The changing hospital landscape: An exploration of international experiences – RAND – August 2014

Posted on August 8, 2014. Filed under: Health Mgmt Policy Planning | Tags: |

The changing hospital landscape: An exploration of international experiences – RAND – August 2014

“The nature of hospital activity is changing in many countries, with some experiencing a broad trend towards the creation of hospitals groups or chains and multi-hospital networks. This report seeks to contribute to the understanding of experiences in other countries about the extent to which different hospital ‘models’ may provide lessons for hospital provision in England by means of a review of four countries: France, Germany, Ireland and the United States, with England included for comparison. We find that here has been a trend towards privatisation and the formation of hospital groups in France, Germany and the United States although it is important to understand the underlying market structure in these countries explaining the drivers for hospital consolidation. Thus, and in contrast to the NHS, in France, Germany and the United States, private hospitals contribute to the delivery of publicly funded healthcare services. There is limited evidence suggesting that different forms of hospital cooperation, such as hospital groups, networks or systems, may have different impacts on hospital performance. Available evidence suggests that hospital consolidation may lead to quality improvements as increased size allows for more costly investments and the spreading of investment risk. There is also evidence that a higher volume of certain services such as surgical procedures is associated with better quality of care. However, the association between size and efficiency is not clear-cut and there is a need to balance ‘quality risk’ associated with low volumes and ‘access risk’ associated with the closure of services at the local level.”

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Promoting Patient Safety Through Effective Health Information Technology Risk Management – RAND – May 2014

Posted on July 14, 2014. Filed under: Health Informatics, Patient Safety | Tags: |

Promoting Patient Safety Through Effective Health Information Technology Risk Management – RAND – May 2014

Promoting Patient Safety by Managing Health IT Risks – Health IT Buzz – 10 July 2014

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What to Do About Dementia? Policy Options for Crucial Long-Term Care – RAND – 2014

Posted on June 25, 2014. Filed under: Aged Care / Geriatrics | Tags: , |

What to Do About Dementia? Policy Options for Crucial Long-Term Care – RAND – 2014

“Millions of Americans already struggle with dementia, a degenerative cognitive condition that costs the United States billions of dollars annually, more than cancer or heart disease. As the nation’s population grows grayer, these numbers will only soar. RAND researchers have developed a national blueprint to help decisionmakers improve long-term services and supports that are crucial for those with dementia and those who care for them.”

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Five Steps to a Successful Workplace Wellness Program: A RAND Toolkit – 2014

Posted on June 25, 2014. Filed under: Occupational Hlth Safety | Tags: , , |

Five Steps to a Successful Workplace Wellness Program: A RAND Toolkit – 2014

“Well-designed, well-executed workplace wellness programs can reduce health risks (such as smoking and physical inactivity), lower health care costs, and improve productivity. RAND researchers determined that these programs are becoming a standard component of benefits packages but that not all of them are created equal: Some generate cost savings whereas others do not, and there are substantial differences in how programs are being designed and implemented. This toolkit synthesizes the lessons learned and best practices from multiple projects and many years of research into a five-step guide for the planning, implementation, and evaluation of a successful workplace wellness program.”

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Estimating the Economic Returns on Cancer Research in the UK – RAND – 2014

Posted on June 19, 2014. Filed under: Health Economics, Oncology, Research | Tags: |

Estimating the Economic Returns on Cancer Research in the UK – RAND – 2014

“In recent years, researchers and funders have aimed to better understand the range of impacts arising from public and charitable funding for medical research — including the resulting economic benefits. Such information provides accountability to taxpayers and charity donors, and increases our understanding of how research effectively translates to health gains. Financial returns may not be a key driver in research decisions, but the demands on public funding are substantial and it is therefore important to evaluate investment in research.

While it is easy to cite examples of breakthroughs that have led to substantial patient benefits or improvements in quality of life, it is more difficult to assess the nature and extent of the economic returns arising from investment in a whole body of medical research, some of which may inevitably be less fruitful.
Goals

This study, led by RAND Europe, the Health Economics Research Group (HERG) at Brunel University and King’s College London, aimed to estimate the returns generated by public and charitable investment in UK research. The work focuses on cancer and followed a ground-breaking study published in 2008, which yielded the first quantitative assessment of the economic benefit of biomedical and health science in the UK. The original report focused on the returns generated from investment in cardiovascular disease research, also testing the methodology to a more limited extent on mental health research.”

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Reducing the Economic Burden of Work-Related Injuries – RAND Corporation – 2014

Posted on June 18, 2014. Filed under: Occupational Hlth Safety | Tags: |

Reducing the Economic Burden of Work-Related Injuries – RAND Corporation – 2014

“This study examines the effectiveness of employer return to work programs in reducing the average duration of absences from work-related injuries. It finds that workers injured with an employer return to work program in place return to sustained employment approximately 1.38 times sooner after an injury. The biggest reductions in work-injury absence are experienced by men and by workers with a permanent disability. Modifying work equipment is associated with the greatest reductions in injury durations relative to other program components. Back-of-the-envelope calculations indicate that these programs are cost effective for large, self-insured employers.”

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Improving the Physical Health of Adults with Serious Mental Illness – RAND Corporation – 2014

Posted on May 30, 2014. Filed under: Mental Health Psychi Psychol | Tags: |

Improving the Physical Health of Adults with Serious Mental Illness – RAND Corporation – 2014

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Redirecting innovation in US health care: options to decrease spending and increase value – RAND Health – 2014

Posted on May 6, 2014. Filed under: Health Informatics, Health Technology Assessment, Pharmacy | Tags: , |

Redirecting innovation in US health care: options to decrease spending and increase value – RAND Health – 2014

Extract:

“A leading cause of high and growing spending is new medical technologies. Previous studies aimed at reining in spending considered changing the ways in which existing technologies are used. Our work for this project focused on identifying promising policy options to change which medical technologies are created in the first place, with
these two related policy goals:

1. Reduce total health care spending with the smallest possible loss of health benefits.
2. Ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases.

These goals reflect our definition of the “value” of a medical technology, which compares the increase in population health from using it to the extra spending attributable to its use. A medical product can have large health benefits for some patients and little or no benefit for others. Thus, a key issue for increasing value is improving the alignment between products and patients who will benefit from them.We define medical technology broadly to include all applications of knowledge to practical medical problems. However, in this study we focused more narrowly on medical products, specifically drugs, devices, and health information technology (HIT).”

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Supporting the development of a new health R&D strategy: A rapid review of international theory and practice for Norway’s HelseOmsorg21 – RAND – 2014

Posted on April 4, 2014. Filed under: Research | Tags: |

Supporting the development of a new health R&D strategy: A rapid review of international theory and practice for Norway’s HelseOmsorg21 – RAND – 2014

“The HelseOmsorg21 initiative was set up by the Ministry of Health and Care Services to develop a new research and innovation strategy for health and care services in Norway. The HelseOmsorg21 Strategy Group, through the Research Council of Norway which is providing the secretariat for the strategy development, asked RAND Europe to support the strategic review process. RAND Europe’s role was to conduct a series of rapid evidence reviews around the recommendations arising from the five working groups that comprise the initiative. The reviews were conducted around networks and collaboration, data linkage and exchange, culture, values and leadership, and incentives for innovation, while capacity building was a recurrent theme throughout.

This report presents the rapid evidence reviews, summarising relevant literature and highlighting international examples of particularly relevant or innovative approaches. The issues and ideas identified around each theme are then pulled together in a suggested conceptual representation of the Norwegian health and care research system.”

 

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The future of public health: A horizon scan – RAND – 18 March 2014

Posted on March 25, 2014. Filed under: Public Hlth & Hlth Promotion | Tags: |

The future of public health: A horizon scan – RAND – 18 March 2014

“Public Health England (PHE) commissioned RAND Europe to undertake a horizon scanning study exploring the future of public health and related scientific services. This work was intended to help inform thinking at the strategic level within PHE, firstly in relation to the wider vision of the Agency (which was only established in April 2013) and, secondly, in relation to the proposals for the creation of an integrated public health science hub.

The report is based on a literature review, a brief Delphi exercise using the ExpertLens platform and key informant interviews with a range of PHE staff and external experts. It focuses on the different future public health science needs and the extent to which an integrated science hub could serve PHE as it evolves over the next twenty years. Thus, the report considers PHE’s future remit and objectives in order that decisions about an integrated and co-located science hub be made in context and with reference to expert perceptions about the future.”

 

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Measuring Success in Health Care Value-Based Purchasing Programs: Findings from an Environmental Scan, Literature Review, and Expert Panel Discussions – RAND – March 2014

Posted on March 5, 2014. Filed under: Health Economics | Tags: |

Measuring Success in Health Care Value-Based Purchasing Programs: Findings from an Environmental Scan, Literature Review, and Expert Panel Discussions – RAND – March 2014

“Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers’ performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals.

This report summarizes the current state of knowledge about VBP based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Three types of VBP models were the focus of the review: (1) pay-for-performance programs, (2) accountable care organizations, and (3) bundled payment programs. The authors report on VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base.”

Measuring Success in Health Care Value-Based Purchasing Programs: Summary and Recommendations – RAND – March 2014

“Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers’ performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services (HHS) is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals.

This report summarizes the current state of knowledge about VBP programs, focusing on pay-for-performance programs, accountable care organizations, and bundled payment programs. The authors discuss VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. The report concludes with a set of recommendations for the design, implementation, and monitoring and evaluation of VBP programs and a discussion of HHS’s efforts in this regard.”

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RAND Suicide Prevention Program Evaluation Toolkit – 2014

Posted on February 11, 2014. Filed under: Mental Health Psychi Psychol | Tags: , |

RAND Suicide Prevention Program Evaluation Toolkit – 2014

“Evaluating suicide prevention programs can be challenging because suicide is a rare event, data on suicides often lag by several years, and programs tend to have multiple components, making it difficult to discern which characteristics contributed to a given outcome. The RAND Suicide Prevention Program Evaluation Toolkit was designed to help program staff overcome these common challenges to evaluating and planning improvements to their programs. It begins by walking users through the process of developing a program logic model that ties program activities to intermediate outcomes, helping staff better understand the drivers of any changes in long-term outcomes, such as suicide rates. It then offers information about the latest evaluation research, helps users design an evaluation that is appropriate for their program type and available resources and expertise, supports the selection of measures for new evaluations and to augment or enhance ongoing evaluations, and offers basic guidance on how to analyze and use evaluation data for program improvement. Through checklists, worksheets, and templates, the toolkit takes users step by step through the process of identifying whether their programs produce beneficial effects, ultimately informing the responsible allocation of scarce resources. The toolkit’s design and content are the result of a rigorous, systematic review of the program evaluation literature to identify evaluation approaches, measures, and tools used elsewhere and will be particularly useful to coordinators and directors of suicide prevention programs in the U.S. Department of Defense, Veterans Health Administration, community-based settings, and state and local health departments. A companion report, Development and Pilot Test of the RAND Suicide Prevention Program Evaluation Toolkit, offers additional background on the toolkit’s design and refinement.”

Development and Pilot Test of the RAND Suicide Prevention Program Evaluation Toolkit – 2014

“Evaluations are critical for assessing the impact of U.S. Department of Defense investments in suicide prevention and can be used as the basis for decisions about whether to sustain or scale up existing efforts. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury asked RAND to draw from the scientific literature and create a toolkit to guide future evaluations of suicide prevention programs. The resulting toolkit is designed to help program staff determine whether their programs produce beneficial effects and, ultimately, to guide the responsible allocation of scarce resources. This report summarizes the three complementary methods used to develop the RAND Suicide Prevention Program Evaluation Toolkit: an examination of the peer-reviewed evaluation literature and clinical trials, a review of other evaluation toolkits, and feedback from staff responsible for implementing suicide prevention programs in the Department of Defense. It is intended to serve as both a companion and supplement to the toolkit and offers additional background on its development and testing.”

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Regulating quality and safety of health and social care: International experiences – RAND – 2014

Posted on February 11, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Regulating quality and safety of health and social care: International experiences – RAND – 2014

“This report is concerned with ‘standards of quality and safety’ within health and social care systems. Care standards are intended to support efforts in maintaining and improving the quality of care; they have been developed across countries, although the ways in which they are implemented and applied differs between nations. Taking a range of six countries, we review the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and consider the range of policy instruments used to encourage and ensure continuous quality improvement. We report on Australia, England, Finland, Germany, the Netherlands and the USA. The report is intended to inform policy thinking for the Department of Health and others in developing the regulation of safety and quality of health and social care in England. It was prepared as part of the project ‘An “On-call” Facility for International Healthcare Comparisons’ funded by the Department of Health in England through its Policy Research Programme.”

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Small Ideas for Saving Big Health Care Dollars – RAND – January 2014

Posted on January 31, 2014. Filed under: Health Economics, Health Systems Improvement | Tags: |

Small Ideas for Saving Big Health Care Dollars – RAND – January 2014

“A focused review of recent RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year, in the aggregate, if successfully implemented. In the substituting lower-cost treatments category, ideas are to reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients, change payment policy for emergency transport, increase use of lower-cost antibiotics for treatment of acute otitis media, shift care from emergency departments to retail clinics when appropriate, eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs, increase use of $4 generic drugs, and reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes. In the patient safety category, ideas are to prevent three types of health care-associated infections: (1) central line-associated bloodstream infections, (2) ventilator-associated pneumonia, and (3) catheter-associated urinary tract infections; use preoperative and anesthesia checklists to prevent operative and postoperative events; prevent in-facility pressure ulcers; use ultrasound guidance for central line placement; and prevent recurrent falls.

Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance.”

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Do Workplace Wellness Programs Save Employers Money? – RAND – January 2014

Posted on January 13, 2014. Filed under: Public Hlth & Hlth Promotion, Workforce | Tags: |

Do Workplace Wellness Programs Save Employers Money? – RAND – January 2014

“Examines the return on investment (ROI) that companies realize from workplace wellness programs, focusing on the ROI provided by disease management programs versus lifestyle management programs.”

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Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy – RAND (Sponsored by the American Medical Association) – 9 October 2013

Posted on October 22, 2013. Filed under: Medicine, Workforce | Tags: |

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy – RAND (Sponsored by the American Medical Association) – 9 October 2013

“Purpose

This project, sponsored by the American Medical Association (AMA), aimed to characterize factors that influence physician professional satisfaction. In the context of recent health reform legislation and other delivery system changes, we sought to identify high-priority determinants of professional satisfaction that can be targeted within a variety of practice types, especially as smaller and independent practices are purchased by or become affiliated with hospitals and larger delivery systems. Based on project findings and input from other sources, including its membership and experts in physician practice design, the AMA plans to develop possible pathways for American physicians to practice in models that are more effective, efficient, sustainable, and conducive to professional satisfaction.”

Press release: Quality of Patient Care Drives Physician Satisfaction; Doctors Have Concerns About Electronic Health Records

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Factors Affecting Physician Professional Satisfaction – RAND – 2013

Posted on October 14, 2013. Filed under: Medicine, Workforce | Tags: |

Factors Affecting Physician Professional Satisfaction – RAND – 2013

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

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Workplace Wellness Programs Study – Final Report – RAND – 2013

Posted on June 6, 2013. Filed under: Workforce | Tags: , , |

Workplace Wellness Programs Study – Final Report – RAND – 2013

“The report investigates the characteristics of workplace wellness programs, their prevalence, their impact on employee health and medical cost, facilitators of their success, and the role of incentives in such programs. The authors employ four data collection and analysis streams: a review of the scientific and trade literature, a national survey of employers, a longitudinal analysis of medical claims and wellness program data from a sample of employers, and five case studies of existing wellness programs in a diverse set of employers to gauge the effectiveness of wellness programs and employees’ and employers’ experiences.”

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The Evolving Roles of Emergency Departments – RAND – May 2013

Posted on May 20, 2013. Filed under: Emergency Medicine | Tags: |

The Evolving Roles of Emergency Departments – RAND – May 2013

“This brief summarizes a RAND analysis of the role of that hospital emergency departments may come to play in either contributing to or reducing the rising costs of health care.”

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Does integrated care deliver the benefits expected? – RAND – May 2013

Posted on May 14, 2013. Filed under: Health Mgmt Policy Planning | Tags: , , |

Does integrated care deliver the benefits expected? – RAND – May 2013

Findings from 16 integrated care pilot initiatives in England

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Why the Rich Drink More but Smoke Less: The Impact of Wealth on Health Behaviors – RAND – April 2013

Posted on April 29, 2013. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: |

Why the Rich Drink More but Smoke Less: The Impact of Wealth on Health Behaviors – RAND – April 2013

“Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.”

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Assessing Research Impact: An international review of the Excellence in Innovation for Australia Trial – RAND – 2013

Posted on March 27, 2013. Filed under: Research | Tags: |

Assessing Research Impact: An international review of the Excellence in Innovation for Australia Trial – RAND – 2013

by Molly Morgan Jones, Sophie Castle-Clarke, Catriona Manville, Salil Gunashekar, Jonathan Grant

“The Australian Technology Network of Universities asked RAND Europe to review the Excellence in Innovation for Australia (EIA) Impact Assessment Trial (‘the EIA Trial’), in order to assess how well universities identified and demonstrated impact, as well as how the process could be further improved. This report offers headlines regarding the success of the process, as well as actionable recommendations for improving the EIA Trial in its current form, and for scaling up the process in the future. It also includes a detailed review of the Trial guidance, an analysis of case studies submitted to the Trial, an analysis of how each case study was scored by the assessment panels and an analysis of surveys completed by institutions and case study authors. The report is intended for those responsible for the EIA Trial, in order to enable them to improve the exercise. However, it may also be of interest to others working in the evaluation of research impact.”

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Regulatory cultures and research governance – RAND – 2013

Posted on March 12, 2013. Filed under: Research | Tags: , |

Regulatory cultures and research governance – RAND – 2013

by Catriona Manville, Petal Hackett, Salil Gunashekar, Molly Morgan Jones

“This report is intended to help improve understanding of health research governance in the UK by exploring the regulatory practices and cultures in other countries and sectors. It is a comparative study of the practice of those who are subject to regulatory requirements in the health research, medical drugs, environmental and financial sectors. The report is informed by a review of a small subset of literature which is particularly relevant to this question, and focuses on different elements of regulation and regulatory governance for each of the different sectors.”

 

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Regulatory cultures and research governance – RAND – 2013

Posted on March 5, 2013. Filed under: Research | Tags: , |

Regulatory cultures and research governance – RAND – 2013

by Catriona Manville, Petal Hackett, Salil Gunashekar, Molly Morgan Jones

“This report is intended to help improve understanding of health research governance in the UK by exploring the regulatory practices and cultures in other countries and sectors. It is a comparative study of the practice of those who are subject to regulatory requirements in the health research, medical drugs, environmental and financial sectors. The report is informed by a review of a small subset of literature which is particularly relevant to this question, and focuses on different elements of regulation and regulatory governance for each of the different sectors.”

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Hepatitis C: a projection of the healthcare and economic burden in the UK – RAND – January 2013

Posted on January 14, 2013. Filed under: Health Economics, Infectious Diseases | Tags: , |

Hepatitis C: a projection of the healthcare and economic burden in the UK – RAND – January 2013

“Work presented in this report sought to assess the healthcare and economic burden of the hepatitis C virus (HCV) infection in the United Kingdom. It used a cohort simulation model to estimate the prevalence of HCV infection in the UK, including the number of persons who live with HCV infection at different disease stages, and the number of deaths that can be attributed to HCV infection through to 2035. It further assessed the healthcare and societal costs that are associated with HCV infection under different scenarios of diagnosis and treatment rates.”

 TR-1307-HCT

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Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California’s Mental Health Prevention and Early Intervention Initiative – RAND – 2012

Posted on January 3, 2013. Filed under: Mental Health Psychi Psychol | Tags: , |

Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California’s Mental Health Prevention and Early Intervention Initiative – RAND – 2012

by Rebecca L. Collins, Eunice C. Wong, Jennifer L. Cerully, Dana Schultz, Nicole K. Eberhart

“A number of programs aim to reduce the stigma and discrimination associated with mental illness, and they can include a variety of components such as training, education, media campaigns, and contact with people with mental illness. Stigma and discrimination reduction activities are evaluated in this report, using evidence from an extensive literature review. Specific areas reviewed include relevant theories of stigma and prejudice reduction, what is and is not known about the effectiveness of various approaches to reducing the stigma of mental illness, the kinds of methodologies previously used in evaluating these approaches, and the methodologies that should be employed in the future. The authors also introduce a conceptual model of mental health stigma reduction based on a variety of existing theories and evidence.”

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Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California’s Mental Health Prevention and Early Intervention Initiative – RAND – 2012

Posted on January 3, 2013. Filed under: Mental Health Psychi Psychol, Preventive Healthcare | Tags: , |

Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California’s Mental Health Prevention and Early Intervention Initiative – RAND – 2012

by Joie Acosta, Rajeev Ramchand, Lisa H. Jaycox, Amariah Becker, Nicole K. Eberhart

“A number of prevention and early intervention initiatives aim to reduce the incidence of suicide, and the authors evaluate these initiatives by reviewing suicide prevention (SP) literature to learn about SP program effectiveness and the methodologies previously used to evaluate SP programs. Using evidence from the literature review, they provide an overview of the epidemiology of suicides and of non-fatal self-inflicted injuries in California and present a framework for conceptualizing SP programs. They find that identifying whether a SP program was effective at reducing suicide deaths is challenging because suicide is such a rare event. They also find that programs may have differential effects on population subgroups, because suicide rates differ by age, race, and gender. Finally, they determine that SP programs may show immediate reductions in suicide attempts but their long-term effects are uncertain.”

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A Review of the U.S. Workplace Wellness Market – RAND – November 2012

Posted on November 28, 2012. Filed under: Health Status, Workforce | Tags: |

A Review of the U.S. Workplace Wellness Market – RAND – November 2012

by Soeren Mattke, Christopher Schnyer, Kristin R. Van Busum

“This paper describes the current state of workplace wellness programs in the United States, including typical program components; assesses current uptake among U.S. employers; reviews the evidence for program impact; and evaluates the current use and the impact of incentives to promote employee engagement. Wellness programs have become very common, as 92 percent of employers with 200 or more employees reported offering them in 2009. Survey data indicate that the most frequently targeted behaviors are exercise (addressed by 63 percent of employers with programs), smoking (60 percent), and weight loss (53 percent). In spite of widespread availability, the actual participation of employees in such programs remains limited. A 2010 survey suggests that typically less than 20 percent of eligible employees participate in wellness interventions.

At this time, it is difficult to definitively assess the impact of workplace wellness on health outcomes and cost. While employer sponsors are mostly satisfied with the results, more than half stated in a recent survey that they did not know their program’s return on investment. The peer-reviewed literature, while predominately positive, covers only a tiny percentage of the universe of programs. Evaluating such complex interventions is difficult and poses substantial methodological challenges that can invalidate findings. The use of incentives, such as cash, cash equivalents, and variances in health plan costs, to promote employee engagement, while increasingly popular, remains poorly understood. Future research should focus on finding out which wellness approaches deliver which results under which conditions to give much-needed guidance on best practices.”

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Developing a framework for establishing clinical decision support meaningful use objectives for clinical specialties – RAND – 2012

Posted on October 23, 2012. Filed under: Evidence Based Practice, Health Informatics, Knowledge Translation | Tags: , |

Developing a framework for establishing clinical decision support meaningful use objectives for clinical specialties – RAND – 2012

Extract from the preface

“The federal electronic health record (EHR) incentive program includes clinical decision support (CDS) as a central requirement of improving health outcomes; however, a process for identifying and prioritizing the most-promising targets for CDS has not been established. CDS provides those involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.

This report describes a protocol for eliciting high-priority targets for electronic CDS for individual clinical specialties, which could serve to inform policymakers’ deliberations and establishment of CDS meaningful use objectives. Researchers from the RAND Corporation tested the protocol with four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics. A CDS target was defined as a clinical performance gap having one or more CDS opportunities that can be implemented to address the gap.  A CDS opportunity is defined as a specific CDS intervention that could be expected to address a clinical performance gap. CDS opportunities include existing CDS tools or interventions that might be developed in the short term.”

… continues on the site

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Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices – RAND – 2011

Posted on October 23, 2012. Filed under: Evidence Based Practice, Knowledge Translation, Research | Tags: , |

Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices – RAND – 2011

by Eric C. Schneider, Justin W. Timbie, D. Steven Fox, Kristin R. Van Busum, John Caloyeras

“Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patients with similar symptoms or conditions has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER — particularly CER funded through the American Recovery and Reinvestment Act of 2009 -are proposed.”

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Evaluating disease management programmes. Learning from diverse approaches across Europe – RAND – 2012

Posted on October 5, 2012. Filed under: Chronic Disease Mgmt | Tags: , |

Evaluating disease management programmes. Learning from diverse approaches across Europe – RAND – 2012

“The DISMEVAL consortium (Developing and validating disease management evaluation methods for European healthcare systems, a consortium of ten partners in seven countries led by RAND Europe), examined approaches to chronic disease management in 13 countries across Europe and tested the methods being used to evaluate these in six countries.”

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Costing the Walking for Health Programme – RAND – July 2012

Posted on August 28, 2012. Filed under: Health Economics, Preventive Healthcare, Public Hlth & Hlth Promotion | Tags: , |

Costing the Walking for Health Programme – RAND – July 2012

“BACKGROUND: When Walking for Health was launched in 2000 walking was not considered a serious form of exercise. Now the health benefits of short, regular, brisk walks are widely understood. The Department of Health considers that health walks can be a way of increasing people’s levels of physical activity and improving their health. In 2007, Department of Health and Natural England working in partnership with local statutory and voluntary organisations took the decision to invest in an expansion of Walking for Health as part of the package of public health initiatives aimed at getting people more active. As part of the Walking for Health expansion a programme of evaluation was established. The aims of the programme were to evaluate, quantitatively and qualitatively, both health and environmental outcomes from the Walking for Health intervention. To deliver the breadth and depth of evaluation Natural England has worked with research and academic partners. This report was commissioned through University of East Anglia and RAND Europe. Walking for Health is a physical activity intervention with the primary purpose of making a positive difference to people’s physical health. Other studies have looked at the differences the intervention makes to people’s level of physical activity (NECR068, 2011). This report presents research the economic costs of Walking for Health. Specifically, the economic costs involved in delivering the programme. These include financial (or accounting) costs and opportunity costs, which are the values of the foregone costs that could have been dedicated some other objective. The results presented in this report are based on a small sample of schemes representative of the variety across the programme as a whole. The results of this work provide a useful insight into economic costs of running local Walking for Health schemes, and the overarching national support programme. The costs are presented by scheme type, walk hours, and walk register. As the report concludes, these data do not provide insight into the cost-effectiveness of Walking for Health as health outcome data were not considered. The purpose of Natural England commissioning this study was to increase our understanding of economic costs of establishing and running a volunteer lead initiative. Natural England will use these findings to inform and support communities in the development of local initiatives to facilitate access and engagement of people with their natural environments.”

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Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Rehabilitation | Tags: |

Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

by  Andrew W. Dick,  Peter J. Huckfeldt,  Hangsheng Liu,  Hao Yu,  Ateev Mehrotra,  Susan L. Lovejoy,  J. Scott Ashwood

“Quality metrics play an increasingly important role in the evaluation and reimbursement of post-acute providers. Currently, it is difficult to ascertain whether changes in inpatient rehabilitation facility (IRF) patient outcomes are due to changes in treatment or the case mix of patients seen in IRFs. Risk adjustment, however, has the potential to improve the comparability of quality metrics both across providers and over time. This report (1) develops risk-adjusted quality metrics at the provider level for IRFs, (2) develops methods to address low case volume, and (3) uses these metrics to estimate national trends in IRF quality from 2004 to 2009. It presents the results for five IRF outcomes: (1) functional gain, (2) discharge to the community, (3) 30-day readmission to acute care given discharge to the community, (4) 30-day readmission to skilled nursing facility (SNF), given discharge to the community, and (5) discharge directly to acute care.”

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Nurse Practitioners and Sexual and Reproductive Health Services. An Analysis of Supply and Demand – RAND – 2012

Posted on July 3, 2012. Filed under: Nursing, Workforce | Tags: , , |

Nurse Practitioners and Sexual and Reproductive Health Services. An Analysis of Supply and Demand – RAND – 2012

by David I. Auerbach et al

“Use of Sexual and Reproductive Health (SRH) services is projected to grow between 10 and 20 percent from 2006 to 2020. This growth is driven largely by changes in the racial/ethnic make-up of the population of women of reproductive age and an increase in the number of people with insurance coverage because of new health care legislation.

Trends in supply and demand for SRH services, particularly for low-income individuals, suggest demand will outstrip supply in the next decade. Nurse Practitioners (NPs) with a women’s health focus are key providers of SRH care in Title X-funded clinics, which deliver a significant proportion of U.S. family planning and SRH services to low-income populations. This report looks at why numbers of women’s health NPs (WHNPs) have been declining, and are projected to continue to decline, despite significant growth in total numbers of NPs. Barriers to increasing the supply of NPs competent in SRH care — such as reduced funding for WHNP training, increased funding for primary care and geriatric NP training, and a shrinking proportion of WHNPs choosing to work in public health, clinics, and family planning — are identified.

From the standpoint that the evolution of the health care delivery system may serve as an opportunity to optimize the delivery of SRH services in the United States, a comprehensive set of options spanning education, federal and state regulations, and emerging models of care delivery are explored to reverse this trend of too few WHNPs, particularly for servicing Title X facilities and their patients.”

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Measuring Health System Progress in Reducing Mortality from Noncommunicable Diseases – RAND – May 2012

Posted on May 31, 2012. Filed under: Chronic Disease Mgmt | Tags: , , , , |

Measuring Health System Progress in Reducing Mortality from Noncommunicable Diseases – RAND – May 2012

by   Soeren Mattke, Jack C. Chow

“Noncommunicable diseases (NCDs) place a heavy burden on developing countries, whose relatively recent adoption of Western-style health behaviors and lifestyle choices has led to increased prevalence of risk factors for NCDs over the past decade. NCDs are compounding the burden of infectious disease on health systems in those countries. In response, the World Health Organization (WHO) has launched several risk reduction initiatives. WHO is drafting a monitoring framework and voluntary targets as the basis for a consultation process with member states. However, the indicators and targets that a global consultation process will produce will inevitably provide high-level, aggregated information, such as progress toward reducing premature NCD mortality. Regional and national decisionmakers and planners, on the other hand, will need more proximal and granular information to track progress toward high-level goals and will be constrained by the resources and demands in their respective jurisdictions. The relative importance of different risk factors and manifest NCDs differs across countries, and so do health systems’ capabilities and resources. Thus, national and regional decisionmakers will need: (1) a comprehensive set of indicators to guide on-the-ground prioritization decisions and track progress toward high-level targets and (2) actionable data to predict the impact of changes in proximal indicators on high-level targets. As a first step, this occasional paper outlines a roadmap toward a comprehensive system for national and regional decisionmakers to (1) track progress toward the key WHO goal of reducing NCD mortality by 25 percent by 2025 and (2) prioritize resources and interventions to achieve that goal.”

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Helping Hospitals Deliver Better Care: A New Toolkit for Quality Improvement – RAND – May 2012

Posted on May 28, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Helping Hospitals Deliver Better Care: A New Toolkit for Quality Improvement – RAND – May 2012

by   Donna O. Farley,  Robin M. Weinick,  Lindsay Mayer,  Julie Cerese,  Rachel M. Burns,  Peter S. Hussey

“A team from RAND and the University HealthSystem Consortium developed a toolkit to help hospitals enhance their quality  improvement efforts using quality indicators from the Agency for Healthcare Research and Quality.”

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Funding and performance on clinical guidelines. The cases of dementia and chronic obstructive pulmonary disease – RAND – April 2012

Posted on April 24, 2012. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Respiratory Medicine | Tags: , , , |

Funding and performance on clinical guidelines. The cases of dementia and chronic obstructive pulmonary disease – RAND – April 2012

by Emmanuel Hassan, Helen Ridsdale, Jonathan Grant, Susan Guthrie

“In September 2009, the United Kingdom (UK) Medical Research Council, the Wellcome Trust and the Department of Health (England) commissioned RAND Europe to investigate the characteristics of research cited in two UK clinical guidelines: Dementia and Chronic Obstructive Pulmonary Disease (COPD).

The exploratory work is part of an overall drive among funders to understand better how research reaches policy and practice.

The objectives of our exploratory study were to understand the following questions.

What are the characteristics of publications cited in these clinical guidelines?
On those papers with a UK affiliation, who funded the research cited in these clinical guidelines?

This report presents the findings of our work, based on the two guidelines.”

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Planning for an Aging Nation. New Estimates to Inform Policy Analysis for Senior Health – RAND – 2012

Posted on April 16, 2012. Filed under: Aged Care / Geriatrics, Health Policy | Tags: |

Planning for an Aging Nation. New Estimates to Inform Policy Analysis for Senior Health – RAND – 2012

“This dissertation contains three papers on the health and welfare of the elderly population. Overall, these papers provide insights into the costs and challenges of providing health care to the elderly population. These papers help us understand the effects of obesity on longevity and health care, as well as better understand the benefits of social insurance.

The first paper uses a micro-simulation model to estimate the longevity effects of poor health trends among younger Americans, and finds that difference in these trends can explain 92% of the difference between US and European longevity.

The second paper estimates the welfare effects of Medicare Part-D from gains in market efficiency and dynamic incentives for pharmaceutical companies. It finds that these gains alone nearly cover the welfare cost of funding Medicare Part-D.

The last paper presents and estimates a structural model of health, exercise, and restaurant consumption. It provides estimates for future welfare analyses of programs targeting obesity through restaurants and exercise in the elderly population. It also estimates the long run effects of making policies which make restaurant food healthier. It finds only minor effects of restaurant policies on health for the elderly.

Overall, these papers further our understanding of the challenging objective of improving senior health while containing costs.”

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Evaluating chronic disease management. Recommendations for funders and users – RAND – April 2012

Posted on April 5, 2012. Filed under: Chronic Disease Mgmt | Tags: |

Evaluating chronic disease management. Recommendations for funders and users – RAND – April 2012

by Ellen Nolte et al

“The report forms part of the DISMEVAL project, funded under the European Commission’s 7th Framework Programme. It is targeted at policymakers, programme operators and researchers, explaining choices, options and trade-offs for the evaluation of disease management based on analyses undertaken within the project. Many of the issues discussed can be seen to apply to any evaluation of complex interventions in healthcare. However, there are specific concerns around evaluation design and metrics that are of relevance to the evaluation of disease management in particular and that are examined in the report. These include (i) the context for evaluating disease management, exploring the reasons for undertaking evaluation in the first place and explaining some of the underlying principles for doing so; (ii) the methods and metrics for evaluating disease management, focusing specifically on themes that have emerged as being pertinent to work carried out within the DISMEVAL project; (iii) practical considerations for disease management evaluation, based on experience of work undertaken in DISMEVAL; and (v) the broader challenges and lessons learned that may be relevant for policymakers, funders and practitioners interested in the use and usefulness of disease management evaluation more generally. This publication provides a major resource to guide the evaluation of disease management interventions in European settings and so contributes to strengthening the evidence-base required to inform the selection of efficient and effective interventions to address the growing burden of chronic disease in Europe.”

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The National Institute for Health Research Leadership Programme: An evaluation of programme progress and delivery – RAND – 2012

Posted on March 16, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

The National Institute for Health Research Leadership Programme: An evaluation of programme progress and delivery – RAND – 2012

by Molly Morgan Jones, Watu Wamae, Caroline Viola Fry, Tom Kennie, Joanna Chataway

“RAND Europe evaluated the National Institute for Health Research Leadership Programme in an effort to help the English Department of Health consider the extent to which the programme has helped to foster NIHR’s aims, extract lessons for the future, and develop plans for the next phase of the leadership programme. Successful delivery of high-quality health research requires not only an effective research base, but also a system of leadership supporting it. However, research leaders are not often given the opportunity, nor do they have the time, to attend formal leadership or management training programmes. This is unfortunate because research has shown that leadership training can have a hugely beneficial effect on an organisation. Therefore, the evaluation has a particular interest in understanding the role of the programme as a science policy intervention and will use its expertise in science policy analysis to consider this element alongside other, more traditional, measures of evaluation.”

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Use of outcome metrics to measure quality in education and training of healthcare professionals: a scoping review of international experiences – RAND – 2012

Posted on March 13, 2012. Filed under: Educ for Hlth Professions | Tags: |

Use of outcome metrics to measure quality in education and training of healthcare professionals: a scoping review of international experiences – RAND – 2012

by Ellen Nolte et al

“This brief report provides a rapid review of the published evidence on initiatives undertaken at international and national levels that may inform the further development of the proposed outcomes framework. It is designed as an exploratory review, with a focus on the use of quality indicators to assess and monitor the delivery of healthcare education and training in international settings.”

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An Evaluation of the Use of Performance Measures in Health Care – RAND Health Quarterly – 2012

Posted on March 13, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

An Evaluation of the Use of Performance Measures in Health Care – RAND Health Quarterly – 2012

by Cheryl L. Damberg et al

Abstract
“The National Quality Forum (NQF), a private, nonprofit membership organization committed to improving health care quality performance measurement and reporting, was awarded a contract with the U.S. Department of Health and Human Services (HHS) to establish a portfolio of quality and efficiency measures. The portfolio of measures would allow the federal government to examine how and whether health care spending is achieving the best results for patients and taxpayers. As part of the scope of work under the HHS contract, NQF was required to conduct an independent evaluation of the uses of NQF-endorsed measures for the purposes of accountability (e.g., public reporting, payment, accreditation, certification) and quality improvement. In September 2010, NQF entered into a contract with the RAND Corporation for RAND to serve as the independent evaluator. This article presents the results of the evaluation study. It describes how performance measures are being used by a wide array of organizations and the types of measures being used for different purposes, summarizes key barriers and facilitators to the use of measures, and identifies opportunities for easing the use of performance measures moving forward.”

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Review of the Evidence on Falls Prevention in Hospitals. Task 4 Final Report – RAND – February 2012

Posted on March 13, 2012. Filed under: Patient Safety, Preventive Healthcare | Tags: , , |

Review of the Evidence on Falls Prevention in Hospitals. Task 4 Final Report – RAND – February 2012

by Susanne Hempel, Sydne Newberry, Zhen Wang, Paul G. Shekelle, Roberta M. Shanman, Breanne Johnsen, Tanja Perry, Debra Saliba, David A. Ganz

“To facilitate the development of a hospital falls prevention resource guide, the authors systematically reviewed and documented the existing evidence base for interventions to prevent falls in hospitals, provided an overview of the performance of existing tools with known measurement properties, and compiled available online resources. The search identified a large number of published fall prevention intervention evaluations. Almost all interventions were multi-component in nature and included fall risk assessments and education for staff and patients and/or families. Intervention complexity and organizational implications varied widely. The review also identified a wide variety of tools for the prevention of falls in hospitals; the majority of the documented tools were fall risk assessment scales. Very few tools, such as the Morse Fall Scale and the STRATIFY scale, have been applied in a number of studies and have generalizable reliability and validity estimates. The documented evidence-based interventions and tools may assist in the development of programs to prevent falls in hospitals. Which tools and interventions are suitable for use in individual hospitals must be evaluated in the context of existing approaches, resources, and individual needs. The identified material will be integrated into the AHRQ toolkit as resources to guide fall prevention approaches for hospitals.”

AHRQ = US Agency for Healthcare Research & Quality

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Preventing emergency readmissions to hospital. A scoping review – RAND – 2012

Posted on February 3, 2012. Filed under: Emergency Medicine, Patient Journey, Patient Safety | Tags: , , |

Preventing emergency readmissions to hospital. A scoping review – RAND – 2012

by Ellen Nolte, Martin Roland, Susan Guthrie, Laura Brereton

“The report reviews the evidence and potential for use of ’emergency readmissions within 28 days of discharge from hospital’ as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns. Reviewed studies suggest that between 5 percent and 59 percent of readmissions may be avoidable. Studies are highly heterogeneous, but based on the evidence reviewed, about 15 percent up to 20 percent may be considered reasonable although previous authors have advised against producing a benchmark figure for the percentage of readmissions that can be avoided. The majority of published studies focus on clinical factors associated with readmission. Studies are needed of NHS organisational factors which are associated with readmission or might be altered to prevent readmission.

The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ’emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.”

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Sustainable Development in the National Health Service (NHS). The views and values of NHS leaders – RAND – 2012

Posted on February 3, 2012. Filed under: Environmental Health | Tags: , |

Sustainable Development in the National Health Service (NHS). The views and values of NHS leaders – RAND – 2012

by Tom Ling, Janice S. Pedersen, Samuel Drabble, Claire Celia, Laura Brereton, Christine Tiefensee

“This report presents National Health Service (NHS) leaders’ views of priorities and approaches regarding sustainable development in the NHS. It was produced in close collaboration with the United Kingdom (UK) NHS Sustainable Development Unit (SDU), and it represents the first systematic picture of leadership views in the NHS. It also provides a commentary on ways forward. Analysis draws on results of a survey of 172 leaders of NHS organisations (primarily chief executives), 12 follow-up interviews, interviews with the SDU, and additional data and literature searches. A major conclusion is that almost all leaders consider sustainable development to be important for the NHS and that a focus on sustainability can most likely be aligned with delivering other corporate goals. Aligned incentives at all organisational levels and support for diversity are considered necessary to achieve sustainability, as well as relevant performance metrics. The main barrier is organisational culture.”

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An Evaluation of the Use of Performance Measures in Health Care – RAND Health Technical Report – 2011

Posted on December 12, 2011. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , , |

An Evaluation of the Use of Performance Measures in Health Care – RAND Health Technical Report – 2011

“NQF [National Quality Forum] engaged the RAND Corporation to conduct an independent examination of the use of performance measures, with particular interest in the use of NQF-endorsed measures. The goal was to better understand
• the current state of performance measure use across the broad spectrum of end-user types
• areas in which gaps in measures exist that hinder the end users’ ability to apply measures to support the achievement of their desired goals
• how the larger measurement enterprise (i.e., measure developers, measure endorsers, foundations and government agencies that support measure development and implementation) might better support the use of performance measures.”

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International Comparisons in Health Economics. Evidence from Aging Studies – RAND – October 2011

Posted on October 18, 2011. Filed under: Health Economics | Tags: |

International Comparisons in Health Economics. Evidence from Aging Studies – RAND – October 2011
by James Banks, James P. Smith

“The authors provide an overview of the growing literature that uses micro-level data from multiple countries to investigate health outcomes, and their link to socioeconomic factors, at older ages. Since the data are at a comparatively young stage, much of the analysis is at an early stage and limited to a handful of countries, with analysis for the US and England being the most common. What is immediately apparent as they get better measures is that health differences between countries amongst those at older ages are real and large. Countries are ranked differently according to whether one considers life-expectancy, prevalence or incidence of one condition or another. And the magnitude of international disparities may vary according to whether measures utilize doctor diagnosed conditions or biomarker-based indicators of disease and poor health. But one key finding emerges — the US ranks poorly on all indicators with the exception of self-reported subjective health status.”

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How Do Quality Improvement Interventions Succeed? Archetypes of Success and Failure – RAND – August 2011

Posted on August 30, 2011. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

How Do Quality Improvement Interventions Succeed? Archetypes of Success and Failure – RAND – August 2011

by Sean Michael O’Neill   222p.

“The quality of heath care in the United States is suboptimal and needs to be improved as part of increasing the value of costly health care services. Achieving broad quality improvements will require reproducing local quality improvement intervention (QII) successes on a larger scale. Such replication has been difficult to come by, however, because we don’t understand the “how” of quality improvement very well. The goal of this analysis was to ascertain the predominant themes and patterns likely to be associated with producing successful QIIs. Cases were compared according to each dimension of the framework. The general approach involved establishing the range (the maximally diverse exemplars), the central tendency (the modal example) and the distribution (the pattern of variation) within each dimension and subcategory. The author assessed cases first on a univariate basis and then on a multivariate basis by grouping them according to more and less successful cases, different domains of care, and different degrees of organizational integration. The strengths of this study include its comparative case study design as well as its unique investigator-based sampling strategy, which sought to maximize the observed variation across cases while achieving an equal balance of “more” and “less” successful cases. Future research endeavors should attempt to operationalize and validate the archetypes suggested by this study. Doing so will produce broadly generalizable and practical tools for explaining how quality improvement results are generated, and for strategizing for success when implementing interventions in different settings.”

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National Evaluation of Safe Start Promising Approaches. Assessing Program Outcomes – RAND – 2011

Posted on August 30, 2011. Filed under: Child Health / Paediatrics, Violence | Tags: |

National Evaluation of Safe Start Promising Approaches. Assessing Program Outcomes – RAND – 2011

by Lisa H. Jaycox, Laura J. Hickman, Dana Schultz, Dionne Barnes-Proby, Claude Messan Setodji, Aaron Kofner, Racine Harris, Joie Acosta, Taria Francois

“Safe Start Promising Approaches (SSPA) is the second phase of a community-based initiative focused on developing and fielding interventions to prevent and reduce the impact of children’s exposure to violence (CEV). This report shares the results of SSPA, which was intended to implement and evaluate promising and evidence-based programs in community settings. Fifteen program sites across the country were selected to implement a range of interventions for helping children and families cope with the effects of CEV. The settings, populations served, intervention types, types of violence addressed, community partners, and program goals differed across the 15 sites. The main body of this report provides information on the designs of the studies, instruments used, data collection and cleaning, analytic methods, and an overview of the results across the 15 sites. The appendixes provide a detailed description of the outcome evaluation conducted at each SSPA program, including a description of the enrollees, enrollment and retention, the amount and type of services received, and child and family outcomes over time.”

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RAND/UCLA Quality-of-Care Measures for Carpal Tunnel Syndrome. Tools for Assessing Quality of Care and Appropriateness of Surgery – RAND – 2011

Posted on August 23, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery | Tags: |

RAND/UCLA Quality-of-Care Measures for Carpal Tunnel Syndrome. Tools for Assessing Quality of Care and Appropriateness of Surgery – RAND – 2011
by Teryl K. Nuckols et al

“Claims relating to carpal tunnel syndrome (CTS) are common in workers’ compensation systems. Given that the human and economic costs related to CTS are considerable, healthcare organizations must be able to offer high-quality care to people affected by this condition. The study on which this report is based is a step toward improving care for CTS. It has produced two unique tools for institutions to use, one for assessing the quality of care received by a population of patients who have or may have CTS, and the other for identifying the appropriateness of surgery for individual patients. Tools that assist in measuring quality of care are fundamental to efforts to improve healthcare quality. Tools that assess the appropriateness of surgery ensure that people who need surgery receive it and, conversely, that people are not subjected to inappropriate operations. Applied in this way, these two tools are likely to improve clinical circumstances and economic outcomes for people with CTS. Together, they can be useful to provider organizations, medical groups, medical certification boards, and other associated decisionmakers attempting to assess, monitor, and provide appropriate care for people with CTS.”

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Peer review in scientific publications – UK House of Commons Science and Technology Committee – Eighth Report – 18 July 2011

Posted on August 23, 2011. Filed under: Research | Tags: , |

Peer review in scientific publications – UK House of Commons Science and Technology  Committee – Eighth Report – 18 July 2011
Extract from the summary

“Peer review in scholarly publishing, in one form or another, has always been regarded as crucial to the reputation and reliability of scientific research. In recent years there have been an increasing number of reports and articles assessing the current state of peer review. In view of the importance of evidence-based scientific information to government, it seemed appropriate to undertake a detailed examination of the current peer-review system as used in scientific publications. Both to see whether it is operating effectively and to shine light on new and innovative approaches. We also explored some of the broader issues around research impact, publication ethics and research integrity.

We found that despite the many criticisms and the little solid evidence on the efficacy of pre-publication editorial peer review, it is considered by many as important and not something that can be dispensed with. There are, however, many ways in which current pre-publication peer-review practices can and should be improved and optimised, although we recognise that different types of peer review are suitable to different disciplines and research communities. Innovative approaches—such as the use of pre-print servers, open peer review, increased transparency and online repository-style journals—should be explored by publishers, in consultation with their journals and taking into account the requirements of their research communities. Some of these new approaches may help to reduce the necessary burden on researchers, and also help accelerate the pace of publication of research. We encourage greater recognition of the work carried out by reviewers, by both publishers and employers. All publishers need to have in place systems for recording and acknowledging the contribution of those involved in peer review.”  … continues

Alternatives to Peer Review in Research Project Funding – RAND – May 2011

Summary

“Peer review is considered the gold standard for reviewing research proposals. However, it is not always the best methodology for every research funding process. Public and private funders that support research as wide-ranging as basic sciences, defence technologies and social sciences utilise a diverse set of strategies to advance knowledge in their respective fields. This report highlights a set of established approaches that offer unique alternatives to traditional peer review – alternatives that address many of the shortcomings in peer review effectiveness and efficiency. The appropriateness of these different approaches will depend on the funder’s organisational structure and mission, as well as short- and long-term financial realities. We hope that the information presented in this folio of cards will inspire thinking amongst research funders by showing how the research funding process can be changed, and give funders the confidence to try novel methods by explaining where and how similar approaches have been used previously.”

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What Is the Impact of Using Evidence-Based Treatments for Posttraumatic Stress Disorder and Depression in Veterans? – RAND – 2011

Posted on July 7, 2011. Filed under: Evidence Based Practice, Mental Health Psychi Psychol | Tags: |

What Is the Impact of Using Evidence-Based Treatments for Posttraumatic Stress Disorder and Depression in Veterans? – RAND – 2011

“If all veterans suffering from major depression and posttraumatic stress disorder were to receive evidence-based treatments, policy simulations suggest that cost savings generated would be $138 million (15 percent) over two years.”  RAND research brief.

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A Prize Worth Paying?: Non-standard ways to support and reward excellence in health research and development in the UK NHS – RAND – 2011

Posted on June 30, 2011. Filed under: Research | Tags: |

A Prize Worth Paying?: Non-standard ways to support and reward excellence in health research and development in the UK NHS – RAND – 2011
by Tom Ling

“This is a short paper scoping the issues involved in considering the merits of using prizes to support the objectives of the Department of Health Research and Development Directorate (DH R&D). The paper concludes that there is indeed merit in developing incentives to support excellence in health research in addition to ‘standard’ performance management and routine inspection. These could act either to reinforce the signals created by standard metrics (for example, awards recognising the best performers as measured by standard metrics) or they could ‘fill the gaps’ to encourage behaviour not influenced by conventional incentives. This would create an ecosystem to more effectively link reward with motivation, which could deliver benefits for patients and the health care system more widely. Prizes, it is argued, should play a more significant role in the UK health R&D system than in the past but it is not suggested that they replace existing systems to support high-quality research and development.”

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Longitudinal Program Evaluation of HHS Healthcare Associated Infections (HAI) National Action Plan (NAP) – RAND – April 2011

Posted on April 27, 2011. Filed under: Infection Control | Tags: , |

Longitudinal Program Evaluation of HHS Healthcare Associated Infections (HAI) National Action Plan (NAP) – RAND – April 2011
Year 1 Report
by Peter Mendel, Daniel Weissbein, Daniel Weinberg, Rebecca Shaw, Donna O. Farley, David P. Baker, Katherine L. Kahn

“The widespread prevalence and enormous cost of healthcare-associated infections (HAIs) have been recognized as public and personal-level health problems. An estimated 1.7 million HAIs are diagnosed annually in hospitals and are associated with approximately 100,000 deaths. However, substantial opportunities exist for adopting evidence-based processes to reduce rates of HAIs. In June 2009 the Department of Health and Human Services (HHS) issued the Action Plan to Prevent Healthcare-Associated Infections, which established national goals for HAI prevention, including key actions for achieving identified short- and long-term objectives over the next five years. The National Evaluation of the HHS Action Plan to Prevent Healthcare-Associated Infections is a large-scale formative evaluation project conducted by IMPAQ International and the RAND Corporation. The evaluation seeks to establish baseline data and provide feedback on how to strengthen ongoing assessments of the scope of HAIs and interventions, how to reduce HAIs, and how to begin to understand the effectiveness of those interventions. This report presents the results of the first year of the team’s evaluation, which focused on a document and literature review and interviews with key stakeholders to gain information about the context in which the action plan was developed. Future years will assess processes associated with the action plan and resulting products. Recommendations include increasing the engagement of stakeholders both within and external to the federal government, acknowledging prevalent conceptual and implementation tensions between differing major perspectives on HAIs, and creating a supplementary document to outline the steps necessary to achieve each action plan goal.”

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Complex trauma research in the UK: A rapid review of the funding landscape – RAND – April 2011

Posted on April 21, 2011. Filed under: Research | Tags: , |

Complex trauma research in the UK: A rapid review of the funding landscape – RAND – April 2011

by Molly Morgan Jones, Jonathan Grant

“At the request of the English Department of Health, a rapid review of research funding in the field of complex trauma in the UK is needed. The information gathered will feed into ongoing strategic discussions between DH and the Ministry of Defence (MoD). RAND Europe will map the research landscape in the UK, with a focus on areas of excellence and the nature of funding (public and private), conduct a series of interviews with leading experts, and undertake a strategic assessment of the wider state of research in this area. A brief assessment of the international landscape will also be provided to assist in the identification of gaps and overlaps. The report draws several conclusions, the most notable of which is that complex trauma research is arguably a ‘niche’ and ‘orphan’ area of research in the UK with approximately £15m of funding per annum. The UK lacks capacity and capability in several areas of complex trauma research, though individual research fields sectors within complex trauma (i.e. regenerative medicine or orthopaedic research) are strong. Complex trauma research in the UK could benefit from better integration between military and civilian sectors to maximise synergies and research strengths in each.”

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Influences on the Adoption of Multifactor Authentication – RAND – April 2011

Posted on April 21, 2011. Filed under: Health Informatics | Tags: |

Influences on the Adoption of Multifactor Authentication – RAND – April 2011
by Martin C. Libicki, Edward Balkovich, Brian A. Jackson, Rena Rudavsky, Katharine Watkins Webb

“Passwords are presently the primary method by which users authenticate themselves to computer systems. But passwords are proving less and less capable of protecting systems from abuse. Multifactor authentication (MFA) — which combines something you know (e.g., a PIN), something you have (e.g., a token), and/or something you are (e.g., a fingerprint) — is increasingly being required. This report investigates why organizations choose to adopt or not adopt MFA — and where they choose to use it. The authors reviewed the academic literature and articles in the trade press and conducted structured conversations with selected organizations that use or have contemplated using MFA. They found that the type of organization — for example, defense contractor, bank, hospital—affected its MFA choices. MFA is mandated for U.S. government agencies, which tend to use PINs and tokens for remote access. Among private users of MFA, tokens that generate one-time passwords, rather than biometrics, predominate. The researchers recommend that the U.S. government develop methodologies by which the costs and benefits of mandating MFA can be evaluated. Guidance by the National Institute of Standards to government agencies may be useful in helping them sort out the various arguments for and against mandating MFA in a given sector.”

ISBN/EAN: 9780833052353
Document Number: TR-937-NIST

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Community-Based Violence Prevention: An Assessment of Pittsburgh’s One Vision One Life Program – RAND – March 2011

Posted on March 24, 2011. Filed under: Violence | Tags: |

Community-Based Violence Prevention: An Assessment of Pittsburgh’s One Vision One Life Program – RAND – March 2011

“In 2006, more than 6 million individuals were victimized by violent crimes. Although violence is below levels of the early 1990s, it remains high. The extent of violence and its impact highlight a critical need to develop and implement effective programs to reduce violence and victimization. Communities have initiated a wide range of such programs, and scholars have conducted numerous evaluations of varying quality of them. Reviews have found certain types of strategies and specific programs to be promising, but additional critical evaluations are needed to plan violence-reduction programs. This monograph assesses the implementation and impact of the One Vision One Life violence-prevention strategy in Pittsburgh, Pennsylvania. In 2003, Pittsburgh witnessed a 49-percent increase in homicides, prompting a “grassroots” creation and implementation of the One Vision One Life antiviolence strategy. This initiative used a problem-solving, data-driven model, including street-level intelligence, to intervene in escalating disputes, and seeks to place youth in appropriate social programs. Analysis of the program, which is modeled on similar efforts elsewhere, can help inform other efforts to address urban violence.”

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Healthcare Technology Co-operatives: Filling a niche in the English R&D landscape – RAND – March 2011

Posted on March 24, 2011. Filed under: Health Technology Assessment, Research | Tags: |

Healthcare Technology Co-operatives: Filling a niche in the English R&D landscape

Document Number: TR-932-DH

“The Department of Health (England) commissioned this evaluation of the pilot Health Technology Cooperatives (HTCs), which are part of its research infrastructure. Its purpose is to explore how this initiative has affected relationships between clinical, industrial and academic partners; how the HTCs fit into the current health innovation landscape; and the alignment of HTC activities to the goals set out in the NIHR strategy.

Since the HTC scheme was intended to focus on medical devices, this review investigated how medical device development is being pursued by other similar entities in England, Australia and the USA. The key question was whether the institutional relationships initiated by the HTCs are contributing to the health research system in England and if this scheme is the most effective way of pursuing these relationships.

This review had no specific theory or hypothesis to test, so information was gathered so as to allow key conclusions to be drawn and linked to existing theories. This review used documented evidence from the institutions involved as well as interviews.

The pilot HTCs have shown that there are different, but equally legitimate, management approaches to the clinician-industry-patient relationship. These different approaches are reflections both of the disease field and the host institution culture. Neither HTC has concluded how best to sustain activities in the long term, particularly core management facilities such as supporting initial meetings with potential partners and early development of technologies from non-commercial sources. Recommendations focussed on how best to support core HTC activities in the future.”

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Preliminary assessment of economic impacts of alcohol pricing policy options in the UK – RAND – March 2011

Posted on March 24, 2011. Filed under: Alcohol & Drug Dep., Health Economics | Tags: |

Preliminary assessment of economic impacts of alcohol pricing policy options in the UK – RAND – March 2011

Document Number: TR-858-1-HO

“In an effort to understand the economic implications associated with various possible measures to tackle alcohol harms, the Home Office commissioned RAND Europe to undertake research into three particular policies — minimum pricing, ban on below-cost sales, and taxation. This study presents evidence on the links between alcohol prices and consumption and the economic impacts of each policy option, the statistical data describing the market for alcohol and findings from interviews with key stakeholders.

Main findings for each policy option are as follows:

Ban on below cost sales (cost defined as VAT + duty): The effect on consumption may be relatively small compared with broader restrictions on discounts and promotions, and also with the introduction of certain minimum prices or tax hikes. Nevertheless, even if the effect is small, where it increases the price of the cheapest drinks, the ban could potentially lead to some reduction in hazardous/harmful drinking.
Increased taxation: When the taxes are passed on, taxes affect all drinkers, which is why taxation has been considered a ‘blunt instrument’ that does not target those drinkers who cause harms, instead affecting all consumers to some extent.
Minimum price: Depending on the minimum price introduced, the effect of this policy is especially strong for low-cost alcohol. Thus, minimum pricing has important implications for young and hazardous/harmful drinkers and low-income groups, who are more likely to purchase cheaper drinks.”

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Informing the development of a resource allocation framework in the German healthcare system – RAND – March 2011

Posted on March 24, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: |

Informing the development of a resource allocation framework in the German healthcare system – RAND – March 2011
Document Number: TR-946-KBV

“In the German statutory health insurance (SHI) system, the payment of office-based physicians in the ambulatory care sector is based on a complex system involving national and regional stakeholders. Payment rates are derived from a national relative value scale but, as budgets are negotiated at the regional level, conversion factors for the relative values and thus prices for the same service can vary by region. Against this background, the National Association of Statutory Health Insurance Physicians (KBV) in Germany is looking to develop a national approach that allocates funds according to a unified framework, while taking account of regional characteristics. As part of this new approach, the KBV seeks to incorporate quality indicators into the allocation formula so as to improve the overall quality of care provided by SHI physicians. This report aims to inform the development of the quality component of the proposed national resource allocation framework in the German statutory healthcare system by providing an overview of quality indicator systems and quality measurement approaches, including criteria for selecting measures of quality currently used for ‘high stakes’ assessment in high-income countries globally. High stakes uses of performance measures mean that the provider’s performance scores are used for public accountability (making results transparent through public reporting) and/or for differentially allocating resources (pay-for-performance or P4P).”

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Assessing the impacts of Revising the Tobacco Products Directive: Study to support a DG SANCO Impact Assessment – RAND – March 2011

Posted on March 18, 2011. Filed under: Public Hlth & Hlth Promotion | Tags: , |

Assessing the impacts of Revising the Tobacco Products Directive: Study to support a DG SANCO Impact Assessment – RAND – March 2011
by Jan Tiessen, Priscillia Hunt, Claire Celia, Mihaly Fazekas

“Tobacco use is one of the largest avoidable causes of morbidity and premature death in the EU. Whilst smoking prevalence in the EU has been declining over the past 30 years, smoking has remained more prevalent among men than women in the EU-27, with some of the new Member States reporting the widest gaps between male and female smokers. For young smokers (13 to 15 years old) this situation is somewhat reversed, with slightly more girls than boys smoking.

Against this background, the European Commission Directorate-General for Health and Consumer Protection (DG SANCO) considered a revision of the Tobacco Products Directive 2001/37/EC across five general areas: scope of the directive, labelling requirements, registration and market control fees, ingredients, and sales arrangements. More specifically, the types of policy options under consideration included (but were not limited to): an increase of warning label sizes on the back of packaging to 100%, a restriction for the display of products at retail outlets and an introduction of additional measurement method for TNCO (the modified ISO method) with maximum limits set accordingly.

DG SANCO commissioned RAND Europe to provide support in assessing the potential health, macroeconomic, and compliance cost and administrative burden impacts of revising the Tobacco Products Directive. In addition to assessing impacts, the study provides an up-to-date overview of the evidence and basis for current tobacco product regulation that may be of interest to a wider audience interested in tobacco control policies.”

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Project Retrosight: Understanding the returns from cardiovascular and stroke research: The Policy Report – RAND – March 2011

Posted on March 18, 2011. Filed under: Cardiol / Cardiothor Surg, Neurology, Research | Tags: |

Project Retrosight: Understanding the returns from cardiovascular and stroke research: The Policy Report – RAND – March 2011
by Steven Wooding, Stephen Hanney, Alexandra Pollitt, Martin Buxton, Jonathan Grant

“This project explores the impacts arising from cardiovascular and stroke research funded 15-20 years ago and attempts to draw out aspects of the research, researcher or environment that are associated with high or low impact.

The project is a case study-based review of 29 cardiovascular and stroke research grants, funded in Australia, Canada and UK between 1989 and 1993. The case studies focused on the individual grants but considered the development of the investigators and ideas involved in the research projects from initiation to the present day. Grants were selected through a stratified random selection approach that aimed to include both high- and low-impact grants. The key messages are as follows: 1) The cases reveal that a large and diverse range of impacts arose from the 29 grants studied. 2) There are variations between the impacts derived from basic biomedical and clinical research. 3) There is no correlation between knowledge production and wider impacts 4) The majority of economic impacts identified come from a minority of projects. 5) We identified factors that appear to be associated with high and low impact.

This report presents the key observations of the study and an overview of the methods involved. It has been written for funders of biomedical and health research and health services, health researchers, and policy makers in those fields. It will also be of interest to those involved in research and impact evaluation.” 

Research Brief on Project Retrosight

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Bibliometric analysis of highly cited publications of health research in England, 2002-2006 – RAND – February 2011

Posted on February 28, 2011. Filed under: Research | Tags: |

Bibliometric analysis of highly cited publications of health research in England, 2002-2006 – RAND – February 2011

by Thed van Leeuwen, Jonathan Grant, Siobhan Ni Chonaill

“This paper describes a bibliometric analysis to support the selection of candidate National Institute of Health Research Biomedical Research Centres (BRCs) and Biomedical Research Units (BRUs). It is intended to assist potential applicants in deciding whether to submit a pre-qualifying questionnaire as part of the procurement process and to inform the deliberations of the selection panel for the BRCs and BRUs. The work presented in this paper is a collaboration between the Centre for Science and Technology Studies in the Netherlands (CWTS) and RAND Europe.”

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Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security – RAND – February 2011

Posted on February 28, 2011. Filed under: Disaster Management | Tags: |

Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security – RAND – February 2011
by Anita Chandra, Joie Acosta, Stefanie Stern, Lori Uscher-Pines, Malcolm V. Williams, Douglas Yeung, Jeffrey Garnett, Lisa S. Meredith

“Community resilience, or the sustained ability of a community to withstand and recover from adversity has become a key policy issue at federal, state, and local levels, including in the National Health Security Strategy. Because resources are limited in the wake of an emergency, it is increasingly recognized that resilience is critical to a community’s ability to reduce long recovery periods after an emergency. This report provides a roadmap for federal, state, and local leaders who are developing plans to enhance community resilience for health security threats and describes options for building community resilience in key areas. Based on findings from a literature review and a series of community and regional focus groups, the authors provide a definition of community resilience in the context of national health security and a set of eight levers and five core components for building resilience. They then describe suggested activities that communities are pursuing and may want to strengthen for community resilience, and they identify challenges to implementation.”
Building Community Resilience to Disasters: A Roadmap to Guide Local Planning

Press release:  Ways for Communities to Build Resilience to Aid Disaster Recovery

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Payment Reform: Analysis of Models and Performance Measurement Implications – RAND – 2011

Posted on February 28, 2011. Filed under: Health Economics | Tags: |

Payment Reform: Analysis of Models and Performance Measurement Implications – RAND – 2011

Eric C. Schneider, Peter S. Hussey, Christopher Schnyer  Sponsored by the National Quality Forum

“In the United States, policymakers are increasingly turning to performance measurement as a cornerstone of health care payment reform. With the support of the National Quality Forum (NQF), the RAND Corporation conducted this evaluation, cataloging nearly 100 implemented and proposed payment reform programs, classifying each of these programs into one of 11 payment reform models (PRMs), and identifying the performance measurement needs associated with each model. A synthesis of the results suggests near-term priorities for performance measure development and identifies pertinent challenges related to the use of performance measures as a basis for payment reform. Our intent is that this report will be useful to a broad range of stakeholders with an interest in the appropriate use of standardized performance measures to improve the quality and efficiency of health care delivery for all of the people of the United States.”

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Seasonal Flu Vaccination: Why Don’t More Americans Get It? – RAND – February 2011

Posted on February 15, 2011. Filed under: Infectious Diseases, Influenza A(H1N1) / Swine Flu | Tags: , |

Seasonal Flu Vaccination: Why Don’t More Americans Get It? – RAND – February 2011

by Katherine M. Harris, Juergen Maurer, Lori Uscher-Pines, Arthur L. Kellermann, Nicole Lurie

“RAND researchers found that less than half of U.S. adults received flu vaccinations in 2010. Strategies to increase flu vaccination rates should include stronger efforts to address public skepticism and negative perceptions.”

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Toward Standardization of Benefit-Cost Analyses of Early Childhood Interventions – RAND – 2011

Posted on February 11, 2011. Filed under: Child Health / Paediatrics, Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: |

Toward Standardization of Benefit-Cost Analyses of Early Childhood Interventions
by Lynn A. Karoly

“A growing body of benefit-cost analyses (BCAs) of early childhood programs has been prompted by the increased demand for results-based accountability when allocating public and private sector resources. While the BCAs of early childhood programs serve to make such investments more compelling, there are limitations in the current state of the art, including a lack of standardization in the BCA methods used, from discount rates to shadow prices. The objective of this paper is to delineate a set of standards for conducting BCAs of early childhood programs. The paper reviews the existing evidence of the economic returns from early childhood programs that serve children and families in the first five years of life, discusses the challenges that arise in applying the BCA methodology such programs, highlights the variation in current methods used, and proposes a set of standards for applying the BCA methodology to early childhood programs. The recommendations concern issues such as the discount rate to use and the age to which costs and benefits should be discounted; stakeholder disaggregation; outcomes to value, the associated values, and projections of future outcomes; accounting for uncertainty; sensitivity analysis; and reporting of results. The proposed standards can guide the choices that analysts need to make about the methods to use when performing BCAs for one or more early childhood programs and they can support greater transparency in the results the analysts provide. The standards can also support consumers of the BCA results in their need to understand the methods employed and the comparability across different studies.”

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Will Adoption of Electronic Health Records Improve Quality in U.S. Hospitals? – RAND – 2011

Posted on February 10, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Will Adoption of Electronic Health Records Improve Quality in U.S. Hospitals? – RAND – 2011

by Spencer S. Jones, John L. Adams, Eric Schneider, Jeanne S. Ringel, Elizabeth A. McGlynn, Mary E. Vaiana

“Shares findings on the potential effects of electronic health records (EHRs) on health care quality, based on analysis of extensive data from 2003 and 2006 on EHR adoption, hospital characteristics, and hospital quality in nearly 2,100 hospitals.”

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A Contribution to Health Capital Theory – RAND – 2011

Posted on February 9, 2011. Filed under: Health Mgmt Policy Planning, Health Status | Tags: |

A Contribution to Health Capital Theory – RAND – 2011

by Titus Galama
“This paper presents a theory of the demand for health, health investment and longevity, building on the human capital framework for health and addressing limitations of existing models. It predicts a negative correlation between health investment and health, that the health of wealthy and educated individuals declines more slowly and that they live longer, that current health status is a function of the initial level of health and the histories of prior health investments made, that health investment rapidly increases near the end of life and that length of life is finite as a result of limited life-time resources (the budget constraint). It derives a structural relation between health and health investment (e.g., medical care) that is suitable for empirical testing.”

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Health and Well-Being in the Home: A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology – RAND – 2010

Posted on February 8, 2011. Filed under: Chronic Disease Mgmt, Telehealth | Tags: |

Health and Well-Being in the Home: A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology – RAND – 2010

by Soeren Mattke, Lisa Klautzer, Tewodaj Mengistu, Jeffrey Garnett, Jianhui Hu, Helen Wu

“In both industrialized and transitioning countries, population aging and better survivability have led to a rapid increase of the prevalence of chronic disease and disability. As a result, there is growing concern about the financial sustainability of health care systems, which is compounded by capacity constraints and workforce shortages. Advanced home health care solutions promise to mitigate these pressures by shifting care from costly institutional settings to patients’ homes and allowing patients to self-manage their conditions. A global study of the needs, priorities, and expectations of key stakeholders regarding home health care in six countries (China, France, Germany, Singapore, the United Kingdom, and the United States) revealed that, despite their potential, such technologies face a number of barriers to adoption. Restrictive coverage and existing incentives for in-person home care create obstacles, as does limited patient readiness because of insufficient health literacy. Concerns about audience-appropriate product design and support and limited data on effectiveness and efficiency also impede uptake. Realizing the promise of telecare requires a concerted stakeholder effort, including creation of a conducive policy environment, design of convincing products, and development and dissemination of persuasive evidence.”

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How health systems make available information on service providers: Experience in seven countries – RAND – 2011

Posted on February 4, 2011. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

How health systems make available information on service providers: Experience in seven countries – RAND – 2011

by Mirella Cacace, Stefanie Ettelt, Laura Brereton, Janice Pedersen, Ellen Nolte

“The report reviews and discusses information systems reporting on the quality or performance of providers of healthcare (‘quality information systems’) in seven countries: Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States. Data collection involves a review of the published and grey literature and is complemented by information provided by key informants in the selected countries using a detailed questionnaire. Quality information systems typically address a number of audiences, including patients (or respectively the general public before receiving services and becoming patients), commissioners, purchasers and regulators. We observe that as the policy context for quality reporting in countries varies, so also does the nature and scope of quality information systems within and between countries. Systems often pursue multiple aims and objectives, which typically are (a) to support patient choice (b) to influence provider behaviour to enhance the quality of care (c) to strengthen transparency of the provider-commissioner relationship and the healthcare system as a whole and (d) to hold healthcare providers and commissioners to account for the quality of care they provide and the purchasing decisions they make. We emphasise that the main users of information systems are the providers themselves as the publication of information provides an incentive for improving the quality of care. Finally, based on the evidence reviewed, we identify a number of considerations for the design of successful quality information systems, such as the clear definition of objectives, ensuring users’ accessibility and stakeholder involvement, as well as the need to provide valid, reliable and consistent data.”

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Economic impacts of alcohol pricing policy options in the UK – RAND – 2011

Posted on February 4, 2011. Filed under: Alcohol & Drug Dep., Health Policy | Tags: |

Economic impacts of alcohol pricing policy options in the UK – RAND – 2011

by Priscillia Hunt, Lila Rabinovich, Ben Baumberg

“In an effort to understand the economic implications associated with various possible measures to tackle alcohol harms, the Home Office commissioned RAND Europe to undertake research into three particular policies — minimum pricing, ban on below-cost sales, and taxation. This study presents evidence on the links between alcohol prices and consumption and the economic impacts of each policy option, the statistical data describing the market for alcohol and findings from interviews with key stakeholders.”

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Disease management evaluation: A comprehensive review of current state of the art – RAND – 2011

Posted on February 4, 2011. Filed under: Chronic Disease Mgmt, Health Systems Improvement | Tags: , |

Disease management evaluation: A comprehensive review of current state of the art – RAND – 2011

by Annalijn Conklin, Ellen Nolte

“Many countries across Europe and elsewhere have been experimenting with various structured approaches to manage patients with chronic illness as a way to improve quality of care, reduce costs and lead to better population health outcomes in the long run. Despite a body of studies of disease management interventions, uncertainty about the effects of these remains not least because current guidance on evaluation methods and metrics require further development to enhance scientific rigour while also being practical in routine operations. This report reviews the academic and grey literature to help advance the task of improving the science of assessing disease management initiatives in Europe. It provides a comprehensive inventory of current evaluation methods and performance measures, and highlights potential challenges to evaluating complex interventions such as disease management. Challenges identified are methodological, analytical and conceptual in nature, with a key issue being the establishment of the counterfactual. An array of sophisticated statistical techniques and analytical frameworks can assist in the construction of a sound comparison strategy when a randomised controlled trial is not possible. Issues to consider include: a clear framework of the mechanisms of action and expected effects of disease management; an understanding of the characteristics of disease management (scope, content, dose, context), and of the intervention and target populations (disease type, severity, case-mix); a period of observation over multiple years; and a logical link between performance measures and the intervention’s aims and underlying theory of behaviour change.”

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Electronic Medical Records Not Always Linked to Better Care in Hospitals – RAND Corporation – 23 Dec 2010

Posted on January 14, 2011. Filed under: Health Informatics | Tags: |

Electronic Medical Records Not Always Linked to Better Care in Hospitals – RAND Corporation – 23 Dec 2010

“Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new RAND Corporation study.

Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.

However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care.” … continues on the RAND site

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Framework for assessing, improving and enhancing health service planning – RAND Corporation – 2010

Posted on January 14, 2011. Filed under: Health Mgmt Policy Planning | Tags: |

Framework for assessing, improving and enhancing health service planning – RAND Corporation – 2010
Pages: 86
Document Number: TR-847-BF
Year: 2010

“Healthcare planning forms a key instrument for decision makers to influence and direct health service provision, a function which is likely to become more important in the light of increasingly complex challenges that demand innovative solutions. How this is achieved best and in what circumstances remains however uncertain, given the variety of approaches adopted in different settings. This report aims to contribute to policy learning across countries from the diversity of healthcare planning approaches in Europe and elsewhere through developing and validating a framework for assessing, improving and enhancing healthcare planning. It identifies a set of criteria within three broad themes: “Vision”, “Governance” and “Intelligence”, which were then tested empirically through an in-depth analysis of four countries, using a case study approach: Germany, Austria, Canada (Ontario) and New Zealand.

The analysis provides important insights into how different systems approach healthcare planning, identifying common challenges, but also differences highlighting the very contextual nature within which healthcare planning as an instrument to directing health service provision sits. It will be important to understand the role and power of actors as powerful stakeholder interests are likely to undermine effective planning if there are no mechanisms in place that allow for consensus building and establish lines of accountability for implementation. Broad political goals, such as ensuring economic sustainability, have to be considered and weighed against the goals of healthcare planning. The framework developed presents a first step towards developing a tool for assessing.”

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Involving the public in healthcare policy: An update of the research evidence and proposed evaluation framework – RAND Corporation – 2010

Posted on January 14, 2011. Filed under: Health Policy, Patient Participation | Tags: |

Involving the public in healthcare policy: An update of the research evidence and proposed evaluation framework – RAND Corporation – 2010
Pages: 81
Document Number: TR-850-BF
Year: 2010
Series: Technical Reports

“Public involvement has been advocated as a means to enhance the responsiveness of healthcare systems. Yet despite its obvious appeal, the concept has remained poorly defined and its rationale and objectives are rarely specified when applied to the healthcare sector. This report aims to update existing work on both the conceptual and the empirical evidence for public involvement in healthcare policy. We draw on a comprehensive review of the published literature, supplemented by exploratory observations from selected public involvement initiatives in different health system contexts.

Despite a growing literature base, the concept of “public involvement” remains poorly defined although as a complex and multidimensional phenomenon a call for simple clarification of the concept may not be desirable. Public involvement practice varies by underlying rationale, public motivation to become involved, and specific mechanisms and their relationship to wider social processes. We propose to interpret the term “involvement” as a descriptive umbrella term for the spectrum of processes and activities that bring the public into the decision-making process as it has the benefit of providing a fuller picture of potential involvement, which is independent of normative assumptions.

Sound empirical evidence of the outcomes of public involvement activities in healthcare remains underdeveloped. We find evidence for the developmental role of public involvement while the evidence for instrumental benefits of public involvement initiatives is less well documented. Yet overly focusing on outcomes of public involvement risks missing the normative argument that involving the public in the process may be seen to be of intrinsic value in itself.”

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Enhancing the benefits from biomedical and health research spillovers between public, private and charitable sectors in the UK – RAND – 2010

Posted on October 5, 2010. Filed under: Health Economics, Research | Tags: |

Enhancing the benefits from biomedical and health research spillovers between public, private and charitable sectors in the UK – RAND – 2010
 
“In innovation processes, it is well established that knowledge spillovers can exist, whereby investments in knowledge creation by one party produces external benefits for other parties. This document highlights key points from a high-level Forum organised and facilitated by the Office of Health Economics and RAND Europe which met in Cambridge on 11th May 2010 to discuss the nature of spillover effects from biomedical and health research and strategies to realise their benefits. The Forum discussed a number of aspects of spillovers and identified the top priorities for policy research that could help bring spillover effects more explicitly into policy decisions.”

Pages: 17
Document Number: OP-319

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Where Do Americans Get Acute Care? Not at Their Doctor’s Office – RAND – 2010

Posted on September 9, 2010. Filed under: Acute Care, Emergency Medicine | Tags: |

Where Do Americans Get Acute Care? Not at Their Doctor’s Office – RAND – 2010

 By: Arthur Lodge Kellermann, Emily R. Carrier, Stephen R. Pitts, Eugene C. Rich
Pages: 2
Document Number: RB-9556
Year: 2010

Less than half of acute care visits in the United States involve a patient’s personal physician. Emergency physicians, who comprise only 4 percent of doctors, handle 28 percent of all acute care encounters and nearly all after-hours and weekend care.
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Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations – RAND – 2010

Posted on August 23, 2010. Filed under: Disaster Management, Emergency Medicine | Tags: |

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations – RAND – 2010
 
By: Brian A. Jackson, Kay Sullivan Faith, Henry H. Willis    224 p.
ISBN/EAN: 9780833050052

“The ability to measure emergency preparedness — to predict the likely performance of emergency response systems in future events — is critical for policy analysis in homeland security. Yet it remains difficult to know how prepared a response system is to deal with large-scale incidents, whether it be a natural disaster, terrorist attack, or industrial or transportation accident. This research draws on the fields of systems analysis and engineering to apply the concept of system reliability to the evaluation of emergency response systems. The authors describe a method for modeling an emergency response system; identifying how individual parts of the system might fail; and assessing the likelihood of each failure and the severity of its effects on the overall response effort. The authors walk the reader through two applications of this method: a simplified example in which responders must deliver medical treatment to a certain number of people in a specified time window, and a more complex scenario involving the release of chlorine gas. The authors also describe an exploratory analysis in which they parsed a set of after-action reports describing real-world incidents, to demonstrate how this method can be used to quantitatively analyze data on past response performance. The authors conclude with a discussion of how this method of measuring emergency response system reliability could inform policy discussion of emergency preparedness, how system reliability might be improved, and the costs of doing so.”

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Policy Implications of the Use of Retail Clinics – RAND – 2010

Posted on August 20, 2010. Filed under: Preventive Healthcare, Primary Hlth Care | Tags: |

Policy Implications of the Use of Retail Clinics – RAND – 2010
 
By: Robin M. Weinick, Craig Evan Pollack, Michael P. Fisher, Emily M. Gillen, Ateev Mehrotra
Pages: 92
Document Number: TR-810-DHHS

“Retail clinics, located within larger retail stores, treat a limited number of acute conditions and offer a small set of preventive services. Although there are nearly 1,200 such clinics in the United States, a great deal about their utilization, relationships with other parts of the health care system, and quality of care remains unknown. The federal government has taken only limited action regarding retail clinics, and little evidence exists about the potential costs and benefits of integrating retail clinics into federal programs and initiatives.

Through a literature review, semistructured interviews, and a panel of experts, the authors show that retail clinics have established a niche in the health care system based on their convenience and customer service. Levels of patient satisfaction and of the quality and appropriateness of care appear comparable to those of other provider types. However, we know little about the effects of retail clinic use on preventive services, care coordination, and care continuity. As clinics begin to expand into other areas of care, including chronic disease management, and as the number of patients with insurance increases and the shortage of primary care physicians continues, answering outstanding questions about retail clinics’ role in the health care system will become even more important. These changes will create new opportunities for health policy to influence both how retail clinics function and the ways in which their care is integrated with that of other providers.”

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Multi-perspective Strategic Decision Making: Principles, Methods, and Tools – RAND Corporation – 2010

Posted on August 20, 2010. Filed under: Health Mgmt Policy Planning | Tags: , , |

Multi-perspective Strategic Decision Making: Principles, Methods, and Tools – RAND Corporation – 2010
 
By: Lynne Wainfan
Pages: 168
Document Number: RGSD-260

“Increasingly, governing groups must take into account diverse perspectives (values, beliefs, and expectations) from within the group, from stakeholders, analysts, and adversaries. Multi-perspective strategic decision making is the process of making long-term decisions that shape the course of an organization, while taking into account diverse perspectives. Often, these perspectives affect the group’s decision more than “objective” criteria. For complex, deeply uncertain problems, groups considering diverse perspectives can be challenged to agree on strategy. This research defines methods, principles, and tools to help groups agree on strategy despite widely diverse perspectives. It extends exploratory analysis techniques to cover new types of factors driving the choice of strategy: “perspective parameters,” including those used for aggregation and scoring variables in a multiresolution model; along with uncertain objective parameters. Six useful simplification techniques are defined to help decision makers see the essence of a complex system and the forces driving it. Finally, this research introduces a heuristic that uses driving forces’ time frame and controllability to identify the best strategy and ways to iterate options. The approach is illustrated using a defense acquisition strategy.”

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What Are the Long-Term Economic Costs of Psychological Problems During Childhood? – RAND – 2010

Posted on August 12, 2010. Filed under: Child Health / Paediatrics, Mental Health Psychi Psychol | Tags: |

What Are the Long-Term Economic Costs of Psychological Problems During Childhood? – RAND – 2010
 
By: James P. Smith, Gillian C. Smith

Examines the lifetime economic damages caused by childhood psychological problems.

Pages: 2
Document Number: RB-9548

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A “Quiet Revolution” in Nephrology: Challenges and Opportunities for Advancing the Treatment of Chronic Kidney Disease – RAND – 2010

Posted on August 12, 2010. Filed under: Nephrology | Tags: |

A “Quiet Revolution” in Nephrology: Challenges and Opportunities for Advancing the Treatment of Chronic Kidney Disease – RAND – 2010
 
By: Richard A. Rettig, Roberto B. Vargas, Keith C. Norris, Allen R. Nissenson
Pages: 4
Document Number: RB-9547-DREW

Shares results of a study examining changes in nephrology as it evolves from a focus on end-stage renal disease to the treatment of all stages of chronic kidney disease (CKD). Earlier stages of CKD progression can be slowed, halted, or even reversed.

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Are Performance-Based Accountability Systems Effective? Evidence from Five Sectors – RAND – 2010

Posted on August 12, 2010. Filed under: Health Mgmt Policy Planning | Tags: |

Are Performance-Based Accountability Systems Effective?  Evidence from Five Sectors – RAND – 2010
 
Brian M. Stecher, Frank Camm, Cheryl L. Damberg, Laura S. Hamilton, Kathleen J. Mullen, Christopher Nelson, Paul Sorensen, Martin Wachs, Allison Yoh, Gail L. Zellman with Kristin J. Leuschner

Pages: 4
Document Number: RB-9549
 
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Creating an effective PBAS requires 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.

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Analyzing the Operation of Performance-Based Accountability Systems for Public Services – RAND – 2010

Posted on August 12, 2010. Filed under: Health Mgmt Policy Planning | Tags: |

Analyzing the Operation of Performance-Based Accountability Systems for Public Services

By: Frank Camm, Brian M. Stecher
ISBN/EAN: 9780833050045
Document Number: TR-853

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“Empirical evidence of the effects of performance-based public management is scarce. This report describes a framework used to organize available empirical information on one form of performance-based management, a performance-based accountability system (PBAS). Such a system identifies individuals or organizations that must change their behavior for the performance of an activity to improve, chooses an implicit or explicit incentive structure to motivate these organizations or individuals to change, and then chooses performance measures tailored to inform the incentive structure appropriately. The study focused on systems in the child-care, education, health-care, public health emergency preparedness, and transportation sectors, mainly in the United States. Analysts could use this framework to seek empirical information in other sectors and other parts of the world. Additional empirical information could help refine existing PBASs and, more broadly, improve decisions on where to initiate new PBASs, how to implement them, and then how to design, manage, and refine them over time.”

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Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services – RAND – 2010

Posted on August 12, 2010. Filed under: Health Mgmt Policy Planning | Tags: |

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services – RAND – 2010
 
By: Brian M. Stecher, Frank Camm, Cheryl L. Damberg, Laura S. Hamilton, Kathleen J. Mullen, Christopher Nelson, Paul Sorensen, Martin Wachs, Allison Yoh, Gail L. Zellman with Kristin J. Leuschner

ISBN/EAN: 9780833050151
Document Number: MG-1019

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“Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little is known about PBAS effectiveness at achieving performance goals or about government and agency experiences. This study examines nine PBASs that are drawn from five sectors: child care, education, health care, public health emergency preparedness, and transportation. In the right circumstances, a PBAS can be an effective strategy for improving service delivery. Optimum circumstances include having a widely shared goal, unambiguous observable measures, meaningful incentives for those with control over the relevant inputs and processes, few competing interests, and adequate resources to design, implement, and operate the PBAS. However, these conditions are rarely fully realized, so it is difficult to design and implement PBASs that are uniformly effective. PBASs represent a promising policy option for improving the quality of service-delivery activities in many contexts. The evidence supports continued experimentation with and adoption of this approach in appropriate circumstances. Even so, PBAS design and its prospects for success depend on the context in which the system will operate. Also, ongoing system evaluation and monitoring are integral components of a PBAS; they inform refinements that improve system functioning over time.”

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Encouraging Work at Older Ages – RAND – July 2010

Posted on July 26, 2010. Filed under: Workforce | Tags: |

Encouraging Work at Older Ages – RAND – July 2010
By: Nicole Maestas

Testimony presented before the Senate Finance Committee on July 15, 2010.

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Chronic Kidney Disease — A Quiet Revolution in Nephrology – Six Case Studies – RAND – July 2010

Posted on July 26, 2010. Filed under: Nephrology | Tags: |

Chronic Kidney Disease — A Quiet Revolution in Nephrology – Six Case Studies – RAND – July 2010
 By: Richard A. Rettig, Roberto B. Vargas, Keith C. Norris, Allen R. Nissenson

“Examines changes in nephrology as it evolves from a focus on end-stage renal disease (ESRD) to the treatment of earlier stages of chronic kidney disease (CKD). Once patients reach ESRD, treatments are limited to kidney transplantation and dialysis. However, the progression of earlier stages of CKD can be slowed, halted, or reversed when treated. Data from 15 clinics focusing on CKD are examined, with the focus on six case studies. Clinics are still establishing best-practice models, and reimbursement remains a challenge. Recommendations also include widespread education for primary care physicians on how to interpret levels of kidney function and on referral of patients with decreased kidney function to nephrologists before ESRD is reached.”

Pages: 94
ISBN/EAN: 9780833049728

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Diagnosing and Treating Food Allergies: The State of the Research – RAND – June 2010

Posted on June 16, 2010. Filed under: Dietetics, Immunology and Allergy | Tags: |

Diagnosing and Treating Food Allergies: The State of the Research – RAND – June 2010
 
By: Jennifer J. Schneider Chafen, Sydne Newberry, Marc Riedl, Dena M. Bravata, Margaret Maglione, Marika Suttorp, Vandana Sundaram, Neil M. Paige, Ali Towfigh, Benjamin J. Hulley, Paul G. Shekelle

A systematic review of food allergy research found that the prevalence of food allergy in the United States appears to be between 1 and 10 percent, but estimates remain questionable because of poor reliability of the tests used for allergy diagnosis.

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Health Care on Aisle 7: The Growing Phenomenon of Retail Clinics – RAND Corporation – June 2010

Posted on June 16, 2010. Filed under: Primary Hlth Care | Tags: |

Health Care on Aisle 7: The Growing Phenomenon of Retail Clinics – RAND Corporation – June 2010
 
By: Ateev Mehrotra, John L. Adams, Katrina Armstrong, Christine Eibner, Peter S. Hussey, Judith Lave, Hangsheng Liu, Elizabeth A. McGlynn, Craig Evan Pollack, M. Susan Ridgely, Rena Rudavsky, Leif I. Solberg, N. Marcus Thygeson, Margaret C. Wang

Presents information on the growing phenomenon of retail medical clinics, the types of patients they serve and the types of care they provide, and whether some common claims about retail clinics are supported by evidence.

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Enhancing Public Health Emergency Preparedness for Special Needs Populations: A Toolkit for State and Local Planning and Response – RAND Corporation – June 2010

Posted on June 16, 2010. Filed under: Disaster Management | Tags: |

Enhancing Public Health Emergency Preparedness for Special Needs Populations: A Toolkit for State and Local Planning and Response – RAND Corporation – June 2010
 
By: Jeanne S. Ringel, Anita Chandra, Malcolm Williams, Karen A. Ricci, Alexandria Felton, David M. Adamson, Margaret M. Weden, Meilinda Huang

“Experiences from recent emergencies, such as Hurricanes Katrina and Rita, have shown that current emergency preparedness plans are inadequate to address the unique issues of special needs populations. This toolkit is meant to assist state and local public health agencies improve their emergency preparedness activities.”

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Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology – RAND – May 2010

Posted on May 27, 2010. Filed under: Health Technology Assessment | Tags: , |

Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology – RAND – May 2010
 
By: Anna-Marie Vilamovska
Pages: 291
Document Number: RGSD-239

“This study investigates whether an upcoming class of health information technology (HIT) can be used to address currently outstanding issues in the quality and cost of healthcare delivery. Expert interviews and a literature review were used to describe the 2009 universe of in- and outpatient healthcare RFID applications and to identify those applications expected to have the largest positive impact on the quality and cost-effectiveness of healthcare delivery over the next five to ten years. Next, case studies of actual RFID implementations across seven hospital sites in the U.S. and Europe were conducted to gain an understanding of how each leading RFID application type creates value, what aspects of care it impacts, and what the critical factors driving the promising RFID’s organizational benefits and costs are. As part of this work, an original set of healthcare RFID cost-benefit evaluation tools was developed and tested. The study’s findings indicate that in contrast to other types of HIT, the majority of benefits associated with successful RFID implementation are directly related to money saved (occurring as direct capital and operational cost savings), and that select RFID applications can substantially impact both the cost (e.g., efficiency) and the quality (e.g., timeliness, capacity for continuous improvement) of care delivery. Critical challenges for RFID adoption are described.”

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Improving the Quality of Care for Dementia – RAND Corporation – May 2010

Posted on May 19, 2010. Filed under: Aged Care / Geriatrics, Mental Health Psychi Psychol | Tags: , |

Improving the Quality of Care for Dementia – RAND Corporation – May 2010  
By: David Reuben, Carol P. Roth, Janet C. Frank, Susan H. Hirsch, Diane Katz, Heather McCreath, Jon Younger, Marta Murawski, Elizabeth Edgerly, Joanne Maher, Katie Maslow, Neil S. Wenger

Results of a pilot program in RAND Health’s Assessing Care of Vulnerable Elders-2 project indicate that quality indicators for dementia care are improved when primary care practices are coupled with links to local Alzheimer’s Association chapters.

Pages: 2
Document Number: RB-9530

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Funding intensive care — approaches in systems using diagnosis-related groups – RAND – May 2010

Posted on May 12, 2010. Filed under: Health Economics, Intensive Care | Tags: , , , |

Funding intensive care — approaches in systems using diagnosis-related groups – RAND – May 2010
 
By: Stefanie Ettelt, Ellen Nolte
Pages: 104
Document Number: TR-792-DH

This report reviews approaches to funding intensive care in health systems that use activity-based payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Mechanisms of funding intensive care services tend to fall into three broad categories: (1) those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy; (2) those that use DRGs in combination with co-payments (Victoria, France); and (3) those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). The review suggests that there is no obvious example of “best practice” or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment.

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In Search of the Holy Grail: Understanding Research Success – RAND – 2010

Posted on April 30, 2010. Filed under: Research | Tags: |

In Search of the Holy Grail: Understanding Research Success – RAND – 2010

By: Jonathan Grant, Steven Wooding
Pages: 16
Document Number: OP-295-GBF
Year: 2010

“This paper considers the continuing challenges facing research funders when trying to allocate research money. It focuses on the area of research policy in mental health research funding, with a particular emphasis on funding for schizophrenia research, and provides an overview of research policy in the last 20-25 years. It then goes on to consider what approaches funders could take to build an evidence base to support future decisions about funding. An earlier version of this paper was used to stimulate thinking prior to a workshop hosted by the Graham Boeckh Foundation in Montreal on 21 and 22 April 2009 to discuss these issues.”

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International benchmarking of healthcare quality: A review of the literature by: Ellen Nolte – RAND – 2010

Posted on March 3, 2010. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

International benchmarking of healthcare quality: A review of the literature by: Ellen Nolte – RAND – 2010
Pages: 62
Document Number: TR-738-DH

“There is growing interest in the systematic assessment and international benchmarking of quality of care provided in different healthcare systems, and major work is under way to support this process through the development and validation of quality indicators that can be used internationally.

Recognising that cross-national data comparison remains a challenge, there is now a considerable body of data that allow for comparisons of healthcare quality in selected areas of care. The report includes a description of existing indicators that could be used to compare healthcare quality in different countries, along with a discussion of specific problems in making comparisons at this level of detail. This is illustrated with case studies of two measures widely used for international comparisons: avoidable mortality and cancer survival. These show both the potential power of cross-national comparisons and some of the difficulties in drawing valid interpretations from the data.

The report focuses on the three quality domains identified as important by the NHS Next Stage Review High Quality Care for All, namely effectiveness of care, patient safety and patient experience. It is however important to recognise that access is an important additional component of quality which may be a key determinant of differences in outcome between different countries. Thus comparing quality across countries is only a first step to then assess the causes underlying those differences and determining what actions may be appropriate to take to improve health outcomes.”

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Capturing Research Impacts: A review of international practice – RAND – January 2010

Posted on January 28, 2010. Filed under: Research | Tags: |

Capturing Research Impacts: A review of international practice – RAND – January 2010
By: Jonathan Grant, Philipp-Bastian Brutscher, Susan Ella Kirk, Linda Butler, Steven Wooding
Pages: 90
Document Number: DB-578-HEFCE
Year: 2010

“In February 2009, the Higher Education Funding Council for England (HEFCE) commissioned RAND Europe to review approaches to evaluating the impact of research as part of their wider work programme to develop new arrangements for the assessment and funding of research — referred to as the Research Excellence Framework (REF). The objectives were 1) to review international practice in assessing research impact and 2) to identify relevant challenges, lessons and observations from international practice that help HEFCE develop a framework for assessing research impact. The report presents the findings of our review, based on four case study examples of impact evaluation approaches: the Australian RQF, the UK RAISS method, the US PART framework and the Dutch ERiC framework.”

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Policy options for Radio Frequency Identification (RFID) application in healthcare; a prospective view – RAND – January 2010

Posted on January 28, 2010. Filed under: Health Informatics, Health Technology Assessment | Tags: |

Policy options for Radio Frequency Identification (RFID) application in healthcare; a prospective view
Final report (D5)
By: Constantijn van Oranje-Nassau, Helen Rebecca Schindler, Maarten Botterman
Pages: 90
Document Number: TR-767-EC
Year: 2010

“This report reviews the state of play of European markets and applications of Radio Frequency Identification technology (RFID) in healthcare in Europe. Based on the current situation the report presents three scenarios for 2020, to describe futures in which the technology and health care sectors develop in different ways. The scenarios were discussed in expert workshops to derive issues that need to be addressed by future policies of the European Union and other stakeholders. The market assessment is based on a review of literature and an analysis of proprietary market data. The chapter on the state of RFID applications in Health in Europe summarises the results of a literature review, an online Delphi survey, expert interviews and seven cases studies in Europe and the US. The policy analysis is based on the outcomes of a scenario gaming workshop with experts from academia, industry, healthcare providers, policymakers and representatives of patient organisations.”

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The Teen Depression Awareness Project – RAND – January 2010

Posted on January 28, 2010. Filed under: Mental Health Psychi Psychol | Tags: |

The Teen Depression Awareness Project
Building an Evidence Base for Improving Teen Depression Care
By: Lisa H. Jaycox, Bradley D. Stein, Susan M. Paddock, Jeremy N. V. Miles, Anita Chandra, Lisa S. Meredith, Terri Tanielian, Scot Hickey, M. Audrey Burnam, Molly M. Scott, Virginia P. Quinn

Pages: 6
Document Number: RB-9495
Year: 2010

Presents findings from the Teen Depression Awareness Project, which explored how depression affects teens, the factors that influence teens’ readiness to seek treatment for depression, and the barriers that teens and parents face when seeking care.

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CAHPS Item Set for Addressing Health Literacy – Consumer Assessment of Healthcare Providers and Systems (CAHPS) – US

Posted on January 7, 2010. Filed under: Patient Participation | Tags: , |

CAHPS Item Set for Addressing Health Literacy –  Consumer Assessment of Healthcare Providers and Systems (CAHPS)
 
“The CAHPS Consortium, led by RAND, has developed a supplemental set for the CAHPS Clinician & Group Survey that focuses on assessing providers’ activities to foster and improve the health literacy of patients. Health literacy is commonly defined as patients’ ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions. While health literacy depends in part on individuals’ skills, it also depends on the complexity of health information and how it is communicated.
 
The primary goal of the CAHPS Item Set for Addressing Health Literacy is to measure, from the patients’ perspective, how well health information is communicated to them by health care professionals. This work on promoting health literacy is part of the Agency for Healthcare Research and Quality’s continuing efforts to encourage a greater emphasis in the provider community on patient-centered care. “

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