Implementing the Post-Deployment Health Practice Guideline. Lessons from the Field Demonstration


Book Description

The Office of the Secretary of Defense/Office of Health Affairs (OSD/HA) is working with the Deployment Health Clinical Center, the Army Quality Management Directorate, and the Army Center for Health Promotion and Preventive Medicine in the implementation of the Department of Defense (DoD) / Department of Veterans Affairs Veterans Health Administration (VA) practice guideline for primary care management and evaluation of patients with post-deployment health (PDH) concerns. This guideline was implemented throughout the Military Health System beginning in January 2002. Under a contract with the Army Medical Department, RAND contributed to preparation for this initiative by (1) providing technical support to the leadership team, (2) guiding design of a demonstration in which the practice guideline and implementation approaches were field-tested, and (3) performing an evaluation of the demonstration. The evaluation was designed to provide information from the field to help DoD establish policy and practices for effective use of the PDH guideline across the Military Health System. Work on this project began in December 2000 under the policy direction of OSD/HA and its collaborating agencies. A tool kit of materials to support use of the guideline was prepared and key metrics were selected for monitoring implementation progress. Three military treatment facilities (MTFs) agreed to participate in the six-month demonstration, which began in March 2001 with a two-day conference at which the MTF teams prepared implementation action plans. This documented briefing presents the results of the RAND evaluation of the field demonstration for implementation of the PDH practice guideline. The primary audience for the document is the leadership of the Military Health System, but the findings also should be of interest to policymakers and practitioners interested in effective use of practice guidelines to achieve clinical practice.




Implementing the Post-deployment Health Practice Guideline


Book Description

This briefing presents the demonstrations findings, which document successes and challenges, how problems were addressed, and systemic issues.




Pain and Depression


Book Description

Pain is the most common physical complaint while depression is the second most debilitating chronic medical condition. The co-occurrence of pain and depression is well known but a detailed understanding of their phenomenology, interrelationship, and effective therapies remains speculative. This book provides a synthetic approach to the evaluation and treatment of patients with chronic pain and depression that will generate therapeutic optimism and lead clinicians to improve quality of life and restore function. The recognition that depression is not just an affective disorder or demoralization is discussed in detail in the contributions: Function, Disability, and Psychological Well-Being and in Structural Models of Comorbidity among Common Mental Disorders: Connections to Chronic Pain. Other articles review the complex regional pain syndrome and the Gulf War syndrome. Further papers discuss issues relating to the use of opioids in the treatment of chronic pain. This book will doubtlessly prove to be essential reading for researchers investigating chronic nonmalignant pain as well as physicians dealing with patients suffering from chronic pain.




Philosophical Transactions


Book Description

Each issue of Transactions B is devoted to a specific area of the biological sciences, including clinical science. All papers are peer reviewed and edited to the highest standards. Published on the 29th of each month, Transactions B is essential reading for all biologists.




Selected Rand Abstracts


Book Description

Includes publications previously listed in the supplements to the Index of selected publications of the Rand Corporation (Oct. 1962-Feb. 1963).




Annual Report


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Forthcoming Books


Book Description




Clinical Practice Guidelines We Can Trust


Book Description

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.