Christopher Nelson

Tech Assets Might Help Make Public Health Data More Equity-Centered

The COVID-19 pandemic has amplified broad societal inequities and trained a spotlight on the strengths and weaknesses of the U.S. public health system. What would more equity-centered, tech-engaged public health data look like?

COVID-19 Has Offered Opportunities for Communities to Come Together

The past year has been among the most turbulent in recent memory. Might recent crises provide a catalyst for a renewed sense of civic engagement that transcends some of the race and class divisions COVID-19 has exacerbated?

How Much Do Americans Value Their Health During the Pandemic?

Do Americans believe that limiting the spread of COVID-19 justifies the social and economic costs of physical-distancing measures? Researchers conducted a survey to better understand how Americans weigh health against other priorities.

Out of the Ashes: Forging the Post-Pandemic U.S. Health System

With shifting insights, new problems, and exacerbation of old problems revealed by the pandemic, innovative solutions in the U.S. health system are being adopted where rapid change would normally have been rare. There is both an opportunity and a responsibility to assess how these changes are working and where they can improve health, reduce inequity, and save money.

Needed: A Blueprint for a Post-Vaccine World

When a COVID-19 vaccine is developed, many in rich countries may be able to afford it while the poor and uninsured may not. The time to plan for equitable access, financing, intellectual property rights, and global production is now.

Don't Waste This Crisis: How America Can Begin Building a System of Health

COVID-19 is shining a harsh spotlight on long-recognized but under-addressed gaps in the U.S. health system. There may never have been a more pressing time to think differently, broadening from health care services to a health-producing System of Health.

Implement Critical Care Surge Strategies Now to Save Lives

As COVID-19 continues to spread, hospitals are bracing for a surge of patients requiring critical care. To meet the demand, U.S. health care facilities may need to fundamentally change the way they allocate space, staff, and equipment.

COVID-19: A Stress Test for a U.S. Health Care System Already Under Stress

There are many things hospitals and health systems could be doing in the coming weeks to best prepare for the advancing novel coronavirus (COVID-19) outbreak. Evaluating their surge response plans will be critical.

Rx Civic Engagement: Keeping the Public Engaged in Public Health

Civic engagement—activities like voting and volunteering—is essential for the health of democracy. A turn at the ballot box might also improve physical and mental health.

After School Shootings, Children and Communities Struggle to Heal

School shootings leave wounds that affect students, school staff, families, and communities for years. Building community resilience, implementing evidence-based mental health support early, and providing access for survivors and the community immediately and in the long term could help promote healing and prevent more tragedy.

Lessons for First Responders on the Front Lines of Terrorism

Given the persistent risk of terrorist attacks, it is critical to learn from past incidents to prepare for future ones. Medical and nonmedical first responders need more training in basic lifesaving skills. Open communication lines such as a dedicated radio frequency could help responders better coordinate. Disaster drills are also essential.

Saving Lives After Tragedy

Natural and man-made mass-casualty incidents are a growing threat. Evaluating successes and shortcomings after each crisis can contribute to the design and implementation of robust and resilient response systems and ensure the best possible outcomes for individuals and impacted communities.

Navigating Research on Alternative Schools

Published commentary by RAND staff.

Journal Article

Has COVID-19 Changed How People Think About the Drivers of Health? If So, Does It Matter?

We assessed changes in health mindset associated with the COVID pandemic and found that respondents were more likely in 2021 than in 2018 to recognize social determinants of health. This is associated with greater openness to pandemic-control measures.

Journal Article

Equity as a Guiding Principle for the Public Health Data System

This article examines what it means to use equity as a guiding principle throughout the components and functions of a modern public health data system.

Journal Article

The Issues of Interoperability and Data Connectedness for Public Health

The article summarizes some of the challenges around data sharing and reuse and identifies where the technology and data sectors can contribute to fill current gaps to promote interoperability and data stewardship.

Journal Article

Technology and Data Implications for the Public Health Workforce

The article identifies where the technology and data sectors can contribute skills, expertise, and assets in support of innovative workforce models and augment the development of public health workforce competencies.

Journal Article

What Data Should Be Included in a Modern Public Health Data System

The article summarizes what data should be included in the public health data system and identifies where the technology and data sectors can contribute to fill current gaps to measure equity, positive health, and well-being.

Report

Strategies for Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC)

The Enhancing Prehospital Outcomes for Cardiac Arrest study sought to identify best practices to address out-of-hospital cardiac arrest events. RAND researchers developed 49 strategies covering all levels of prehospital response.

Journal Article

Conceptual Framework for Understanding Incident Management Systems During Public Health Emergencies

We present a conceptual framework of incident management drawn from expert feedback, and a review of literature on incident management and related fields.

Report

COVID-19 and the Experiences of Populations at Greater Risk: Description and Top-Line Summary Data — Wave 4, Fall 2021

This report summarizes descriptive findings from the last of four waves of a survey on how Americans' health views and values have been affected by the COVID-19 pandemic, with a focus on populations deemed vulnerable or underserved.

Journal Article

Transforming Public Health Data Systems: White Papers to Inform Commission

RWJF commissioned RAND to produce a series of white papers that describe the current landscape, emerging innovations, and opportunities for transforming and transitioning to a new public health data system.

Report

COVID-19 and the Experiences of Populations at Greater Risk: Description and Top-Line Summary Data — Wave 3, Winter 2021

This report presents the results of the third of four surveys on how Americans' health views and values have been affected by the COVID-19 pandemic, with a focus on populations deemed vulnerable or underserved.

Journal Article

Americans' View of the Impact of COVID-19: Perspectives on Racial Impacts and Equity

The COVID-19 pandemic has had a disparate effect on African Americans and Latino groups. But it is unknown how aware the public is of these differences, and how the pandemic has changed perceptions of equity and access to health care.

Testimony

Core Principles of Public Health Emergency Preparedness (PHEP)

Testimony presented before the Florida House of Representatives Pandemics and Public Emergencies Committee on March 16, 2021.

Report

COVID-19 and the Experiences of Populations at Greater Risk: Description and Top-Line Summary Data — Wave 2, Fall 2020

This report presents the results of the second of four surveys on how Americans' health views and values have been affected by the COVID-19 pandemic, with a focus on populations deemed vulnerable or underserved.

Report

COVID-19 and the Experiences of Populations at Greater Risk: Description and Top-Line Summary Data — Wave 1, Summer 2020

This report presents the results of the first of four surveys on how Americans' health views and values have been affected by the COVID-19 pandemic, with a focus on populations deemed vulnerable or underserved.

Report

Health and Social Services in Puerto Rico Before and After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Themes for Recovery

This overview of health and social services in Puerto Rico includes 31 courses of action to better recover from health crises, build a more resilient system to future disasters, and actively promote health and well-being.

Report

The Education Sector in Puerto Rico After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Themes for Recovery

Presenting a strategic approach to aid Puerto Rico's recovery from Hurricanes Irma and Maria, the report details prestorm conditions, assesses damage and recovery needs, and describes courses of action for the Education sector.

Journal Article

Amplifying Stewardship: Characteristics and Trends Stewards Consider When Expanding Equitable Well-Being

This report profiles characteristics of people who are not only impressive stewards, but also are helping to grow the entire field of system stewardship for well-being.

Journal Article

Factors Related to Health Civic Engagement: Results from the 2018 National Survey of Health Attitudes to Understand Progress Towards a Culture of Health

Health civic engagement may help improve conditions that influence health and well-being for all. Focusing on individuals' sense of community and highlighting investments in community health may be associated with increased health civic engagement and improved community and population health.

Research Brief

Critical Care Surge Capacity in U.S. Hospitals: Strategies for Responding to the COVID-19 Pandemic

In this brief, the authors present methods for creating critical care surge capacity in hospitals in response to the COVID-19 pandemic and estimate patient capacity, given the number of doctors, nurses, respiratory therapists, ventilators, and beds.

Report

Critical Care Surge Response Strategies for the 2020 COVID-19 Outbreak in the United States

In this report, the authors present strategies for creating critical care surge capacity in hospitals and estimate patient capacity, given the number of available critical care doctors and nurses, respiratory therapists, ventilators, and beds.

Tool

RAND Critical Care Surge Response Tool: An Excel-Based Model for Helping Hospitals Respond to the COVID-19 Crisis

A Microsoft Excel-based tool that allows decisionmakers at all levels -- hospitals, health care systems, states, regions -- responding to the COVID-19 crisis to estimate current critical care capacity and rapidly explore strategies for increasing it.

Report

Does the United States Need to Strengthen the System of Care for Infectious Diseases?

RAND researchers consider responses to prior infectious disease outbreaks, identify options that could strengthen the current system of care for rare but serious infectious diseases, and discuss key financial considerations for sustainability.

Report

Examining Civic Engagement Links to Health: Findings from the Literature and Implications for a Culture of Health

This report summarizes a structured review to understand what the current scientific literature indicates about whether health is a cause of civic engagement, a consequence of it, or both.

Report

Updating the Costs of Compliance for California's Hospital Seismic Safety Standards

California Senate Bill 1953 requires structural and nonstructural upgrades to hospital buildings to enhance resilience to seismic events. This report estimates the costs to hospitals of compliance, with a focus on the 2030 deadline.

Report

Supporting the Development of a Vision and Strategic Plan for Zhejiang University's Academic Medical Center (为浙江大学学术型医学中心制定愿景与战略规划): Chinese Translation (simplified characters)

This is a Chinese translation of a report that identifies and assesses potential models of organization to help achieve the goals of Zhejiang University's academic medical center.

Report

Supporting the Development of a Vision and Strategic Plan for Zhejiang University's Academic Medical Center

This report identifies and assesses potential models of organization to help achieve the goals of Zhejiang University's academic medical center.

Report

Understanding the Economic Benefit Associated with Research and Services at the National Institute for Occupational Safety and Health: An Approach and Three Case Studies

The National Institute for Occupational Safety and Health (NIOSH) asked the RAND Corporation to develop an approach for estimating the economic benefit of NIOSH research, using three case studies. A new report details findings and recommendations.

Journal Article

Can Measures Change the World?

The purpose of this article is to start a dialogue about how one can better use measurement to promote large-scale system change.

Journal Article

Assessing and Improving Hospital Mass-Casualty Preparedness: A No-Notice Exercise

An exercise developed for hospitals helps them assess and improve their readiness for mass casualty incidents.

Journal Article

Governing Academic Medical Center Systems: Choosing Among Alternative Governance Approaches

This assessment of governance approaches for academic medical centers (AMCs) helped the University of California respond to changes in the funding environment and provides a systematic way for any AMC to weigh the strengths and weaknesses of its governance approaches..

Report

Process and Outcome Evaluation of the Alternative and Renewable Fuel and Vehicle Technology Program

Presents the results of a process and outcome evaluation of the California Energy Commission's Alternative and Renewable Fuel and Vehicle Technology Program, relying on quantitative and qualitative methods.

Journal Article

Creating Healthier, More Equitable Communities by Improving Governance and Policy

Political and governance considerations should play a central role in the national conversation about improving health and health equity.

Journal Article

Using Insights from Behavioral Economics to Strengthen Disaster Preparedness and Response

Behavioral economics has achieved positive results in decision-making contexts similar to those surrounding disaster preparedness and response, and therefore the low cost and potentially high impact of behavioral economics-based interventions warrant further investigation.

Report

Building a National Culture of Health: Background, Action Framework, Measures, and Next Steps

In 2013, the Robert Wood Johnson Foundation (RWJF) began its Culture of Health initiative. To implement the primary Culture of Health outcome of improved population health, well-being, and equity, RWJF worked with RAND to develop an action framework.

Journal Article

Wearing Many Hats: Lessons About Emergency Preparedness and Routine Public Health from the H1N1 Response

Describes some of the challenges the Los Angeles County Department of Public Health (LACDPH) faced during the pH1N1 response associated with simultaneous operation of emergency and routine operations.

Journal Article

Lessons About the State and Local Public Health System Response to 2009 H1N1 Pandemic: A Workshop Summary

The response to the 2009 H1N1 influenza pandemic provides an opportunity to learn about the public health system's emergency response capabilities and to identify ways to improve preparedness for future events.

Journal Article

Learning About After Action Reporting from the 2009 H1N1 Pandemic: A Workshop Summary

The after action report/improvement plan (AAR/IP) can be useful for both accountability and quality improvement, but these objectives require different foci and methodological approaches.

Report

CMS Innovation Center Health Care Innovation Awards: Evaluation Plan

The Center for Medicare and Medicaid Innovation has funded 108 projects implementing new service delivery or payment models intended to deliver lower cost through improving quality of care. This report describes a strategy for evaluating the results.

Journal Article

Building Performance-Based Accountability with Limited Empirical Evidence: Performance Measurement for Public Health Preparedness

Efforts to respond to performance-based accountability mandates for public health emergency preparedness have been hindered by a weak evidence base linking preparedness activities with response outcomes.

Report

Analysis of the Cities Readiness Initiative

Examines (1) the status of communities' capability to deliver medical countermeasures within 48 hours of a federal decision to deploy assets and (2) whether the Cities Readiness Initiative has improved communities' capability to meet that goal.

Journal Article

Assessing Relationships Between State and Local Public Health Organizations: Evidence from the NACCHO 2008 Profile of Local Health Departments

Public health systems vary by degree of centralization, reflecting the distribution of authority, responsibility, and effort between state and local public health agencies.

Journal Article

Developing and Pilot Testing a Laboratory Specific Continuity of Operations Tabletop Exercise

Describes the importance of a Continuity of Operations Plan (COOP), and identifies common strengths and potential vulnerabilities of laboratoy-specific COOPs.

Journal Article

Developing National Standards for Public Health Emergency Preparedness with a Limited Evidence Base

National performance standards for public health preparedness can be developed based on existing evidence, but would be helped immensely by a stronger evidence base.

Research Brief

Are Performance-Based Accountability Systems Effective? Evidence from Five Sectors

Effective performance-based accountability systems (PBAS) require careful attention to selecting an appropriate design for the PBAS, given the context in which it is to operate, and to monitor, evaluate, and adjust the system, as appropriate.

Report

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services — Executive Summary

Performance-based accountability systems (PBASs) link incentives to measured performance to improve public services. This report explores PBAS design and effectiveness in child care, education, health care, emergency preparedness, and transportation.

Report

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services

Performance-based accountability systems (PBASs) link incentives to measured performance to improve services to the public. This book discusses PBASs' effectiveness in child care, education, health care, emergency preparedness, and transportation.

Report

An Assessment of the U.S. Environmental Protection Agency's National Environmental Performance Track Program

The National Environmental Performance Track program sought to encourage facilities to improve their environmental performance. The U.S. Environmental Protection Agency should continue to find ways to enhance traditional regulatory approaches.

Journal Article

Federal Initiative Increases Community Preparedness for Public Health Emergencies

This article describes an evaluation of the Cities Readiness Initiative, a federal program to improve communities' ability to dispense medications rapidly during emergencies.

Journal Article

The Pennsylvania Certified Safety Committee Program: An Evaluation of Participation and Effects on Work Injury Rates

Since 1994, Pennsylvania, has provided a 5% discount on workers' compensation premiums for firms with a certified joint labor-management safety committee. This study found that injury rates at participating firms with good compliance records dropped more than at other firms.

Draft

Decision-Making Modules for the RSS-POD Supply Management Game: A Game-Based Assessment of Crisis Decision Making During Inventory Management and Distribution of Medical Countermeasures

Introduces and explains two new modules for the RSS-POD Supply Chain Management Game, an Excel-based computer simulation game designed to provide practice in managing inventories of medical countermeasures during a largescale public health emergency.

Draft

The RSS-POD Supply Chain Management Game: An Exercise for Improving the Inventory Management and Distribution of Medical Countermeasures

Introduces and explains the RSS-POD Supply Chain Management Game, a Microsoft Excel-based simulation game designed to provide practice in managing inventory of medical countermeasures during large-scale public health emergency.

Report

New Tools for Assessing State and Local Capabilities for Countermeasure Delivery

Presents assessments that test five critical elements of state and local health departments' capability to deliver countermeasures to the population under rapid timeframes.

Report

Measuring Crisis Decision Making for Public Health Emergencies

Describes a tool for assessing key features of good crisis decision making that focuses on the processes of decision making -- situational awareness, action planning, and process control -- and can be used for exploratory analysis and process improvement.

Report

A National Agenda for Public Health Systems Research on Emergency Preparedness

The Office of the Assistant Secretary for Preparedness and Response asked RAND to facilitate the development of a public health systems research agenda for emergency preparedness with a focus on both short- and long-term priorities.

Draft

A Workshop Template to Assess and Improve SNS Planning

Contains a template that public health agencies can use to conduct a workshop to improve key aspects of Strategic National Stockpile planning: pediatric dispensing, altered standards of care, and allocation of scarce resources.

Research Brief

Are Communities Ready to Conduct Rapid and Large-Scale Dispensing of Medications During a Public Health Emergency?

This research highlight summarizes the findings of RAND's initial evaluation of the Cities Readiness Initiative and the program's impact on communities' readiness to conduct mass dispensing of medications and other medical supplies.

Report

Initial Evaluation of the Cities Readiness Initiative

The Centers for Disease Control and Prevention asked RAND to provide an initial evaluation of the impact of the Cities Readiness Initiative on awardees' readiness and capability to conduct mass countermeasure dispensing.

Report

Foundation for Integrating Employee Health Activities for Active Duty Personnel in the Department of Defense

Describes current Department of Defense (DoD) safety and occupational health programs and health information systems, and employee health programs outside of DoD as a foundation for considering a more integrated DoD employee health program.

Research Brief

A Step Forward in Accountability for Public Health Emergency Preparedness: Developing Standards for Mass Antibiotic Dispensing

This fact sheet summarizes the results of a RAND initiative to develop performance standards for distributing antibiotics and other lifesaving medical countermeasures on a large scale within the critical first 48 hours of a public health emergency.

Report

Recommended Infrastructure Standards for Mass Antibiotic Dispensing

This report presents recommended standards for points of dispensing (or PODs), locations where the public would receive life-saving antibiotics or other medical countermeasures during a large-scale public health emergency.

Draft

The Pennsylvania Certified Safety Committee Program: An Evaluation of Participation and Effects on Work Injury Rates

This evaluation of the voluntary Pennsylvania Certified Safety Committee program found that although compliance did reduce injuries, most participants did not comply and injury rates did not decline more at participating firms.

Draft

Conceptualizing and Defining Public Health Emergency Preparedness

Discusses an effort to develop a clear and widely applicable definition of public health emergency preparedness (PHEP) that can provide a basis on which to develop PHEP standards and measures.

Journal Article

How Can We Strengthen the Evidence Base in Public Health Preparedness?

In this article, the authors argue that initial funding priorities for public health systems research on preparedness should focus on using engineering-style methods to identify core preparedness processes, developing novel data sources and measures based on smaller-scale proxy events, and developing performance improvement approaches to support the translation of research into practice within the wide variety of public health systems found in the nation.

Research Brief

Promoting Accountability in Public Health Emergency Preparedness

This research brief summarizes research that has identified the advantages and disadvantages of some approaches used to measure public health preparedness and suggested avenues for developing new preparedness tools.

Journal Article

Assessing Public Health Emergency Preparedness: Concepts, Tools, and Challenges

Have government investments in public health preparedness left the public health system prepared to respond to large-scale public health emergencies?

Journal Article

Quality Improvement in Public Health Emergency Preparedness

Quality improvement (QI) methods have been used in many industries to improve performance and outcomes.

Journal Article

Conceptualizing and Defining Public Health Emergency Preparedness

A substantial federal investment has been made to increase our nation's ability to prepare for, and respond to, public health emergencies.

Research Brief

Emergency Preparedness Is Stimulating Changes in Public Health Practice

This fact sheet summarizes interrelated RAND projects to examine public health infrastructure and how public health preparedness is transforming public health agencies.

Research Brief

Quality Improvement Methods Can Be Used to Improve Public Health Emergency Preparedness

This fact sheet summarizes a RAND study to show how quality improvement methods can be used to improve the emergency preparedness of the U.S. public health system.

Report

Organizing State and Local Health Departments for Public Health Preparedness

Assesses whether there is a link between how state and local public health departments are organized and their level of emergency preparedness.

Research Brief

Are Small Businesses Riskier Than Larger Ones?

This research brief summarizes research that provides a more complete picture of fatality risks found at both smaller establishments and smaller firms, to help inform effective policies toward small businesses.

Report

Small Businesses and Workplace Fatality Risk: An Exploratory Analysis

Analyzes the relationship between fatality rate and business size, both in terms of establishment and firm size, from 1992 to 2001.

Report

Quality Improvement: Implications for Public Health Preparedness

Develops a framework for applying quality improvement (QI) in public health; investigates the applicability of those models to public health emergency preparedness.

Research Brief

Disparities in Care for HIV Patients: Results of the HCSUS Study

This research brief summarizes the findings on access to care from the HIV Costs and Services Utilization Study (HCSUS), the first comprehensive U.S. survey of health care use among a nationally representative sample of HIV-positive patients.

Journal Article

Public Health Preparedness: Evolution or Revolution?

This paper describes how public health preparedness is transforming public health agencies.

Report

Evaluation of a Patient Safety Training Program

Evaluates a pilot fellowship program on patient safety concepts that addresses the issue of deaths from preventable medical errors.

Report

Assessment of 24-Hour Care Options for California

Assesses the value of 24-hour care--an insurance plan that consolidates employers' health care benefits for work-related and non-work-related claims--as a mechanism for reducing workers' compensation costs.