Teague Ruder

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Alcohol and Substance Use Among U.S. Veterans

Nearly one-quarter of all veterans report binge drinking within the past month. Veterans who served after 9/11 have higher rates of all substance use behaviors, including alcohol and drug use disorders, than those who served exclusively before 9/11.

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Prevalence of Past-Year Serious Psychological Distress Among U.S. Veterans

Certain subgroups of veterans — including female veterans, veterans aged 18–34, multiracial veterans, and bisexual veterans — experienced past-year serious psychological distress at rates significantly higher than the overall veteran population.

Report

A Summary of Veteran-Related Statistics

Researchers summarize estimates and trends related to U.S. veterans' demographics, mental health, and labor market outcomes, based on analysis of public nationally representative datasets.

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Trends in U.S. Veteran Demographics

Veterans who served after the September 11, 2001, terrorist attacks are younger, more diverse in terms of sex and race/ethnicity, and more educated than earlier cohorts of veterans. The overall number of U.S. veterans has been steadily declining.

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U.S. Veteran Labor Market Trends

Veterans, regardless of race/ethnicity, have lower unemployment rates than nonveterans and are more likely to work in the public sector. The top industries for veteran employment are public administration and manufacturing.

Research Brief

Reducing Policy Barriers to SNAP Participation by Food-Insecure Veterans

Food-insecure veterans are consistently less likely than their nonveteran peers to be enrolled in the Supplemental Nutrition Assistance Program (SNAP), but there are opportunities to improve policies and boost veterans’ program participation.

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Food Insecurity Among Veterans: Examining the Discrepancy Between Veteran Food Insecurity and Use of the Supplemental Nutrition Assistance Program (SNAP)

Food-insecure veterans are consistently less likely than their nonveteran peers to be enrolled in SNAP, and two groups are particularly at risk of falling through the cracks in SNAP access: older veterans and disabled veterans.

Report

Virtual Behavioral Health for Army Soldiers: Soldier Perspectives and Patterns of Treatment

The authors examined trends in the use of virtual behavioral health (VBH) care for U.S. Army soldiers and their spouses from prior to the onset of the COVID-19 pandemic through March 2022 and surveyed soldiers about their perceptions of VBH care.

Research Brief

Delivering Exceptional Pain Care to Service Members

The Military Health System provides high-quality care to its service members with pain conditions, offering opioids and nonpharmacologic treatment in a manner largely consistent with recommended guidance. However, there opportunities for improvement.

Report

Behavioral Health Care Delivery Following the Onset of the COVID-19 Pandemic: Utilization, Telehealth, and Quality of Care for Service Members with PTSD, Depression, or Substance Use Disorder

This report examines changes in behavioral health care delivered to service members by the Military Health System following the onset of the COVID-19 pandemic, including patterns of care, use of telehealth, and quality of care.

Report

A Needs Assessment of Women Veterans in Western Pennsylvania: Final Report to Adagio Health

To identify opportunities to expand and enhance Adagio Health's efforts to support women veterans' health and wellness, the authors quantitatively and qualitatively assessed the needs of women veterans in the Adagio Health service area.

Research Brief

Opportunities to Improve Support for Western Pennsylvania's Women Veterans

An assessment of the needs of women veterans provides a clearer picture of this often-underserved population, available programs and resources, gaps in support, barriers to access, and opportunities to better meet the needs of women who served.

Report

An Evaluation of a Multisite, Health Systems–Based Direct Care Worker Retention Program: Key Findings and Recommendations

A mixed-methods evaluation of a program to help stem the loss of newly hired entry-level caregivers found no positive effect on retention or financial sustainability.

Research Brief

Helping Caregivers Thrive? An Evaluation of a Direct Care Worker Retention Program

The 12-month program, Transformational Healthcare Readiness through Innovative Vocational Education, took a multipronged approach to addressing employment barriers for entry-level health care workers across three health systems from 2019 to 2021.

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Assessing the Quality of Outpatient Pain Care and Opioid Prescribing in the Military Health System

Pain conditions are the leading cause of disability among active-duty service members. RAND conducted a comprehensive assessment of outpatient care for acute and chronic pain, including opioid prescribing, delivered by the Military Health System.

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New York State 1115 Demonstration Independent Evaluation: Interim Report

This report examines whether two components of New York State's Medicaid Section 1115 Waiver—the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy—have achieved their goals.

Report

Practice Expense Data Collection and Methodology: Phase II Final Report

In this report, the authors address how the Centers for Medicare & Medicaid Services might improve the methodology used in practice expense (PE) rate-setting, update data that inform PE rates, or both.

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Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2018 Data

The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in 2018 and paid for by Medicare. This report follows an earlier report that summarized these patterns from July 1, 2017, through June 30, 2018.

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Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in calendar year 2019 and paid for by Medicare. This report follows two earlier reports that summarized these patterns for earlier periods.

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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data

This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.

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Behavioral Health Care for National Guard and Reserve Service Members from the Military Health System

There are differences in Military Health System behavioral health care access and quality between reserve- and active-component personnel and between reserve-component personnel who live far from military treatment facilities and those who do not.

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Assessing Health and Human Services Needs to Support an Integrated Health in All Policies Plan for Prince George's County, Maryland

This report describes a health and human services needs assessment of Prince George's County, Maryland. Findings from this report can inform Prince George's County's pursuit of a Health in All Policies approach to policymaking.

Research Brief

Post 9/11 Trends in Medical Separation and Separation for Service Members with Posttraumatic Stress Disorder and Traumatic Brain Injury

Trends in military medical discharges and disability ratings can help the U.S. Department of Defense set goals for diagnosing, treating, and evaluating service members with posttraumatic stress disorder or traumatic brain injury.

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Trends in Department of Defense Disability Evaluation System Ratings and Awards for Posttraumatic Stress Disorder and Traumatic Brain Injury, 2002–2017

The authors conduct an empirical analysis of trends in diagnosis, treatment, and disability evaluation for posttraumatic stress disorder and traumatic brain injury among military service members between 2002 and 2017.

Research Brief

Improving Behavioral Health Care for Remote Service Members: Three Key Priorities

Service members who are geographically remote from a military treatment facility may face unique challenges accessing high-quality behavioral health care. RAND research identified three key priority areas for the U.S. Department of Defense.

Report

Behavioral Health Care in the Military Health System: Access and Quality for Remote Service Members

The authors evaluated access and quality of behavioral health care provided to service members who reside remotely from a military treatment facility and compared their care with that received by non-remote personnel.

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Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report

The authors of this report summarize patterns of post-operative visits where Medicare bundles payment for post-operative care into payment for surgical procedures. The results suggest fewer visits occur than Medicare assumes in its payment rates.

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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods

This report describes how CMS could use new claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.

Journal Article

Section 1332 Waiver Evaluation Report: Evaluating the Minnesota Reinsurance Program

This report documents findings from the evaluation of Minnesota's waiver, through which the state implemented the Minnesota Premium Security Plan.

Journal Article

Section 1332 Waiver Evaluation Report: Evaluating the Oregon Reinsurance Program

This report documents findings from the evaluation of Oregon's waiver, through which the state implemented the Oregon Reinsurance Program (ORP).

Journal Article

Section 1332 Waiver Evaluation Report: Evaluating the Alaska Reinsurance Program

This report documents findings from the evaluation of Alaska's waiver, through which the state implemented the Alaska Reinsurance Program (ARP).

Journal Article

Trends In Home Care Versus Nursing Home Workforce Sizes: Are States Converging Or Diverging Over Time?

Since 2009, most states have increased the size of their home care workforces and decreased the size of their nursing home workforces, but there is substantial variation across states. More targeted efforts may be needed to ensure that people with disabling conditions can have their needs met in their desired setting across the nation.

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Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report

In this report, the authors address how the Centers for Medicare and Medicaid Services can improve the methodology or update data used for setting practice expense payment rates under the Medicare Physician Fee Schedule.

Journal Article

Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries

To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.

Report

Using the Person-Event Data Environment for Military Personnel Research in the Department of Defense: An Evaluation of Capability and Potential Uses

Researchers seek to determine whether RAND's federally funded research and development centers can effectively use the Person-Event Data Environment (PDE) to support manpower and personnel research and identify potential improvements to the PDE.

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Practice Expense Methodology and Data Collection Research and Analysis

This report proposes alternative methodologies for determining the practice expense (PE) component of the Medicare Physician Fee Schedule in order to avoid misvalued payment rates. A main concern is the allocation of indirect practice costs.

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The Impact of Health Reform on Purchased Care Access: National Health Reform and Modernization of the Military Health System Study

Newly insured patients through the Affordable Care Act coverage expansion may change how civilian providers interact with the TRICARE program. Some physicians may face financial incentives to drop TRICARE patients for newly insured patients.

Journal Article

Sex Differences in Recent First-Onset Depression in an Epidemiological Sample of Adolescents

Sex differences in the incidence of depression originate during childhood and increase during adolescence.

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Multiple Chronic Conditions in the United States

This chartbook updates previous versions with more recent data on the prevalence of multiple chronic conditions (2008-2014) and associated health care utilization and spending.

Journal Article

Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients

Researchers found little difference in the quality of nursing home care provided to Medicare enrollees in managed care and those enrolled in traditional fee-for-service nursing homes.

Research Brief

Characteristics and Treatment Patterns of Service Members with Mild Traumatic Brain Injury

This research brief describes the first comprehensive study of care for mild traumatic brain injury, or concussion, in the Military Health System, including patient characteristics, care settings, co-occurring conditions, and long-term care needs.

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Understanding Treatment of Mild Traumatic Brain Injury in the Military Health System

This first population-based study of care received by service members with mild traumatic brain injury in the Military Health System profiles patients, their care settings and treatments, co-occurring conditions, and risk factors for long-term care.

Journal Article

Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records

Anesthesia and operating room (OR) times can be used to estimate surgical time, thereby improving the payment for surgical procedures in the Medicare fee schedule.

Report

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

The Department of Veterans Affairs health care system, with broad resources and capabilities, provides timely and high-quality care to most, but not all, patients. Meeting veterans' needs over the next five years will require additional capacity.

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Development of a Model for the Validation of Work Relative Value Units for the Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) uses the resource-based relative value scale to pay physicians and other practitioners for services. CMS asked RAND to develop a model to validate physician work values using external data sources.

Research Brief

RAND Modeling Offers Support for Transparent and Consistent CMS Physician Fee Schedules

The current process used by the Centers for Medicare & Medicaid Services for valuing physician work is based on physician survey responses. RAND researchers examined the feasibility of developing a model based instead on external data sources.

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Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S.

Geospatial and longitudinal analyses helped determine how many military service members and dependents are geographically distant from behavioral health care and the resulting effect on use of care.

Research Brief

Far from Care: Increasing Access to Behavioral Health Care for Remote Service Members and Their Families

RAND researchers sought to identify how many U.S. military service members and their dependents are remote from behavioral health care and the effects of this distance on their access to and use of care.

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Improving Access to Behavioral Health Care for Remote Service Members and Their Families

Geospatial and longitudinal analyses helped determine how many military service members and dependents are geographically distant from behavioral health care and the resulting effect on use of care.

Journal Article

Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications

In the more than 1500 counties studied, fewer than 25% of children prescribed ADHD drugs received talk therapy in the same year they received medication. The percentage of children who received both drugs and therapy varied across counties and did not always reflect the number of available psychologists.

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2013 Interactive Community Health Needs Assessment

This interactive web tool draws attention to specific findings in the community health needs assessment in a format that is user friendly and can help to inform the public.

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District of Columbia Community Health Needs Assessment

Analyzes existing demographic, health status, and hospital service use data for the District of Columbia, as well as current stakeholder perspectives, health policy, and investment priorities.

Journal Article

Impact of Socioeconomic Adjustment on Physicians' Relative Cost of Care

Ongoing efforts to profile physicians on their relative cost of care have been criticized because they do not account for differences in patients' socioeconomic status (SES).

Report

Monitoring Cancer Outcomes Across the Continuum: Data Synthesis and Analysis for the District of Columbia

This report synthesizes and analyzes available data regarding cancer-related outcomes among District of Columbia residents, highlighting key findings and data gaps across the continuum of cancer prevention, treatment, and outcomes.

Journal Article

A New Estimate of the Impact of OSHA Inspections on Manufacturing Injury Rates, 1998-2005

A prior study indicated that the effect of OSHA inspections on lost workday injuries had declined from 1979 through 1998. This study provides an updated estimate for 1998–2005.

Journal Article

Mixed-method Approach to Understanding the Experiences of Non-Deployed Military Caregivers

Caregivers affiliated with the National Guard and those with more months of deployment report significantly poorer emotional well-being, and more household and relationship hassles.

Report

Patient Incentives to Motivate Doctor Visits and Reduce Hypertension Disparities

Examines whether small financial incentives for patients can motivate physician visits and reduce racial/ethnic disparities in hypertension.

Report

Policy Options for Addressing Medicare Payment Differentials Across Ambulatory Settings

Building on prior RAND analyses, this report presents options for modifying Medicare payment policies to improve the value of services and to address payment differentials for similar services provided in various ambulatory settings.

Research Brief

Views from the Homefront: How Military Youth and Spouses Are Coping with Deployment

Reports the results of a longitudinal study of youth from military families and their caregivers concerning their emotional well-being and how well they are coping with servicemembers' extended deployments.

Report

Views from the Homefront: The Experiences of Youth and Spouses from Military Families

Examines the behavioral and emotional well-being of a sample of military families over a year as they cope with the stress of war and deployment, using surveys and in-depth interviews with youth and their nondeployed caregivers.

Journal Article

PartyIntents: A Portal Survey to Assess Gay and Bisexual Men's Risk Behaviors at Weekend Parties

Portal survey methods can be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party–oriented vacation.

Journal Article

Children on the Homefront: The Experience of Children from Military Families

Although studies have begun to explore the impact of the current wars on child well-being, none have examined how children are doing across social, emotional, and academic domains.

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Estimating and Mapping Health Literacy in the State of Missouri

Using predictive models and information about the demographic makeup of census areas, this paper generates estimates of health literacy for each geographic area and maps the results to identify 'hot spots' of low health literacy across Missouri.

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.

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Behavioral Health in the District of Columbia: Assessing Need and Evaluating the Public System of Care

Research Brief

Children's Health in Washington, D.C. Access and Health Challenges Despite High Insurance Coverage Rates

Assesses children's health issues in Washington, D.C., including the health care delivery system and neighborhood health environments.

Report

Health and Health Care Among District of Columbia Youth

Assesses health and health care use among youth in Washington, D.C., using a unique combination of survey, administrative, and focus group data, and offers recommendations for addressing District children's health needs.

Report

Serving the Underserved: A Mid-Course Evaluation of Montgomery Cares

A summary of the 2008 findings from a planned five-year evaluation (2006-2011) of the Montgomery Cares initiative, a Montgomery County, Maryland-funded program designed to provide basic health care to low-income, adult, uninsured county residents.

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Assessing Health and Health Care in Prince George's County

Assesses the health care needs of the residents of Prince George's County, Maryland, and the capacity of the county's health care system to meet those needs.

Report

Ambulatory Care Sensitive Hospitalizations and Emergency Department Visits in Baltimore City

Provides an in-depth analysis of ambulatory care sensitive inpatient hospitalizations and emergency department visits among Baltimore City residents.

Report

Cellulitis-Associated Hospitalizations in Baltimore City

Describes hospitalizations associated with cellulitis, a skin infection frequently linked to methicillin-resistant staphylococcus aureus, in Baltimore City.

Journal Article

Developing Predictive Models of Health Literacy

The authors developed two models to estimate health literacy.

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A Baseline Assessment of the District of Columbia School Health Nursing Program

Describes findings from a baseline assessment of the District of Columbia School Health Nurse Program.

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What Kinds of Injuries Do OSHA Inspections Prevent?

This study finds that OSHA inspections reduce both injuries that are related to OSHA standards and those that are not. Citations of the general personal protection equipment standard are most likely to be followed by reductions in injuries.

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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

Assessing Health and Health Care in the District of Columbia: Phase 2 Report

Provides recommendations for improving the health care delivery system in the District of Columbia.

Draft

Assessing Health and Health Care in the District of Columbia

Study of health and the health care delivery system, including an assessment of emergency medical services, in the District of Columbia.