Rand health quarterly最新文献

RAND Europe was commissioned by the Novo Nordisk Foundation to conduct a study on pathogen surveillance and current initiatives. The study aims to provide an overview of the pathogen surveillance space internationally and the stakeholders involved, as well as to understand the strengths and weaknesses of different initiatives, the challenges of pathogen surveillance and how they have been addressed, and how data has been used to inform public health decision making. To do this, a scoping review of pathogen surveillance initiatives was conducted, and ten case studies were developed and selected for further review following a workshop attended by the Novo Nordisk Foundation and RAND Europe study team. Interviews were conducted with individuals involved in pathogen surveillance initiatives to gather additional information to develop case studies, and expert interviews addressed gaps in the pathogen surveillance space and models that would be helpful in filling these gaps.

Like the United States as a whole, Virginia faces a significant shortage of health care workers in nursing, primary care, and behavioral health. If current trends persist, these shortages will increase across Virginia. The authors of this study identify interventions that can help the Virginia Health Workforce Development Authority (VHWDA) address these health care workforce shortages. To accomplish this goal, they applied an analytic framework to existing or potential interventions for retaining, recruiting, and improving the structural efficiency of the nursing, primary care, and behavioral health workforces in Virginia. In this study, they highlight which interventions VHWDA should prioritize based on its desired outcomes and policy goals.

In response to the widespread youth mental health crisis, some kindergarten-through-12th-grade (K-12) schools have begun employing artificial intelligence (AI)-based tools to help identify students at risk for suicide and self-harm. The adoption of AI and other types of educational technology to partially address student mental health needs has been a natural forward step for many schools during the transition to remote education. However, there is limited understanding about how such programs work, how they are implemented by schools, and how they may benefit or harm students and their families. To assist policymakers, school districts, school leaders, and others in making decisions regarding the use of these tools, the authors address these knowledge gaps by providing a preliminary examination of how AI-based suicide risk monitoring programs are implemented in K-12 schools, how stakeholders perceive the effects that the programs are having on students, and the potential benefits and risks of such tools. Using this analysis, the authors also offer recommendations for school and district leaders; state, federal, and local policymakers; and technology developers to consider as they move forward in maximizing the intended benefits and mitigating the possible risks of AI-based suicide risk monitoring programs.

Retired service members with a service-connected disability cannot always receive their full retirement pay and disability benefits because of rules against "double-dipping" from federal funding sources. Veterans' advocates have long argued that the current law is unfair and that it denies disabled veterans the full compensation that they have earned from their military service. New legislation would drop the offset that reduces retirement pay for some disabled veterans. If the Major Richard Star Act is signed into law, what would change for disabled veterans, and how many would actually see an increase in their compensation?

Global health engagement (GHE) is an integral part of the cooperation efforts of the U.S. Department of Defense (DoD) and the geographic combatant commands (GCCs) with partner nations and provides support in training and preparing their military and civilian health systems. These activities encompass a wide spectrum of engagements-military-to-military, military-to-civilian, and multilateral-and support joint missions of humanitarian aid and disaster response, deterrence, access and presence, counterterrorism, and homeland defense. Global health engagements and activities require extensive planning, funding, and resource allocation within the GCCs and component commands. For a continuously growing breadth of GHE and the need to support joint exercises with partner military and civilian medical professionals for partner capacity-building, GHE also requires a robust information technology infrastructure. In this study, the authors assess the technology and process requirements to support the life cycle of GHE activities and assessments-from planning to evaluation-and the information- and knowledge-sharing needs of the GHE community. To do so, they conducted a literature review related to GHE activities, funding sources, and stakeholders; the evolution of technology solutions to support GHE; systems in use by GHE practitioners; and technology solutions in the market, focusing particularly on cloud infrastructure and services and cloud service providers. They held discussions with GHE subject-matter experts to document and analyze GHE technology platform requirements. And they assessed the available and planned platforms according to their features, enhancements, support and maintenance, data integration, interoperability, and future road maps.

Over the past two decades, pandemic preparedness has proven to be critical to health, national, and economic security. Now, countries are investing billions of dollars in various pandemic preparedness tools, such as vaccines and broad-spectrum medical countermeasures (MCM), to address the threats arising from outbreaks. These tools not only offer protection against naturally occurring and accidental biological incidents but can also help provide some protection against deliberate biological attacks. Furthermore, pandemic preparedness has substantial economic implications for both the public and private sectors because of its connection with the biotechnology industry, an important component of the worldwide economy. With so many aspects of pandemic preparedness tied to public health, national security, and economic competition, understanding the key technology and policy trends of the major country stakeholders in this space provides valuable insights into pandemic preparedness gaps and ways of addressing them. This study provides a brief characterization of the trends and strategic implications associated with specific aspects of pandemic preparedness in the United States, China, and Russia. The authors discuss both technical and policy aspects of vaccine concepts and technologies, broad-spectrum MCM, and immunization facilitation.

Leading up to the 2020 general election, state election boards grew concerned that the coronavirus disease 2019 (COVID-19) pandemic might drive voters away from the polls or that crowded polling stations would spread the virus and lead to a wave of new cases, hospitalizations, and deaths. In an effort to safely conduct the 2020 general election, many states changed their voting laws by implementing automatic voter registration, removing excuse requirements for absentee ballots, and expanding early voting windows. These changes, meant to encourage turnout and protect public health, were expensive to implement, politically contentious, or both. But did the changes have the desired effects? This study examines the impact of voting laws on voter turnout and choice of voting method in the 2020 election and the effects of in-person voting on the spread of COVID-19.

Delivery of high-quality behavioral health (BH) care is essential to supporting the readiness of the U.S. armed forces and their families. The coronavirus disease 2019 (COVID-19) pandemic led to a dramatic expansion of virtual behavioral health (VBH) care: remote patient access to BH care using technology such as a computer or cellular phone. The U.S. Army asked RAND Arroyo Center to examine the use of VBH to inform recommendations on the role of VBH care in the future of BH care in the Military Health System. The authors analyzed administrative data on VBH and in-person BH care from prior to the pandemic through March 2022 and surveyed soldiers who received BH care to assess their perceptions of VBH care. Administrative data analyses showed that direct care providers were less likely to deliver VBH care than private-sector providers and relied heavily on audio rather than video VBH. In addition, soldiers who received VBH care typically received a mix of VBH and in-person visits. Survey respondents who used VBH care had similar perceptions of the quality of their care and more-positive views of VBH than respondents who did not use VBH care. Few respondents had declined VBH care in favor of in-person care. Using these findings, the authors make recommendations on the role of VBH care in overall BH delivered by the military.

California leads the nation with its relatively low rate of maternal deaths during pregnancy and the postpartum period. However, individuals insured via Medi-Cal suffer a disproportionate share of maternal deaths and severe complications at birth; within this group of publicly insured individuals, certain racial and/or ethnic groups have even higher rates of poor outcomes. The state can attribute part of its success in lowering rates of maternal mortality (MM) to the implementation of a data-driven statewide portfolio of quality improvement activities focused on the leading causes of maternal death. This quality improvement infrastructure has not previously been leveraged to respond in a focused way to the relatively large shares of MM and morbidity still seen in the Medi-Cal-insured population. B-CORE aimed to expand on existing statewide quality improvement efforts to effectively mitigate these adverse outcomes in Medi-Cal births by engaging Medi-Cal stakeholders.

Acute and chronic pain are common among service members, with musculoskeletal pain and injuries being the leading cause of nondeployability among active-duty service members. Given the significant implications for individual health and force readiness, providing high-quality pain care to service members is a priority of the Military Health System (MHS). Prior RAND research used administrative data to assess the quality and safety of pain care and opioid prescribing in the MHS, generated a set of quality measures that the MHS could adopt going forward, and identified strengths and opportunities for improvement in care provided to service members with pain conditions. In this study, authors document findings from interviews with MHS administrators, providers, and patients, providing valuable detail and context for those findings, along with on-the-ground perspectives on MHS pain care policies and guidance in practice. Staff and patients recommended prioritizing increases in treatment access and availability to improve pain care, and patients emphasized effective treatment and patient-centered care as the most important facilitators of high-quality pain care.