Archive

Archive for the ‘RAND Corporation’ Category

Spillover from the Conflict in Syria: An Assessment of the Factors that Aid and Impede the Spread of Violence

August 29, 2014 Comments off

Spillover from the Conflict in Syria: An Assessment of the Factors that Aid and Impede the Spread of Violence
Source: RAND Corporation

All roads lead to Damascus and then back out again, but in different directions. The financial and military aid flowing into Syria from patrons and neighbors is intended to determine the outcome of the conflict between a loose confederation of rebel factions and the regime in Damascus. Instead, this outside support has the potential to perpetuate the existing civil war and to ignite larger regional hostilities between Sunni and Shia areas that could reshape the political geography of the Middle East. This report examines the main factors that are likely to contribute to or impede the spread of violence from civil war and insurgency in Syria, and then examines how they apply to Turkey, Lebanon, Iraq, and Jordan.

About these ads

DoD — Small Business and Strategic Sourcing: Lessons from Past Research and Current Data

August 28, 2014 Comments off

Small Business and Strategic Sourcing: Lessons from Past Research and Current Data
Source: RAND Corporation

The Department of Defense (DoD) may face challenges as it attempts to maintain its goal of spending about 23 percent of its prime-contract dollars for goods and services with small businesses and at the same time apply strategic-sourcing practices to reduce total costs and improve performance in ways that will not conflict with small-business goals while making DoD purchasing more effective and efficient. Strategic sourcing practices, for example, recommend consolidation of the supply base to reduce total costs, which can lead to fewer, larger, longer-term contracts with fewer and, often, larger suppliers.

Toward Improved Management of Officer Retention: A New Capability for Assessing Policy Options

August 26, 2014 Comments off

Toward Improved Management of Officer Retention: A New Capability for Assessing Policy Options
Source: RAND Corporation

The U.S. Department of Defense (DoD) needs the capability to assess alternative policies to enhance the retention of officers. This capability should be founded on empirically based estimates of behavioral response to policy and recognize that, when making decisions, members are forward-looking and take into account future opportunities and uncertainty and the outcomes of past decisions and policies. Further, the capability should enable DoD to simulate or predict the effects of alternative policies on officer retention and the costs of those policies. This report documents efforts to implement such a capability for officers and illustrates its use. The authors statistically estimate the parameters of a dynamic retention model of officer behavior and use the parameter estimates in a simulation model to help evaluate the effect that changes in compensation can have on the retention of officers and to show how policies that change the retention behavior of these officers can also change the aggregate retention of the population of officers at earlier or later years of their careers. The model can also be used to gauge the effect of alternative policies to enhance retention. In addition, the authors have created a spreadsheet version of the model that can provide quick estimates of the effect that bonuses, gate pays, and separation pays can have on retention in all years of service. This report provides the mathematical foundations and the source code for the spreadsheet model. The spreadsheet model is also available on request from the RAND Forces and Resources Policy Center.

The changing hospital landscape: An exploration of international experiences

August 20, 2014 Comments off

The changing hospital landscape: An exploration of international experiences
Source: RAND Corporation

The nature of hospital activity is changing in many countries, with some experiencing a broad trend towards the creation of hospitals groups or chains and multi-hospital networks. This report seeks to contribute to the understanding of experiences in other countries about the extent to which different hospital ‘models’ may provide lessons for hospital provision in England by means of a review of four countries: France, Germany, Ireland and the United States, with England included for comparison. We find that here has been a trend towards privatisation and the formation of hospital groups in France, Germany and the United States although it is important to understand the underlying market structure in these countries explaining the drivers for hospital consolidation. Thus, and in contrast to the NHS, in France, Germany and the United States, private hospitals contribute to the delivery of publicly funded healthcare services. There is limited evidence suggesting that different forms of hospital cooperation, such as hospital groups, networks or systems, may have different impacts on hospital performance. Available evidence suggests that hospital consolidation may lead to quality improvements as increased size allows for more costly investments and the spreading of investment risk. There is also evidence that a higher volume of certain services such as surgical procedures is associated with better quality of care. However, the association between size and efficiency is not clear-cut and there is a need to balance ‘quality risk’ associated with low volumes and ‘access risk’ associated with the closure of services at the local level.

More Americans May Be Adequately Prepared for Retirement Than Previously Thought

August 12, 2014 Comments off

More Americans May Be Adequately Prepared for Retirement Than Previously Thought
Source: RAND Corporation

While many believe that Americans are in terrible shape when it comes to being financially prepared for their “golden years,” new evidence indicates that the news may not be as dire as previously thought. Moving away from previous studies that focused on income replacement rates, a recent report from the RAND Corporation looks instead at consumption in retirement to gain a better understanding of what is needed for adequate preparation. This focus on consumption reflects the fact that spending during retirement is not flat; instead, it tends to decline with age for the vast majority of people, who spend less money on travel or other leisure activities, as well as less on transportation, clothes, and other regular expenses.

Using a rich data-focused approach, RAND researchers came to the conclusion that, overall, about 71 percent of individuals ages 66–69 are adequately economically prepared to retire, given expected consumption. Other key findings — with consequences for both individuals and policymakers — indicate large disparities across subsets of the population and highlight the significant contribution of Social Security to seniors’ financial preparation for retirement.

Promoting Patient Safety Through Effective Health Information Technology Risk Management

July 29, 2014 Comments off

Promoting Patient Safety Through Effective Health Information Technology Risk Management (PDF)
Source: RAND Corporation

The potential for health information technology (IT) to improve health care delivery has been appreciated for decades, but “digitizing” health care can also introduce new risks and even harm. As the use of health IT has grown, these risks have become more apparent. The authors of this report evaluated the efforts of 11 hospitals and ambulatory practices to use an improvement strategy and tools developed to promote safe use of health IT and to diagnose, monitor, and mitigate health IT–related safety risks. Through interviews, the authors discovered that some health care organizations (especially hospitals) with expertise in process improvement were able to identify and begin to mitigate health safety risks, but in most others, awareness of these risks was limited (especially in ambulatory practices). The authors concluded that better tools like the recently released Safety Assurance Factors for EHR Resilience (SAFER) Guides are needed to help organizations optimize the safe use of health IT. However, health care organizations will require a better understanding of the safety risks posed by electronic health record (EHR) use to take full advantage of the SAFER Guides. There may also be a need for additional tools and metrics (and further usability studies of existing tools and metrics) to better support the needs of health care organizations as they increasingly rely on health IT to improve the quality and safety of patient care.

Continuity of Care and the Cost of Treating Chronic Disease

July 21, 2014 Comments off

Continuity of Care and the Cost of Treating Chronic Disease
Source: RAND Corporation

Strengthening coordination of care in the U.S. health care system is a priority for policymakers and the medical community. Poor coordination of care can drive up costs and harm patient health, especially for patients with chronic illnesses who see many different providers across many different settings. Some new models of care, such as the patient-centered medical home, focus on improving coordination as a way to provide affordable, high-quality care. Are these new models having the desired effect?

To answer this question, RAND researchers studied one important aspect of care coordination: continuity of care — the extent to which a patient’s care visits occur with the same provider. Researchers reviewed insurance claims data to gauge the association between continuity of care, costs, and patient outcomes during episodes of care for Medicare patients with one or more of three chronic diseases: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (DM).

Researchers used a continuity of care (COC) index to measure the number of providers and/or practices involved in a patient’s care during a 365-day episode of care. The index ranges from 0 (each visit involved a unique provider) to 1 (all visits were billed by a single provider). An increase in the COC index reflects either fewer providers involved in a patient’s care or a concentration of visits among fewer providers.

Findings from this study show that modest improvements in continuity of care correlate with sizable reductions in service use, complications, and costs:

  • Higher levels of care continuity for CHF, COPD, and DM patients were consistently associated with lower rates of hospitalizations, emergency room visits, and complications.
  • An 0.1-unit increase in the COC index (which ranges from 0 to 1) was associated with episode-of-care costs for CHF, COPD, and DM patients that were on average 5 percent lower.
Follow

Get every new post delivered to your Inbox.

Join 898 other followers