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.

Pathways to independent living in early adulthood: marriage, semiautonomy, and premarital residential independence.

Abstract: Data from the National Longitudinal Study of the High School Class of 1972 are used to examine factors influencing young adults' departure from the parental home and the initial pathways taken, including leaving home for marriage, residential semi-autonomy (Semi), and premarital residential independence (PRI). Parents' education and continuing in school decrease the likelihood of leaving home via marriage and increase the likelihood of leaving home via Semi or PRI. All other factors considered affect all pathways out of the parental home in the same direction, but in differing magnitudes. The predominant influences on PRI are indicators of modern family values, whereas the predominant influences on leaving home for marriage are measures of resources, both those of the parents and those of the young adults.

The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: An Introduction to the Series

Abstract: In 1985, we began a 4-year evaluation of the effects of the diagnosis related groups-based prospective payment system on quality of care for hospitalized Medicare patients. This article provides an overview of the study's background, aims, design, and methods. We used a clinically detailed review of the medical record supplemented by data on postdischarge outcomes drawn from the files of the Health Care Financing Administration and fiscal intermediaries to (1) compare outcomes of care after adjustment for sickness at admission, (2) assess the process of in-hospital care and relationships between processes and outcomes, and (3) assess status at discharge for a nationally representative sample of patients hospitalized before and after prospective payment was implemented.

Work group structures and computer support: a field experiment

Abstract: It is frequently suggested that work groups that have computer technology to support activities such as text editing, data manipulation, and communication develop systematically different structures and working processes from groups that rely on more conventional technologies such as memos, phone calls, and meetings. However, cross-sectional or retrospective research designs do not allow this hypothesis to be tested with much power. This field experiment created two task forces, each composed equally of recently retired employees and employees still at work but eligible to retire. They were given the identical tasks of preparing reports for their company on retirement planning issues, but they were randomly assigned to different technology conditions. One group had full conventional office support; the other had, in addition, networked microcomputers with electronic mail and routine office software. Structured interviews were conducted four times during the year-long project; in addition, electronic mail activity was logged in the on-line group. Although both groups produced effective reports, the two differed significantly in the kind of work they produced, the group structures that emerged, and evaluations of their own performance. Although the standard group was largely dominated by the employees through the extensive reliance on informal meetings, the electronic technology used by the other task force allowed the retirees to exercise primary leverage. We conclude that use of computer support for cooperative work results in both quantitative and qualitative changes but that effective participation in such electronically supported groups requires significant investments of time and energy on the part of its members to master the technology and a relatively high level of assistance during the learning process.

Integrating the Use of Patient-Reported Outcomes for Both Clinical Practice and Performance Measurement: Views of Experts from 3 Countries

Abstract: Policy Points: The patient-reported outcome (PRO) is a standardized method for measuring patients' views of their health status. Our international study showed that experts in clinical practice and performance measurement supported the integrated collection of PRO data for use in both clinical care and performance measurement. The measurement of PROs to support patient-provider decisions and the use of PRO performance measures to evaluate health care providers have developed both separately and in parallel. The use of PROs would benefit from a shared vision by health care providers, purchasers of care, and patients regarding the aims and purposes of the various applications; and the establishment of trust among stakeholders concerning the prudent use of PRO performance measures. CONTEXT: Patient-reported outcomes (PROs) can play an important role in patient-centered health care by focusing on the patient's health goals guiding therapeutic decisions. When aggregated, PROs also can be used for other purposes, including comparative effectiveness research, practice improvement, assessment of the performance of clinicians and organizations, and as a metric for value-based payments. The feasibility of integrating the use of PROs for these various purposes on a wide scale has not yet been demonstrated. Our study was conducted to inform policymakers of prudent next steps for implementing PROs in clinical practice and performance measurement programs in order to maximize their impact on the quality of health care. METHODS: We conducted a qualitative study, interviewing 58 experts and leaders from 37 organizations (response rate: 88%) in the United States, England, and the Netherlands. Respondents included clinical practitioners (n = 30), measure developers (n = 11), and leaders of performance measurement programs (n = 17). We used a qualitative content analysis to assess current strategies for applying PROs in clinical practice and performance measurement and to identify barriers to and facilitators of further implementation. FINDINGS: The use of PROs in clinical practice and for performance measurement has developed both separately and in parallel. Experts across the stakeholder spectrum support the collection of PRO data in an integrated manner that would enable using the data for these distinct purposes. We identified 2 main concerns about the feasibility for integrated use of PRO data: the complexity of establishing routine data collection and the tension among stakeholders when using PRO data for different purposes. These contrasting stakeholder views suggested varying interests among clinicians, measure developers, and purchasers of care. CONCLUSIONS: Data collection approaches that support the use of PROs in health care are underdeveloped, need better integration with clinical care, and must be tailored to the characteristics of the health care system. Enabling the sustainable use of PROs will require a shared vision of clinical professionals, purchasers, and patients, with a prudent selection of the steps in implementing PROs that will maximize their impact on the quality of health care.

The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse.

Abstract: OBJECTIVES: The purpose of this study was to determine whether high school-aged virgins engage in sexual practices that can transmit sexually transmitted diseases, including the human immunodeficiency virus (HIV). METHODS: Data were collected from an anonymous self-administered survey of 2026 urban students in 9th through 12th grades. RESULTS: Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities were rare. Condom use for fellatio was also rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other non-sexual risk behaviors, even after demographic variables had been controlled. CONCLUSI...