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.

When does information change practitioners' behavior?

Abstract: Programs that disseminate information to health care practitioners often do so partly to encourage appropriate changes in practice. However, merely providing information is seldom enough to accomplish such changes. If information transfer programs are to influence practice, they must be designed to maximize the conditions facilitating change. Reliance on a diffusion model for thinking about how information reaches practitioners has led researchers to over-emphasize the importance of exposure to information and ignore other factors that determine whether change will occur, such as practitioners' motivation to change, the context in which clinical decisions are made, and how information is presented. The fact that successful dissemination will not necessarily produce change also has implications for how information transfer programs should be monitored and evaluated.

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Abstract: Objectives The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. Methods As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. Results In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be “extremely” or “very” helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Conclusions Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.

Waste in the U.S. Health care system: a conceptual framework.

Abstract: Health care costs in the United States now account for 16 percent of the country's gross domestic product, and per capita health care spending is approximately twice that of other major industrialized countries (OECD 2008). Given that the U.S. system's performance is no better than that of other countries, much of the money must be spent unnecessarily or wastefully (Commonwealth Fund 2008). Our immense spending makes health care and health insurance increasingly unaffordable, and furthermore, 45.7 million Americans have no health insurance (DeNavas-Walt et al. 2008). It also threatens the nation's ability to pay for new treatments and technologies, which often are expensive, and to make other discretionary expenditures. Current and looming health care–spending obligations prevent the federal government from achieving universal insurance coverage or other national goals outside the health care system while maintaining national fiscal health (Orszag and Ellis 2007a, 2007b). Inefficiencies persist within the health care system because—in contrast to other economic sectors in which competition and other economic incentives act to reduce the level of waste—none of the health care system's players have strong incentives to economize. Although it is necessary for protection against the potentially catastrophic costs of treatment, generous health insurance coverage insulates patients from the true cost of medical care (Pauly 1969). Fee-for-service providers are paid for all services, whether or not they are necessary. Furthermore, because physicians advise patients on what care they need and also provide that care, they lack incentives to ration. Insurance and medical uncertainties muffle price competition and, in our litigious climate, promote overscreening and overtreatment. Health insurers, chastened by the backlash against managed care, act passively in reimbursing health care spending and, as expenditures increase, merely pass costs along to purchasers in the form of higher premiums. The impact of these higher premiums on the insured is limited, however, owing to Medicare and other public insurance entitlements, as well as the tax subsidization of employer-sponsored health insurance. Together, all these factors allow inefficiency to thrive in the U.S. health care system.

Conflict Cultures in Organizations: How Leaders Shape Conflict Cultures and Their Organizational-Level Consequences

Abstract: Anecdotal evidence abounds that organizations have distinct conflict cultures, or socially shared norms for how conflict should be managed. However, research to date has largely focused on conflict management styles at the individual and small group level, and has yet to examine whether organizations create socially shared and normative ways to manage conflict. In a sample of leaders and members from 92 branches of a large bank, factor analysis and aggregation analyses show that 3 conflict cultures— collaborative, dominating, and avoidant—operate at the unit level of analysis. Building on Lewin, Lippitt, and White’s (1939) classic work, we find that leaders’ own conflict management behaviors are associated with distinct unit conflict cultures. The results also demonstrate that conflict cultures have implications for macro branch-level outcomes, including branch viability (i.e., cohesion, potency, and burnout) and branch performance (i.e., creativity and customer service). A conflict culture perspective moves beyond the individual level and provides new insight into the dynamics of conflict management in organizational contexts.