Letter from the editor for the third issue of Volume 9, 2022.
RAND Health Quarterly
RAND Health Quarterly is an online journal that showcases the breadth and depth of RAND's health-related research. Our work spans a wide range of topics each year, including health policy and health economics; health care delivery, quality, and patient safety; clinical care; global health; mental health; health promotion and disease prevention; public health and emergency preparedness; military health; research methods; and science policy.
RAND Health Quarterly also facilitates access to our work for scholars using PubMed to identify top-quality research relevant to their question or interest.
In This Issue: 2022, Vol. 9, No. 3
Consumers of health care in the United States often lack information on the actual prices of the care they receive and can also lack access to information about the quality of their care. RAND researchers gathered information on how health care prices are set, price variation in health care markets, barriers to price and quality transparency for consumers, and the extent to which price and quality information is used in marketing efforts.
Independent Evaluation of the New York State 1115 Waiver Amendment: The Children's Design: Interim Findings
In this interim evaluation of the New York State Medicaid program's Children's Design, the authors identify facilitators of, and barriers to, its implementation, describe and delineate baseline trends in outcomes of interest, and assess the feasibility of identifying comparison groups for analyses that will contribute to a summative evaluation of the program.
MACRA Palliative Care Quality Measure Development—Testing Summary Report: Measure Name: Feeling Heard and Understood
Stakeholders such as palliative care patients and their providers and health systems lack actionable measures to assess performance and guide improvement efforts in palliative care. In this study, the authors describe the results of their national beta field test for a performance measure designed to assess the extent to which patients who used ambulatory palliative care felt heard and understood by their palliative care provider and team.
MACRA Palliative Care Quality Measure Development—Testing Summary Report: Measure Name: Receiving Desired Help for Pain
Stakeholders such as palliative care patients and their providers and health systems lack actionable measures to assess performance and guide improvement efforts in palliative care. In this study, the authors describe the results of their national beta field test for a performance measure designed to assess the extent to which patients who used ambulatory palliative care received the help they wanted for their pain.
New York State's Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. This final interim evaluation examines whether two components of the 1115 Demonstration Waiver—the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy—have helped achieve the program's goals.
This study examined the potential impact in Canada of continued, long-term use of telemedicine. Researchers found that, alongside the benefits from tools such as telemonitoring and digital health records, widespread use of teleconsultations could lead to significant benefits for patients, the economy and wider Canadian society. The findings directly contribute to the evidence base in telemedicine and virtual healthcare more generally.
The authors describe the stakeholders involved in prescription drug supply chains and the flows of products, payments, and information between stakeholders. Many stakeholders and steps are involved in the life cycle of a prescription drug as it moves from chemical synthesis and formulation through dispensing or administration to patients.
In this article, the authors describe the findings and recommendations of a four-year study of the World Trade Center Health Program's research portfolio and its translational impact. The study is intended to guide Program planning by the World Trade Center Health Program leadership as it aims to maximize the impacts of Program research and achieve its goal of translating research into care for those affected by the attacks on 9/11.
The state of Connecticut is considering different policy options to improve health insurance affordability, access, and equity, and policymakers need an accurate picture of the current distributions of insurance enrollment. The authors provide the state with estimates of the distributions in enrollment by age, gender, race, and ethnicity in detailed insurance categories and note the need for better, more-detailed health insurance enrollment data.
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
Medicare payment for many health care procedures covers the procedure itself and most post-operative care during a fixed “global period.” This article describes how the Centers for Medicare & Medicaid Services could use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. These results may inform further policy development around revaluation for global procedures.
Assessing Health and Human Services Needs to Support an Integrated Health in All Policies Plan for Prince George's County, Maryland
With evolving demographics and a changing health system landscape, Prince George's County is considering its future policy approaches and resource allocations related to health and well-being. This study describes a health and human services needs assessment of the county. Recommendations are offered related to (1) creating a Health in All Policies system, (2) aligning investments, and (3) implementing new measurement and data systems.
Using a mixed-methods analysis, the authors identify strategies to boost COVID-19 vaccine acceptance in the United States, grouping them according to three overall goals: boosting confidence in the safety and effectiveness of the COVID-19 vaccines, combating complacency about the pandemic, and increasing the convenience of getting vaccinated. They emphasize that combating misinformation about the COVID-19 vaccine is key to achieving these goals.
Messaging Strategies for Mitigating COVID-19 Through Vaccination and Nonpharmaceutical Interventions
This article addresses the importance of effectively matching the message, the audience, and the sender to encourage people to get a COVID-19 vaccine. It offers suggestions about how to leverage variations between individuals in such factors as risk perception and variation among U.S. subcultures for tendencies to follow rules or act for the collective good. It further discusses how to deal with misinformation.
Posttraumatic stress disorder (PTSD) involves several symptoms, including sleep disturbance. The purpose of this review was to synthesize the evidence from randomized controlled trials on the effects that interventions for adults with PTSD have on sleep outcomes. The authors found that interventions reported positive effects on sleep, in particular interventions targeting sleep.
Behavioral health (BH) problems are common in the military. Research suggests that primary care–behavioral health (PCBH) integration can improve BH outcomes. The authors conducted a process evaluation of the PCBH program in the military health system to understand program implementation and inform quality improvement. Findings are in four key areas: staffing/capabilities, valued tasks, program stewardship, and fostering program awareness/support.
Evolution of Department of Defense Disability Evaluation and Management of Posttraumatic Stress Disorder and Traumatic Brain Injury: Overview of Policy Changes, 2001–2018
U.S. Department of Defense (DoD) policies for medically evaluating service members have changed considerably since 2001, with major changes to the disability evaluation system beginning in 2007. Simultaneously, DoD also implemented new policies in response to the “signature injuries” of the wars in Iraq and Afghanistan: posttraumatic stress disorder and traumatic brain injury. The authors review these concurrent developments.
Military Behavioral Health Staff Perspectives on Telehealth Following the Onset of the COVID-19 Pandemic
The COVID-19 pandemic prompted sweeping changes to behavioral health care delivery in the Military Health System (MHS), which turned to telehealth to minimize disruptions and ensure continuity of care for service members. Four to seven months into the pandemic, MHS behavioral health staff shared their experiences using telehealth and their perspectives on its utility, barriers to its wider integration, and concerns about its use in the future.
Preparing for the Future of Combat Casualty Care: Opportunities to Refine the Military Health System's Alignment with the National Defense Strategy
To prepare for future combat operations, the Military Health System needs an agile, resilient, and global network of treatment facilities, storage sites for medical supplies, and transportation assets. It must also understand the implications for the U.S. health care system and the industrial base for medical supplies. Identifying gaps and risks is necessary to strengthening combat medical support in an evolving security environment.
Readiness of Soldiers and Adult Family Members Who Receive Behavioral Health Care: Identifying Promising Outcome Metrics
Behavioral health (BH) conditions comprise the second most common medical reason for nondeployability in the U.S. Army. To inform the Army's efforts to monitor and improve outcomes, the authors aimed to identify promising metrics to assess readiness among soldiers and adult family members who receive BH care. Such metrics would expand the Army's outcome monitoring efforts beyond symptom improvement metrics for patients who received BH care.
Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis, which places stress on personnel. This study presents a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders.
Suicide is a major public health challenge that disproportionately affects service members and veterans. Researchers have been studying veteran suicide rates and prevention strategies, but there are opportunities to improve risk identification, evaluation, support, and treatments and interventions. These strategies must include community-based efforts to reach veterans outside the U.S. Department of Veterans Affairs system.
Trends in Department of Defense Disability Evaluation System Ratings and Awards for Posttraumatic Stress Disorder and Traumatic Brain Injury, 2002–2017
The authors analyze trends in disability outcomes by identifying cohorts of service members who were diagnosed with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) and look prospectively at medical discharge and other career outcomes. They also look retrospectively at service members who were medically discharged with a disability rating for PTSD or TBI and examine trends in diagnoses, treatments, and other service outcomes.
Researchers present a subset of results from May and October 2020 surveys fielded through the RAND American Life Panel to assess changes in levels of trust in the Centers for Disease Control and Prevention during the coronavirus disease 2019 pandemic. Non-Hispanic White and Hispanic respondents reported significant declines in trust, while the changes were not statistically significant for non-Hispanic Black respondents or respondents of other races.
The coronavirus disease 2019 (COVID-19) pandemic required significant public health interventions from local governments. To help in those decisions, researchers used the Robust Decision Making approach to stress-test California's COVID-19 reopening strategy. This article presents lessons learned from these experiments and outlines four characteristics of the best strategies.
Boards in health and care organisations play a key role in the governance, strategy, direction and culture of an organisation. It is therefore important to ensure that board decisions are informed by the best available evidence. We conducted a scoping study on how boards use research evidence and how this can be improved. The principal data collection method was 17 qualitative interviews with board members.
This study provides an independent assessment of the breadth, scope, and impact of health services and primary care research funded by the U.S. Department of Health and Human Services and U.S. Department of Veterans Affairs from FYs 2012 to 2018. The authors identify research gaps and offer recommendations for maximizing the outcomes and value of future investments in health services and primary care research by federal agencies.
Well-defined, systematic, and transparent processes to identify health research gaps, needs, and priorities are vital to ensuring that available funds target areas with the greatest potential for impact. The authors conducted a scoping review of published methods used for identifying health research gaps, establishing research needs, and determining research priorities.
RAND Health Quarterly is produced by the RAND Corporation. ISSN 2162-8254.