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.

Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership

Abstract: Background. Recent work has highlighted a negative correlation between proprietary status and nursing home quality of care. This relationship might be explained by the context in which proprietary homes operate. However, another possible explanation is that some proprietary homes take excessive profit to the detriment of care quality. Objective. To examine the relationship between profit levels and quality in proprietary and nonproprietary nursing homes (NHs), accounting for resident and market characteristics. Methods. Data on 1098 free-standing NHs were taken from the California Office of State-wide Health Planning and Development, the On-line Survey Certification and Reporting System, and California licensing and statistical reports for 1998 and 1999. Tobit multivariate techniques were used to examine the relationship between deficiency citations and a range of explanatory variables, including profit. Results. Proprietary homes in California had significantly lower quality of care than nonproprietary homes. A stratified analysis revealed that, controlling for resident, facility, and market characteristics, profits located within the highest 14% of the proprietary sector's profit distribution were associated with significantly more total deficiencies and serious deficiencies. This relationship was not found in nonproprietary facilities. Other factors related to deficiencies included the ethnic mix of residents and facility size. Conclusions. Within the context in which proprietary homes operate, profit above a given threshold is associated with a higher number of deficiencies. Given this and the role of the proprietary sector in NH care, careful monitoring of profit levels in this sector appears warranted.

Are The Young Becoming More Disabled

Abstract: This paper investigates trends in disability in the U.S. population, particularly among people under age fifty. Even as the elderly have become less disabled, reported disability has risen for younger Americans, especially those ages 30–49. We suggest some possible explanations for rising disability levels, such as obesity, technological advances in medicine, and changing disability insurance laws. Obesity and its attendant disorders seem particularly associated with these trends, although the data are not definitive. Whatever its sources, rising disability among the young could have adverse consequences for public programs such as disability insurance, Medicare, and Medicaid.

Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development

Abstract: Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions.

Thinking Globally, Acting Locally - The U.S. Response to Covid-19.

Abstract: Thinking Globally, Acting Locally The defining feature of the U.S. response to Covid-19 has been localized action against a global threat. Under our federalist system, what more can the federal gov...

Empirical Bayes on vector observations: An extension of Stein's method

Abstract: SUMMARY The statistician is considering several independent normal linear models with identical structures, and desires to estimate the vector of unknown parameters in each of them. An estimator is constructed which dominates the usual Gauss-Markov estimator in terms of total squared error loss. This estimator is shown to have good efficiency in the Bayesian situation where the parameter vectors themselves have a normal prior distribution. A practical example is given.