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  • 1
    Online Resource
    Online Resource
    Recommended infrastructure standards for mass antibiotic dispensing (2008)
    Santa Monica, CA : RAND Health
    Details
    ISBN: 9780833060068 , 0833060066
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: Technical report
    DDC: 614.4273
    Keywords: United States ; United States ; Antibiotics ; Epidemics ; Emergency management ; Antibiotics ; Epidemics ; Emergency management ; Anti-Bacterial Agents supply & distribution ; Disease Outbreaks prevention & control ; Civil Defense standards ; Disaster Planning standards ; Mass Casualty Incidents prevention & control ; United States ; Emergency management ; Epidemics ; Antibiotics ; United States ; Electronic books ; Statistics ; Technical Report
    Abstract: Since 2001, the U.S. government has spent more than 7 billion dollars to enhance state and local preparedness for bioterrorism attacks, natural disasters, disease outbreaks, and other large-scale public health emergencies. A central component of this effort involves the ability to dispense antibiotics and other life-saving medical countermeasures to large populations under short timelines. This report presents recommended standards for points of dispensing (or PODs), locations where the public would receive life-saving antibiotics or other medical countermeasures during a large-scale public health emergency. The standards, which are designed to apply to widely divergent jurisdictions, rely on expert panel evaluations, current POD planning practices, and computer-modeled scenarios
    Note: "Sponsored by the Department of Health and Human Services and was carried out within the RAND Health Center for Domestic and International Health Security , Includes bibliographical references , Title from PDF cover
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    MPI Ethno. Forsch.
  • 2
    Online Resource
    Online Resource
    The evolving role of emergency departments in the United States (2013)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833080820 , 0833080822 , 9780833080806 , 0833080792 , 0833080806 , 9780833080790
    Language: English
    Pages: 1 Online-Ressource (xi, 63 pages)
    Edition: Santa Monica, CA RAND Electronic reproduction; Available via World Wide Web
    Parallel Title: Online version Morganti, Kristy Gonzalez Evolving role of emergency departments in the United States
    Parallel Title: Print version Evolving role of emergency departments in the United States
    DDC: 362.18
    Keywords: Emergency medical services ; Hospitals Emergency services ; Emergency medicine ; Emergency medical services ; Hospitals ; Emergency medicine ; Emergency Service, Hospital trends ; Emergency Service, Hospital economics ; Electronic books ; Public Health ; Emergency medicine ; POLITICAL SCIENCE ; Public Policy ; Social Security ; Emergency medical services ; Hospitals ; Emergency services ; United States ; Health & Biological Sciences ; Hospitals & Medical Centers ; POLITICAL SCIENCE ; Public Policy ; Social Services & Welfare ; United States ; Electronic book
    Abstract: The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as "the safety net of the safety net" for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care
    Abstract: The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as "the safety net of the safety net" for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care
    Note: "RAND Health , Includes bibliographical references (pages 57-63) , Electronic reproduction; Available via World Wide Web
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  • 3
    Online Resource
    Online Resource
    Organizing state and local health departments for public health preparedness (2006)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833060044 , 083306004X
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: Technical report
    DDC: 363.3480973
    Keywords: Hospitals Administration ; Planning ; Public health administration ; Emergency management Evaluation ; Crisis management Health aspects ; Preparedness ; Disaster medicine Evaluation ; Public health Evaluation ; Hospitals ; Public health administration ; Emergency management ; Crisis management ; Preparedness ; Disaster medicine ; Public health ; Public Health Administration ; Disaster Planning organization & administration ; State Government ; Local Government ; Delivery of Health Care organization & administration ; Hospitals ; Administration ; Planning ; Social Welfare & Social Work - General ; Preparedness ; Public health administration ; Public health ; Evaluation ; Social Welfare & Social Work ; Social Sciences ; United States ; Emergency management ; Evaluation ; United States ; Electronic books ; Technical Report
    Abstract: Improving the ability to respond to bioterrorism and other emergencies is an important challenge facing the U.S. public health system. Despite having a knowledgeable workforce, practice and experience, capacity, and partnerships with other responders in the community, the system₂s ability to respond may depend largely on its structure. This study examines a key question: Are state and local public health agencies related to one another in a way that facilitates emergency response? Specific objectives of this study are to explain the factors influencing the particular ways in which state and local public health systems are organized, how the various types of relationships that exist between state and local public health departments have been arrived at, and, most important, the consequences of such structures and relationships for emergency preparedness. We also examine alternative structures from several different types of service industries (public education, banking, the welfare system, and port authorities). Finally, we recommend concrete strategies to improve public health preparedness. This report will be of interest to policymakers and to public health professionals at the state and local levels who are involved in bioterrorism response and emergency preparedness, as well as to other agencies involved in emergency response
    Abstract: Improving the ability to respond to bioterrorism and other emergencies is an important challenge facing the U.S. public health system. Despite having a knowledgeable workforce, practice and experience, capacity, and partnerships with other responders in the community, the system₂s ability to respond may depend largely on its structure. This study examines a key question: Are state and local public health agencies related to one another in a way that facilitates emergency response? Specific objectives of this study are to explain the factors influencing the particular ways in which state and local public health systems are organized, how the various types of relationships that exist between state and local public health departments have been arrived at, and, most important, the consequences of such structures and relationships for emergency preparedness. We also examine alternative structures from several different types of service industries (public education, banking, the welfare system, and port authorities). Finally, we recommend concrete strategies to improve public health preparedness. This report will be of interest to policymakers and to public health professionals at the state and local levels who are involved in bioterrorism response and emergency preparedness, as well as to other agencies involved in emergency response
    Note: Includes bibliographical references , Mode of access: internet via WWW.
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  • 4
    Online Resource
    Online Resource
    Learning from experience : the public health response to West Nile virus, SARS, monkeypox, and hepatitis A outbreaks in the United States (2005)
    Santa Monica, CA : Rand Health
    Details
    ISBN: 9780833059994 , 0833059998
    Language: English
    Pages: 1 Online-Ressource
    Keywords: Epidemics Prevention ; Epidemics ; Bioterrorism prevention & control ; Disaster Planning ; Civil Defense ; Communicable Diseases epidemiology ; Communicable Disease Control ; Disease Outbreaks prevention & control ; MEDICAL ; Public Health ; United States ; Epidemics ; Prevention ; United States ; Electronic books
    Abstract: Describes the response of state and local health departments to outbreaks of Severe Acute Respiratory Syndrome (SARS), monkeypox, West Nile virus, and hepatitis A that took place from 1999 to 2003. In general, public health agencies demonstrated a robust ability to implement the major components of response to a public health emergency. Researchers found that the most pervasive problem involved communication difficulties within public health agencies and with public health partners
    Abstract: Describes the response of state and local health departments to outbreaks of Severe Acute Respiratory Syndrome (SARS), monkeypox, West Nile virus, and hepatitis A that took place from 1999 to 2003. In general, public health agencies demonstrated a robust ability to implement the major components of response to a public health emergency. Researchers found that the most pervasive problem involved communication difficulties within public health agencies and with public health partners
    Note: "TR-285-DHHS"--Homepage , At head of title: Report , Includes bibliographical references , Title from PDF title page (viewed Oct. 19, 2005)
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  • 5
    Online Resource
    Online Resource
    District of Columbia community health needs assessment (2013)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833080530 , 0833082000 , 0833080539 , 9780833082008
    Language: English
    Pages: 1 Online-Ressource (xxiii, 94 pages)
    Series Statement: Research report
    Keywords: Health surveys ; Health surveys ; Health Behaviors ; Socioeconomic Factors ; Health Care Rationing ; Health Status ; Health Services Needs and Demand ; Health Behavior ; MEDICAL ; Public Health ; Washington (D.C.) ; Medical Statistics ; Statistics ; Medical ; Health surveys ; Health & Biological Sciences ; Public Health ; Washington (D.C.) Statistics, Medical ; Washington (D.C.) ; District of Columbia ; Electronic book ; Statistics
    Abstract: The District of Columbia Healthy Communities Collaborative (DCHCC) represents a unique collaboration among D.C.-area hospitals and federally qualified health centers. In response to its community commitment and Affordable Care Act requirements, DCHCC set forth to conduct a community health needs assessment (CHNA) that can guide decisions about where and how to allocate resources and implement appropriate health interventions for the population it serves. The CHNA described in this report includes analysis of existing demographic, health status, and hospital service use data, as well as hospital and emergency department discharge data. The analysis of this quantitative data is complemented by an analysis of current stakeholder perspectives regarding health needs, as well as health policy and investment priorities. This CHNA demonstrates the persistence of many issues identified in prior CHNAs: asthma, obesity, mental health, and sexual health. Despite high insurance rates, health care services are not evenly distributed by ward, creating significant challenges to access. There is a need to expand these services, as well as improve care coordination between health and social services to help residents navigate the system and obtain the services they need. In addition to these intervention pathways by priority health condition, we identified emerging issues that require further investigation, including declines in coronary atherosclerosis discharges and a spike in stress-related diagnoses (headaches and back pain) and associated alcohol-related issues. This may be related to a host of factors, including economic downturn and demographic transitions in the District
    Note: "RAND Health , Includes bibliographical references (pages 93-94)
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  • 6
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    Online Resource
    Dissemination and adoption of comparative effectiveness research findings when findings challenge current practices (2011)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833079367 , 0833079360
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: Technical report
    Keywords: Medicine Research ; Evaluation ; Medicine ; Quality Assurance, Health Care ; Evidence-Based Medicine ; Clinical Trials as Topic ; Comparative Effectiveness Research ; Delivery of Health Care methods ; MEDICAL ; Evidence-Based Medicine ; Medicine ; Research ; Evaluation ; Electronic books
    Abstract: Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patient with similar symptoms or conditions has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER⁰́₄particularly CER funded through the American Recovery and Reinvestment Act of 2009⁰́₄are proposed
    Abstract: Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patient with similar symptoms or conditions has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER⁰́₄particularly CER funded through the American Recovery and Reinvestment Act of 2009⁰́₄are proposed
    Note: "RAND Health , Document formatted into pages; contains 132 pages , Includes bibliographical references , Title from title screen (viewed November 28, 2011)
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  • 7
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    Online Resource
    Enhancing public health emergency preparedness for special needs populations : a toolkit for state and local planning and response (2009)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833060037 , 0833060031
    Language: English
    Pages: 1 Online-Ressource (1 online resource)
    DDC: 363.3480973
    Keywords: Emergency management ; Health planning ; Emergency management ; Health planning ; Vulnerable Populations ; Disaster Planning ; United States ; Emergency management ; Health planning ; United States ; Electronic books
    Abstract: Experiences from recent emergencies, such as Hurricanes Katrina and Rita, have shown that current emergency preparedness plans are inadequate to address the unique issues of special needs populations. This toolkit is meant to assist state and local public health agencies improve their emergency preparedness activities. It distills the most relevant strategies, practices, and resources from a variety of sources, including peer-reviewed research, government reports, the trade literature, and public health leaders, to identify priority populations and critical strategies. The contents include potential strategies for addressing special needs, summaries of promising practices implemented in communities across the country, information on how to select one or more practices that will work in a specific community, information on how to determine whether a practice is working, and a Web-based Geographic Information Systems (GIS) tool to identify and enumerate those with special needs in communities across the United States. Used together, this toolkit and the GIS tool are intended to provide a comprehensive resource to enable public health planners to account for special needs populations in their emergency preparedness efforts
    Note: Includes bibliographical references , Mode of access: internet via WWW.
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  • 8
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    Online Resource
    National agenda for public health systems research on emergency preparedness (2009)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833049087 , 0833049089
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: RAND Corporation technical report series TR660
    DDC: 616.071
    Keywords: Disaster relief Research ; Emergency management ; Disaster relief ; Emergency management ; Emergencies ; Disaster Planning methods ; Health Services Research ; Emergency Medical Services ; Disaster relief ; Research ; Emergency management ; United States ; Electronic books
    Abstract: 1. Introduction -- 2. Approach -- 3. Research priorities related to planning and other pre-incident activities -- 4. Research priorities related to key response capabilities -- 5. Research priorities related to infrastructure, resources, and legal frameworks -- 6. Research priorities related to accountability and quality improvement -- 7. Conclusion -- Appendix A: Expert Panel -- Appendix B: Developing the Research Agenda -- Appendix C: Literature Review -- Appendix D: Peer-Reviewed Literature -- Appendix E: Summaries of Statutes, Policies, and Other Governmental or Organizational Reports Reviewed -- Appendix F: Data Abstraction Forms
    Abstract: 1. Introduction -- 2. Approach -- 3. Research priorities related to planning and other pre-incident activities -- 4. Research priorities related to key response capabilities -- 5. Research priorities related to infrastructure, resources, and legal frameworks -- 6. Research priorities related to accountability and quality improvement -- 7. Conclusion -- Appendix A: Expert Panel -- Appendix B: Developing the Research Agenda -- Appendix C: Literature Review -- Appendix D: Peer-Reviewed Literature -- Appendix E: Summaries of Statutes, Policies, and Other Governmental or Organizational Reports Reviewed -- Appendix F: Data Abstraction Forms
    Note: Includes bibliographical references , The research described in this paper was prepared for the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. This research was conducted within the RAND Health Center for Public Health Preparedness , Title from PDF title page
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  • 9
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    Online Resource
    A two-step procedure to estimate participation and premiums in multistate health plans (2013)
    Santa Monica, CA : RAND
    Details
    ISBN: 9780833082893 , 0833082892
    Language: English
    Pages: 1 Online-Ressource (55 pages)
    DDC: 368.38/200973
    Keywords: United States ; United States ; Health insurance ; Health insurance ; United States ; Patient Protection and Affordable Care Act (United States) ; Health insurance ; Electronic books
    Abstract: Multistate plans (MSPs) provide an attractive alternative among the health insurance plans established by the Affordable Care Act (ACA) because they will have to be offered in multiple states. In this study, the authors⁰́₉ first objective was to identify and characterize population groups that would likely be interested in enrolling in MSPs (Phase 1 of the study). The second objective was to develop a methodology to project participation and to estimate premiums for these plans (Phase 2). For this second phase, the authors developed a two-step procedure to estimate the demand for MSPs. In the first step, they used the COMPARE microsimulation model and its utility maximization algorithms to project enrollment, irrespective of whether exchange participants choose an MSP or another exchange plan. The second step consists of calculating MSP premiums by means of a tool written in the R language that separates MSP participants from enrollees in other exchange plans using criteria selectable by the user. In this report, the authors present results from Phase 1 and from the first step of Phase 2 and explain the methodology and challenges associated with the second step. National-level microsimulation results suggest that three target population groups expected to prefer MSPs are also more likely to join the exchanges than the general population by over two percentage points. States with a higher uninsurance rate and lower participation in the nongroup market under current law, such as Texas, are projected to have a larger percentage enrollment in the individual market exchanges after enactment of the ACA. Thus, these states may also have a higher percentage of MSP participants than other states. The main policy recommendation is for the Office of Personnel Management to make use of the findings of this report and to exercise the MSP premium calculator tool to aid in the implementation of the Multistate Plan Program
    Abstract: Multistate plans (MSPs) provide an attractive alternative among the health insurance plans established by the Affordable Care Act (ACA) because they will have to be offered in multiple states. In this study, the authors⁰́₉ first objective was to identify and characterize population groups that would likely be interested in enrolling in MSPs (Phase 1 of the study). The second objective was to develop a methodology to project participation and to estimate premiums for these plans (Phase 2). For this second phase, the authors developed a two-step procedure to estimate the demand for MSPs. In the first step, they used the COMPARE microsimulation model and its utility maximization algorithms to project enrollment, irrespective of whether exchange participants choose an MSP or another exchange plan. The second step consists of calculating MSP premiums by means of a tool written in the R language that separates MSP participants from enrollees in other exchange plans using criteria selectable by the user. In this report, the authors present results from Phase 1 and from the first step of Phase 2 and explain the methodology and challenges associated with the second step. National-level microsimulation results suggest that three target population groups expected to prefer MSPs are also more likely to join the exchanges than the general population by over two percentage points. States with a higher uninsurance rate and lower participation in the nongroup market under current law, such as Texas, are projected to have a larger percentage enrollment in the individual market exchanges after enactment of the ACA. Thus, these states may also have a higher percentage of MSP participants than other states. The main policy recommendation is for the Office of Personnel Management to make use of the findings of this report and to exercise the MSP premium calculator tool to aid in the implementation of the Multistate Plan Program
    Note: "RAND Health , Includes bibliographical references , Title from title screen (viewed March 20, 2013)
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  • 10
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    Online Resource
    Developing a framework for establishing clinical decision support meaningful use objectives for clinical specialties (2012)
    Santa Monica, CA : RAND Health
    Details
    ISBN: 9780833079374 , 0833079379
    Language: English
    Pages: 1 Online-Ressource (1 PDF file (xxxvi, 222 pages)))
    Series Statement: Technical report TR-1129-DHHS
    DDC: 610
    Keywords: Clinical medicine Decision making ; Data processing ; Clinical medicine ; Electronic Health Records ; Decision Support Systems, Clinical ; Clinical medicine ; Decision making ; Data processing ; United States ; Electronic books
    Abstract: The federal electronic health record (EHR) incentive program includes clinical decision support (CDS) as a central requirement of improving health outcomes; however, a process for identifying and prioritizing the most promising targets for CDS has not been established. CDS provides those involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. This report describes a protocol for eliciting high-priority targets for electronic CDS for individual clinical specialties, which could serve to inform policymakers' deliberations and establishment of CDS meaningful use objectives. Researchers from the RAND Corporation tested the protocol with four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics. A CDS target was defined as a clinical performance gap having one or more CDS opportunities that can be implemented to address the gap. A CDS opportunity is defined as a specific CDS intervention that could be expected to address a clinical performance gap. CDS opportunities include existing CDS tools or interventions that might be developed in the short term. Identification of candidate performance gaps and CDS opportunities was based on a review of the literature and expert clinical input from the members of each of the four clinical specialty panels. High-priority CDS targets were the performance gaps that the panels rated as highly important and as having one or more CDS opportunities that could have a high impact on closing the performance gap and were considered compatible with clinical workflow. This report summarizes lessons learned from testing the protocol
    Abstract: The federal electronic health record (EHR) incentive program includes clinical decision support (CDS) as a central requirement of improving health outcomes; however, a process for identifying and prioritizing the most promising targets for CDS has not been established. CDS provides those involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. This report describes a protocol for eliciting high-priority targets for electronic CDS for individual clinical specialties, which could serve to inform policymakers' deliberations and establishment of CDS meaningful use objectives. Researchers from the RAND Corporation tested the protocol with four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics. A CDS target was defined as a clinical performance gap having one or more CDS opportunities that can be implemented to address the gap. A CDS opportunity is defined as a specific CDS intervention that could be expected to address a clinical performance gap. CDS opportunities include existing CDS tools or interventions that might be developed in the short term. Identification of candidate performance gaps and CDS opportunities was based on a review of the literature and expert clinical input from the members of each of the four clinical specialty panels. High-priority CDS targets were the performance gaps that the panels rated as highly important and as having one or more CDS opportunities that could have a high impact on closing the performance gap and were considered compatible with clinical workflow. This report summarizes lessons learned from testing the protocol
    Note: Includes bibliographical references , Title from PDF title page , Mode of access: internet via WWW.
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