RAND Corporation

About: RAND Corporation is a nonprofit organization based out in Santa Monica, California, United States. It is known for research contribution in the topics: Health care & Population. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

Diet and Perceptions Change with Supermarket Introduction in a Food Desert, but Not Because of Supermarket Use

Abstract: Placing full-service supermarkets in food deserts--areas with limited access to healthy food--has been promoted as a way to reduce inequalities in access to healthy food, improve diet, and reduce the risk of obesity. However, previous studies provide scant evidence of such impacts. We surveyed households in two Pittsburgh, Pennsylvania, neighborhoods in 2011 and 2014, one of which received a new supermarket in 2013. Comparing trends in the two neighborhoods, we obtained evidence of multiple positive impacts from new supermarket placement. In the new supermarket neighborhood we found net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket was improved perceived access to healthy food. We did not observe differential improvement between the neighborhoods in fruit and vegetable intake, whole grain consumption, or body mass index. Incentivizing supermarkets to locate in food deserts is appropriate. However, efforts should proceed with caution, until the mechanisms by which the stores affect diet and their ability to influence weight status are better understood.

Recurrence of high-risk bladder cancer: a population-based analysis.

Abstract: BACKGROUND Patients with bladder cancer are apt to develop multiple recurrences that require intervention. The recurrence, progression, and bladder cancer–related mortality rates were examined in a cohort of individuals with high-grade non–muscle-invasive bladder cancer. METHODS Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, subjects were identified who had a diagnosis of high-grade, non–muscle-invasive disease in 1992 to 2002 and who were followed until 2007. Multivariate competing-risks regression analyses were then used to examine recurrence, progression, and bladder cancer–related mortality rates. RESULTS Of 7410 subjects, 2897 (39.1%) experienced a recurrence without progression, 2449 (33.0%) experienced disease progression, of whom 981 succumbed to bladder cancer. Using competing-risks regression analysis, the 10-year recurrence, progression, and bladder cancer–related mortality rates were found to be 74.3%, 33.3%, and 12.3%, respectively. Stage T1 was the only variable associated with a higher rate of recurrence. Women, black race, undifferentiated grade, and stage Tis and T1 were associated with a higher risk of progression and mortality. Advanced age (≥ 70) was associated with a higher risk of bladder cancer–related mortality. CONCLUSIONS Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within 10 years of their diagnosis. Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer. Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first 2 years of diagnosis warrants an intense surveillance schedule. Cancer 2013;119:3219–3227. © 2013 American Cancer Society.

Assessing care of vulnerable elders: methods for developing quality indicators.

Abstract: Quality of care can be measured by using either processes or outcomes. Each method has its strengths and limitations (1). With the concurrence of the Assessing Care of Vulnerable Elders (ACOVE) Policy Advisory Committee (2), we chose to assess the care of vulnerable elders by using processes rather than outcomes. We did so because 1) processes are a more efficient measure of quality; 2) for most conditions there are insufficient information in the medical record and a paucity of validated models to adequately adjust outcomes for differences in case mix between providers; and 3) ultimately, processes of care are amenable to direct action by providers. To be a valid measure of quality, a health care process must be strongly linked to an outcome that is important to patients. Ideally, high-quality published studies would link performance of all such processes to outcomes; however, few health care processes are supported by high-quality evidence (3). Even when a process is supported by strong evidence from randomized clinical trials, the inclusion and exclusion criteria of the clinical trials leave the evidence directly applicable to only a narrow group of patients (4, 5). This is particularly true for vulnerable elders, who are typically excluded from clinical trials (6). Therefore, as we developed the ACOVE quality indicators, we used expert opinion to interpret the available evidence for applicability to vulnerable elders. Our methods entailed a literature review and several levels of expert opinion (Figure), which we explain in detail.