Showing papers by "RAND Corporation published in 2005"

Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs

Abstract: To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.

Meta-Analysis: Chronic Disease Self-Management Programs for Older Adults

Abstract: The authors examined studies of the effectiveness of self-management programs for osteoarthritis, hypertension, and diabetes mellitus. Self-management programs appear to produce clinically importan...

Meta-analysis: Pharmacologic Treatment of Obesity

Abstract: This meta-analysis of studies of pharmacologic treatment of obesity supports the American College of Physicians' clinical guideline in this issue Sibutramine, orlistat, phentermine, bupropion, and

Entry by Spinoffs

Abstract: Entry by spinoffs from incumbent firms is investigated for the laser industry. A model in which spinoffs exploit knowledge from their parents is constructed to explain the market conditions conducive to spinoffs, the types of firms that spawn spinoffs, and the relationship of spinoffs to their parents. The model is tested using detailed data on all laser entrants from the start of the industry through 1994. Our findings support the basic premise of the model that spinoffs inherit knowledge from their parents that shapes their nature at birth. Implications of our findings for organizational behavior, business strategy, entry and industry evolution, and technological change are discussed.

Early Childhood Interventions: Proven Results, Future Promise.

Abstract: This book presents a review and synthesis of current research that addresses the potential for various forms of early childhood intervene to improve outcomes for participating children and their families.

Mental health of Cambodian refugees 2 decades after resettlement in the United States

Abstract: ContextLittle is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in host countries.ObjectiveTo assess the prevalence, comorbidity, and correlates of psychiatric disorders in the US Cambodian refugee community.Design, Setting, and ParticipantsA cross-sectional, face-to-face interview conducted in Khmer language on a random sample of households from the Cambodian community in Long Beach, Calif, the largest such community in the United States, between October 2003 and February 2005. A total of 586 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993 were selected. One eligible individual was randomly sampled from each household, with an overall response rate (eligibility screening and interview) of 87% (n = 490).Main Outcome MeasuresExposure to trauma and violence before and after immigration (using the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence); weighted past-year prevalence rates of posttraumatic stress disorder (PTSD) and major depression (using the Composite International Diagnostic Interview version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification Test).ResultsAll participants had been exposed to trauma before immigration. Ninety-nine percent (n = 483) experienced near-death due to starvation and 90% (n = 437) had a family member or friend murdered. Seventy percent (n = 338) reported exposure to violence after settlement in the United States. High rates of PTSD (62%, weighted), major depression (51%, weighted), and low rates of alcohol use disorder were found (4%, weighted). PTSD and major depression were highly comorbid in this population (n = 209; 42%, weighted) and each showed a strong dose-response relationship with measures of traumatic exposure. In bivariate analyses, older age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty were also associated with higher rates of PTSD and major depression. Following multivariate analyses, premigration trauma remained associated with PTSD (odds ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI, 1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR, 1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89).ConclusionMore than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma.

A meta-analysis of interventions to improve care for chronic illnesses.

Abstract: OBJECTIVE The Chronic Care Model (CCM) is a framework aimed at improving chronic illness care. We used empirical data from previously published literature to address two research questions: 1) do interventions that incorporate one or more elements of the CCM result in improved outcomes of interest for specific chronic illnesses; and 2) are any elements essential for improved outcomes?

Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial.

Abstract: ContextDepression is a common condition associated with significant morbidity in adolescents. Few depressed adolescents receive effective treatment for depression in primary care settings.ObjectiveTo evaluate the effectiveness of a quality improvement intervention aimed at increasing access to evidence-based treatments for depression (particularly cognitive-behavior therapy and antidepressant medication), relative to usual care, among adolescents in primary care practices.Design, Setting, and ParticipantsRandomized controlled trial conducted between 1999 and 2003 enrolling 418 primary care patients with current depressive symptoms, aged 13 through 21 years, from 5 health care organizations purposively selected to include managed care, public sector, and academic medical center clinics in the United States.InterventionUsual care (n = 207) or 6-month quality improvement intervention (n = 211) including expert leader teams at each site, care managers who supported primary care clinicians in evaluating and managing patients’ depression, training for care managers in manualized cognitive-behavior therapy for depression, and patient and clinician choice regarding treatment modality. Participating clinicians also received education regarding depression evaluation, management, and pharmacological and psychosocial treatment.Main Outcome MeasuresDepressive symptoms assessed by Center for Epidemiological Studies-Depression Scale (CES-D) score. Secondary outcomes were mental health–related quality of life assessed by Mental Health Summary Score (MCS-12) and satisfaction with mental health care assessed using a 5-point scale.ResultsSix months after baseline assessments, intervention patients, compared with usual care patients, reported significantly fewer depressive symptoms (mean [SD] CES-D scores, 19.0 [11.9] vs 21.4 [13.1]; P = .02), higher mental health–related quality of life (mean [SD] MCS-12 scores, 44.6 [11.3] vs 42.8 [12.9]; P = .03), and greater satisfaction with mental health care (mean [SD] scores, 3.8 [0.9] vs 3.5 [1.0]; P = .004). Intervention patients also reported significantly higher rates of mental health care (32.1% vs 17.2%, P<.001) and psychotherapy or counseling (32.0% vs 21.2%, P = .007).ConclusionsA 6-month quality improvement intervention aimed at improving access to evidence-based depression treatments through primary care was significantly more effective than usual care for depressed adolescents from diverse primary care practices. The greater uptake of counseling vs medication under the intervention reinforces the importance of practice interventions that include resources to enable evidence-based psychotherapy for depressed adolescents.

Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans?

Abstract: Objectives: This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans. Methods: We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States. Results: A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociodemographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, men’s attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior. Conclusions: HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.

Self-Control, Violent Offending, and Homicide Victimization: Assessing the General Theory of Crime

Abstract: Criminologists have long recognized that offending and victimization share common ground. Using Gottfredson and Hirschi’s general theory of crime, with its emphasis on self-control as a theoretical backdrop, we examine the extent to which self-control is related to both violent offending and homicide victimization. To examine this issue, we use 5-year post-parole data on violent offending and homicide victimization from a sample of parolees from the California Youth Authority. Using rare-events logistic regression models, results indicate that self-control is related to each outcome, but that other risk factors are also uniquely related to each outcome. The implications of this study for theory and future research are addressed.

The Impact of Childhood Health on Adult Labor Market Outcomes.

Abstract: This paper examines impacts of childhood health on SES outcomes observed during adulthood-levels and trajectories of education, family income, household wealth, individual earnings and labor supply. The analysis is conducted using data that collects these SES measures in a panel who were originally children and who are now well into their adult years. Since all siblings are in the panel, one can control for unmeasured family and neighborhood background effects. With the exception of education, poor childhood health has a quantitatively large effect on all these outcomes. Moreover, these estimated effects are larger when unobserved family effects are controlled. (JEL codes; I10, J00).

The Aging, Demographics, and Memory Study: study design and methods.

Abstract: Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outco

Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment

Abstract: Aims To examine the relationship between exposure to different forms of alcohol advertising and subsequent drinking among US adolescents and assess whether exposure to an alcohol and drug prevention program mitigates any such relationship. Design Regression models with multiple control variables examined the relationship between exposure to alcohol advertising in grade 8 and grade 9 drinking for two groups of South Dakotan adolescents: (1) seventh-grade non-drinkers (n = 1206) and (2) seventh-grade drinkers (n = 1905). Interactions between the intervention program and the significant advertising predictors were tested. Setting Forty-one middle schools in South Dakota, USA. Participants A total of 3111 seventh-graders followed through grade 9. Measurements Advertising variables were constructed for four types of alcohol advertising—television, in-store displays, magazines and concession stands. Other predictors tested included measures tapping social influences, social bonds, problem behavior, alcohol beliefs, television exposure and demographics. Findings For seventh-grade non-drinkers, exposure to in-store beer displays predicted drinking onset by grade 9; for seventh-grade drinkers, exposure to magazines with alcohol advertisements and to beer concession stands at sports or music events predicted frequency of grade 9 drinking. Although exposure to television beer advertising had a significant bivariate relationship with alcohol use for grade 7 non-drinkers, it was not a significant predictor of drinking for either group in multivariate analyses. Participation in the prevention program, ALERT Plus, reduced future drinking for both groups and counteracted the effect of in-store beer displays. Conclusions Several forms of alcohol advertising predict adolescent drinking; which sources dominate depends on the child's prior experience with alcohol. Alcohol prevention programs and policies should help children counter alcohol advertising from multiple sources and limit exposure to these sources.

A New and Improved Design for Multiobject Iterative Auctions

Abstract: In this paper we present a new improved design for multiobject auctions and report on the results of experimental tests of that design. We merge the better features of two extant but very different auction processes, the Simultaneous Multiple Round (SMR) design used by the FCC to auction the electromagnetic spectrum and the Adaptive User Selection Mechanism (AUSM) of Banks et al. (1989, "Allocating uncertain and unresponsive resources: An experimental approach," RAND Journal of Economics, Vol. 20, No. 1, pp. 1-25). Then, by adding one crucial new feature, we are able to create a new design, the Resource Allocation Design (RAD) auction process, which performs better than both. Our experiments demonstrate that the RAD auction achieves higher efficiencies, lower bidder losses, higher net revenues, and faster times to completion without increasing the complexity of a bidder's problem.

Does WIC work? The effects of WIC on pregnancy and birth outcomes.

Abstract: Support for WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children, is based on the belief that "WIC works." This consensus has lately been questioned by researchers who point out that most WIC research fails to properly control for selection into the program. This paper evaluates the selection problem using rich data from the national Pregnancy Risk Assessment Monitoring System. We show that relative to Medicaid mothers, all of whom are eligible for WIC, WIC participants are negatively selected on a wide array of observable dimensions, and yet WIC participation is associated with improved birth outcomes, even after controlling for observables and for a full set of state-year interactions intended to capture unobservables that vary at the state-year level. The positive impacts of WIC are larger among subsets of even more disadvantaged women, such as those who received public assistance last year, single high school dropouts, and teen mothers.

Substance use Trajectories from Early Adolescence to Emerging Adulthood: A Comparison of Smoking, Binge Drinking, and Marijuana use:

Abstract: Over the past several years, there has been growing interest in identifying distinct developmental trajectories of substance use. Using data from the RAND Adolescent/Young Adult Panel Study (N = 6,527), we synthesize our prior findings on patterns of smoking, binge drinking, and marijuana use from early adolescence (age 13) to emerging adulthood (age 23). We also present new data on how these trajectory classes compare on key psychosocial and behavioral outcomes during emerging adulthood. For each type of substance use, we found two periods of vulnerability: early adolescence and the transition to emerging adulthood. As expected, early users were at relatively high risk for poor outcomes at age 23 compared to consistent low-level users and abstainers, even if they reduced their use during adolescence. However, youths who were not early users, but steadily increased their use over time, also tended to be at relatively high risk. Results suggest that multiple prevention approaches might be needed to success...

A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder

Abstract: Objective: To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting. Design: Randomized, controlled study comparing intervention to treatment as usual. Setting: Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population. Participants: Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be provided and were not acutely life threatening. Intervention: Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitivebehavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist. Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy. Main Outcomes Measures: Proportion of subjects remitted (no panic attacks in the past month, minimal anticipatory anxiety, and agoraphobia subscale score 10 on Fear Questionnaire) and responding (Anxiety Sensitivity Index score 20) and change over time in World Health Organization Disability Scale and short form 12 scores. Results: The combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores. These effects were obtained in spite of similar rates of delivery of guideline-concordant pharmacotherapy to the 2 groups. Conclusion: Delivery of evidence-based CBT and medication using the collaborative care model and a CBTnaive, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder. Arch Gen Psychiatry. 2005;62:290-298

Influence of ambient (outdoor) sources on residential indoor and personal PM2.5 concentrations: analyses of RIOPA data.

Abstract: The Relationship of Indoor, Outdoor and Personal Air (RIOPA) study was designed to investigate residential indoor, outdoor and personal exposures to several classes of air pollutants, including volatile organic compounds, carbonyls and fine particles (PM2.5). Samples were collected from summer, 1999 to spring, 2001 in Houston (TX), Los Angeles (CA) and Elizabeth (NJ). Indoor, outdoor and personal PM2.5 samples were collected at 212 nonsmoking residences, 162 of which were sampled twice. Some homes were chosen due to close proximity to ambient sources of one or more target analytes, while others were farther from sources. Median indoor, outdoor and personal PM2.5 mass concentrations for these three sites were 14.4, 15.5 and 31.4 microg/m3, respectively. The contributions of ambient (outdoor) and nonambient sources to indoor and personal concentrations were quantified using a single compartment box model with measured air exchange rate and a random component superposition (RCS) statistical model. The median contribution of ambient sources to indoor PM2.5 concentrations using the mass balance approach was estimated to be 56% for all study homes (63%, 52% and 33% for California, New Jersey and Texas study homes, respectively). Reasonable variations in model assumptions alter median ambient contributions by less than 20%. The mean of the distribution of ambient contributions across study homes agreed well for the mass balance and RCS models, but the distribution was somewhat broader when calculated using the mass balance model with measured air exchange rates.

Inequality in Life Spans and a New Perspective on Mortality Convergence Across Industrialized Countries

Abstract: The second half of the twentieth century witnessed much convergence in life expectancy around the world. We examine differences in the age pattern of mortality between countries over time to show that inequality in adult life spans, which we measure with the standard deviation of life table ages at death above age 10, S10, is increasingly responsible for the remaining divergence in mortality. We report striking differences in level and trend of S10 across industrialized countries since 1960, which cannot be explained by aggregate socioeconomic inequality or differential external-cause mortality. Rather, S10 reflects both within and between-group inequalities in life spans and conveys new information about their combined magnitudes and trends. These findings suggest that the challenge for health policies in this century is to reduce inequality, not just lengthen life.

Problem-solving skills and affective expressions as predictors of change in marital satisfaction.

Abstract: Specific skills and affective expressions coded from the problem-solving interactions of 172 newlywed couples were examined in relation to 8-wave, 4-year trajectories of marital satisfaction. Effects varied as a function of whether husbands' versus wives' topics were under discussion and whether husbands' versus wives' satisfaction was predicted, but results indicate that skills, affect, and their statistical interaction account for unique variance in rates of change in marital satisfaction. The interaction between positive affect and negative skills was particularly robust, indicating that (a) low levels of positive affect and high levels of negative skills foreshadowed particularly rapid rates of deterioration and that (b) high levels of positive affect buffered the effects of high levels of negative skills. Findings suggest specific targets for intervention in programs for developing marriages.

Insurance status and access to urgent ambulatory care follow-up appointments.

Abstract: ContextThere is growing pressure to avoid hospitalizing emergency department patients who can be treated safely as outpatients, but this strategy depends on timely access to follow-up care.ObjectiveTo determine the association between reported insurance status and access to follow-up appointments for serious conditions that are commonly identified during an emergency department visit.Design, Setting, and ParticipantsEight research assistants called 499 randomly selected ambulatory clinics in 9 US cities (May 2002–February 2003) and identified themselves as new patients who had been seen in an emergency department and needed an urgent follow-up appointment (within 1 week) for 1 of 3 clinical vignettes (pneumonia, hypertension, or possible ectopic pregnancy). The same person called each clinic twice using the same clinical vignette but different insurance status.Main Outcome MeasureProportion of callers who were offered an appointment within a week.ResultsOf 499 clinics contacted in the final sample, 430 completed the study protocol. Four hundred six (47.2%) of 860 total callers and 277 (64.4%) of 430 privately insured callers were offered appointments within a week. Callers who claimed to have private insurance were more likely to receive appointments than those who claimed to have Medicaid coverage (63.6% [147/231] vs 34.2% [79/231]; difference, 29.4 percentage points; 95% confidence interval, 21.2-37.6; P<.001). Callers reporting private insurance coverage had higher appointment rates than callers who reported that they were uninsured but offered to pay $20 and arrange payment of the balance (65.3% [130/199] vs 25.1% [50/199]; difference, 40.2; 95% confidence interval, 31.4-49.1; P<.001). There were no differences in appointment rates between callers who claimed to have private insurance coverage and those who reportedly were uninsured but willing to pay cash for the entire visit fee (66.3% [132/199] vs 62.8% [125/199]; difference, 3.5; 95% confidence interval −3.7 to 10.8; P = .31). The median charge was $100 (range, $25-$600). Seventy-two percent of clinics did not attempt to determine the severity of the caller’s condition.ConclusionsReported insurance status is associated with access to timely follow-up ambulatory care for potentially serious conditions. Having private insurance and being willing to pay cash may not eliminate the difficulty in obtaining urgent follow-up appointments.

Welfare-Enhancing Technological Change and the Growth of Obesity.

Abstract: The theory explores how technological change can produce obesity as an unintended consequence of economic development, which reduces food prices and the strenuousness of work. The empirical analysis presents a specific example of how food-price declines can improve health and well-being, even in a developed country.

Regional Differences in the Price-Elasticity of Demand For Energy

Abstract: The object of this report is to determine whether the relationship between price and demand differs at the regional, state, and sub-state level and to assess whether the Department of Energy should explore a similar disaggregation of data when estimating the benefits of energy-efficient technologies.

The PedsQL: reliability and validity of the short-form generic core scales and Asthma Module.

Abstract: Objective:We sought to assess the reliability and validity of the PedsQL™ 4.0 SF15, a shortened version of the 23-item PedsQL™ 4.0 Generic Core Scales, which is a pediatric health-related quality of life (HRQoL) instrument, and the PedsQL™ 3.0 SF22 Asthma Module, a short-form of the PedsQL™ 3.0 Asth

Strategic hedging and the future of Asia‐pacific stability

Abstract: Because Washington and Beijing are both hedging their security bets about the other at precisely the time that the East Asian regional order is being redefined, reciprocal hedging today could precipitate a shift toward rivalry and regional instability unless it is carefully managed.