Santa Monica, CA, United States

Frederick S. Pardee RAND Graduate School
Santa Monica, CA, United States

The Frederick S. Pardee RAND Graduate School is a private, higher-education institution that offers doctoral studies in policy analysis and practical experience working on RAND research projects to solve current public policy problems. Its campus is co-located with the RAND Corporation, a nonprofit research institution in Santa Monica, California. Most of the faculty is drawn from the 950 researchers at RAND. The 2011-12 student body includes approximately 100 men and women from more than 20 countries around the world. Wikipedia.

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Black W.C.,Dartmouth Hitchcock Medical Center | Gareen I.F.,Brown University | Soneji S.S.,Dartmouth Hitchcock Medical Center | Sicks J.D.,Brown University | And 7 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: The National Lung Screening Trial (NLST) showed that screening with low-dose computed tomography (CT) as compared with chest radiography reduced lung-cancer mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST. METHODS: We estimated mean life-years, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratios (ICERs) for three alternative strategies: screening with low-dose CT, screening with radiography, and no screening. Estimations of life-years were based on the number of observed deaths that occurred during the trial and the projected survival of persons who were alive at the end of the trial. Quality adjustments were derived from a subgroup of participants who were selected to complete quality-of-life surveys. Costs were based on utilization rates and Medicare reimbursements. We also performed analyses of subgroups defined according to age, sex, smoking history, and risk of lung cancer and performed sensitivity analyses based on several assumptions. RESULTS: As compared with no screening, screening with low-dose CT cost an additional $1,631 per person (95% confidence interval [CI], 1,557 to 1,709) and provided an additional 0.0316 life-years per person (95% CI, 0.0154 to 0.0478) and 0.0201 QALYs per person (95% CI, 0.0088 to 0.0314). The corresponding ICERs were $52,000 per life-year gained (95% CI, 34,000 to 106,000) and $81,000 per QALY gained (95% CI, 52,000 to 186,000). However, the ICERs varied widely in subgroup and sensitivity analyses. CONCLUSIONS: We estimated that screening for lung cancer with low-dose CT would cost $81,000 per QALY gained, but we also determined that modest changes in our assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented. Copyright © 2014 Massachusetts Medical Society.

Fernandes M.,Frederick S. Pardee RAND Graduate School | Sturm R.,RAND
Preventive Medicine | Year: 2010

Objectives: The objectives were to: (1) document correlations among facility provision (availability and adequacy) in elementary schools, child sociodemographic factors, and school characteristics nationwide; and (2) investigate whether facility provision is associated with physical education (PE) time, recess time, and obesity trajectory. Methods: The analytic sample included 8935 fifth graders from the Early Childhood Longitudinal Survey Kindergarten Cohort. School teachers and administrators were surveyed about facility provision, PE, and recess time in April 2004. Multivariate linear and logistic regressions that accounted for the nesting of children within schools were used. Results: Children from disadvantaged backgrounds were more likely to attend a school with worse gymnasium and playground provision. Gymnasium availability was associated with an additional 8.3 min overall and at least an additional 25 min of PE per week for schools in humid climate zones. These figures represent 10.8 and 32.5%, respectively, of the average time spent in PE. No significant findings were obtained for gymnasium and playground adequacy in relation to PE and recess time, and facility provision in relation to obesity trajectory. Conclusions: Poor facility provision is a potential barrier for school physical activity programs and facility provision is lower in schools that most need them: urban, high minority, and high enrollment schools. © 2009 Elsevier B.V. All rights reserved.

Landrigan C.P.,Brigham and Women's Hospital | Landrigan C.P.,Harvard University | Parry G.J.,Harvard University | Parry G.J.,Cambridge Healthcare | And 6 more authors.
New England Journal of Medicine | Year: 2010

BACKGROUND: In the 10 years since publication of the Institute of Medicine's report To Err Is Human, extensive efforts have been undertaken to improve patient safety. The success of these efforts remains unclear. METHODS: We conducted a retrospective study of a stratified random sample of 10 hospitals in North Carolina. A total of 100 admissions per quarter from January 2002 through December 2007 were reviewed in random order by teams of nurse reviewers both within the hospitals (internal reviewers) and outside the hospitals (external reviewers) with the use of the Institute for Healthcare Improvement's Global Trigger Tool for Measuring Adverse Events. Suspected harms that were identified on initial review were evaluated by two independent physician reviewers. We evaluated changes in the rates of harm, using a random-effects Poisson regression model with adjustment for hospital-level clustering, demographic characteristics of patients, hospital service, and high-risk conditions. RESULTS: Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2). Multivariate analyses of harms identified by internal reviewers showed no significant changes in the overall rate of harms per 1000 patient-days (reduction factor, 0.99 per year; 95% CI, 0.94 to 1.04; P=0.61) or the rate of preventable harms. There was a reduction in preventable harms identified by external reviewers that did not reach statistical significance (reduction factor, 0.92; 95% CI, 0.85 to 1.00; P=0.06), with no significant change in the overall rate of harms (reduction factor, 0.98; 95% CI, 0.93 to 1.04; P=0.47). CONCLUSIONS: In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement. Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time. (Funded by the Rx Foundation.) Copyright © 2010 Massachusetts Medical Society.

Shier V.,Frederick S. Pardee RAND Graduate School | An R.,Frederick S. Pardee RAND Graduate School | Sturm R.,RAND
Public Health | Year: 2012

Objectives: To examine the robustness of the relationship between neighbourhood food environment and youth body mass index (BMI) percentile using alternative measures of food environment and model specifications. Study design: Observational study using individual-level longitudinal survey data of children in fifth and eighth grades merged with food outlet data based on student residential census tracts. Methods: The relationship between food environment and BMI was examined with two individual outcomes (BMI percentile in eighth grade and change in BMI percentile from fifth to eighth grade) and three alternative measures of food environment (per-capita counts of a particular outlet type, food environment indices, and indicators for specific combinations of outlet types). Results: No consistent evidence was found across measures (counts of a particular type of food outlet per population, food environment indices, and indicators for the presence of specific combinations of types of food stores) and outcomes to support the hypothesis that improved access to large supermarkets results in lower youth BMI; or that greater exposure to fast food restaurants, convenience stores and small food stores increases BMI. Conclusions: To the extent that there is an association between food environment and youth BMI, the existence of more types of food outlets in an area, including supermarkets, is associated with higher BMI. © 2012 The Royal Society for Public Health.

Batorsky B.,Frederick S. Pardee RAND Graduate School
Journal of Occupational and Environmental Medicine | Year: 2016

OBJECTIVE:: Assess whether adding more components to a workplace wellness program is associated with better outcomes by measuring the relationship of program components to one another and to employee participation and perceptions of program effectiveness. METHODS:: Data came from a 2014 survey of 24,393 employees of 81 employers about services offered, leadership, incentives, and promotion. Logistic regressions were used to model the relationship between program characteristics and outcomes. RESULTS:: Components individually are related to better outcomes, but this relationship is weaker in the presence of other components and non-significant for incentives. Within components, a moderate level of services and work time participation opportunities are associated with higher participation and effectiveness. CONCLUSIONS:: The “more of everything” approach does not appear to be advisable for all programs. Programs should focus on providing ample opportunities for employees to participate and initiatives like results-based incentives. Copyright © 2016 by the American College of Occupational and Environmental Medicine

Hooker R.S.,Frederick S. Pardee RAND Graduate School | Muchow A.N.,Frederick S. Pardee RAND Graduate School
Journal of the American Academy of Physician Assistants | Year: 2014

As part of healthcare reform, physician assistants (PAs) are needed to help mitigate the physician shortage in the United States. This requires understanding the population of clinically active PAs for accurate prediction purposes. An inventory projection model of PAs drew on historical trends, the PA stock, graduation estimates, retirement trends, and PA intent to retire data. A new source of licensed health professionals, Provider 360 Database, was obtained to augment association information. Program growth and graduate projections indicated an annual 4.7% trend in new entrants to the workforce, offset by annual attrition estimates of 2.9%. As of 2013, there were 84,064 licensed PAs in the United States. The stock and flow equation conservatively predicts the supply of PAs to be 125,847 by 2026. Although the number of clinically active PAs is projected to increase at least by half by 2026, substantial gaps remain in understanding career trends and early attrition influences. Furthermore, education production could be constrained by inadequate clinical training sites and scarcity of faculty. Copyright © 2014 American Academy of Physician Assistants.

Datar A.,University of Southern California | Nicosia N.,RAND Corporation | Shier V.,Frederick S. Pardee RAND Graduate School
Social Science and Medicine | Year: 2014

Mothers' work hours are likely to affect their time allocation towards activities related to children's diet, activity and well-being. For example, mothers who work more may be more reliant on processed foods, foods prepared away from home and school meal programs for their children's meals. A greater number of work hours may also lead to more unsupervised time for children that may, in turn, allow for an increase in unhealthy behaviors among their children such as snacking and sedentary activities such as TV watching. Using data on a national cohort of children, we examine the relationship between mothers' average weekly work hours during their children's school years on children's dietary and activity behaviors, BMI and obesity in 5th and 8th grade. Our results are consistent with findings from the literature that maternal work hours are positively associated with children's BMI and obesity especially among children with higher socioeconomic status. Unlike previous papers, our detailed data on children's behaviors allow us to speak directly to affected behaviors that may contribute to the increased BMI. We show that children whose mothers work more consume more unhealthy foods (e.g. soda, fast food) and less healthy foods (e.g. fruits, vegetables, milk) and watch more television. Although they report being slightly more physically active, likely due to organized physical activities, the BMI and obesity results suggest that the deterioration in diet and increase in sedentary behaviors dominate. © 2014 Elsevier Ltd.

Weatherford B.,Frederick S. Pardee RAND Graduate School
Transportation Research Record | Year: 2011

Policy makers have begun to consider replacing state and federal fuel taxes with per mile user charges that would be more financially sustainable. The distributional implications of this change in tax policy are uncertain and raise equity concerns. This study uses data from the 2001 National Household Travel Survey to evaluate the distributional implications of replacing the per-gallon federal fuel tax with an equivalent flatrate vehicle miles traveled (VMT) fee of 0.98 cent per mile. The analysis indicates that VMT fees will be less regressive than fuel taxes by shifting the burden of taxation from low-income households to high-income households. The results provide new insight on the transportation tax burdens of households at different stages of life and suggest that a VMT fee would shift the tax burden from retired households to younger households with children. Consistent with previous research, VMT fees are shown to shift the tax burden from rural households to urban households. These findings challenge conventional wisdom that VMT fees would be inequitable for low-income and rural households. Overall, a revenueneutral VMT fee would change the annual tax burden of 98% of the population by less than $20. The small magnitude of these distributional implications suggest that addressing concerns about the equity of VMT fees should, perhaps, take a lower priority relative to other concerns, such as administration costs, evasion, and privacy.

Datar A.,Frederick S. Pardee RAND Graduate School | Datar A.,RAND Corporation | Shier V.,RAND Corporation | Sturm R.,Frederick S. Pardee RAND Graduate School
Pediatrics | Year: 2011

OBJECTIVE: To analyze changes in BMI, according to gender and race/ethnicity, in a nationally representative cohort of children in the United States during their elementary and middle school years to identify critical periods of excess BMI gains. METHODS: The Early Childhood Longitudinal Study-Kindergarten Class monitored a nationally representative cohort of kindergarten students over 9 years (1998-2007). Height and weight measurements were available for 4240 white, 640 black, and 1070 Hispanic children in kindergarten and 1st, 3rd, 5th, and 8th grades. In each wave, we estimated the proportions of children with BMI values in each quartile of the Centers for Disease Control and Prevention reference-population distribution according to gender and race/ethnicity. We conducted non-parametric tests of differences in BMI distributions over time within racial/ethnic groups and across racial/ethnic groups in each wave. Piecewise linear growth models were estimated to test for specific time periods during which the largest gains in BMI percentiles occurred. RESULTS: Overall, nearly 40% of children started kindergarten with a BMI in the top quartile of the growth charts (BMI > 75th percentile). This proportion increased significantly during the elementary school years, and the largest gains were between 1st and 3rd grades (5.8 percentage points), but there was no further increase during middle school. Increases in BMI percentiles over time were most notable among Hispanic children and black girls. CONCLUSIONS: The early school years might be a critical time for excess BMI gains, even among children with normal BMI values at kindergarten entry. Copyright © 2011 by the American Academy of Pediatrics.

Muchow A.N.,Frederick S. Pardee RAND Graduate School
Journal of the American Academy of Physician Assistants | Year: 2014

A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession. In 2013, a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider 360 Database was probed for all licensed PAs, and 84,064 were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. In the aggregate, the mean age was 42 years (median 45; mode 32; range 22-74) and 75% of US licensed PAs were women. Statewide distribution per capita ranged from 60 per 100,000 in Alaska to 3.9 per 100,000 in Mississippi; the US mean was 26.8. The robustness of this database draws on active licensure data to identify clinically active PAs. Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates. © 2014 American Academy of Physician Assistants.

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