. Using data for a one-year period from 2,...

Report

The Effect of Coinsurance on the Health of Adults: Results from the RAND Health Insurance Experiment

Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?

Journal Article

Quality Assurance in Medicine

Describe and reflect on current activities in the field, and focus on three initiatives in quality assurance sponsored by the federal government.

Report

Quality Assurance in Medicine: Experience in the Public Sector

This report describes and reflects upon current quality assurance efforts in the health care field. It defines the concepts of quality of care and quality assurance, and recounts the history of the quality assurance movement.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 15, Surgical Conditions

Data on the prevalence and adverse consequences of, and use of medical care for, three disorders ultimately treatable by surgical intervention are used in the Health Insurance Study (HIS) to investigate the effect of different levels of insurance on health status and quality of care.

Report

Measurement of Physiologic Health for Children: Volume 3, Seizure Disorders

Two types of seizure disorders are discussed: febrile (fever) and nonfebrile (epileptic) seizures.

Report

Measurement of Physiologic Health for Children: Volume 1, Allergic Conditions

Data on their prevalence and adverse consequences are used in the Health Insurance Experiment (HIE) to investigate the effect of different levels of health insurance on health and quality of care.

Report

Measurement of Physiologic Health for Children: Volume 2, Middle Ear Disease and Hearing Impairment

Four upper respiratory conditions are investigated: middle ear disease (otitis media), hearing loss, tonsillitis, and colds.

Report

Measurement of Physiologic Health for Children : Volume 5, Anemia

The RAND Health Insurance Experiment (HIE) uses data on the prevalence and adverse impact of anemia to investigate the effects of differing levels of health insurance on health status and quality of care for children.

Journal Article

Who Is the Primary Physician?

Several studies have concluded that specialists form a hidden system for primary-care delivery.

Report

Conceptualization and Measurement of Health for Adults: Use of Hypnotic and Anxiolytic Drugs

The Health Insurance Study (HIS) used data on the prevalence and adverse consequences of use to investigate the effect of different levels of health insurance on health and the quality of medical care.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 8, Chronic Obstructive Airway Disease

This volume reviews pertinent medical literature, details the HIS definitions for three chronic obstructive airway diseases, describes HIS methods for measuring their presence and impact on people's lives, presents and discusses the enrollment data from the six HIS sites, and outlines quality of care criteria.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 9, Thyroid Disease

This volume reviews pertinent medical literature, details HIS disease definitions, describes HIS methods for measuring their presence and impact on people's lives, presents enrollment data from the six HIS sites, and outlines quality-of-care criteria.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 17, Peptic Ulcer Disease

Peptic ulcer disease is a prevalent condition. Data on its prevalence and adverse consequences are used in the Health Insurance Study (HIS) to investigate the effects of different levels of health insurance on health status and the quality of medical care because of its prevalence, potentially serious consequences, and responsiveness to treatment.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 12, Vision Impairment

The Health Insurance Study (HIS) will use data on impaired vision to study the relationship of health insurance to health status and quality of medical care. Impaired eyesight was selected as a health indicator because it is highly prevalent, easy to measure, and improvable in most cases.

Report

Construction and Scoring of Aggregate Functional Status Measures: Volume II, Appendixes

The appendixes included in this Note present details on how to score the aggregate indexes described in the companion volume, R-2551, Construction and Scoring of Aggregate Functional Status Indexes: Volume I.

Report

Construction and Scoring of Aggregate Functional Status Measures: Volume I

Presents information on several aggregate measures of functional status developed for use in a general population such as that enrolled in the Health Insurance Study (HIS).

Report

Some Interim Results from a Controlled Trial of Cost Sharing in Health Insurance

Interim results indicate that persons fully covered for medical services spend around 50 percent more than similar persons insured with an income-related catastrophic plan.

Report

Choosing Measures of Health Status for Individuals in General Populations

Offers suggestions to aid in the selection of appropriate instruments and data-gathering methods for studies that require measures of personal health status applicable in general populations.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 16, Urinary Tract Infection

Urinary tract infection (UTI) is the presence and growth of bacteria anywhere in the kidneys, their collecting systems, or the bladder.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 13, Hay Fever

Reviews pertinent medical literature, details the HIS definition of hay fever, describes the HIS methods for measuring its presence and impact on people's lives, presents and discusses the enrollment data from the six HIS sites, and outlines ...

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 14, Hearing Loss

Hearing loss (higher-than-normal threshold for perceiving sound as a function of its frequency) is the final common pathway of various diseases affecting the ear and its nerve connection to the brain.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 7, Diabetes Mellitus

Reviews pertinent medical literature, details the HIS definition of diabetes, describes HIS methods for measuring its presence and impact on people's lives, presents and discusses enrollment data from the six HIS sites.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 11, Hypercholesterolemia

Hypercholesterolemia (excessively high blood cholesterol) is an important laboratory finding because of its marked association with increased risk of coronary heart disease.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 4, Angina Pectoris

Angina is a common, serious manifestation of arteriosclerotic cardiovascular disease typically characterized by short-term episodic chest pain upon exertion. ...investigate the effect of different levels of insurance on health status and quality of care

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 5, Congestive Heart Failure

Congestive heart failure (CHF) is a chronic, progressively debilitating condition that appears almost exclusively and not uncommonly among persons over 40 years of age.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 10, Joint Disorders

Joint disorders, in the form of arthritis, are among the more common ailments in the United States. ...investigate the effect of different levels of health insurance on health and on the quality of medical care.

Report

Peer Review and Technology Assessment in Medicine

The analysis in this report explores the potential role of Professional Standards Review Organizations (PSROs) in medical technology assessment.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 2, Acne

Data on the prevalence and adverse consequences of acne are used in the Health Insurance Study (HIS) to investigate the effect of different levels of insurance on health status and quality of care.

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. I, Model of Health and Methodology

First in a series reviewing published literature and documenting conceptualization and construction of health status measures used in the Health Insurance Study (HIS).

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. VI, Analysis of Relationships Among Health Status Measures

Conceptualization and measurement of health for adults in the health insurance study. Vol. VI,Analysis of relationships among health status measures

Report

Conceptualization and Measurement of Health for Children in the Health Insurance Study

Reviews published literature and documents health status measures used in the Health Insurance Study for children aged 13 and younger.

Report

Conceptualization and Measurement of Health Habits for Adults in the Health Insurance Study: Vol. II, Overweight

Discusses overweight in relation to health status and how overweight is measured in the RAND Health Insurance Study (HIS).

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 3, Hypertension

Details the HIS definition of hypertension, describes HIS methods for measuring its presence and impact on people's lives, presents and discusses the enrollment data of the six HIS sites, and outlines quality-of-care criteria.

Report

Conceptualization and Measurement of Physiologic Health for Adults: Vol. 6, Anemia

Anemia, defined as abnormally low levels of hemoglobin in the blood, is an important sign of underlying disease. ... investigate the effect of different levels of insurance on health status and quality of care because of its ease of diagnosis,...

Report

Quality assurance in medical care: lessons from the U.S. experience

Describes the major developments in quality assessment and assurance in U.S. medical care, primarily as monitored by local Professional Standards Review Organizations (PSROs). For uncertain reasons, PSROs appear not to have produced hoped-for reduct...

Journal Article

Quality of Care in Episodes of Respiratory Illness Among Medicaid Patients in New Mexico

The New Mexico EMCRO developed medical guidelines for the use of injections and informed physicians through written communications and visits.

Report

Quality of care in the New Mexico Medicaid program (1971-1975) : the effect of the New Mexico Experimental Medical Care Review Organization on the use of antibiotics for common infectious diseases

Quality of care in the New Mexico Medicaid program (1971-1975) : the effect of the New Mexico Experimental Medical Care Review Organization on the use of antibiotics for common infectious diseases

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. III, Mental Health

This report discusses the conceptualization and measurement of the mental health of individual members of general populations in developed countries.

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. VII, Power Analysis of Health Status Measures

Conceptualization and measurement of health for adults in the health insurance study. Vol. VII,Power analysis of health status measures

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study : Vol. VIII, Overview

The final volume in a series reviewing published literature and documenting conceptualization and construction of health status measures used in RAND's Health Insurance Study (HIS).

Report

Conceptualization and Measurement of Health Habits for Adults in the Health Insurance Study: Vol. I, Smoking

An examination of smoking behavior in the first of a four-volume series of the RAND Health Insurance Study (HIS).

Report

Measuring Components of Children's Health Status

Measures of physical, mental, and social components of health status were studied for children ages 0-4 (N=679) and 5-13 (N=1473).

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The PSRO and the nursing home. Vol. 1, An assessment of PSRO long-term care review

The PSRO and the nursing home. Vol. 1, An assessment of PSRO long-term care review

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The PSRO and the nursing home. Vol. II, Ten demonstration projects in PSRO long-term care review

The PSRO and the nursing home. Vol. II, Ten demonstration projects in PSRO long-term care review

Report

Quality Assessment in Mental Health

Examines the quality of mental health care and the psychosocial aspects of medical care.

Report

Selected reflections on quality of medical care evaluation in the 1980s

A collection of thoughts and opinions on factors that the authors believe will affect attempts to (1) integrate quality assurance activities within the health services system, (2) perform such activities, and (3) evaluate their effectiveness. Althou...

Report

Associations Among Psychological Well-Being and Other Health Status Constructs

Six scales were constructed from a 22-item adaptation of Dupuy's General Well-Being (GWB) questionnaire: Anxiety, Depression, Self-Control, Positive Well-Being, General Health, and Vitality.

Report

Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. IV, Social Health

Fourth in a series on Health Insurance Study (HIS) measures, this volume reviews published literature and documents the conceptualization and construction of social health measures.

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Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. II, Physical Health in Terms of Functioning

Conceptualization and measurement of health for adults in the health insurance study. Vol. II,Physical health in terms of functioning

Report

Controlling the Use and Cost of Medical Services: The New Mexico Experimental Medical Care Review Organization — A Four-Year Case Study

Evaluates a generously funded comprehensive peer review system in place for a fairly long time.

Report

The Health Insurance Study Screening Examination Procedures Manual

The Health Insurance Study is a social experiment investigating the effects of different health care financing arrangements on the use of medical services, individual health status, satisfaction with care, and quality of care.

Report

Research opportunities in primary care

Primary care is expected to redress many of the ill effects brought about by medical specialization and technology, but it is being advocated with the same uncritical enthusiasm as were earlier technological developments in medicine. This paper focu...

Journal Article

Use, Costs, and Quality of Medical Services: Impact of the New Mexico Peer Review System : a 1971-1975 Study

Authors assess the effect of areawide peer review (such as that conducted by Professional Standards Review Organizations [PSROs]).

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Development of Outcome Criteria and Standards to Assess the Quality of Care for Patients with Osteoarthrosis

Results of the first step in assessment of quality of care for patients with osteoarthrosis using short-term outcome measures.

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Evaluation of the New Mexico Peer Review System, 1971 to 1973.

Evaluation of the New Mexico Peer Review System, 1971 to 1973.

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Mechanisms for Assuring Quality of U.S. Medical Care Services: Past, Present, and Future

Reviews public- and private-sector programs for assessing and assuring the quality of medical care services, and analyzes their potential effectiveness.

Report

Quality assurance and cost control in ambulatory care

Examines the interrelationship and tradeoff between quality assurance and cost control in ambulatory care. The author highlights the policy questions that must be addressed in deciding how to improve health and what levels of resource commitment are...

Report

A Study of the Reliability, Validity, and Precision of Scales to Measure Chronic Functional Limitations Due to Poor Health

Results of psychometric studies of 14 questionnaire items used to define limitations due to poor health are reported.

Journal Article

Effect of Medical Care Review on the Use of Injections: A Study of the New Mexico Experimental Medical Care Review Organization

Evaluation of peer review activities in the New Mexico Medicaid program (1971 to 1973) showed that it can affect aspects of quality.

Report

Foreign Medical Graduates and Their Effects on the Quality of Medical Care in the United States

The literature on quality of care delivered by foreign medical graduates (FMGs) substantiated the existence of differences between U.S. medical graduates (USMGs) and FMGs, especially in terms of structural (proxy) characteristics.

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The Impact of the New Mexico Experimental Medical Care Review Organization on the Quality of the Use of Injections.

Evaluation of the impact of formal peer review of the New Mexico Medicaid program during its first two years of operation demonstrated that peer review can affect the level of quality of care provided. Use of injections dropped by over 60 percent. ...

Journal Article

Quality Assurance Today and Tomorrow: Forecast for the Future

The authors review here the definition, history, and current findings of quality assessment.

Report

Quality of Medical Care Assessment Using Outcome Measures: Executive Summary

Last in a series of three volumes, this report briefly states the conclusions and recommendations resulting from the study.

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Quality of Medical Care Assessment Using Outcome Measures: An Overview of the Method

This report reviews the current state of the art of assessing the quality of medical care using the outcome method and describes in detail the approach taken during this year-long RAND research project.

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Quality of Medical Care Assessment Using Outcome Measures: Eight Disease-Specific Applications

Eight separate technical papers on eight conditions and procedures: asthma in children and adults; breast mass and breast cancer; cholecystectomy; diarrhea and dehydration in children; ischemic heart disease; osteoarthrosis;...

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Evaluating Quality of Health Care for the Disadvantaged: A Literature Review

The current literature on the assessment of quality of health care is reviewed in terms of health care for the American public in general and for the disadvantaged populations in particular.

Report

Policy Issues in Quality Assurance.

A discussion of fundamental issues pertinent to investigations of the assessment or assurance of the quality of medical care, with the goal of fostering interdisciplinary work in this area. The first fundamental issue is the relative efficacy and/or...

Report

Quality Assurance in the 20th Century: Will It Lead to Improved Health in the 21st?

Reviews ongoing developments in measurement of the quality of medical care and efforts to assure the quality of medical care services in the United States. It recommends several topics in need of continued research to solve problems in measurement o...

Report

The Relationship Between Medical Malpractice and Quality of Care

Examines the impact of present and future malpractice systems on the quality of medical care.