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JULY 2008 HOT TOPICValidating the Link Between Quality of Care Measures and Better Health-Related Quality of Life for Patients
The health care community and policymakers need to know that the measures used to determine quality of care are valid. One set of measures relates to the process of care—that is, how well and how appropriately health care providers care for patients, from taking medical histories to ordering laboratory tests. A better process should lead to better health-related quality of life outcomes, but because of analytical challenges, that link had never been clearly established. Now, however, the link has been validated by a team led by RAND researcher Katherine Kahn. The researchers overcame the previous analytical challenges by examining their data with a statistical approach used by econometricians but rarely used in health services or health policy work. The team analyzed the ambulatory care provided to 963 managed care patients with at least one chronic illness, looking for provider adherence to 120 process of care criteria. They then compared that information with the patients' self-reported health-related quality of life. The researchers found a statistically significant link between better physician process of care and better health-related quality of life outcomes for patients. Furthermore, the study helped resolve a troubling paradox from previous studies, which had found that, for severely ill people, better process of care was associated with worse outcomes. By accounting for the burden of illness, the researchers showed that the link between better process of care and better outcomes still holds true for seriously ill patients. The team's paper received the 2008 Eisenberg Award from Health Services Research. The award recognizes major achievements in improving patient safety and quality. Read the Fact Sheet »Acupuncture Substitutes for Some Conventional Medicine, Potentially Reducing Health Care Costs
Around 1 percent of the U.S. population turns to acupuncture to improve health. In recent years, utilization, spending, and research related to acupuncture have increased significantly. This healing tradition, which originated in China more than 2,000 years ago, is now recognized by the medical community as beneficial or potentially effective for a range of conditions, from controlling chemotherapy-induced nausea to treating addiction. Little is known, however, about how people actually use acupuncture in relation to conventional health care. Is acupuncture used in addition to conventional care, with the potential to increase health care costs, or is it a substitute, with the potential to decrease costs? The answers are of interest to insurers, health care practitioners, and policymakers. RAND researcher Andrew Dick was part of a team that examined utilization and expenditure patterns in medical and drug claims data on 17,970 people, including 1,688 acupuncture users, from a midsize metropolitan insurance company. The team found that acupuncture substituted for a range of services, including primary care, all outpatient services, pathology services, all surgery, and gastrointestinal medications. These relationships were documented at statistically significant levels. The study also suggested that acupuncture complements some therapies, particularly chiropractic and physical therapy and allergy services. These findings indicate that acupuncture expenditures may be offset through reductions in the use of possibly more expensive conventional medical services, thus countering insurance companies' fears of covering acupuncture because of increased costs. The researchers urge that these preliminary findings be verified with additional studies, including analyses with larger datasets, studies of how acupuncture affects patient health, and an evaluation of expenditure data to quantify the financial impact of acupuncture. Read the Fact Sheet »Health System Reconstruction: Lessons for Future Nation-Building Operations
Nation-building efforts cannot be successful unless adequate attention is paid to the population's health. This is the fundamental argument of a RAND study that examined attempts to rebuild public health and health care delivery systems following U.S. military deployments in seven countries over the past 60 years. The study shows that policymakers often fail to plan health reconstruction adequately or to provide sufficient infrastructure and resources. Several important lessons emerge from their case studies. (1) Health can have a significant, independent effect in nation-building efforts, helping to "win hearts and minds." In Japan, powdered skim milk improved the health of millions of schoolchildren and created reservoirs of goodwill toward the United States. In Iraq, failure to improve health conditions for the general population may have generated support for the insurgency. (2) Successful health system reconstruction includes effective planning, coordination, and leadership. Health reconstruction in Iraq has suffered from the lack of a lead actor, potentially resulting in duplicated efforts or wasted resources. (3) Measures of success in health reform should be linked to success in other sectors, such as power, transportation, and governance. Measures should link policy actions and donor interventions across all areas in which lack of progress carries the risk of reversing the recovery process—from political and security issues to economic and health recovery. (4) Health-sector reform needs to be sustainable, with responsibility passed to the country's health care providers and leaders. Countries such as Afghanistan that have weak national health capacities may never reach the point of sustainability. (5) Security is essential for all reconstruction, including health. Poor security in Iraq and Afghanistan continues to hamper reconstruction efforts. Read the Fact Sheet » |
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RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health/. The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. Learn More »Copyright © 2008 RAND Corporation. 1776 Main Street, Santa Monica, CA 90401-3208. RAND® is a registered trademark. The RAND Health Congressional Newsletter is distributed on an opt-in basis only by visiting us at www.rand.org. We respect your privacy. If you do not wish to receive this periodic newsletter, please email ocr@rand.org or call (703) 413-1100 x5395. This newsletter is also available on the RAND Congressional web site » |
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