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MARCH 2007 HOT TOPICSMany California hospitals are unprepared for a major earthquake
Following the devastating Northridge earthquake of 1993, the state of California established seismic safety standards for hospitals. The standards are intended to ensure that hospitals can function following a major earthquake. The state adopted a two-step approach. The most vulnerable buildings were required to retrofit or renovate by 2008, a deadline later extended to 2013. All California hospitals are required to meet the new code by 2030. However, a recent study led by RAND analyst Charles Meade found that almost half of California hospitals subject to the 2013 deadline will be noncompliant; indeed, many will face difficulty meeting the 2030 deadline as well. The two-phase approach assumed that most retrofits could be completed more quickly and cheaply than rebuilding. However, this assumption turned out to be inaccurate. The costs of retrofits have been comparable to new construction. The report also found other barriers to compliance that pose difficulties for hospitals, including the high cost of building new hospitals, which are among the expensive infrastructure projects, and difficulty finding funds for new construction. California policymakers now face difficult choices: They can move ahead implementing the new standards, which risks forcing noncompliant hospitals to close; they can modify or eliminate requirements so that more facilities can meet standards; or they can provide public funds for hospitals that are unable or unwilling to comply. Read More »Quality of medical care affects daily quality of life for people with chronic illness
A vexing problem in the study of the quality of medical care has been knowing how much difference high-quality care makes. One way to understand this difference is to consider the degree to which patients with better processes of care have better outcomes. A team of RAND researchers led by Katherine Kahn developed an approach to understanding the relationship between the quality of outpatient medical care received by people with chronic health problems and an important outcome: physical functioning in daily life. The researchers studied 963 adults from three western states who suffered from heart disease, asthma, emphysema, or diabetes. The researchers used an innovative method to account for the paradoxical finding that even though the sickest patients are most likely to receive recommended care, they also have the worst outcomes. Since all of the patients aged with time and also had serious illnesses, their health declined during the 2.5 year period of the study. But those who received better-quality medical care experienced the smallest decline in health. Patients who received better-quality care were more likely to preserve their functioning—for example, they continued to manage activities involving exertion. The results underscore that measuring quality of care is not an academic exercise. Clinicians, patients, and policymakers often struggle with the fact that measuring care is not the same as improving it. However, knowing that better process of care is associated with better quality of life should motivate all stakeholders to improve the process of care. Read More »Most lesbian, gay, and bisexual teens do not discuss sexual orientation with their doctors
The American Medical Association, the American Academy of Pediatrics, and the Society for Adolescent Medicine recommend discussing sexual orientation as part of the health supervision of adolescents. If aware of an adolescent's sexual orientation, a doctor can provide appropriate counseling, identify individual risk, and perform targeted screening tests and treatment. However, a recent study conducted by a team from RAND and UCLA found that a majority of lesbian, gay, and bisexual (LGB) youth had not discussed the issue with their doctor. The researchers surveyed 131 participants at the Models of Pride Youth Conference hosted by a southern California campus in October 2003. The researchers knew that the survey sample was not representative of all LGB youth; however, the sample gave them a group of teens who were open about their sexual orientation to all or nearly all the people in their lives, and, therefore, fear of disclosure was relatively unimportant. The study found that 90 percent of these teens had seen a doctor in the past two years, and nearly two-thirds had gone within the past year. But although 66 percent thought it was very or somewhat important that their doctor know their sexual orientation in order to provide the best possible health care, only 35 percent said their physician knew their sexual orientation. Of those teens whose physician knew their sexual orientation, only 21 percent said their doctor had raised the topic. Most LGB youth in the study indicated that they would welcome a discussion of sexual orientation with their physician. Read More »
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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 © 2007 RAND Corporation. 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 x5320. This newsletter is also available on the RAND Congressional web site » |
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