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Book
Assesing the needs of soldiers and their families at the Garrison Level

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Book
Today's soldier : assessing the needs of soldiers and their families

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"Soldiers and their families are susceptible to the same range of problems that face all families, but the nature of military service can exacerbate those problems or introduce new ones. The Army recognizes these challenges and has instituted a wide range of programs and services to help soldiers and their families deal with them. This report describes the results of a unique, holistic survey approach to understanding the most-pressing problems soldiers and their families face, the needs those problems generate, the use of resources available to address these needs, and barriers to using those resources. It also reports soldiers' perceptions about the effectiveness of the resources used and projected effect if those resources were no longer available, and it discusses the relationship between how soldiers address their pressing problems and important attitudes toward military service. The survey of more than 7,000 active component soldiers provided insights suggesting that Army programs generally meet the needs of soldiers and their families. There is room for improvement, however, because some soldiers encountered barriers to using resources, and the needs of some soldiers remained unmet even after reaching out to available programs and support providers. Soldiers with unmet needs had worse attitudes toward the Army than did those who accessed resources and had their needs met. We describe options for the Army to consider to improve the ability of leaders and programs to meet the diverse range of soldier and family needs"--Publisher's description


Book
Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 3: Sample Description)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 3 of the final report on the National Beta Test. It provides a sample description and reports analyses that evaluate the generalizability of results from the National Beta Test sample, both in terms of the representativeness of the facility/agency-level sample to the national population of PAC facilities/agencies, as well as the patients and residents who participated in the National Beta Test relative to the national population of patients and residents receiving PAC in the United States.

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Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 7: Global Health, Care Preferences, and Medication Reconciliation)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 7 of the final report on the National Beta Test, which includes the identification and testing of candidate SPADEs that fall into other clinical categories (care preferences, medication reconciliation, and global health). This volume provides results and significance tests on the feasibility, reliability, validity, stability and change over time, and sensitivity to national representativeness of the candidate SPADEs. The data elements tested include PROMIS Global Health, Care Preferences, and Medication Reconciliation. All three data element sets performed fairly well, with some variability in performance.

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Book
Development of Palliative Care Quality Measures for Outpatients in a Clinic-Based Setting: A Report on Information Gathering Activities

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Palliative care has expanded rapidly in recent years. Hence, there has been a growing awareness of and emphasis on the importance of developing quality measures specific to palliative care. This report describes information-gathering activities conducted by RAND to develop two measures of palliative care quality for patients receiving such care in outpatient, clinic-based settings. The authors describe the consensus that has developed for measurement priorities in the palliative care community, provide a summary of clinical practice guidelines, and review the evidence base for palliative care. The authors also review current relevant regulations, existing measures of patient and caregiver experience, findings from a gap analysis on palliative care assessment, and findings from provider focus groups and interviews with patients and caregivers or family members.

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Book
Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 2: Background and Methods)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 2 of the final report on the National Beta Test. It focuses on the design and methods for the National Beta Test. This volume covers the candidate SPADEs tested; the design and sampling plan; information on training, recruitment, and retention; information on the data collection process and analytic plan.

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Book
Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 1: Executive Summary)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 1 of the final report on the National Beta Test. It summarizes the material presented in the other seven volumes, including background; methods and sample; basic feasibility and reliability results for each of the candidate SPADEs; results across SPADEs pertaining to evaluation of validity, look-back differences (Day 3, 5, 7 repeat assessment and Day 1, 3, 5, 7 chart review), and stability/change from admission to discharge; and a summary evaluation of the candidate SPADEs in terms of feasibility for use in PAC, psychometric performance, potential for improving quality, and utility for describing case mix.

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Book
Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 6: Impairments and Special Services, Treatments, and Interventions)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 6 of the final report on the National Beta Test. It describes the identification and testing of candidate SPADEs in the clinical categories of (1) impairments and (2) special services, treatments, and interventions (SSTIs). This volume provides results and significance tests on the feasibility, reliability, validity, stability and change over time, and sensitivity to national representativeness of the candidate SPADEs. Impairments data elements included (1) Hearing and Vision and (2) Bladder and Bowel Continence (both patient interview and chart review). SSTI data elements included (1) Nutritional Approaches and (2) Special Treatments. All five data element sets performed fairly well, showing feasibility, acceptable reliability, and moderate support from assessors.

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Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 5: Mental Status and Pain)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 5 of the final report on the National Beta Test. It describes the identification and testing of candidate SPADEs in the clinical categories of mental status and pain. This volume provides results and significance tests on the feasibility, reliability, validity, stability and change over time, and sensitivity to national representativeness of the candidate SPADEs. The mental status data elements tested consisted of the Patient Health Questionnaire (PHQ)-2 to 9, Patient Reported Outcome Measurement Information System (PROMIS) Depression, and PROMIS Anxiety. The pain data element set tested was the Pain Interview. All four data element sets performed fairly well, showing feasibility, acceptable reliability, and moderate support from assessors.

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Book
Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 4: Cognitive Function)

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The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. This is Volume 4 of the final report on the National Beta Test, which includes the identification and testing of candidate SPADEs in the cognitive status clinical category. This volume provides results and significance tests on the feasibility, reliability, validity, stability and change over time, and sensitivity to national representativeness of the candidate SPADEs. The data elements tested include the Brief Interview for Mental Status (BIMS), the Confusion Assessment Method (CAM), Expression and Understanding, and Behavioral Signs and Symptoms. All four cognitive status data elements performed reasonably well, showing feasibility, acceptable reliability, and substantial support from assessors.

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