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This report presents the findings of a quick-turn study conducted between February 2021 and May 2021. During this time frame, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 83 million confirmed infections and more than 1.8 million deaths worldwide. In the Middle East, there were close to 21 million cases reported and 336,000 COVID-19 deaths. Many countries in the Middle East struggled with health care capacity and access prior to the pandemic, and this crisis has placed significant additional strain on health care delivery in the region. Evaluating strategies used by health care systems and public health and policies implemented by governments in the Middle East during the ongoing pandemic is critical to understanding and disseminating successful approaches to meeting the health care demands of populations in the region. This report outlines the results of an exploratory analysis of five Middle East countries - Iran, Jordan, Lebanon, Qatar, and Tunisia. Drawing from a literature review and qualitative data collected from focus groups and one-on-one interviews conducted between March 2021 and May 2021, the authors identify common challenges regarding COVID-19 faced by the countries studied, highlight successes and innovations in addressing these challenges, and recommend strategies for strengthening internal infrastructure and regional cooperation between countries. This work should be of interest to regional and international stakeholders as they continue to combat the pandemic, and its findings could inform future research around pandemic response.
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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 report 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 report, they highlight which interventions VHWDA should prioritize based on its desired outcomes and policy goals.
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The coronavirus disease 2019 (COVID-19) virus is creating unprecedented stresses on hospital and critical care systems. Hospitals, health care systems, states, and regions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity, which refers to the resources needed to care for the sickest patients with the novel coronavirus. In this report, the authors present a list of strategies for creating critical care surge capacity and estimate the number of patients accommodated, given the number of available critical care doctors and nurses, respiratory therapists, ventilators, and hospital beds. They also document the development of a user-friendly, Microsoft Excel–based tool that allows decisionmakers at all levels — hospitals, health care systems, states, regions — to estimate current critical care capacity and rapidly explore strategies for increasing it. The strategies are organized into two tiers. Tier 1 includes contingency capacity strategies: adaptations to medical care spaces, staffing constraints, and supply shortages in a way that can increase capacities without significant impact on medical care delivery. Tier 2 includes crisis capacity strategies: changes that likely will have significant impact on routine care delivery and operations.
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Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event that is a leading cause of death in the United States. However, it is unclear how to design strategies that can be successfully implemented in emergency medical services (EMS) agencies and broader emergency response systems (such as fire, police, dispatch, and bystanders to OHCA events) in different communities to help improve daily care processes and outcomes in OHCA. The National Heart, Lung, and Blood Institute-funded Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study lays the foundation for future quality improvement efforts in OHCA by identifying, understanding, and validating the best practices adopted within emergency response systems to address these life-threatening events and by addressing potential barriers to implementation of these practices. RAND researchers developed recommendations covering all levels of the prehospital OHCA incident response and the principles of change management necessary to implement those recommendations.
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To track how well different countries and U.S. states are responding to the pandemic—and to make valid cross-country and cross-state comparisons—uniform measures are needed for key indicators, such as case identification/testing, hospitalization, mortality, and excess mortality. The authors of this report examined measures used in the early stages of the pandemic (December 2019–May 2020) and found tremendous variability in how different countries and U.S. states measure and report on COVID-19 indicators. The authors make recommendations for the use and development of measures that would allow for more standardized and valid comparisons.
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In September 2017, Puerto Rico was struck by two major hurricanes—Irma and Maria—that intensified existing challenges in Puerto Rico's health and social services infrastructure. In the aftermath, the government of Puerto Rico created a long-term recovery plan built on an evidence-based assessment of the damage from the hurricanes and the ongoing needs across Puerto Rico. Development of the recovery plan was supported by the Federal Emergency Management Agency, other federal agencies, local stakeholders, and analysis from the Homeland Security Operational Analysis Center (HSOAC), operated by RAND Corporation under contract with the U.S. Department of Homeland Security. HSOAC research provided the foundation for the 31 courses of action in the recovery plan addressing the health and social services sector. These actions are a mix of social, governmental, fiscal, and economic policies and reforms. This collection of actions presents an opportunity to build a more resilient health and social services infrastructure and regional health care networks to ensure reliable access to services, promote health and well-being, and more efficiently and effectively respond to public health crises and future disasters. The actions span the areas of health care, public health and emergency preparedness, environmental health, mental and behavioral health, and social services. The damage and needs assessment and courses of actions cover four major themes: building system capacity to respond both during disasters and routine times; strengthening the health and social services workforce; strengthening support services for at-need populations; and creating health-promoting communities.
Public health --- Social service --- Hurricane damage --- Hurricane Irma, 2017. --- Hurricane Maria, 2017. --- Public Health. --- Puerto Rico. --- Puerto Rico.
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