Publications on Health Care Organization and Capacity

RAND Health Care research on the organization and capacity of the health care system takes a broad perspective. Our work has examined how organization affects the system’s ability to provide high-quality care and to use resources efficiently and effectively. Many studies have focused on the link between health system organization and the ability of the public health system to respond to public health emergencies, whether natural or the result of hostile action.

2022

• Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California—2021 2022

  Ryan K. McBain, Jonathan H. Cantor, Nicole K. Eberhart, Shreya S. Huilgol, Ingrid Estrada-Darley

  This report presents an evaluation of California's psychiatric bed needs in 2021 and the coming years. California, like many states, is confronting a psychiatric bed shortage. To strategically build capacity, the state must understand its psychiatric bed needs. The authors examine California's adult bed capacity, need, and the gap between them at three levels of inpatient and residential care: acute, subacute, and community residential services.

• Appropriateness of Telemedicine Versus In-Person Care: A Qualitative Exploration of Psychiatrists' Decision Making 2022

  Lori Uscher-Pines, Amanda Parks, Jessica L. Sousa, Pushpa Raja, Ateev Mehrotra, Haiden A. Huskamp, Alisa B. Busch

  Psychiatrists perceived that most patients are good candidates for telemedicine visits in the context of hybrid care models.

• Availability and Accessibility of Mental Health Services in New York City 2022

  Joshua Breslau, Dionne Barnes-Proby, Mallika Bhandarkar, Jonathan H. Cantor, Russell Hanson, Aaron Kofner, Rosemary Li, Nipher Malika, Alexandra Mendoza-Graf, Harold Alan Pincus

  Mental health services provide essential supports to people living with psychiatric disorders. However, in the United States as a whole and in New York City in particular, the use of mental health services is low and care is not equitably distributed. To advance policy strategy for addressing gaps in the mental health services system, RAND researchers investigate the availability and accessibility of mental health services in New York City.

• Clinicians' Perceptions of Collaborative Palliative Care Delivery in Chronic Kidney Disease 2022

  Natalie Ernecoff, Lindsay F. Bell, Robert Arnold, Christopher M. Shea, Galen E. Switzer, Manisha Jhamb, Jane O. Schell, Dio Kavalieratos

  In interviews with clinicians, they expressed barriers to delivering chronic kidney disease care. To address barriers, clinicians outlined intervention points, such as building models, and structural triggers to identify patients who may be appropriate for palliative care.

• Content and Actionability of Recommendations to Providers After Shadow Coaching 2022

  Denise D. Quigley, Nabeel Qureshi, Alina I. Palimaru, Chau Pham, Ron D. Hays

  This study aimed to examine the content of the recommendations given to providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability.

• Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic: Results from the Connected Care Accelerator Initiative 2022

  Lori Uscher-Pines, Natasha Arora, Maggie Jones, Abbie Lee, Jessica L. Sousa, Colleen M. McCullough, Sarita Lee, Monique Martineau, Zachary Predmore, Christopher M. Whaley, et al.

  In early 2020, as the COVID-19 pandemic emerged, widespread social-distancing efforts suspended much of the delivery of nonurgent health care. Telehealth proved to be a viable alternative to in-person care, at least on a temporary basis, and utilization skyrocketed. Researchers investigated changes in telehealth utilization and health center staff experiences with implementation.

• The Impact of the COVID-19 Pandemic and Policy Response on Health Care Utilization: Evidence from County-Level Medical Claims and Cellphone Data 2022

  Jonathan H. Cantor, Neeraj Sood, Dena M. Bravata, Megan F. Pera, Christopher M. Whaley

  Shelter-in-place policies during the COVID-19 pandemic were associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries.

• Implementation of South Africa's Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation 2022

  Laura M. Bogart, Zinhle Shazi, Sarah MacCarthy, Alexandra Mendoza-Graf, Nafisa J. Wara, Dani Zionts, Nduduzo Dube, Sabina Govere, Ingrid V. Bassett

  Participants had highly favorable attitudes about the Chronic Care and Medicine Dispensing and Distribution (CCMDD) program for HIV treatment. Patient-level barriers to care included inadequate education about CCMDD and inability to get refills. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid rules, and inadequate infrastructure.

• Incorporating Complementary and Integrative Health Providers in the Public Health Pandemic Response: Lessons from COVID-19 and Recommendations for the Future from a Multidisciplinary Expert Panel 2022

  Ian D. Coulter, Margaret D. Whitley, Raheleh Khorsan, Patricia M. Herman

  Complementary and integrative health providers, such as chiropractors and naturopathic doctors, have been an underutilized public health asset in the response to the COVID-19 pandemic. This report seeks to inform how they can be better integrated into future responses to public health emergencies.

• Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States 2022

  Ryan K. McBain, Jonathan H. Cantor, Aaron Kofner, Bradley D. Stein, Hao Yu

  Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.

• Assessment of Patient Preferences for Telehealth in Post-COVID-19 Pandemic Health Care 2022

  Zachary Predmore, Elizabeth Roth, Joshua Breslau, Shira H. Fischer, Lori Uscher-Pines

  Most adults in this survey study were willing to use video visits for nonemergency care but preferred in-person care, suggesting that patient preferences will help define telehealth's role in US health care after the COVID-19 pandemic.

2021

• 10Plan, How Would It Affect Health Care Spending by Consumers and the Federal Government 2021

  Kandice A. Kapinos, Carter C. Price, Drew M. Anderson, Adrienne M. Propp, Raffaele Vardavas, Christopher M. Whaley

  The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. The authors built a microsimulation model to estimate health care spending under both the status quo and the 10Plan.

• Alignment Between Objective and Subjective Assessments of Health System Performance: Findings From a Mixed-Methods Study 2021

  Dmitry Khodyakov, Christine Buttorff, Lea Xenakis, Cheryl L. Damberg, M. Susan Ridgely

  The article examines whether subjective performance assessments from health system executives match objective performance assessments and qualitatively explores ways to achieve high performance.

• Analysis of the 10Plan: A Self-Pay System Designed to Minimize the Burden of Health Care Costs 2021

  Kandice A. Kapinos, Carter C. Price, Drew M. Anderson, Adrienne M. Propp, Raffaele Vardavas, Christopher M. Whaley

  The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. Individuals would pay no premiums up front, face Medicare rates, pay a copayment for each encounter, and have the option to pay cash for services or borrow from the government at a low interest rate to pay for care. The authors built a microsimulation model to estimate health care spending under the status quo and the 10Plan.

• Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond 2021

  Seema Choksy Pessar, Anne E. Boustead, Yimin Ge, Rosanna Smart, Rosalie Liccardo Pacula

  Researchers summarize the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy during COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication.

• Common Themes in Early State Policy Responses to Substance Use Disorder Treatment During COVID-19 2021

  Barbara Andraka-Christou, Kathryn E. Bouskill, Rebecca Lee Haffajee, Olivia Randall-Kosich, Matthew Golan, Rachel Totaram, Adam J. Gordon, Bradley D. Stein

  States have made significant policy changes to SUD treatment policies during COVID-19, particularly regarding telehealth and facilitation of remote care. Understanding these changes could help policymakers prioritize guidance during the pandemic and for future health crises.

• The Coronavirus Pandemic Highlights Why Family Caregivers Need to Be Integrated into the Health Care Team and Shows Us How to Make It Happen 2021

  Esther M. Friedman, Patricia K. Tong, Robert S. Rudin

  Family caregivers provide a significant portion of health and support services in the United States to individuals with serious illnesses but are often overlooked by existing health care systems. The authors describe why, in light of COVID-19, it is more critical than ever to integrate family caregivers into patients' health care teams and highlight several solutions for accomplishing this goal.

• The Doctor Will See You: Online Physician Transformations During COVID-19 2021

  Jonathan H. Cantor, Christopher M. Whaley

  Examines physicians use of telemedicine during COVID-19 to quantify physician-level substitution between in-person interactions with patients and virtual interactions.

• How to Integrate Pharmacotherapy for Substance Use Disorders at Your Mental Health Clinic: A Step-By-Step Guide for Screening and Treating Adults with Co-Occurring Mental Illness and Alcohol and/or Opioid Use Disorders with Pharmacotherapy in Mental Health Clinics 2021

  Katherine E. Watkins, Allison J. Ober, Sarah B. Hunter, Brian Hurley, John Sheehe, Jeremy Martinez, Elizabeth Bromley, Derjung M. Tarn, Ivan Beas, Alanna Montero, et al.

  Most people with co-occurring substance use and mental health disorders never get the high-quality care they need to recover. To address this issue, RAND researchers created a toolkit to support the delivery of effective, evidence-based pharmacotherapy for clients with co-occurring alcohol and/or opioid use and mental health disorders in mental health clinics.

• How to Transform the U.S. Mental Health System: Evidence-Based Recommendations 2021

  Ryan K. McBain, Nicole K. Eberhart, Joshua Breslau, Lori Frank, M. Audrey Burnam, Vishnupriya Kareddy, Molly M. Simmons

  The United States is at a time of promise for historic transformation in mental health care. This report describes the landscape of mental health in the United States and identifies opportunities for transformative change. The result is an analysis of key problems and the research evidence for solutions, with recommendations to promote change to improve the lives of the millions of Americans living with mental illness.

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