Donna O. Farley

Addresses one step in the process of moving from teamwork training to teamwork practices that improve outcomes of care: identifying outcomes that are most likely to be affected as teamwork practices improve in an implementing organization. It discusses a literature search, methods for selecting and testing candidate measures, measures highly rated by clinical experts, and results of measure testing on administrative data of the DoD health system.

To learn how hospital labor and delivery units can achieve effective and sustainable teamwork practices and how much such practices affect staff experiences and patient outcomes, RAND researchers studied five units as they implemented improvements in their teamwork practices over a one-year period. They identified some key factors required by any given strategy for teamwork improvement but no standard template for implementation.

Presents the results of a two-year study that analyzes how patient safety practices are being adopted by U. S. health care providers, examines hospital experiences with a patient safety culture survey, and assesses patient safety outcomes trends. In case studies of four U. S. communities, researchers collected information on the dynamics of local patient safety activities and on adoption of safe practices by hospitals.

This book updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the current priorities and activities undertaken; and assesses contributions of funded projects and dissemination actions to support adoption of evidence-based safe practices. It discusses implications for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities. It evaluates progress of the patient safety initiative led by the Agency for Healthcare Research and Quality (AHRQ), focusing on how the current experiences of AHRQ and its funded projects can be used to strengthen subsequent program activities.

Updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the priorities and activities being undertaken; lays out an evaluation framework and possible measures of the effects on patient outcomes and on stakeholders other than patients. Discusses implications of the findings for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities.

Updates the policy context of the Agency for Healthcare Research and Quality (AHRQ) patient safety initiative; documents the priorities and activities being undertaken; lays out an evaluation framework and possible measures of the effects on patient outcomes and on stakeholders other than patients. Discusses implications of the findings for future AHRQ policy, programming, and research; suggests ways to strengthen AHRQ activities.

The Tobacco Settlement Proceeds Act, passed by Arkansans in November 2000, invests Arkansas' share of the tobacco Master Settlement Agreement funds in seven health-related programs. This report charts the progress of each program, updates trends in outcome measures developed to monitor effects of the funded programs on smoking and other health-related outcomes, and provides recommendations for future activities and funding.

Can the Army effectively implement clinical treatment guidelines in its military treatment facilities to achieve consistent and high-quality practices throughout its health system? This is a 450-character abstract. In partnership with the Army Medical Department, RAND worked to implement clinical practice guidelines. This report evaluates the asthma guideline demonstration. It documents the actions, assesses effects, and measures the quality and limitations of data for monitoring outcomes. The authors found that the implementation scored successes but resource limitations and organizational barriers curbed progress. They conclude that flexibility, monitoring, and training are the keys to implementing the guidelines. They also found that patient education needed improvement.

Can the Army effectively implement clinical treatment guidelines in its military treatment facilities to achieve consistent and high-quality practices throughout its health system? In partnership with the Army Medical Department (AMEDD), RAND has been working to implement clinical practice guidelines. This report evaluates the diabetes guideline demonstration. It documents the intended actions, assesses effects, and measures the quality and limitations of data for monitoring outcomes. The authors found that the implementation scored successes but resource limitations and organizational barriers curbed progress. They conclude that flexibility, adequate resources, and experience are the keys to implementing guidelines throughout AMEDD.

In September 2002, RAND contracted with the U. S. Agency for Healthcare Research and Quality to serve as the evaluation center for its national patient safety initiative. This report assesses the context and goals that were the foundation for the initiative, documents the baseline status of the activities being undertaken, and identifies priorities the researchers believe will have the strongest positive impact on the future of AHRQ's patient safety initiative.

Evaluates the progress and implementation of the Arkansas tobacco settlement program. Documents the initiation and first two years of activity by the seven funded health-related programs set up under the Tobacco Settlement Proceeds Act, evaluates their progress, and makes recommendations for future program activities and funding.

Assesses the value of 24-hour care--an insurance plan that consolidates employers' health care benefits for work-related and non-work-related claims--as a mechanism for reducing workers' compensation costs. 450-character abstract: Proponents of a type of insurance program called 24-hour care--which would consolidate employers' health care benefits, and possibly disability benefits, for both work-related and non-work-related claims--believe that it could yield substantial workers' compensation savings for California. In this monograph, the authors present their assessment of the value of 24-hour care as a mechanism for reducing workers' compensation costs and discuss possible options for 24-hour-care model programs.

The Medicare-Department of Defense (DoD) Subvention Demonstration tested Senior Prime as a managed care approach for enhancing access to affordable health care for Medicare-eligible DoD beneficiaries.

This report analyzes four types of special payments that Medicare has been making to rural hospitals and physicians. These special payments are intended to support the rural health care infrastructure to help ensure access to care for Medicare beneficiaries. The research provides a comprehensive overview of these payments, including documentation of the supply of providers, trends in payments, and Medicare costs per beneficiary.

There is beauty and grace in the Church year. These short yet thoughtful reflections help weave the great feasts into the fabric of our lives.

Congress established a demonstration that allows beneficiaries of the Department of Defense (DoD) health benefits program, who also are Medicare-eligible, to enroll in the Federal Employees Health Benefits Program (FEHBP). The three-year demonstration began January 1, 2000. The DoD Office of Health Affairs is evaluating the costs and other effects of the demonstration. One source of cost effects may be risk selection, where beneficiaries who choose the FEHBP option are more or less costly than those who do not enroll. Health Affairs asked RAND to apply current theory and knowledge to identify how selection bias might occur as Medicare-eligible DoD beneficiaries enrolled in FEHBP plans under this demonstration, and to suggest an analytic approach to estimate the effects of selection on DoD costs. This report presents the results of that analysis. It describes the supplemental health benefits options available to Medicare beneficiaries in the demonstration sites, reviews the theoretical literature on risk selection, and develops hypotheses regarding risk selection that can be tested in the evaluation of the demonstration. It also suggests analytic methods for measuring selection and estimating the extent to which it may occur for enrollments in the FEHBP demonstration. The methods are designed to estimate (1) the extent to which adverse selection occurs in Medicare supplemental insurance enrollments for the DoD FEHBP demonstration, and (2) how much effect selection has on DoD health care costs for Medicare-eligible beneficiaries.