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.

Measuring underuse of necessary care among elderly medicare beneficiaries using inpatient and outpatient claims

Abstract: ContextContinuing changes in the health care delivery system make it essential to monitor underuse of needed care, even for relatively well-insured populations. Traditional approaches to measuring underuse have relied on patient surveys and chart reviews, which are expensive, or simple single-condition claims-based indicators, which are not clinically convincing.ObjectiveTo develop a comprehensive, low-cost system for measuring underuse of necessary care among elderly patients using inpatient and outpatient Medicare claims.DesignA 7-member, multispecialty expert physician panel was assembled and used a modified Delphi method to develop clinically detailed underuse indicators likely to be associated with avoidable poor outcomes for 15 common acute and chronic medical and surgical conditions. An automated system was developed to calculate the indicators using administrative data.Setting and SubjectsA total of 345,253 randomly selected elderly US Medicare beneficiaries in 1994-1996.Main Outcome MeasuresProportion of beneficiaries receiving care, stratified by indicators of necessary care (n = 40, including 3 for preventive care), and avoidable outcomes (n = 6).ResultsFor 16 of 40 necessary care indicators (including preventive care indicators), beneficiaries received the indicated care less than two thirds of the time. Of all indicators, African Americans scored significantly worse than whites on 16 and better on 2; residents of poverty areas scored significantly lower than nonresidents on 17 and higher on 1; residents of federally defined Health Professional Shortage Areas scored significantly lower than nonresidents on 16 and higher on none (P<.05 for all).ConclusionsThis claims-based method detected substantial underuse problems likely to result in negative outcomes in elderly populations. Significantly more underuse problems were detected in populations known to receive less-than-average medical care. The method can serve as a reliable, valid tool for monitoring trends in underuse of needed care for older patients and for comparing care across health care plans and geographic areas based on claims data.

Crowdsourcing based business models: In search of evidence for innovation 2.0

Abstract: Open innovation has gained increased attention as a potential paradigm for improving innovation performance. This paper addresses crowdsourcing, an under-researched type of open innovation that is often enabled by the web. We focus on a type of crowdsourcing where financial rewards exist, where a crowd is tasked with solving problems which solution seekers anticipate to be empirically provable, but where the source of solutions is uncertain and addressing the challenge in-house perceived to be too high-risk. There is a growing recourse to crowdsourcing, but we really know little about its effectiveness, best practices, challenges and implications. We consider the shift to more open innovation trajectories over time, define crowdsourcing as an open innovation model, and clarify how crowdsourcing differs from other types of 'open' innovation (e.g. outsourcing and open-source). We explore who is crowdsourcing and how, looking at the potential diversity and core features and variables implicated in crowdsourcing models.

Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review

Abstract: BACKGROUND: Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States. METHODS: Data sources included PubMed, Advisory Committee on Immunization Practices statements, package inserts, existing reviews, manufacturer information packets, and the 2011 Institute of Medicine consensus report on vaccine safety. We augmented the Institute of Medicine report with more recent studies and increased the scope to include more vaccines. Only studies that used active surveillance and had a control mechanism were included. Formulations not used in the United States were excluded. Adverse events and patient and vaccine characteristics were abstracted. Adverse event collection and reporting was evaluated by using the McHarm scale. We were unable to pool results. Strength of evidence was rated as high, moderate, low, or insufficient. RESULTS: Of 20 478 titles identified, 67 were included. Strength of evidence was high for measles/mumps/rubella (MMR) vaccine and febrile seizures; the varicella vaccine was associated with complications in immunodeficient individuals. There is strong evidence that MMR vaccine is not associated with autism. There is moderate evidence that rotavirus vaccines are associated with intussusception. Limitations of the study include that the majority of studies did not investigate or identify risk factors for AEs; and the severity of AEs was inconsistently reported. CONCLUSIONS: We found evidence that some vaccines are associated with serious AEs; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide.

Response burden, reliability, and validity of the CAGE, Short MAST, and AUDIT alcohol screening measures

Abstract: We administered the CAGE, the Short MAST, and the AUDIT to 832 clients at drinking driver treatment programs in Southern California. Correlations among the alcohol screening measures ranged from 0.62 (CAGE and AUDIT) to 0.70 (CAGE and Short MAST). As expected, response time for the CAGE was quicker than for the Short MAST and the AUDIT, but the internal consistency reliability of the CAGE was the lowest and the standard error of measurement largest. Moreover, greater support was found for the relative validity of the Short MAST and AUDIT than the CAGE. The CAGE provides a substantial amount of information quickly, but more reliable and valid information can be obtained with the short MAST or AUDIT measures, which require an additional 1-2 min to administer.

A systematic review of measures of end-of-life care and its outcomes.

Abstract: For the vast majority of Americans, the end of life includes a prolonged experience of chronic progressive disease, often associated with uncertainty, pain, suffering, and cost (Hogan et al. 2000; Lunney et al. 2003; National Consensus Project 2004; Teno 2005). For these reasons, coupled with an expansion of knowledge and research in managing and improving the dying experience, end-of-life care has been designated as a priority area for quality improvement, policy change and implementation, and cost effectiveness of work (Institute of Medicine 1997; Institute for the Future 2003; National Consensus Project 2004). In order to address end-of-life care, clinicians, administrators, researchers, and policy makers need to be able to evaluate the patient and caregiver experience. However, end-of-life care is not a singular entity with a universal experience and well agreed upon course of care. Prognostication is poor and imprecise for most conditions, and patients and caregivers cope with illness for years, often with different trajectories of functional decline and needs (Lynn et al. 1997; Steinhauser et al. 2000, 2001; Patrick, Engelberg, and Curtis 2001; Lunney et al. 2003; Patrick et al. 2003; National Consensus Project 2004). The differing patterns of decline, as well as variable factors such as age, race, gender, culture, and preferences, suggest the need for diverse measures to assess the full spectrum of patients' and caregivers' end-of-life experience. From the health care system and policy perspective, it is also useful to consider the role of settings of care such as nursing homes, hospitals, home care, or hospice all play important roles and face different challenges in delivering care. Substantial consensus derived from expert opinion and confirmed through nationally representative surveys of patients, families, and providers has established the principle domains to guide evaluation of the end-of-life experience (Hanson, Danis, and Garrett 1997; Lynn et al. 1997; Singer, Martin, and Kelner 1999; Steinhauser et al. 2000, 2001; Patrick, Engelberg, and Curtis 2001; Patrick et al. 2003; Wenrich et al. 2003; National Consensus Project 2004; Teno et al. 2004). Patients and families endorse important concerns including the extent to which care addresses pain and other physical and emotional symptoms, advance care planning, continuity of care, spiritual well-being, practical support for caregiving, and overall satisfaction. End-of-life care and palliative care have evolved over the last two decades to apply increasingly rigorous scientific methods to assess outcomes in these domains (National Consensus Project 2004; Teno 2005). Developing an adequate evidence base for improving end-of-life care requires reliable and valid measures of the patient and caregiver experience that also allow for comparability across the important care settings, populations, and clinical conditions. As a part of systematic review of end-of-life care and outcomes, we identified measures that evaluate domains of the patient and caregiver experience and described their psychometric properties. Our objectives were to characterize measures that are available for evaluating end-of-life care and to characterize their use in the highest quality intervention studies that have been conducted in the field.