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: Population & Health care. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care

Abstract: Importance Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified. Objective To quantify the prevalence and cost of treatment perceived to be futile in adult critical care. Design, Setting, and Participants To develop a common definition of futile care, we convened a focus group of clinicians who care for critically ill patients. On a daily basis for 3 months, we surveyed critical care specialists in 5 intensive care units (ICUs) at an academic health care system to identify patients whom the physicians believed were receiving futile treatment. Using a multivariate model, we identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. We estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs. Main Outcome and Measure Prevalence of patients perceived to be receiving futile treatment. Results During a 3-month period, there were 6916 assessments by 36 critical care specialists of 1136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment, 123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range, 1-58 days), accounting for 6.7% of all assessed patient days in the 5 ICUs studied. Eighty-four of the 123 patients perceived as receiving futile treatment died before hospital discharge and 20 within 6 months of ICU care (6-month mortality rate of 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million. Conclusions and Relevance In 1 health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.

Fostering the Use of Educational Technology: Elements of a National Strategy

Abstract: The nation's most important educational goal must be to produce learners adequately prepared for life and work in the 21st century. Computer- and network-based technology will play a key role in reaching that goal. In 1983, there was about one computer for every 125 students in the nation's public schools. By 1995, there was one computer for every nine students. In 1994, U.S. schools spent about $3 billion on computer- and network-based technology. Despite all this activity, however, examples of schoolwide use of technology are comparatively rare and isolated. This report identifies principles for guiding public officials, educators, and others concerned with increasing the use of technology to improve the performance of schools and school systems. Prepared as a result of RAND's Critical Technologies Institute (CTI) participation in federal efforts to plan a research agenda and develop a national educational technology plan, it is based upon a series of workshops, interviews, and literature reviews. This report takes stock of the current status of the use of technology by U.S. public elementary and secondary schools and suggests some of the challenges that face educators, policymakers, and producers of educational technology and software as they seek to expand and deepen the use of technology in schools.

Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending

Abstract: The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health...

Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results-Medicare analysis.

Abstract: BACKGROUND: Single-institution series have documented the adverse impact of a 12-week delay between resection of muscle-invasive bladder cancer and radical cystectomy. These data are derived from tertiary centers, in which referral populations may confound outcomes. The authors sought to examine the survival impact of a delay in radical cystectomy using nationally representative data. METHODS: From the linked Surveillance, Epidemiology, and End Results–Medicare dataset, the authors identified subjects with stage II transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy between 1992 and 2001. They examined delays of 8, 12, and 24 weeks and incorporated these delay cutoffs into multivariate Cox proportional hazards survival models. Covariates included age, race/ethnicity, marital status, Charlson comorbidity index, and cancer grade. RESULTS: The authors identified 441 subjects with stage II TCC who underwent cystectomy during the study period. Compared with immediate surgery (ie, within 4-8 weeks of transurethral resection), longer time to cystectomy increased the risk of both disease-specific and overall mortality (hazard ratio [HR], 2.0; P < .01 and HR, 1.6; P < .01, respectively, for those delayed 12-24 weeks; HR, 2.0; P < .01 for disease-specific and overall death among those delayed beyond 24 weeks 1 year after diagnosis). Covariates associated with overall mortality included older age (HR, 1.04; P < .01) and comorbidity (HR, 2.0 for Charlson ≥3 vs Charlson 0-1; P < .01). CONCLUSIONS: Delay in definitive surgical treatment beyond 12 weeks conferred an increased risk of disease-specific and all-cause mortality among subjects with stage II bladder cancer. Cancer 2009. © 2009 American Cancer Society.